Background
Specific treatment strategies are sorely needed for scirrhous-type gastric cancer still, which has poor prognosis. Based on the promising results of our previous phase II study (JCOG0210), ...we initiated a phase III study to confirm the efficacy of neoadjuvant chemotherapy (NAC) in type 4 or large type 3 gastric cancer.
Methods
Patients aged 20–75 years without a macroscopic unresectable factor as confirmed via staging laparoscopy were randomly assigned to surgery followed by adjuvant chemotherapy with S-1 (Arm A) or NAC (S-1plus cisplatin) followed by D2 gastrectomy plus adjuvant chemotherapy with S-1 (Arm B). The primary endpoint was overall survival (OS).
Results
Between October 2005 and July 2013, 316 patients were enrolled, allocating 158 patients to each arm. In Arm B, in which NAC was completed in 88% of patients. Significant downstaging based on tumor depth, lymph node metastasis, and peritoneal cytology was observed using NAC. Excluding the initial 16 patients randomized before the first revision of the protocol, 149 and 151 patients in arms A and B, respectively, were included in the primary analysis. The 3-year OS rates were 62.4% 95% confidence interval (CI) 54.1–69.6 in Arm A and 60.9% (95% CI 52.7–68.2) in Arm B. The hazard ratio of Arm B against Arm A was 0.916 (95% CI 0.679–1.236).
Conclusions
For type 4 or large type 3 gastric cancer, NAC with S-1 plus cisplatin failed to demonstrate a survival benefit. D2 surgery followed by adjuvant chemotherapy remains the standard treatment.
•The initial growth of heteroepitaxial diamond on Ir(001)/MgO(001) was investigated.•Diamond grains gradually grew larger in diameter and thickness in a three-dimensional manner.•In-plane orientation ...of diamond grains had improved significantly before coalescence.•The proportion of diamond component gradually increased as diamond grain grew.•Initial growth of heteroepitaxial diamonds from nucleation-treated surfaces to film formation through coalescence was modelled.
It is important to clarify the mechanism of heteroepitaxial diamond growth, focusing on the change from three-dimensional to two-dimensional growth through coalescence, including dislocation reduction, impurity doping, etc. A detailed investigation was made of the relationship between the surface morphology and the crystalline quality of diamonds during the initial and early stages of their growth. An Ir (001) layer formed on a MgO (001) substrate was treated by ion irradiation through direct-current discharge.
Diamond was then grown on the ion-irradiated surface for a short time by using a microwave plasma CVD (MPCVD) process. Surface and cross-sectional scanning electron microscopy (SEM) and atomic-force microscopy (AFM) were used to investigate how the diamond grains grew to form a film. The resulting diamond grains and film were also characterized by means of X-ray diffraction (XRD) and Raman spectroscopy. The diamond grains randomly united to form a film, their in-plane orientation improved until coalescence was complete, and the proportion of diamond component gradually increased. Finally, we developed a model for growth of heteroepitaxial diamond grains based on our detailed observations.
Background
The Charlson Comorbidity Index (CCI), an indicator that objectively quantifies comorbidities, reduces nutritional status; however, the impact of the CCI on the postoperative nutrition ...indexes of patients with esophageal cancer remains unclear.
Methods
In total, 336 patients with esophageal cancer who underwent surgery between January 2011 and April 2017 were included in this study. We investigated the relationship between the CCI and postoperative nutrition indexes.
Results
Patients were divided into two groups: CCI ≤1 (low CCI group) and CCI ≥2 (high CCI group). A high CCI was significantly associated with shortened overall survival (OS; 3-year OS rate of 77.9% in the low CCI group versus 59.7% in the high CCI group;
p =
0.008). Nutritional indexes, such as the Prognostic Nutritional Index (PNI), at 1 month after esophagectomy were significantly lower in the high CCI group than in the low CCI group (
p =
0.031); however, the PNI at 6 months after surgery was similar between the high and low CCI groups. Multivariate analysis identified high CCI as an independent risk factor associated with PNI <45 in esophageal cancer patients at 1 month after esophagectomy (
p =
0.047).
Conclusion
This study showed that CCI ≥2 was significantly associated with poor PNI at 1 month after surgery for esophageal cancer, indicating that it is necessary to administer effective nutritional interventions for patients with postoperative malnutrition, especially those with multiple comorbidities.
This study aimed to investigate risk factors for sarcopenia in community-dwelling older adults visiting regional medical institutions. We retrospectively analyzed medical records of 552 participants ...(mean age: 74.6 ± 6.7 years, males 31.3%) who underwent body composition evaluation between March 2017 and December 2018 at one of 24 medical institutions belonging to the Kadoma City Medical Association in Japan. We collected the participant's characteristics and laboratory data. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019. Sarcopenia, including severe sarcopenia, was detected in 22.3% of all participants, 17.3% of men, and 24.5% of women; rates increased with age. Multivariate logistic regression analysis revealed age (odds ratio OR: 2.12; 95% confidence interval CI 1.20-3.75), obesity (OR: 0.15; 95% CI 0.07-0.32), hypertension (OR: 0.44; 95% CI 0.25-0.76), certification of long term care (OR: 3.32; 95% CI 1.41-7.81), number of daily conversations (OR: 0.44; 95% CI 0.25-0.77), and malnutrition (OR: 2.42; 95% CI 1.04-5.60) as independent predictors of sarcopenia. Receiver operating characteristic curve analysis demonstrated that the cut-off for daily conversations defining sarcopenia was 4.8 persons. The prevalence of sarcopenia in this study was 22.3%. Besides traditional risk factors for sarcopenia, the number of daily conversations was an independent factor.
Background
Neoadjuvant chemotherapy (NAC) followed by radical surgery is a promising strategy to improve survival of patients with stage III gastric cancer, but is associated with the risk of ...preoperative overdiagnosis by which patients with early disease may receive unnecessary intensive chemotherapy.
Methods
We assessed the validity of a preoperative diagnostic criterion in a prospective multicenter study. Patients with gastric cancer with a clinical diagnosis of T2/T3/T4, M0, except for diffuse large tumors and extensive bulky nodal disease, were eligible. Prospectively recorded clinical diagnoses (cT category, cN category) were compared with postoperative pathological diagnoses (pT category, pN category, and pathological stage). The primary endpoint was the proportion of pathological stage I tumors among those diagnosed as cT3/T4, which we expected to be 5% or less.
Results
Data from 1260 patients enrolled from 53 institutions were analyzed. The proportion of pathological stage I tumors in those with a diagnosis of cT3/T4 (primary endpoint) was 12.3%, which was much higher than the prespecified value. The positive predictive value and the sensitivity for pathological stage III tumors were 43.6% and 87.8% respectively. The sensitivity and specificity of contrast-enhanced CT for lymph node metastasis were 62.5% and 65.7% respectively. After exploring several diagnostic criteria, we propose, for future NAC trials in Japan, a diagnosis of “cT3/T4 with cN1/N2/N3,” by which inclusion of pathological stage I tumors was reduced to 6.5%, although its sensitivity for pathological stage III tumors decreased to 64.5%.
Conclusion
Clinical diagnosis of T3/T4 tumors was not an optimal criterion to select patients for intensive NAC trials because more than 10% of patients with pathological stage I disease were included. We propose the criterion “cT3/T4 and cN1/N2/N3” instead.
Standard methods for swallowing function evaluation are videofluoroscopy (VF) and videoendoscopy, which are invasive and have test limitations. We examined the use of an earphone-type sensor to ...noninvasively evaluate soft palate movement in comparison with VF. Six healthy adults wore earphone sensors and swallowed barium water while being filmed by VF. A light-emitting diode at the sensor tip irradiated infrared light into the ear canal, and a phototransistor received the reflected light to detect changes in ear canal movement, including that of the eardrum. Considering that the soft palate movement corresponded to the sensor waveform, a Bland–Altman analysis was performed on the difference in time recorded by each measurement method. The average difference between the time taken from the most downward retracted position before swallowing to the most upward position during swallowing of the soft palate in VF was −0.01 ± 0.14 s. The Bland–Altman analysis showed no fixed or proportional error. The minimal detectable change was 0.28 s. This is the first noninvasive swallowing function evaluation through the ear canal. The earphone-type sensor enabled us to measure the time from the most retracted to the most raised soft palate position during swallowing and validated this method for clinical application.
Here, we assess the ability of metabolic tumor volume (MTV) as measured by F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) to evaluate neoadjuvant chemotherapy ...response for patients with locally advanced esophageal cancer (EC).
Optimal methods to evaluate treatment response for EC patients have not yet been established. Although previous studies have reported the value of standardized uptake value (SUV), the accuracy of predicting histological response or long-term survival in EC is limited.
In all, 102 EC patients without distant metastasis who underwent F-FDG PET/CT both before and after the preoperative chemotherapy series were analyzed.
The median primary tumor MTV values before and after preoperative chemotherapy were 22.55 (range 0.4-183.1) and 2.75 (0-52.9), respectively, and the median MVT reduction rate was 86.5%. We found the most significant difference in survival between PET responders and nonresponders with a cut-off value of 60% MTV reduction, using a 10% stepwise cut-off analysis 2-year progression-free survival (PFS): 79.2 vs 44.4%; hazard ratio (HR) 3.397; P < 0.0001). With this cut-off value, histological response (P = 0.0091), tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, and pM. Multivariate analysis further identified pM (HR 3.063; P = 0.0279) and MTV reduction rate (HR 2.471; P = 0.0263) to be independent prognostic predictors, but not decrease of primary lesion by CT or SUVmax reduction rate.
MTV change is clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients, after determining the optimal cut-off value based on survival analysis.
Anaerobic threshold (AT) from cardiopulmonary exercise tests (CPX) is the standard for measuring exercise intensity among patients with cardiovascular disease in Japan. However, it remains ...controversial whether AT represents the safety limit for exercise intensity in patients with cardiovascular disease. The purpose of this study was to investigate cardiac rehabilitation (CR) efficacy and safety with exercise intensities above the AT and at a traditional AT in a randomized trial. The participants included 57 patients who were admitted to the outpatient CR unit with a diagnosis of acute myocardial infarction. The participants were randomly divided as follows: 25 patients in the AT group, who performed aerobic exercises with an intensity at the AT; and 32 patients in the “Over AT” group, who performed exercises at an intensity higher than the AT. The following components were measured: maximum oxygen uptake (peak
V
O
2
), oxygen uptake at the AT (AT
V
O
2
), increase in oxygen uptake during exercise (Δ
V
O
2
/ΔWR) during the CPX, vascular endothelial function test (%FMD: the percentage of flow-mediated dilation), and isometric knee extension strength. The measurements were obtained at the start of the exercise therapy and after 2, 3, and 4 months. They were compared within and between groups, and the correlation between the rates of improvement was investigated. Peak
V
O
2
, AT
V
O
2
, Δ
V
O
2
/ΔWR, and %FMD had significantly improved after 3 months in both groups. The isometric knee extension strength had improved in the “Over AT” group after 2 months. Interactions were observed with peak
V
O
2
, Δ
V
O
2
/ΔWR, and isometric knee extension strength. However, %FMD was not significantly different between the groups. In the “Over AT” group, the rate of improvement in peak
V
O
2
was positively correlated with the improvement in the isometric knee extension strength (
r
= 0.61,
p
< 0.001), but not with %FMD. These data suggest that exercise at an intensity above the AT improved exercise tolerance faster than that at the AT, and this improvement rate was associated with changes in isometric knee extension strength.
The performance of yttrium-doped barium zirconate and cerate-based perovskite-type oxide supported ruthenium catalysts for the thermal catalytic NH3 synthesis process has been studied; these ...materials are expected to be applied as electrode catalysts for the electrochemical synthesis process of ammonia (NH3), namely, NH3 electrolysis. The BaZr0.9Y0.1O3-δ (BZY10, with Y substituting for 10 mol% Zr in BaZrO3)-supported Ru catalyst (Ru/BZY10) exhibited a high NH3 synthesis rate (4.00 mmol h−1 g-cat.−1) under the following reaction conditions: S.V. = 36 L h−1 g-cat.−1, T = 400 °C, P = 0.1 MPa. Furthermore, the calcination at 1200 °C of BZY10 enhanced the catalytic performance of Ru/BZY10 (4.63 mmol h−1 g-cat.−1 at 400 °C). Considering the NH3 synthesis rate per Ru amount, the optimal amount of Ru loading was 2.0 wt%. Furthermore, the addition of K and Cs to Ru/BZY10 can further improve the catalyst performance, which is found to be comparable to that of the other reported catalysts and is due to the electron-donating effect to active sites of Ru species. Based on various characterizations, we conclude that the particle size of Ru, the presence of BaCO3 and BaO crystalline phases, and the coverage of Ba species strongly affect the catalyst performance.
Display omitted
•Y-doped BaZrO3 and BaCeO3-supported Ru catalysts were evaluated for NH3 synthesis reaction.•Ru/BaZr0.9Y0.1O3-δ catalyst exhibited the highest performance for NH3 synthesis at 0.1 MPa.•Optimal conditions of BaZr0.9Y0.1O3-δ calcination temperature and Ru loading were 1200 °C and 2.0 wt%.•The addition of K and Cs to Ru/BaZr0.9Y0.1O3-δ promoted the performance due to electron donation to Ru.
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