The prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with distal bile duct cancer.

BACKGROUND: A growing body of evidence suggests that inflammatory response markers such as the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are associated with outcomes of various malignancies. However, no study has reported the prognostic value of NLR and LMR in patients with distal bile duct cancer (DBDC) to date. We investigated the prognostic significance of these inflammatory markers in patients with DBDC who underwent radical resection. METHODS: The study included 40 patients diagnosed with DBDC who underwent pancreaticoduodenectomy at Narita Red Cross Hospital between January 2000 and December 2017. The cutoff values for these markers were determined by receiver operating characteristic curve analysis. Survival curves are estimated for each group in the study considered separately using the Kaplan-Meier method. The association between overall survival (OS) and the NLR, LMR, and other prognostic factors was investigated using log-rank test and multivariate Cox proportional hazards regression analysis. RESULTS: Corresponding to the point with the maximum combined sensitivity and specificity on the ROC curve, the best cutoff value for NLR and LMR was determined to be 3.14 and 4.55, respectively. Most clinicopathological factors were not associated with the NLR and LMR based on these cutoff values. However, serum albumin levels were associated with both the NLR and LMR (P = 0.011 and P = 0.023, respectively), and serum carbohydrate antigen 19-9 (CA 19-9) levels were also associated with the LMR (P = 0.030). Univariate analysis showed that a high NLR (P < 0.001), low LMR (P = 0.002), hypoalbuminemia (P = 0.004), high serum CA 19-9 levels (P = 0.008), and lymph node metastasis (P = 0.033) were significantly associated with poor survival rates. Multivariate analysis showed that a high NLR (hazard ratio 5.799, 95% confidence interval 1.188-28.32, P = 0.030) and a low LMR (hazard ratio 4.837, 95% confidence interval 1.826-2.331, P = 0.025) were independent prognostic factors for OS. CONCLUSION: Both NLR and LMR may serve as significant independent preoperative prognostic indicators of disease in patients with DBDC who undergo radical resection.

Liver, Muscle, and Insulin Resistance in Obese Subjects: Exercise Effects / 体力科学

Both westernization of diet and lifestyle habits and chronic inactivity have accelerated the obese population in Japan. Obesity is defined as being a condition in which the excessive energy is stored in the body as fat. Irrespective of organs and tissues, excessive fat accumulation impairs their structure and function, that is, ectopic adiposis. These days, the rapid increase in the number of adult people with abnormal liver function associated with obesity is largely attributed to an increase in the incidence of non-alcoholic fatty liver disease (NAFLD), a chronic liver disease accompanying fat accumulation. In Japan, about 30% of obese people suffer from NAFLD. About 10% of NAFLD progresses to non-alcoholic steatohepatitis (NASH). NASH is a progressive disease leading to liver cirrhosis. Any treatment with consensus other than diet restriction and exercise training is ineffective for the prevention of onset and progression of NAFLD. The important thing is a practice of suitable amounts of exercise, since it maintains muscle volume, increases the utilization of glucose, and attenuates insulin resistance, all of which may contribute to a decease in hepatic fat accumulation levels. It may be of great significance to practice exercise training for patients with chronic liver disease for improving the liver pathophysiology of NAFLD. In this review, first, the onset mechanism for NAFLD in obese subjects is summarized; second, beneficial effects of exercise on liver pathophysiology of NAFLD are reviewed based on the data from a weight reduction program consisting of dietary restriction plus aerobic exercise; and finally, medical support of obese patients with NAFLD in Tsukuba University Hospital are introduced.