Introduction: Upper gastrointestinal symptoms are common in both Western countries and Japan. This study was performed to i) clarify the factors associated with high scores on the modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) among 3,505 relatively healthy subjects undergoing routine medical health checkups with gastrointestinal endoscopy and ii) compare risk factors for high FSSG scores between subjects with and without reflux esophagitis. Methods: In total, 3,505 subjects (male/female: 1922/1583) who underwent upper gastrointestinal endoscopy during medical health checkups at 5 hospitals in Saga, Japan from January 2013 to December 2013 were enrolled. All subjects completed a modified FSSG questionnaire, which comprised seven questions regarding reflux symptoms and seven questions regarding acid-related dyspepsia. Results: Endoscopic reflux esophagitis was detected in 395 subjects (11.3%), and most esophagitis was not severe (grade A, n=329; grade B, n=63; grade C, n=3; grade D, n=0). Hiatal herniation and Barrett's esophagus were present in 1,196 (34.1%) and 940 (26.8%) subjects, respectively, and most cases of Barrett's esophagus were short-segment (928/940). Gastric and duodenal ulcers were not common. Of all 3,505 subjects, 1,030 (29.3%) were infected with Helicobacter pylori at the time of their medical health checkup, and H. pylori had already been eradicated in 540 subjects (15.4%). A high FSSG score of ≥6 points was detected in 919 subjects (26.2%). Multivariate analysis indicated that the risk factors for a high FSSG score were young age (P<0.001), female sex (P<0.001), hiatal hernia (P=0.02), and endoscopic esophagitis (P<0.001). Other factors, including Barrett's esophagus, eradication of H. pylori infection, and peptic ulcers, were not related to a high FSSG score. The highscoring subjects with and without esophagitis were compared with each other. Multivariate analysis indicated that the only risk factor for a high FSSG score in subjects without esophagitis was female sex (P<0.001); hiatal herniation and Barrett's esophagus were observed with high frequency in subjects with reflux esophagitis. Conclusion: Younger age, female sex, hiatal hernia, and endoscopic esophagitis were risk factors for a high FSSG score. Healthy Japanese females complained upper gastrointestinal symptoms more frequently than males regardless endoscopic esophagitis.
Objective: Locally advanced uterine cervical carcinoma (LAUCC) treated with chemoradiotherapy is considered to be the standard treatment regimen. However, no evidence of its efficacy and safety has been obtained from the Japanese population. Furthermore, the total dose of Japanese radiation therapy protocol is less than that of the USA which indicated that chemoradiotherapy for LAUCC is better than radiation therapy alone by phase III clinical trials. Thus, the current phase II study was designed to evaluate chemoradiotherapy with a lower radiation dose for LAUCC using weekly nedaplatin effectively and safely in the Japanese population. Nedaplatin is a platinum drug and no hydration is required to infuse patients because it is less toxic on renal function. If this phase II trial is successful, chemoradiotherapy for LAUCC in out-patient clinics could be possible. Patients and Methods: Patients registered in the current study were found to have LAUCC based on the following criteria i) pathologically proven squamous cell carcinoma or adenocarcinoma, ii) FIGO clinical Stage Ib, IIa, IIb with bulky tumor (diameter > 40 mm assessed by pelvic magnetic resonance imaging) or pelvic lymph node swelling (diameter > 10 mm assessed by pelvic computed tomography); iii) FIGO clinical Stage IIIa, IIIb and IVa with no paraaortic lymph node swelling (diameter > 10 mm) observed by abdominal computed tomography; iv) age: 20-75 years; v) performance status: 0-2. The treatment protocol was as follows: Radiation therapy in a combination of external beam radiation therapy (total dose: 50 Gy-52 Gy/25-27 fractions with central shielding after 30-32 Gy) with high-dose rate intracavitary irradiation (24-30 Gy/4-6 fractions to point A). Chemotherapy applied in the current study was weekly nedaplatin infused intravenously (30 mg/mm 2 /time, once a week, total 150 mg/mm2/5 weeks). Sample size in the current study was 45 LAUCC patients recruited for three years at a single institution. This protocol was permitted by the ethics committee of Kitasato University Hospital. Results: Ten patients were registered in this study between June 2005 and March 2006. The median age was 57.5 years (range 36-73). PSO was five and PS1 was five. As for clinical stage, nine were IIIb and only one was IIb. Nine patients were proven to have squamous cell carcinoma and one adenocarcinoma. The median maximum tumor diameter was 62.5 mm (range 30-100 mm). As for initial response, eight had CR and two had PR (100% response rate). As for hematological acute morbidity, three were grade 2, six were grade 3, and one was grade 4. Conclusions: This initial analysis of the phase II study confirmed that concurrent chemoradiotherapy using nedaplatin is safe and efficacious, thus we decided to undergo further studies.
The characteristic narrowing of left main coronary artery (LMCA) was found in 44% of patients (pts) with atrial septal defect and pulmonary hypertension (ASD + PH). The cause of the narrowing is thought to be the compression by pulmonary trunk (PT). Cardiac catheterization and coronary arteriography (CAG) were performed in 38 pts with ASD ranging in age from 15 to 62 years. We defined abnormal narrowing as 50% or more stenosis of AHA classification. Sixteen pts (42%) had PH, and of these pts 7 show the abnormal narrowing of LMCA. (18% of all pts with ASD, 44% of pts with ASD + PH). They had no signs of syphilis or aortitis. Of the pts with PH, those with abnormal LMCA revealed higher pulmonary artery mean pressure than those with normal LMCA (43.6 +/- 17.3 and 27.1 +/- 5.5 mmHg respectively. p less than 0.01). Other parts of coronary arteries are intact in all pts. These findings suggest that the LMCA abnormality relates to PH. In all cases with LMCA abnormality the narrowing revealed some special features indicate the cause of narrowing is compression. First, the most severe part of narrowing was the coronary ostium, and severity reduced gradually as distal LMCA. Second, the narrowing was estimated most severely in the view of LAO 20, but almost normal in the view of RAO 30. This finding suggests the narrowing is ellipsoid. Third, the shape of LMCA changed in the different phase of cardiac cycle. In the systole, the cranial border of LMCA was convex, but in the diastole it was concave. This indicates LMCA was soft and compressed.(ABSTRACT TRUNCATED AT 250 WORDS)
The prophylactic and therapeutic effects of S-312-d (S-(+)-methyl-4,7-dihydro-3-isobutyl-6-methyl-4-(3-nitrophenyl)thieno[2, 3- b]pyridine-5-carboxylate, CAS 120056-57-7) were compared with those of nimodipine or nicardipine using male stroke-prone spontaneously hypertensive rats (SHRSP). The survival rate of SHRSP was dose-dependently increased by once a day oral administration of S-312-d (0.3, 1, and 3 mg/kg) or nimodipine (10 mg/kg), while all non-treated SHRSP fed with high Na+ diet died within 40 days after the start of the experiment. All SHRSP treated with 3 mg/kg S-312-d survived during the 60-day experiment periods. Marked decreases of body weights and various neurological symptoms were also inhibited with S-312-d or nimodipine. Moderate diuretic effects were observed with S-312-d at doses of 1 and 3 mg/kg. The appearance of urinary occult blood in control SHRSP was markedly inhibited with S-312-d at 1 mg/kg and nimodipine at 10 mg/kg. Histological examination of the brain of SHRSP showed that cerebral stroke lesion including edema, hemorrhage, and/or softening was dose-dependently inhibited with S-312-d. Once a day oral administration of S-312-d (1, 3, or 10 mg/kg) dose-dependently increased the body weights and improved the neurological symptoms of diseased SHRSP. The appearance of proteinuria and of occult blood in the urine of SHRSP were also markedly inhibited with S-312-d or nicardipine. Histological examination of the brain of SHRSP showed that the arbitrary neurotoxic index (ANI) for stroke lesion dose-dependently decreased with S-312-d at 1, 3, and 10 mg/kg as follows: 4.8, 3.0, 2.3. The ANI for non-treated SHRSP was 7.6. The therapeutic effects of nicardipine (ANI 3.9) at 10 mg/kg corresponded to those of S-312-d at 3 mg/kg. Thus, S-312-d can be recommended for the treatment of cerebral insufficiency or vasospasm following stroke as well as in essential hypertension.
Recent data reveal phenotypic HoFH patients may be responsive to PCSK9 inhibitors, challenging prior assumptions.Genetic testing advancements now more accurately forecast patient responses to these therapies, improving treatment strategies.
Key Clinical Message Although the lean mass hyper‐responder (LMHR) phenotype is well known, its diagnosis is impeded by the influence of fat type and intake on the lipid profile. Accordingly, a detailed assessment is warranted if LMHR is suspected. Abstract A 47‐year‐old man with suspected familial hypercholesterolemia presented with elevated triglyceride and low‐density lipoprotein cholesterol levels. He had adhered to a ketogenic diet and was suspected of a lean mass hyper‐responder phenotype; however, his lipid profile did not meet the definition. His lipid profile improved through dietary management without medication.
The aim of the present study was to evaluate the clinical significance of tumor volumetry measured by three-dimensional (3-D) multidetector row computed tomography (MD-CT).A total of 50 patients with gastric cancer who had undergone pre-operative tumor volumetry using 3D-MD-CT followed by subsequent laparotomy (11 women, 39 men; mean age 63.9 years) were examined. Tumor volume and conventional clinicopathological factors were studied and then analyzed with respect to survival.Tumor volume was distributed widely and ranged from 0.16 cm3 to 363.5 cm3 with a mean of 43.6 cm3 (<10 cm3, 21 tumors; ≥10 cm3, 29 tu- mors). Significant differences in survival were found for volume (<10.0 cm3 vs. ≥10.0 cm3; p=0.0414), and depth of invasion (T1-2 vs. T3-4; p=0.0475), but not for diameter (<50 mm vs. ≥50 mm; p=0.2142), location (proximal third vs. middle or distal third; p=0.3254), macroscopic type (localized vs. invasive; p=0.3619), or microscopic type (differentiated vs. undifferentiated; p=0.1230).The present findings suggest that tumor volume measured by pre-operative 3D-MD-CT offers an alternative indicator for determining the prognosis in gastric cancer.
