Impact of neoadjuvant chemotherapy on physical fitness, physical activity, and health-related quality of life of patients with resectable esophageal cancer.

Neoadjuvant chemotherapy (NAC) followed by radical surgery is the standard treatment for patients with resectable esophageal squamous cell carcinoma (ESCC) in Japan. However, some adverse events associated with NAC may result in a decrease in physical fitness that may influence the patient's ability to tolerate surgery. The purpose of this study was to evaluate the impact of NAC on physical fitness, physical activity, and health-related quality of life (HRQOL) of patients with ESCC

Tissue damage in the canine normal esophagus by photoactivation with talaporfin sodium (laserphyrin): a preclinical study.

[Background] Treatment failure at the primary site after chemoradiotherapy is a major problem in achieving a complete response. Photodynamic therapy (PDT) with porfimer sodium (Photofrin®) has some problems such as the requirement for shielding from light for several weeks and a high incidence of skin phototoxicity. PDT with talaporfin sodium (Laserphyrin) is less toxic and is expected to have a better effect compared with Photofrin PDT. However, Laserphyrin PDT is not approved for use in the esophagus. In this preclinical study, we investigated tissue damage of the canine normal esophagus caused by photoactivation with Laserphyrin. [Methodology/Principal Findings] Diode laser irradiation was performed at 60 min after administration. An area 5 cm oral to the esophagogastric junction was irradiated at 25 J/cm2, 50 J/cm2, and 100 J/cm2 using a three-step escalation. The irradiated areas were evaluated endoscopically on postirradiation days 1 and 7, and were subjected to histological examination after autopsy. The areas injured by photoactivation were 52 mm2, 498 mm2, and 831 mm2 after irradiation at 25 J/cm2, 50 J/cm2, and 100 J/cm2, respectively. Tissue injury was observed in the muscle layer or even deeper at any irradiation level and became more severe as the irradiation dose increased. At 100 J/cm2 both inflammatory changes and necrosis were seen histologically in extra-adventitial tissue. [Conclusions/Significance]To minimize injury of the normal esophagus by photoactivation with Laserphyrin, diode laser irradiation at 25 J/cm2 appears to be safe. For human application, it would be desirable to investigate the optimal laser dose starting from this level

Magnetic-Field-Induced Superconductivity in Eu_<0.8>Sn_<0.2>Mo_6S_<7-y>Se_y (Transport and Fermiology)

The electrical resistance of Eu_Sn_Mo_6S_Se_y (0≤y≤0.7) was measured under the magnetic fields up to 230 kOe. The hysteresis of the resistance was observed in the field range where the superconductive-normal-superconductive transitions appear. Analysis of the hysteresis provides a direct evidence that the magnetic-field-induced superconductivity of these compounds is caused by the Jaccarino-Peter compensation mechanism

An integrated analysis of hyponatremia in cancer patients receiving platinum-based or nonplatinum-based chemotherapy in clinical trials (JCOG1405-A)

Background: Hyponatremia is a common electrolyte abnormality in cancer patients who receive chemotherapy. Among anticancer agents, platinum-based agents are reported to cause chemotherapy-induced hyponatremia. However, the actual incidence and risk factors remain unknown. Results: The reports of 29 trials were analyzed. The incidence of grade 3/4 hyponatremia was 11.9% in patients treated with platinum-based chemotherapy and 3.8% in those treated with nonplatinum-based regimens (P < 0.01). Univariable analysis revealed a high incidence of hyponatremia in patients receiving cisplatin, three-drug combination regimen, two-drug combination regimen with amrubicin or irinotecan, or high-dose cisplatin (weekly equivalent cisplatin dose ≥20 mg/m²), and in patients with small-cell lung cancer. Conclusion: This is the first report of the actual incidence and the potential risk factors of chemotherapy-induced hyponatremia. Careful monitoring of serum sodium level is needed when platinum-based chemotherapy is administered. Methods: This study included all clinical trials of systemic chemotherapies for solid cancers that were conducted by the Japan Clinical Oncology Group (JCOG) after January 2000 and of which the patient enrolment was completed by January 2014. The latest reports of each trial were used for analysis. The incidence of chemotherapy-induced grade 3/4 hyponatremia and the potential risk factors were investigated with univariable analysis

Identification of Respiratory Sounds Collected from Microphones Embedded in Mobile Phones

Sudden deterioration of condition in patients with various diseases, such as cardiopulmonary arrest, may result in poor outcome even after resuscitation. Early detection of deterioration is important in medical and long-term care settings, regardless of the acute or chronic phase of disease. Early detection and appropriate interventions are essential before resuscitating measures are required. Among the vital signs that indicate the general condition of a patient, respiratory rate has a greater ability to predict serious events such as thromboembolism and sepsis than heart rate and blood pressure, even in early stages. Despite its importance, however, respiratory rate is frequently overlooked and not measured, making it a neglected vital sign. To facilitate the measurement of respiratory rate, a non-invasive method of detecting respiratory sounds was developed based on deep learning technology, using a built-in microphone in a smartphone. Smartphones attached to the bed headboards of 20 participants undergoing polysomnography (PSG) at Kyoto University Hospital recorded respiratory sounds. Sound data were synchronized with overnight respiratory information. After excluding periods of abnormal breathing on the PSG report, sound data were processed for each 1-minute period. Expiration sound was determined using the pressure flow sensor signal on PSG. Finally, a model to identify the expiration section from the sound information was created using a deep learning algorithm from the convolutional Long Short Term Memory network. The accuracy of the learning model in identifying the expiratory section was 0.791, indicating that respiratory rate can be determined using the microphone in a smartphone. By collecting data from more patients and improving the accuracy of this method, respiratory rates could be more easily monitored in all situations, both inside and outside the hospital

Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan

Background: Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. Objectives: To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. Design: A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. Participants: From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3–5, and an attending physician were requested to respond to the survey. Measurements: The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains (“discussion about end-of-life care” and “death pronouncement”). Items related to potential solutions for alleviating the difficulties as well were investigated. Results: A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. Conclusion: The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care

含歯性嚢胞より生じた原発性骨内歯原性癌腫

Malignant tumors arising from dentigerous cysts are classified as primary squamous cell carcinoma derived from an odontogenic cyst or as odontogenic carcinoma according to the 2005 WHO classification and are extremely rare. We report a malignant tumor arising from a dentigerous cyst in the right maxillary anterior teeth , together with a literature review. The patient was a 75-year-old man who visited a hospital with complaining of discomfort in the lingual part of the right maxillary anterior teeth. On panoramic radiography and plain computed tomography (CT), dentigerous cyst, keratocystic odontogenic tumor or ameloblastoma was suspected. The extirpated material was histopathologically diagnosed as an odontogenic carcinoma (in situ) arising from the dentigerous cyst. Postoperative ultrasonography (US) and contrast enhanced CT revealed no metastasis to the cervical lymph nodes. The patient is currently being followed up without resection or anticancer drug administration. Neither local recurrence nor metastases were observed 18 month after surgery.症例は75歳男性で、右上顎前歯の舌部不快感を主訴として受診した。パノラマX線撮影とCT検査により含歯性嚢胞、角化細胞歯原性腫瘍またはエナメル上皮腫が疑われた。切除切片の病理組織学的検査の結果、含歯性嚢胞より生じた歯原性癌腫と診断した。術後超音波検査と造影増強CT画像では頸部リンパ節への転移は見られなかった。抗癌剤投与はせずに経過観察中で、術後18ヵ月時点で再発や転移は見られていない。含歯性嚢胞より生じる悪性腫瘍は2005年のWHO分類によれば歯原性嚢胞由来の原発性扁平上皮癌または歯原性癌腫に分類され、極めて稀である。本症例は右上顎前歯の含歯性嚢胞より生じた悪性腫瘍であった。他の症例についても文献レビューした

Palliative treatment of malignant esophageal-cardiac stricture in the ederly

The aging of the population and longer life expectancy entails an increased number of elderly patients with esophageal cancer and benign pathologies referred for surgical treatment. Esophageal cancer is a pathology that mainly involves elderly patients. The aim of this study is to assess the effects of age on the outcome of surgery for esophageal cancer and benign pathologies in patients treated in our department

Repeated talaporfin sodium photodynamic therapy for esophageal cancer: safety and efficacy

[Background] Talaporfin sodium photodynamic therapy (tPDT) is an effective salvage treatment for local failure after chemoradiotherapy for esophageal cancer. Repeated tPDT could also be indicated for local recurrence or residue after the first salvage tPDT. However, the safety and efficacy of repeated tPDT have not been elucidated. [Methods] We reviewed 52 patients with esophageal cancer who were treated with the first tPDT at Kyoto University Hospital between October 2015 and April 2020. [Results] Among 52 patients, repeated tPDT after the first tPDT was indicated for 13 patients (25%), of which six had residual tumor, four had local recurrence after complete response (CR) after the first tPDT at the primary site, and six had metachronous lesion. The total session of repeated tPDT was 25; 16 were for primary sites and nine were for metachronous sites. Among them, six patients (46.2%) achieved local (L)-CR and nine lesions (56.3%) achieved lesion L-CR. By session, 10 sessions (40%) achieved L-CR. There were no severe adverse events except for one patient; this patient showed grade 3 esophageal stenosis and perforation after the third tPDT on the same lesion that was previously treated with porfimer sodium photodynamic therapy four times. [Conclusion] Repeated tPDT could be an effective and safe treatment for local failure even after salvage tPDT for esophageal cancer