The Ki-67 labeling index and lymphatic/venous permeation predict the metastatic potential of rectal neuroendocrine tumors

Background

Endoscopic resection has been used to treat small rectal neuroendocrine tumors (NETs). However, the indication for additional surgery after endoscopic resection is unclear. The aim of this study was to identify risk factors for rectal NET metastasis and to determine the indication for additional surgery.

Methods

Fifty-five patients with a total of 57 rectal NETs, treated between October 2003 and January 2013, were retrospectively divided into metastatic (11 lesions) and non-metastatic (46 lesions) groups. Tumor size, central depression, invasion depth, lymphatic and venous permeation, mitotic activity, nuclear abnormality, Ki-67 labeling index, and World Health Organization grading classification (G1 or G2) were compared between the groups. Patients underwent endoscopic submucosal resection with a ligation device, transanal full-thickness surgical resection, or radical surgery.

Results

By univariate analysis, the odds ratios (OR) for a Ki-67 labeling index >3.0 %, positive lymphatic or venous permeation, World Health Organization grading classification G2, tumor size >10 mm, submucosal invasion >4000 μm, and central depression were 120 (P < 0.001), 67.6 (P < 0.001), 58.7 (P < 0.001), 9.8 (P = 0.0037), 6.8 (P = 0.012), and 5.7 (P = 0.018), respectively. Multivariate logistic regression analyses showed that vascular permeation (OR 111; P = 0.006) and a Ki-67 labeling index >3.0 % (OR 88; P = 0.012) were independent risk factors for metastasis.

Conclusions

The Ki-67 labeling index and lymphatic/venous permeation were reliable predictors of rectal NET metastases.

     

Cross-sectional observation of the relationship of depressive symptoms with lifestyles and parents’ status among Japanese junior high school students

Objectives

Students’ depressive symptoms might be related to their own risk factors and to their parents’ status. The objective of this cross-sectional study was to examine the relationship of depressive symptoms with lifestyle variables and parents’ psychological and socio-demographic status among Japanese junior high school students.

Methods

Of 477 students and their parents, 409 (85.7 %) students and 314 (65.8 %) parents participated in the study. Students answered self-reported questionnaire on depressive symptoms, their heights and weights, subjective stress, body dissatisfaction, lifestyles including sleep duration and extracurricular physical activity in school and other physical activity outside the school, and nutritional intake. Parents responded to questionnaire on depressive symptoms and socio-demographic status.

Results

The prevalence of depressive symptoms was 24.9 %. Students with depressive symptoms were more likely to have stress. Students in shorter and longer sleep duration groups were more likely to have depressive symptoms. The students with depressive symptoms had smaller amount of energy intake than did those without depressive symptoms. Multiple logistic regression analysis revealed significant relationships between students’ depressive symptoms and some independent variables. Sex, subjective stress, “almost-never”-categorized extracurricular physical activity in school and other physical activity outside the school, and having a parent with depressive symptoms were significantly associated with students’ depressive symptoms.

Conclusion

Reducing mental stress and taking care of lifestyles, especially, “almost-everyday”-categorized extracurricular physical activity in school and other physical activity outside the school, may have benefits for students’ mental health, and having a parent with depressive symptoms may be associated with students’ depressive symptoms.

     

Effects of the anti-interleukin-6 receptor antibody, tocilizumab, on serum lipid levels in patients with rheumatoid arthritis

We investigated the effects of anti-IL-6 receptor antibody, tocilizumab (TCZ), on lipid metabolism. Nineteen patients with rheumatoid arthritis (RA), entered in clinical case?Ccontrol study of SAMURAI trial at Sasebo Chuo Hospital, were examined. Nine patients received TCZ monotherapy at 8?mg/kg intravenously every 4?weeks (TCZ group) and 10 patients received conventional DMARDs (control group). Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoprotein (Apo) A-1, Apo A-2 and Apo B as well as disease activity score (DAS), C-reactive protein and serum amyloid A protein were examined at baseline and after 3?months of the treatment. IL-6 inversely was correlated with LDL, Apo A-1 and Apo A-2, and also tended to correlate with Apo B. In TCZ group, serum levels of TC, HDL, LDL, Apo A-1 and Apo A-2 were significantly increased after 3?months treatment with TCZ. There was no significant change in Apo B, the atherogenic index, and TC/HDL by the TCZ treatment. Changes in the DAS28-ESR negatively correlated with those in TC. In one patient, whose serum level of TCZ was not detected after 3?months of the treatment, the absence of the increment in serum levels of Apo A-1 and A-2 in the patient was remarkable. All of the markers did not change during 3?months in control group. These data may raise an important issue to evaluate the impact of these alternations in lipid metabolism for longer periods in RA patients treated with TCZ.     

Cytokine profiles affecting the pathogenesis of autoimmune hepatitis in Japanese patients

Aim: Autoimmune hepatitis (AIH) is a chronic hepatitis of unknown etiology, although several cytokines have been implicated in its pathogenesis and severity. This study investigated the relationship between circulating cytokines in the pretreatment phase and remission following corticosteroid therapy phase in Japanese AIH patients. Methods: A total of 28 cytokines were measured simultaneously by multiple bead array technology in the sera of 40 patients with AIH collected during pretreatment and remission phases. Results: Interleukin (IL)‐12p40, interferon‐γ‐inducible protein (IP‐10), macrophage inflammatory protein (MIP)‐1α, MIP‐1β, IL‐17F and IL‐18 were significantly decreased during remission from pretreatment stage levels. The level of IP‐10 in the pretreatment phase was correlated with serum levels of alanine aminotransferase. Conclusion: Our results suggest that a complex interplay of several cytokines, especially pro‐inflammatory and T‐helper 17 cytokines and regulatory T‐cell suppression by IL‐12p40 may play a pivotal role in the pathogenesis of AIH.