Usefulness of an Inflammation-Based Prognostic Score (mGPS) for Predicting Survival in Patients with Unresectable Malignant Biliary Obstruction

Background

An inflammation-based prognostic score, the modified Glasgow Prognostic Score (mGPS), has been established as a useful tool for predicting postoperative outcome in patients with cancer. However, no studies have investigated the usefulness of the mGPS for prognostication in patients undergoing palliative surgery for unresectable malignant biliary obstruction (UMBO). The present study was conducted to investigate whether the mGPS is useful for predicting the postoperative survival of patients undergoing intraoperative placement of an expandable metal stent for UMBO, or not.

Methods

The mGPS was calculated as follows: patients with both an elevated level of C-reactive protein (CRP) (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2. Patients with only an elevated CRP level were allocated a score of 1, and patients without an elevated CRP level (≤1.0 mg/dL) were allocated a score of 0. Postoperative survival was evaluated by Kaplan–Meier analysis and log rank test. The significance of risk factors for postoperative survival was evaluated with the Cox proportional hazards model.

Results

Kaplan–Meier analysis revealed that patients with mGPS 0 (n = 36) and 1 (n = 7) had better postoperative survival (p = 0.017) than patients with mGPS 2 (n = 17). The 6-month and 1-year survival rates of patients with mGPS 0 and 1 were 58.1 and 27.3 %, and those for patients with mGPS 2 were 25.0 and 6.2 %, respectively. Multivariate analysis revealed that mGPS (0, 1/2) was a significant risk factor for postoperative survival (hazard ratio 3.271; 95 % CI 1.109–9.649; p = 0.032).

Conclusion

The mGPS is not only one of the most significant predictors of postoperative survival for UMBO patients receiving intraoperative biliary stenting but also a useful indicator capable of dividing such patients into two independent groups before surgery.     

Age-related production of osteoclasts and the changes of serum levels of vascular endothelial growth factor (VEGF) and receptor activator for nuclear factor (NF)-κB ligand (RANKL) in osteopetrotic (op/op) mice

ObjectiveExpression of osteoclasts in osteopetrotic (op/op) mice is substantially reduced by the absence of functional macrophage colony-stimulating factor (M-CSF). However, it has been reported that osteoclasts do gradually appear in the bones of op/op mice and spontaneously correct the osteopetrosis.DesignAge-related production of osteoclasts and the changes of serum levels of vascular endothelial growth factor (VEGF) and receptor activator for nuclear factor (NF)-κB ligand (RANKL) in op/op mice were examined.ResultsThe number of femoral osteoclasts, and the serum levels of VEGF, both gradually increased in op/op mice after birth and reached a peak in 120- and 60-day-old mice, respectively. However, the serum levels of RANKL showed an inverse relationship to osteoclast number.ConclusionsThese findings suggest that the appearance of osteoclasts may be influenced by the serum levels of VEGF and that the serum levels of RANKL may be influenced by the appearance of osteoclasts.     

Differences in expression patterns of cathepsin C/dipeptidyl peptidase I in normal,pathological and aged mouse central nervous system

Cathepsin C (CC) (EC 3.4.14.1, dipeptidyl peptidase I) is a lysosomal cysteine protease that is required for the activation of several granule‐associated serine proteases in vivo. CC has been shown to be constitutively expressed in various tissues, but the enzyme is hardly detectable in central nervous system (CNS) tissues. In the present study, we investigated the regional and cellular distribution of CC in normal, aging and pathological mouse brains. Immunoblotting failed to detect CC protein in whole brain tissues of normal mice, as previously described. However, low proteolytic activity of CC was detected in a brain region‐dependent manner, and granular immunohistochemical signals were found in neuronal perikarya of particular brain regions, including the accessory olfactory bulb, the septum, CA2 of the hippocampus, a part of the cerebral cortex, the medial geniculate, and the inferior colliculus. In aged mice, the number of CC‐positive neurons increased to some extent. The protein level of CC and its proteolytic activity showed significant increases in particular brain regions of mouse models with pathological conditions – the thalamus in cathepsin D‐deficient mice, the hippocampus of ipsilateral brain hemispheres after hypoxic–ischemic brain injury, and peri‐damaged portions of brains after penetrating injury. In such pathological conditions, the majority of the cells that were strongly immunopositive for CC were activated microglia. These lines of evidence suggest that CC is involved in normal neuronal function in certain brain regions, and also participates in inflammatory processes accompanying pathogenesis in the CNS.     

3D evaluation of composite resin restoration at practical training using swept-source optical coherence tomography (SS-OCT)

Internal adaptation of restorations to the cavity wall is one of the important topics in clinical dentistry. The purpose of this study was to investigate the possibility to utilize the non-invasive tomographic imaging system for teaching the importance of cavity adaptation at dental school pre-clinical training. Swept-source optical coherence tomography (SS-OCT) was used for detection of marginal and internal defects in the composite resin restorations as an educational device. Class 1 and Class 2 composite restorations to melamine resin molar tooth were assigned to the students and prepared during the skill test, and SS-OCT imaging was performed to evaluate students' works. SS-OCT could detect the internal gaps and voids within the restorations in tomography images synthesized based on the backscatter signal from within the restoration. It is suggested that the SS-OCT is promising diagnostic modality, as well as educational imaging device for the detection of internal gaps in adhesive restorations.