Peritoneal lavage CEA/CA125 is a prognostic factor for gastric cancer patients

Background We recently found an elevation in the pre-operative peritoneal lavage carcinoembryonic antigen (CEA) level to be associated with an earlier detection of recurrent peritoneal dissemination and a poor prognosis. Method Two hundred and twenty-nine patients with gastric cancer were intraoperatively measured for tumor markers, CEA and CA125 based on peritoneal lavage using a chemiluminescent enzyme immunoassay. Results The patients were divided into four groups. (A) The peritoneal lavage CEA (−) CA125 (−) group (CEA < 0.4 ng/ml, CA125 < 200 ng/ml, n = 129); (B) the peritoneal lavage CEA (−) CA125 (+) group (CEA < 0.4 ng/ml, CA125 ≧ 200 ng/ml, n = 50); (C) the peritoneal lavage CEA (+) CA125 (−) group (CEA ≧ 0.4 ng/ml, CA125 < 200 ng/ml, n = 18); and (D) the peritoneal lavage CEA (+) CA125 (+) group (CEA ≧ 0.4 ng/ml, CA125 ≧ 200 ng/ml, n = 32). The 5-year survival of the patients in groups C and D was 40 and 26%, respectively, which was lower than that of the patients in any other group (group A, B; p < 0.0001). Recurrent sites were both peritoneal dissemination and lymph node/liver in group C, while those were only peritoneal dissemination in group D. Conclusion This combined analysis of these markers is therefore considered to be helpful method to accurately estimate the recurrent sites and prognosis for advanced gastric cancer patients.     

Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis

STUDY DESIGN: A radiographic study in 111 patients using radiographs was conducted. OBJECTIVE: To clarify whether the modified laminoplasty with C3 laminectomy preserving the semispinalis cervicis (SSC) inserted into C2 could maintain the postopertive range of motion (ROM) and sagittal alignment compared with conventional C3-C7 laminoplasty reattaching the muscle to C2. SUMMARY OF BACKGROUND DATA: Intraoperative injury of the SSC is relevant to the significant loss of ROM and the malalignment after laminoplasty. To expose the C3 lamina, however, the SSC inserted into C2 could not be preserved in conventional C3-C7 laminoplasty. METHODS: The ROM and sagittal alignment of 70 patients (group A) (52 men, 18 women, mean age 59 y, mean follow-up period 1 y and 7 mo) with C4-C7 laminoplasty with C3 laminectomy were compared with those of 41 patients (group B) (28 men, 13 women, mean age 59 y, mean follow-up period 2 y and 6 mo) with C3-C7 laminoplasty using radiographs of the cervical spine. RESULTS: Regarding C2-C7 ROM, the postoperative ROM was larger (P=0.003) and the decrease rate of ROM was smaller (P=0.0006), and decreased ROM in extension was smaller (P<0.0001) in group A. Regarding O-C2 ROM, the increased ROM was smaller (P=0.043) and increased ROM in extension was smaller (P=0.001) in group A. Regarding O-C7 ROM, the postoperative ROM was larger (P=0.029) in group A. Regarding the cervical alignment, the increased lordotic angle at O-C2 was smaller (P=0.046) in group A. CONCLUSIONS: This modified laminoplasty preserving the SSC inserted into C2 is an effective procedure for maintaining postoperative ROM, especially in extension, and sagittal alignment of the upper cervical spine well.     

Original cementless femoral stem for dysplastic hip: clinical results of HPF stem

We designed and developed the original cementless femoral stem (HPF) adapted to femurs of developmental dysplasia of the hip (DDH). Twenty-three arthroplasties using HPF were performed in 22 cases. The average age at the operation was 48.4 years. The average follow-up period was 6 years and 10 months. The average Harris Hip Score improved from 46.3 points preoperatively to 93.4 points postoperatively. All stems were classified as bone-ingrown or stable fibrous fixation. Clinically and radiologically excellent results proved the design concept of the HPF realized good fixation in the proximal femur with deformities of DDH. The surface treatment worked well for biological fixation even in clinically difficult cases with poor bone quality and/or complicated deformity of the femur of DDH.     

Limitations of activities of daily living accompanying reduced neck mobility after cervical laminoplasty

Introduction After laminoplasty, difficulties with neck mobility often interfere with patients’ activities of daily living (ADL). Although it has been reported that the flexion–extension range of motion significantly decreased after laminoplasty, in many studies using radiographs there were few patient-based outcomes. The purpose of this study was to reveal the frequency, severity and factors related to limitations of ADL accompanying neck mobility after laminoplasty. Materials and methods A total of 58 patients were evaluated after laminoplasty to determine the frequency, severity and pre- and postoperative related factors of postoperative limitations of ADL accompanying each of three neck movements: (1) extension, (2) flexion and (3) rotation. The severity of limitations of each ADL was assessed using a questionnaire that was completed by the patient. Results Difficulties in neck movement, such as rotation (41%), extension (34%) and flexion (17%), in that order (P = 0.001), caused limitations of ADL. The most relevant factor of limitations of ADL accompanying extension, flexion, and rotation were small postoperative O–C7 range of motion (P = 0.0001), small preoperative O–C7 range of motion (P = 0.001), and small postoperative rotation range of motion (P = 0.0005), respectively. Conclusion There were more than a few patients with limitations of ADL accompanying reduced neck mobility after laminoplasty. This knowledge may be useful in the clinical outcomes of cervical laminoplasty.     

Evaluation of recurrent nodal disease after definitive radiation therapy for nasopharyngeal carcinoma: diagnostic value of fine-needle aspiration cytology and CT scan

BACKGROUND: Recurrent nodal disease in patients with nasopharyngeal carcinoma (NPC) after definitive radiotherapy presents a difficult clinical problem. This cohort of patients poses a diagnostic challenge to the head and neck surgeon because evaluation of the post-irradiated neck, both clinically and radiologically, is known to be difficult, and it is not uncommon for neck dissection specimen in suspected recurrent nodal disease to contain no viable tumor cells. Currently, there is no well-accepted method for the preoperative determination of the presence of malignancy in these nodal diseases. METHODS: Over a 7-year period in a tertiary hospital, we systematically reviewed the clinical charts of 42 patients with NPC who were diagnosed with suspected recurrent nodal disease, after radical definitive radiotherapy. Fine-needle aspiration cytology (FNAC) was performed on clinically palpable nodes and results were correlated with final histopathologic results. Findings on CT scan were also correlated with final histopathologic specimens. RESULTS: The specificity and sensitivity of FNAC was 75.0% and 75.0%, respectively. The positive and negative predictive value of FNAC was 93.8% and 37.5%, respectively. CT scan had a positive predictive value of 78.6%. The negative predictive value for multilevel involvement on CT scan was 20%. CONCLUSION: Radiological imaging and FNAC are useful diagnostic modalities in assessing recurrent nodal disease in the post-irradiated neck in patients with NPC. Although routine CT scan criteria for pathologic lymphadenopathy cannot be accurately applied in the post-irradiated neck, it is a useful surveillance tool in the routine follow-up of patients with post-irradiated neck with NPC. Clinicians, however, must understand their limitations when assessing these patients. The possibility of negative neck dissection must be conveyed to the patients.     

HLA/KIR基因系统与HCV感染的相关性研究进展

丙型肝炎是由丙型肝炎病毒(hepatitis C virus,HCV)感染导致的世界范围的感染性疾病,我国是高流行地区.多项研究表明:人类白细胞抗原(human leucocyte antigen,HLA)以及其特异配体-杀伤细胞免疫球蛋白样受体(killer cell immunoglobulin-like receptors,KIR)类型与HCV感染结局相关.HLA、KIR各自的多态性使得受体KIR与配体HLA的结合更为复杂化,二者结合的强弱以及KIR抑制性和激活性受体之间的平衡关系,直接影响了机体对HCV感染的免疫能力.该文将从HLA/KIR基因系统与HCV易感性,HLA/KIR基因系统与HCV自体清除的相关性以及它们在HCV感染进程中的作用三个方面来进行综述.     

Lactoferrin inhibits Porphyromonas gingivalis proteinases and has sustained biofilm inhibitory activity

Porphyromonas gingivalis is a bacterial pathogen associated with chronic periodontitis that results in destruction of the tooth's supporting tissues. The major virulence determinants of P. gingivalis are its cell surface Arg- and Lys-specific cysteine proteinases, RgpA/B and Kgp. Lactoferrin (LF), an 80-kDa iron-binding glycoprotein found in saliva and gingival crevicular fluid, is believed to play an important role in innate immunity. In this study, bovine milk LF displayed proteinase inhibitory activity against P. gingivalis whole cells, significantly inhibiting both Arg- and Lys-specific proteolytic activities. LF inhibited the Arg-specific activity of purified RgpB, which lacks adhesin domains, and also inhibited the same activity of the RgpA/Kgp proteinase-adhesin complexes in a time-dependent manner, with a first-order inactivation rate constant (k(inact)) of 0.023 min(-1) and an inhibitor affinity constant (K(I)) of 5.02 μM. LF inhibited P. gingivalis biofilm formation by >80% at concentrations above 0.625 μM. LF was relatively resistant to hydrolysis by P. gingivalis cells but was cleaved into two major polypeptides (53 and 33 kDa) at R(284) to S(285), as determined by in-source decay mass spectrometry; however, these polypeptides remained associated with each other and retained inhibitory activity. The biofilm inhibitory activity of LF against P. gingivalis was not attributed to direct antibacterial activity, as LF displayed little growth inhibitory activity against planktonic cells. As the known RgpA/B and Kgp inhibitor N-α-p-tosyl-l-lysine chloromethylketone also inhibited P. gingivalis biofilm formation, the antibiofilm effect of LF may at least in part be attributable to its antiproteinase activity.     

PS2-20: Identifying Treatment Resistant Depression in Administrative Claims Databases

Background/Aims Over 50% of depressed patients fail to remit after an adequate antidepressant (AD) treatment course, and 35% remain symptomatic after two adequate treatment courses. Patients with treatment-resistant depression (TRD) have higher risks of morbidity and mortality, and substantially higher healthcare expenditures. This study aims to develop and validate algorithms to identify patients with TRD in claims databases. Methods We first identified Harvard Pilgrim Health Care members aged 18 years or older who had a diagnosis of depression and new use of selective serotonin reuptake inhibitors or serotonin- norepinephrine reuptake inhibitors (after at least 365 days of no AD use) in 2000-2009. Among these patients, we identified those who received adequate treatment, defined as treatment initiated at or greater than the recommended starting dose based on practice guidelines and taken for at least 8 weeks. We will further identify patients with TRD, i.e., patients who are treated adequately but fail to remit. Although multiple definitions for TRD exist in the guidelines and literature, we will use the emerging consensus of failure to remit after two adequate treatment courses as our definition of TRD. We will consider various markers of treatment resistance such as switching ADs (particularly to those reserved for second-line), adding atypical antipsychotics or other non-AD medications commonly used for depression, and invasive nonpharmacologic intervention. We will validate our algorithms via chart review. Results In preliminary results, 114,002 patients meeting inclusion criteria initiated an AD and 63,882 (56.0%) completed an adequate treatment course. Among these patients, 35,547 (55.6%) continued that treatment, 10,255 (16.1%) stopped treatment, and 5,753 (9.0%) switched to another AD. Among switchers, 3,625 (63.0%) achieved adequate treatment with the second AD. After examining treatment patterns and markers of treatment resistance, we will select the most promising algorithm and validate 300 randomly selected potential cases identified by the algorithm beginning in December. Discussion Claims databases have potential to identify TRD, but algorithms to identify such patients must be developed. Once such an algorithm is validated, these databases can be assessed to answer important questions about the safety and effectiveness of treatments for TRD patients. Primary: Mental Health.