Varying length of central myelin along the trigeminal nerve might contribute to trigeminal neuralgia

Several studies have suggested that vascular compression of more distal portions of the trigeminal nerve (Vth cranial nerve: VN) may cause trigeminal neuralgia (TN). However, neurosurgeons performing microvascular decompression intraoperatively cannot identify which type of myelin is being compressed by blood vessels. The aim of this study was to clarify the histological anatomy of central and peripheral myelin in the human VN. Histological analyses were conducted using photomicrographs from 134 cisternal segments of the VN from the brains of 67 cadavers. The three dimensions of the VN were measured in these sections: distance from the point at which the lateral‐most pontine VN merges with the boundary between central and peripheral myelin (line‐a), distance along the medial aspect (line‐b), and the length of the transitional zone (TZ), known as the Obersteiner‐Redlich zone. Twenty‐nine of 134 VNs were available for study. The length of central myelin ranged from 0.69 to 8.66 mm (mean, 3.56 mm; median, 3.10 mm) along the lateral aspect and from 0.36 to 5 mm (mean, 1.81 mm; median, 1.40 mm) along the medial aspect of the VN. The length of the TZ ranged from 0.31 to 3.37 mm (mean, 1.75 mm; median, 1.63 mm). We report here, for the first time, that some individuals had much longer spans of central myelin than those reported previously. Some cases of TN may thus be caused by vascular compression of VN peripheral myelin, especially in cases where central myelin is extended to an unprecedented degree. Clin. Anat. 32:541–545, 2019. © 2019 Wiley Periodicals, Inc.     

Ethnoracial Disparity in Hospital Survival following Transjugular Intrahepatic Portosystemic Shunt Creation for Acute Variceal Bleeding in the United States

PurposeTo investigate the magnitude of racial/ethnic differences in hospital mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation for acute variceal bleeding and whether hospital care processes contribute to them.MethodsPatients aged ≥18 years undergoing TIPS creation for acute variceal bleeding in the United States (n = 10,331) were identified from 10 years (2007–2016) available in the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between patient race and inpatient mortality, controlling for disease severity, treatment utilization, and hospital characteristics.ResultsA total of 6,350 (62%) patients were White, 1,780 (17%) were Hispanic, and 482 (5%) were Black. A greater proportion of Black patients were admitted to urban teaching hospitals (Black, n = 409 (85%); Hispanic, n = 1,310 (74%); and White, n = 4,802 (76%); P < .001) and liver transplant centers (Black, n = 215 (45%); Hispanic, n = 401 (23%); and White, n = 2,267 (36%); P < .001). Being Black was strongly associated with mortality (Black, 32% vs non-Black, 15%; odds ratio, 3.0 [95% confidence interval, 1.6–5.8]; P = .001), as assessed using the risk-adjusted regression model. This racial disparity disappeared in a sensitivity analysis including only patients with a maximum Child-Pugh score of 13 (odds ratio 1.2 [95% confidence interval, 0.4–3.6]; P = .68), performed to compensate for the absence of Model for End-stage Liver Disease scores. Ethnoracial differences in access to teaching hospitals, liver transplant centers, first-line endoscopy, and transfusion did not significantly contribute (P > .05) to risk-adjusted mortality.ConclusionsBlack patients have a 2-fold higher inpatient mortality than non-Black patients following TIPS creation for acute variceal bleeding, possibly related to greater disease severity before the procedure.     

Reduction of Ochratoxin A during the Preparation of Porridge with Sodium Bicarbonate and Fructose

Ochratoxin A (OTA) is a potential human carcinogen that poses a significant concern in food safety and public health. OTA has been found in a wide variety of agricultural commodities, including cereal grains. This study investigated the reduction of OTA during the preparation of rice- and oat-based porridge by a simulated indirect steam process. The effects of sodium bicarbonate (NaHCO₃) and fructose on the reduction of OTA were also investigated. During the processing, OTA in rice- and oat-porridge was decreased by 59% and 14%, respectively, from initial OTA artificially added at 20 μg/kg (dry weight basis). When 0.5% and 1% of sodium bicarbonate were added to rice porridge, increased reduction of OTA was observed as 78% and 68%, respectively. The same amounts of added sodium bicarbonate also further reduced OTA in oat porridge to 58% and 72%, respectively. In addition, increased reduction of OTA in the presence of fructose was observed. A combination of the two, i.e., 0.5% sodium bicarbonate and 0.5% fructose, resulted in a 79% and 67% reduction in rice porridge and oat porridge, respectively. These results indicate that indirect steaming may effectively reduce OTA in preparation of porridge-type products, particularly when sodium bicarbonate and/or fructose are added.     

Efficacy and tolerability of ramucirumab monotherapy or in combination with paclitaxel in gastric cancer patients from the Expanded Access Program Cohort by the Korean Cancer Study Group (KCSG)

Background

Ramucirumab improves survival in gastric cancer patients. The efficacy and safety of ramucirumab outside of a clinical trial were evaluated using an expanded access program (EAP).

Methods

Advanced gastric cancer patients treated with ramucirumab in combination with paclitaxel or with ramucirumab monotherapy in a Korean EAP were evaluated. Baseline characteristics were assessed for progression-free survival (PFS) and overall survival (OS), and adverse events were evaluated according to the treatment regimen.

Results

Of 265 patients, 228 received ramucirumab plus paclitaxel, and 37 received ramucirumab monotherapy. Grade 3 or 4 neutropenia was more common with ramucirumab plus paclitaxel than with ramucirumab monotherapy (46.7 vs. 8.1%). Gastrointestinal (GI) perforation developed in seven patients (3.1%) in the ramucirumab plus paclitaxel group. The overall response and disease control rates were 16.6 and 66.3% in the ramucirumab plus paclitaxel group, and 5.4 and 37.8% in the ramucirumab monotherapy group, respectively. PFS and OS were 3.8 and 8.6 months in the ramucirumab plus paclitaxel group, and 1.8 and 6.4 months in the ramucirumab monotherapy group, respectively. In multivariate analysis, alkaline phosphatase, albumin, and neutrophil-to-lymphocyte ratio (NLR) were the independent prognostic factors for PFS, while albumin, NLR, number of metastatic sites, and large amount of ascites were independent prognostic factors for OS.

Conclusion

In the Korean EAP cohort, ramucirumab showed similar efficacy to the results of the previous trials for gastric cancer. However, the level of GI perforation was slightly increased in the ramucirumab plus paclitaxel group.

     

Poor prognosis in Epstein–Barr virus-negative gastric cancer with lymphoid stroma is associated with immune phenotype

Background

Gastric cancer with lymphoid stroma (GCLS) is pathologically characterized by poorly developed tubular structures with a prominent lymphocytic infiltration. Its clinical and prognostic features differ in patients positive and negative for Epstein–Barr virus (EBV) infection. This study analyzed the expression of programmed cell death-1 (PD-1), programmed cell death ligand-1 (PD-L1), and the density of tumor-infiltrating lymphocytes (TILs) including CD3+ and CD8+ T cells, as well as their prognostic significance in patients with GCLS.

Methods

The study included 58 patients with GCLS (29 EBV+ and 29 EBV?) who underwent curative resection. Expression of CD3, CD8, PD-1, and PD-L1 in tumor cells and TILs was analyzed using a quantitative multispectral imaging system (Opal?), with these results validated by immuno-histochemical assays for PD-L1 on whole slide sections.

Results

The proportion of tumors overexpressing PD-L1 (31.0 vs. 0%, P = 0.002), TIL density (4548 vs. 2631/mm², P < 0.001), and intra-tumoral CD8+ T-cell density (2650 vs. 1060/mm², P < 0.001) were significantly higher in EBV+ than in EBV? GCLS. In addition, CD8+/CD3+ T-cell ratio was higher in EBV+ than in EBV? GCLS (55.3 vs. 35.8%, P < 0.001). Lower TIL density, defined as < 1350/mm², was a significant negative factor of survival.

Conclusions

Despite histopathological similarity, quantitative multispectral imaging revealed differences in the tumor immune micro-environment between EBV+ and EBV? GCLS, indicating that the underlying pathogenesis differs in these two disease entities. TIL density may be a prognostic marker in patients with GCLS.

     

Complete metabolic response (CMR) in positron emission tomography–computed tomography (PET‐CT) scans may have prognostic significance in patients with marginal zone lymphomas (MZL)

Although clinical use of positron emission tomography–computed tomography (PET‐CT) scans is well established in aggressive lymphomas, its prognostic value in marginal zone lymphoma (MZL) remains yet unclear. Hence, we investigated potential role of PET‐CT in predicting MZL patients' outcomes following systemic chemotherapy. A total of 32 patients with MZL who received first‐line chemotherapy were included in the analysis. They all underwent pretreatment, interim, and posttreatment PET‐CT scans. The primary objective was to evaluate the role of complete metabolic response (CMR) in posttreatment PET‐CT scans in predicting progression‐free survival (PFS). Compared with non‐CMR group, 5‐year PFS rate was significantly higher in patients who achieved CMR in posttreatment PET‐CT (54.2% vs 0.0%, P = .003) and also in patients gaining CMR in interim PET‐CT scans (62.5% vs 15.6%, P = .026). Interestingly, early CMR group, who achieved and maintained CMR in both interim and posttreatment PET‐CT scans, showed significantly higher 5‐year PFS than those with delayed or never CMR group (62.5% vs 37.5% vs 0%, P = .008). Therefore, interim and/or posttreatment CMR can be prognostic at least in these subsets of patients with MZL treated with chemotherapy.     

Effects of symptom clusters and depression on the quality of life in patients with advanced lung cancer

People with advanced lung cancer experience later symptoms after treatment that is related to poorer psychosocial and quality of life (QOL) outcomes. The purpose of this study was to identify the effect of symptom clusters and depression on the QOL of patients with advanced lung cancer. A sample of 178 patients with advanced lung cancer at the National Cancer Center in Korea completed a demographic questionnaire, the M.D. Anderson Symptom Inventory–Lung Cancer, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy–General scale. The most frequently experienced symptom was fatigue, anguish was the most severe symptom‐associated distress, and 28.9% of participants were clinically depressed. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Three symptom clusters were identified: treatment‐associated, lung cancer and psychological symptom clusters. The regression model found a significant negative impact on QOL for depression and lung cancer symptom cluster. Age as the control variable was found to be significant impact on QOL. Therefore, psychological screening and appropriate intervention is an essential part of advanced cancer care. Both pharmacological and non‐pharmacological approaches for alleviating depression may help to improve the QOL of lung cancer patients.