Search

Takahiro Fuji,1 Jun Arai,1 Yumi Otoyama,1 Yuta Nio,2,3 Ikuya Sugiura,1 Yoko Nakajima,1 Atsushi Kajiwara,1 Yuki Ichikawa,1 Shojiro Uozumi,1 Yuu Shimozuma,1 Manabu Uchikoshi,1 Masashi Sakaki,1 Hisako Nozawa,1 Kenji Momo,2 Tadanori Sasaki,3 Hitoshi Yoshida1 1Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, Japan; 2Department of Hospital Pharmaceutics, School of Pharmacy, Showa University Hospital, Tokyo, Japan; 3Department of Pharmacy, Showa University Hospital, Tokyo, JapanCorrespondence: Jun Arai, Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan, Tel +81-3-3784-8535, Fax +81-3-3784-7553, Email araiguma10@med.showa-u.ac.jpAbstract: Systemic chemotherapy has shown a significant survival benefit in patients with hepatocellular carcinoma (HCC). However, it is associated with various immune-related adverse events (irAEs). We report a case with grade 3 diarrhea and grade 2 colitis following systemic chemotherapy, successfully treated with prednisolone. An 89-year-old man was incidentally detected with a 140-mm hypervascular intrahepatic nodule on contrast-enhanced computed tomography (CECT). Washout of the contrast medium was also detected, and protein induced by vitamin K deficiency or antagonists-II (PIVKA-II) was elevated. Since the Albumin–Bilirubin (ALBI) grade was 2a without any distant metastasis, transarterial chemoembolization (TACE) was performed to treat the HCC, but several intrahepatic nodules were seen in both lobes. Therefore, the patient was treated with lenvatinib for 1 year and 4 months. A complete response according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria was achieved in 2 months; however, multiple hypervascular nodules were detected again. Since the ALBI grade was 1, a second round of chemotherapy with atezolizumab and bevacizumab was initiated. Although a complete response was achieved, the therapy was discontinued due to grade 3 diarrhea and grade 2 colitis after the sixth course. Based on the stool analysis and culture, CECT, and colonoscopy, the diagnosis was atezolizumab-associated colitis. Diarrhea was controlled following the oral administration of 0.5 mg/kg/day of prednisolone, and atezolizumab-bevacizumab therapy was successfully reinitiated without recurrence of colitis. The management of irAEs is important for a significant survival benefit. Systemic chemotherapy with atezolizumab and bevacizumab can be resumed despite a grade 3 irAE due to atezolizumab.Keywords: hepatocellular carcinoma, immune checkpoint inhibitors, immune-related adverse events, ICI-mediated colitis, IL-17, PIVKA-II

Reports on surveillance systems useful for determining the risk of developing hepatocellular carcinoma （HCC） after direct-acting antiviral （DAA） treatment for hepatitis C have been published. Liver cirrhosis （LC） is a high-risk factor for HCC, but the evaluation frequency necessary for patients with chronic hepatitis （CH） remains unknown. Here, we aimed to identify how frequent CH patients should be evaluated for HCC, with particular emphasis on patients achieving a sustained virological response （SVR） with DAA treatment. Data were collected pre-treatment （Pre） and at the time of SVR for 141 patients with hepatitis C receiving DAA treatment. We defined LC by a platelet （PLT） count ≤10×104/µl, and CH was defined by a PLT count of ＞10×104/µl. The incidence of HCC in patients with CH after achieving SVR was retrospectively evaluated. In total, 128 patients （CH, n＝102; LC, n＝26） achieved SVR, and 13 developed HCC after SVR during the follow-up period （mean, 748 days）. Although fibrosis-4 （FIB-4） index, the presence of α-fetoprotein, and prothrombin time were significant risk factors for HCC in patients with CH in the univariate analysis, only the Pre-FIB-4 index was an independent predictive factor for HCC development in the multivariate analysis （p＝0.04）. An FIB-4 index ≥3 was a significant risk factor for HCC （p＝0.005）. The cumulative risk for HCC at 1000 days was 2.6％ and 24.2％ in the FIB-4 index ＜3 and FIB-4 index ≥3 groups, respectively （p＝0.004）. Frequent HCC examination is recommended for FIB-4 index ≥3 CH patients who obtain SVR after DAA treatment.

The original online version of this article (Ichikawa Yuki, Ueshima Hironobu, Hiroshi Otake, Akira Kitamura (2016) Regardless of the Puncture Angle, a Tuohy Needle with Sand-Blasted Steel at the Tip of the Bevel Is a Valid Needle on the Ultrasonic Images, 2016, 6, 101-104, https://file.scirp.org/Html/1-1920418_68780.htm) unfortunately contains some mistakes. The authors wish to correct the errors in co-authors, Table 1, and Table 2.

The original online version of this article (Ichikawa Yuki, Ueshima Hironobu, Hiroshi Otake, Akira Kitamura (2017) PECS Block Provides Effective Postoperative Pain Management for Breast Cancer Surgery—A Retrospective Study. International Journal of Clinical Medicine, 8, 198-203. https://doi.org/10.4236/ijcm.2017.83019) unfortunately contains some mistakes. The author wishes to correct the errors in pain management tools, method, and figures.

We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs were recorded in the postoperative care unit within 24 hours after the operation. Postoperative complications (i.e., nausea and vomiting) were noted. Results: Patients who received the PECS block under general anesthesia (PECS group) reported lower visual analog scale pain scores at 0, 1, 2, 4, 6, 12, 24 hours after the operation than patients who did not receive PECS block under general anesthesia (control group). Moreover, the use of additional analgesic drugs during the first 24 hours after surgery was lower in the PECS group than in the control group. While in the postoperative care unit, the PECS group had less nausea and vomiting than the control group. Conclusion: The PECS block provides effective postoperative analgesia within the first 24 hours after breast cancer surgery.

Background & AimsPrimary biliary cholangitis (PBC) is an autoimmune liver disease characterized by portal inflammation and immune‐mediated destruction of intrahepatic bile ducts that often leads to liver decompensation and liver failure. Although the biochemical response to ursodeoxycholic acid (UDCA) can predict disease outcome in PBC, few biomarkers have been identified as prognostic tools applicable prior to UDCA treatment. We therefore sought to identify such indicators of long‐term outcome in PBC in the Japanese population.MethodsThe prebiopsy serum samples and subsequent clinical data of 136 patients with PBC treated with UDCA were analysed over a median follow‐up period of 8.8 years. Serum levels of biomarkers related to microbial translocation (sCD14, EndoCAb and I‐FABP) were measured along with those of 33 cytokines and chemokines and additional auto‐antibodies. Associations between the tested parameters and the clinical outcomes of liver decompensation and liver‐related death/liver transplantation were evaluated using the Cox proportional hazards model with stepwise methods and Kaplan‐Meier analysis.ResultsElevated levels of serum IL‐8, and sCD14 before UDCA therapy were significantly associated with both liver decompensation and liver‐related death/liver transplantation. In multivariate analyses, IL‐8≥46.5 pg/mL or sCD14≥2.0 μg/mL at enrolment demonstrated the same results. Kaplan‐Meier analysis also revealed IL‐8 and sCD14 to be significantly associated with a poor outcome. sCD14 was significantly correlated with IL‐8. EndoCAb and I‐FABP were not related to disease outcome.ConclusionsSerum IL‐8 and sCD14 levels before UDCA therapy represent noninvasive surrogate markers of prognosis in patients with PBC., Article, LIVER INTERNATIONAL.37(6):897-905(2016)

Wayside noise reduction arises as a major issue when increasing the Shinkansen’s operating speed. We have been working on reduction of noise from the lower part of train cars, a major source of Shinkansen noise. First, using the experimental train “FASTECH360”, we identified the noise source from around wheels. We confirmed that noise from around the wheels was aerodynamic noise generated from air through the ventilation route of brake discs. Thus, we developed a low-noise brake disc for new Shinkansen Trains “Series E5.” Next, we used test equipment to investigate the mechanism of noise generation of the rotating wheel with a low-noise disc attached to further improve the low-noise disc. As a result, we found that: (1) Air through the ventilation route generated noise over 700 Hz and this noise consists mostly of noise generated by rotating wheels with low-noise brake discs; (2) Circumference gap generated noise around 500 Hz; (3) Bolt holes generated noise around 2500 Hz.