Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes

Introduction

Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer.

Implications of electrocardiographic frontal QRS axis on left ventricular diastolic parameters derived from electrocardiogram-gated myocardial perfusion single photon emission computed tomography

Background

Current electrocardiographic (ECG) machines report various variables including frontal QRS axis automatically. We tested the hypothesis that QRS axis is associated with left ventricular (LV) diastolic parameters derived from ECG-gated myocardial perfusion single photon emission computed tomography (SPECT) independent of myocardial ischemia.

Methods

Ninety-three patients with preserved LV ejection fraction and no evidence of myocardial ischemia were enrolled based on ECG-gated SPECT. Peak filling rate (PFR), one-third mean filling rate (1/3 MFR) and time to peak filling (TTPF) were obtained as LV diastolic parameters.

Results

There were 82 male and 11 female patients with a mean age of 69?±?9 years. QRS axis ranged from ??40° to 85° (36°?±?31°). QRS axis was correlated with PFR (r?=?0.28, p?<?0.01), 1/3 MFR (r?=?0.25, p?=?0.02) and TTPF (r?=???0.21, p?=?0.04). QRS axis was also correlated with age (r?=???0.23, p?=?0.03), body mass index (BMI) (r?=???0.36, p?<?0.01) and LV mass index (LVMI) (r?=???0.27, p?<?0.01). Linear regression analysis showed that QRS axis was associated with PFR, 1/3 MFR and TTPF for LV diastolic function, but was not associated with these LV diastolic parameters after adjustment of various confounders.

Conclusions

Our data suggest that QRS axis depends on age, BMI or LVMI, and serves as a surrogate marker of LV diastolic function.

     

Neuro-otological study on Beh?et disease]

It seems acceptable that pathological brain stem lesions exist in the patient with Neuro-Beh?et disease (NB). However, only few reports have been published in this field. We report the neuro-otological findings in 33 patients who fulfilled the diagnostic criteria of Beh?et disease completely or incompletely. The patients were classified into 2 groups: one is group of NB and the other is a group of Beh?et disease without NB (non-NB). Furthermore, the latter was divided into 2 subgroups of patients with dysequilibrium and patients with normal equilibrium. They underwent equilibrium function tests, such as body balance test, gaze test, spontaneous and positional nystagmus test, eye tracking test (ETT) and optokinetic pattern test (OKP) by using electro-nystagmography (ENG). The following results were obtained. 1. Cerebellar and brain stem lesions were confirmed in all cases of NB group. 2. Most cases (6 of 8 cases) in the subgroup of dysequilibrium of the non-NB group showed peripheral vestibular disturbance. The other two patients were diagnosed to be vertebro-basilar insufficiency (VBI) and vascular Beh?et disease with CNS disorder, respectively. 3. Nine of 13 patients in the normal equilibrium subgroup of the non-NB group were diagnosed to be neuro-otologically normal. However, we found two patients with peripheral vestibular disturbance and CNS disorder associated with hearing disturbance of the retrocochlear origin, respectively. 4. The neuro-otological examination is assumed to be useful to diagnose neuro-Beh?et disease, to reveal the lesion site and the state of dysequilibrium in patients with Beh?et disease.     

Exogenous porcine surfactant (Curosurf) is inactivated by monoclonal antibody to the surfactant-associated hydrophobic protein SP-B

A monoclonal antibody to the surfactant-associated hydrophobic protein SP-B was added at various concentrations to a standard preparation of porcine surfactant (Curosurf 10 mg/ml), and surface properties were evaluated with pulsating bubble. Retarded adsorption of surfactant was observed at antibody concentrations > or = 0.5 mg/ml and significantly increased values for minimum surface tension were observed at antibody concentrations > or = 1 mg/ml. In vivo effects of the antibody were tested in immature newborn rabbits ventilated with a standardized sequence of insufflation pressures. Animals receiving 0.1 ml surfactant (80 mg/ml) mixed with antibody at concentrations > or = 4 mg/ml had low tidal volumes, poor lung stability in pressure-volume recordings, poor alveolar expansion in histological sections and widespread epithelial necrosis in peripheral airways. Admixtures of IgG had no such effects. We conclude that this monoclonal antibody inactivates exogenous porcine surfactant, probably by preventing fast adsorption of surfactant lipids to the alveolar air-liquid interfaces.     

Catalytic lectin (leczyme) from bullfrog (Rana catesbeiana) eggs

Catalytic lectins (leczymes) of frog eggs are sialic acid-binding lectins that have intrinsic RNase activity. They inhibit tumor cell proliferation in vitro and in vivo, although their cytotoxic mechanism remains unclear. RNase A has no tumoricidal activity. It is hypothesized that leczymes bind to cell surface sialoglycoconjugate receptors, enter the cell, and subsequently degrade RNA. In order to investigate the cytotoxic mechanism of cSBL, a leczyme from Rana catesbeiana eggs, we established cSBL-resistant clone RC-150 from mouse leukemia P388 cells. cSBL-treated P388 cells showed extensive RNA degradation over the course of 1 h, whereas cSBL-treated RC-150 cells showed no RNA degradation even over the course of 24 h. Treatment of P388 cells with cSBL led to decreased concentration of intracellular Ca2+, decreased protein kinase A activity, and increased protein kinase G activity. Incubation with cSBL decreased glutathione levels and enhanced glutathione-S-transferase (GST) activity in P388 cells, but had no effect on RC-150 cells. We conclude that cSBL-specific degradation of RNA occurs in cSBL-sensitive tumor cells, that cSBL leads to alteration of signal transduction and an intracellular protein kinase cascade reaction, and that internalized cSBL is detoxified by GST or thioltransferase. Our findings support a bifunctional model in which a leczyme is both an adhesive protein (binding to sialoglycoconjugates) and an enzyme (displaying RNnase activity).     

Preoperative chemoradiotherapy does not compromise the feasibility of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma

Purpose

Preoperative chemoradiotherapy (CRT) is a novel, emerging treatment strategy for pancreatic ductal adenocarcinoma (PDAC), but it remains unclear whether post-surgery adjuvant chemotherapy is feasible following preoperative CRT. This retrospective study evaluates the feasibility of adjuvant therapy after preoperative CRT.

Methods

The subjects of this study were 99 consecutive patients who underwent pancreatectomy for PDAC between January, 2007 and February, 2013 in our hospital. Sixty patients received preoperative CRT: as gemcitabine (GEM) and 40 Gy radiation in 28 (G-CRT group), and as GEM, S-1, and 50.4 Gy radiation in 32 (GS-CRT group). We also evaluated 39 patients who underwent surgery alone (SA group). We investigated adjuvant chemotherapy induction and completion rates and the frequency of adverse events rated ≥grade 3, based on Common Terminology Criteria for Adverse Events (version 4.0) in all three groups.

Results

In the G-CRT, GS-CRT, and SA groups, the induction rates were 78 % (22/28), 78 % (25/32), and 72 % (28/39), respectively; completion rates were 86 % (19/22), 88 % (22/25), and 82 % (23/28), respectively; and adverse event frequencies were 36 % (8/22), 28 % (7/25), and 43 % (12/28), respectively. No significant difference was found among the three groups.

Conclusion

Preoperative CRT was demonstrated to be safe and did not compromise the feasibility of adjuvant chemotherapy.

     

Antineutrophil cytoplasmic antibody-associated glomerulonephritis with immunoglobulin deposition

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis is commonly classified as pauci-immune glomerulonephritis; however, some cases have granular immunoglobulin deposition along the glomerular capillary. The pathogenesis of immune deposits is poorly studied.

Methods

Of 66 patients diagnosed with ANCA-associated glomerulonephritis on renal biopsy, cases with immunoglobulin deposition along the glomerular capillary were identified and their clinicopathological characteristics were analyzed. We also performed myeloperoxidase (MPO) and double immunofluorescence (IF) stainings to determine the presence of immune complex antigens.

Results

Granular IgG deposition, IgG plus IgM deposition, and IgM deposition were observed in 15 (22.1%), 8 (11.2%), and 17 (25.0%) cases, respectively. In cases with granular IgG deposition, MPO-IgG double IF staining revealed co-localization of MPO and IgG. In cases with granular IgM deposition, MPO-IgM double IF staining did not co-localize. By electron microscopy, subepithelial deposition as well as intramembranous, subendothelial, and mesangial deposition was detected in the patients with IgG deposition. In addition, renal survival curves were not significantly different between the immunoglobulin deposition and non-deposition groups.

Conclusions

Granular IgG and/or IgM deposition was observed in 60.6% of patients with ANCA-associated glomerulonephritis. In cases with IgG deposition, electron-dense deposits (EDDs) were observed at various sites in the glomerulus, and MPO and IgG immunocomplex deposition was frequently observed along the glomerular capillary. With IgM deposition, EDDs were not obvious in the glomerular basement membrane, and MPO and IgM immunocomplex was not detected. These data suggest differential mechanism between IgG deposition and IgM deposition.

     

Effect of Patient Characteristics on Vessel Enhancement in Pediatric Chest Computed Tomography Angiography

IntroductionTo evaluate the effect of sex, age, height, cardiac output (CO), total body weight (TBW), body surface area (BSA), and lean body weight (LBW) on vessel enhancement of the ascending aorta in pediatric chest computed tomography angiography (c-CTA).Materials and MethodsThis retrospective study received institutional review board approval; parental prior informed consent for inclusion was obtained for all patients. All 50 patients were examined using our routine protocol; iodine (600 mg/kg) was the contrast medium (CM). Unenhanced and contrast-enhanced scans were obtained. We calculated the CM volume per vessel enhancement and performed univariate and multivariate linear regression analysis of the relationship between CM volume per vessel enhancement and each of the body parameters.ResultsAll patient characteristics were significantly related to CM volume per vessel enhancement (P < .05). Multivariate linear regression analysis revealed a significant correlation between CM volume per vessel enhancement and TBW, BSA, and LBW, but not the patient sex, age, CO, and height. The LBW model for CM volume per vessel enhancement yielded the highest determination coefficient (R² = .913) and the lowest Akaike Information Criterion (400.324).ConclusionsOur findings support the delivery of an iodine dose adjusted to the LBW at c-CTA.