Incidence of lymph node metastasis in intramucosal gastric cancer measuring 30 mm or less,with ulceration; mixed,predominantly differentiated-type histology; and no lymphovascular invasion: a multicenter retrospective study

Background

Intramucosal gastric cancer, ≤3 cm (≤30 mm) with ulceration, and mixed histology (predominantly differentiated), was previously considered curative after endoscopic resection, and additional surgery was thought to be unnecessary. However, as the evidence base for these criteria remains insufficient, the Japanese Gastric Cancer Treatment Guidelines, ver. 3 (2010) specify that this pathology should be considered noncurative and recommend additional surgery. We report the frequency of lymph node metastasis in patients with these conditions based on a multicenter study.

Methods

Of patients with early gastric cancer who underwent gastrectomy with lymph node dissection, those with a mixed, predominantly differentiated tumor type, ulceration, a tumor diameter ≤3 cm, and no lymphovascular invasion were entered into this study.

Results

Four hundred and seven patients met the criteria, 21 of whom were excluded owing to a lack of available information. Thus, a total of 386 patients were included in the analysis, from 37 of the 42 member institutions. The mean study duration was 125 months. The most common combination of mixed histology was tub2 + por (67 %). None of the 386 patients had lymph node metastasis (95 % confidence interval, 0–0.8 %).

Conclusion

The results of this retrospective study indicate that the risk of lymph node metastasis was less than 1 % among patients with the criteria defined here, considered to be criteria for noncurative resection as per the current guidelines, and suggest that observation alone without additional surgery may result in a good outcome.

     

Diabetes Care Providers’ Manual for Disaster Diabetes Care

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the “Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake” under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata‐Chuetsu Earthquakes, the current “Manual for Disaster Diabetes Care” has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.     

A case of hypopharyngeal cancer successfully treated with concurrent S-1, nedaplatin and radiotherapy

A 68-year-old man was admitted with hoarseness. Laryngofiberscopy showed a tumor that obstructed the posterior hypopharyngeal wall and the larynx, and biopsy revealed well-differentiated squamous cell carcinoma. CT demonstrated bilateral cervical lymph node metastases. The patient was diagnosed as having hypopharyngeal cancer(T4N2cM0)and was treated with concurrent S-1, nedaplatin and radiotherapy(hereafter referred to as SN therapy). CT and endoscopy after primary treatment showed disappearance of the tumor, and the treatment outcome was assessed as complete response(CR). Currently, the patient is being treated with S-1 as adjuvant chemotherapy in the outpatient setting, and no recurrence or metastasis has been observed. These results suggest that SN therapy was effective for advanced hypopharyngeal cancer from the viewpoint of both curative treatment and organ and function preservation.     

A unique N-glycan on human transferrin in CSF: a possible biomarker for iNPH

Idiopathic normal pressure hydrocephalus (iNPH) is an elderly dementia caused by abnormal metabolism in the cerebrospinal fluid (CSF). The tap test is the current basis for confirming iNPH, but it shows very low sensitivity, indicating that many patients who might be cured by a shunt operation will be missed. On sodium dodecyl sulfate-polyacrylamide gel electrophoresis, we found two transferrin isoforms: one had a unique N-glycan (Tf-1) whereas the other had N-glycan similar to that of serum transferrin (Tf-2). Glycan analyses revealed that Tf-1 had branching (biantennary) asialo- and agalacto-complex type N-glycans (N-acetylglucosamine [GlcNAc]-terminated glycans), which carried bisecting β1,4-N-acetylglucosamine and core α1,6-fucose. To examine glycoform whether changes in iNPH, we introduced the Tf-2/Tf-1 ratio as a diagnostic index, which minimized blot-to-blot variations in measurement. The Tf-2/Tf-1 ratios of iNPH patients are significantly higher than those of controls (p = 0.0019) and Alzheimer's patients (p = 0.0010). This suggests that the Tf-2/Tf-1 ratio could distinguish iNPH from Alzheimer's disease, and possibly other dementias. In conclusion, glycoform analysis has diagnostic potential in neurological diseases.     

No association between glutathione-synthesis-related genes and Japanese schizophrenia

Aims: Schizophrenia is a major psychiatric disorder with complex genetic, environmental, and psychological causes, and oxidative stress may be involved in the pathogenesis of the disease. Glutathione (GSH), one of the main cellular non‐protein antioxidants and redox regulators, and altered GSH levels have been reported in various regions in patients with schizophrenia. Three enzymes are responsible for GSH synthesis: glutamate cysteine ligase modifier (GCLM), glutamate cysteine ligase catalytic subunit (GCLC), and glutathione synthetase (GSS). Previously, positive associations between GCLM and schizophrenia were reported in Europeans, but not in the Japanese population. Thus, in this study, we investigated the association between the GSH synthesis genes (GCLM, GCLC, and GSS) and schizophrenia in Japanese individuals. Methods: Seventeen single‐nucleotide polymorphisms (SNP) in GCLM, GCLC, and GSS were genotyped in 358 patients with schizophrenia and in 359 controls. Results: No SNP showed a significant association between their allelic or genotypic frequencies and schizophrenia. Case–control haplotype association analysis using windows of two or three SNP showed no significant associations with schizophrenia. The case–control haplotype analyses based on the ascertained linkage disequilibrium blocks also showed no significant associations in any genes with schizophrenia. Conclusions: The three primary GSH synthesis genes do not have an apparent degree of association with schizophrenia in the Japanese population.     

Diagnostic performance in differentiation of breast lesion on digital mammograms: comparison among hard-copy film, 3-megapixel LCD monitor, and 5-megapixel LCD monitor

We compared observer performance of digital mammography among hard-copy readings and soft-copy readings using 3-megapixel (3M) and 5-megapixel (5M) liquid crystal display (LCD) monitors. Five experienced radiologists assessed 80 mammograms of 40 cancers and 40 benign lesions. There were no significant differences among the average A_z of three modalities and among the κ values for intra- and interobserver agreement. The soft-copy reading using the 3M LCD monitor took a slightly longer time, although there were no significant differences.