Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. Serum albumin (Alb) is an important prognostic factor for patients with HCC. Moreover, plasma levels of branched-chain amino acids (BCAA), L-valine, L-leucine, and L-isoleucine, are commonly decreased in patients with cirrhosis. Accordingly, formulations of BCAA has been used to maintain the Alb level and prevent ascites in patients with cirrhosis. The aim of this study is to investigate differences in the changes in Alb between a group that received a BCAA formulation (n = 29) and a group given a standard diet (n = 60) in the course of HCC recurrences. All patients experienced more than one hospitalization (mean: 2.6; range: 2-10) owing to recurrence. The plasma BCAA concentration and BCAA-to-tyrosine ratio (BTR), which is a good indicator of the severity of hepatic parenchymal injury in patients with cirrhosis, were significantly correlated with Alb. We defined the changes in BCAA and Alb between recurrences as ΔBCAA and ΔAlb, respectively, and stratified the patients in both groups based on number of recurrences (3 < early, 3-5 middle, or 5 > later). There was also a positive correlation between ΔBCAA and ΔAlb. Interestingly, in the group with BCAA, ΔAlb and ΔBCAA were significantly smaller, especially in the middle period (3-5 recurrences), than in the group without BCAA. These results indicate that the BCAA supplementation could maintain the BCAA and Alb levels in the middle period (3-5 recurrences). BCAA formulation is useful for hypoalbuminemia in the course of HCC recurrence.
Japanese herbal medicine, also known as Kampo, is used for various diseases in Japan. One of those medicines, Dai-Kenchu-To (DKT), is considered clinically effective for adhesive bowel obstruction and chronic constipation. Although scientific evidence of DKT to improve adhesive bowel obstruction was shown in several previous reports, mechanism of DKT to improve constipation remains unknown. Our aim was to study the effect of intragastric DKT on colonic motility and defecation, and the involvement of various receptors in DKT-induced colonic contractions. Five beagle dogs were instructed with serosal strain-gauge force transducers to measure circular muscle activity at the proximal, middle, and distal colon. Dogs are suitable for a present study to administer the drugs repeatedly to the same individual and look at its effect on colonic motility. We studied the effects of DKT (2.5 or 5 g) administered into the stomach on colonic motility. Muscarinic receptor antagonist atropine, nicotinic receptor antagonist hexamthonium, or 5-hydroxytryptamine-3 receptor antagonist ondansetron was injected intravenously 10 min before DKT administration. Capsazepine, an antagonist to transient receptor potential cation channel subfamily V member 1 (TRPV1), was administered into the stomach 5 min before DKT administration. Intragastric DKT (2.5 or 5 g) induced colonic contractions within 10 min after administration but did not induce defecation. Pretreatment with atropine, hexamthonium, ondansetron, or capsazepine inhibited DKT-induced colonic contractions. These results indicate that orally administered DKT stimulates colonic motility via TRPV1, muscarinic, nicotinic, and 5-hydroxytryptamine-3 receptors, thereby providing scientific support for the efficacy of oral DKT in chronic constipation.
Rete mirabile (or carotid rete) is a normal structure that plays physiological roles in the lower mammals. However, the rete does not exist in the normal carotid circulation of humans. Carotid rete mirabile (CRM) is a rare condition compensating for congenital dysplastic internal carotid artery. Arterial plexus at the cavernous region, which supplies intradural internal carotid artery instead of the aplastic cavernous portion of internal carotid artery, looks like the “rete mirabile” seen in the lower mammals, and is a characteristic angiographical finding of CRM. In addition to the CRM, existence of segmental occlusion and tortuous collaterals of vertebral artery, so-called carotid and vertebral rete mirabile (CVRM), is a very rare condition. We report a 70-year-old female patient with bilateral CVRM presenting with subarachnoid hemorrhage (SAH) caused by the rupture of a cervical spinal artery aneurysm. Our patient is the oldest, compared with the previously reported four patients with CVRM. Moreover, this is the first report of ruptured spinal artery aneurysm as a cause of SAH associated with CRM/CVRM. To avoid rebleeding in the patient, we successfully treated the patients by performing coil embolization of the remaining spinal aneurysms. In patients with CVRM, aneurysm formation of the cervical spinal artery may be a reasonable consequence because of the hemodynamic stress on the spinal artery as a collateral pathway. Detailed evaluation of the cervical spinal arteries should be performed to detect or to rule out ruptured aneurysm in patients with SAH associated with CVRM.
Yolk sac tumor (YST) of the ovary is a rare germ cell tumor comprising about 1% of all ovarian malignancies. YST usually occurs as a rapidly growing unilateral tumor in young women. With the introduction of cisplatin, YST has been changed from a fatal tumor to a curable tumor. The standard treatment of YST consists of fertility-preserving surgery and 3 or 4 courses of adjuvant combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the long-term prognosis of BEP-treated YST patients has not been well studied. We therefore conducted a retrospective multicenter study to investigate the prognostic factors of 33 YST patients, including 25 patients treated with BEP. The median age at initial treatment was 20 years (range 10-53). There were 15 patients (at stage I), one (stage II), 16 (stage III), and one (stage IV). Nominal and grouped numerical values were analyzed by the Kaplan-Meier method. All patients had unilateral tumor, with right-side predominance (23 patients; P = 0.02). Eighteen patients had pure YST, 13 had mixed germ cell tumor with YST component, and other 2 patients were not specified. Twenty-eight patients received fertility-preserving surgery. Twenty-seven patients had optimal surgery with less than 1 cm residual tumor diameter. Median number of chemotherapy courses was 5. Median follow-up period was 49 months. The cumulative 5-year survival rate was 87%. Univariate analysis revealed the following significant prognostic factors (P < 0.05): stage, tumor diameter, and residual tumor. Extensive debulking surgery to minimize residual tumor would improve the prognosis.
Langerhans cell histiocytosis (LCH) is characterized by uncontrolled proliferation of Langerhans cells accompanying eosinophils. It often attacks children under 10 years of age. LCH in identical twins is very rare and its prognosis is different. Here we report identical-twin sisters with LCH. Computed tomography (CT) revealed osteolytic change in each twin’s skull, and the elder exhibited poor eyesight. There were massive histiocyte-like cells surrounded by eosinophils in pathologic specimen of the abnormal lesions, which is typical pathologic finding in LCH. These pathologic cells were positive for S-100 and the cell surface protein CD1 antigen (CD1α), the known markers of LCH. After treating them with surgery, no symptoms were seen in the younger until now. While the older was found another soft mass (about 2.0 cm in diameter) in the left temporal area 18 months later. The same treatment was given to the older after admission, and she is healthy to date. To explore the relationship between hallmarks and the prognosis of identical-twin patients with LCH, we retrieved the 16 literatures (16 identical-twin pairs, 31 patients) listed in PubMed during the past 60 years. The data revealed all those patients who have disseminated to the bone marrow, spleen and liver with symptoms of fever and hepatosplenomegaly exhibited worse prognosis (9 out of the 31 patients). The other identical-twin subjects without infiltration of those organs recovered well. In conclusion, this study reveals the adverse hallmarks of prognosis in identical-twin patients with LCH by reviewing relevant literatures.
Hepatitis B virus (HBV) infection is a global public health problem, because patients with chronic hepatitis B (CHB) may progress to liver cirrhosis and eventually evolve into hepatocellular carcinoma. Decoy receptor 3 (DcR3) is a soluble receptor of the tumor necrosis factor receptor superfamily, and has been implicated in anti-apoptotic and anti-inflammatory pathways. In this study, we explored the clinical value of serum DcR3 in predicting the active status of CHB in hepatitis B e antigen-negative patients (active HBeAg (−) CHB), which was determined with ELISA. The serum level of DcR3 in active HBeAg (−) CHB patients (1.92 ± 0.68 ng/ml) was higher than that in healthy controls (0.80 ± 0.25 ng/ml, p < 0.0001) and that in inactive status of HBeAg (−) CHB (inactive hepatitis B surface antigen carrier, HBsAg-IaC) patients (0.95 ± 0.26 ng/ml, p < 0.0001). DcR3 level was correlated with HBV DNA level (r = 0.819, p < 0.0001) and alanine transaminase level (ALT, r = 0.704, p < 0.0001) in active HBeAg (−) CHB patients. The area under the Receiver Operating Characteristics curve of DcR3 for detecting the active status of HBeAg (−) CHB patients was 0.914 (95% confidence interval, 0.851-0.977). The optimal cut-off value for DcR3 to predict active HBeAg (−) CHB was 1.22 ng/ml, which had a sensitivity of 87.5% and a specificity of 84.4%. These results suggest that serum DcR3 level may be useful for detecting HBeAg (−) CHB in the active stage, which requires medical treatment.
Falling is one of the most common complications of stroke. The purpose of this study was to investigate the impact of falling on cognitive and physical function in post-stroke patients. Further, the predictive factors associated with independence of activity of daily living (ADL) in stroke patients with falls experience were investigated. Sixty-six participants were divided into 2 groups according to history of falling: faller (n = 34) and non-faller (n = 32). All participants were examined for cognitive and physical function. Static balance was measured by postural sway using a force platform. Dynamic balance was measured using the Berg Balance Scale (BBS) and the Modified Rivermead Mobility Index (MRMI), which shows the degree of performance for balance tasks. ADL was measured using the Modified Barthel Index (MBI), which shows the degree of independence. The fallers showed lower cognitive and physical function than the non-fallers (p < 0.05). This finding indicates that falling is associated with reduced physical function, as well as reduced cognitive function. In the fallers, the ADL (MBI) was moderately correlated with each of cognition [MMSE (r = 0.388, p = 0.023)], dynamic balance [MRMI (r = 0.514, p = 0.002) and BBS (r = 0.572, p < 0.000)]. In addition, regression analysis showed that BBS was a primary predictor for ADL performance (R2 = 0.327, β = 0.572, p < 0.000). Our findings indicate that enhancement of dynamic balance is needed to improve in activities necessary for normal self-care of stroke patients with falls experience.
Improving maternal health is a Millennium Development Goal adopted at the 2000 Millennium Summit of the United Nations. As part of the improving maternal health in Tanzania, it has been recommended that skilled birth attendants be present at all births to help reduce the high maternal mortality ratio. However, utilization of these attendants varies across socio-economic groups. The government of Tanzania has repeatedly attempted to carry out health sector reforms (HSRs) to alleviate disparities in health service utilization. In particular, around 1999, HSRs were incorporated into two approaches, including Decentralization by Devolution and Sector Wide Approach. This study aims to clarify the unresolved questions with little published evidence on the effect of HSRs on reducing disparities in utilization of skilled birth attendants across socio-economic groups over time. We used four cross-sectional datasets from the Tanzania Demographic and Health Survey: 1992, 1996, 1999, and 2004/05. Subjects included 14,752 women of reproductive age (15-49 years) and data on the most recent birth in the 5 years before each survey. Logistic regression analysis was performed with the dependent variable of whether respondents utilized skilled birth attendants or not, and with the main independent variables of time and socio-economic group. Results showed that the disparity in utilization of skilled birth attendants was significantly decreased from 1999 to 2004/05. These findings suggest that the two strategies, Decentralization by Devolution and Sector Wide Approach, in the process of HSRs are effective in reducing the disparities in utilization of skilled birth attendants among socio-economic groups.
In Japan, the number of workers with depressive symptoms has increased recently, and long working hours are considered one of the main contributing factors. Currently, the number of workers engaging in discretionary work is small but is expected to increase, as a diverse method of employment is believed to contribute to workers’ well-being. However, the factors related to discretionary workers’ depressive symptoms are unclear. This study aimed to identify the factors associated with depressive symptoms in discretionary workers. The subjects were 240 male discretionary workers in a Japanese insurance company. A cross-sectional study was performed using a questionnaire that includes demographic characteristics, living and working conditions, work-related and non-work-related stressful events, and the Center for Epidemiologic Studies Depression Scale (CES-D). Depressive symptoms were assessed as more than 16 points on the CES-D. Multiple logistic regression models were employed to estimate odd ratios (OR) with 95% confidence intervals (95% CI) of depressive symptoms in relation to possible factors. Thirty-six subjects (15.5%) showed depressive symptoms. The depressive symptoms were significantly related to age (p = 0.04), presence of child(ren) (p = 0.02), and length of employment (p = 0.01), but unrelated to working hours. Subjects who reported “financial matters” (OR = 4.50, 95% CI = 1.89-10.72) and “own event” such as divorce or illness (OR = 2.93, 95% CI = 1.13-7.61) were more likely to show depressive symptoms. In conclusion, mental health measures for discretionary workers should focus on addressing financial difficulties and consultations and assistance in personal health and family issues.