Hepatic sinusoidal obstruction associated with S-1 plus cisplatin chemotherapy for highly advanced gastric cancer with paraaortic lymph node metastases: report of a case

A 56-year-old man who was diagnosed with gastric cancer with multiple paraaortic lymph node metastases was treated with S-1 plus cisplatin. The spleen gradually enlarged during the therapeutic courses. After the 6th course of therapy, the primary gastric lesion and paraaortic lymphadenopathies disappeared. He underwent a curative resection, including a distal gastrectomy with regional and paraaortic lymph node dissections. Irregularly distributed congestion of the liver was noted during the surgery. Histological examinations revealed residual cancer cells in 3 regional lymph nodes and no cancer cells in the primary site and paraaortic lymph nodes. Hepatic sinusoidal obstruction syndrome (SOS) was also confirmed histologically. This is the first report of a case with SOS after S-1 plus cisplatin therapy. S-1 plus cisplatin therapy can cause SOS, although it is a promising preoperative chemotherapy for highly advanced gastric cancer.     

Is access to neighborhood green space associated with BMI among Egyptians? A multilevel study of Cairo neighborhoods

Evidence of a link between green space and obesity has increased in the developed world, but few studies have been conducted in the developing world. Our study tests whether availability of neighborhood green space is associated with BMI among adults in Cairo, Egypt. Using data from the 2007 Cairo Urban Inequity Study, we conducted multilevel analyses and found no significant green space-BMI association, leading us to conclude that this intervention may not be as promising in this developing world context as it has been in some western urban contexts. Other aspects of the urban environment should be evaluated to better understand neighborhood variations in obesity in Cairo.     

Broad-range real-time PCR assay for detection of bacterial DNA in ocular samples from infectious endophthalmitis

Background

To evaluate a broad-range real-time polymerase chain reaction (PCR) targeting the bacterial 16S rRNA gene for detection of bacterial DNA in infectious endophthalmitis.

Methods

The bacterial 16S rRNA gene was measured by quantitative real-time PCR. For the assay, bacterial DNA was prepared from 12 Gram-positive and 4 Gram-negative strains. To determine the optimum method for DNA extraction, four extraction procedures were selected by using DNA extraction program cards with and without the use of lysozyme. To evaluate PCR sensitivity, PCR fragments were amplified from Staphylococcus aureus and Escherichia coli DNA.

Results

DNA extraction using the Bacteria card^? without enzymes resulted in detection of all the tested strains at concentrations ≥10⁷?copies/mL. Extraction with the Bacteria card^? with lysozyme resulted in detection of all the tested strains at concentrations ≥10⁶?copies/mL, indicative of no significant difference between the two procedures. DNA extraction using the Virus card^?, both with and without enzymes, resulted in reduced efficiency of detection of all strains compared with use of the Bacteria card^?. The PCR could detect as few as 1–10?colony-forming units (CFU) in diluted vitreous samples per reaction, and all tested bacterial species known to cause endophthalmitis were detected.

Conclusions

Bacterial 16S-specific PCR can comprehensively detect the main causative bacteria of clinically suspected endophthalmitis.     

Comparison of efficacy of four prostaglandin analogues by bilateral treatment in healthy subjects

Purpose

To compare the drug efficacy of four prostaglandin analogues (PGAs) by bilateral treatment in normal subjects.

Methods

Three consecutive studies comparing latanoprost to three other PGAs (travoprost, tafluprost and bimatoprost) were performed in 24 healthy subjects. Each study was separated by a washout period of over 6?weeks. In each study, two drugs were randomly assigned to one eye of each subject. Study subjects instilled the assigned medication at 9:00?p.m. every day for 2?weeks. The same masked investigator measured intraocular pressure (IOP) at 9:00?a.m., 1:00?p.m. and 5:00?p.m. at baseline and repeated measurements on days 7 and 14. The differences in IOP reduction were compared between the drugs.

Results

Mean diurnal IOP reduction with latanoprost on days 7 and 14 was similar to that with travoprost and tafluprost, but was significantly lower than that with bimatoprost. The association of the mean diurnal IOP reduction between latanoprost and bimatoprost on day 14 (r ²?=?0.25) was weak, in remarkable contrast to the strong association between latanoprost and travoprost (r ²?=?0.81) and between latanoprost and tafluprost (0.82).

Conclusions

The short-term bilateral treatment revealed a different IOP-lowering efficacy of bimatoprost compared to other PGAs in healthy subjects.     

Health benefits of reduced patient cost sharing in Japan

Objective

To assess the effect on out-of-pocket medical spending and physical and mental health of Japan’s reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age.

Methods

Study data came from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design.

Findings

For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of-pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P = 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P = 0.084).

Conclusion

Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults.