Background
The optimal surgical approach for treatment of oesophagogastric junction (OGJ) cancer is controversial. A randomized clinical trial (JCOG9502) comparing transhiatal (TH) and left ...thoracoabdominal (LTA) approaches was stopped after the first interim analysis owing to limited efficacy for LTA resections. Complete 10‐year follow‐up data are now available.
Methods
Patients with histologically proven adenocarcinoma of the OGJ or gastric cardia with oesophageal invasion of 3 cm or less were randomized to a TH or LTA approach. Both groups underwent total gastrectomy and splenectomy with D2 nodal dissection plus para‐aortic lymphadenectomy above the left renal vein. For LTA, a thorough mediastinal lymphadenectomy below the left inferior pulmonary vein was also mandatory. The primary endpoint was overall survival.
Results
A total of 167 patients (82 TH, 85 LTA) were enrolled. The 10‐year overall survival rate was 37 (95 per cent c.i. 26 to 47) per cent for the TH approach and 24 (15 to 34) per cent for the LTA technique (P = 0·060). The hazard ratio for death was 1·42 (0·98 to 2·05) for the LTA technique. Subgroup analysis based on the Siewert classification indicated non‐significant survival advantages in favour of the TH approach.
Conclusion
LTA resections should be avoided in the treatment of adenocarcinoma of the OGJ or gastric cardia. Registration number: NCT00149266 (https://www.clinicaltrials.gov).
No survival benefit from a more extensive operation
This study investigated the usefulness of a novel inflammation-based prognostic system, named the COP-NLR (COmbination of Platelet count and Neutrophil to Lymphocyte Ratio), for predicting the ...postoperative survival of patients with colorectal cancer (CRC).
The COP-NLR was calculated on the basis of data obtained on the day of admission: patients with both an elevated platelet count (>30 × 10(4) mm(-3)) and an elevated NLR (>3) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively.
Four-hundred and eighty patients were enrolled. Multivariate analysis of clinical characteristics selected by univariate analysis showed that the COP-NLR (1, 2/0) (odds ratio, 0.464; 95% confidence interval, 0.267-0.807; P=0.007) had an association with cancer-specific survival, along with pathology, lymph node metastasis, the serum levels of carcinoembryonic antigen, C-reactive protein and albumin, and the Glasgow Prognostic Score. Kaplan-Meier analysis and log-rank test revealed that the COP-NLR was able to divide such patients into three independent groups (P<0.001).
The COP-NLR is considered to be a useful predictor of postoperative survival in patients with CRC.
Polymerizable bactericides, such as quaternary ammonium compound–based monomers, have been intensively studied as candidates for immobilizing antibacterial components on dental resin. However, they ...predominantly exhibit a bacteriostatic behavior, rather than bactericidal, as the immobilized components are left with insufficient molecular movement to disrupt the bacterial surface structure through contact-mediated action. In this study, we developed a novel strategy to increase the density of the immobilized bactericide and enhance its antibacterial/antibiofilm properties by combining a surface-grafting technique with electron beam irradiation. A solution of the quaternary ammonium compound–based monomer, 12-methacryloyloxydodecylpyridinium bromide (MDPB), was coated on polymethyl methacrylate (PMMA) resin specimens at the concentrations of 30, 50, and 80 wt%. The coated resins were subsequently exposed to 10 MeV of electron beam irradiation at 50 and 100 kGy, followed by thermal stabilization at 60 °C. The antibacterial effect was evaluated by inoculating a Streptococcus mutans suspension on the coated PMMA resin samples, which exhibited bactericidal effects even after 28 d of aging (P < 0.05, Tukey’s honestly significant difference test). Transmission electron microscopy and bacteriolytic activity evaluation revealed that the S. mutans cells had sustained membrane depolarization. Furthermore, the antibiofilm effects against S. mutans and bacteria collected from human saliva were assessed. The thickness and the percentage of membrane-intact cells of the S. mutans and multispecies biofilms formed on the MDPB-immobilized surfaces were significantly lower than the uncoated PMMA specimens, even after 28-d aging (P < 0.05, Tukey’s honestly significant difference test). Thus, the immobilization of antibacterial MDPB via electron beam irradiation induced rapid membrane depolarization, increasing membrane permeability and eventually causing cell death. Our strategy substantially enhances the antibacterial properties of the resinous materials and inhibits biofilm formation, therefore demonstrating significant potential for preventing infectious diseases in the oral environment.
Objective
Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of ...antithrombin III (ATIII) for DIC in obstetrics; however, its effect remains uncertain. The present study aimed to investigate the effect of ATIII for DIC in obstetrics, using a national inpatient database in Japan.
Design
Nationwide observational study.
Setting
Japan.
Population
We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018.
Methods
Propensity score matching analyses were performed to compare in‐hospital maternal mortality and hysterectomy during hospitalisation between users and non‐users of ATIII on the day of delivery.
Main outcome measures
In‐hospital mortality, hysterectomy.
Results
A total of 9920 patients were enrolled, including 4329 patients (44%) who used ATIII and 5511 patients (56%) who did not use ATIII. One‐to‐one propensity score matching created 3290 pairs. In‐hospital maternal mortality did not differ significantly between the propensity‐matched groups (0.3% in the ATIII group versus 0.5% in the control group; odds ratio 0.73; 95% CI 0.35–1.54). A significantly lower proportion of patients in the ATIII group, compared with those in the control group, underwent hysterectomy during hospitalisation (5.3% versus 8.7%; absolute risk difference −2.9%; 95% CI −4.2 to −1.6%).
Conclusions
Although the present study did not show a mortality‐reducing effect of ATIII for patients with DIC in obstetrics, it may have clinical benefit in terms of reducing the number of patients undergoing hysterectomy.
Tweetable
This study did not show mortality‐reducing effect of antithrombin III for patients with DIC in obstetrics.
Tweetable
This study did not show a mortality‐reducing effect of antithrombin III for patients with DIC in obstetrics.
Abstract
Information about the ecotoxicological impacts of surface waters that receive discharges from legacy mines is valuable to infer the ecological impacts on natural environment for managing ...mine discharges. In this study, we investigated behavioural and reproductive responses of two cladoceran species Ceriodaphnia dubia and Daphnia magna to water samples collected from metal-contaminated and reference rivers near legacy mines in Japan. The toxicity identification evaluation (TIE) of water samples that caused D. magna immobility was conducted to evaluate the key metals causing acute toxicity. The results of our water quality assessment performed using two cladoceran species demonstrated modest to significant adverse effects on their behaviour and reproduction, suggesting the potential for ecotoxicological impacts on natural populations and communities at several contaminated sites that received mine drainage. The results of TIE of water samples that caused D. magna immobility indicated likely contributions of Zn and Cu. These results imply that effect-based water quality assessments such as ours can provide direct and unique evidence of the ecotoxicological impacts of metals in river waters, which will be useful for better understanding and predicting the ecological effects of these metals in the natural environment.
Various clinical studies have indicated that interferon (IFN)‐alpha treatment prevents the development of hepatocellular carcinoma (HCC) in people chronically infected with hepatitis C virus. ...However, it has been controversial whether IFN‐alpha treatment prevents HCC recurrence. The aim of this study was to identify the preventive effect of IFN‐alpha treatment after curative therapy of primary tumours within the Milan criteria (three or fewer nodules 3 cm or less in diameter or a single nodule of 5 cm or less) on HCC recurrence. We conducted a meta‐analysis of five trials including 355 patients (167 patients received IFN‐alpha treatment after curative therapy of primary tumours) and estimated relative risks (RRs) and 95% confidence intervals (CIs) for the effect of IFN‐alpha on HCC recurrence according to the DerSimonian and Laird method. IFN‐alpha treatment after curative therapy of primary tumours significantly prevented HCC recurrence (RR 0.33; 95%CI 0.19–0.58, P < 0.0001) without a significant heterogeneity (Q = 4.52, P = 0.34). An evaluation using the Begg method suggested no evidence of publication bias. Sub‐group analyses revealed that IFN‐alpha treatment reduced HCC recurrence in two studies achieving sustained virologic response (SVR) rates >30% (RR 0.20; 95%CI 0.05–0.81, P = 0.02) and in three studies achieving SVR rates ≤30% (RR 0.44; 95%CI 0.23–0.84, P = 0.01). In conclusion, IFN‐alpha treatment after curative treatment of primary tumour within Milan criteria may be effective for the prevention of HCC recurrence, and higher SVR rate may be associated with better preventive effect of IFN‐alpha treatment on HCC recurrence.
Information about the overall documentary filmmaking process is available; however, there is a lack of literature and educational resources about how to conduct subject research and data collection. ...As documentary filmmaking becomes an increasingly democratic endeavor due to technology, and information distribution and education use increases, there is a corresponding need for quality resources to support this essential step. In this study, a content-rich, technology-enhanced, online instructional module that was designed and developed in another study to guide and assist beginner documentary filmmakers with subject research and data collection, was implemented and evaluated by the target audience. This module featured five filmmaking tips summarizing professional documentary filmmakers’ wisdom and expertise with subject research and data collection. Motivational and instructional models served as frameworks to inform and guide the study’s learning design process. The quantitative and qualitative findings, field notes and observations provided data triangulation. After analysis and interpretation were completed, the results significantly confirmed the module had a positive, educational impact on the target audience and accomplished its purpose. This module addressed the lack of resources and utilized consultation of experts in content design and development to improve the creativity and production of beginner documentary filmmakers. This project successfully merged learning sciences theory and instructional design with humanities and arts research. It will contribute to the literature of documentary film research studies, the fields of instructional design and education, and the humanities. It has significant potential to influence and impact the broad possibilities of innovative, interdisciplinary research design and collaboration.
Oligonucleotides are key elements of nucleic acid therapeutics such as small interfering RNAs (siRNAs). Influenza and Ebolaviruses are zoonotic RNA viruses mutating very rapidly, and their sequence ...changes must be characterized intensively to design therapeutic oligonucleotides with long utility. Focusing on a total of 182 experimentally validated siRNAs for influenza A, B and Ebolaviruses compiled by the siRNA database, we conducted time-series analyses of occurrences of siRNA targets in these viral genomes. Reflecting their high mutation rates, occurrences of target oligonucleotides evidently fluctuate in viral populations and often disappear. Time-series analysis of the one-base changed sequences derived from each original target identified the oligonucleotide that shows a compensatory increase and will potentially become the 'awaiting-type oligonucleotide'; the combined use of this oligonucleotide with the original can provide therapeutics with long utility. This strategy is also useful for assigning diagnostic reverse transcription-PCR primers with long utility.
Clinically amyopathic dermatomyositis (CADM) patients frequently develop refractory interstitial lung disease (ILD), with a poor prognosis. We aimed to verify the efficacy and safety of plasma ...exchange (PE) treatment for ILD in CADM.
A retrospective case-control study was conducted to compare clinical outcomes with and without PE treatment in CADM-ILD patients refractory to combination therapy of high-dose glucocorticoids, calcineurin inhibitors, and cyclophosphamide. Among 19 enrolled patients, 11 were further treated with PE. We compared survival rates and other clinical characteristics. PE consisted of either fresh-frozen plasma or albumin as a replacement solution.
Basal clinical characteristics at diagnosis, including age, gender, serum ferritin, Krebs von den Lungen-6 (KL-6), C-reactive protein, and respiratory function tests, did not differ between the two groups. The survival rate for treatment with PE was higher than for treatment without PE (91% and 50%, respectively, p < 0.05). Among PE-treated patients, anti-melanoma differentiation-associated gene-5 (anti-MDA-5) antibody titre, ferritin, and KL-6 as serological activity markers were sustainably reduced only after initiating PE. Therapeutic intervention with PE reduced the frequency of exacerbation of ILD requiring methylprednisolone pulse therapy. The occurrence of bacterial, fungal, and cytomegalovirus infection did not differ between the groups with and without PE, and adverse events associated with PE resolved with appropriate intervention.
Combination therapy with PE was associated with an improved survival rate, and may be effective for the management of refractory ILD in CADM patients. A personalized therapeutic strategy including PE could be introduced for fatal rapidly progressive ILD.
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