[Growth rates of gastric cancer in the aged].

Yamashiro et al reported "growth patterns of gastric cancers in the aged" in 1991 using 219 autopsy cases and 33 followup cases of gastric cancer in the natural course without operations obtained for 16 years. They also showed a certain curve of cancer area and ordinal number of tumor size on the logarithmic scale of both axes obtained from 120 gastric cancer cases from autopsy. We considered the curve by Yamashiro as a model curve of cancer growth by regarding ordinal numbers of tumor size as course times of tumor growth. Then we re-examined the 33 follow-up cases and calculated the tumor growth rate in each case by means of comparing case data with the model curve described above. In the result, the follow-up cases were grossly divided into 5 groups of ratios of growth rate 2(0), 2(1), 2(2), 2(3) and 2(4). In some articles about the cancer growth-rate of digestive organs, their data-values of doubling-time are suggestive of an arrangement with groups and gaps in it, respectively. They seem supportive of our results above.

[Relevant factors concerning phenomena related to the process of initiating dialysis in elderly patients with chronic renal failure: predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon].

AIM: We previously investigated the relevant factors concerning each individual phenomenon related to the process of initiating dialysis in elderly patients with chronic renal failure. Background factors that were identified as relevant factors were significant in terms of enabling us to predict the outcome of each phenomenon in new patients. However, the significance of these factors in predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon was unclear. This was attributed to the fact that the subjects with phenomena decreased in number and because of changes in characteristics (hereafter, changes in subjects) with the progression of the process of initiating dialysis. In the present study, we aimed to identify relevant factors for predicting the outcomes of subsequent phenomena at the stage of the initial phenomenon. For this purpose, we assumed that "progression of the process of initiating dialysis does not result in significant reductions in the number of cases and causes only minor changes in characteristics". METHODS: We studied a total of 152 patients with advanced chronic renal failure aged >or=60 years. Background factors were investigated in all patients. The following phenomena were analyzed: acceptance of dialysis, urgency of initiating dialysis, alleviation of disease, and returning home. In order to identify new relevant factors, we focused on the order and condition of the process by which each background factor was narrowed down during logistic regression analysis for each phenomenon. We determined which background factor to focus on for each phenomenon based on changes in background factors. RESULTS: Age and cognitive function were related to the urgency of initiating dialysis and alleviation of disease. Age, walking ability, and cognitive function were related to returning home. Age was eliminated at the final stage of logistic regression analysis for alleviation of disease and at the penultimate stage of logistic regression analysis for returning home. CONCLUSION: We simulated the restoration of cases lost during the process of initiating dialysis in order to determine the relationship of age to alleviation of disease as well as returning home. Although age significantly affected alleviation of disease, its relationship to returning home was unclear. Age was thus identified as a new relevant factor for alleviation of disease. In addition, all relevant factors identified from investigation of each phenomenon enabled prediction of outcomes of subsequent phenomena at the stage of the initial phenomenon.

[Refusal of initiation of dialysis by elderly patients with chronic renal failure].

AIM: Refusal of dialysis is not uncommon in elderly patients with chronic renal failure. In this study, we retrospectively inspected our dealings with patients who refused our offer to initiate dialysis. In addition, we discussed how to grasp the meaning of this phenomenon. METHODS: We treated 152 patients with advanced chronic renal failure aged 60 years and over at Tokyo Metropolitan Geriatric Hospital. The patients fulfilling the following two criteria were considered to be refusal cases. The first criterion was that an acceptance of the initiation of dialysis could not be obtained in spite of repeated counseling. The second criterion was that a definite outcome was precipitated by the development of severe uremic symptoms. In every refusal case, clinical characteristics and household members were surveyed. Verbal expressions of the reasons for refusal were retrieved from medical charts. The outcome was also studied. RESULTS: The two criteria were fulfilled in 7 cases. The male/female ratio was 5:2. The age was 78 +/- 7 years (mean +/- standard deviation). All but one cases were ambulatory, and all cases had normal cognitive function. Four cases were married, and the other cases had lost their partners. The number of household members was 3.9 +/- 1.8. We speculated that every case could maintain a good quality of life even after the initiation of dialysis. Representative expressions of the reasons for refusal were "I have already lived fully" and "I would prefer to accept death rather than dialysis". The outcome was urgent initiation of dialysis (five cases) and death (two cases). The time between initial counseling and the outcome was 115 +/- 37 days. CONCLUSION: Accepting or refusing dialysis therapy is a selection related to life or death. We must make an effort to obtain consent to initiating dialysis if patients are assessed as suitable for dialysis.

[A pitfall in analyses of relevant factors concerning phenomena in the process of initiating dialysis: alterations in the characteristics of subjects diminish the significance of age].

In our previous studies, relevant factors concerning the main phenomena related to the process of initiating dialysis were examined in elderly patients with chronic renal failure. Examined phenomena were as follows: (1) the acceptance of dialysis; (2) the urgency of initiating dialysis; (3) short-term outcome; (4) returning home. Multivariate logistic regression analysis was used to determine relevant factors. Although we speculated that age should be a relevant factor for each phenomenon, the phenomenon on which age had some impact was only the first. We suspected the existence of a pitfall, through which the relation of age was lost in the second, the third, or the fourth phenomenon. The fact that every phenomenon had its own relevant factors was thought to be an important clue to the discovery of pitfalls. Relevant factors were derived from both the number of dropout-patients and their demographic and clinical status. From the viewpoint of nondropout-patients, the progression of the process of initiating dialysis might alter the characteristics of subjects for successive phenomena In this study, we set out to investigate whether alterations in the characteristics of subjects were pitfalls. Alterations were regarded as a fall of the mean age, an increment of the rate of the patients with ability to walk, and an increment of the rate of the patients with normal cognitive function. In addition, the old-old patients tended to have limited numbers of those who had the ability to walk and normal cognitive function. In other words, aging changes in ambulatory and cognitive function were not brought to subjects. These alterations may cause the loss of the relation of age to each phenomenon. Thus, we presumed these alterations to be pitfalls. We must clarify whether aging changes are brought to subjects beforehand in analyses that include the old-old patients as subjects.

Malformation of immature starfish oocytes by theonellapeptolide Ie, a Tridecapeptide lactone from a marine sponge Petrosia species, through disturbance of cortical F-actin distribution.

Theonellapeptolide Ie (Tp), an oligopeptide lactone isolated from a marine sponge, Petrosia sp., was shown to induce an unprecedented morphological change in the immature oocytes of the starfish Asterina pectinifera. The cortical F-actin was disturbed and assembled to form dots and rings, as evidenced by staining with rhodamine-conjugated phalloidin. The oocyte eventually became malformed. When Tp was added to an immature oocyte which had been pretreated with cytochalasin B or D, inhibitors of actin polymerization, no malformation was observed. When Tp was added to an oocyte which had been induced to mature by 1-methyladenine (1-MeAde), a maturation-inducing substance in starfishes, no morphological changes were observed in the maturing oocytes which reached the first meiotic prometaphase 40 min after the start of 1-MeAde treatment. This is the first description of a chemical that induces aberrant redistribution of F-actin-based cytoskeleton in an animal oocyte which is arrested at the first meiotic prophase.

[Analyses of factors concerning the short-term outcome of elderly patients beginning dialysis].

The aim of the present study is to clarify relevant factors concerning the short-term outcome of elderly patients beginning dialysis. One hundred nineteen patients aged 60 years and over who had newly started dialysis at our hospital were studied. The male/female ratio was 70:49. The age was 74 +/- 7 years (mean +/- standard deviation). In all patients, the timing of referral to a nephrologist (early/late), the urgency of the initiation of dialysis (non-urgent/urgent), the cause of renal failure (nondiabetes/diabetes), serum albumin concentration, comorbid conditions (cerebrovascular disease, ischemic heart disease, etc.), ambulation, cognitive function, and the outcome (relief/death) were surveyed. Twelve patients did not obtain relief and finally died. The influence of the timing of referral on the urgency of the initiation of dialysis was studied. Furthermore the influence of the urgency of the initiation of dialysis on the outcome was studied. The chi 2 test was used for statistical comparisons. The need for urgent dialysis was less among early referral cases as compared with late referral cases (p < 0.0001). The incidence of death was more frequent in urgent dialysis than in non-urgent dialysis (p = 0.016). Multivariate logistic regression analysis was performed using background factors as explanatory variables and the outcome as a dependent variable. Statistically significant factors were the urgency of the initiation (p = 0.040), serum albumin concentration (p = 0.022), and cerebrovascular disease (p = 0.002). The most common cause of death was severe infectious diseases (pneumonia, sepsis). It was speculated that background factors associated with the outcome could contribute to the onset and the progression of infectious diseases.

[Acceptance of dialysis therapy in elderly patients with chronic renal failure].

The aim of the present study is to clarify relevant factors concerning acceptance of dialysis therapy in elderly patients with chronic renal failure. Patients with advanced renal failure aged 60 years and over (152 cases) were investigated. The male/female ratio was 85:67. The age was 76 +/- 7 years (mean +/- standard deviation). The proportion of patients with acceptance of dialysis to patients with non-acceptance was 121:31. In all patients, the cause of renal failure (non-diabetes/diabetes), serum albumin level, comorbid conditions, ambulation, cognitive function, marital status, and presence of younger cohabitants were surveyed. The patients were divided into two groups for each category. Patients were categorized as the young-old (aged 60 to 74 years) and the old-old (aged 75 years and over). Serum albumin level was categorized as either low (less than 3.5 g/dl) or normal (3.5 g/dl and over). The number of patients who accepted dialysis therapy was evaluated for each group. Intergroup comparisons were carried out by the chi 2 test. Statistically significant factors were age (p < 0.0001), serum albumin level (p = 0.016), ambulation (p = 0.011), cognitive function (p < 0.0001), and marital status (p = 0.009). Multivariant logistic regression analysis was also performed using background factors as explanatory variables and acceptance or non-acceptance of dialysis therapy as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were age (p < 0.0001) and cognitive function (p < 0.0001). Serum albumin level, ambulation, and marital status were significant only in the chi 2 test. This could be explained by the close correlations of these factors with age and cognitive function. The old-old category and poor cognitive function were dominant factors with regard to non-acceptance of dialysis therapy.

[Differences in features between young-old and old-old patients beginning dialysis].

We investigated differences in features between young-old and old-old patients beginning dialysis. Patients aged over 60 years who had newly started dialysis (121 cases) were studied. These were 71 men and 50 women. The age was 74 +/- 7 years (mean +/- standard deviation). The patients were divided into the young-old group (aged 60 to 74 years) and the old-old group (aged over 75 years), 64 patients were young-old and 57 were old-old. In every patient, the cause of renal failure (non-diabetes/diabetes), body indexes, comorbid conditions, laboratory data of nutritional status, ambulation, cognitive function, and psychosocial status (acceptance of dialysis therapy, marital status, younger cohabitants, and engagement in work) were surveyed. Data were assessed in each group. Intergroup comparisons were made using Student's t-test, the chi 2 test, and the Mann-Whitney's U-test. Diabetes was frequent in the young-old group. The results concerning body indexes, comorbid conditions, and laboratory data reflected age-related phenomena or skew distribution of diabetic patients. Though differences were not statistically significant, both the percentage of patients with inability to walk and the percentage of patients with impaired cognitive function were lower in the old-old. These results could not be interpreted as age-related phenomena or skew distribution of diabetic patients. From the data of psychosocial indexes, it would speculate that the young-old had some advantage over the old-old for initiation of dialysis. We look for the explanation to psychosocial aspects of dialysis therapy.

Presence of a Tetrahymena growth promoting activity in fetal bovine serum.

Treatment of cultures of the ciliate Tetrahymena with fetal bovine serum (FBS) enhanced the rate of cell proliferation. The growth promoting activity was partially purified from FBS as a high Mr complex including four components with apparent Mr values of 180 kDa, 68 kDa, 60 kDa and 30 kDa by a 4-step procedure. The 180 kDa component was identified by amino acid sequencing as α2-macroglobulin. The addition of purified α2-macroglobulin from bovine plasma to cultures of Tetrahymena was also found to enhance the rate of cell proliferation. This report is the first dealing with the direct identification of a mammalian factor which promotes the growth of free-living protozoa.