Laparoscopic anti-reflux surgery to treat proton pump inhibitor-resistant non-erosive reflux disease

We performed surgery for proton pump inhibitor-resistant non-erosive reflux disease patients whose symptom index, confirmed by combined multichannel intraluminal impedance–pH monitoring, was positive. Laparoscopic Nissen fundoplication was performed in five patients and laparoscopic Toupet fundoplication in 3 patients. In 6 of 8 patients, non-acid or minor acid reflux caused the symptoms. Satisfaction percentages assessed 1 year postoperatively were 12.5 % (excellent) and 87.5 % (good).The number of total reflux events decreased to 28.5 ± 14.4 % postoperatively. The symptom index decreased from 63.8 to 20.8 %. It is controversial whether the surgery reduces weakly acidic reflux to the same degree as acid reflux. Previous reports discuss the effect of laparoscopic Nissen fundoplication on acid and weakly acidic reflux; however, the results of these studies are contradictory. In our cases, laparoscopic Toupet fundoplication as well as Nissen fundoplication improved symptoms, and reduced acid and non-acid reflux similarly. These findings strongly support the importance of surgical intervention in proton pump inhibitor-resistant non-erosive reflux disease patients.     

Association between social capital and second dose of measles vaccination in Japan: Results from the A-CHILD study

Background and Objectives

Measles vaccination is important to prevent outbreak, and social capital can be an important preventive factor. However, there have been very few studies that investigated the association between social capital and measles vaccination, especially the second dose, which is more likely to be suboptimal. This study aimed to investigate the association between social capital and second dose of measles vaccine.

Bowel strangulation caused by massive intraperitoneal adhesion due to effective chemotherapy for multiple peritoneal metastases originating from descending colon cancer

We describe a case of bowel strangulation caused by massive peritoneal adhesion as a result of effective chemotherapy. A 71-year-old man, who had obstructive descending colon cancer with massive peritoneal metastases and, therefore, received palliative surgery consisting of diverting colostomy and sampling of peritoneal nodules, developed bowel strangulation on day 4 of the 2nd course of chemotherapy, including irinotecan, l-leucovorin, and 5-fluorouracil. Emergent celiotomy showed a massive intraperitoneal adhesion formed around several intestinal loops, which were not observed at the prior surgery. One loop was strangled, but recovered by adhesiotomy alone. Intestinal loops were formed around aggregates of peritoneal nodules as the centers, several of which were then sampled. We closed the abdomen after all intestinal loops were eradicated by total enterolysis. Fortunately, the patient has been doing well and received chemotherapy without recurrent bowel obstruction 10 months after the present episode. Histological findings of the aggregates causing intestinal loops demonstrated extensive necrosis of cancerous tissue surrounded by fibrosis with abundant lymphocyte infiltration. These findings were not observed in the specimen sampled before chemotherapy, suggesting that intestinal loops were caused by inflammatory adhesion occurring around the peritoneal metastases as a result of effectiveness of chemotherapy.     

Gefitinib as first-line treatment in elderly epidermal growth factor receptor-mutated patients with advanced lung adenocarcinoma: results of a Nagano Lung Cancer Research Group study

Introduction

Feasibility of gefitinib therapy in elderly patients with non–small-cell lung cancer is uncertain. This phase II study aimed to investigate the efficacy and usefulness of gefitinib therapy as a first-line treatment for elderly patients who have advanced lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutations.

Patients and Methods

We enrolled chemotherapy-naïve advanced lung adenocarcinoma patients aged 75 years or older. Patients were administered gefitinib (250 mg) once daily until progression or unacceptable toxicity. The primary endpoint was response rate (RR), and secondary endpoints were disease control rate (DCR; defined as complete response [CR] plus partial response [PR] plus stable disease [SD]), progression-free survival (PFS), overall survival (OS), and toxicity profile.

Results

Between April 2008 and November 2009, 17 lung adenocarcinoma patients were enrolled. Overall RR was 59% (95% confidence interval [CI]: 33% to 81%), with 2 patients achieving CR and 8 PR. SD was noted in 5 patients, and DCR was 88% (95% CI: 62% to 98%). Median PFS was 12.9 months (95% CI: 2.2 to 23.6 months), and median OS had not yet been reached. Major grade 3 toxicities were skin rash (12%) and increased levels of aspartate aminotransferase or alanine aminotransferase (18%).

Conclusion

First-line treatment with gefitinib was effective and well-tolerated in elderly patients with EGFR mutations.     

Dietary glycemic index is inversely associated with the risk of Parkinson's disease: A case–control study in Japan

ObjectiveHigh glycemic index (GI) or glycemic load (GL) carbohydrates might be expected to decrease the risk of Parkinson's disease (PD) by an insulin-induced increase in brain dopamine. We conducted a hospital-based case–control study in Japan to examine associations between dietary GI and GL and other dietary carbohydrate variables, including intake of available carbohydrate and dietary fiber, and PD.MethodsPatients with PD diagnosed using the U.K. Parkinson's Disease Society Brain Bank criteria (n = 249) and controls without neurodegenerative diseases (n = 368) were recruited. Dietary intake during the preceding month was assessed at the time of study recruitment using a validated, self-administered, semiquantitative, comprehensive diet history questionnaire.ResultsAfter adjustment for potential dietary and non-dietary confounding factors, dietary GI was significantly inversely associated with the risk of PD. Multivariate odds ratios (95% confidence intervals) for PD in the first, second, third, and fourth quartiles of dietary GI were 1.00 (reference), 1.03 (0.64–1.66), 0.68 (0.41–1.15), and 0.61 (0.34–1.09), respectively (P for trend = 0.04). Conversely, no significant association was observed for other dietary carbohydrates, including dietary GL (P for trend = 0.77), available carbohydrate intake (P for trend = 0.28), or dietary fiber intake (P for trend = 0.73).ConclusionThis preliminary case–control study based on current dietary habits found an independent inverse relation between dietary GI and PD. Considering the plausibility of the putative mechanism, further investigation using a case–control design with accurate assessment of past dietary habits or a prospective design is warranted.     

Tunnel location in transparent 3-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique

It is difficult to precisely identify the locations of tunnels after double-bundle anterior cruciate ligament (ACL) reconstruction postoperatively. Using our novel transparent 3-dimensional computed tomography (T-3DCT), we evaluated intra-articular outlet locations and the angles of the anteromedial (AM) and posterolateral (PL) tunnels after anatomic double-bundle ACL reconstruction using the trans-tibial technique. A prospective study was performed with 123 consecutive patients. Tunnel outlet locations were identified on T-3DCT images showing the true lateral view of the femur and indicated by our originally defined X, Y coordinates. We also determined the angles between the tunnel axis and a joint surface line in the coronal plane, the long axis of the femur in the sagittal plane, and the posterior condyle line in the axial plane of both the femur and the tibia. The mean X, Y coordinates of the AM and PL tunnel outlets were 21, 43% and 0, 33%, respectively. In the coronal, sagittal, and axial planes, the mean AM femoral tunnel angles were 63°, 48°, and 55°, respectively; the mean AM tibial tunnel angles in the tibia were 63°, 49°, and 71°, respectively; the mean PL femoral tunnel angles were 38°, 58°, and 43°, respectively; and the mean PL tibial tunnel angles were 46°, 53°, and 45°, respectively. The AM and PL tunnel outlets and angles could be detailed precisely in three dimensions by using T-3DCT. This imaging technique may be useful to confirm surgical techniques and to improve clinical outcomes.     

Crystal structure of the Bach1 BTB domain and its regulation of homodimerization

The BTB/POZ domain is known as a protein–protein interaction motif that mediates homodimer and higher order self-associations. Proteins containing the BTB domain exist throughout eukaryotes; however, there is little information about the mechanism that determines the oligomeric state of the BTB domain. To address this question, we have determined the X-ray structure of the mouse Bach1 BTB domain. The present structure is similar to the previously determined BTB domain folds, including the human Bach1 BTB domain; however, distinct structural features are present, such as a novel homodimer interaction surface. The homodimer formation was found to involve a novel hydrogen bond network and interactions between hydrophobic surfaces of the kinked N-terminus (N-hook) and the partner's C-terminal residues. The deletion of the N-hook resulted in the conversion of the homodimer into a monomer in solution, indicating that the N-hook promotes the homodimerization of the mBach1 BTB domain. We have also found that the BTB domain of Bach2, a protein highly related to Bach1, is present as a monomer due to a short peptide insertion at the N-hook. These results represent the first example of the key modulatory element of BTB domain homodimerization.     

Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation

Introduction  Computed tomography images of 35 shoulders of 34 patients with recurrent anterior dislocation and 13 shoulders of 13 healthy normal volunteers were used to determine the location of the Hill-Sachs lesion in reference to the location of the bare area using computed tomography. Method  We measured the location, and size of the Hill-Sachs lesion and the bare area, and described them on a clock face on the humeral head. Results  The Hill-Sachs lesion was observed in slices between 0–3 and 22–24 mm distal from the top of the humeral head. The bare area was located only in slices 19–21 mm and below. Conclusion  From these data, we concluded that the Hill-Sachs lesion exists in the area between 0 and 24 mm from the top of the humeral head, and the inferior portion of the Hill-Sachs lesion overlaps the bare area if it extends beyond 19 mm from the top of the humeral head.     

Effects of third-party perspective taking on social comparison processes

This study examined the effects of attention by a third party to a comparison target on self-evaluation in social comparison. University students (N=114; 42 males and 72 females) were randomly assigned to comparison-target (superior, inferior) and perspective-taking (perspective taking of a third party, nonperspective taking) conditions. First, participants completed a linguistic performance test and were given feedback on their results. Next, participants were asked to look at another's score (either high or low) from the viewpoint of a friend, or from their own viewpoint. Finally, participants rated their own test performance. In social comparison research, a contrast effect is said to occur when self-evaluation is displaced away from the evaluation of the comparison target. The results indicated that undergraduate females who saw the other's score from the viewpoint of a friend had a contrast effect in their self-ratings. Conversely, undergraduate males who saw the other's score from their own viewpoint showed a contrast effect in their self-ratings. The results suggest that social comparison depends on the attention of a third party and that there are gender differences in the direction of this influence.     

High-dose of multiple antipsychotics and cognitive function in schizophrenia: the effect of dose-reduction

We evaluated the effect of antipsychotic dose-reduction on the neurocognitive function of 17 schizophrenic patients (11 male and 6 female, mean age=42.4+/-11.3) who have been taking high-doses of multiple conventional antipsychotics. The mean (+/-SD) of total daily antipsychotic doses (in mg/day, chlorpromazine-equivalent) was 2,253 (+/-668) at baseline, which was reduced to 1,315 (+/-276). Possible changes in neurocognitive function were assessed using Wisconsin card sorting test (WCST) and continuous performance test (CPT). As controls, we examined WCST and CPT in 6 schizophrenic patients (4 male and 2 female, mean age=47.7+/-14.2) who had been taking high-doses of multiple antipsychotics (mean daily antipsychotic dose=1,753+/-165 mg) and declined to change their antipsychotic regimen. In WCST, the mean number of total correct answers significantly increased (53.2+/-16.3 vs. 63.8+/-19.6, P=0.035, Wilcoxon signed rank test); perseverative errors significantly decreased (54.4+/-27.3 vs. 35.4+/-20.1, P=0.013, Wilcoxon signed rank test) after the antipsychotic dose-reduction. In contrast, the control group showed no significant difference between the two WCST performances conducted with a three-month interval. The improvements in WCST performance significantly correlated with the decreases in PANSS negative syndrome score in the subject patients. No significant change was observed in CPT performances in either group. Our preliminary data shows that, in schizophrenic patients taking high-doses of multiple conventional antipsychotics, dose-reduction might lead to improvements in cognitive functions.