An application of the Science Impact Framework to the Cancer Prevention and Control Research Network from 2014-2018.

The Cancer Prevention and Control Research Network (CPCRN) is a strategic collaborative effort focused on accelerating the dissemination and implementation of evidence-based cancer prevention and control interventions to communities. In 2014, the CPCRN Coordinating Center began collecting information in alignment with the Centers for Disease Control and Prevention's (CDC) Science Impact Framework. The Science Impact Framework is a CDC-developed approach to trace and link CDC science to events and/or actions recognized as influential to public health, beyond peer-reviewed publications. The purpose of this paper is to highlight the impact of CPCRN activities using key indicators guided by the CDC's Science Impact Framework. We reviewed annual progress reports submitted by CPCRN centers from 2014 to 2019 to identify the impact indicators. The CPCRN activities were linked to four domains from the Science Impact Framework and its key indicators: Disseminating Science (presentations, training, general communication, and other communication reports), Creating Awareness (requests for expertise, and feedback), Catalyzing Action (grant applications, partnerships and collaborations, research & development, advocacy groups, office practice/point of care changes, and technology creating), and Effecting Change (building public health practice, creation of registries/surveillance, legal/policy changes, and change instilled). Overall, CPCRN activities demonstrate impact beyond peer-reviewed publications and thus should continue building scientific impact to ultimately influence health outcomes.

Magnetic resonance diffusion-weighted imaging in the characterization of pancreatic mucinous cystic lesions.

AIM: The aim of the study was to evaluate the utility of diffusion-weighted imaging (DWI), including apparent diffusion coefficient (ADC) measurement, in order to differentiate mucinous cystic neoplasms (MCNs) from intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. MATERIALS AND METHODS: Fifty cases of IPMN with a total of 62 lesions, and eight cases of MCN, were retrospectively selected for the study. The cases of IPMN were selected using multimodality clinical or histopathological criteria, while all MCN lesions were histopathologically proven. DWI was carried out using b values of 500 and 1000s/mm(2). Visual assessment was performed by two radiologists who used two categories (low-iso or high signal intensity). ADC values of the lesions were also calculated. Fisher's exact test and the Mann-Whitney U test were used for statistical analysis. RESULTS: All IPMN lesions demonstrated low-iso signal intensities compared with the pancreatic parenchyma on DWI. Two of the MCN lesions demonstrated low-iso signal intensities, and six lesions demonstrated high signal intensities. The ADC values for IPMNs (mean 2.9 ± 0.024 × 10(-3)mm(2)/s) were significantly higher than those for MCNs (mean 2.1 ± 0.30 × 10(-3)mm(2)/s). ROC analysis showed an optimal cut-off value of 2.4 × 10(-3)mm(2)/s for differentiating between the two types of lesions, providing a sensitivity of 98% and a specificity of 88%. CONCLUSION: The results of the present study suggest that ADC values in mucinous cystic lesions of the pancreas can be advantageous for their characterization into IPMN and MCN.

Effect of duration of contrast material injection on peak enhancement times and values of the aorta, main portal vein, and liver at dynamic MDCT with the dose of contrast medium tailored to patient weight.

AIM: To investigate the effects of contrast material injection duration on peak enhancement times and attenuation values of the aorta, main portal vein, and liver at MDCT when the dose of contrast material is adjusted to patient weight. MATERIAL AND METHODS: Seventy-five patients were randomly assigned to one of five groups, with durations of injection of 25, 30, 35, 40, or 45 s. All patients were injected with 2 ml/kg iodine (300 mg/ml). Attenuation values and peak enhancement times for the aorta, main portal vein, and liver were determined. The relationship between patient weight and enhancement times and values, the differences regarding peak enhancement times, and the relationship between injection duration and enhancement values were investigated using Pearson correlation, analysis of variance (ANOVA), and Spearman rank correlation, respectively. RESULTS: No significant correlations were seen between patient weight and peak enhancement times or values. Mean peak enhancement times for the aorta, main portal vein, and liver were 9-11 s, 18-22 s, and 30-34 s, respectively (p>0.05). The correlations between injection duration and peak enhancement values were significant and negative. CONCLUSIONS: Regardless of patient weight and injection duration, peak enhancement times of aorta, main portal vein and liver were approximately 10, 20, and 30 s, respectively. The enhancement values tended to be higher for shorter injection durations.

Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas.

PURPOSE: To define the duct-penetrating sign at magnetic resonance (MR) cholangiopancreatography (MRCP) and to assess the usefulness of this sign for distinguishing an inflammatory pancreatic mass (IPM) from a conventional pancreatic carcinoma (CPC) compared with arterial phase computed tomography (hereafter, CT) and arterial phase MR imaging (hereafter, MR imaging). MATERIALS AND METHODS: MRCP, CT, and MR images were compared by means of receiver operating characteristic (ROC) analysis for 11 IPMs and 43 CPCs. With the MRCP images, a morphologic classification of the main pancreatic duct (MPD) was attempted for all lesions. On the basis of this classification and the enhancement patterns of a lesion, all readers graded the presence of IPM or CPC on a five-point scale for all images. RESULTS: On the MRCP images, the morphologic characteristics of the MPD were nonobstruction for IPM (28 of 33, 85%) and obstruction or irregular stenosis for CPC (124 of 129, 96%). At ROC analysis among all the techniques, MRCP images had the highest value (0.98) for significant areas under the ROC curve (CT, 0.84; MR, 0.76) (P <.001). For the duct-penetrating sign in the broad sense (nonobstructed MPD) and the sign in the narrow sense (only normal MPD), the sensitivity, specificity, and accuracy for diagnosis of IPM were 85%, 96%, and 94%, respectively, and 36%, 100%, and 87%, respectively. CONCLUSION: The duct-penetrating sign on MRCP images was more helpful to distinguish IPM from CPC than were the enhancement patterns on CT and MR images.

Local immune response in infertile patients with minimal endometriosis.

OBJECTIVE: To evaluate the role of local immunity in women with minimal endometriosis. METHODS: Uterine endometrium and endometrial implants were obtained simultaneously from 30 infertile women with minimal endometriosis and examined immunohistochemically using antibodies of T cell, B cell, macrophage, Langerhans cell, immunoglobulin (Ig)G, and complement (C) 3d. Serum IgG, IgA, IgM, C3, C4, antinuclear antibody and anti-DNA antibody were also examined in 24 of the women. Data from uterine endometrium and serum were compared with 10 fertile women without endometriosis as a control. RESULTS: Microscopic examination revealed that the endometrial implants were divided into two groups: group 1 (n = 13) showed lymphocytic infiltration in the endometrial implants and group 2 (n = 17) showed no or slight lymphocytic infiltration. The endometrial implants of group 1 showed significantly more dense T-cell infiltration than those of group 2. Other types of infiltrating cells and deposits of IgG and C3d revealed no significant differences between groups 1 and 2. The immunohistochemical examination of the uterine endometrium and the serum data revealed no significant differences among all three groups. Cumulative pregnancy rates showed no significant difference between groups 1 and 2. CONCLUSION: The difference of local immune response in endometrial implants did not affect systemic immunity.

A case of obstructive icterus caused by incarceration of a pancreatic stone in the common channel of the pancreatobiliary ducts.

A 51-year-old man had repeated admissions and discharges from the hospital for alcohol dependence and alcoholic hepatitis. Thereafter, with a diagnosis of chronic pancreatitis, he was examined on an outpatient basis. He presented with right hypochondriac pain as the chief complaint, and was admitted to the hospital because of a suspected acute exacerbation of chronic pancreatitis. Pyrexia and jaundice were present from about the 5th hospital day, and he was admitted to Kurume University Hospital with a diagnosis of obstructive icterus. Percutaneous transhepatic biliary tract drainage (PTBD) was immediately performed. A roentgenogram revealed moderate dilatation of the extrahepatic bile ducts and stricture of the intrapancreatic common bile duct. No calculi were observed in the gallbladder or bile ducts by ultrasonography of the abdominal region. The main pancreatic duct was dilated to 10 mm, and a strong echo, probably a calculus, was observed in the main pancreatic duct. Pancreatoduodenectomy was performed with a diagnosis of stricture of the common bile duct due to chronic pancreatitis with a pancreatic stone. Examination of the excised specimens revealed a rigid pancreatic head; and when the common bile duct was incised, no stricture was observed. A milk-white calculus about 10 mm in diameter was observed in the common channel of the lower portion of the common bile duct. The orifice of the pancreatic duct was also observed at the same site. The common channel was about 20 mm long, and malfusion of the pancreatobiliary ducts was observed. The obstructive icterus was due to an impaction of the pancreatic stone at the confluence of the pancreatobiliary ducts. The calculus was composed of calcium carbonate, and the histopathological findings in the pancreas showed chronic pancreatitis.

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures.

Pancreatojejunal sutural insufficiency occurring after pancreatoduodenectomy and countermeasures are discussed. In the Department of Surgery at Kurume University School of Medicine, 318 patients underwent pancreatoduodenectomies. The present study includes 15 of these patients, all of whom had pancreatojejunal sutural insufficiency. The frequency of sutural insufficiency was 4.7%. Five patients had bile duct cancer, 5 had cancer of the papilla of Vater, 2 had a carcinoma of the pancreatic head, 1 each had gallbladder cancer, chronic pancreatitis, and papillitis. Six (40%) of the 15 patients died during hospitalization. The presence or absence of sutural insufficiency was confirmed mainly by radiography and determining the properties and amylase levels of the drainage fluid. There was no significant difference due to the method of anastomosis. End-to-side anastomosis had a rate of 5 (5.9%) of 85 patients, while end-to-end had 10 (4.3%) of 233 patients. The sutural insufficiency was manifested as a major leakage in 6 patients and a minor leakage in 9. The degree of lymph node dissection was D0 in 6.1%, D1 in 1.4%, D2 in 4.8% and D3 in 10.8%, with a high incidence of sutural insufficiency in D3 patients. The pancreatic duct diameter was smaller than 4 mm in 10, 5-7 mm in 4 and over 8 mm in 1 patient. The intraoperative pancreatic findings were a soft pancreas in 8, slightly hard in 3, and hard in 4 patients. Fibrosis of the pancreas was normal to slight in 11 and moderate in 4 patients. Drainage by relaparotomy was performed in 4 of the 6 patients with major leakages to control sutural insufficiency, and the other 2 underwent continuous aspiration with an intraperitoneal drain inserted during the operation. The 9 patients with minor leakage underwent conservative treatment including continuous aspiration via an intraperitoneal drain inserted during surgery, fasting, intravenous hyperalimentation, and antibiotic administration. All of the patients with major leakage died from an associated occurrence of hepatic insufficiency, renal insufficiency, intraperitoneal hemorrhage or diffuse peritonitis during hospitalization. However, 8 of the 9 patients with minor leakage had some healing, and the 1 remaining patient developed a pancreatic fistula. The frequency of pancreatojejunal sutural insufficiency was high in patients with minimal pancreatic fibrosis, with soft pancreatic tissue without dilatation of the pancreatic duct, and with relatively good pancreatic function.

Leiomyoblastoma causing acute gastric outlet obstruction in an infant.

A 1-year-old boy had acute gastric outlet obstruction, the cause of which was a prepyloric submucosal mass. The mass and the ulcerated overlying mucosa were excised. The histological diagnosis was leiomyoblastoma with parenchymatous hemorrhage. Apparently, he is the youngest patient reported to have this disease.

[The study of continuous arterial infusion chemotherapy with 5-FU and CDDP in patients with hepatocellular carcinoma].

Between Feb. 1992 and March in 1994, 14 patients with hepatocellular carcinoma (7: recurrence, 7: unresectable) received continuous arterial infusion of 5-FU and CDDP via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days, as one course, and 4 courses were basally administered. The duration of the administration was 24 or 6 hours/day. Side effects consisted of nausea or loss of appetite for 7 (50%), suppression of bone marrow for 3 (21%), and they disappeared after the agents were discontinued. However, there were 3 patients with gastro-duodenal ulcer, so careful follow-up was necessary. The efficacy rate was 64% and two-year survival rate was 57% and thus this treatment seemed to be effective. Further study on the duration and dose of the administration is necessary to improve the therapeutic effect and QOL.

[A case report of progressive symmetric erythrokeratodermia and a review of progressive erythrokeratodermia in Japan].

The patient is a 5-year-old boy. There was no family history of the similar skin eruptions. The erythema with scales appeared on his head, face and neck at 1 month of birth. The erythematous hyperkeratotic plaques spread symmetrically. There was no follicular components. The eruption was chronic and persistent. In histopathology, hyperkeratosis with focal parakeratosis, acanthosis and intact granular layer were observed. In electron microscopy, a large number of mitochondria that frequently appeared to be swollen and lipidlike vacuoles in corneocytes were observed. On account of the features, we diagnosed this case as progressive symmetric erythrokeratodermia (PSE). PSE is a rare disease, and besides, it is difficult to define PSE because of contradictions in existing literatures, the variability of clinical expression and the lack of histologic, hereditary, and biochemical criteria. Nearly 70 cases were diagnosed as PSE and its variants in Japan i.e. 4 cases with PSE, 8 cases with progressive erythrokeratodermia, and 58 cases with Asahi-Ijiri disease and its variants. However, only 2 cases diagnosed as PSE and 4 cases nominated as others satisfied the recently established criteria by Ruiz-Maldonado, et al. In this paper, reported cases of PSE and its variants were reviewed and reassessed.

Clinical features of long contraction wave recorded by an external tocodynamometer.

Clinical features of a long contraction wave, lasting 3 minutes or more, recorded on an external tocodynamometer were studied. The long wave was observed in 50 out of 1,050 pregnant women. Clinical significance was not indicated by the shape of each wave which was either a long relaxing type or a fused type, but by the frequency of occurrence. Vaginal delivery and its close relation to oxytocin administration were significantly more frequent in the sporadic type, in which the long wave was observed once within a week, and fetal distress and a low Apgar score were more frequently observed in the frequent type, in which long waves occurred twice or more within a week. The results suggest that the obstetric prognosis is normal unless the long wave occurs sporadically and its recovery is good, and that it is ominous when long waves are observed twice or more within a week. Careful observation is needed in that case.

Immunohistochemical expression of epidermal growth factor receptors in human adrenocortical carcinoma.

Epidermal growth factor (EGF) receptors were examined immunohistochemically in 64 adrenocortical carcinomas obtained at autopsy, and in 23 adrenocortical adenomas and seven pheochromocytomas obtained during surgery. In the nonneoplastic adrenal gland, EGF receptors were scattered to the zona glomerulosa, zona fasciculata, and zona reticularis. Adrenocortical carcinomas (63 of 64), more than adrenocortical adenomas (10 of 23) or pheochromocytomas (four of seven), stained positively for EGF receptors (P less than .01). The immunoreactivity was limited to the cytoplasm, cell membrane, and chromatin. When the antibody was immunoabsorbed with an excess of immunogen peptide, there was no evidence of immunostaining. The adrenocortical carcinomas could be classified into 16 cases of the well-differentiated type, 33 cases of the moderately differentiated type, and 15 cases of the poorly differentiated type. There was no relationship between histologic grading and staining intensity of the EGF receptors. On the other hand, more than 80% of the cases of adrenocortical carcinomas revealed a moderate to high intensity for EGF receptors. In 62 of the 64 patients, there was already metastases to other organs. We conclude that the expression of EGF receptors is associated with tumor growth and/or metastatic potential in adrenocortical carcinoma.