Validation study of the prediction system for clinical response of M-VAC neoadjuvant chemotherapy

To predict the efficacy of the M-VAC neoadjuvant chemotherapy for invasive bladder cancers, we previously established the method to calculate the prediction score on the basis of expression profiles of 14 predictive genes. This scoring system had clearly distinguished the responder group from the non-responder group. To further validate the clinical significance of the system, we applied it to 22 additional cases of bladder cancer patients and found that the scoring system correctly predicted clinical response for 19 of the 22 test cases. The group of patients with positive predictive scores had significantly longer survival than that with negative scores. When we compared our results with a previous report describing the prognosis of the patients with cystectomy alone, the results imply that patients with positive scores are likely to benefit from M-VAC neoadjuvant chemotherapy, but that the chemotherapy would shorten the lives of patients with negative scores. We are confident that our prediction system to M-VAC therapy should provide opportunities for achieving better prognosis and improving the quality of life of patients. Taken together, our data suggest that the goal of 'personalized medicine', prescribing the appropriate treatment regimen for each patient, may be achievable by selecting specific sets of genes for their predictive values according to the approach shown here.     

A case of adenosquamous gastric carcinoma successfully treated with TS-1, low-dose CDDP and docetaxel as neoadjuvant chemotherapy

The patient was a 66-year-old male with extremely advanced gastric cancer type 3 and diagnosed with adenocarcinoma by endoscopic biopsies specimens. Combined chemotherapy of TS-1, CDDP and docetaxel was prescribed in order for tumor reduction and downstaging. TS-1 (80 mg/m(2)) was administered 28 days followed by 14 days rest as one course. CDDP (8 mg/m(2)) was administered on days 1, 2, 14 and 15 and docetaxel (40 mg/m(2)) was administered on day 1 and 14, followed by 4 weeks rest as one course. After 2 courses of treatment, a CT scan revealed a minor response of tumor reduction. Therefore, total gastrectomy, partial pancreas body and tail resection, and D 2 lymph node dissection were performed. The patient had undergone adjuvant chemotherapy of TS-1 and biweekly docetaxel after surgery with no recurrence for 13 months. Adverse reactions were grade 3 neutropenia and grade 2 diarrhea. Combined chemotherapy of TS-1, low-dose CDDP and docetaxel were intensive and required constant patient monitoring. However, it proved effective and feasible as a neoadjuvant chemotherapy regimen for advanced gastric cancer.     

Assessment of health-related quality of life after radiofrequency ablation or laparoscopic surgery for small renal cell carcinoma: a prospective study with medical outcomes Study 36-Item Health Survey (SF-36)

OBJECTIVE: The purpose of this study was to assess the changes in health-related quality of life (HRQoL) during follow-up period in patients treated with percutaneous radiofrequency ablation (RFA) or laparoscopic surgery for small renal cell carcinoma. METHODS: From December 2004 through September 2006, for 37 consecutive patients, who were diagnosed with renal cell carcinoma and underwent percutaneous RFA (n = 20) or laparoscopic radical nephrectomy (n = 17) at our institution. HRQoL was evaluated prospectively using SF-36 Health survey pre- and post-operatively (1, 4, 12 and 24 weeks after surgery). RESULTS: Four of the eight scale scores of SF-36 were significantly lower pre-operatively in the RFA group than in the laparoscopic surgery group. The QoL scores in physical functioning, role-physical functioning and role-emotional functioning were significantly reduced one week after laparoscopic surgery. However, there was no reduction of the SF-36 QoL scores one week after operation in the RFA group. Furthermore, HRQoL scores in the RFA group showed a tendency to improve during follow-up periods. CONCLUSIONS: This is the first study to evaluate HRQoL changes (up to 24 weeks) in patients who have undergone RFA or laparoscopic radical nephrectomy for small renal cell carcinoma. No reduction, but rather an improvement, in HRQoL was seen in the RFA group during follow-up periods. From the point of view of QoL, RFA could be a viable alternative treatment for selected patients with small renal cell carcinoma. RFA could be a viable alternative treatment for the selected patients with small renal cell carcinoma.     

Difficulty in diagnosing a case with apparent sequel cerebral sparganosis

BACKGROUND: We report on a case of cerebral sparganosis that was correctly identified by a biopsy 10 years after the initial infection. CASE DESCRIPTION: A 62-year-old man presented with an unusual case of cerebral sparganosis mansoni. He was admitted to our hospital for removal of a right frontal meningioma. Computed tomographic scan and MRI of the brain showed atrophy of the left cerebral hemisphere, enlargement of the lateral ventricle, and several small ring-enhanced lesions in the left frontal lobe. The patient had suffered from motor aphasia and right hemiparesis for 10 years; in addition, he had been treated for cerebral infarction. We performed a left frontal biopsy, during which we also removed the meningioma. The histologic diagnosis was cerebral sparganosis mansoni. CONCLUSIONS: The follow-up CT findings after the patient's first attack were thought to be characteristic of cerebral sparganosis mansoni. However, the radiographic findings were difficult to differentiate from those of neoplasias.     

A protective role of hydrogen sulfide against oxidative stress in rat gastric mucosal epithelium

We investigated effect of hydrogen sulfide (H(2)S) on oxidative stress-caused cell death in gastric mucosal epithelial cells. In rat normal gastric epithelial RGM1 cells, NaHS, a H(2)S donor, at 1.5mM strongly suppressed hydrogen peroxide (H(2)O(2))-caused cell death, while it slightly augmented the H(2)O(2) toxicity at 0.5-1mM. The protective effect of NaHS was abolished by inhibitors of MEK or JNK, but not of p38 MAP kinase. NaHS at 1.5mM actually phosphorylated ERK and JNK in RGM1 cells. Glibenclamide, an ATP-sensitive K(+) (K(ATP)(+)) channel inhibitor, did not affect the protective effect of NaHS, although mRNAs for K(ATP)(+) channel subunits, Kir6.1 and SUR1, were detected in RGM1 cells. In anesthetized rats, oral administration of NaHS protected against gastric mucosal lesion caused by ischemia-reperfusion. These results suggest that NaHS/H(2)S may protect gastric mucosal epithelial cells against oxidative stress through stimulation of MAP kinase pathways, a therapeutic dose range being very narrow.     

Desensitization of guinea-pig taenia caeci smooth muscle induced by a low concentration of carbachol

1. In guinea-pig taenia caeci smooth muscle we have found that 10(-4) mol/L carbachol-induced desensitization to muscarinic agonists develops within 15-30 s, followed by transient resensitization at 1 min, whereas the desensitization to depolarizing high K(+) develops with maximal desensitization at 1 min followed by sustained resensitization up to 30 min. In both cases, Ca(2+)-dependent processes play a crucial role in determining the development of desensitization. 2. To elucidate whether these peculiar processes of desensitization/resensitization may be induced by a lower concentration of carbachol, we examined the development of desensitization induced by 10(-6) mol/L carbachol, because at this concentration carbachol is known to induce biphasic changes in intracellular Ca(2+) concentrations, with a smaller transient increase followed by a larger sustained increase than seen with 10(-4) mol/L carbachol. 3. Contractile responses to muscarinic agonists (carbachol or AHR-602) and high K(+) were desensitized by pretreatment with 10(-6) mol/L carbachol for 30 min in a manner dependent on the presence of extracellular Ca(2+). 4. The development of 10(-6) mol/L carbachol-induced desensitization to these muscarinic agonists in the presence of extracellular Ca(2+) showed three successive phases: fast desensitization within 30 s, followed by transient resensitization at 1 min and the subsequent development of desensitization up to 30 min. In contrast, desensitization to high K(+) did not develop up to 10 min and significant desensitization occurred at 30 min, with no apparent resensitization phase. 5. These results suggest that the characteristics of the Ca(2+)-dependent development of desensitization to muscarinic agonists, but not to high K(+), are well maintained in desensitization induced by a lower concentration of carbachol.