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Disasters could jeopardize breast cancer care, and the 2011 Japan’s triple disaster (earthquake, tsunami, and nuclear accident) has been no exception. However, the information is lacking regarding its details, including that concerning breast cancer-related lymphedema (BCRL). We aimed to explore the process of becoming aware of BCRL among the local patients and the problems faced and the support needed by them. We also aimed to clarify any effects of the 2011 disaster on the experiences related to lymphedema among the target population. Patients who developed BCRL following the breast cancer treatment were recruited in Iwaki City, a municipality located in the southern coastal Fukushima (N = 16). In-depth semi-structured interviews were conducted face-to-face, and the obtained data were appraised with thematic analysis. Five themes related to BCRL were identified: 1) process of becoming aware of BCRL, 2) troubles or worries/concerns due to BCRL, 3) information source regarding BRCA management, 4) strategies to cope with BCRL, 5) adverse impacts of the 2011 disaster on BCRL management. This qualitative analysis clarified the five themes related to BCRL. The themes except for the disaster context were in line with the previous studies conducted in the non-disaster context. There were limited but non-neglectable adverse impacts of the 2011 disaster on the long-term local BCRL management.

BackgroundMutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may reduce the efficacy of neutralizing monoclonal antibody therapy against coronavirus disease 2019 (COVID-19). We here evaluated the efficacy of casirivimab-imdevimab in patients with mild-to-moderate COVID-19 during the Delta variant surge in Fukushima Prefecture, Japan.MethodsWe enrolled 949 patients with mild-to-moderate COVID-19 who were admitted to hospital between July 24, 2021 and September 30, 2021. Clinical deterioration after admission was compared between casirivimab-imdevimab users (n = 314) and non-users (n = 635).ResultsThe casirivimab-imdevimab users were older (P < 0.0001), had higher body temperature (≥ 38°C) (P < 0.0001) and greater rates of history of cigarette smoking (P = 0.0068), hypertension (P = 0.0004), obesity (P < 0.0001), and dyslipidemia (P < 0.0001) than the non-users. Multivariate logistic regression analysis demonstrated that receiving casirivimab-imdevimab was an independent factor for preventing deterioration (odds ratio 0.448; 95% confidence interval 0.263–0.763; P = 0.0023). Furthermore, in 222 patients who were selected from each group after matching on the propensity score, deterioration was significantly lower among those receiving casirivimab-imdevimab compared to those not receiving casirivimab-imdevimab (7.66% vs 14.0%; p = 0.021).ConclusionThis real-world study demonstrates that casirivimab-imdevimab contributes to the prevention of deterioration in COVID-19 patients after hospitalization during a Delta variant surge.SummaryThis real-world retrospective study demonstrates the contribution of treatment with casirivimab-imdevimab to the prevention of deterioration in patients with mild-to-moderate coronavirus disease 2019 (COVID-19) even during the Delta variant pandemic.

Objectives: Post-operative urinary incontinence (PUI) after robotic-assisted radical prostatectomy (RARP) is an important complication; PUI occurs immediately after postoperative urethral catheter removal, and, although approximately 90% of patients improve within one year after surgery, it can significantly worsen their quality of life. However, information is lacking on its nature in community hospital settings, particularly in Asian countries. The purposes of this study were to investigate the time required to recover from PUI after RARP and to identify its associated factors in a Japanese community hospital. Methods: Data were extracted from the medical records of 214 men with prostate cancer who underwent RARP from 2019 to 2021. We then calculated the number of days elapsed from the surgery to the initial outpatient visit confirming PUI recovery among the patients. We estimated the PUI recovery rate using the Kaplan–Meier product limit method and evaluated associated factors using the multivariable Cox proportional hazards model. Results: The PUI recovery rates were 5.7%, 23.4%, 64.6%, and 93.3% at 30, 90, 180, and 365 days following RARP, respectively. After an adjustment, those with preoperative urinary incontinence experienced significantly slower PUI recovery than their counterparts, while those with bilateral nerve sparing experienced recovery significantly sooner than those with no nerve sparing. Conclusion: Most PUI improved within one year, but a proportion of those experiencing recovery before 90 days was smaller than previously reported.

Background It is unclear whether molnupiravir has a beneficial effect on vaccinated patients infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We here evaluated the efficacy of molnupiravir in patients with mild-to-moderate coronavirus disease 2019 (COVID-19) during the Omicron variant surge in Fukushima Prefecture, Japan. Methods We enrolled patients with mild-to-moderate COVID-19 who were admitted to hospitals between January and April, 2022. Clinical deterioration after admission was compared between molnupiravir users (n = 281) and non-users (n = 1,636). Results The molnupiravir users were older (P

Specific background information on cancer patients affected more severely by crisis and disasters is lacking. We experienced an advanced breast cancer patient whose hospital visits were interrupted for two years due to multiple internal and external factors. These factors need to be taken more into account for breast cancer management.

A 66-year-old female without prior history of abdominal surgery visited the emergency department with a complain of sudden intensive lower abdominal pain. Closed loop bowel obstruction was discovered on contrast-enhanced computed tomography, leading to a laparoscopic examination of 5 h after the onset. During laparoscopy, 100 cm of distal jejunum with borderline viability was found incarcerated in a gap of the greater omentum. A 3-cm small incision was made at the umbilical trocar site to observe the bowel after it was released laparoscopically. When viewed under the shadowless lamp, the affected bowel appeared reddish, with peristalsis and a palpated mesentery artery. The surgical team determined no need for resection. The postoperative recovery went smoothly without any complications. Laparoscopic surgery for transomental hernias can be performed safely even in patients with borderline bowel viability, and observing bowel extra-peritoneally with a small incision could be helpful for laparoscopic surgery for internal hernias with borderline viability.

BACKGROUNDDue to the dissemination of vaccination against severe acute respiratory syndrome coronavirus 2 in the elderly, the virus-susceptible subjects have shifted to unvaccinated non-elderlies. The risk factors of COVID-19 deterioration in non-elderly patients without respiratory failure have not yet been determined. This study was aimed to create simple predicting method to identify such patients who have high risk for exacerbation.METHODSWe analyzed the data of 1,675 patients aged under 65 years who were admitted to hospitals with mild-to-moderate COVID-19. For validation, 324 similar patients were enrolled. Disease progression was defined as administration of medication, oxygen inhalation and mechanical ventilator starting one day or longer after admission.RESULTSThe patients who exacerbated tended to be older, male, had histories of smoking, and had high body temperatures, lower oxygen saturation, and comorbidities such as diabetes/obesity and hypertension. Stepwise logistic regression analyses revealed that comorbidities of diabetes/obesity, age ≥ 40 years, body temperature ≥ 38°C, and oxygen saturation < 96% (DOATS) were independent risk factors of worsening COVID-19. As a result two predictive scores were created: DOATS score, which includes all the above risk factors; and DOAT score, which includes all factors except for oxygen saturation. In the original cohort, the areas under the receiver operating characteristic curve of the DOATS and DOAT scores were 0.789 and 0.771, respectively. In the validation, the areas were 0.702 and 0.722, respectively.CONCLUSIONWe established two simple prediction scores that can quickly evaluate the risk of progression of COVID-19 in non-elderly, mild/moderate patients.SummaryThe risk stratification models using independent risks, namely comorbidity of diabetes or obesity, age ≥ 40 years, high body temperature ≥ 38□, and oxygen saturation < 96%, DOATS and DOAT scores, predicted worsening COVID-19 in patients with mild-to-moderate cases.

We experienced an advanced breast cancer patient who failed to receive diagnostic imaging despite regular video conferences with her physician during the COVID-19 pandemic, resulting in delayed liver metastasis detection. Recognizing shortcomings of telemedicine and collaboration among medical institutions for uninterrupted cancer care is imperative during the pandemic.

Recognition of Individual and environmental risks is crucial to alleviate damage inflicted by disasters. In particular, an awareness of floods and their health risks in patients’ residences is important for patients and their healthcare professionals.

ObjectivesThis study aimed to examine whether and how the COVID-19 pandemic has affected the postponement or cancellation of elective surgeries in Japan.Design and settingA cross-sectional, web-based, self-administered survey was conducted nationwide from August 25 to September 30 2020. We used data from the Japan ‘COVID-19 and Society’ Internet Survey collected by a large internet research agency, Rakuten Insight, which had approximately 2.2 million qualified panellists in 2019.ParticipantsFrom a volunteer sample of 28 000 participants, we extracted data from 3678 participants with planned elective surgeries on any postponement or cancellation of elective surgeries.Outcome measuresThe main outcome measure was any postponement or cancelltion of elective surgeries. In addition, for all respondents, we extracted data on sociodemographic, health-related characteristics, psychological characteristics and prefectural-level residential areas. We used weighted logistic regression approaches to fulfil the study objectives, minimising potential bias relating to web-based surveys.ResultsOf the 3678 participants, 431 (11.72%) reported experiencing postponement or cancellation of their elective surgeries. Notably, the participants living in prefectures where the declaration of the state of emergency was made on 7 April 2020 were significantly more likely to experience postponement or cancellation of elective surgeries than those residing in prefectures with the state of emergency beginning on 16 April 2020 (174 (26.02%) vs 153 (12.15%)).ConclusionsThe proportion of patients whose elective surgery had been postponed was limited during Japan’s first wave of the COVID-19 pandemic, although the declaration of a state of emergency increased the likelihood of postponement. It is imperative to increase awareness of the secondary health effects related to policy intervention in pandemics and other health crises and to use appropriate countermeasures such as standard infectious control measures and triage of surgical patients.

Cancer patients, particularly those post-surgery, are prone to skin infection following immersion in flood waters. We reported secondary surgical site infection in a postoperative 80-year-old post-operation breast cancer patient affected by Typhoon Hagibis. Individualized responses based on individual and environmental risks are crucial to alleviate the damage of disasters.

One of the major factors for successful DCs immunotherapy is thought to be the maintenance of the migratory activity of matured DCs. We evaluated the effectiveness of PSK on OK432-activated DCs, in terms of maturation, migration and induction of CTLs. When DCs were treated with both OK432 and PSK, migration ability of the DCs were significantly high as compared to OK432 alone preserving the beneficial effect of OK432 treatment. BRM cocktail treatment with OK432 and PSK induced high level of migration activity in activated DCs, suggesting a potential protocol for more effective DCs immunotherapy for cancer.

Background. To determine the significance of bone marrow disseminated tumor cells in gastric cancer, we investigated the mRNA expression levels of carcinoembryonic antigen (CEA), cytokeratin 19 (CK19), and cytokeratin 20 (CK20) using the real-time quantitative reverse-transcription polymerase chain reaction (RQ-PCR). Methods. Bone marrow samples were aspirated from the sternum at the time of surgery in 65 patients with resectable gastric cancer. Total RNA was extracted from bone marrow; and the expression levels of CEA, CK19, and CK20 mRNA were determined by RQ-PCR using an ABI PRISM 7000 and quantified against the GAPDH mRNA level. Results. The detection limits of these genes were determined in the gastric cancer cell line MKN-45 and the colon cancer cell line C-1, which had been serially diluted in peripheral blood mononuclear cells (PBMCs). A rate of 1 cancer cell/ million PBMCs was obtained by detecting CEA and CK19 mRNA in MKN-45 and by detecting CK20 mRNA in C-1. In the clinical samples, only 1 of the 65 gastric cancer patients (1.5%) who had stage IV disease was positive for CEA, CK19, and CK20 mRNA; none of CEA, CK19, or CK20 mRNA was positive in the remaining 64 patients. No significant correlation was observed between disseminated cancer cells in bone marrow and clinicopathological features, including simultaneous or metachronous hepatic metastasis and patient survival. Conclusion. The incidence of disseminated cancer cells in bone marrow in our study appears low, unlike that in previous reports. The significance of disseminated cancer cells in bone marrow may also be quite low in gastric cancer.

特異な形態および経過を示した,多発する小腸潰瘍の1例を経験した.症例は48歳,男性.腹痛,下血を主訴に当科紹介.腹部全体に膨満と筋性防御が認められ,画像上小腸の拡張と腹水あり,汎発性腹膜炎疑いにて緊急手術を施行.開腹するに, Treitz靭帯から60～100cmの小腸に多発する鮮赤色の縞状斑が存在し,同部位腸間膜側に非連続性に多発する浅い潰瘍が存在,約50cmを切除.病理は粘膜と粘膜下層の出血,壊死が顕著で,小血管特に細静脈の血管炎と循環障害に基づく変化であった.術後,食事開始にて発熱,下血,下痢,腹痛などの症状が出現.成分栄養投与,プレドニゾロン20mg/dayの内服を開始したところ改善し,術後3カ月で退院した.血管炎が小血管にみられたことより,全身性血管炎に伴う小腸病変を検索したが,原疾患は特定できなかった.非特異性小腸潰瘍の一因として,今回のような微小な血管炎の関与が示唆される1例であった.

症例は15歳,男性.発熱および右大腿部痛あり.歩行困難となり,当院搬入された.来院時,右大腿部は著明に腫脹し,激しい疼痛あり.さらに右側腹部を中心に圧痛を認めた.腹部CT上,右腎の高さから右後腹膜に膿瘍を形成し,大腿部も膝上まで鏡面像を伴った膿瘍を形成していた.大腿部および背側より後腹膜ヘドレナージを施行したところ,便汁様の膿汁が約1,000ml排出された.腸管が後腹膜への穿孔し,後腹膜および大腿にガスを伴った膿瘍を形成したものと診断し,開腹手術を行った.虫垂先端が直腸右側の後腹膜に癒着,穿通し,後腹膜から大腿へ広範に膿瘍を形成していた.後腹膜を開放すると約500mlの便汁様の膿が排出された.また大腿へは大腿輪にて交通し膿瘍を形成していた.術後は,敗血症性ショックの状態であったが,順調に回復し,後術8カ月後退院となった.早期に診断,開腹ドレナージを施行できたことが,救命できた要因と考えた.

To seek for a candidate gene that would regulate tumour progression and metastasis in gastric cancer, we investigated gene expression profiles by using DNA microarray. Tumour tissue and adjacent normal tissue were obtained from 21 patients with gastric cancer and then examined for their gene expression profiles by the Gene Chip® Human U95Av2 array, which includes 12 000 human genes and EST sequences. A total of 25 genes were upregulated and two genes were downregulated by at least four-fold in the tumour tissue. In a further analysis according to lymph node metastasis, the expressed levels of maspin, as well as carcinoembryonic antigen and nonspecific crossreacting antigen were significantly higher in tumours with lymph node metastasis than in those without it. Maspin expression in 85 gastric cancer patients was further investigated by using immunohistochemistry. Maspin expression was not observed in normal gastric epithelia without intestinal metaplasia. In contrast, maspin was expressed in 74 of 85 tumour tissues. There was a significant correlation between the incidence of maspin-positive tumour staining and lymph node metastasis. These results suggest that maspin has a potential role for tumour metastasis in gastric cancer.

This study was designed to investigate the role of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and thymidine phosphorylase (TP) in tumor progression and sensitivity to 5-fluorouracil (5-FU).A total of 275 tumor samples from 275 patients with gastric cancer were utilized in this study. TS activity was determined in 130 samples by 5-fluorodeoxyuridine monophosphate binding assay. DPD activity was measured in 140 samples by radioenzymatic assay, and TP protein level was determined in 157 samples by an enzyme-linked immunosorbent assay (ELISA) system. These parameters were compared with several clinicopathologic factors and sensitivity to 5-FU determined by in-vitro ATP assay. The antitumor activities of 5-FU, uracil plus tegafur (UFT), and 1M tegafur--0.4 M 5-chloro-2,4-dihydroxypyridine--1 M potassium oxonate (S-1 [TS-1]) were also compared, using three human gastric cancer xenografts in nude mice.There was no correlation between either TS or TP and sensitivity to 5-FU. However, a weak inverse correlation was found between DPD activity and sensitivity to 5-FU. High DPD activity in tumor resulted in poor prognosis, especially in patients who received 5-FU-based adjuvant chemotherapy. Although TP was significantly correlated with depth of tumor invasion and with lymphatic and venous invasions, TP alone had no impact on survival. On the other hand, TS, as well as peritoneal, hepatic, and lymph node metastases, was selected as an independent prognostic factor in gastric cancer. In the animal model, there was no significant difference in antitumor activities among the drugs in a tumor with low DPD activity. However, S-1 showed superior antitumor activity to 5-FU or UFT in tumors with high DPD activity.DPD is considered to be a most important predictive factor of 5-FU sensitivity. The use of DPD inhibitory fluoropyrimidines is strongly recommended for tumors with high DPD activity.

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon of unknown etiology. There are varied manifestations in the natural course of UC. However, duodenum is not generally considered a target organ of UC. Here, we report two patients with steroid-responsive ulcerative duodenitis with colitis that was consistent with UC, but not with Crohn's disease. We also reviewed six cases of ulcerative duodenitis with UC. Duodenal lesion with UC may be a more common phenomenon, although infrequently clinically manifested under steroid therapy. Upper gastrointestinal tract inflammation in UC warrants further studies to ascertain whether the duodenum is a target organ in UC, especially in steroid-free conditions.

The streptococcal preparation OK-432 induces maturation of T cells and dendritic cells (DCs). However, the mechanisms by which OK-432 induces DC maturation are not well understood.The effects of OK-432 and TNF-alpha on peripheral blood mononuclear cells (PBMCs) were compared. Antibody-based approaches were used to detect proteins characteristic of antigen-presenting cells and cytokines. Cytotoxicity was evaluated by measuring the release of LDH after incubation of effector and target cells. The TLR-4 levels were measured by real-time quantitative PCR.Changes in cell surface marker levels were detected in both treatment groups but OK-432 had a greater effect on induction of Th-1-type cytokines. Furthermore, TLR-4 mRNA was up-regulated in cells from two out of five patients in response to OK-432, but not in response to TNF-alpha.OK-432 has a more profound effect on human DCs than TNF-alpha and may act through multiple signaling pathways.

This study was designed to seek for the optimal anticancer agents for a combination of chemotherapy and specific immunotherapy using dendritic cells (DC) in gastric cancer. We investigated the immuno-suppressive activity of anticancer agents on human peripheral blood mononuclear cells (PBMC), apoptosis inducing activity on gastric cancer cells and expression of Toll-like receptor (TLR)-4 mRNA on immatureDCs (iDCs) by paclitaxel (TXL) and docetaxel (TXT). We further compared the cytotoxicity of cytotixic T lymphocytes (CTLs) induced by DCs pulsed with tumor cell lysate and apoptotic cells induced by TXT. Although most of the anticancer agents demonstrated the suppression activity on proliferation of PBMC in a dose dependent manner, TXT, doxifluridine and irinotecan did not show the suppressive activity on PBMC even in the highest drug concentration. About 60% of gastric cancer cells demonstrated apoptosis after a 24-48 hour treatment with both TXL and TXT. Expression of TLR-4 mRNA in iDCs was up-regulated by TXT, not by TXL, and peaked at 2 hours after the treatment. CTLs induced by DCs pulsed with tumor cell lysate and apoptotic cells showed a similar killing activity to target cells. These results suggest that TXT appears to be an optimal anticancer agent for a combination therapy with chemotherapy and tumor specific immunotherapy using dendritic cells in gastric cancer.

4200 Background: We had previously reported that peritoneal micrometastasis determined by CEA mRNA level in peritoneal washings using real-time quantitative RT-PCR (RQ-PCR) is a good predictor for ...