Background:The Geriatric Nutritional Risk Index (GNRI) is a simple tool for assessing nutritional risk that predicts prognosis in patients with heart failure. This study evaluated associations ...between the GNRI at first hospitalization and prognosis in patients with pulmonary artery hypertension (PAH) and those with chronic thromboembolic pulmonary hypertension (CTEPH).Methods and Results:This retrospective investigation included 104 patients with either PAH or CTEPH who were treated at Kagoshima University Hospital in Japan. Patients were divided into a high (≥92) and low (<92) GNRI groups. Body mass index and serum albumin levels were significantly lower in the low GNRI group (P<0.001). Over a median follow-up period of 24 months, the incidence of pulmonary hypertension rehospitalization was higher in the low GNRI group (P=0.04). Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower in the low GNRI group (P=0.002). Low GNRI was significantly associated with a poorer outcome after adjusting for different sets of confounding factors, including: age and sex (P=0.004); age, sex, and PAH (P=0.043); and age, sex, and mean pulmonary artery pressure (P=0.003).Conclusions:The GNRI at first hospitalization is useful for predicting prognosis in PAH and CTEPH patients.
Background: Our previous study suggested a significant association between Ureaplasma urealyticum and nongonococcal urethritis (NGU). However, association of the serovars of U. urealyticum with NGU ...remains unclear. A polymerase chain reaction (PCR)-based assay can distinguish 4 serovars of Ureaplasma parvum from each other and categorize 10 serovars of U. urealyticum into 3 subtypes: subtype 1 (serovars 2, 5, 8, and 9), subtype 2 (serovars 4, 10, 12, and 13), and subtype 3 (serovars 7 and 11). Goal: The goal of this study was to determine which subtypes of U. urealyticum are associated with NGU as determined by PCR-based assay. Study: The prevalence of U. urealyticum subtypes in 106 ureaplasma-positive men with urethritis was compared with that in 30 ureaplasma-positive men without urethritis. Results: In men with nonchlamydial NGU and men with Mycoplasma genitalium-negative nonchlamydial NGU, only U. urealyticum subtype 1 (serovars 2,5,8, and 9) was detected significantly more often than in men without urethritis. Conclusion: This study suggests that subtype 1 of U. urealyticum (serovars 2, 5, 8, and 9) is associated with NGU independently of Chlamydia trachomatis or M. genitalium.
Gouty tophi are relatively simple to diagnose because they almost always occur in patients with persistent hyperuricemia. Treatment typically consists mainly of oral medication, and surgical ...intervention is necessary for only a small number of patients.
We present a case of 66-year-old Japanese man presented with a painful gouty tophus diagnosed by dual-energy computed tomography in the right foot without hyperuricemia that had gradually increased in size over the past 20 years. The tophus was removed and the patient's plantar pain disappeared after surgery and there was no recurrence.
We obtained a favorable outcome through surgical intervention for a gouty tophus of the foot diagnosed by dual-energy computed tomography in a patient without hyperuricemia. Our experience suggests that proactive surgical removal of gouty tophi should be considered for symptomatic cases and to prevent further joint destruction.
Abstract
Background
In patients with Parkinson's disease, executive deficits are known to correlate with motor dysfunctions, such as gait and postural instability. However executive deficits are ...sometimes difficult to detect using common frontal assessment batteries. Behavioral Assessment of Dysexecutive Syndrome includes six subtests to evaluate different aspects of executive function required in daily life. Among these the Modified Six Elements Test examines higher levels of executive function with regard to prospective memory and organization of behavior.
Aim
Using Behavioral Assessment of Dysexecutive Syndrome we examined which types of executive dysfunction correlate with motor symptoms in Parkinson's disease without apparent dementia.
Methods
A total of 54 Parkinson's disease patients with Mini‐Mental State Examination scores over 24 were assessed with the Unified Parkinson's Disease Rating Scale (total score of parts
II
and
III
as general motor function, subscores of tremor, rigidity, bradykinesia, gait disturbance and postural instability) for motor assessment, and both the Behavioral Assessment of Dysexecutive Syndrome (total raw score of all subtests and subscores of each of the 6 subtests) and Frontal Assessment Battery for executive function. Correlation coefficients for executive and motor assessments were compared.
Results
Among the Behavioral Assessment of Dysexecutive Syndrome subtests, the Modified Six Elements Test showed the strongest correlation with the Unified Parkinson's Disease Rating Scale subscore of gait disturbance, but did not correlate with patient background factors, such as age.
Conclusion
Even in Parkinson's disease without apparent dementia, deficits in complex executive functions, such as prospective memory and organization of behavior, correlate with motor dysfunctions, especially gait. We believe the Modified Six Elements Test is useful to evaluate early executive deficits.
The aims of this study were to assess the efficacy and toxicity of concurrent chemoradiotherapy with divided schedule of cisplatin and vinorelbine in patients with locally advanced non-small-cell ...lung cancer (NSCLC).
Patients with previously untreated, unresectable, and stage IIIA or IIIB NSCLC were eligible if they had a performance status of 0 or 1, were 75 years or younger, and had adequate organ function. Twenty-six patients (24 men and 2 women; median age, 66 years; age range, 42-75 years) were enrolled. Both cisplatin (40 mg/m(2)) and vinorelbine (20 mg/m(2)) were given on days 1 and 8 every 3 weeks. Beginning on day 2 of chemotherapy, thoracic radiotherapy was given for approximately 6 weeks (2 Gy per fraction; total dose, 60 Gy).
Five of the 26 patients achieved a complete response, and 16 achieved a partial response for an overall response rate of 80.8% (95% confidence interval, 60.6-93.4%). The median survival time was 23 months (range, 4-43 months). Overall survival rates at 1 and 2 years were 80 and 56%, respectively. Hematologic toxicities included grade 3-4 neutropenia in 84.6% of patients, grade 3-4 thrombocytopenia in 3.8%, and grade 3-4 anemia in 61.5%. Two patients (7.7%) had grade 3 radiation esophagitis that resolved completely without dilation. Grade 3-4 radiation pneumonitis occurred in two patients (7.7%) and was treated with corticosteroids. Both patients had a good partial resolution of symptoms and radiographic abnormalities. There were no treatment-related deaths. The actual delivered dose intensities for both cisplatin and vinorelbine were 79.5%. Radiotherapy was completed in 96% of patients.
Concurrent chemoradiotherapy with cisplatin and vinorelbine administered on a divided schedule is effective and well tolerated in patients with locally advanced NSCLC.
Background:Pulmonary hypertension (PH) is an important cause of morbidity in patients with connective tissue disease (CTD), and an early stage of PH could present as exercise-induced PH (EIPH). This ...study investigated the significant clinical indexes of EIPH in patients with CTD.Methods and Results:We enrolled 63 patients with CTD who did not have PH at rest. All patients underwent the 6-min walk test (6MWT), and systolic pulmonary artery pressure (SPAP) was evaluated on echocardiography before and after 6MWT. EIPH was defined as SPAP ≥40 mmHg after 6 WMT. Thirty-five patients had EIPH. On univariate logistic analysis, SPAP at rest, log brain natriuretic peptide (BNP), vital capacity (VC), and forced expiratory volume in 1 s (FEV1.0) were significantly correlated with EIPH. On multiple logistic analysis, SPAP at rest and VC were independent predictors of EIPH, whereas FEV1.0 and log BNP were not significantly associated with EIPH. The area under the receiver operating characteristics curve between EIPH and BNP, SPAP at rest, VC or FEV1.0 was 0.67, 0.76, 0.74, and 0.75, respectively.Conclusions:SPAP at rest and respiratory function, especially VC, could be independent predictors of EIPH in patients with CTD.
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