Validity and reliability of the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) for evaluating oncologist consultations

Objective

To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability.

Methods

A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patient characteristics and psychometric scales, like the PSQ-J, willingness to recommend an oncologist to others, trust in the healthcare system, uncertainty, and the Physician Compassion Questionnaire were collected. Validity was examined using exploratory and confirmatory factor analyses and by calculating the correlations between the total PSQ-J score and the criterion variables. Reliability was confirmed by Cronbach's alpha and test-retest score correlations at a two-week interval.

Results

The first and second surveys were conducted on 309 and 107 patients, respectively. One-dimensionality and model fit were verified using factor analyses. The PSQ-J was significantly associated with other comparable scales. Cronbach's alpha was 0.962; the correlation between the PSQ-J test-retest scores was 0.835 (p < .001).

Conclusion

The current study indicates that the PSQ-J can be valid and reliable for assessing satisfaction with oncologist consultation.

Innovation

The PSQ-J enables the effective assessment of patient satisfaction with oncologist consultations, leading to better practice reflecting the patient's viewpoint.

Validation of the Japanese version of the full and short form Trust in Oncologist Scale

OBJECTIVES

This study aimed to validate the Japanese versions of the Trust in Oncologist Scale (TiOS-J) and the TiOS-Short Form (TiOS-SF-J).

METHODS

A cross-sectional web-based survey was conducted among cancer patients in Japan. The forward-backward translation method was used to develop the TiOS-J. The web-based survey was mailed to 633 people, of whom 309 responded. After 2 weeks, 103 among the 156 first-time respondents completed the second survey to verify the reliability of the retest method. The validity was evaluated by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Spearman's correlation coefficients between the Patient Satisfaction Questionnaire-Japanese, willingness to recommend the oncologist, trust in health care, and number of oncological consultations. To evaluate reliability, Cronbach's α and test-retest correlation were calculated.

RESULTS

The theoretically driven four-factor model and the EFA-driven one-factor model of the full-form TiOS-J (18 items) did not result in an acceptable fit; however, CFA supported the one-dimensionality of the 5 items from the TiOS-SF-J (χ² (5) = 12.36, p = 0.03, goodness-of-fit index = 0.984, adjusted goodness-of-fit index = 0.952, comparative fit index = 0.991, and root mean square error of approximation = 0.069). With regard to the reliability of TiOS-J and TiOS-SF-J, the Cronbach's alpha values were 0.94 and 0.89, respectively; the test-retest values were 0.82 and 0.78.

SIGNIFICANCE OF RESULTS

This study indicated that the TiOS-J and TiOS-SF-J are valid and reliable instruments for measuring patients' trust in their oncologists and can be used to assess trust in oncologists for both clinical and research purposes.

Optimization of a fast deuterium diagnostic method based on visible energetic 3He spectroscopy for high electron density plasmas

Fast ions play a crucial role in plasma heating, and their behavior in the plasma must be accurately understood. A diagnostics method based on charge exchange emission from the n = 4 - 3 transition (λ0 = 468.6 nm) of energetic 3He produced by the deuteron-deuteron reaction has been proposed as a for fast deuterons with energies in the order of MeV. The proposed method has the following advantages: No beam emission interferes with the spectra, the direction of the measuring line of sight, and the injection angle of the diagnostic beam can be freely determined. In previous studies, due to competing bremsstrahlung, it was expected that the proposed method will not be practical in the case of high electron density operation. This paper makes the proposed method available for measurement even at high electron densities by optimizing the measurement line of sight direction and the diagnostic beam incidence angle. This allows an electron density five times larger than the range of applications shown in previous studies. This result will contribute to measure of DT alpha in ITER.

Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study

BACKGROUND

Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer.

METHODS

This single-center, follow-up cohort study included Japanese patients with advanced cancer who received chemotherapy at Tohoku University Hospital between January 2015 and January 2016. Patients were surveyed at enrollment and followed up for clinical events for 5 years thereafter. We compared (i) the patients' prognostic awareness with both actual survival time and physician's prediction of survival and (ii) physician's prediction of survival time with actual survival. Factors associated with accurate prognostic awareness were identified by univariate analysis.

RESULTS

Of the 133 patients eligible for the study, 57 patients were analyzed. Only 10 (17.5%) patients had accurate prognostic awareness. Forty-three patients (75.4%) were optimistic about their prognosis; >80% of patients were more optimistic than their physicians about their prognosis. The physicians' predictions were accurate in for patients (37.5%). Accurate prognostic awareness was associated with physician's explanation of the prognosis and patients' perception of a good death.

CONCLUSIONS

A majority of the patients with advanced cancer in this study had prognostic awareness that was more optimistic in comparison with their actual survival, and most were more optimistic than their physicians about their prognosis. Further research is needed to develop programs to facilitate the discussion of life expectancy with patients in a manner that is consistent with their preferences.

Radiographs Are Comparable With 3-Dimensional Computed Tomography-Based Models as a Modality for the Preoperative Planning of the Arthroscopic Lateral Acromioplasty: A Retrospective Comparative Study

Purpose

To compare plain radiographs with 3-dimensional (3D) computed tomography (CT) data for preoperative planning of arthroscopic lateral acromioplasty (ALA) for patients in whom ALA was performed along with arthroscopic rotator cuff repair (ARCR).

Methods

Patients older than 25 years old who underwent ALA along with ARCR in our institution between October 2019 and February 2021 were included in this study. Preoperative ALA simulations were performed on plain radiographs and 3D models based on CT data. The critical shoulder angle (CSA) was compared between simulations based on radiographs and those based on 3D models. The ALA procedure was performed using the 3D model simulation, along with ARCR. The CSA after surgery was investigated using radiographs.

Results

We evaluated 11 shoulders in 10 patients. There was no significant difference between the mean preoperative CSA on radiographs and 3D models (38.0° ± 2.6° vs 38.6° ± 1.8°, respectively; P = .55). The mean CSA after 4-mm ALA simulation using radiographs was not significantly different to that using 3D models (34.1° ± 2.6° vs 34.3° ± 2.5°, respectively; P = .84). Four cases (36.4%) required 8-mm ALA to reduce the CSA to <35° on radiographic analysis, and 2 (18.2%) required 8-mm ALA on 3D model analysis. The mean CSA on postoperative radiographs was significantly smaller than that on preoperative radiographs (32.1° ± 2.7° vs 38.0° ± 2.6°, respectively; P < .01).

Conclusions

There was no significant difference between the mean CSA after a 4-mm ALA simulation using radiographs and that using 3D models based on preoperative CT data, which suggests that radiographs are comparable with 3D CT data models as a reliable modality for the preoperative simulation of ALA.

Level of Evidence

III, retrospective comparative study.

A newly established monoclonal antibody against ERCC1 detects major isoforms of ERCC1 in gastric cancer

Identifying patients resistant to cisplatin treatment is expected to improve cisplatin-based chemotherapy for various types of cancers. Excision repair cross-complementing group 1 (ERCC1) is involved in several repair processes of cisplatin-induced DNA crosslinks. ERCC1 overexpression is reported as a candidate prognostic factor and considered to cause cisplatin resistance in major solid cancers. However, anti-ERCC1 antibodies capable of evaluating expression levels of ERCC1 in clinical specimens were not fully optimized. A mouse monoclonal antibody against human ERCC1 was generated in this study. The developed antibody 9D11 specifically detected isoforms of 201, 202, 203 but not 204, which lacks the exon 3 coding region. To evaluate the diagnostic usefulness of this antibody, we have focused on gastric cancer because it is one of the major cancers in Japan. When ERCC1 expression was analyzed in seventeen kinds of human gastric cancer cell lines, all the cell lines were found to express either 201, 202, and/or 203 as major isoforms of ERCC1, but not 204 by Western blotting analysis. Immunohistochemical staining showed that ERCC1 protein was exclusively detected in nuclei of the cells and a moderate level of constant positivity was observed in nuclei of vascular endothelial cells. It showed a clear staining pattern in clinical specimens of gastric cancers. Antibody 9D11 may thus be useful for estimating expression levels of ERCC1 in clinical specimens.

Factors related to specialized palliative care use and aggressive care at end of life in Japanese patients with advanced solid cancers: a cohort study

PURPOSE

This study aimed to (1) describe characteristics of aggressive care at the end of life (EOL) and (2) identify factors associated with specialized palliative care use (SPC) and aggressive care at the EOL among Japanese patients with advanced cancer.

METHODS

This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death.

RESULTS

We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20-59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30-12.91; p = 0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07-17.37; p = 0.04) were associated with chemotherapy in the last month before death.

CONCLUSION

Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.

Fast deuteron diagnostics using visible light spectra of 3He produced by deuteron-deuteron reaction in deuterium plasmas

The fast deuteron (non-Maxwellian component) diagnostic method, which is based on the higher resolution optical spectroscopic measurement, has been developed as a powerful tool. Owing to a decrease in the D-H charge-exchange cross section, the diagnostic ability of conventional optical diagnostic methods should be improved for ∼MeV energy deuterons. Because the ³He-H charge-exchange cross section is much larger than that of D-H in the ∼MeV energy range, the visible light (VIS) spectrum of ³He produced by the dueteron-dueteron (DD) reaction may be a useful tool. Although the density of ³He is small because it is produced via the DD reaction, improvement of the emissivity of the VIS spectrum of ³He can be expected by using a high-energy beam. We evaluate the VIS spectrum of ³He for the cases when a fast deuteron tail is formed and not formed in the ITER-like beam injected deuterium plasma. Even when the beam energy is in the MeV energy range, a large change appears in the half width at half maximum of the VIS spectrum. The emissivity of the VIS spectrum of ³He and the emissivity of bremsstrahlung are compared, and the measurable VIS spectrum is obtained. It is shown that the VIS spectrum of ³He is a useful tool for the MeV beam deuteron tail diagnostics.

Identifying factors predicting prolonged rehabilitation after simultaneous bilateral total knee arthroplasty: a retrospective observational study

Background

Rehabilitation is an effective procedure for promoting functional recovery after simultaneous bilateral total knee arthroplasty (TKA); however, it has been cited as a significant economic burden of medical care. We hypothesized that preoperative factors, including age, sex, body mass index, living alone, the knee society function score (KSS), the American society of anesthesiologists (ASA) class, hemoglobin (Hb), albumin level, mean range of motion, and the Kellgren–Lawrence grade, would predict prolonged rehabilitation utilization.

Methods

In total, 191 patients undergoing simultaneous bilateral TKA in a single hospital were enrolled. The successful compliance group included patients who completed their rehabilitation program and could return to their residence within 3 weeks after surgery (n = 132), whereas the delayed group included the remaining patients (n = 59). Logistic regression analysis was performed using preoperative factors. A prediction scoring system was created using the regression coefficients from the logistic regression model.

Results

Logistic regression analysis revealed that age (β = − 0.0870; P <  0.01) and Hb (β = 0.34; P <  0.05) were significantly associated with prolonged rehabilitation programs, whereas body mass index, living alone, KSS score, and ASA class were not significantly associated with successful completion of rehabilitation programs; however, these factors contributed to the prediction scoring formula, which was defined as follows: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ {\displaystyle \begin{array}{l}\mathrm{Score}=10-\left(0.09\times \mathrm{age}\right)-\left(0.09\times \mathrm{body}\ \mathrm{mass}\ \mathrm{index}\right)-\left(0.56\times \mathrm{living}\ \mathrm{alone}\ \right[\mathrm{alone}:1,\\ {}\mathrm{others}:0\left]\right)+\left(0.03\times \mathrm{KSS}\ \mathrm{stairs}\right)+\left(0.34\times \mathrm{Hb}\right)-\left(1.1\times \mathrm{ASA}\ \mathrm{class}\right).\end{array}} $$\end{document}Score=10-0.09×age-0.09×body mass index-(0.56×living alone[alone:1,others:0])+0.03×KSSstairs+0.34×Hb-1.1×ASAclass.

The C-statistic for the scoring system was 0.748 (95% confidence interval, 0.672–0.824). The positive and negative likelihood ratios were 2.228 (95% CI, 1.256–3.950) and 0.386 (95% CI, 0.263–0.566), respectively. These results showed an increase of 15–20% and a decrease of 20–25% in the risk of prolonged rehabilitation. The optimal cutoff point for balancing sensitivity and specificity was 3.5, with 66.6% sensitivity and 78.0% specificity.

Conclusions

Older age and lower preoperative Hb were significantly associated with prolonged rehabilitation programs. We defined a new scoring formula using preoperative patient factors to predict prolonged rehabilitation utilization in patients undergoing simultaneous bilateral TKA.

Effect of Decreasing the Anterior Pelvic Tilt on Range of Motion in Femoroacetabular Impingement: A Computer-Simulation Study

Background:

The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology.

Purpose:

To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery.

Study Design:

Controlled laboratory study.

Methods:

The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions.

Results:

The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline (P < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model (P < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model.

Conclusion:

Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement.

Clinical Relevance:

Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.

Prevalence of groin pain in unicycle athletes: A nationwide questionnaire survey

BACKGROUND AND PURPOSE

This nationwide questionnaire survey was performed to clarify the prevalence of groin pain in unicycle athletes and to reveal the relationship between groin pain and factors such as age or athletic career.

PATIENTS AND METHODS

To evaluate the prevalence of groin pain, the questionnaire was sent to 1304 unicyclists belonging to the Japan Unicycle Association. All subjects aged 6 years or older at the time they answered the questionnaire.

RESULTS

Overall, 17% of unicyclists complained of groin pain. Pain was more common in those aged 13-19 years and in those with a career lasting more than 6 years.

CONCLUSION

The incidence of groin pain (17%) among unicyclists is higher than that among athletes participating in other sports. Unicyclists aged between 13 and 19 years old and those with an athletic career of more than 6 years often suffer from groin pain.

Patients' understanding of communication about palliative care and health condition in Japanese patients with unresectable or recurrent cancer: a cross-sectional survey

BACKGROUND

Understanding treatment goal is essential for decision-making among patients with unresectable/recurrent solid cancers. However, no previous studies in Japan have examined the association between patients' understanding and physicians' explanations. We aimed to examine agreement between patients' and physicians' reports of communication about palliative care and current health condition among patients with unresectable/recurrent cancer and explore factors associated with optimistic understanding in Japan.

METHODS

In this cross-sectional, multicenter, observational survey in Japan, 178 patients with unresectable/ recurrent solid cancers and 16 physicians responded to questionnaires. The primary outcome was agreement between patients' and physicians' reports of communication about palliative care and current health condition.

RESULTS

Of 56 patients who reported their communication about palliative care, 25/56 (44.6%) agreed with physician reports, and 31/56 (55.4%) were more optimistic than their physicians. Regarding current overall health condition, 45/122 (36.9%) patients gave reports that agreed with physicians' reports, and 77/122 (63.1%) were optimistic relative to physicians. Physicians' general approach about disclosure were not associated with patients' understanding.

CONCLUSIONS

Fewer than 50% of Japanese patients with unresectable/recurrent cancer agreed with their physicians, whereas most others were more optimistic about palliative care communication and their health condition as compared to physicians. Effective communication is essential to ensure informed decisionmaking.

Effect of Flurbiprofen and S-Flurbiprofen Patches on Multimodal Pain Management After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

BACKGROUND

Total knee arthroplasty (TKA) is an established procedure for knee osteoarthritis. Multimodal analgesia is reportedly more effective for postoperative analgesia. We investigated the efficacy of 2 patches after TKA.

METHODS

Seventy-nine knees that underwent unilateral TKA for osteoarthritis were included. Oral administration, local periarticular analgesic injection, and patches were adopted for pain management. The knees were randomly assigned to the flurbiprofen patch (FPP), S-flurbiprofen patch (SFPP), and control (no patch) groups. Patch treatment was continued for 14 days. Pain according to the visual analog scale, knee flexion angle, renal dysfunction, gastrointestinal injury, duration of hospitalization, dermatitis, and the rate of using additional oral nonsteroidal anti-inflammatory drugs were compared (from preoperative to postoperative day 14).

RESULTS

The FPP, SFPP, and control groups included 29, 27, and 23 knees, respectively. Visual analog scale was lower in the FPP and SFPP groups than in the control group on days 1 and 3 (day 1: 24.4, 25.0, and 39.4, respectively; day 3: 25.5, 23.3, and 39.3, respectively). Knee flexion angle was larger in the SFPP group than in the control group on days 7 and 14 (day 7: 89.8° and 76.6°, respectively; day 14: 98.3° and 84.2°, respectively). Neither renal dysfunction nor gastrointestinal injury was confirmed. The duration of hospitalization did not differ among the groups. Dermatitis occurred only in the SFPP group. The rate of using additional oral nonsteroidal anti-inflammatory drugs was higher in the control group.

CONCLUSION

Both patches were effective and safe as part of multimodal analgesia for postoperative TKA.

Correlations and Reproducibility Between Radiographic and Radial Alpha Angles in the Evaluation of Cam Morphology

Background:

The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle.

Purpose:

To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated.

Results:

The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI (P = .005) and BDDH (P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH (P < .001).

Conclusion:

We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

Posterior acetabular uptake on 18F-fluoride positron emission tomography/computed tomography reveals a putative contrecoup region in patients with femoroacetabular impingement

BACKGROUND AND PURPOSE

The pathology of the posterior acetabular lesions, so-called "contrecoup regions", in femorocacetabular impingement (FAI) has not been elucidated fully. ¹⁸F-fluoride positron emission tomography/computed tomography (PET/CT) can visualize abnormal uptake caused by impingement. Therefore, we aimed to evaluate posterior acetabular uptake on PET/CT in FAI patients.

PATIENTS AND METHODS

Patients with FAI who underwent ¹⁸F-fluoride PET/CT between October 2014 and October 2016 were retrospectively evaluated. The maximum standardized uptake value (SUV_max) in the posterior acetabulum was evaluated. The mean SUV_max of FAI with cam morphology (the cam group) was compared with that of FAI with pincer morphology (the pincer group). In addition, the numbers of cases with SUV_max ≥ 6 and SUV_max < 6 in each group were evaluated. The entire study cohort was also grouped according to SUV_max, and the mean α and center edge angles were evaluated.

RESULTS

In total, 41 hips were analyzed (34 hips in the cam group and 7 in the pincer group). The mean SUV_max of the cam group (11.2 ± 7.4) was significantly higher than that of the pincer group (4.9 ± 1.9) (p < 0.01). The incidence of cases with SUV_max ≥ 6 in the cam group was significantly high (p < 0.01). In the overall cohort, the mean α angle of the SUV_max ≥ 6 group was significantly higher than that of the SUV_max < 6 group (p < 0.01).

CONCLUSION

Evaluation of posterior acetabular uptake suggests an association between cam morphology and increased posterior acetabular uptake.

Elevation of Memory Cytotoxic T Lymphocytes, Including Human T Lymphotropic Virus Type 1 Tax-Specific and Hepatitis Virus Type C-Specific Cytotoxic T Lymphocytes, in a Patient with Adult T-Cell Leukemia/Lymphoma and Hepatocellular Carcinoma

Herein, we present the case of a patient who suffered from adult T-cell leukemia/lymphoma (ATLL) and hepatocellular carcinoma (HCC) after obtaining a sustained virological response following treatment with a direct-acting antiviral (DAA) at different points in time. The patient went into complete remission (CR) for ATLL. Unfortunately, subsequent relapse of ATLL was observed. This situation was overcome using chemotherapy with pegylated interferon alpha-2b. Human T lymphotropic virus type 1 Tax-specific cytotoxic T lymphocytes (CTLs) were recognized after obtaining second CR, and those CTLs have been maintained for many years. After 4 years from the second CR, chronic hepatitis type C was treated with a DAA, and sustained virological response was attained. However, the occurrence of HCC was detected. Surprisingly, the tumor disappeared spontaneously. Hepatitis virus type C-specific CTLs were also detected in the patient. T-cell receptor (TCR) V beta gene repertoire analyses revealed oligoclonal expansion of effector and memory CTLs. The number of CTLs expressing the TCR V beta 13.1 has increased over the years since HCC occurrence. The activation and maintenance of anticancer cellular immunity may have allowed the patient to obtain long-term survival and overcome two lethal neoplasms.

Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship

We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.

Patient perceptions of curability and physician-reported disclosures of incurability in Japanese patients with unresectable/recurrent cancer: a cross-sectional survey

Background

Although reports have described the perceptions of curability among patients with unresectable/recurrent cancer and the quality of death and dying, the association between patients' perceptions and physicians' disclosures of incurability remained unexplored. This survey aimed to evaluate the association between patients' perceptions of curability and physicians' disclosures of incurability.

Methods

In this cross-sectional, multicenter, observational study in Japan, we asked outpatients with unresectable/recurrent solid cancers about their perceptions of incurability. The patient inclusion criteria were unresectable/recurrent solid cancer, failure of first-line chemotherapy and an age ≥ 20 years. Additionally, we surveyed their primary responsible physicians regarding disclosures to patients regarding incurability.

Results

Although we estimated the necessary sample size as 250, we discontinued recruitment because the responsible researcher transferred to another hospital. Among the 135 included and surveyed patients, 39% responded that their cancer was incurable, 33% responded that their cancer was curable and 23% responded 'I don't know' or 'I don't wish to answer'. No significant association was observed between patients' perceptions of curability and physician-reported disclosures of incurability.

Conclusion

In this Japanese population, 39% of patients with unresectable/recurrent solid cancers perceived that their cancers were incurable. However, such perceptions did not appear to be significantly affected by physician-reported disclosures. We recommend additional research to determine the best disclosure method to ensure that patients truly understand their disease status.

Effect of neutron and γ -ray on charge-coupled device for vacuum/extreme ultraviolet spectroscopy in deuterium discharges of large helical device

A charge-coupled device (CCD) is widely used as a detector of vacuum spectrometers in fusion devices. Recently, a deuterium plasma experiment has been initiated in a Large Helical Device (LHD). Totally 3.7 × 10¹⁸ neutrons have been yielded with energies of 2.45 MeV (D-D) and 14.1 MeV (D-T) during the deuterium experiment over four months. Meanwhile, γ-rays are radiated from plasma facing components and laboratory structural materials in a wide energy range, i.e., 0.01-12.0 MeV, through the neutron capture. It is well known that these neutrons and γ-rays bring serious problems to the CCD system. Then, several CCDs of vacuum ultraviolet/extreme ultraviolet/X-ray spectrometers installed at different locations on LHD for measurements of spectra and spatial profiles of impurity emission lines are examined to study the effect of neutrons and γ-rays. An additional CCD placed in a special shielding box made of 10 cm thick polyethylene contained 10% boron and 1.5 cm thick lead is also used for the detailed analysis. As a result, it is found that the CCD has no damage in the present neutron yield of LHD, while the background noise integrated for all pixels of CCD largely increases, i.e., 1-3 × 10⁸ counts/s. The data analysis of CCD in the shielding box shows that the background noise caused by the γ-ray is smaller than that caused by the neutron, i.e., 41% from γ-rays and 59% from neutrons. It is also found that the noise can be partly removed by an accumulation of CCD frames or software programming.

The Relationship Between the Location of Uptake on Positron Emission Tomography/Computed Tomography and the Impingement Point by Computer Simulation in Femoroacetabular Impingement Syndrome With Cam Morphology

PURPOSE

To clarify the concordance rate of the location of uptake on positron emission tomography/computed tomography (PET/CT) and the impingement point demonstrated in computer simulation in femoroacetabular impingement (FAI) syndrome with cam morphology.

METHODS

We included hip joints with FAI syndrome that underwent ¹⁸F-fluoride PET/CT. We also excluded hips with SUV_max <6. Each hip was evaluated for the region of the SUV_max point on PET/CT as well as the impingement point by computer simulation. We used ZedHip software (Lexi, Tokyo, Japan) for impingement simulation analysis based on CT data. Bony impingement is identified if there is a mesh in acetabular and femoral side contact in at least one unit. We investigated the rate of concordance between these 2 regions for each 10° flexion angle of the hip, ranging from 0° to 90°.

RESULTS

Twenty-two hips of 22 patients were evaluated. The SUV_max region was most frequently distributed in the proximal middle region in 12 hips. In 18 of 22 hips (81.8%), the SUV_max region was concordant with the impingement region for at least one flexion angle. The concordance rates in 50° (P = .034), 60° (P = .007), 70° (P = .011), and 80° (P = .046) of flexion were significantly higher than in 90° of flexion.

CONCLUSIONS

It was possible to visualize and clarify the detailed location of abnormal uptake in FAI syndrome patients with cam morphology by applying ¹⁸F-fluoride PET/CT. The concordance rates in 50°, 60°, 70°, and 80° of flexion were significantly higher than in 90° of flexion, which suggested that impingement may more frequently occur at less than 90° of flexion in FAI syndrome with cam morphology.

LEVEL OF EVIDENCE

Level III, cross-sectional diagnostic study.

Synthetic lethal interaction of CDK inhibition and autophagy inhibition in human solid cancer cell lines

Cell cycle control is a promising target in cancer treatments, and some small-molecule cyclin-dependent kinase (CDK) inhibitors have exhibited clinical effectiveness. However, no biomarkers predictive of efficacy have been developed. Recent studies have revealed that CDK inhibitor (CKI) proteins, such as p27 and p16, also induced cytoprotective autophagy in cancer cells. However, it is unclear whether small-molecule CKIs also induce autophagy in solid tumors, as induced autophagy promotes cancer cell survival. In this study, we revealed that a CDK4 inhibitor and a CKI with a broad range of targets (flavopiridol) induced autophagy in some, but not all, solid cancer cell lines. Autophagy induction by CDK4 inhibitor was observed in BT474, MDA-MB435S, SKBr3 (derived from breast cancer), A431 (derived from epidermoid cancer), and SW480 (derived from colorectal cancer) cell lines. No such autophagy was observed in MCF7, MDA-MB231 (derived from breast cancer), NCI-N87 (derived from gastric cancer), and KMST-6 (derived from a fibroblast). In the cell lines showing autophagy, which was induced by CDK4 inhibitor, the combination of CDK4 inhibitor and autophagy inhibition by either chloroquine (CQ) or knockdown of ATG5 or BECN1 induced apoptosis. However, it did not induce apoptosis in the cell lines in which autophagy was not induced by CDK4 inhibitor. These findings indicate that the autophagy induced by CDK4 inhibitor mimics stress-induced autophagy in some solid cancer cell lines. The combination of a small-molecule CKI involved in G₁/S arrest and an autophagy inhibitor leads to a synthetic lethal interaction and could become a new antitumor strategy for solid tumors showing cytoprotective autophagy induced by small-molecule CKIs.

Development of beam emission spectroscopy for turbulence transport study in Heliotron J

This paper describes the development study of the beam emission spectroscopy (BES) for the turbulent transport study in Heliotron J. Modification of the sightlines (10 × 4 for edge and 10 × 2 for edge) enables us to obtain 2-dimensional BES imaging. The cooling effect on the reduction in the electrical noise of avalanche photodiode (APD) assembly has been investigated using a refrigerant cooling system. When the temperature of the APD element has set to be -20 °C, the electrical noise can be reduced more than 50%. The measurement error of the phase difference in the case of low signal level has been tested by two light-emitting diode lamps. The APD cooling has an effect to improve the measurement error at the low signal level of APD.

Up-down asymmetry measurement of tungsten distribution in large helical device using two extreme ultraviolet (EUV) spectrometers

Two space-resolved extreme ultraviolet spectrometers working in wavelength ranges of 10-130 Å and 30-500 Å have been utilized to observe the full vertical profile of tungsten line emissions by simultaneously measuring upper- and lower-half plasmas of LHD, respectively. The radial profile of local emissivity is reconstructed from the measured vertical profile in the overlapped wavelength range of 30-130 Å and the up-down asymmetry is examined against the local emissivity profiles of WXXVIII in the unresolved transition array spectrum. The result shows a nearly symmetric profile, suggesting a good availability in the present diagnostic method for the impurity asymmetry study.

Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma

BACKGROUND

To examine the effect of the histology of carcinoma and sarcoma components on survival outcome of uterine carcinosarcoma.

PATIENTS AND METHODS

A multicenter retrospective study was conducted to examine uterine carcinosarcoma cases that underwent primary surgical staging. Archived slides were examined and histologic patterns were grouped based on carcinoma (low-grade versus high-grade) and sarcoma (homologous versus heterologous) components, correlating to clinico-pathological demographics and outcomes.

RESULTS

Among 1192 cases identified, 906 cases were evaluated for histologic patterns (carcinoma/sarcoma) with high-grade/homologous (40.8%) being the most common type followed by high-grade/heterologous (30.9%), low-grade/homologous (18.0%), and low-grade/heterologous (10.3%). On multivariate analysis, high-grade/heterologous (5-year rate, 34.0%, P = 0.024) and high-grade/homologous (45.8%, P = 0.017) but not low-grade/heterologous (50.6%, P = 0.089) were independently associated with decreased progression-free survival (PFS) compared with low-grade/homologous (60.3%). In addition, older age, residual disease at surgery, large tumor, sarcoma dominance, deep myometrial invasion, lymphovascular space invasion, and advanced-stage disease were independently associated with decreased PFS (all, P < 0.01). Both postoperative chemotherapy (5-year rates, 48.6% versus 39.0%, P < 0.001) and radiotherapy (50.1% versus 44.1%, P = 0.007) were significantly associated with improved PFS in univariate analysis. However, on multivariate analysis, only postoperative chemotherapy remained an independent predictor for improved PFS [hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.27-0.43, P < 0.001]. On univariate analysis, significant treatment benefits for PFS were seen with ifosfamide for low-grade carcinoma (82.0% versus 49.8%, P = 0.001), platinum for high-grade carcinoma (46.9% versus 32.4%, P = 0.034) and homologous sarcoma (53.1% versus 38.2%, P = 0.017), and anthracycline for heterologous sarcoma (66.2% versus 39.3%, P = 0.005). Conversely, platinum, taxane, and anthracycline for low-grade carcinoma, and anthracycline for homologous sarcoma had no effect on PFS compared with non-chemotherapy group (all, P > 0.05). On multivariate analysis, ifosfamide for low-grade/homologous (HR 0.21, 95% CI 0.07-0.63, P = 0.005), platinum for high-grade/homologous (HR 0.36, 95% CI 0.22-0.60, P < 0.001), and anthracycline for high-grade/heterologous (HR 0.30, 95% CI 0.14-0.62, P = 0.001) remained independent predictors for improved PFS. Analyses of 1096 metastatic sites showed that carcinoma components tended to spread lymphatically, while sarcoma components tended to spread loco-regionally (P < 0.001).

CONCLUSION

Characterization of histologic pattern provides valuable information in the management of uterine carcinosarcoma.

Efficacy and Safety Assessment of Paclitaxel in Patients with Docetaxel-Resistant Esophageal Squamous Cell Carcinoma

Background: Incomplete cross-resistances between paclitaxel (PTX) and docetaxel (DTX) has been demonstrated in several types of cancer. The objective of the present study was to assess the existence of cross-resistance between PTX and DTX in esophageal squamous cell carcinoma. Methods: Patients in the PTX group received PTX without DTX pretreatment, patients in the prior DTX (Pr-DTX) group received PTX after the development of resistance to DTX, and patients in the DTX group received DTX without subsequent PTX treatment. Results: A total of 73 patients were enrolled. The response rates to PTX in the PTX and Pr-DTX groups were 22.7 and 20.0%, respectively. The median progression-free survival times from the first day of PTX treatment in the PTX and Pr-DTX groups were 113 (95% CI 56-154) and 97 days (95% CI 36-189), respectively. The median overall survival times from the first day of DTX treatment in the Pr-DTX and DTX groups were 315 (95% CI 124-453) and 148 days (95% CI 139-177), respectively. Conclusions: There is no or incomplete clinical cross-resistance between PTX and DTX in esophageal squamous cell carcinoma. Replacement of DTX with PTX is a suitable treatment option for patients with DTX-resistant esophageal squamous cell carcinoma.

Line spectrum and ion temperature measurements from tungsten ions at low ionization stages in large helical device based on vacuum ultraviolet spectroscopy in wavelength range of 500-2200 Å

Vacuum ultraviolet spectra of emissions released from tungsten ions at lower ionization stages were measured in the Large Helical Device (LHD) in the wavelength range of 500-2200 Å using a 3 m normal incidence spectrometer. Tungsten ions were distributed in the LHD plasma by injecting a pellet consisting of a small piece of tungsten metal and polyethylene tube. Many lines having different wavelengths from intrinsic impurity ions were observed just after the tungsten pellet injection. Doppler broadening of a tungsten candidate line was successfully measured and the ion temperature was obtained.

Coaxial pellets for metallic impurity injection on the large helical device

Two coaxial pellets with tungsten inserted into graphite carbon and polyethylene (PE) tubes are compared for tungsten spectroscopic study in the Large Helical Device. The tungsten pellet with carbon tube causes plasma collapse, while that with PE tube smoothly ablates without collapse. The deposition profile of the pellets is analyzed with a help of pellet ablation spectroscopy. It is found that the tungsten pellet with carbon tube can significantly penetrate into the core plasma and leads to the plasma collapse. A tungsten spectrum with radial profile is successfully observed when the tungsten pellet with PE tube is used.

Abstract 1655: Synthetic lethal interaction of CDK inhibition and autophagy inhibition in human solid cancer cell lines

Autophagy is a stress-induced cellular reaction in cancer cells. Recent studies showed that cyclin dependent kinase inhibitor proteins, such as p27 or p16, also induced cytoprotective autophagy in cancer cells. However, it is not clear whether small molecule CDK inhibitors also induce autophagy in solid cancer cells. In this study, we revealed that CDK4 inhibitor and a broad-range CDK inhibitor (flavopiridol) induced autophagy in some solid cancer cell lines, but not all. The autophagy induced by CDK4 inhibitors was observed in BT474, MDA-MB435S, SKBr3 (derived from breast cancer), A431 (derived from lung cancer) and SW480 (derived from colorectal cancer), While it was not observed in MCF7, MDA-MB231 (derived from breast cancer), NCI-N87 (derived from gastric cancer) and KMST-6 (derived from fibroblast). In the cell lines which were induced autophagy by CDK inhibitors, the combination of a CDK4 inhibitor and an autophagy inhibition, by either chloroquine or knockdown of ATG5 or BECN1, induced apoptosis. However it did not induce apoptosis in the cell lines which were not induced autophagy by CDK4 inhibitor. From these results, the autophagy induced by CDK4 inhibitor mimic the stress-induced autophagy in some solid cancer cell lines. The combination of a small-molecule CDK inhibitor and an autophagy inhibitor is a synthetic lethal interaction and could become a new antitumor strategy in solid tumors which are induced cytoprotective autophagy by CDK inhibitors.

Citation Format: Yoshinari Okada, Shunsuke Kato, Yasuhiro Sakamoto, Takayuki Oishi, Chikashi Ishioka. Synthetic lethal interaction of CDK inhibition and autophagy inhibition in human solid cancer cell lines. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1655. doi:10.1158/1538-7445.AM2013-1655

Density fluctuation measurements using beam emission spectroscopy on Heliotron J

This paper describes the measurement of the density fluctuation using beam emission spectroscopy in Heliotron J, having the non-symmetrical helical-magnetic-axis configuration. In order to optimize the sightlines, the numerical calculations are carried out to estimate the spatial resolution and the observation location. When a tangential neutral beam is used as diagnostic one, suitable sightlines from the newly installed diagnostic port are selected whose spatial resolution Δρ is less than ± 0.07 over the entire plasma region. Modification of the interference filter and the detection systems enables us to measure the radial profile of the density fluctuation. Each of the three coherent modes due to the fast-ion-driven magnetohydrodynamic instabilities has different radial structure of the density fluctuation.

Clinical outcome of recombinant human soluble thrombomodulin (rTM) for patients with disseminated intravascular coagulation (DIC) complicating advanced solid cancer: Retrospective analysis

e19611

Background: Disseminated intravascular coagulation (DIC) is a syndrome characterized by the activation of coagulation leading to systemic microvascular thrombosis. DIC is frequently observed in patients with hematologic malignancy and often in patients with advanced cancer. Recombinant human soluble thrombomodulin (rTM) has been introduced as a new type of anti-DIC agent for clinical use in patients with hematological cancer or infectious disease. However, the efficacy for advanced solid cancer has not been elucidated. Methods: All patients with DIC complicating advanced solid cancer who were treated by rTM in Tohoku university hospital from December 2009 to November 2011 were enrolled in this retrospective study. DIC was diagnosed and scored according to the diagnostic criteria established by the Japanese Ministry of Health and Welfare (JMHW DIC criteria). Change in DIC score and period of overall survival (OS) after treatment of rTM (380U/kg/day) were evaluated. The Kaplan-Meier method was used to calculate OS. Results: Twenty-two patients (32% female) were enrolled. The median age was 61.5 (r: 32-82). The primary organs were 7 stomach, 3 colorectal, 2 esophageal and 10 other cancers. DIC score (63.6%), FDP (54.5%), PT-INR (45.4%), FBG (36.4%) were kept or improved in these patients between day 1 and day 5 in rTM treatment. Median OS (mOS) was 30 days (r: 2–301). Subgroup analyses revealed that mOS was longer in patients who underwent chemotherapy following rTM treatment than in patients who did not (114 days vs. 10 days, p = 0.0083). Patients with better ECOG PS (<2 vs. >3; 114 days vs. 15 day, p = 0.018), smaller number of chemotherapy treated before DIC (<2 vs. >3; 69 days vs. 6 days, p = 0.0008) also showed better mOS. No critical complication was observed. Conclusions: This study showed that rTM was effective and safe for patients with DIC complicating advanced solid cancer. PS and number of chemotherapy regimens could be predictive factor of rTM. We considered that rTM yield the chance of chemotherapy to advanced cancer patients with DIC by preventing deterioration of DIC.

3.0T MR Imaging of the Cranial Arterial Wall for the Strategy of Stroke Prevention

3.0T refined MRI reveals the anatomical structures clearly. Operative findings correspond well with MRI findings. The authors have used this equipment for prevention of stroke. Especially evaluation of the arterial wall is important for this purpose. Showing illustrative cases including operative ones, the authors discuss the MRI findings and strategy of treatment. The examinations of the Carotid artery (CA) and vertebro-basilar artery (VBA) were performed with 3.0T MRI (Philips Achiva 3.0T, Holland). Specialized sequences for each arterial wall were planned after TOF-MRA screening. The sequences include T1, T2 VISTA (3D Fatsaturation Volume ISotropic Turbospinecho Acquisition), mPROSET (Multiple Principle Selective Excitation Technique), B-FFE(Balanced Fast Field Echo) and T1 and T2 Black Blood. Intentionally directed pictures were acquired with reconstruction. Components of the plaque were estimated with the combination of the intensity of each picture. Distributions of carotid plaques were well demarcated and its components were diagnosed. Prognosis of each plaque was estimated and the surgical and/or non-surgical treatment plan was secured. Preoperative MRI plaque findings and the specimens from carotid endarterectomy (CEA) correlated well. The stability of the plaque could be evaluated, which afforded the decision of timing and method of operation. Lacerated walls of VBA dissection were well illustrated and strategies were planned. Intra-aneurysmal thrombus was revealed and its development was imaged. The wall of the unruptured aneurysm could be evaluated but not always. 3.0T MRI provides more anatomical and pathological information than conventional MRI. Prognosis of each lesion could be estimated. Routine examination of the cranial arterial wall contributes to the prevention of stroke.

Risk factors for recurrence of artificial gastric ulcers after endoscopic submucosal dissection

It has been reported previously that artificial gastric ulcers caused by endoscopic submucosal dissection (ESD) would heal within 8 weeks, irrespective of their size and location. The aim of this retrospective study was to describe long-term outcomes of gastric ESD ulcers. Check-up of ulcers was performed by periodic endoscopy. The rate of ESD ulcer recurrence and clinicopathological factors that may relate to recurrence were assessed. During the median observation period of 33 months, a benign ulcer recurrence occurred in 10 lesions in 10 patients (2.1%). Univariate analysis showed that Helicobacter pylori infection and presence of pathological ulcer findings within the ESD specimen were significantly related to the risk of ESD ulcer recurrence. Although the frequency is low, there is a possibility of ESD ulcer recurrence in patients with H. pylori infection and in patients who undergo ESD for a lesion with ulceration.

Degradation characteristics of polylactide in thermophilic anaerobic digestion with hyperthermophilic solubilization condition

To test whether hyperthermophilic treatment promotes polylactide (PLA) dissolution and methane conversion under anaerobic digestion conditions, a single thermophilic control reactor (55 °C) and a two-phase system consisting of a hyperthermophilic reactor (80 °C) and a thermophilic reactor (55 °C) were continuously fed with a mixture of PLA and artificial kitchen garbage. In Runs 1 and 2, the PLA dissolution ratios in the two-phase system were 79.2 ± 6.5% and 85.2 ± 7.0%, respectively, higher than those of the control. Batch experimental results indicated that hyperthermophilic treatment could promote PLA dissolution to a greater degree as compared with single thermophilic treatment and that ammonia addition also had a promotional effect on PLA dissolution. In the two-phase system, after hyperthermophilic treatment, dissolved PLA was converted to methane gas under the subsequent thermophilic condition.