Comparison of evaluations for hormone receptors in breast carcinoma using two manual and three automated immunohistochemical assays

The aims of this study were to compare the quality of immunohistochemical assays of estrogen receptor (ER) and progesterone receptor (PR) and to compare the intermethod variability of assays from different manufacturers. immunohistochemical staining was entrusted to the following laboratories in Japan: Kyowa Medex, dealing with the products of BioGenex (Mishima, Shizuoka), DAKO Japan (Kyoto) and Ventana Japan (Yokohama). All slides were semiquantitatively evaluated according to the Allred score. Intermethod variability showed fair to moderate multirater kappa values for ER and PR (for total score, ER, kappa = 0.34; PR, kappa = 0.45). Another scoring system was also applied in which, irrespective of the intensity of nuclear staining, the proportion of cells stained in each specimen was recorded as 0; less than 1%; 1% or more and less than 10%; or 10% or more. Intermethod variability showed substantial multirater kappa values for ER and PR (according to percentage of positive cells, ER, kappa = 0.67; PR, kappa = 0.72). Concerning intermethod consistency, the scoring system based on the percentage of positive cells was advantageous over other scoring systems.     

Serum concentrations of von Willebrand factor and soluble thrombomodulin indicate alteration of endothelial function in inflammatory bowel diseases

Serum concentrations of immunoreactive von Willebrand factor (vWF) and soluble thrombomodulin (TM), and vWF multimer patterns were measured to assess endothelial function in patients with inflammatory intestinal diseases. In Crohn's disease and acute infective diarrhea, vWF concentrations were significantly higher than in normal controls. In all patient groups, multimeric analysis of vWF and the concentration of serum TM were not different from normal controls. The results indicate alteration of endothelial function in inflammatory intestinal disorders. They may be compatible with the presence of localized vasculitis, but indicate that systemic endothelial destruction does not occur in inflammatory bowel disease.     

Safety and efficacy of the combination of the glucagon‐like peptide‐1 receptor agonist liraglutide with an oral antidiabetic drug in Japanese patients with type 2 diabetes: Post‐hoc analysis of a randomized, 52‐week,open‐label,parallel‐group trial

Aims/Introduction

The aim of the present post‐hoc analysis was to investigate the safety and efficacy of liraglutide in combination with one oral antidiabetic drug (OAD) across different OAD classes.

Materials and Methods

This was a post‐hoc analysis using data from a 52‐week, open‐label, parallel‐group trial, in which patients with type 2 diabetes inadequately controlled with a single OAD (α‐glucosidase inhibitor, glinide, metformin or thiazolidinedione) were randomized to either pretrial OAD in combination with liraglutide 0.9 mg/day (liraglutide group) or pretrial OAD in combination with an additional OAD (additional OAD group). The primary outcome investigated in this post‐hoc analysis was the incidence of adverse events.

Results

The proportions of patients experiencing adverse events across the different groups of pretrial OADs were comparable between liraglutide and additional OAD (α‐glucosidase inhibitor 74.6 vs 70.0%; glinide 93.1 vs 87.1%; metformin 91.8 vs 87.1%; thiazolidinedione 86.2 vs 96.4%, respectively). Minor hypoglycemia was infrequent (seven episodes in two patients randomized to liraglutide, and two episodes in two patients randomized to additional OAD). The mean reduction in glycated hemoglobin appeared greater with liraglutide therapy, with the estimated mean treatment difference (95% confidence interval [CI]) for liraglutide vs additional OAD ranging from ?0.14%, 95% CI: ?0.48 to 0.21 (?1.5 mmol/mol, 95 CI: ?5.2 to 2.3) to ?0.44%, 95% CI:?0.79 to ?0.09 (?4.8 mmol/mol, 95% CI: ?8.6 to ?1.0).

Conclusions

The present analysis suggests that Japanese patients on OAD monotherapy might benefit from a greater improvement in glycemic control, without impacting tolerability, by combining their OAD with liraglutide rather than another OAD, regardless of which OAD monotherapy they are receiving.

     

How many lymph nodes should be examined in Dukes' B colorectal cancer? Determination on the basis of cumulative survival rate

BACKGROUND/AIMS: We analyzed how many lymph nodes should be examined to establish the presence or absence of lymph node metastasis, a staging factor, based on cumulative survival rate in colorectal cancer. METHODOLOGY: Among those who had undergone curative resection of colorectal cancer and lymphadenectomy exceeding D2, 94 patients with Dukes' B colorectal cancer (group B) and 108 patients with Dukes' C colorectal cancer (group C) were investigated, excluding obvious deaths from other diseases. Group B was divided into two groups by the number of lymph nodes examined, and the minimum number of retrieved lymph nodes yielding significant difference in survival rate was determined. RESULTS: Dividing group B into two groups by the number of lymph nodes examined, survival rate was studied. The minimum number of retrieved lymph nodes yielding significant difference in survival rate between the two groups was observed when group B was divided into one group with 9 or more lymph nodes (72 patients) and the other with less than 9 (22 patients), with cumulative five-year survival rate of 86.7% and 66.7%, respectively. More favorable prognoses were observed in the 9 or more group compared with the less than 9 group or Dukes' C group (p=0.0284, p=0.0032, respectively). On the other hand, survival rate of the less than 9 group was similar to that of the Dukes' C group (p=0.8167). CONCLUSIONS: Based on survival rate, 9 or more lymph nodes should be examined in order to correctly ascertain nodal negativity in lymphadenectomy exceeding D2 for Dukes' B colorectal cancer.     

Predictive factors for the progression of primary localized stage small-bowel follicular lymphoma

Journal of Gastroenterology - Primary small-bowel follicular lymphoma (FL) is mainly diagnosed as a duodenal lesion during esophagogastroduodenoscopy. Recently, with the widespread use of...     

Giant Cell Arteritis with Internal Carotid Artery Occlusion in the Absence of Typical Clinical Features

A 65-year-old man presented with a slight headache and transient visual disturbance. Magnetic resonance imaging (MRI) revealed occlusion of the left internal carotid artery (ICA) and acute brain infarctions in both hemispheres, and a blood examination indicated inflammation. Gadolinium enhancement was observed in the walls of the temporal arteries and ICAs. After we diagnosed giant cell arteritis (GCA) by a temporal artery biopsy, aspirin and corticosteroids were administered. The typical symptoms of GCA, such as jaw claudication and temporal artery tenderness, were absent during the entire clinical course, and the findings of contrast-enhanced MRI contributed to the diagnosis.