The accuracy and characteristics of gastric cancer treatment information in the national data of the hospital-based cancer registry.

OBJECTIVE: The hospital-based cancer registry is used extensively for research to support cancer control activities by providing an overview of how cancer treatments are provided nationwide. This study aimed to shed light on the quality and characteristics of treatment data in the hospital-based cancer registry using the linked dataset on gastric cancer. METHODS: Using the nationally linked data of the hospital-based cancer registry and the health services utilization data, the treatment data in the hospital-based cancer registry for patients who were newly diagnosed with gastric cancer in 2016 and 2017 and received the first course of treatment at their own institutions were examined. The agreement rates between registry data and utilization data were analyzed by stage, treatment, age, period from the date of diagnosis to the date of treatment and hospital type. RESULTS: The sensitivity of open surgery, laparoscopic surgery and endoscopic treatment tended to decrease in advanced stages, whereas the sensitivity of chemotherapy and radiation therapy increased. Specificity was high for all treatments and stages, at ˃90%. Sensitivity by age was slightly different for chemotherapy and radiation therapy, but specificities did not differ.For all treatments, the longer the time from diagnosis to treatment implementation, the higher the coverage rate. CONCLUSIONS: The hospital-based cancer registry recorded the treatment performed appropriately. It is necessary to interpret the data from the hospital-based cancer registry whilst keeping in mind that, chemotherapy and radiation therapy are registered less frequently than surgical treatments administered.

The real-world selection of first-line systemic therapy regimen for metastatic gastroenteropancreatic neuroendocrine neoplasm in Japan.

In November 2013, the first edition of evidence-based guidelines for treatment of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) was published in Japan. However, whether medical practitioners have adopted the first-line regimens recommended for metastatic GEP-NEN in clinical practice is not yet known. The purpose of this study was to identify which first-line systemic therapy regimens have been selected and the proportion of cases that are adherent to the guidelines (i.e., number of patients receiving recommended therapy/total number of patients). We combined hospital-based cancer registry data and insurance claims-equivalent data for patients with GEP-NEN treated between January 2013 and December 2014 and extracted those with metastatic GEP-NEN who received systemic therapy. The proportions that were adherent with the guideline were calculated according to tumor classification (neuroendocrine tumor [NET] or neuroendocrine carcinoma [NEC]), primary site (gastrointestinal or pancreatic), and hospital volume (high, medium, or low). The study included 109 patients with GEP-NET and 424 with GEP-NEC. Overall, guideline-adherent treatment was provided in only 54.8% of cases (58.1% for gastrointestinal NET, 63.6% for pancreatic NET, 56.6% for gastrointestinal NEC, and 44.9% for pancreatic NEC). The recommended therapy for GEP-NET was used in 16.5% of patients with GEP-NEC, and 21.5% received fluoropyrimidine-containing chemotherapy. This report is the first to describe real-world selection of first-line regimens for metastatic GEP-NEN. About half of all these patients received systemic therapy that was not recommended in the guidelines.

Determination of Inorganic Arsenic in Fish Oil and Fish Oil Capsules by LC-ICP-MS.

BACKGROUND: As inorganic arsenic is a highly toxic compound, its concentration in foods should be determined. OBJECTIVE: Develop an analytical method for determining inorganic arsenic in fish oil and fish oil capsules. METHOD: Inorganic arsenic was extracted from fish oil by heating at 80°C in 1.6% tetramethylammonium hydroxide-ethanol. The concentration of inorganic arsenic in fish oil was determined by liquid chromatography (LC) inductively coupled plasma (ICP) MS using an octadecylsilane (ODS) column with a mobile phase containing an ion-pair reagent. RESULTS: The LOD (0.005, 0.004 mg/kg), LOQ (0.016, 0.011 mg/kg), repeatability (4.2, 3.5%), intermediate precision (5.4, 3.5%), and trueness (recoveries 94-109% based on spiked samples) of the proposed method were satisfactory for inorganic arsenic in fish oil and fish oil capsules. A low level of inorganic arsenic was detected only in anchovy oil among all fish oil samples that were used in this study. Inorganic arsenic levels were below the quantitation limit in all fish oil capsules. CONCLUSIONS: Inorganic arsenic was determined after extraction from fish oil by heating at 80°C in 1.6% tetramethylammonium hydroxide-ethanol. The level of inorganic arsenic in all fish oil samples examined in this study was lower than 0.1 mg/kg of the maximum level defined in the Codex. HIGHLIGHTS: Arsenic speciation in fish oil and fish oil capsules was analyzed by LC-ICP-MS using an ODS column with a mobile phase containing an ion-pair reagent. A low level of inorganic arsenic was detected only in anchovy oil. No inorganic arsenic was detected in fish oil capsules.

Thermally Induced Switch of Coupling Reaction Using the Morphological Change of a Thermoresponsive Polymer on a Reactive Heteroarmed Nanoparticle.

Control of the cross-linking reaction is imperative when developing a sophisticated in situ forming hydrogel in the body. In this study, a heteroarmed thermoresponsive (TR) nanoparticle was designed to investigate the mechanism of controlling reactivity of the functional groups introduced into the nanoparticles. The coupling reaction was suppressed/proceeded by utilizing temperature-induced morphological changes of the TR polymer. The heteroarmed TR nanoparticle was prepared by the coassembly of amphiphilic block copolymers possessing both a TR segment and hydrophilic segment with reactive functional groups of succinimide. The longer TR chain on the nanoparticle covered the succinimide group and suppressed the reaction with the primary amine on the external nanoparticle. In contrast, the coupling reaction was promoted at a high temperature to create the chemical cross-linking structure between the nanoparticles because of the exposure of the succinimide group on the surface of the particle as a consequence of the morphological change of the TR polymer. In addition, the thermally controlled chemical reaction modulated initiation of the gelation using a highly concentrated nanoparticle solution. The heteroarmed TR nanoparticle offers great practical advantages for clinical uses, such as embolization agents, through precise control of the reaction.

Validation of the Japanese version of the barriers questionnaire II in cancer pain management: a cross-sectional study.

BACKGROUND: The Barriers Questionnaire II (BQ-II) was developed to assess barriers to effective pain management. In this study, we aimed to assess the reliability and validity of the newly developed Japanese version of the BQ-II (JBQ-II). METHODS: This study used a cross-sectional design. The study was conducted an ambulatory infusion center for cancer in a general hospital in Tokyo, Japan. Participants were 120 Japanese patients with cancer and 21 Japanese health professionals with experience in pain management. Cronbach's alpha coefficient was used to calculate reliability. Test-retest reliability was assessed with Spearman's intra-class correlation coefficient (ICC). Construct, criterion-related, and discriminant validity were assessed using information about pain management, daily life, mental health, and subjective health. RESULTS: The Cronbach's alpha was 0.90 for the JBQ-II, and all ICCs exceeded 0.70 (P < 0.01). Factor analysis showed the JBQ-II had a virtually identical structure to the BQ-II, and path analysis supported the JBQ-II constructs. The JBQ-II was weakly correlated with poor mental state (r = 0.36, P < 0.01). Patients' JBQ-II scores were significantly higher than health professionals' scores. CONCLUSION: The JBQ-II is a valid and reliable measure of patient-related barriers to pain management among Japanese adult patients with cancer.

Determination of Inorganic Arsenic in Seaweed and Seafood by LC-ICP-MS: Method Validation.

Background: Seaweed and seafood often contain both inorganic and organic arsenic compounds showing distinct toxicities. Speciation must be taken into account when determining the concentrations of arsenic compounds and how they relate to overall toxicity. Objective: An analytical method for the quantitation of inorganic arsenic was validated in seaweed and seafood. Methods: Food samples were heated at 100°C in 0.3 mol/L nitric acid. Arsenic speciation was quantitatively determined by LC-inductively coupled plasma-MS (LC-ICP-MS) using an octadecilsilane (ODS) column with a mobile phase containing an ion-pair reagent. Results: Limits of detection (0.0023-0.012 mg/kg), LOQ (0.0077-0.042 mg/kg), repeatability (3.0-7.4%), intermediate precision (4.4-7.4%), and trueness (recoveries 94-107%) of the proposed method were satisfactory for inorganic arsenic in seaweed and seafood. Inorganic arsenic was detected in almost all the evaluated dried seaweed products, the Japanese oyster, nam pla, oyster sauce, and the intestinal organs of seafood. Conclusions: Among the dried seaweed products, significant inorganic arsenic was detected in the brown algae akamoku, hijiki, and mozuku. The small amounts of inorganic arsenic detected in nam pla and oyster sauce likely derive from the internal organs of the raw seafood used in their preparation. Highlights: Arsenic speciation in seaweed and seafood was measured by LC-ICP-MS using an ODS column with a mobile phase containing an ion-pair reagent. Among the dried seaweed products, brown algae akamoku, hijiki, and mozuku contained significantly high levels of inorganic arsenic. The intestinal organs of oyster, sardine, and scallop contained higher arsenic levels than the muscles.

Negative pain management index scores do not necessarily indicate inadequate pain management: a cross-sectional study.

BACKGROUND: The Pain Management Index (PMI) is widely used in the assessment of pain management, and negative scores are traditionally considered to indicate inadequate pain management. However, it is not known whether negative PMI scores are always problematic. METHODS: In this prospective observational study, we examined the data of 1156 patients with cancer and pain who were hospitalized in a cancer care hospital in Japan from July 2012 to January 2015 and compared the proportion of patients with PI across various PMI scores in this cohort. We further evaluated the predictive validity of PMI scores for PI using different cutoffs. This study aimed to examine the association between PMI scores and the proportion of patients whose pain interferes with their daily lives (i.e., pain interference [PI]). RESULTS: We found that lower PMI scores were generally associated with a higher percentage of patients with PI. A smaller proportion of patients with PMI scores of - 1 (567/1550, 36.6%) reported PI compared with those with PMI scores of 0 (788/1505, 52.4%). The sensitivities of PMI scores < - 1 and < 0 for predicting PI were 0.16 and 0.37 and the corresponding specificities were 0.95 and 0.71, respectively. CONCLUSIONS: These findings suggest that PMI scores are inversely associated with the proportion of patients with PI. However, PMI scores of - 1 do not always indicate inadequate pain management; pain management should therefore be evaluated from multiple perspectives.

Treatment selection for esophageal cancer: evaluation from a nationwide database.

BACKGROUND: Most elderly patients poorly tolerate the standard treatment for esophageal cancer; however, little information is available regarding the appropriateness of non-standard esophageal cancer treatments for those patients. This study aims to analyze the treatment costs and completion rates of patients undergoing a real-world treatment for esophageal cancer to elucidate the treatment selection and its quality. MATERIALS AND METHODS: We analyzed treatment costs and completion rates for patients with esophageal cancer and analyzed these data relative to patient age and center volumes. Patients with esophageal cancer [UICC, TMN, Clinical stage II/III (excluding T4)] who were diagnosed in 2013 were analyzed. Patients were classified into five groups defined as follows: surgical therapy, chemotherapy, concurrent chemoradiotherapy (CCRT), modified concurrent chemoradiotherapy (mCRT), and radiotherapy (RT). RESULTS: Mean and median age of patients who received surgery and CCRT were comparable; however, patients who underwent mCRT and RT tended to be older. Medical costs associated with surgery were higher than costs associated with other non-surgical treatments. Cost and completion rate of chemoradiotherapy did not differ between CCRT and mCRT; however, both had higher completion rates compared to that of RT. Surgical expenses tended to be the highest in low-volume centers and the lowest in high-volume centers. CONCLUSION: Treatment of esophageal cancer at high-volume centers seems well balanced compared with medium- to low-volume centers. mCRT was widely performed and comparable in medical cost to CCRT, although additional clinical impacts were unclear.

Age-related and obstacle height-related differences in movements while stepping over obstacles.

BACKGROUND: This study aims to examine age-related and obstacle height-related differences in movements while stepping over obstacles. METHODS: The participants included 16 elderly and nine young women. Obstacles that were either 5 or 20 cm high were positioned at the center of a 4-m walking path. The participants were instructed to walk along the path as quickly as possible. The participants' movements were analyzed using a three-dimensional motion analysis system that recorded their movements as they walked and stepped over the obstacles. RESULTS AND CONCLUSIONS: Seven joint angles and the distances between the ground and six markers were examined in the initial contact and swing instants of the leading and trailing limbs. In the initial contact instant, the elderly women prepared for stepping with a lower toe height than the young women when stepping over the 20-cm obstacle. Trunk rotation was greater in the young women than in the elderly women. In the swing instant, the elderly women showed greater ankle dorsiflexion and hip adduction angles for the leading limb when stepping over the 20-cm obstacle. They moved the trailing limb with increased ankle dorsiflexion, knee flexion, hip flexion, and foot inversion to ensure that they did not touch the obstacle as they stepped over it. These movement patterns are characteristic of elderly individuals who cannot easily lift their lower limbs because of decreased lower-limb strength.

Histological difference between pulsed wave laser and continuous wave laser in endovenous laser ablation.

BACKGROUND: Endovenous laser ablation to saphenous veins has been popular as a minimally invasive treatment for chronic venous insufficiency. However, adverse effects after endovenous laser ablation using continuous wave laser still remain. Pulsed wave with enough short pulse duration and sufficiently long thermal relaxation time may avoid the excess energy delivery, which leads to the perforation of the vein wall. METHOD: (1) Free radiation: Laser is radiated in blood for 10 s. (2) Endovenous laser ablation: Veins were filled with blood and placed in saline. Endovenous laser ablations were performed. RESULTS: (1) There were clots on the fiber tips with continuous wave laser while no clots with pulsed wave laser. (2) In 980-nm continuous wave, four of 15 specimens had ulcers and 11 of 15 had perforation. In 1470-nm continuous wave with 120 J/cm of linear endovenous energy density, two of three presented ulcers and one of three showed perforation. In 1470-nm continuous wave with 60 J/cm of linear endovenous energy density, two of four had ulcers and two of four had perforation. In 1320-nm pulsed wave, there were neither ulcers nor perforation in the specimens. CONCLUSIONS: While endovenous laser ablation using continuous wave results in perforation in many cases, pulsed wave does not lead to perforation.

The onset of heat-induced testicular calcification in mice: involvement of the telomeric locus on chromosome 1.

Spermatocytes of MRL/MpJ mice are more heat resistant than those of C57BL/6 mice in experimental cryptorchidism. This phenotype depends in part on the locus at the 81-cM region of MRL/MpJ-type chromosome 1 (Chr 1). To evaluate the function of this locus, we examined pathological changes in mouse testes resulting from transient scrotal heat stress. Immediately after scrotal heat stress, meiosis progression and blood-testis barrier integrity were preserved in MRL/MpJ but not in C57BL/6 mice, nor in a C57BL/6-based congenic strain carrying the MRL/MpJ-derived Chr 1 locus (B6.MRLc1). Testicular damage was severe in the weeks after scrotal heat stress in all three strains; however, testicular calcification was observed only in C57BL/6 and MRL/MpJ mice (initially as nanocrystals in mitochondria of degenerating germ cells). In testes, expression of gremlin 2, a bone morphogenetic protein antagonist encoded on Chr 1, was markedly higher in B6.MRLc1 than in C57BL/6 or MRL/MpJ mice. Furthermore, gremlin-2 and bone morphogenetic protein 2 mRNA levels in heated testes correlated negatively and positively, respectively, with calcification. Thus, although the MRL/MpJ-derived locus on Chr 1 may play a pivotal role in recovery from heat-induced testicular damage, especially via inhibition of calcification, MRL/MpJ mice have a precipitating factor for testicular calcification and heat shock-resistant factors that reside outside the 81-cM region of Chr 1.

Validation of the Japanese version of the Fatigue Barriers Scale (JFBS).

BACKGROUND: The Fatigue Barriers Scale (FBS) is an instrument to identify patient-derived barriers to fatigue management. OBJECTIVE: To assess the reliability and validity of the Japanese version of the FBS (JFBS). METHODS: Participants were 112 cancer patients. Reliability was determined through internal consistency using Cronbach's alpha coefficient and through test-retest reliability using Spearman's intra-class correlation coefficient (ICC). Construct, convergent, criterion-referenced, and concurrent validities were assessed. The Cancer Fatigue Scale (CFS), Patient Fatigue Knowledge Tool (PFKT), and Kessler 6-item distress scale (K6) were used for comparisons. RESULTS: Cronbach's alpha coefficients were 0.74, 0.78, 0.72, and 0.54 for the JFBS total and for each subscale, respectively. All ICCs exceeded 0.65 (P<0.05). The JFBS had a weak negative correlation with the PFKT and a positive correlation with the CFS. The K6 scores showed weak positive correlations with the JFBS total and fatalism subscale scores. CONCLUSIONS: The JFBS can be used to measure fatigue barriers in Japanese people with cancer.

Aortic valve replacement to a patient with high titer of cold agglutinin.

A 60-year-old man was admitted to our hospital because of aortic stenosis with a peak pressure gradient of 61 mmHg, moderate aortic regurgitation, and a dilatation of the ascending aorta of 50 mm in diameter, which had grown 5 mm in 2 years. Because of severe aortic stenosis with a bicuspid valve and fast progression of the ascending aorta in size, replacements of both the aortic valve and the ascending aorta were planned.He had experienced severe acute renal failure with hemolysis because of cold agglutinin one year before the operation. The hemoglobin had decreased to 4.3 g/dL during hemolytic attack. His titer of cold agglutinin was extremely high. The titer of cold agglutinin has kept above than 1:131072 at 4 degree Celsius. It once increased to 1:524288.Both the replacement of the aortic valve and the ascending aorta under normothermic cardiopulmonary bypass using intermittent warm blood cardioplegia were completed uneventfully. He was discharged from the hospital on postoperative day 11.

Determination method for total arsenic and partial-digestion method with nitric acid for inorganic arsenic speciation in several varieties of rice.

The determination method of total arsenic (As) and the speciation method of inorganic As for non-glutinous rice reported in our preceding paper were applied to several varieties of rice under optimized experimental conditions. In the determination of total As with ICP-MS, acetic acid was added to increase the sensitivity and an internal reference method with germanium was adopted to increase the precision. The extraction temperature in the partial-digestion method with nitric acid to speciate inorganic As was raised to 100 degrees C, because extraction efficiency over 90% was obtained from glutinous rice and colored rice at this temperature. In the investigation of polished and unpolished forms of non-glutinous, glutinous, and colored rice, the amounts of total and inorganic As were 0.04-0.54 mg/kg and 0.02-0.41 mg/kg, respectively. The color of rice was not related to total or inorganic As content. These results indicate that the inorganic As content in commercial rice should be carefully monitored.

Quantitative assessment of dyssynchrony using ECG-gated SPECT myocardial perfusion imaging prior to and following cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) assists patients with advanced heart failure (HF) by improving left ventricular (LV) dyssynchrony, but there are significant numbers of non-responders, 1 reason being that the QRS duration is used as the only surrogate determinant of mechanical dyssynchrony, so an effective indicator of LV dyssynchrony is required. The present patient, who had HF, underwent CRT and showed clinical improvement with marked LV reverse remodeling. The regional contraction timing in the LV was assessed with software developed in an application on ECG-gated SPECT myocardial perfusion imaging that depicts the time-volume relationship of the segmented ventricular myocardium and the dispersion of time to end-systole as an expression of dyssynchrony. It was reduced in this patient following CRT. Discordance of systole in regional myocardial segments may present as mechanical dyssynchrony in the LV and could be used as an alternative to QRS duration. Quantitative assessment of dyssynchrony may be possible using this novel method, but further evaluation of the methodology is required.

Direct determination of the "organic extent" of tin species in environmental samples by X-ray absorption near-edge structure spectroscopy.

A direct method for the speciation of Sn compounds in solid environmental samples by X-ray absorption near-edge structure spectroscopy (XANES) has been developed. It was found that the method can provide the "organic extent", the average number of organic ligands bound to Sn, for environmental samples. For Sn XANES at the L(III), L(I), and K edges, systematic variations were found in the spectra for butyl-, phenyl-, and methyl-substituted Sn compounds depending on the organic extent. A quantitative relationship between the organic extent and the characteristics in the XANES spectra was determined based on the peak position, peak area ratio, and peak width. The detection limit was better than 10 microg/g Sn when using the K edge, which is sensitive enough for some environmental samples, e.g., sediments, biological samples, and antifouling paints, and the sensitivity will be better if a more intense X-ray source such as an undulator or Wiggler beamline is used. The present XANES method is totally nondestructive, having the advantage that no complicated pretreatment procedures are needed, whereas such procedures are essential in conventional chromatographic analyses, which may cause experimental error by alteration of Sn species and poor recovery during analyses. Although the XANES method only provides the average number of organic ligands, the direct speciation using XANES will be helpful for estimating roughly the ratio of organic and inorganic Sn species, which can be used to study organotin transformations in sediment cores and inspection of organotin compounds in antifouling paints. In particular, micro-XANES analysis based on the present method is a promising tool in obtaining the distribution of organotin species in biological samples and specific phases in sediments.

Surgical treatment of congenital coronary artery fistulas: 27 years' experience and a review of the literature.

BACKGROUND AND AIM OF THE STUDY: A congenital coronary artery fistula (CAF) is a relatively rare congenital anomaly and is defined as an abnormal direct communication between any coronary artery and any of the cardiac chambers. This article reviews our experience over the past 27 years, as well as other literature, and discusses the surgical indications and methods relating to CAF. METHODS: From 1973, 25 patients aged from 2 to 69 years underwent surgical treatment for congenital CAF. Seventeen patients were diagnosed as isolated CAF. All patients under 19 years of age with isolated CAF were asymptomatic. Twenty fistulas originated from the left coronary artery and 9 from the right. The pulmonary artery was the most dominant drainage site. Four patients among the isolated CAF cases were surgically treated without a cardiopulmonary bypass. RESULTS: All patients were discharged from hospital without any perioperative complications. Postoperative coronary angiography was done on all patients with only one slightly residual CAF flow. The average follow-up time was 9.6 years and all patients were asymptomatic and doing well. CONCLUSIONS: Definitive surgical correction is safe and effective, with good results. Therefore, it should be considered even in asymptomatic patients because of the risk of future complications.