Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient’s characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

Youngest case of an early gastric cancer after successful eradication therapy

A 28-year-old woman visited our clinic with a chief complaint of epigastralgia. She had received successful Helicobacter pylori (H. pylori ) eradication therapy 5 years before. We repeated esophagogastroduodenoscopy, and a discolored depressed area with reddish spots and converging folds, 20 mm in size, was detected. No atrophic change including intestinal metaplasia or nodular gastritis was seen endoscopically. Two endoscopic biopsies revealed undifferentiated adenocarcinoma. No H. pylori was found, and the 13 C-urea breath test was also negative. Abdominal computed tomography demonstrated no nodal involvement, distant metastasis or fluid collection. She underwent a laparoscopyassisted distal gastrectomy. Histologically, the resected specimen revealed an early undifferentiated gastric cancer that had invaded deeply into the submucosal layer. Nodal involvement was histologically confirmed.No atrophic change or H. pylori infection was evident histologically. This is the youngest patient ever reported to have developed a node-positive early gastric cancer after eradication of H. pylori .

Development of conversion therapy for advanced hepatocellular carcinoma

Although the number of hepatocellular carcinoma(HCC)patients is decreasing due to the development of hepatic anti-virus therapy,it remains a leading cause of cancer-related death worldwide.The recent development of systemic or locoregional therapy for advanced or unresectable HCC has enabled advanced HCC to be downstaged,and reports of conversion therapy have increased;however,many clinical and scientific subjects rely on the therapeutic strategies of advanced HCC.There is a need to assess the evidence and develop clinical guidelines for conversion therapy for HCC;therefore,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition),consisting of 16 statements,has been developed for clinical practice(1).This consensus addresses treatment strategies for both technically and oncologically unresectable HCCs.We applaud Chinese establishment of this comprehensive and cutting-edge consensus on the treatment of advanced HCC.

Hunt for the tipping point during endocrine resistance process in breast cancer by dynamic network biomarkers

Acquired drug resistance is the major reason why patients fail to respond to cancer therapies.It is a challenging task to deter.mine the tipping point of endocrine resistance and detect the associated molecules.Derived from new systems biology theory, the dynamic network biomarker (DNB) method is designed to quantitatively identify the tipping point of a drastic system transition and can theoretically identify DNB genes that play key roles in acquiring drug resistance.We analyzed time-course mRNA sequence data generated from the tamoxifen-treated estrogen receptor (ER)-positive MCF-7 cell line, and identified the tipping point of endocrine resistance with its leading molecules.The results show that there is interplay between gene mutations and DNB genes, in which the accumulated mutations eventually affect the DNB genes that subsequently cause the change of transcriptional landscape, enabling full-blown drug resistance. Survival analyses based on clinical datasets validated that the DNB genes were associated with the poor survival of breast cancer patients.The results provided the detection for the pre-resistance state or early signs of endocrine resistance.Our predictive method may greatly benefit the scheduling of treatments for complex diseases in which patients are exposed to considerably different drugs and may become drug resistant.

A contract theory analysis to fiscal relations between the central and local governments in China

We use a contract theory/mechanism design framework to analyse the fiscal relations and reforms between the central and local governments in China,which are said to have made great contributions to economic growth since the‘economic reform’.First,we present the mechanism(a fiscal incentive contract model),which has created incentives for the development agent(local government),and clarify theoretically how the concept of bao(contract)works.We then comprehend the concept of bisai(contest)within the framework of the yardstick competition between local governments,and review the mechanism which encourages proper information revelation through intergovernmental comparison and competition.Lastly,we make a theoretical comparative analysis on the fiscal system reform(from the fiscal contracting system to the tax sharing system),from the perspective of how much room was left for the‘ratchet effect’in the dynamic relation between the central and local governments,and how it was solved(or mitigated)in the two fiscal systems.