Biopathologic features and clinical significance of micrometatasis in the lymph node of early gastric cancer

AIM: To evaluate the biopathologic features and clinical significance of nodal micrometastasis(MI) in early gastric cancer(EGC).METHODS: Among 1022 EGC patients who underwent gastrectomy with lymphadenectomy of D1 + β or more from March 2001 to December 2005 at the Korean National Cancer Center, available nodal metastasis was found in 90 p T1N1 patients. Nodal metastasis was confirmed by immunohistochemistry(IHC) with cytokeratin and patients were classified into MI and macrometastasis(MA) groups based on the main tumor burden according to the 6th International Union Against Cancer/American Joint Committee on Cancer staging system; the main tumor burden with a diameter of greater than 0.2 mm but no greater than 2 mm as MI, and greater than 2 mm as MA of the representative metastatic node. Proliferative and apoptotic activities of the primary tumor and the nodal metastasis were measured by IHC with Ki-67 and terminal deoxynucleotidyl transferase d UTP nick end labeling, respectively. Biopathologic and clinical features of the patients were analyzed and compared between MI and MA groups. Patients with recurrence were compared with those without recurrence to identify risk factors for recurrence.RESULTS: Thirty-seven patients showed MI and the other 53 patients revealed MA in the lymph node; the incidence of patients with MI and MA was 41.1% and 58.9%. The main tumor burden was 0.9 and 4.6 mm in the representative metastatic node, respectively. Japanese N2 stations were more frequently involved in MA group(20.9%) than in MI group(10.3%) butthe difference was not statistically different(P = 0.338). Proliferative and apoptotic activities of MI were decreased than those of MA(26.7% vs 40.5%, P = 0.004 and 1.0% vs 3.0%, P < 0.001, respectively). However, nodal MI in the current study showed a relatively high proliferative activity and an equivalent apoptotic activity compared to other cancers in the previously published studies. Recurrence was observed in 6 patients during the mean follow up period of 87.6 ± 26.2 mo. The recurrence was significantly associated with the presence of MA(P = 0.041) and lymphovascular invasion of the primary tumor(P = 0.032).CONCLUSION: Lymphadenectomy of D1 + β or more might be necessary in patients with MI in sentinel node to prevent recurrence by clearing MI involving Japanese N2 station.

Intravenous iron supplementation may be superior to observation in acute isovolemic anemia after gastrectomy for cancer

AIM: To determine whether the application of post-operative intravenous (IV)-iron for acute isovolemic anemia after gastrectomy for cancer may be effective.

Acute-to-Chronic Ratio as a Metric for HIV Surveillance

Early diagnosis is important for HIV control on both the individual and the population level. Patients who are diagnosed shortly after infection have more treatment options which can result in delayed progression to AIDS. Early diagnosis can also help to reduce the spread of HIV: with viral loads at the highest level, the newly infected have the highest risk of transmitting HIV to partners. Accordingly it is important to evaluate at a population level whether individuals are diagnosed shortly after infection. For this purpose, we introduce the acute-tochronic ratio, which is the odds of the infected individuals being diagnosed in the acute infection stage versus the chronic infection stage among those who seek HIV testing. We demonstrate this new metric through HIV testing results from sexually transmitted disease clinics of four cities, and compare the four populations with respect to how quickly the infected get HIV testing.

Meta-analyses on prevalence of selected Parkinson’s nonmotor symptoms before and after diagnosis

Background:Nonmotor symptoms are common among patients with Parkinson’s disease(PD)and some may precede disease diagnosis.Methods:We conducted a meta-analysis on the prevalence of selected nonmotor symptoms before and after PD diagnosis,using random-effect models.We searched PubMed(1965 through October/November 2012)for the following symptoms:hyposmia,constipation,rapid eye movement sleep behavior disorder,excessive daytime sleepiness,depression,and anxiety.Eligible studies were publications in English with original data on one or more of these symptoms.Results:The search generated 2,373 non-duplicated publications and 332 met the inclusion criteria,mostly(n=320)on symptoms after PD diagnosis.For all symptoms,the prevalence was substantially higher in PD cases than in controls,each affecting over a third of the patients.Hyposmia was the most prevalent(75.5%in cases vs.19.1%in controls),followed by constipation(50%vs.17.7%),anxiety(39.9%vs.19.1%),rapid eye movement sleep behavior disorder(37.0%vs.7.0%),depression(36.6%vs.14.9%),and excessive daytime sleepiness(33.9%vs.10.5%).We observed substantial heterogeneities across studies and meta-regression analyses suggested that several factors might have contributed to this.However,the prevalence estimates were fairly robust in several sensitivity analyses.Only 20 studies had data on any symptoms prior to PD diagnosis,but still the analyses revealed higher prevalence in future PD cases than in controls.Conclusion:These symptoms are common among PD patients both before and after diagnosis.Further studies are needed to understand the natural history of nonmotor symptoms in PD and their etiological and clinical implications.

Artificial intelligence and improved early detection for pancreatic cancer

Due mainly to a late stage at diagnosis and lack of effective treatment modalities,pancreatic cancer(PC)is a highly lethal malignancy with an overall 5-year survival rate of only 12%.1 Separating patients into those diagnosed with latestage disease with distant metastases and those diagnosed with localized tumors reveals a striking difference of 3%vs.44%5-year survival rates,respectively.Increasing the fraction of patients detected at an early stage,when PC is most likely to be curable,could therefore be of a major benefit.