Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures

This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.

BACKGROUND

Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.

OBJECTIVE

This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.

METHODS

This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients' conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.

RESULTS

The mean observation period was 4.0 years (range 0-7 years). The average age at the time of admission was 82 years (range 60-101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82-91), low risk (92-98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]).

CONCLUSIONS

We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.

Development of a risk prediction score and equation for chronic kidney disease: a retrospective cohort study

Background

Chronic kidney disease (CKD) is a risk factor for end-stage renal disease and contributes to increased risk of cardiovascular disease morbidity and mortality. We aimed to develop a risk prediction score and equation for future onset of CKD using large-scale health checkup data.

Methods

This retrospective cohort study included 58,423 participants without baseline CKD who were randomly assigned to Derivation (n=38,948) and Validation cohorts (n=19,475) at a ratio of 2:1. The predictors were anthropometric indices, life style, and blood sampling data. In the Derivation cohort, we performed multivariable logistic regression analysis and obtained the standardized beta coefficient of each factor that was significantly associated with new-onset CKD and assigned scores to each factor. We created a score and an equation to determine the risk of developing CKD after 5 years and applied them to the Validation cohort to assess their reproducibility.

Results

The risk prediction scores ranged from 0 to 16, consisting of the seven indicators, including age, sex, hypertension, dyslipidemia, diabetes, hyperuricemia, and estimated glomerular filtration rate (eGFR). From the receiver operating characteristic (ROC) curve predicting CKD incidence, the area under the curve (AUC) was 0.78. A score of ≥8 showed the highest Youden index in the Derivation cohort, with a sensitivity of 0.90 and specificity of 0.52. The CKD incidence gradually and constantly increased as the score increased from ≤6 to ≥14 (Figure). The risk prediction equation consisted of aforementioned seven indicators: 1/(1 + exp[−(9.4876 + 0.0311×age + 0.2400×sex + 0.3470×hypertension + 0.0893×dyslipidemia + 0.3444×diabetes + 0.0832×hyperuricemia + (−0.1980)×eGFR]). The median probability obtained from the Derivation cohort was 0.018 (interquartile range 0.002–0.084), and the AUC value of the ROC curve for the development of CKD after 5 years was 0.88, with a sensitivity of 0.84 and a specificity of 0.78 at a cutoff value of 0.077. The Validation cohort analysis yielded similar results.

Conclusion

We developed a clinically useful risk score and equation to predict the CKD incidence after 5 years in the general Japanese population. These models have reasonably high predictability and reproducibility.

Funding Acknowledgement

Type of funding sources: None.

Gender differences in the effects of weight reduction on future blood pressure elevation in the overweight middle-aged population

Background

The effectiveness of weight loss (WL) to prevent blood pressure (BP) elevation is common knowledge; however, the effect of gender differences on this efficacy is not known. We aimed to investigate whether there were gender differences in the degree of BP increase and the prevalence of hypertension in the future when middle-aged obese participants achieved slight WL.

Methods

We analyzed the annual health checkup data for the general Japanese population collected from January 2001 through December 2015. Middle-aged participants (40–49 years old) with overweight (body mass index [BMI], 25.0–29.9 kg/m2) who had examination data for two follow-up time-points (after 3 and 10 years) were included. The participants with a BMI decrease ≥1.0 kg/m2 in 3 years (WL group) were propensity score (PS)-matched to those with a BMI decrease &lt;1.0 kg/m2 or weight gain (non-WL group) based on the data of the first examination, including age, BMI, smoking and drinking status, eGFR, systolic BP and diastolic BP, and hypertension (defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg). We compared the BMI, systolic BP, and hypertension prevalence after 10 years in both groups.

Results

There were 17,554 individuals, aged 40–49 years, with overweight. After excluding subjects who did not satisfy the inclusion criteria and PS matching, we identified 232 men and 160 women in both WL and non-WL groups. The BMI in the WL group after 3 years was significantly lower than that in the non-WL group (men, 25.2±1.4 kg/m2 vs. 27.1±1.6 kg/m2, P&lt;0.001; women, 24.9±1.4 kg/m2 vs. 27.1±1.5 kg/m2, P&lt;0.001), and the significance persisted even after 10 years among both men and women (men, 25.5±1.8 kg/m2 vs. 26.8±2.1 kg/m2, P&lt;0.001; women, 25.3±2.0 kg/m2 vs. 26.8±2.2 kg/m2, P&lt;0.001). Among women, the systolic BP and hypertension prevalence after 10 years were significantly lower in the WL group than in the non-WL group (systolic BP, 124.8±16.3 mmHg vs. 130.3±19.0 mmHg, P&lt;0.01; hypertension prevalence, 35.0% vs. 48.1%, P&lt;0.05). In contrast, there were no significant differences in the SBP and hypertension prevalence after 10 years among men between the groups (systolic BP, 129.0±17.7 mmHg vs. 129.0±17.5 mmHg, P=0.96; hypertension prevalence, 46.1% vs. 48.7%, P=0.57).

Conclusions

There were gender differences in the effectiveness of WL to prevent future BP elevation in overweight middle-aged participants. WL could prevent future BP elevation and the hypertension onset in women but not in men.

Funding Acknowledgement

Type of funding source: None

Fib4 index is a more relevant marker for pulse wave velocity but not for carotid intima-media thickness in a men population

Background

Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) are useful markers for predicting cardiovascular disease not only in patients with cardiovascular disease but also in the general population. On the other hand, liver disease due to obesity has become a problem and has been reported to be associated with the progression of atherosclerosis. Recently, an indicator of liver stiffness, the Fibrosis-4 index (Fib4 index), has been used to detect the pre-stage liver diseases. However, there is no report to investigate the association between atherosclerotic parameters such as IMT and PWV, and Fib4 index. The Fib4 index is a simple index calculated from age and three blood sample data, and it will be useful for screening for an early stage of atherosclerosis if we can show the association between Fib4 index and these parameters.

Purpose

To investigate the association between atherosclerotic parameters such as IMT or PWV and Fib4 index

Methods

We recruited 3, 128 men participants who underwent health checkup. IMT was evaluated by carotid ultrasonography, and branchial-ankle PWV (baPWV) was measured by an automatic device. We analysed the association of IMT or baPWV with Fib4 index and atherosclerotic risk factors such as age, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) and fasting blood sugar (FBS). baPWV ≥1,600 cm/s was defined high baPWV and we performed the receiver operating characteristics (ROC) analysis to demonstrate the significance of Fib4 index for baPWV.

Results

Mean Fib4 index was 1.39±0.68. In the univariate linear regression analysis, all factors such as age, SBP, LDL-C, FBS, Fib4 index were significantly associated with IMT or baPWV. On the other hand, in the multivariate linear regression analysis, Fib4 index was an independent factor for baPWV but not for IMT (IMT, p=0.498; baPWV, p=0.023). Figure 1 showed the result of ROC analysis to predict the high baPWV by Fib4 index. The area under curve (AUC) was 0.73, with the highest discriminating sensitivity and specificity at 0.71 and 0.65, respectively at Fib4 index = 1.27.

Conclusions

Fib4 index was significantly related to baPWV and could be the useful screening marker for arterial stiffness in a general men population.

Figure 1. ROC curve analysis

Funding Acknowledgement

Type of funding source: None

Gender-specific relationship between abdominal obesity and prevalence of new-onset atrial fibrillation in the general Japanese population

Background

The number of incidences of atrial fibrillation (AF) is expected to rise rapidly in the near future because of the increased number of geriatric patients in Japanese society. In addition, obesity is increasing in the general Japanese population. Although a higher body mass index is associated with a higher risk of AF, the relationship between abdominal obesity (large waist circumference) and new-onset AF is unclear.

Methods and results

We performed a longitudinal retrospective observational study from January 2007 to October 2018 using the annual health checkup data. Data from 58,844 adults (29,572 males, age 54±13 years) without baseline AF, who underwent routine health checkups, were analyzed. We performed logistic regression analyses to determine the strength of the association between abdominal obesity and new-onset AF. We also examined the effect of abdominal obesity on the incidences of AF stratified by gender. During a median follow-up of 4 years, we recorded new cases of AF in 322 (0.5%) individuals. In univariate analysis, a large waist circumference was significantly associated with new-onset AF, both in males [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02 to 1.05, p&lt;0.001] and in females (HR 1.04, 95% CI 1.01 to 1.06, p=0.002), respectively. In multivariate analysis adjusted for clinical variables (age, hypertension, dyslipidemia, estimated glomerular filtration rate, habitual drinking and diabetes), a large waist circumference was significantly and independently associated with new-onset AF in males (HR 1.04, 95% CI 1.03 to 1.06, p&lt;0.001), but not in females (HR 1.01, 95% CI 0.99 to 1.04, p=0.269).

Conclusion

Abdominal obesity is independently associated with an increased risk of new-onset AF in males. This association in males might imply some sex-specific mechanisms. There might be a gender difference in the effectiveness of interventions to decrease abdominal obesity to prevent AF.

Funding Acknowledgement

Type of funding source: None

P6232Exploring the bottom of J-shaped curve association between serum uric acid and cardiovascular risks: description using a large Japanese general population

Background

The J-shaped association between serum uric acid (SUA) and cardiovascular risks is known. However, the bottom of the J-shaped curve has not been elucidated because of the lack of epidemiological knowledge about hypouricemia.

Purpose

To explore the SUA levels related to the most preferable cardiovascular risks using data from a Japanese general population.

Methods

Data from 246,923 individuals (111,117 men and 135,806 women) who underwent routine health checkups between January 2001 and December 2015 were analyzed. The participants were divided into quartiles according to their SUA levels, and patients with hypouricemia (SUA level <2.0 mg/dL) were subdivided into two groups according to their distributions. We compared their characteristics, including their cardiovascular risks.

Results

The prevalence of hypouricemia was 0.46% overall, 0.21% for men, and 0.66% for women (P<0.001). The subjects with hypouricemia were divided into two groups according to SUA level: a lower hypouricemia group (0.4–1.1 mg/dL, which included a peak at 0.7–0.8 mg/dL) and a higher hypouricemia group (1.4–2.0 mg/dL). The two groups exhibited significanly different characteristics in several variables: body mass index and triglyceride in men, and age, body mass index, triglyceride, low-density lipoprotein cholesterol, and renal function in women. Furthermore, several cardiovascular risk factors showed the most preferable values in subjects with SUA 1.4–2.0 mg/dL (Figure).

Conclusions

There were two independent distributions in subjects with SUA ≤2.0 mg/dL. The individuals with SUA 1.4–2.0 mg/dL exhibited the most preferable values for several cardiovascular risk factors, suggesting an association with the bottom of the J-shaped curve between SUA and cardiovascular risks.

Arrhythmia Curve Interpretation Using a Dynamic System Model of the Myocardial Pacemaker

A problem of identifying the phase response curve of the myocardial pacemaker was investigated using a simple dynamic system model of cardiac arrhythmia. A hybrid optimization method of a genetic algorithm and a local optimization technique was employed to obtain a solution of the model fitting. The method was applied to two categories of arrhythmias, ventricular parasystole and high-degree AV block. The present study offered a new insight into the mechanism of cardiac arrhythmias.

[Rupture of an internal carotid artery pseudoaneurysm after irradiation for a nasopharyngeal carcinoma--case report]

The primary treatment of nasopharyngeal carcinoma (NPC) has been external radiotherapy. Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare complication of irradiation therapy for a nasopharyngeal carcinoma. A 78 years old man had a history of NPC treated with radiotherapy in 1993. He was admitted to the hospital because of epistaxis. Angiography showed an ICA pseudoaneurysm pointing medially to the nasopharynx. Coil embolization of the ICA was performed, but cerebral infarction occurred. Internal carotid artery (ICA) pseudoaneurysms are an uncommon but potentially lethal condition. Angiography is the mainstay of diagnosis of the aneurysm and planning the embolization of the ICA. We should be more aware of this complication in NPC patients.

Topological surface states with persistent high spin polarization across the Dirac point in Bi2Te2Se and Bi2Se2Te

Helical spin textures with marked spin polarizations of topological surface states have been unveiled for the first time by state-of-the-art spin- and angle-resolved photoemission spectroscopy for two promising topological insulators, Bi(2)Te(2)Se and Bi(2)Se(2)Te. Their highly spin-polarized natures are found to be persistent across the Dirac point in both compounds. This novel finding paves a pathway to extending the utilization of topological surface states of these compounds for future spintronic applications.

p53 tumor suppressor gene and ras oncogene mutations in hypopharyngeal squamous cell carcinomas

To examine the potential role of p53 and ras gene mutations in hypopharyngeal tumorigenesis, twenty-eight primary hypopharyngeal carcinomas, obtained at biopsy or total pharyngolaryngectomy, were investigated. Exons 5 through 9 of the p53 gene and exons 1 and 2 of the H-, K-, N-ras gene were screened using a combination of immunohistochemistry and single-strand conformation polymorphism analysis of polymerase chain reaction products (PCR-SSCP). The targeted DNA sequences coding for p53 and ras were confirmed by direct DNA sequencing. Point mutations of p53 were found in 9 (32.1%) of the 28 cases, including one with a double mutation, 3 in exon 5, 1 in exon 6, 2 in exon 7 and 4 in exon 8. Positive nuclear immunostaining for p53 was evident in 14 (50.0%) lesions. Seven (25.0%) of the 28 demonstrated point mutations in the H-rns gene, and 11 (39.3%) showed positive cytoplasmic staining for I as. The 5-year survival rate was worse with than without p53 overexpression (p <0.05). The present results suggest that gene mutations, although they occur at a relatively low incidence, are involved in hypopharyngeal tumorigenesis with p53 expression being a prognostic factor.

Experimental verification of PbBi2Te4 as a 3D topological insulator

The experimental evidence is presented of the topological insulator state in PbBi2Te4. A single surface Dirac cone is observed by angle-resolved photoemission spectroscopy with synchrotron radiation. Topological invariants Z2 are calculated from the ab initio band structure to be 1;(111). The observed two-dimensional isoenergy contours in the bulk energy gap are found to be the largest among the known three-dimensional topological insulators. This opens a pathway to achieving a sufficiently large spin current density in future spintronic devices.

Giant Rashba-type spin splitting in bulk BiTeI

There has been increasing interest in phenomena emerging from relativistic electrons in a solid, which have a potential impact on spintronics and magnetoelectrics. One example is the Rashba effect, which lifts the electron-spin degeneracy as a consequence of spin-orbit interaction under broken inversion symmetry. A high-energy-scale Rashba spin splitting is highly desirable for enhancing the coupling between electron spins and electricity relevant for spintronic functions. Here we describe the finding of a huge spin-orbit interaction effect in a polar semiconductor composed of heavy elements, BiTeI, where the bulk carriers are ruled by large Rashba-like spin splitting. The band splitting and its spin polarization obtained by spin- and angle-resolved photoemission spectroscopy are well in accord with relativistic first-principles calculations, confirming that the spin splitting is indeed derived from bulk atomic configurations. Together with the feasibility of carrier-doping control, the giant-Rashba semiconductor BiTeI possesses excellent potential for application to various spin-dependent electronic functions.

Distribution of thermal neutron flux around a PET cyclotron

The number of positron emission tomography (PET) examinations has greatly increased world-wide. Since positron emission nuclides for the PET examinations have short half-lives, they are mainly produced using on-site cyclotrons. During the production of the nuclides, significant quantities of neutrons are generated from the cyclotrons. Neutrons have potential to activate the materials around the cyclotrons and cause exposure to the staff. To investigate quantities and distribution of the thermal neutrons, thermal neutron fluxes were measured around a PET cyclotron in a laboratory associating with a hospital. The cyclotron accelerates protons up to 18 MeV, and the mean particle current is 20 μA. The neutron fluxes were measured during both 18F production and C production. Gold foils and thermoluminescent dosimeter (TLD) badges were used to measure the neutron fluxes. The neutron fluxes in the target box averaged 9.3 × 10(6) cm(-2) s(-1) and 1.7 × 10(6) cm(-2) s(-1) during 18F and 11C production, respectively. Those in the cyclotron room averaged 4.1 × 10(5) cm(-2) s(-1) and 1.2 × 10(5) cm(-2) s(-1), respectively. Those outside the concrete wall shielding were estimated as being equal to or less than ∼3 cm s, which corresponded to 0.1 μSv h(-1) in effective dose. The neutron fluxes outside the concrete shielding were confirmed to be quite low compared to the legal limit.

[Long-term histological outcome for the larynx after Gore-Tex medialization thyroplasty]

OBJECTIVES

We studied the long-term histological response of the human larynx to Gore-Tex implant and evaluated whether its biocompatibility.

STUDY DESIGN

Retrospective histological study.

METHODS

We conducted medialization laryngoplasty with expanded polytetrafluoroethylene (ePTEE or Gore-Tex) in a patient with vocal-fold paralysis. A strip of Gore-Tex was folded several times and inserted into the pocket preserving the inner perichondrium through a thyroid cartilage window. The patient died 12 months later and we histologically analyzed the larynx.

RESULTS

No evidence was seen of foreign body granuloma, migration, extrusion, or infection. A modest inflammatory response with a fibrous capsule was present around implants. We confirmed the infiltration of abundant collagen and numerous fibroblasts into the microporous implant structure.

CONCLUSION

Histological examination results suggest that Gore-Tex implants are safe and biocompatible with the human larynx. A slight inflammatory response and infiltration of fibrous tissue into the implant itself demonstrated that Gore-Tex implants are immunologically well tolerated.

[Effects and use of the suture direction mimicking only the force action of the lateral cricoarytenoid muscle in arytenoid adduction combined with thyroplasty type I]

Isshiki's arytenoid adduction combined with thyroplasty type I is a useful procedure for correcting the membranous vocal fold atrophy and the height difference between the two vocal folds, particularly in patients with a large posterior glottal chink and atrophy. Conventional arytenoid adduction (Isshiki's arytenoid adduction) is designed to place a suture through the muscular process of the arytenoid attached anteriorly to the thyroid ala, stimulating the function of the thyroarytenoid muscle and lateral cricoarytenoid muscle. Combining with thyroplasty type I, the suture direction of conventional arytenoid adduction prevented inserting implant material into the pocket of the thyroid cartilage window. In contrast to conventional arytenoid adduction, the suture direction in our approach is anchored anteroinferiorly, mimicking only the action of the lateral cricoarytenoid muscle (the major adductor of the larynx). It is used the thyroid cartilage window in thyroplasty type I to determine the direction of the lateral cricoarytenoid muscle. After approaching the muscular process based on Isshiki's arytenoid adduction, two nylon sutures are tied across the muscular process or the lateral cricoarytenoid muscle nearby the muscular process. The cricoarytenoid joint is not dislocated. One of the sutures was anchored to the inferior rear corner of the thyroid cartilage window to be used with thyroplasty type I and the other was anchored to the rear lower margin of the thyroid lamina. Gore-tex medialization thyroplasty is done after tying the sutures on the thyroid ala. Subjects were 30 unilateral paralytic dysphonia. Maximum phonation of all patients improved significantly after surgery. The preoperative and postoperative mean maximum phonation times were 6.0 and 17.9 seconds. No major complications occurred in this study. Our approach effectively combined arytenoid adduction and thyroplasty type I for patients with severe insufficient glottic closure.

Delayed Facial Nerve Palsy After Otologic Surgery

Delayed facial nerve palsy (DFP) is rarely experienced after otologic surgeries that do not directly touch the facial nerves, such as tympano-mastoidectomy, cochlear implants, and stapes surgery, and is troublesome to both surgeons and patients if it happens. Here, we report 7 cases of DFP, including one case that developed DFP after endolymphatic sac surgery. The ratios of occurrence were as follows: 0.7% (2/305) for tympano-mastoidectomy, 0.8% (3/354) for cochlear implant, 0.4% (1/260) for stapes surgery and 1.0% (1/98) for endolymphatic sac surgery. All otologic surgeries, except for endolymphatic sac surgery, exposed the chorda tympani, and all surgeries, except for stapes surgery, underwent drilling for a mastoidectomy. Furthermore, DFP was always observed ipsilaterally to the operated ear after otologic surgeries and was never seen after benign parotid tumor surgery or total laryngectomy. Therefore, there may be a strong relationship between DFP and the procedures, used during otologic surgeries.

Spindle cell carcinoma of the larynx

Four rare cases of spindle cell carcinoma of the larynx are reported and the histo-pathological and immuno-histochemical findings are described. The spindle cell carcinoma involved the right vocal cord of an 88-year-old and an 86-year-old male patients and the anterior commissure of a 76-year-old and a 68-year-old male patients. Two patients underwent total laryngectomy, one patient extirpation under laryngomicrosurgery and one radiation therapy. All were well controlled thereafter and there was no recurrence. Surgery seemed to be the most satisfactory therapeutic approach and radiation therapy was effective in a patient with relatively small tumor. The histo-pathological and immuno-histochemical analysis in one patient revealed a sarcoma-like component of the carcinoma and the findings suggested that this was the result of a metaplastic change in the mesenchyme without inflammatory changes.

[Four cases of hypopharyngeal cancer treated with docetaxel, cisplatin, and 5-FU followed by radiotherapy and/or neck dissection]

We treated 4 patients with hypopharyngeal cancer, each of whom had a complete response after 2 cycles of chemotherapy with docetaxel, cisplatin, and 5-FU followed by radiation and/or neck dissection. Twenty-one months to 2 years after this therapy, 3 patients had no recurrence and no metastasis with their laryngeal framework and function preserved. Chemotherapy including docetaxel, cisplatin, and 5-FU is a useful treatment for early head and neck cancer.

[A case of neck metastasis from hypopharyngeal carcinoma successfully treated with TS-1]

We report a case of hypopharyngeal carcinoma with recurrent neck metastasis. Preoperative chemoradiation and pharyngo-laryngo-esophagectomy with bilateral neck dissection was done as first-line therapy. Six months later, the carcinoma metastasized to the right paratracheal lymph node. Because of resistance to chemoradiation (CBDCA) as second-line therapy, we administered TS-1 for the treatment after 60 Gy radiation. The chemotherapy with TS-1 resulted in complete response by diagnostic imaging (CT). There was no sign of recurrence for 1 year after 5 courses of treatment. TS-1, which allows oral chemotherapy on an outpatient basis, would be a useful drug for treatment with radiotherapy in patients with advanced and/or recurrent head and neck cancer.

Highly precise measurements of the relative gamma-ray intensities for 56Mn and 72Ga

Precise relative gamma-ray intensities of 56Mn and 72Ga produced by neutron irradiation of natural Mn3O4 and enriched 71Ga2O3 (99.8%) were measured by an HPGe detector with highly-precisely calibrated detection efficiencies. As both nuclides exhibit no beta branch to the ground state, the absolute emission probabilities of the 846.8 keV gamma ray for 56Mn and 834.0 keV gamma ray for 72Ga were determined to be 0.9888+/-0.0014 and 0.9553+/-0.0005, respectively.

Precise measurement of the emission probability of the 543keV γ ray of 199Pt

199Pt has been produced by neutron irradiation of enriched 198Pt (95.71%) metal powder, and precise measurements have been made of the gamma-ray emission probabilities by means of 4pibeta-gamma coincidence apparatus and a live-timed two-dimensional data-acquisition system. Daughter 199Au decays with a half-life of 3.139 d, and therefore the measured disintegration rate had to be corrected. The absolute emission probability of the 543.0 keV gamma ray was determined to be 0.1174+/-0.0007 from the gamma-ray intensity and the corrected disintegration rate.

[A case of posterior wall cancer of the hypopharynx treated with docetaxel followed by radiation]

We treated a 67-year-old female with hypopharyngeal cancer (T2N0) in the posterior wall, who had a complete response after two cycles of chemotherapy with docetaxel followed by radiation. Five years after this therapy she has had no recurrence and no metastasis, with preserved laryngeal framework and function. Docetaxel is useful for treating early head and neck cancer.

[A clinical study of 213 patients with laryngeal cancer]

We retrospectively analyzed 213 patients--197 men and 14 women aged 40 to 87 years--with laryngeal cancer treated at our department from September 1986 to December 1997. The male to female ratio was about 12:1. Cases included 120 glottic (56.3%), 90 supraglottic (42.3%), and 3 subglottic (1.4%). Radiotherapy for early cases and surgery, mainly total laryngectomy for T3 and T4 were conducted first. The 5-year cause-specific survival by site was 97.6% glottic and 77.5% supraglottic. The five-year survival was 88.6% overall. Local control was 83.8% in glottic T1a and 84.6% in glottic T1b. The 3-year preservation of the larynx was 89.1% in glottic T1a and 92.3% in glottic T1b. Distant metastases were observed in 14 cases, mostly to the lung, bones, and liver. At high risk for distant metastasis were those with supraglottic T3-T4, N1, N2b, or pN2c.

Determination of the emission probabilities of the principal gamma-rays for 134Cs to a high precision

While multi-gamma-ray emitting nuclides such as 75Se, 134Cs and 152Eu have reasonably well-defined decay scheme, some inconsistencies still remain. Detailed evaluations and weighted-mean analyses result in the recommendation of gamma-ray emission probabilities with small uncertainties, although significant deviations exist in the measured values. Therefore, the gamma-ray emission probabilities of 134Cs have been measured to a high precision after an extremely accurate calibration of detection efficiency. The resulting data agree extremely well with the evaluated values in IAEA-TECDOC-619 (IAEA, X-ray and gamma-ray standards for detector calibration, IAEA-TECDOC-619, IAEA, Vienna, 1991).

Pharmacodynamic analysis of steroid 5alpha-reductase inhibitory actions of Z-350 in rat prostate

The pharmacodynamics of (S)-4-[3-[4-[1-(4-methylphenyl)-3-[4-(2-methoxyphenyl)piperazine-1-yl]propoxy]benzoyl]indole-1-yl] butyric acid hydrochloride (Z-350), which has alpha(1)-adrenoceptor antagonistic and steroid 5alpha-reductase inhibitory effects, were investigated in rats. The disposition of Z-350 was a function of linear kinetics at doses from 1 to 30 mg/kg; the bioavailability was calculated to be 65.2%. The inhibition of 5alpha-reductase was dependent on the concentration of Z-350 in plasma and in the prostate. Analysis of the relationship between the concentration in the prostate and the inhibition seen after a single oral administration showed that the Hill constant was almost 1.0 and EC(50)(n(H)) was 47.4 ng/g of tissue; these parameters did not change after multiple administration. Z-350 inhibited 5alpha-reductase 1 h after oral administration at a dose of 3 mg/kg; maximum inhibition was observed after 2-4 h, and the inhibition (%) was maintained for 24 h after oral administration.

LC determination of Z-338, novel gastroprokinetic agent in dog plasma by SCX solid phase extraction

A simple high-performance liquid chromatographic assay with using UV detection (266 nm) was developed to determine a novel gastroprokinetic agent, Z-338 in dog plasma. The extraction procedure using solid-phase extraction with a Isolute SCX column produces extremely clean eluates and a high recovery. Intra- and inter-day variabilities were lower than 5%. The limit of quantitation of the method was 2.5 ng/ml. This assay was applied to the monitoring of Z-338 concentrations in dogs after oral administration. The method also appeared rapid, simple and suitable for therapeutic Z-338 monitoring.

Precise emission probabilities of gamma-rays of 159Gd

Measurement of emission probabilities for principal gamma-rays of 159Gd with 4pibeta(ppc)-gamma(HPGe) coincidence apparatus has given precise values as indicated by uncertainties of about 1%. Improved certainties are seen when comparing the present results with emission probabilities evaluated in Nuclear Data Sheets (Helmer, 1994, p. 72) for which the uncertainties are about 24%. The improvement resulted in precise decay scheme parameters of the nuclide.

Base mutation analysis by a ferrocenyl naphthalene diimide derivative

An electrochemical DNA sensing technique was developed by using ferrocenyl naphthalene diimide coupled with a probe DNA-immobilized electrode. This technique enabled detection of target DNA quickly and with high sensitivity. Applicability of this technique for single nucleotide polymorphisms (SNPs) analysis was demonstrated by successful analysis of a DNA mismatch on the cancer repression gene p53 with high precision.

Factors affecting emotional instability in female rheumatoid arthritis outpatients with limited functional disorder

Abstract We attempted to identify which background factors were the most important indicators of such psychological problems as emotional instability, a feeling of hopelessness, and suicidal tendencies in female rheumatoid arthritis (RA) outpatients with limited functional disorder. Among female RA patients aged 20 years and older who visited the outpatient clinic, 101 class I and II patients were selected as subjects for the present study. An original questionnaire and a psychological test (CMI) were given to those subjects who had given their written consent to such testing, and an analysis was carried out on 85 patients who returned all the written forms. Their emotional instability was related to factors such as "not being able to understand the nature of RA disease and its treatment," "sense of value had changed after developing RA," "nonuse of drugs," and "duration of disease." A feeling of hopelessness was related to "smoking," and a suicidal tendency was related to "smoking" and "class I." We identified a characteristic correlation between emotional instability and background factors in this study. Paying close attention to these factors may thus be useful in preventing the appearance of psychological problems as well as in developing effective early treatment strategies.

Mannose binding lectin (MBL) gene mutation is not a risk factor for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in Japanese

Mannose binding lectin (MBL) deficiency may be associated with increased susceptibility to infection and autoimmune disorders, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In the present study, we performed for the first systematic search for mutations in all the four exons of the MBL gene using polymerase chain reaction (PCR)/single-strand conformation polymorphism (SSCP) analysis. Of 49 healthy Japanese individuals studied, only the previously reported mutation at the codon 54 (substitution from Gly to Asp; G54D) was identified. The allele frequencies of G54D in 105 healthy Japanese individuals, 95 SLE patients and 59 RA patients, were 0.233, 0.226 and 0.178, respectively, which were not significantly different. In addition, two polymorphisms at positions of -550 and -221 in the promoter region were not associated with SLE and RA. It is unlikely that MBL deficiency plays a major role in the pathogenesis of SLE and RA in Japanese.

CDDP induces p53-dependent apoptosis in tongue cancer cells

We have investigated the CDDP sensitivities of two tongue cancer cell lines with differing p53 genetic status, one with wild-type p53 (SAS) and the other with mutant-type p53 (HSC-4). SAS was about 2 times more sensitive at the D10 dose and demonstrated increased p53 and Bax protein levels at 10 h after CDDP treatment on Western blot analysis. On the other hand, overexpression of p53 in HSC-4 was observed without CDDP treatment and no elevation of Bax could be detected. Apoptosis was observed after CDDP treatment in SAS but not in HSC-4 by Hoechst 33342-staining and electrophoresis methods. These findings indicate that p53 plays an important role in apoptosis as a positive regulator of Bax expression. It is suggested that p53 status may have predictive potential with regard to response to CDDP therapy.

Potential role of microvessel density in predicting radiosensitivity of T1 and T2 stage laryngeal squamous cell carcinoma treated with radiotherapy

Curative radiotherapy is the first choice of therapy for T1 and T2 stage laryngeal squamous cell carcinoma (LSCC) patients to preserve their phonation. Patients with recurrent tumors who undergo salvage surgery require prolonged nasal feeding. Therefore, clinical interest has been focused on elucidating a predictive factor indicating which tumors are likely to be radiosensitive before radiotherapy. We analyzed the relations between radiosensitivity and clinicopathological factors (gender, tumor location, histological factors, and clinical tumor-node-metastasis stage), expression of apoptosis-related proteins (p53, bax, bcl-2), apoptotic index using the terminal deoxynucleotidyltransferase-mediated nick end labeling method, expression of cell proliferation-related proteins (Ki-67-labeling index and epidermal growth factor receptor overexpression) and microvessel density (MVD, vessels/field = 0.391 mm2) in biopsy specimens from 31 LSCC patients given radiotherapy (total radiotherapy dose of 52-70 Gy over 4-6.5 weeks). Univariate analysis revealed that tumors with a high MVD (> or =35 vessels/field) showed better radiosensitivity than those with a low MVD (<35 vessels/field, P = 0.008) and that a high Ki-67-labeling index (> or =40%) was weakly associated with radiosensitivity (P = 0.056). Multivariate analysis and Kaplan-Meier analysis showed that MVD alone had significant predictive power for radiosensitivity in T1 and T2 stage LSCCs after radiotherapy (P = 0.012, 0.0003, respectively). No significant association between clinicopathological factors, or of overexpression of p53, bax, bcl-2, epidermal growth factor receptor, or apoptotic index, with radiosensitivity was found. These results indicate that MVD is a potentially useful clinical factor predicting radiosensitivity for patients with early stage LSCCs before treatment.