103 research outputs found

    Intermediate disturbance on rangelands : Management applicability of the intermediate disturbance hypothesis across Mongolian rangeland ecosystems

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    The current growing body of evidence for diversity-disturbance relationships suggests that the peaked pattern predicted by the intermediate disturbance hypothesis (IDH) may not be the rule. Even if ecologists could quantify the diversity-disturbance relationship consistent with the IDH, the applicability of the IDH to land management has rarely been addressed. We examined two hypotheses related to the generality and management applicability of the IDH to Mongolian rangeland ecosystems: that the diversity-disturbance relationship varies as a function of landscape condition and that some intermediate scales of grazing can play an important role in terms of sustainable rangeland management through a grazing gradient approach. We quantified the landscape condition of each ecological site using an ordination technique and determined two types of landscape conditions, relatively benign and harsh environmental conditions. At the ecological sites characterized by relatively benign environmental conditions, diversity-disturbance relationships were generally consistent with the IDH and maximum diversity was observed at some intermediate distance from the source of the grazing gradient. In contrast, the IDH was not supported at most but not all sites characterized by relatively harsh environmental conditions. The intermediate levels of grazing were generally located below the ecological threshold representing the points or zones at which disturbance should be limited to prevent drastic changes in ecological conditions, suggesting that there is little ā€œconundrumā€ with regard to intermediate disturbance in the studied systems in terms of land management. We suggest that the landscape condition is one of the primary factors that cause inconsistencies in diversity-disturbance relationships. The ecological threshold can extend its utility in rangeland management because it also has the compatibility with the maintenance of species diversity. This study thus suggests that some intermediate scales of grazing and ecological thresholds are mutually supportive tools for sustainable management of Mongolian rangelands

    Venetoclax plus low-dose cytarabine in patients with newly diagnosed acute myeloid leukemia ineligible for intensive chemotherapy: an expanded access study in Japan

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    Background: In a Phase 3 international clinical trial (VIALE-C), venetoclax plus low-dose cytarabine improved the response rate and overall survival versus placebo plus low-dose cytarabine in patients with newly diagnosed acute myeloid leukemia who were ineligible for intensive chemotherapy. After the enrollment period of VIALE-C ended, we conducted an expanded access study to provide preapproval access to venetoclax in combination with low-dose cytarabine in Japan. Methods: Previously, untreated patients with acute myeloid leukemia who were ineligible for intensive chemotherapy were enrolled according to the VIALE-C criteria. Patients received venetoclax (600 mg, Days 1ā€“28, 4-day ramp-up in Cycle 1) in 28-day cycles and low-dose cytarabine (20 mg/m2, Days 1ā€“10). All patients took tumor lysis syndrome prophylactic agents and hydration. Safety endpoints were assessed. Results: Fourteen patients were enrolled in this study. The median age was 77.5 years (range = 61ā€“84), with 78.6% over 75 years old. The most common grade ā‰„ 3 treatment-emergent adverse event was neutropenia (57.1%). Febrile neutropenia was the most frequent serious adverse event (21.4%). One patient developed treatment-related acute kidney injury, leading to discontinuation of treatment. Two patients died because of cardiac failure and disease progression that were judged not related to study treatment. No patients developed tumor lysis syndrome. Conclusions: The safety outcomes were similar to those in VIALE-C without new safety signals and were well managed with standard medical care. In clinical practice, more patients with severe background disease are expected, in comparison with in VIALE-C, suggesting that it is important to carefully manage and prevent adverse events

    Dietary patterns associated with fall-related fracture in elderly Japanese: a population based prospective study

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    <p>Abstract</p> <p>Background</p> <p>Diet is considered an important factor for bone health, but is composed of a wide variety of foods containing complex combinations of nutrients. Therefore we investigated the relationship between dietary patterns and fall-related fractures in the elderly.</p> <p>Methods</p> <p>We designed a population-based prospective survey of 1178 elderly people in Japan in 2002. Dietary intake was assessed with a 75-item food frequency questionnaire (FFQ), from which dietary patterns were created by factor analysis from 27 food groups. The frequency of fall-related fracture was investigated based on insurance claim records from 2002 until 2006. The relationship between the incidence of fall-related fracture and modifiable factors, including dietary patterns, were examined. The Cox proportional hazards regression model was used to examine the relationships between dietary patterns and incidence of fall-related fracture with adjustment for age, gender, Body Mass Index (BMI) and energy intake.</p> <p>Results</p> <p>Among 877 participants who agreed to a 4 year follow-up, 28 suffered from a fall-related fracture. Three dietary patterns were identified: mainly vegetable, mainly meat and mainly traditional Japanese. The moderately confirmed (see statistical methods) groups with a Meat pattern showed a reduced risk of fall-related fracture (Hazard ratio = 0.36, 95% CI = 0.13 - 0.94) after adjustment for age, gender, BMI and energy intake. The Vegetable pattern showed a significant risk increase (Hazard ratio = 2.67, 95% CI = 1.03 - 6.90) after adjustment for age, gender and BMI. The Traditional Japanese pattern had no relationship to the risk of fall-related fracture.</p> <p>Conclusions</p> <p>The results of this study have the potential to reduce fall-related fracture risk in elderly Japanese. The results should be interpreted in light of the overall low meat intake of the Japanese population.</p

    Sequential therapies after atezolizumab plus bevacizumab or lenvatinib first-line treatments in hepatocellular carcinoma patients

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    Introduction: The aim of this retrospective proof-of-concept study was to compare different second-line treatments for patients with hepatocellular carcinoma and progressive disease (PD) after first-line lenvatinib or atezolizumab plus bevacizumab.Materials and methods: A total of 1381 patients had PD at first-line therapy. 917 patients received lenvatinib as first-line treatment, and 464 patients atezolizumab plus bevacizumab as first-line.Results: 49.6% of PD patients received a second-line therapy without any statistical difference in overall survival (OS) between lenvatinib (20.6 months) and atezolizumab plus bev-acizumab first-line (15.7 months; p = 0.12; hazard ratio [HR] = 0.80). After lenvatinib first-line, there wasn't any statistical difference between second-line therapy subgroups (p = 0.27; sorafenib HR: 1; immunotherapy HR: 0.69; other therapies HR: 0.85). Patients who under-went trans-arterial chemo-embolization (TACE) had a significative longer OS than patients who received sorafenib (24.7 versus 15.8 months, p &lt; 0.01; HR = 0.64). After atezolizumab plus bevacizumab first-line, there was a statistical difference between second-line therapy subgroups (p &lt; 0.01; sorafenib HR: 1; lenvatinib HR: 0.50; cabozantinib HR: 1.29; other therapies HR: 0.54). Patients who received lenvatinib (17.0 months) and those who under-went TACE (15.9 months) had a significative longer OS than patients treated with sorafenib (14.2 months; respectively, p = 0.01; HR = 0.45, and p &lt; 0.05; HR = 0.46).Conclusion: Approximately half of patients receiving first-line lenvatinib or atezolizumab plus bevacizumab access second-line treatment. Our data suggest that in patients progressed to atezolizumab plus bevacizumab, the systemic therapy able to achieve the longest survival is lenvatinib, while in patients progressed to lenvatinib, the systemic therapy able to achieve the longest survival is immunotherapy

    Adverse Events as Potential Predictive Factors of Activity in Patients with Advanced HCC Treated with Atezolizumab Plus Bevacizumab

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    Background In the context of patients with hepatocellular carcinoma (HCC) treated with systemic therapy, the correlation between the appearance of adverse events (AEs) and reported efficacy outcomes is well-known and widely investigated. From other pathological settings, we are aware of the prognostic and predictive value of the occurrence of immune-related AEs in patients treated with immune-checkpoint inhibitors. Objective This retrospective multicenter real-world study aims to investigate the potential prognostic value of AEs in patients with HCC treated with atezolizumab plus bevacizumab in the first-line setting. Patients and methods The study population consisted of 823 patients from five countries (Italy, Germany, Portugal, Japan, and the Republic of Korea). Results Of the patients, 73.3% presented at least one AE during the study period. The most common AEs were proteinuria (29.6%), arterial hypertension (27.2%), and fatigue (26.0%). In all, 17.3% of the AEs were grade (G) 3. One death due to bleeding was reported. The multivariate analysis confirmed the appearance of decreased appetite G &lt; 2 [versus G &gt;= 2; hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.13-0.90; p &lt; 0.01] and immunotoxicity G &lt; 2 (versus G &gt;= 2; HR: 0.70; 95% CI 0.24-0.99; p = 0.04) as independent prognostic factors for overall survival, and the appearance of decreased appetite G &lt; 2 (versus G &gt;= 2; HR: 0.73; 95% CI 0.43-0.95; p = 0.01), diarrhea (yes versus no; HR: 0.57, 95% CI 0.38-0.85; p = 0.01), fatigue (yes versus no; HR: 0.82, 95% CI 0.65-0.95; p &lt; 0.01), arterial hypertension G &lt; 2 (versus G &gt;= 2; HR: 0.68, 95% CI 0.52-0.87; p &lt; 0.01), and proteinuria (yes versus no; HR: 0.79, 95% CI 0.64-0.98; p = 0.03) as independent prognostic factors for progression-free survival. Conclusions As demonstrated for other therapies, there is also a correlation between the occurrence of AEs and outcomes for patients with HCC for the combination of atezolizumab plus bevacizumab

    Integrative Annotation of 21,037 Human Genes Validated by Full-Length cDNA Clones

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    The human genome sequence defines our inherent biological potential; the realization of the biology encoded therein requires knowledge of the function of each gene. Currently, our knowledge in this area is still limited. Several lines of investigation have been used to elucidate the structure and function of the genes in the human genome. Even so, gene prediction remains a difficult task, as the varieties of transcripts of a gene may vary to a great extent. We thus performed an exhaustive integrative characterization of 41,118 full-length cDNAs that capture the gene transcripts as complete functional cassettes, providing an unequivocal report of structural and functional diversity at the gene level. Our international collaboration has validated 21,037 human gene candidates by analysis of high-quality full-length cDNA clones through curation using unified criteria. This led to the identification of 5,155 new gene candidates. It also manifested the most reliable way to control the quality of the cDNA clones. We have developed a human gene database, called the H-Invitational Database (H-InvDB; http://www.h-invitational.jp/). It provides the following: integrative annotation of human genes, description of gene structures, details of novel alternative splicing isoforms, non-protein-coding RNAs, functional domains, subcellular localizations, metabolic pathways, predictions of protein three-dimensional structure, mapping of known single nucleotide polymorphisms (SNPs), identification of polymorphic microsatellite repeats within human genes, and comparative results with mouse full-length cDNAs. The H-InvDB analysis has shown that up to 4% of the human genome sequence (National Center for Biotechnology Information build 34 assembly) may contain misassembled or missing regions. We found that 6.5% of the human gene candidates (1,377 loci) did not have a good protein-coding open reading frame, of which 296 loci are strong candidates for non-protein-coding RNA genes. In addition, among 72,027 uniquely mapped SNPs and insertions/deletions localized within human genes, 13,215 nonsynonymous SNPs, 315 nonsense SNPs, and 452 indels occurred in coding regions. Together with 25 polymorphic microsatellite repeats present in coding regions, they may alter protein structure, causing phenotypic effects or resulting in disease. The H-InvDB platform represents a substantial contribution to resources needed for the exploration of human biology and pathology

    Middle Ear Carcinoid Tumor : Case Report and Literature Review

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    We herein report a rare case of a carcinoid tumor observed in the middle ear. The 51-year-old female patient presented to our hospital with an 8-year history of mild deafness and sensation of obstruction within the left ear. Otoscopic examination revealed a pinkish mass in the hypotympanum, which was visible through an intact tympanic membrane. Computed tomography (CT) of the temporal bone showed a well-circumscribed mass of soft tissue density filling the left hypotympanum. The provisional clinical diagnosis was cholesteatoma or another type of tumor (e.g. glomus jugulare tumor or facial nerve neurilemmoma). Transcanal tympanotomy was performed under general anesthesia to explore the lesion. At surgery, a well-delineated, encapsulated pinkish mass was found in the hypotympanum. It was not adherent to the tympanic membrane or ossicles. The mass arose, via a narrow pedicle, from the lining epithelium at the promontory. Complete resection of the mass was performed with careful clearance around the ossicles and epithelium at the promontory. Histological examination showed a carcinoid tumor composed of islands, cords, and nests of tumor cells in a fibrous stroma. Immunohistochemistry revealed granular cytoplasmic positivity for chromogranin A. No general symptoms of carcinoid syndrome were observed in this patient. Endoscopic examination revealed no evidence of other carcinoid tumors in the gastrointestinal and respiratory tracts. Eight years postoperatively, no evidence of recurrence or metastatic disease has been observed
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