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Reports of zinc and selenium deficiencies accompanying inflammatory bowel disease (IBD) mostly have originated from Western countries and concerned adult patients. Whether Japanese children with IBD have similar deficiencies remained unclear. We aimed to elucidate differences in serum zinc and selenium concentrations in Japanese children between types of IBD. Children under 17 years old undergoing care at 12 Japanese pediatric centers were retrospectively enrolled between November 2016 and February 2018 to 3 groups representing Crohn’s disease (CD), ulcerative colitis (UC), and normal controls (NC) with irritable bowel syndrome or no illnesses. Serum zinc and selenium were measured by atomic absorption spectrophotometry. Zinc and selenium deficiencies were defined by serum concentrations

BACKGROUND AND AIM Serologic markers such as myeloperoxidase (MPO) antineutrophil cytoplasmic antibodies (ANCA) (MPO-ANCA) have been used to screen patients for ulcerative colitis (UC). However, MPO-ANCA shows limited accuracy in Asians. Proteinase 3 ANCA (PR3-ANCA) has performed better at UC diagnosis in Japanese adults than MPO-ANCA. The present study aimed to evaluate usefulness of PR3-ANCA for diagnosis of UC in Japanese pediatric practice. METHODS Patients under 17 years old undergoing assessment at 12 Japanese pediatric centers between November 2016 and February 2018 were prospectively enrolled and divided into groups with UC, Crohn's disease (CD), intestinal disease control (IC), and healthy control (HC). Serum PR3-ANCA and MPO-ANCA were analyzed using chemiluminescence enzyme immunoassay kits. RESULTS Sera from 367 patients (148 with UC at a median age of 12 years; 120 with CD, 13 years; 56 with IC, 10.5 years; and 43 with HC, 10 years) were examined. Median PR3-ANCA values in UC (1.6 U/mL) were greater than in CD (0.2; P

Although HER2-positive (HER2+) invasive breast carcinomas (BC) have a different clinical therapeutic responsiveness according to estrogen and progesterone receptor expression, the relationship with androgen receptors (AR), which are the same family of steroid hormones, is poorly understood. We investigated the relationship between AR expression in HER2 BCs and therapeutic responsiveness and prognosis in this study. We evaluated patients with HER2 (H) + invasive BC undergoing surgery after neoadjuvant chemotherapy (± HER2-targeted therapies) from 2007–2017, classified as hormone receptor-positive (Allred score: 2–8) (luminal B: LH) and receptor-negative groups (Allred: score 0) (non-luminal: NLH). AR expression was assessed by immunostaining pre-neoadjuvant chemotherapy biopsy specimens, positive with Allred score ≥ 4. The pathological complete response, disease-free survival, and overall survival rates were compared between AR-positive and AR-negative groups. We classified 82 patients with HER2 + invasive BC into LH (n = 45, 54.9%) and NLH groups (n = 37, 45.1%), and AR + was observed in 43 patients (52.4%) (LH: 23, 51.1%; NLH: 20, 54.1%; p = 0.79). Quasi-pathological complete response was observed in 40 patients (48.8%) (LH: 18, 40%; NLH: 22, 59.5%; p = 0.08) overall, and in 31 AR + patients (72.1%) (LH: 15, 34.9%; NLH: 16, 37.2%), significantly higher than in the AR − group for both subgroups (p

AIMS HER2-positive (HER2+) breast carcinoma (BC) cases are often treated similarly; however, they can be classified as either luminal B (LH) or non-luminal type (NLH) BC, which have different prognoses. In this study, we investigated the clinicohistomorphological features of each HER2+ BC subgroup. METHODS AND RESULTS We classified 166 patients with HER2+ invasive BC into LH (n = 110, 66.3%) and NLH groups (n = 56, 33.7%). We further subclassified LH into patients with carcinomas expressing high levels of hormone receptors [LH-high; Allred score, oestrogen receptor (ER) and/or progesterone receptor (PgR) 4-8, n = 89, 53.6%] or low levels (LH-low; Allred score, ER and/or PgR 2 or 3, n = 21, 12.7%) for clinicohistomorphological characterisation. Morphological review showed that NLH included a percentage of patients with comedo necrosis, while LH patients had significantly more central scarring. In terms of immune responsiveness, NLH showed significantly higher rates of tumour-infiltrating lymphocytes and healing. The LH-high and NLH groups showed distinct characteristics (by both models, P

Aim Combined hepatocellular cholangiocarcinoma, subtype with stem-cell features, intermediate-cell subtype (INT) shows various histological appearances and could be misdiagnosed as intrahepatic cholangiocarcinoma (iCCA). In the present study, we aimed to identify specific histological diagnostic markers of INT. Methods We extracted RNA from FFPE sections of six INT, five iCCA, and five hepatocellular carcinoma (HCC) cases and compared gene expression between INT, iCCA, and HCC by microarray analysis. We then undertook immunohistochemical (IHC) staining of potential key molecules identified by microarray analysis, the conventional hepatocytic marker, hepatocyte paraffin (HepPar)-1, and the cholangiocytic markers, keratin (K) 7 and K19, on 35 INT, 25 iCCA, and 60 HCC cases. Results Microarray analysis suggested that malic enzyme 1 (ME1) was significantly upregulated in INT. Immunohistochemical analysis revealed that the positive rates of ME1 in INT, iCCA, and HCC were 77.1% (27/35), 28.0% (7/25), and 61.7% (37/60), respectively. Analysis of classification and regression trees based on IHC scores indicated that HepPar-1 could be a good candidate for discriminating HCC from the others with high sensitivity (93.3%) and high specificity (96.7%). A multiple logistic regression model and receiver operating characteristic curve analysis based on the IHC scores of ME1, K7, and K19 generated a composite score that can discriminate between INT and iCCA. Using this composite score, INT could be discriminated from iCCA with high sensitivity (88.6%) and high specificity (88.0%). Conclusions We propose that ME1 is a useful diagnostic marker of INT when used in combination with other hepatocytic and cholangiocytic markers.

Summary Background & aims Elderly patients who receive enteral nutrition after stroke are at a high risk of malnutrition. However, there are few investigations of the changes in the nutritional status of very elderly tube-fed patients in the long-term. We aimed to clarify the improvement in the nutritional status of very elderly patients who receive long-term complete tube feeding after stroke. Methods Our subjects were 68 elderly bedridden patients who received complete enteral nutrition after stroke. All subjects had hypoalbuminemia and low body weight. The subjects were divided into the Elderly group ( n = 37) and the Very elderly group ( n = 31). Their nutritional indices were measured at the time of admission, and at 6 and 12 months after admission. Changes in the nutritional indices of each group were assessed. Results In both groups, the albumin, prealbumin, total cholesterol, and hemoglobin levels and body mass index, mid-arm circumference, and triceps skinfold thickness after 12 months were significantly higher than baseline levels. There was no significant difference between the C-reactive protein level and mid-upper-arm muscle circumference at baseline and after 12 months. The raise in albumin and prealbumin levels were significantly higher in the Elderly group as compared with in the Very elderly group. However, there were no significant differences in the change in other biochemical and anthropometric parameters between the Elderly and Very elderly groups. The BMI in both groups improved to within the normal range. However, the serum albumin levels in both groups did not improve to within the normal range. Both groups showed a mild inflammatory response during the study period. Albumin and prealbumin levels were negatively associated with age. Conclusions Long-term complete tube feeding after stroke is effective for improving the nutritional status of very elderly patients. Both in the elderly and in the very elderly patients, most of the biochemical parameters and anthropometric parameters improved. However, the change in albumin levels differed between elderly patients and very elderly patients, probably because albumin levels are influenced by aging. In addition, it was difficult to improve the low serum albumin levels of bedridden elderly patients who exhibited an inflammatory response to within the normal range. Especially, in the very elderly patients, serum albumin levels were hard to reflect improvement of malnutrition.

Patients who have neurological dysphagia induced by cerebrovascular disease are at high risk of malnutrition and aspiration pneumonia. Since trace elements in serum bind to serum protein, serum trace elements concentration is influenced by serum protein concentration. In addition, serum protein concentration is influenced by malnutrition and inflammation. Therefore, evaluation of serum trace elements concentration has to consider influence of malnutrition and inflammation. In recent years, enteral formula including rich trace elements were developed to prevent trace elements deficiency. However, serum trace elements concentration showed a low level even if patients were receiving enough trace elements intake. We thought that it was effective in nutritional management of patients with malnutrition and inflammation to clarify about correlation among nutritional indices, serum trace elements, and the amount of trace element intake in tube-fed patients. In this study, we aimed to determine nutritional indices that are predictors of serum trace elements in patients with neurological dysphagia on long-term tube feeding.Subjects were 40 elderly bedridden patients with neurological dysphagia induced by cerebrovascular disease. All subjects were fed total enteral nutrition via nasogastric tube. We investigated serum trace elements (iron, copper, zinc) and nutritional indices (body mass index, albumin, transferrin, ceruloplasmin, C-reactive protein, hemoglobin, lymphocyte, trace elements intake), and analyzed by multiple regression analysis. In addition, we divided subjects into two groups based on inflammatory response. The first group was 20 patients with inflammation (inflammation group), and another group was 20 patients without pneumonia (control group).Subjects were malnourished and showed inflammatory response: low body weight (55%), hypoalbuminemia (58%), moderate or severe inflammation (53%), anemia (38%). Ratio of low serum iron concentration was 43%. Ratio of high serum copper concentration was 45%. Ratio of low serum zinc concentration was 65%. Mean of trace elements intake was slightly more than requirements. In multiple regression analysis in all subjects, predictor of serum iron was hemoglobin (P0.01) and transferrin (P0.05), predictor of serum copper was ceruloplasmin (P0.001) and C-reactive protein (P0.05), predictor of serum zinc was albumin (P0.05). In comparisons of nutritional status between inflammation group and control group, serum zinc concentration in inflammation group was significantly lower than control group. On the other hand, ceruloplasmin, C-reactive protein and serum copper concentration in inflammation group were significantly higher than control group. There was no significant difference in daily trace elements intake between inflammation group and control group.In tube-fed patients with neurological dysphagia, serum trace elements concentration was influenced by malnutrition and inflammation. It was suggested that serum trace elements concentration might not be normalized if malnutrition and inflammation are not treated. We recommend periodical monitoring of trace elements for long-term tube-fed patients with neurological dysphagia.

The effect on the nutritional status of elderly patients with chronic dysphagia was assessed of a diet with the texture modified by gelatin. The subjects were 26 chronic stage rehabilitation inpatients (18 males and 8 females with a mean age±SD of 73.0±13.0). We assessed the hematological and biochemical data, anthropometric measurements, nutritional intake and occurrence of aspiration pneumonia before and after intervention with the modified-texture diet.There were no significant changes in any of the nutritional parameters over a 6-month period before the dietary intervention. However, the albumin, pre-albumin and total cholesterol levels during the 6-month period after the dietary intervention were significantly higher than those at the starting point. Similarly, BMI, arm circumference and energy intake adequacy during the 6-month period after the dietary intervention were significantly higher than those at the starting point. The occurrence of aspiration pneumonia during the 6-month period after the intervention was significantly lower than that at the starting point.These results show that the nutritional status was improved by the dietary intervention, while the occurrence of aspiration pneumonia was prevented. It is suggested that the diet with the texture modified by gelatin was effective for the treatment of chronic dysphagia.

The relationship was investigated between the swallowing ability and nutritional index of long-term hospitalized patients to clarify the influence of dysphagia on the nutritional status.55 chronic-stage rehabilitation patients under long-term hospitalization who were feeding orally were divided to two groups. One group consisted of 22 patients who had normal swallowing function (12 males and 10 females with an average age of 69.7±14.1 years) and received a solid diet, this group being regarded as the normal swallowing group, while the other group consisted of 33 patients who had mild dysphagia (21 males and 12 females with an average age of 75.5±11.3 years) and received a diet prepared for dysphagia, this group being regarded as the dysphagia group. The serum albumin level, body mass index (BMI) and energy intake adequacy of both groups were compared, and the relationship between dysphagia and nutritional index investigated.There was a significant difference in the serum albumin level between the normal swallowing group and dysphagia group, i.e., 4.0±0.3g/dl in the normal swallowing group and 3.4±0.4g/dl in the dysphagia group. The ratio of hypoalbuminemia was also significantly lower in the normal swallowing group than in the dysphagia group (i.e., 9.1% and 48.5%). BMI was significantly different between the normal swallowing group and the dysphagia group, i.e., 22.6±4.3kg/m2 in the normal swallowing group and 19.4±3.5kg/m2 in the dysphagia group. The incidence of low weight tended to be lower in the normal swallowing group than in the dysphagia group (i.e., 18.2% and 42.4%), while the incidence of obesity tended to be higher in the former than in the latter (i.e., 31.8% and 12.1%). The energy intake adequacy was significantly different between the normal swallowing group and the dysphagia group, i.e., 107.3±11.3% and 92.7±16.4%, respectively, there being a significant negative correlation between dysphagia and nutritional index.These results show that the dysphagia group was suffering from malnutrition, the nutritional status of this group being worse than that of the normal swallowing group. It is therefore suggested that dysphagia is a risk factor in the decline of nutritional status in chronic-stage rehabilitation patients during long-term hospitalization.

The objective of the present study was to clarify the influence of introduction of clinical pathways on the nutritional status of patients undergoing distal gastrectomy. We investigated changes in the nutritional status of the patients at admission and discharge, before and after the introduction of clinical pathways.A group consisted of 32 patients who had undergone distal gastrectomy before introduction of clinical pathways (22 males and 10 females with the average age of 66.2±12.0) was regarded as the control group, and another group consisted of 31 patients who had undergone distal gastrectomy after introduction of clinical pathways (21 males and 10 females with the average age of 64.2±9.2) was regarded as the pathway group. Both groups were compared on body weight, body mass index (BMI), body weight reduction rate, serum albumin, hemoglobin, energy intake and energy intake adequacy.While body weight and BMI at the time of discharge significantly reduced in both groups as compared with those at the time of admission (p