Positive and negative associations of individual social capital factors with health among community-dwelling older people

AIM

Previous literature has found positive correlations between social capital and health in older adults, fewer studies have investigated the subdimension's effects of social capital on health. We aimed to determine the individual social capital subfactors in community-dwelling older adults in Japan, and to analyze the associations of these factors with physical and mental health.

METHOD

We sent a self-administered questionnaire assessing their perception of social group activity as the individual social capital, and mental and physical health (measured by the Medical Outcomes Study Short Form-36) to 4320 randomly selected older people.

RESULTS

There were 1836 valid responses. We clarified that people who participated in any social activity group were in significantly better physical and mental health compared with the people who did not. By the factor analysis of the perception for the social group activity, we identified three components of the individual social capital aspect that we termed harmonious, hierarchic and diversity. Using multiple linear regression, we found the hierarchic aspect was significantly negatively associated with mental health, whereas the harmonious aspect was significantly positively associated with mental and physical health, and diversity was significantly positively associated with mental health.

CONCLUSION

As the previous research literature on social capital has mainly emphasized its positive health consequences, the present findings provide a novel demonstration that some aspects of individual social capital can have negative associations with health outcomes in community-dwelling older people. For the practical application of promoting a healthier society, it is important to consider both the positive and negative sides of social capital. Geriatr Gerontol Int 2017; 17: 2427-2434.

Can colorectal delivery technology provide a platform for enteral oligonucleotide-based therapeutics?

Nucleic acid-based therapeutics including antisense and siRNA oligonucleotides has been expected as an innovative treatment for intractable diseases. Oral drug delivery is the most patient-friendly route of administration but developing an effective delivery system for oligonucleotides remains a major challenge. In this commentary, we discuss the potential benefits of the colorectal route as another platform for the development of oral oligonucleotide therapeutics. The importance of the targeting or the availability of oligonucleotides in targeted tissue is highlighted in contrast to systemic availability, while the liver-targeted enteral siRNA delivery technology that we recently developed is introduced.

Prevalence of myofascial pain syndrome in patients with incurable cancer

BACKGROUND

Myofascial pain syndrome (MPS) is a condition that involves skeletal muscles. It is caused by overload or disuse of muscles and is characterized by extreme tenderness in the muscles with taut bands. Treatment for MPS is different from that for cancer-related pain. Cancer patients have many factors that cause restriction of body movement and posture. Although cancer patients appear to demonstrate risk factors for MPS, its prevalence has not been reported in patients with incurable cancer. This study was conducted to investigate the prevalence of MPS in patients with incurable cancer.

METHODS

A retrospective chart review. The data for patients with incurable cancer who received palliative care at our department between September 2015 and March 2016 were investigated. We examined the prevalence of MPS, which was diagnosed on the basis of the Rivers criteria (RC) and Simons criteria (SC). We also examined the following factors associated with MPS: performance status (PS), use of medical devices, and primary cancer sites. The primary outcome was the prevalence of MPS based on RC. Secondary outcomes included the prevalence of MPS based on SC and the relationship between MPS and either PS or medical devices.

RESULTS

Thirty-four patients with incurable cancer were identified. MPS based on RC or SC was detected in 10 (29%) and 20 (59%) patients, respectively. Twenty-two of 34 patients who complained of pain, 10 (45%) had MPS based on RC and 20 (90%) had MPS based on SC. Age and central venous port were risk factors for MPS by multivariate analysis.

CONCLUSION

A very high prevalence of MPS was detected in our study population. MPS should be considered when patients with incurable cancer complain of pain.

Chronological grey scale changes in supporting alveolar bone by removable partial denture placement on patients with periodontal disease: A 6-month follow-up study using digital subtraction analysis

OBJECTIVES

The purpose was to assess the early effects of removable partial denture (RPD) placement on abutment teeth in patients with periodontal disease.

METHODS

Fifteen distal-extension RPDs and 19 abutment teeth were evaluated in 13 patients with moderate-to-severe periodontal diseases. Clinical periodontal records and grey level (GL) score based on digital subtraction radiography were measured on the day of denture placement (baseline) and at 1day, 1 week, 1 month, 3 months, and 6 months after the placement. Occlusal force on total dentition (Ft) and abutment tooth (Fa) were recorded with (baseline) and without denture on the day of the placement, and with denture in the follow-up examinations.

RESULTS

No statistically significant difference between a follow-up period and the baseline was found in the clinical periodontal and occlusal force records, except for Ft with denture on the day of the placement, which was significantly lower than the baseline (p<0.05). The GL at distal crestal of the abutment was significantly higher at 1 week after the placement than at the baseline (p<0.05), while the scores of following examinations returned to the baseline level.

CONCLUSIONS

The distal crestal bone of the abutment tooth transitorily reacts to mechanical stress due to the denture placement, while this does not suggest a detrimental effect within the limitation of the study design with a short-term observation period.

CLINICAL SIGNIFICANCE

The RPDs can be safely used for patients with periodontal diseases for at least 6 months if they are properly placed and maintained by professional care.

Tandem μ-reactor-GC/MS for online monitoring of aromatic hydrocarbon production via CaO-catalysed PET pyrolysis

Online monitoring of products by a tandem μ-reactor-GC/MS system revealed the CaO catalysed PET pyrolysis pathway.

Prevalence of myofascial pain syndrome in patients with incurable cancer

97

Background: Myofascial pain syndrome (MPS) is a condition that involves skeletal muscles. It is caused by overload or disuse of muscles and is characterized by extreme tenderness in the muscles with taut bands. Treatment for MSP is different from that for cancer-related pain. Cancer patients have many factors that cause restriction of body movement and posture. Although cancer patients appear to demonstrate risk factors for MPS, its prevalence has not been reported in patients with incurable cancer. This study was conducted to investigate the prevalence of MPS in patients with incurable cancer. Methods: The data for patients with incurable cancer who received palliative care by our department between September 2015 and March 2016 were retrospectively investigated. We examined the prevalence of MPS. MPS was diagnosed on the basis of the Rivers criteria (RC) and Simons criteria (SC). We also examined the following factors associated with MPS: performance status (PS), use of medical devices (MD), and primary cancer sites. The primary outcome was the prevalence of MPS using the RC. Secondary outcomes included the prevalence of MPS using the SC, and the relationship between MPS and either PS or MD. Results: Thirty-four patients with incurable cancer were identified. The clinical characteristics are as follows: age (median, range): 65 (39-89) years; male/female ratio: 16/18; primary sites: pancreas (n = 8), breast (n = 8), lung (n = 4), colorectal (n = 4), head and neck (n = 2), and other primary sites (n = 8). Seventeen of 34 patients (50%) had a PS 3 or 4. Twenty-two patients (64.7%) complained of pain. MPS using the RC was detected in 10 patients (29%). MPS using the SC was detected in 20 patients (59%). Of 22 patients who complained of pain, MPS using the RC was detected in 10 (45%) patients and MPS using the SC was detected in 20 (90%) of patients. Patients with central venous port (CVP) devices had a significantly higher number of MPS lesions than patients without CVP devices (p = 0.029). Conclusions: A very high prevalence of MPS was detected in our study population. MPS should be considered when patients with incurable cancer complain of pain. A multi-center prospective study will be conducted to confirm our findings.

The requirement of fentanyl patch in terminally ill patients with cancer

202

Background: Cancer pain is the most important problem to overcome in terminally ill cancer patients (TICPs). Recently, the fentanyl patch (FP) has been widely used for the treatment of cancer pain. However, the FP requirement largely varies in patients. The purpose of this study was to identify the determinants of the FP requirement in TICPs and propose effective pain relief using a FP. Methods: In a retrospective chart review, we investigated cancer patients who were admitted in our hospital from April 2012 to July 2015 and used FP until their deaths. We examined the time course of FP use in TICPs until death. We used descriptive statistics and a mixed effect model. The primary endpoint of this study was the final dose of FP use (FDFP). Results: Eighty patients were included the analysis. The clinical characteristics were as follows: age (median, range): 64.5 (29-88) years; male/female ratio: 40/40; primary tumor sites: pancreas (n = 33), digestive tract (n = 12), liver and bile duct (n = 7), ovary and uterus (n = 6), hematologic (n = 5), lung (n = 4), head and neck (n = 4), breast (n = 3), and other (n = 6). FDFP was inversely correlated with age (R = -0.272, P < 0.05; Spearman test). The FDFP (mean ± SD) administered in the patients was 3.06 ± 3.20 mg/day (Male/Female: 3.83 ± 4.06/2.29 ± 1.81 mg/day). The FDFP was 4.36 ± 4.32/2.15 ± 1.64 mg/day in patients with/without pancreatic cancer. FDFP was significantly higher in male than in female patients (P < 0.05; student’s t test), and also significantly higher in patients with pancreatic cancer than in patients without pancreatic cancer (P < 0.005; student’s t test). In pancreatic cancer patients, the FP adjustments were more frequent in the last 60 days of life than in patients with other malignancies (P for interaction < 0.001; mixed effect model). Conclusions: We found that younger age, male sex, and pancreatic cancer were risk factors for higher requirement of FP in TICPs. TICPs with pancreatic cancer in particular required more frequent adjustment of FP near death. We should consider quick titration of fentanyl in patients with pancreatic cancer because the pain-relieving action of FP requires time.

Abstract 2031: Association between CYP2D6 genotype and response to tamoxifen in a prospective multicenter study in Japan

Purpose:

CYP2D6 is key enzyme responsible for the generation of the potent active metabolite of tamoxifen, “endoxifen”. We previously reported that reduced- or null-function alleles of CYP2D6 were significantly associated with poor clinical outcome of breast cancer patients treated with tamoxifen. However, there are still discrepant reports questioning the association between CYP2D6 genotype and tamoxifen efficacy. Hence, we carried out prospective multicenter studies to evaluate the value of CYP2D6 genotyping in tamoxifen therapy.

Patients and Methods:

We studied 279 patients with hormone receptor-positive and Her-2 negative, invasive breast cancer receiving preoperative tamoxifen monotherapy for 14 - 28 days. Ki-67 response in breast cancer tissues after tamoxifen therapy was used as a surrogate marker of response to tamoxifen. We investigated the effects of allelic variants of CYP2D6 on Ki-67 change in breast cancer tissues, histological response, breast conservative operation and hot flash.

Results:

Ki-67 labeling index in breast cancer tissues significantly decreased after preoperative tamoxifen monotherapy for 14-28 days (P = 0.00000000024). Moreover, proportion of estrogen receptor positive cells in breast cancer tissues were significantly associated with Ki-67 change after tamoxifen therapy (P = 0.0099). CYP2D6 variants were not significantly associated with histological response, breast conservative operation and hot flash (P = 0.25, P = 0.28 and P = 0.34, respectively). However, CYP2D6 variants were significantly associated with Ki-67 decrease after the preoperative tamoxifen therapy (P = 0.000014; in patients with two variant alleles v patients carrying one or two wild-type alleles).

Conclusion:

Our result suggest that genetic variation in CYP2D6 is a key predictor for the prognosis of patients with breast cancer treated with tamoxifen.

Citation Format: Hitoshi Zembutsu, Seigo Nakamura, Sadako Akashi-Tanaka, Takashi Kuwayama, Chie Watanabe, Tomoko Takamaru, Hiroyuki Takei, Kana Miyahara, Hiroshi Matsumoto, Yoshie Hasegawa, Goro Kutomi, Hiroaki Shima, Fukino Satomi, Hideki Maeda, Minoru Okazaki, Hisamitsu Zaha, Mai Onomura, Ayami Matsukata, Yasuaki Sagara, Shinichi Baba, Akimitsu Yamada, Kazuhiro Shimada, Daisuke Shimizu, Koichiro Tsugawa, Arata Shimo, Tan Ern Yu, Mikael Hartman, Chan Ching Wang, Soo Chin Lee, Yusuke Nakamura. Association between CYP2D6 genotype and response to tamoxifen in a prospective multicenter study in Japan. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2031.

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Patients With an Initial Diagnosis of Cytology-Proven Lymph Node-Positive Breast Cancer

BACKGROUND

Sentinel lymph node biopsy (SNB) is the standard treatment of node-negative breast cancer; however, whether SNB should be performed for patients with node-positive disease before neoadjuvant chemotherapy (NAC) is controversial. We evaluated the accuracy of SNB after NAC in patients with breast cancer with nodal metastasis before chemotherapy to determine the false-negative rate (FNR) and detection rate for SNB.

PATIENTS AND METHODS

In the present multicenter prospective study performed from September 2011 to April 2013, 143 patients with breast cancer and positive axillary nodes, proved by fine needle aspiration cytology at the initial diagnosis (stage T1-T3N1M0), were enrolled. All patients underwent breast surgery with SNB and complete axillary lymph node dissection.

RESULTS

After NAC, the pathologic complete nodal response rate was 52.4%. The sentinel lymph node could be identified in 130 cases (90.9%); the FNR was 16.0% (13 of 81). The FNR of each clinical subtype was 42.1% (8 of 19) for the estrogen receptor-positive and human epithelial growth factor 2 (HER2)-negative (luminal type), 16.7% (2 of 12) for ER-positive and HER2-positive (luminal-HER2 type), 3.2% (1 of 31) for HER2-positive (HER2-enriched type), and 10.5% (2 of 19) for ER-negative and HER2-negative (triple-negative breast cancer; P = .003). The FNR was significantly greater in the luminal than in the nonluminal type (odds ratio, 9.91; 95% confidence interval, 6.77-14.52).

CONCLUSION

SNB after NAC in patients with initially node-positive breast cancer was technically feasible but should not be recommended for the luminal subtype. However, the tumor subtype can guide patient selection, and axillary lymph node dissection could be omitted for the luminal-HER2, HER2-enriched, and triple-negative breast cancer subtypes.

0.43 THz emission from high-T(c) superconducting emitters optimized at 77 K

A liquid helium-free, compact and continuous sub-terahertz radiation system operating at 77 K has been developed using a rectangular mesa device made from a high T(c)-superconducting Bi2Sr2CaCu2O(8+δ) single crystal, based on a different design of a stand-alone mesa sandwich structure to reduce the dc-current Joule heating effects. The mesa was thermally connected to sapphire plates through thin thermal grease embedded with diamond nano-crystals. When immersed in liquid N 2, the device emits intense radiation at 0.437 THz, the highest frequency ever achieved at 77 K, due to excitation of the TM(1, 0) rectangular cavity mode. By varying the dc current-voltage bias and the bath temperature in a He-flow cryostat, the device's emission frequency is broadly tunable from 0.31 THz at 79 K to 1.31 THz at 30 K.

Pollinosis and all-cause mortality among middle-aged and elderly Japanese: a population-based cohort study

BACKGROUND

Having an allergic disease may have health implications beyond those more commonly associated with allergy given that previous epidemiological studies have suggested that both atopy and allergy are linked to mortality. More viable immune functioning among the elderly, as indicated by the presence of an allergic disease, might therefore be associated with differences in all-cause mortality.

OBJECTIVE

Using data from a Japanese cohort, this study examined whether having pollinosis (a form of allergic rhinitis) in a follow-up survey could predict all-cause and cause-specific mortality.

METHODS

Data came from the Komo-Ise cohort, which at its 1993 baseline recruited residents aged 40-69 years from two areas in Gunma prefecture, Japan. The current study used information on pollinosis that was obtained from the follow-up survey in 2000. Mortality and migration data were obtained throughout the follow-up period up to December 2008. Proportional hazard models were used to examine the relation between pollinosis and mortality.

RESULTS

At the 2000 follow-up survey, 12% (1088 of 8796) of respondents reported that they had pollinosis symptoms in the past 12 months. During the 76 186 person-years of follow-up, 748 died from all causes. Among these, there were 37 external, 208 cardiovascular, 74 respiratory, and 329 neoplasm deaths. After adjusting for potential confounders, pollinosis was associated with significantly lower all-cause [hazard ratio 0.57 (95% confidence interval = 0.38-0.87)] and neoplasms mortality [hazard ratio 0.48 (95% confidence interval = 0.26-0.92)].

CONCLUSIONS AND CLINICAL RELEVANCE

Having an allergic disease (pollinosis) at an older age may be indicative of more viable immune functioning and be protective against certain causes of death. Further research is needed to determine the possible mechanisms underlying the association between pollinosis and mortality.

Abstract 5482: CYP2D6 genotype and response to neoadjuvant tamoxifen therapy: a prospective study in Japan

Although lots of CYP2D6-Tamoxifen studies have been reported, the results of the association are still controversial. Because prospective studies are necessary to fully establish the value of CYP2D6 genotyping in tamoxifen therapy, we have initiated the prospective study to clarify the relationship between CYP2D6 genotype and response to preoperative Tamoxifen therapy using a surrogate marker of Ki-67 labeling index in cancer tissue (C-GENT study) since July, 2012. Of the 342 patients who have been recruited in this study, we analyzed 173 cases whose genotyping and measurement of Ki-67 Labeling Index were completed. We observed significant Ki-67 decrease after 2-4 weeks preoperative Tamoxifen therapy (P = 0.000052). Moreover, the patients with CYP2D6 *V/*V is unlikely to show Ki-67 decrease compared with those with CYP2D6 Wt/Wt or Wt/*V (P = 0.00046). Although further analysis should be continuing using a larger number of samples registered in this study, our results suggested that polymorphisms in CYP2D6 could be a key predictor for the prognosis of patients with breast cancer treated with tamoxifen.

Citation Format: Hitoshi Zembutsu, Seigo Nakamura, Sadako Akashi, Takashi Kuwayama, Chie Watanabe, Hiroyuki Takei, Takashi Ishikawa, Yoshie Hasegawa, Soo Chin Lee, Tan Ern Yu, Ayami Matsukata, Hiroshi Matsumoto, Goro Kutomi, Yusuke Nakamura. CYP2D6 genotype and response to neoadjuvant tamoxifen therapy: a prospective study in Japan. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5482. doi:10.1158/1538-7445.AM2015-5482

EXFOLIATIVE DERMATITIS FROM CHINESE HERBS (DECOCTION)

A patient, aged 78, with exfoliative dermatitis due to the ingestion of Chinese herbs (decoction) was presented. Provocative medication showed that he was sensitive to 4 composite materials (Radix angelicae acutilobae, Rhizoma zingiberis, Radix paeoniae and Radix glycyrrhizae). Patch tests were positive to each of these materials while the intradermal test was negative. These results indicate that systemic contact-type hypersensitivity to the ingested medicines is involved in evoking the exfoliative dermatitis lesion and that, in addition, purely epidermal contact sensitivity as defined by S. Epstein and Baer plays an important role.