Statistical Analysis of Prognostic Factors for Survival in Patients with Spinal Metastasis

There are a variety of treatment options for patients with spinal metastasis, and predicting prognosis is essential for selecting the proper treatment. The purpose of the present study was to identify the significant prognostic factors for the survival of patients with spinal metastasis. We retrospectively reviewed 143 patients with spinal metastasis. The median age was 61 years. Eleven factors reported previously were analyzed using the Cox proportional hazards model:gender, age, performance status, neurological deficits, pain, type of primary tumor, metastasis to major organs, previous chemotherapy, disease-free interval before spinal metastasis, multiple spinal metastases, and extra-spinal bone metastasis. The average survival of study patients after the first visit to our clinic was 22 months. Multivariate survival analysis demonstrated that type of primary tumor (hazard ratio [HR]＝6.80, p＜0.001), metastasis to major organs (HR＝2.01, p＝0.005), disease-free interval before spinal metastasis (HR＝1.77, p＝0.028), and extra-spinal bone metastasis (HR＝1.75, p＝0.017) were significant prognostic factors. Type of primary tumor was the most powerful prognostic factor. Other prognostic factors may differ among the types of primary tumor and may also be closely associated with primary disease activity. Further analysis of factors predicting prognosis should be conducted with respect to each type of primary tumor to help accurately predict prognosis

Serum CXCL9 and CCL17 as biomarkers of declining pulmonary function in chronic bird-related hypersensitivity pneumonitis.

The clinical course of chronic hypersensitivity pneumonitis (HP) with fibrosis is similar to that of idiopathic pulmonary fibrosis (IPF). Current research is expected to identify biomarkers effective in predicting the deterioration of lung function in a clinical setting. Our group analyzed the relationships between the following parameters in chronic bird-related HP: patient characteristics, serum markers, lung function, HRCT findings, BALF profiles, and the worsening of lung function. We also analyzed serum levels of CXCL9, CCL17, and Krebs von den Lungen 6 (KL-6) as serum markers. Patients showing declines in vital capacity (VC) of over 5% at 6 months after first admission were categorized as the "decline group"; the others were categorized as the "stable group." The serum level of CCL17 and the percentage of BALF macrophages were significantly higher in the decline group compared to the stable group. Serum levels of CXCL9 and CCL17 were significant variables in a multivariate logistic regression analysis of factors associated with VC decline. Patients with a chemokine profile combining lower serum CXCL9 and higher serum CCL17 exhibited significantly larger VC decline in a cluster analysis. Higher serum CCL17 and lower serum CXCL9 were important predictors of worsening lung function in patients with chronic bird-related HP

LIMB MUSCLE MASS DECREASE WITH AGING IN JAPANESE MEN AND WOMEN AGED 15-97 yr

Although skeletal muscle mass decreases with aging, its decrease rate may differ among parts of the body. There have been few studies examining the differences in the muscle mass decrease rate between proximal and distal parts of the limbs or between the left and right legs in a large population. Bioelectrical impedance (BI) index, calculated as the ratio of the square of segment length to impedance, is linearly correlated with the muscle mass calculated by MRI (r=0.902-0.976, p<0.05, Miyatani et al., 2001) in the limb segments. The purpose of this study was to examine differences in the decrease rate of muscle mass between the proximal and distal parts of the limbs and between the upper and lower limbs in healthy Japanese. The BI index was measured in the bilateral thighs, lower legs, upper arms, and forearms of 1006 healthy Japanese men and women (aged 15-97 years). While the BI index decreased with aging in all examined parts of the body, the decrease rate was larger in the lower limb than in the upper limb, and in the thigh than in the lower leg. The percentage of people who showed a difference of more than 10% in the BI index between the left and right lower limbs was significantly higher in the elderly than in young subjects. These differences in the decrease rate of muscle mass between limbs may be associated with decreases in physical functions in the elderly.http://ci.nii.ac.jp/naid/11000642109

Possible mechanisms underlying the midazolam-induced relaxation of the noradrenaline-contraction in rabbit mesenteric resistance artery

1. The mechanisms underlying the midazolam-induced relaxation of the noradrenaline (NA)-contraction were studied by measuring membrane potential, isometric force and intracellular concentration of Ca(2+)([Ca(2+)](i)) in endothelium-denuded muscle strips from the rabbit mesenteric resistance artery. The actions of midazolam were compared with those of nicardipine, an L-type Ca(2+)-channel blocker. 2. Midazolam (30 and 100 μM) did not modify either the resting membrane potential or the membrane depolarization induced by 10 μM NA. 3. NA (10 μM) produced a phasic, followed by a tonic increase in both [Ca(2+)](i) and force. Midazolam (10–100 μM) did not modify the resting [Ca(2+)](i), but attenuated the NA-induced phasic and tonic increases in [Ca(2+)](i) and force, in a concentration-dependent manner. In contrast, nicardipine (0.3 μM) attenuated the NA-induced tonic, but not phasic, increases in [Ca(2+)](i) and force. 4. In Ca(2+)-free solution containing 2 mM EGTA, NA (10 μM) transiently increased [Ca(2+)](i) and force. Midazolam (10–100 μM), but not nicardipine (0.3 μM), attenuated this NA-induced increase in [Ca(2+)](i) and force, in a concentration-dependent manner. However, midazolam (10 and 30 μM), had no effect on the increases in [Ca(2+)](i) and force induced by 10 mM caffeine. 5. In ryanodine-treated strips, which have functionally lost the NA-sensitive Ca(2+)- storage sites, NA slowly increased [Ca(2+)](i) and force. Nicardipine (0.3 μM) did not modify the resting [Ca(2+)](i) but partly attenuated the NA-induced increases in [Ca(2+)](i) and force. In the presence of nicardipine, midazolam (100 μM) lowered the resting [Ca(2+)](i) and further attenuated the remaining NA-induced increases in [Ca(2+)](i) and force. 6. The [Ca(2+)](i)-force relationship was obtained in ryanodine-treated strips by the application of ascending concentrations of Ca(2+) (0.16–2.6 mM) in Ca(2+)-free solution containing 100 mM K(+). NA (10 μM) shifted the [Ca(2+)](i)-force relationship to the left and enhanced the maximum Ca(2+)-induced force. Under these conditions, whether in the presence or absence of 10 μM NA, midazolam (10 and 30 μM) attenuated the increases in [Ca(2+)](i) and force induced by Ca(2+) without changing the [Ca(2+)](i)-force relationship. 7. It was concluded that, in smooth muscle of the rabbit mesenteric resistance artery, midazolam inhibits the NA-induced contraction through its inhibitory action on NA-induced Ca(2+) mobilization. Midazolam attenuates NA-induced Ca(2+) influx via its inhibition of both nicardipine-sensitive and -insensitive pathways. Furthermore, midazolam attenuates the NA-induced release of Ca(2+) from the storage sites. This effect contributes to the midazolam-induced inhibition of the NA-induced phasic contraction