Survival impact of immune cells infiltrating peritumoral area of hepatocellular carcinoma

Inflammatory and immune cells in the tumor microenvironment are reported to be associated with tumor progression in several cancers. In total, 225 patients who underwent initial and curative hepatectomy for hepatocellular carcinoma (HCC) from 2004 to 2013 were enrolled in this study. Tumor‐associated neutrophils (TANs), M2 macrophages (TAMs; tumor‐associated macrophages), CD8⁺ T cells, and regulatory T cells (Tregs) were evaluated by immunohistochemistry (IHC), and their relationships with patient clinicopathological characteristics and prognosis were evaluated. IHC was performed focusing on TANs first. We could not find a relationship between intratumoral and peritumoral TANs and clinicopathological features except for the fibrous capsule and infiltration of tumors into capsule. Next, TAMs, CD8⁺ cells and Tregs were evaluated by IHC. At the peritumoral area, TANs and TAMs (r = 0.36, p = 0.001) or Tregs (r = 0.16, p = 0.008) showed a positive correlation, whereas TANs and CD8⁺ cells showed a negative correlation (r = −0.16, p = 0.02). As for survival outcomes, at the peritumoral area, high TANs (p = 0.0398), low CD8⁺ cells (p = 0.0275), and high TAMs (p = 0.001) were significantly associated with worse overall survival (OS). In addition, high TANs (p = 0.010), and high TAMs (p = 0.00125) were significantly associated with worse disease‐free survival (DFS). Finally, we established a risk signature model by combining the expression patterns of these cells. The high‐risk signature group had significantly worse OS (p = 0.0277) and DFS (p = 0.0219) compared with those in the low‐risk signature group. Our risk signature based on immune cells at the peritumoral area of the HCC can predict patient prognosis of HCC after curative hepatectomy.     

Analysis of follow-up data from an outpatient pain management program for refractory chronic pain

Background

Numerous reports indicate that multifaceted pain management programs based on cognitive-behavioral principles are associated with clinically meaningful long-term improvements in chronic pain. However, this has not yet been investigated in Japan. This study investigated the effects of a multifaceted pain management program in Japanese patients with chronic pain, both immediately after the program and 6 months thereafter.

PAPULAR MUCINOSIS (SCLEROMYXOEDEMA) COMPLICATING DIFFUSE SYSTEMIC SCLEROSIS: CLINICAL FEATURES AND ELECTRON MICROSCOPE OBSERVATIONS

Papular mucinosis (scleromyxoedema) is an uncommon disordercharacterized by generalized papular eruption and cuta neousinduration, which may be associated with a variety of extracutaneousmanifestations. Although scleroderma and papular mucinosis sharemany features, they are clinically and histologically distinctentities. We report here a patient with diffuse sclerodermawho developed superimposed papular mucinosis. Degranulatingmast cells were a prominent ultra- structural finding in theinvolved skin. The occurrence of scleroderma and papular mucinosis,two uncommon cutaneous indurative diseases, in the same patienthas not been described previously. KEY WORDS: Papular mucinosis, Scleromyxoedema, Systemic sclerosis, Cutaneous mucinosis     

Diagnostic utility of transbronchial lung cryobiopsy: Two cases of anti-aminoacyl-tRNA synthetase syndrome with respiratory failure

Transbronchial lung cryobiopsy (TBLC) is a useful and safe method for the diagnosis of interstitial lung disease (ILD). Herein, we describe the cases of two patients who developed ILD from anti-aminoacyl-tRNA synthetase syndrome with respiratory failure. TBLC was performed instead of surgical lung biopsy. There were no complications, and sufficient specimens were harvested to make the precise histopathological diagnosis. TBLC should be considered as a critical approach for the histopathological diagnosis of ILD in patients who cannot undergo surgical lung biopsy because of respiratory failure.     

A Case of Hemophilia B with Esophageal Varices Treated by Sclerotherapy with Factor-IX Complex

A 64-year-old man with hemophilia B and HCV-positive chronic hepatitis who had been followed at our hospital presented with hematemesis. Gastrointestinal fiber-scopy (GIF) demonstrated a small active gastric ulcer (Az stage) at the pyloric ring and esophageal varices (F₁ L_m C_w RC₍₊₎). He was admitted and the esophageal varices were safely and successfully treated by sclerotheapy. Sclerotherapy was performed by in-traluminal injection of 4 mL 5% ethanolamine oleate with sufficient supplementation of factor-lX complex (PPSB -HT) for four days to a total amount of 24,000 U. The patient was followed with GIF and endoscopic ultrasonography. Sclerotherapy proved effective after six months. We report a rare case of hemophilia B with esophageal varices successfully treated by sclerotherapy.     

A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40–60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.Key words: Home-based rehabilitation, Life-Space mobility, Older people