Recurrence pattern for superficial bladder cancer

AIM: Patients with superficial bladder tumors sometimes have long recurrence-free intervals. We evaluated whether patients with long recurrence-free periods had subsequent recurrences. We also clarified how these patients should be followed. MATERIALS AND METHODS: We enrolled 244 patients with superficial bladder cancer (62 pTa and 182 pT1) treated by transurethral resection of bladder tumor (TURBT) and adjuvant chemotherapy with pirarubicin. Median follow up was 75.5 months. Patients were stratified by the length of their recurrence-free interval. RESULTS: Recurrences occurred in 124 patients (50.8%). Of 185 patients who did not have a recurrence for the first 3 years, subsequent recurrences occurred in 65 patients; in more than half the first recurrence developed after 5 years or more. Ta tumors had a low recurrence rate (14.5%) with the first recurrence often developing after a long recurrence-free period. Of 40 patients who remained recurrence-free for 3 years or more after at least one recurrence occurred, 16 patients (40%) had subsequent recurrences. Furthermore, most of these patients who remained free of recurrence for more than 5 years eventually had a recurrence. The overall progression rate was 15.6%, and this did not relate to the length of the recurrence-free interval. CONCLUSION: When patients did not have a recurrence for the first 3 years, tumors subsequently often recurred, even in pTa tumors. In patients with at least once recurrence, subsequent recurrences appear to occur irrespective of the length of the recurrence-free period. Thus, we recommend that all patients with superficial bladder tumors be followed for as long as possible.     

Pure red cell aplasia in a prostate cancer patient treated with leuprolide acetate and chlormadinone acetate

Abstract  Pure red cell aplasia (PRCA) is characterized by anemia with reticulocytopenia but with normal leukocyte and platelet counts, and a bone marrow with a selective absence of erythroid precursor cells. Drug-induced PRCA is a rare secondary form of PRCA, and is usually acute and fully reversible by the withdrawal of the causative drugs. We report a rare case of PRCA in a prostate cancer patient treated with combined androgen blockade (CAB) consisted of leuprolide acetate as a luteinizing hormone-releasing hormone agonist and chlormadinone acetate as an antiandrogen. This case demonstrated that these drugs could be a cause of PRCA, and suggests that regular close monitoring for anemia is needed in prostate cancer patients treated with these drugs.     

Development of nurses with specialties: the nurse administrators’ perspective

Aim This study clarified how Japanese nurse administrators consider the current status and future prospects of development and utilization of nurses with specialties. Background The demand for specialized nurses is not satisfied throughout the country. Methods Nine nurse administrators participated in three focus‐group discussions. Data were analyzed using qualitative content analysis technique. Results On development of specialized nurses, four categories were abstracted: offering opportunities for career development; establishing an environment of life‐term continuous learning; providing well‐balanced support for the needs of organizations and individual nurses; and support for career development as a specialist. Conclusions To develop specialized nurses effectively it is important to focus more attention on qualitative aspects of nurses’ professional experience in in‐service education and to support appropriate personnel for strategic human resource development. Implications for Nursing Management Facilitating frequent contacts between specialized and general nurses should be highly valued as making an environment where nurses can face career goals daily leads to steady preservation of human resources. It is necessary for nurse administrators to keep human resources quantitatively and to clarify the developmental process after nurses obtain special roles to plan for continuous education.     

Relationship between interleukin-8 levels and myeloperoxidase activity in human gastric mucosa

Although interleukin (IL)-8 is well known as a chemotactic agent for neutrophil migration in vitro, the relationship between IL-8 activity and the degree of neutrophil infiltration in gastric mucosa is still unclear. In the present study, we investigated IL-8 and myeloperoxidase activity, a marker of neutrophil infiltration, in gastric antral mucosa using biopsy samples in 23 patients with no gastric lesions. The results indicate that there is a good correlation between IL-8 and myeloperoxidase activity (y = 0.173x + 13.9; r = 0.49, P<0.01). Furthermore, IL-8 and myeloperoxidase activity are significantly higher in Helicobacter pylori-positive patients than in H. pylori-negative patients. In conclusion, an increase of IL-8 activity in the gastric mucosa causes increased neutrophil infiltration in human gastric mucosa and H. pylori infection acclerates these reactions in the mucosa.     

Characteristics of patients with staghorn calculi in our experience

PURPOSE: To elucidate the factors contributing to staghorn stone formation in patients. MATERIALS AND METHODS: The records of 82 patients (44 men and 38 women) with complete staghorn calculi were reviewed retrospectively for clinical presentation, metabolic disturbances and anatomical abnormalities. RESULTS: There were 79 unilateral and three bilateral cases. The patient performance of the activities of daily life was assessed with the modified Rankin scale (MRS) and it was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic indwelling catheters (8.5%). A positive urine culture was found in 24.4% of patients. Analysis of stone composition revealed magnesium ammonium phosphate and mixed calcium oxalate-phosphate were the most frequently identified types of stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities of the kidney. CONCLUSIONS: Our data show that the patients with severe disability, urinary tract infection and hypercalciuria could be recognized more frequently in staghorn calculi compared with common urolithiasis. However, in Western countries, the frequency of both urinary tract infection and struvite stones is much higher than in our data. Other Japanese authors have also reported the low frequency of struvite stones in staghorn calculi, suggesting that various factors other than urinary tract infection possibly contribute to the formation of staghorn calculi in Japan.     

Myocardial {beta}-receptor and cardiac angiotensin alterations during the acute and chronic phases of viral myocarditis

Recovery from viral myocarditis is usually excellent and completealthough it occasionally results in sudden death during itsacute stage. While neurohormonal mechanisms play an importantrole in the adaptation to heart diseases, little is known aboutthe alteration of the neurohormonal system in viral myocarditis.Therefore, we examined the myocardial ß-adrenergicreceptor and cardiac angiotensin I and II concentrations ina murine model of viral myocarditis induced by an encephalomyocarditisvirus. The down-regulation of the ß₁-adrenergic receptorsubtype was observed on day 10. The heart weight, heart weight/bodyweight ratio and myocardial necrosis were significantly increasedat this stage. On day 30, the ß₂-adrenergic receptorsubtype was up-regulated without up-regulation of the totalß-adrenergic receptor. Both angiotensin I and II concentrationswere significantly increased with myocardial hypertrophy inthe left ventricle on day 30. The up-regulation of the totalß-adrenergic receptor and ß₂-subtype wasobserved on day 120, but neither the angiotensin I nor II concentrationwas increased. Therefore, the up-regulation of the ß₂-adrenergicreceptor density and the temporal increase of the angiotensinI and II concentrations in the murine ventricle during viralmyocarditis may play an important role in the pathophysiologyof post-viral myocarditis.     

饲喂高亚油酸玉米对奶牛瘤胃发酵、产乳量和乳成分的影响

选用 6头经产荷斯坦种乳牛分为对照和HLAC两组 ,以二乘反转法 ,研究了高亚油酸玉米 (HLAC)、对奶牛瘤胃发酵、产乳量和乳成分的影响。HLAC组用HLAC部分替换了对照组饲料中的普通玉米 ,两组日粮组成和营养成分基本相同。结果表明 ,HLAC的替换对瘤胃液氨氮浓度、挥发性脂肪酸浓度及其组成无显著影响 (P>0 .1) ,但纤毛虫总数显著增加 (P <0 .0 5 )。两组牛干物质采食量和产乳量无显著差异 ,但HLAC组乳脂率有下降趋势 (P <0 .1)、乳脂肪中C18:2比例小幅提高、C18:1比例显著提高 (P <0 .0 5 )、乳蛋白质率及其产量小幅增加、乳糖率和无脂固形物率及其产量显著提高 (P <0 .0 5 )。以上结果显示 :奶牛饲料中HLAC的使用可改善乳成分 ,并对瘤胃发酵产生一定影响     

PREDICTION OF THE SURFACE-INTERIOR DIAGRAM OF GLOBULAR PROTEINS BY AN EMPIRICAL METHOD

The number of amino acid residues in contact with a residue in a globular protein is a simple and good measure to show the relative location of the residue on the surface or in the interior of the protein. The contact number is estimated as the number of Cα atoms within a sphere of radius r (8 A) centered at the Cα atom of a given residue. The predictor: of a diagram (the plot of the contact number against the residue number) from a given amino acid sequence may be meaningful as an alternative to the secondary-structure prediction currently performed. Parameter values are determined empirically using the observed contact numbers calculated from known structures of 39 proteins. In order to assess the real efficiency of the method, the prediction has been performed in the following way; all the proteins are divided into two groups; one group is used to derive parameter sets and the other serves to test the prediction accuracy. The test reveals that the parameter sets empirically determined are biased significantly towards the data base, the extent of which is roughly proportional to the number of parameter terms included. The results show that an adequate smoothing of a parameter set is the best way to reduce the extent of biasing towards the data base and to give the best prediction for ‘unknown’ proteins. The prediction accuracy finally obtained is about 0.4 (or roughly 70%), on the average, measured by the correlation coefficient between the predicted and observed diagrams. This value is of the same order as the accuracy in the current predictions of secondary structures.