A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index.

First published online: April 2, 2015[Objective] Existing prognostic indices for malignant pleural mesothelioma do not incorporate the recent advances in oncology care. The purpose of this study was to provide a prognostic index for overall survival in malignant pleural mesothelioma patients treated with chemotherapy with pemetrexed or best supportive care in the recent clinical setting. [Methods] A retrospective cohort study was performed in two hospitals in Japan (2007–13). The primary outcome was overall survival. The Cox proportional hazards model was used for multivariable analyses to identify prognostic factors. A final model was chosen based on both clinical and statistical significance. [Results] A total of 283 patients (chemotherapy: n = 228, best supportive care: n = 55) were enrolled in the study. On multivariate analysis, regimen including platinum plus pemetrexed, a performance status >0, non-epithelial histological type and Stage IV disease predicted poor overall survival in chemotherapy patients. As hazard ratios of individual risk factors were approximately similar, a prognostic index for overall survival was constructed by counting the risk factors. Median overall survival in chemotherapy patients decreased by each one-point increase in this count: 1030 days for zero; 658 days for one; 373 days for two; 327 days for three; 125 days for four. Internal validation using the bootstrapping technique showed robustness of the model (c-index, 0.677; 95% confidence interval, 0.624–0.729). Further, the discrimination was consistent in best supportive care patients (c-index, 0.799; 95% confidence interval, 0.725–0.874). [Conclusions] This novel index can provide clinicians and malignant pleural mesothelioma patients with a better framework for discussing prognosis at the time of diagnosis

Customized chemotherapy based on epidermal growth factor receptormutation status for elderly patients with advanced non-small-cell lung cancer: a phase II trial

BACKGROUND: Elderly patients are more vulnerable to toxicity from chemotherapy. Activating epidermal growth factor receptor (EGFR) mutations in non-small-cell lung cancer (NSCLC) are associated with enhanced response to EGFR tyrosine-kinase inhibitors. We studied patients with advanced NSCLC for whom treatment was customized based on EGFR mutation status. METHODS: We screened 57 chemotherapy-naïve patients with histologically or cytologically confirmed NSCLC, stage IIIB or IV, aged 70 years or older, and with an Eastern Cooperative Oncology Group performance status 0 or 1, for EGFR exon 19 codon 746–750 deletion and exon 21 L858R mutation. Twenty-two patients with EGFR mutations received gefitinib; 32 patients without mutations received vinorelbine or gemcitabine. The primary endpoint was the response rate. RESULTS: The response rate was 45.5% (95% confidence interval [CI]: 24.4%, 67.8%) in patients with EGFR mutations and 18.8% (95% CI: 7.2%, 36.4%) in patients without EGFR mutations. The median overall survival was 27.9 months (95%CI: 24.4 months, undeterminable months) in patients with EGFR mutations and 14.9 months (95%CI: 11.0 months, 22.4 months) in patients without EGFR mutations. In the gefitinib group, grade 3/4 hepatic dysfunction and dermatitis occurred in 23% and 5% of patients, respectively. In patients treated with vinorelbine or gemcitabine, the most common grade 3 or 4 adverse events were neutropenia (47%; four had febrile neutropenia), anemia (13%), and anorexia (9%). No treatment-related deaths occurred. CONCLUSIONS: Treatment customization based on EGFR mutation status deserves consideration, particularly for elderly patients who often cannot receive second-line chemotherapy due to poor organ function or comorbidities. TRIAL REGISTRATION: This trial is registered at University hospital Medical Information Network-clinical trial registration (http://www.umin.ac.jp/ctr/index/htm) with the registration identification number C000000436

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study

Background: Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear. Methods: A prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP. Results: Compared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP. Conclusions: Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings

Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study

Objectives: Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients. Methods: Patients with RA were administered TCZ, with or without MTX, for 3 years; those who received TCZ+MTX combination therapy were selected. After remission was achieved, MTX was discontinued without flare development in one group (discontinued [DISC] group, n = 33) and continued without flare development in another group (maintain [MAIN] group, n = 37). The clinical efficacy of TCZ+MTX therapy, patient background characteristics, and adverse events were compared between groups. Results: The disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) at 3, 6, and 9 months was significantly lower in the DISC group (P < .05, P < .01, and P < .01, respectively). Further, the DAS28-ESR remission rate at 6 and 9 months and Boolean remission rate at 6 months were significantly higher in the DISC group (P < .01 for all). Disease duration was significantly longer in the DISC group (P < .05). Furthermore, the number of patients with stage 4 RA was significantly higher in the DISC group (P < .01). Conclusions: Once remission was achieved, MTX was discontinued in patients who responded favorably to TCZ+MTX therapy, despite the prolonged disease duration and stage progression

JASMINE: Near-infrared astrometry and time-series photometry science

The Japan Astrometry Satellite Mission for INfrared Exploration (JASMINE) is a planned M-class science space mission by the Institute of Space and Astronautical Science, the Japan Aerospace Exploration Agency. JASMINE has two main science goals. One is Galactic archaeology with a Galactic Center survey, which aims to reveal the Milky Way’s central core structure and formation history from Gaia-level (∼25 ${\mu}$as) astrometry in the near-infrared (NIR) Hw band (1.0–1.6 ${\mu}$m). The other is an exoplanet survey, which aims to discover transiting Earth-like exoplanets in the habitable zone from NIR time-series photometry of M dwarfs when the Galactic Center is not accessible. We introduce the mission, review many science objectives, and present the instrument concept. JASMINE will be the first dedicated NIR astrometry space mission and provide precise astrometric information on the stars in the Galactic Center, taking advantage of the significantly lower extinction in the NIR. The precise astrometry is obtained by taking many short-exposure images. Hence, the JASMINE Galactic Center survey data will be valuable for studies of exoplanet transits, asteroseismology, variable stars, and microlensing studies, including discovery of (intermediate-mass) black holes. We highlight a swath of such potential science, and also describe synergies with other missions

Long-term investigation of Propsilocerus akamusi (Tokunaga) (Diptera, Chironomidae) from a shallow eutrophic lake, Suwa, in Central Japan : An attempt to forecast the massive emergence of adult midges

The long-term population dynamics of chironomids were investigated in Lake Suwa, a shallow eutrophic lake in Central Japan, in order to clarify the temporal variations in the abundance of Propsilocerus akamusi (Tokunaga). The characteristics of the emergence of P. akamusi from the lake in recent years are (1) shorter emergence periods, (2) smaller number of midges collected, and (3) high ratio of females. These results clearly show that the number of D. akamusi in Lake Suwa has recently tended to decrease. There is significant relationship between the density of larvae in spring and the total number of midges trapped during the emergence period in fall. Thus, it is possible to estimate the focus of massive emergence of the midges from the larval density in the spring.ArticleMedical Entomology and Zoology. 54(1):89-96 (2003)journal articl

The likelihood of compliance-gaining strategies : Time-series combination of compliance-gaining strategy

本研究の目的は, 他者に要請する状況で, 人がどのように承諾獲得方策を時系列的に組み合わせて使用するかを明らかにすることである。承諾獲得方策の時系列的組み合わせを承諾獲得方略とする。調査の結果, 3種類の承諾獲得方策(個人評価, 丁重, 他者利用)は, 1回目の要請よりも相手から断られた後の2回目の要請時に使用される可能性が高かった。反対に, 強硬方策は, 2回目の要請よりも1回目の要請時に使用される可能性が高かった。また, 承諾獲得方策の時系列的組み合わせに関して65.8%の人が, 1回目の要請と2回目の要請で異なる方策を使用することが分かった。そして, 1回目の要請時には様々な方策が使用されていても, 2回目の要請では, 91.5%の人が丁重方策や他者利用方策を使用することが分かった

Geochemical features of Antarctic lakes

Geochemical investigations of Antarctic lakes have been carried out on major components, nutrient matters, stable isotopes and organic substances in waters in order to clarify the geochemical features of the lakes. The present waters of inland lakes are supplied from the melt water of glacier or snow. But the waters of saline lakes on the coast of the continent have originated mainly from the sea water, for example Lake Nurume, Lake Hunazoko (Syowa Oasis) and Lake Fryxell (McMurdo Oasis). The isotopic compositions of waters in some lakes such as Lake Vanda, are similar to that of the snow or melt water of the glacier, while the isotopic composition of sulfur in the salt deposited or dissolved in the lake is similar to that of the sea origin sulfur compound. The water of highly saline lakes should have been produced in the process of concentration of the sea water under a frigid condition. For some of the lakes, it is considered that the water was evaporated once or several times and the residue were extracted with melt water of glacier. From the contents of organic substances, nutrient matters and gases in the lake, activity of microorganisms is suggested in some of the lakes. In view of the abundance and relative ratios of some heavy metal elements, such as copper, zinc, lead and cadmium, these elements should have been supplied from snow

Data from: Pleural effusion biomarkers and computed tomography findings in diagnosing malignant pleural mesothelioma: a retrospective study in a single center

In this study, we aimed to examine the clinical value of the pleural effusion (PE) biomarkers, soluble mesothelin-related peptide (SMRP), cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA), and the utility of combining chest computed tomography (CT) findings with these biomarkers, in diagnosing malignant pleural mesothelioma (MPM). We conducted a retrospective cohort study in a single center. Consecutive patients with undiagnosed pleural effusions who underwent PE analysis between September 2014 and August 2016 were reviewed. This study included 240 patients (32 with MPM and 208 non-MPM). SMRP and the CYFRA 21-1/CEA ratio had a sensitivity and specificity for diagnosing MPM of 56.3% and 86.5%, and 87.5% and 74.0%, respectively. Using receiver operating characteristics (ROC) curve analysis of the ability of these markers to distinguish MPM from all other PE causes, the area under the ROC curve (AUC) for SMRP and the CYFRA 21-1/CEA ratio was 0.804 and 0.874, respectively. The sensitivity and specificity of SMRP combined with the CYFRA 21-1/CEA ratio were 93.8% and 64.9%, respectively. The sensitivity of the combination of SMRP, the CYFRA 21-1/CEA ratio, and the presence of Leung's criteria (a chest CT finding that is suggestive of malignant pleural disease) was 93.8%. In conclusion, the combined PE biomarkers had a high sensitivity for diagnosing MPM, although the addition of chest CT findings did not improve the sensitivity of SMRP combined with the CYFRA 21-1/CEA ratio. Combination of these biomarkers helped to rule out MPM effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy

Secondary Electrons from Water Vapor with the Impact of 6.0 MeV/u He2+ Ions: Atomic Data and their Application to Biomedical Investigations

We measured the energy and angular distributions (7 eV-10 keV and 20&#730;-160&#730;) of secondary electrons produced in collisions of 6.0 MeV/u He2+ ions with water vapor. Binary-encounter collision peaks were clearly observed at the calculated energies at angles of &#61500;90&#61616;, as well as the K-LL Auger peak of oxygen at about 500 eV for all angles. From these measurements, the doubly differential cross sections (DDCS) of electron emissions were deduced with an estimated uncertainty of &#61617;13%. The energy distribution (SDCS) was also obtained by integrating the DDCS values with respect to the ejected angles, and compared with an empirical model of Rudd. The energy spectrum (SDCS) showed good agreement with the model of Rudd in the energy range of secondary electrons of 3keV. To assess the new cross sections, these values were incorporated in the kurbuc Monte-Carlo track structure code system for a simulation of secondary electrons. Radial dose distributions for 6.0 MeV/u He2+ ions were obtained by analyzing the tracks generated by the code kurbuc using the new DDCS values. In the core with a radius (r) of less than 1 nm, the dose is very high due mainly to excitation events, induced by low-energy electrons. The penumbra shows a well-known r-2 dependence