It is difficult to predict the clinical outcome of gemtuzumab ozogamicin (GO) therapy based solely on the previously identified predictive factors. We retrospectively analyzed the relationship between clinical factors and outcomes in 12 patients with relapsed or refractory acute leukemia who received GO monotherapy. The median patient age at initial GO infusion was 56 years, and the average initial dosage was 8.1 mg/m². Four patients (33%) achieved an overall remission (OR). The time from diagnosis to GO infusion was significantly longer in patients with OR than in patients with no remission (NR)(1747 vs. 501 days, respectively; P < 0.01). The number of karyotype abnormalities before GO infusion was significantly greater in NR patients (9.5) than in OR patients (0.5; P = 0.03). Monocyte counts in the bone marrow before GO therapy were significantly lower in OR than in NR patients (100/μL vs. 1080/μL, respectively; P = 0.048). In a multivariate analysis, monocyte count was significantly associated with overall survival (P = 0.005). CD14 expression in OR patients was lower than in NR patients, with the exception of 4 patients whose French-American-British subtypes were M4 or M5 (OR, 0.3%; NR, 2.5%; P = 0.04). NR was noted in all 6 patients who underwent allogeneic stem cell transplantation before and/or after GO infusion. Patients showing good sensitivity to conventional chemotherapy with good survival after diagnosis tend to be sensitive to GO as well. A low monocyte count in the bone marrow at infusion of GO might indicate improved efficacy of GO therapy. Further investigation is warranted for establishing appropriate patient selection and for clarifying efficient conditions for GO therapy.

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We evaluated clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices in patients with portal hypertension. Of 50 patients with gastric varices who underwent B-RTO, 46 (94.0%) patients in whom B-RTO was technically successful were reviewed retrospectively. Gastric and esophageal varices after B-RTO were evaluated by contrast-enhanced computer tomography and endoscopy, respectively. Liver function parameters and Child-Pugh scores were estimated before and at 1 year after B-RTO. The cumulative survival rate was calculated, and univariate and multivariate analyses were used to assess the prognostic factors. No major complications occurred in any of the patients following B-RTO and no recurrence or bleeding of gastric varices was noted. Of the 42 patients who were followed up for the progression of esophageal varices, 13 (31.0%) had worsened varices and of these, 6 (14.3%) showed bleeding. Prothrombin activity had significantly improved at 1 year after B-RTO, although there were no changes in other liver function parameters. The overall cumulative survival rates at 1, 3, and 5 years after B-RTO were 91.6%, 70.9%, and 53.6%, respectively. Multivariate analysis identified the occurrence of advanced hepatocellular carcinoma (HCC) during the observation period as a prognostic factor for survival (hazard ratio = 4.1497, 95% CI = 1.32314-13.0319, P = 0.0148). B-RTO of gastric varices is an effective treatment ensuring lower recurrence and bleeding rates; however, these patients require careful observation for progression of esophageal varices. The management of HCC is crucial for achieving long-term survival after B-RTO.

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This study sought to compare the effects of either a blue light-filtering intraocular lens (blue-filtering IOL) or an ultraviolet light-filtering intraocular lens (UV-filtering IOL) on the incidence of angiographic macular edema (ME) 3 and 12 months after implantation. A prospective randomized parallel clinical study was performed at Showa University Hospital. Forty-five cataract patients randomly received either a blue-filtering IOL (n = 21) or a UV-filtering IOL (n = 24), and macular leakage was evaluated by fluorescence angiography. At 3 months, ME was 24% in the blue- and 25% in the UV-filtering IOL group. At 12 months, ME was 5% in the blue- and 21% in the UV-filtering IOL group. The recovery rate in the blue-filtering IOL group was higher than in the UV-filtering IOL group at 12 months after surgery (P = 0.0457). These results suggested that an implanted blue-filtering IOL is more effective for recovery of ME than a UV-filtering IOL.

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Secondary normal pressure hydrocephalus (NPH) frequently occurs after severe head injury and cerebrovascular disease. This condition is usually treated by surgically implanting a cerebrospinal fluid (CSF) shunt with a pressure-setting valve or programmable valve. However, some patients do not respond to the shunt operation. Among these non-responders, we found 7 patients whose pressure-setting shunts were mechanically patent, but were not functioning due to very low intracranial pressure (ICP). In these 7 cases, continuous ICP monitoring indicated low pressure with occasional negative pressure, and the patients' consciousness improved during negative-pressure CSF drainage. We performed shunt revisions with zero setting on-off valves, which raised the mean functional independence measure (FIM) scores from 26 to 62. Four patients in a persistent vegetative state (PVS) regained their ability to communicate and recovered to the level of severely disabled (SD). We propose very low-pressure hydrocephalus (VLPH) as a new clinical entity, and describe the process of diagnosis and treatment.

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Among animal-facilitated therapies, dolphin-facilitated therapy has been shown to beneficially affect human behavior, emotion and speech ability. We recently showed that touching a dolphin reduced the respiratory rate and state anxiety in healthy children. In this study, we collected electroencephalographic data (EEG), widely used for examining various brain functions, before and after touching dolphins. We examined the relationship between EEG power spectra and individual trait anxiety scores. The results showed that the appearance of slow waves in the frontal area increased significantly after touching a dolphin. Furthermore, the difference in slow wave activity was negatively, but significantly, correlated with trait anxiety in the frontal area. This negative correlation showed that slow wave power was greater in subjects with lower trait anxiety, indicating that touching a dolphin may be more effective for subjects with low trait anxiety than those with high trait anxiety. However, even though the increase in slow wave power was lower in subjects with high trait anxiety, touching a dolphin appeared to affect brain rhythms by increasing slow waves.

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Recent studies have shown that chronic obstructive pulmonary disease (COPD) causes various extrapulmonary comorbidities. In addition, cardiovascular disease, the pathogenesis of which involves atherosclerosis, has been emphasized as a cause of mortality in patients with COPD. In the present study, we investigated the presence of classical risk factors for atherosclerosis in 183 patients with COPD. The prevalence of comorbidities (hypertension, diabetes mellitus [DM], and dyslipidemia) was investigated and compared with that in a general population. In patients with COPD, the prevalence of hypertension, DM, and dyslipidemia was 43.2%, 15.8%, and 25.7%, respectively, with the prevalence of DM and dyslipidemia significantly higher in patients than in the general population. Furthermore, there were significant differences in the prevalence of the three disorders in patients with COPD. For example, the prevalence of hypertension was significantly higher than that of diabetes mellitus in patients aged 60-69 years and higher than the prevalence of DM and dyslipidemia in patients aged ≥ 70 years. Regardless of age, hypertension was noted in the greatest number of patients. In conclusion, a high proportion of patients with COPD were found to have the classical risk factors for atherosclerosis. In particular, the prevalence of DM and dyslipidemia was significantly higher in COPD patients than in the general population.

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Although chromoendoscopy and narrow band imaging (NBI) are widely used in diagnosing the invasion depth of colorectal cancers, comparative studies of these modalities are lacking. This meta-analysis compared the performance of these two modalities in colorectal cancer diagnosis. MEDLINE, EMBASE, and Cochrane Library were searched for relevant original articles published up to December 20^th, 2010. Major criteria for article inclusion were: (i) magnifying chromoendoscopy or NBI was used as a diagnostic modality and pit pattern or vascular pattern was used as a diagnostic classification; (ii) sensitivity and specificity were reported; (iii) absolute numbers of true-positive, false-positive, true-negative, and false-negative cases, or their equivalent, were provided; and (iv) pathology of biopsy, endoscopy, or surgical treatment was used as the reference standard. Sensitivity and specificity were pooled using a random effects model. Regression analysis was performed to compare the discriminatory power between chromoendoscopy and NBI by including a dummy variable. We made the assumption that a positive regression coefficient implied a better discriminatory power for NBI, and vice versa. Of 1846 screened articles, 16 fulfilled all inclusion criteria. Pooled sensitivity for chromoendoscopy and NBI was 0.85 (95% CI: 0.82-0.87) and 0.80 (0.76-0.85), respectively, and specificity was 0.98 (0.97-0.99) and 0.98 (0.97-0.99), respectively. The regression coefficient for chromoendoscopy versus NBI was -0.02 (95%CI: -1.18-1.71). These results indicate that chromoendoscopy and NBI may have similar power for the diagnostic assessment of colonic neoplasms. However, other factors such as convenience, time, and cost still must be taken into account in making the final diagnostic choice.

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