Publications

OBJECTIVES

Endoscopic resection (ER) including endoscopic submucosal dissection has been widely accepted for treatment of early gastric cancer (EGC) in Japan. Additional surgery is recommended when ER is non-curative histologically. Many elderly patients, however, do not undergo radical surgery due to comorbid disease or limited life expectancy. The aim of this study is to assess the survival outcomes of radical surgery compared with observation only in elderly patients after non-curative ER.

METHODS

We reviewed existing data of all elderly patients (older than 75 years) who had undergone ER for EGC at the National Cancer Center Hospital between January 1999 and December 2005. We compared the overall and disease-free survival rates between three patients groups: curative ER, non-curative ER with additional surgery, and non-curative ER without additional surgery.

RESULTS

In total, 428 patients underwent ER; 308 (72%) curative ER and 120 (28%) non-curative ER. Of the 120 non-curative ER patients, 38 patients (31.7%) underwent additional surgery and 82 patients (68.3%) were followed without surgery. There was no significant difference in American Society of Anesthesiologist score between three groups. Patients who did not undergo surgery tended to be older. Overall 5-year survival rates in the curative ER, non-curative ER with surgery, and non-curative ER without surgery were 85, 92, and 63%, respectively. There was no significant difference in overall and disease-free survival between patients in the curative ER and non-curative ER with surgery groups. On the contrary, a significant difference in overall and disease-free survival was evident between the curative ER and non-curative ER without surgery groups (hazard ratio (95% confidence interval): 1.89 (1.08-3.28), 2.30 (1.35-3.94)).

CONCLUSIONS

In our elderly patient cohort, additional surgery following non-curative ER improved overall and disease-free survival compared with non-surgical observation only. Thus, surgery should be considered following non-curative ER in EGC patients >75 years of age.

OBJECTIVES

HIV disease is associated with increased arterial stiffness, which may be related to inflammation provoked by HIV-related immune perturbation. We assessed the association of T cell markers of immune activation and immunosenescence with carotid artery stiffness among HIV-infected women.

METHODS

Among 114 HIV-infected and 43 HIV-uninfected women, we measured CD4+ and CD8+ T cell populations expressing activation (CD38+HLA-DR+) and senescence (CD28-CD57+) markers. We then related these measures of immune status with parameters of carotid artery stiffness, including decreased distensibility, and increased Young's elastic modulus, as assessed by B-mode ultrasound.

RESULTS

HIV infection was associated with increased CD4+ T cell activation, CD8+ T cell activation and CD8+ T cell senescence. Among HIV-infected women, adjusted for age, HIV medications, and vascular risk factors, higher CD4+CD38+HLA-DR+ T cell frequency was associated with decreased carotid artery distensibility (β=-2.00, 95% confidence interval [CI]=-3.86, -0.14, P=0.04) and increased Young's modulus (β=1.00, 95% CI=0.03, 1.97, P=0.04). These associations were affected little by further adjustment for CD4+ T cell count and viral load. Among HIV-infected women, higher frequencies of immunosenescent T cells, including CD4+CD28-CD57+ and CD8+CD28-CD57+ T cells, were also associated with decreased arterial distensibility. Among HIV-uninfected women, frequencies of activated or senescent T cells were not significantly associated with measures of carotid stiffness.

DISCUSSION

T cell activation and senescence are associated with arterial stiffness, suggesting that pro-inflammatory populations of T cells may produce functional or structural vascular changes in HIV-infected women.

This document is an international evidence-based guideline on the diagnosis and management of idiopathic pulmonary fibrosis, and is a collaborative effort of the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association. It represents the current state of knowledge regarding idiopathic pulmonary fibrosis (IPF), and contains sections on definition and epidemiology, risk factors, diagnosis, natural history, staging and prognosis, treatment, and monitoring disease course. For the diagnosis and treatment sections, pragmatic GRADE evidence-based methodology was applied in a question-based format. For each diagnosis and treatment question, the committee graded the quality of the evidence available (high, moderate, low, or very low), and made a recommendation (yes or no, strong or weak). Recommendations were based on majority vote. It is emphasized that clinicians must spend adequate time with patients to discuss patients' values and preferences and decide on the appropriate course of action.

The OPTN classifies high infectious risk donors (HRDs) based on criteria originally intended to identify people at risk for HIV infection. These donors are sometimes referred to as 'CDC high risk donors' in reference to the CDC-published guidelines adopted by the OPTN. However, these guidelines are also being used to identify deceased donors at increased risk of window period (WP) hepatitis C virus (HCV) infection, although not designed for this purpose. The actual risk of WP HCV infection in HRDs is unknown. We performed a systematic review of 3476 abstracts and identified 37 eligible estimates of HCV incidence in HRD populations in the United States/Canada. Pooled HCV incidence was derived and used to estimate the risk of WP infection for each HRD category. Risks ranged from 0.26 to 300.6 per 10,000 donors based on WP for ELISA and 0.027 to 32.4 based on nucleic acid testing (NAT). Injection drug users were at highest risk (32.4 per 10,000 donors by NAT WP), followed by commercial sex workers and donors exhibiting high risk sexual behavior (12.3 per 10,000), men who have sex with men (3.5 per 10,000), incarcerated donors (0.8 per 10,000), donors exposed to HIV infected blood (0.4 per 10,000) and hemophiliacs (0.027 per 10,000). NAT reduced WP risk by approximately 10-fold in each category.