Prognosis after neoadjuvant chemoradiation or chemotherapy for locally advanced gastro-oesophageal junctional adenocarcinoma.

BACKGROUND: Trials typically group cancers of the gastro-oesophageal junction (GOJ) with oesophageal or gastric cancer when studying neoadjuvant chemoradiation and perioperative chemotherapy, so the results may not be fully applicable to GOJ cancer. Because optimal neoadjuvant treatment for GOJ cancer remains controversial, outcomes with neoadjuvant chemoradiation versus chemotherapy for locally advanced GOJ adenocarcinoma were compared retrospectively. METHODS: Data were collected from all patients who underwent neoadjuvant treatment followed by surgery for adenocarcinoma located at the GOJ at a single high-volume institution between 2002 and 2017. Postoperative major complications and mortality were compared between groups using Fisher's exact test. Overall survival (OS) and disease-free survival (DFS) were assessed by log rank test and multivariable Cox regression analyses. Cumulative incidence functions were used to estimate recurrence, and groups were compared using Gray's test. RESULTS: Of 775 patients, 650 had neoadjuvant chemoradiation and 125 had chemotherapy. These groups were comparable in terms of clinical tumour and lymph node categories, although the chemoradiation group had greater proportions of white men, complete pathological response to chemotherapy, and smaller proportions of diffuse cancer, poor differentiation, and neurovascular invasion. Postoperative major complications (20.0 versus 17.6 per cent) and 30-day mortality (1.7 versus 1.6 per cent) were not significantly different between the chemoradiation and chemotherapy groups. After adjustment, type of therapy (chemoradiation versus chemotherapy) was not significantly associated with OS (hazard ratio (HR) 1.26, 95 per cent c.i. 0.96 to 1.67) or DFS (HR 1.27, 0.98 to 1.64). Type of recurrence (local, regional, or distant) did not differ after neoadjuvant chemoradiation versus chemotherapy. CONCLUSION: In patients undergoing surgical resection for locally advanced adenocarcinoma of the GOJ, OS and DFS did not differ significantly between patients who had neoadjuvant chemoradiation compared with chemotherapy.

Treating advanced cancer of the gastro-oesophageal junction (GOJ) poses a challenge given its location in the distal oesophagus and proximal stomach, and whether it should be treated as oesophageal or gastric cancer. Given the indistinct location, it is unclear whether GOJ cancer should be treated with neoadjuvant chemoradiation, which is the treatment of choice for advanced oesophageal cancers, or perioperative chemotherapy, which is the treatment of choice for advanced gastric cancers. Few studies have addressed treatment options specifically for GOJ cancers. This study investigated whether there was a difference in survival between patients with GOJ cancer who were treated with chemoradiation versus chemotherapy.

Clinical benefits and tolerability of increased fill volumes in Japanese peritoneal dialysis patients.

BACKGROUND: Increasing fill volume is an effective means of improving clearances in patients on peritoneal dialysis (PD). Since Japanese PD patients are physically smaller than their Western counterparts, there is some concern that PD patients in Japan may be unable to tolerate larger fill volumes. OBJECTIVE: To determine patient tolerance and changes in solute clearance and net ultrafiltration resulting from increased fill volumes in Japanese patients on PD. DESIGN: Prospective double-blind study, randomizing patients to three different fill volumes (2.5% dextrose solution: 1.5 L, 2.0 L, or 2.5 L) administered in random order on three different occasions separated by 1 week. RESULTS: Twenty-one patients with a mean age of 55.4 +/- 2.1 years and a mean body surface area of 1.66 +/- 0.03 m2 were studied. On a scale of 0 to 10, patients' mean discomfort scores were 2.14 +/- 0.59, 3.48 +/- 0.54, and 3.81 +/- 0.63 (p = 0.047) at the end of the 1.5-L, 2.0-L, and 2.5-L dwells, respectively. There were no reports of cramps or shortness of breath with any fill volume. Patients were able to correctly guess the actual fill volume for only 34 of the 63 total exchanges (54.0%). Increasing fill volume resulted in an incremental improvement in peritoneal creatinine clearance, from 3.74 +/- 0.16 to 4.49 +/- 0.21 (p < 0.001, 2.0 L vs 1.5 L) to 5.12 +/- 0.20 mL/minute (p< 0.001, 2.5 L vs 2.0 L) for 1.5-L, 2.0-L, and 2.5-L dwells, respectively. Peritoneal urea clearance also increased significantly, from 5.65 +/- 0.13 to 7.04 +/- 0.17 (p < 0.001, 2.0 L vs 1.5 L) and 8.16 +/- 0.29 mL/minute (p < 0.001, 2.5 L vs 2.0 L), with incremental increases in fill volume. Similarly, net ultrafiltration in a 4-hour dwell increased significantly with fill volume, from 255.24 +/- 24 mL with 1.5 L, to 356 +/- 24 (p < 0.004, 2.0 L vs 1.5 L) and 392 +/- 29 mL (p < 0.086, 2.5 L vs 2.0 L) in patients receiving 2.0 L and 2.5 L, respectively. CONCLUSION: Increasing the fill volume results in improvement in solute clearance and net ultrafiltration in Japanese PD patients, with minimal increase in patient discomfort. A large percentage of patients were unable to identify the actual fill volume.

Abnormal lateral notch in knees with anterior cruciate ligament injury.

We reviewed plain radiograms of anterior cruciate ligament injuries to determine the frequency of an abnormal lateral notch found in the lateral femoral condyle, and we investigated a possible mechanism for its occurrence by determining the relationship with associated injuries. We analyzed data for 216 patients who underwent ACL reconstruction between 1993 and 1996, whose radiographic images of the contralateral knee were available. The numbers of male and female patients were 122 and 94, respectively, and their ages ranged from 14 to 47 years (average, 25 years). The abnormal notch visualized by lateral radiograph was found in 66 of 216 knees (30. 6%) and was classified into three types. The type of abnormal notch seen most frequently (73%) was located at the same site as the notch on the contralateral side, but appeared deeper than normal. Knees with abnormal notches showed lateral meniscal injuries more frequently than those without such notches (P<0.005). The abnormal notch was assumed to have formed at the time of injuries, after impingement of the lateral femoral condyle on the lateral tibial condyle. Cartilage damage at the abnormal notch should be carefully observed in the future.

[Relationship between renal function and morphometric assessment in chronic glomerulonephritis].

In an attempt to reveal a correlation between the degree of glomerular hypertrophy, interstitial damage, and hemodynamic parameters in chronic nephritis, the glomerular area (GA) and proportion of interstitial area (IA%) were determined quantitatively with an image analyzer, and the effective renal plasma flow (ERPF) and filtration fraction (FF) were determined simultaneously. The subjects were 12 patients with focal glomerulosclerosis (FGS) and 12 patients with IgA nephropathy (IgAN), all of whom had a similar glomerular filtration rate (GFR). The GFR was 58.6 +/- 11.4 ml/min/1.48 m2 in the FGS group and 53.9 +/- 13.1 ml/min/1.48 m2 in the IgAN group, and the difference between the two groups was not significant. On the other hand, ERPF was significantly lower and FF was significantly higher in the FGS group than in the IgAN group. GA was significantly higher in the FGS group than in the control group (10 kidney donors), and GA in the IgAN group was equivalent to that in the control group. IA% was almost equal in the FGS and IgAN groups, and significantly higher in both groups than in the control group. Although GA was not correlated with GFR in the two groups, it tended to be positively correlated with FF in the FGS group, and the correlation between GA and FF reached statistical significance when the IgAN group was combined with the FGS group. The above findings suggest that the pattern of progression of the glomeruli and interstitial lesions and of the intrarenal hemodynamics involved in them may differ in the FGS and IgAN groups. However, since ERPF significantly decreased in the FGS group, even though IA% was the same in both groups, the possibility that ERPF was functionally decreased in the FGS group cannot be ruled out.

Sequence analysis of cDNA and genomic DNA, and mRNA expression of the medaka fish homolog of mammalian guanylyl cyclase C.

We isolated the cDNA and genomic DNA encoding a membrane guanylyl cyclase of medaka fish (designated as OlGC6), and determined their complete nucleotide sequences. The open reading frame for OlGC6 cDNA predicted a protein of 1,075 amino acids. Phylogenetic analysis indicated that OlGC6 is a member of the enterotoxin/guanylin receptor family. We also determined the partial genomic structure of the gene of another membrane guanylyl cyclase of medaka fish, OlGC2, which is a member of the natriuretic peptide receptor family. The intron positions relative to the protein-coding sequence are highly conserved in the intracellular domains of OlGC6, OlGC2, mammalian GC-A, and GC-E. Despite their divergent primary structures, some intron positions also seem to be conserved in the extracellular domains of different membrane guanylyl cyclase genes. Northern blot analysis demonstrated that an OlGC6 transcript of 3.9 kb is only present in the intestine, while reverse transcription (RT)-PCR analysis demonstrated that the OlGC6 transcript is present in the kidney, spleen, liver, pancreas, gallbladder, ovary, testis, brain, and eye. RT-PCR also demonstrated that OlGC6 is only expressed zygotically and that transcripts are present from 1 day after fertilization, i.e. long before the intestinal tissues begin to develop.

Removal of salt and organic acids from solution used to season salted Japanese apricots (ume) by electrodialysis, precipitation and adsorption.

With the aim of repeatedly reusing the solution used to season salted ume (Japanese apricot), we investigated its desalting and deacidification by electrodialysis, precipitation, and adsorption. Although NaCl and acids could be easily removed from used seasoning solution by electrodialysis, useful substances such as amino acids were removed at the same time. Precipitation using Ca(OH)2 could remove only organic acids, but the treated solution became bitter. Two weakly basic commercial resins, DIAION WA30 and Chitopearl CCS, adsorbed organic acids selectively. Chitopearl CCS in particular selectively adsorbed citric acid in the used seasoning solution without also adsorbing useful substances. The equilibrium data of a citric acid, which was a main organic acid, were correlated by the Langmuir equation. The saturation capacity decreased with increasing concentrations of NaCl in the solution but the equilibrium constant did not change. By combining electrodialysis and adsorption, NaCl and organic acids could be removed while amino acids largely remained. The resultant solution was considered to be suitable for repeated reuse.

Antibody to hepatitis B e positive hepatitis induced by withdrawal of steroid therapy for polymyositis: response to interferon-alpha and cyclosporin A.

A 57-year-old woman was admitted with symmetrical proximal muscle weakness, liver dysfunction, abnormal muscle enzymes, and she was an antibody to hepatitis B e (anti-HBe) positive hepatitis B virus (HBV) carrier. Biopsy of her left quadriceps femoris showed myositis, so prednisolone was started at 40 mg/day. However, her hepatic function deteriorated and liver biopsy after 4 months showed acute hepatitis with partial submassive necrosis. Treatment with interferon-alpha and cyclosporin A progressively reduced the transaminase and HBV-DNA levels. Early treatment with interferon-alpha plus cyclosporin A can control exacerbation of hepatitis B.

[The clinical efficacy of imipenem/cilastatin sodium in orthopedic infections and drug levels in the bone tissue].

We evaluated the clinical efficacy of imipenem/cilastatin sodium (IPM/CS--a carbapenem antibiotic) against orthopedic infections, and the drug levels of the bone tissues were determined. The clinical efficacies for 6 patients in the infection group were good in 3 cases, and fair in the other 3; giving an efficacy rate of 50%. Bacteriologically, 8 strains were isolated from patients with the infection and an eradication rate of 87.5% was obtained upon the treatment. In 39 patients that were given the drug prophylactically, no postoperative infections occurred. Mean IPM levels in the bone and the bone marrow at 1 hour after administration in 5 patients of the prophylactic group were 17.3 micrograms/ml and 5.9 micrograms/g, respectively. The ratio of concentrations the bone to those in the bone marrow was 34.6%. The results of this study suggest that IMP/CS reaches to the bone tissue providing sufficient concentrations and that the drug is efficacious for the prophylaxis and the treatment of orthopedic infections.

[Nephropathy associated with electrolyte disorders].

It is well known that renal dysfunction is associated with several types of electrolyte disorders. On the other hand, renal manifestations have been attributed to electrolyte disorders. Hypokalemia is the most frequent electrolyte abnormality encountered in clinical practice. The main cause of hypokalemia is due to abuse of laxatives and diuretics or to anorexia nervosa. Hypercalcemia is another major electrolyte abnormality, associated with numerous renal manifestations. Renal tubules damages and chronic interstitial nephritis are characteristic pathological findings in prolonged electrolyte disorders. The mechanism of renal involvement and characteristic clinical manifestations of the electrolyte disorders are reviewed.

Phylogenetic Relationships between Solitary and Colonial Ascidians, as Inferred from the Sequence of the Central Region of their Respective 18S rDNAs.

Ascidians (tunicates) are primitive chordates. In spite of their elevated phylogenetic position in the animal kingdom, ascidians have evolved a varied reproductive repertoire; some of them live as individuals (solitary ascidians), while others form colonies (colonial ascidians). Colonial ascidians propagate asexually by budding and strobilation, and they have an extensive capacity for regeneration. However, the orthodox taxonomic classification of ascidians categorizes them into two major groups (the orders Enterogona and Pleurogona), irrespective of their solitary or colonial life style. To examine whether the orthodox classification of ascidians is substantiated by molecular phylogeny, the complete nucleotide sequence of a region of about 1000 base pairs in the central part of their respective 18S rDNAs was determined, and the sequences were compared among five solitary and three colonial ascidians. The phylogenetic tree deduced from these results suggests that the three species of Enterogona and the five species of Pleurogona examined form discrete and separate groups irrespective of their potential to form colonies. Therefore, a solitary or colonial life style is likely to have developed independently after the divergence of the two major groups of ascidians.

Localization of two calcium binding proteins, calbindin (28 kD) and parvalbumin (12 kD), in the vertebrate retina.

We used immunocytochemistry to locate two calcium binding proteins, calbindin (CaB) and parvalbumin (PV), in the retina of goldfish, frog, chick, rat, guinea pig, dog, and man. The location of CaB depended on the type of dominant photoreceptor cells in birds and mammals. In cone-dominant retinas such as those of the chick, CaB-like immunoreactivity was found in the cones, cone bipolars, and ganglion cells. Amacrine cells 5-12 microns across were also labeled. In rod-dominant retinas, such as those of the rat, guinea pig, and dog, horizontal cells, small amacrine cells (about 6 microns across), and cells in the ganglion cell layer were labeled. In the human retina, which has both cones and rods in abundance, cones, cone bipolars, ganglion cells, horizontal cells, and small and large amacrine cells were labeled. In the frog and goldfish, the level of CaB-like immunoreactivity was low. In the frog, a few cones, amacrine cells, and cells in the ganglion cell layer were labeled. No immunoreactive structures were seen in the goldfish retina. PV-like immunoreactivity was found in chicks, rats, and dogs. No such immunoreactive structures were seen in the other species. In the chick, only amacrine cells were labeled. In the rat, amacrine cells and several displaced amacrine cells were labeled. In the dog, in addition to amacrine cells and displaced amacrine cells, horizontal cells were strongly labeled. Thus, PV-like immunoreactivity was found in those elements relating to the modulation of the main pathway of the visual transmission system.

[Spotted fever group rickettsiosis on Awaji Island, Japan].

Three cases of spotted fever group rickettsiosis occurring on Awaji Island, Hyogo Prefecture, the first reported in the Kinki District, are described. The illness appeared from August to September in 1988. High-grade fever and papular erythema were observed in all cases. Eschar, lymphadenopathy and hepatomegaly were observed in two-thirds of the cases, respectively. The antibody titers for Proteus OX-2 by the Weil-Felix reaction were elevated, and immunofluorescence test with R. rickettsii of the spotted fever group demonstrated a significant rise in specific antibody titer. Tetracycline was effective in all cases. Every patient was thought to have been infected with rickettsiae in the Yuzuruha mountain range in the southern part of Awaji Island. On the other hand, tsutsugamushi disease occurs in autumn and winter in the northern part of Awaji Island. It would be of considerable interest from an epidemiological viewpoint to study the vector of these spotted fever group rickettsiae.

A calcium-dependent galactose-binding lectin from the tunicate Polyandrocarpa misakiensis. Isolation, characterization, and amino acid sequence.

A lectin was isolated from the homogenate of the tunicate Polyandrocarpa misakiensis by heat treatment, ammonium sulfate fractionation, gel filtration, and high-performance ion-exchange chromatography. Analytical gel filtration on Superose 12 and sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that the lectin is a monomeric protein with a molecular mass of approximately 15 kDa. The lectin bound to an immobilized D-galactose column in the presence of calcium ion with a threshold of 500 microM and eluted completely with 5 mM EDTA. It did not bind to an immobilized D-mannose or N-acetyl-D-galactosamine column. Thus, Polyandrocarpa lectin was found to be a calcium-dependent galactose-binding lectin. The complete amino acid sequence of Polyandrocarpa lectin was determined by automated or manual Edman sequencing of the peptides derived by digestion with trypsin, endoproteinase Asp-N, Staphylococcus aureus V8 protease, and pepsin. It is composed of 125 residues, contains no carbohydrate group, and has a calculated molecular mass of 14,034 Da. The lectin contains four half-cystines, and Cys-21 and Cys-119 and also Cys-96 and Cys-111 form intrachain disulfide bridges, respectively. The amino acid sequence of Polyandrocarpa lectin shows about 20-30% homology with those of fly, barnacle, sea urchin, and several vertebrate lectins that belong to C-type lectin (Drickamer, K. (1988) J. Biol. Chem. 263, 9557-9560). Although the physiological role of Polyandrocarpa lectin is not clear, preliminary experiments suggest that the lectin may be related to defense mechanisms because it has a strong antibacterial activity.

Co-localization of adrenergic receptors and vitamin-D-dependent calcium-binding protein (calbindin) in the dopaminergic amacrine cells of the rat retina.

Using antisera against tyrosine hydroxylase (TH) and purified beta 2-adrenergic receptors (beta 2-AdR), we found that TH- and AdR-like immunoreactivities coexisted in large amacrine cells. These findings indicated an association between dopamine-containing amacrine cells and adrenergic amacrine cells. The present study also showed that amacrine cells with TH-like immunoreactivity have vitamin-D-dependent calcium-binding protein (calbindin, 27,000 kDa)-like immunoreactivity as well, suggesting that calbindin plays an important postsynaptic role in dopaminergic amacrine cells.

Intrahepatic migration of a peritoneal shunt catheter: case report.

The intrahepatic migration of a peritoneal shunt tube of a ventriculoperitoneal shunt system (low pressure Pudenz valve and low pressure Pudenz peritoneal catheter) is reported. This is a rare complication of ventriculoperitoneal shunting and was diagnosed by metrizamide shuntography and abdominal computed tomography. To our knowledge, this is the second case complicated with migration of a peritoneal shunt tube into the liver.

Ascidian one-half embryos can develop into functional adult ascidians.

Although adult ascidians have remarkable regenerative potency, the ascidian egg is considered a typical "mosaic" egg. A single blastomere isolated at the two-cell stage develops into a half tadpole with minor or major defects, and this rigidity of ascidian development is known to depend on the localization of cytoplasmic determinants. Between the egg and adult, the ascidian larva has a dual nature consisting of differentiated cells for larval activities and undifferentiated cells that later become differentiated and function in the adult. Although ascidian larvae derived from a hemiembryo are deficient, no one has yet investigated the possibility that the adult might have regulative powers not present in the embryo and might be able to form an entire adult ascidian. Using Styela plicata, we have approached this problem. We report here for the first time that ascidian half embryos can form tadpoles that have the potency to hatch, metamorphose, and develop into functional ascidians.