Nisshin Scientia (Japan)

Adjuvant immunotherapy improved patient outcomes in two trials in completely resected non-small cell lung cancer (NSCLC), but with conflicting primary end point results. The Canadian Cancer Trials Group BR.31 trial evaluated adjuvant durvalumab in completely resected early-stage NSCLC. Following resection of stage IB (≥4 cm) to IIIA NSCLC (American Joint Committee on Cancer 7th Edition) and optional adjuvant chemotherapy, patients were randomly assigned 2:1 to durvalumab 20 mg/kg or placebo 20 mg/kg once every 4 weeks for 12 cycles. Random assignment was stratified by stage, extent of nodal dissection, tumor cell (TC) PD-L1 expression, adjuvant chemotherapy use, and center. The primary end point was investigator-assessed disease-free survival (DFS). Secondary outcomes included overall survival (OS), adverse events, and quality of life. The primary analysis was in the subgroup with cancers that had a PD-L1 TC expression ≥25%, no common activating EGFR mutations (EGFR-), and no ALK gene rearrangements (ALK-). Secondary analyses in hierarchical order included DFS in the subgroup whose tumors were EGFR-/ALK- with PD-L1 TC ≥1%, followed by all patients whose tumors were EGFR-/ALK-, followed by OS in the same primary and secondary subgroups in the same hierarchical order. Of 1,415 patients randomly assigned, 1,219 (86%) had EGFR-/ALK- tumors: 815 randomly assigned to durvalumab and 404 to placebo. With a median follow-up of 60 months, there were no differences in DFS between patients assigned durvalumab (316) versus placebo (161) in the primary population (stratified hazard ratio [HR], 0.93 [95% CI, 0.71 to 1.25]; P = .64) or in the secondary populations. Grade 3 to 4 adverse events were higher in durvalumab-treated patients (D = 26% v P = 20%). Adjuvant durvalumab following complete resection was not associated with improvement in DFS compared with placebo in EGFR-/ALK- NSCLC, regardless of PD-L1 status.

Flap blood glucose decreases when flap congestion occurs. The hypothesis that flap blood glucose works as an indicator for venous congestion was tested experimentally, and flap congestion was reproduced in rodent models. Blood glucose levels of a rat abdominal skin flap, with or without its vein pedicle clamped, were checked before and every 10 minutes after flap elevation. In rats whose pedicle vein was shut off, it was further followed up every 5 minutes after declamping. To examine the effect of systemic blood glucose on flap blood glucose, in some rats, glucose solution was administered intraperitoneally before the experiment to artificially produce hyperglycemia. Forty-two rats were divided into four groups, with (n = 24) or without (n = 18) venous blockage and with (n = 20) or without (n = 22) glucose preloading. Flap blood glucose decreased rapidly to off-scale low (<20 mg/dl) within 40 minutes only when the vein pedicle was shut off in normoglycemic (40 ± 8.2 minutes, mean ± SD) and hyperglycemic (40 ± 9.9 minutes) rat groups (p < 0.01). There was no significant difference in the time taken for the flap blood glucose to decrease to off-scale low after venous blockage between both groups (p = 0.379). When the vein was declamped, flap blood glucose again rapidly returned to the systemic level in 15 minutes or earlier in both groups (p = 0.0283). Flap blood glucose sensitively and specifically reflects the state of vein occlusion, whether the systemic blood glucose is normal or high. The authors' results indicate that flap blood glucose works as a reliable indicator for the venous system.

OBJECTIVE: To clarify the usefulness of CSF-GFAP in the diagnosis and the prognosis of inflammatory CNS diseases. BACKGROUND: Neuromyelitis optica spectrum disorders (NMOSD) is anti-aquaporin4 (AQP4) antibody mediated autoimmune disease characterized by severe optic neuritis and/or longitudinally extensive, transverse myelitis. We previously reported the significantly elevated CSF-glial fibrillary acidic protein (GFAP) level in AQP4 antibody (NMO-IgG) seropositive NMOSD patients. However, the clinical significance of astrocytic damage in seronegative NMOSD and other inflammatory CNS diseases are still unknown. DESIGN/METHODS: We conducted multicentric cross-sectional study in Japan from January 1999 to December 2012 including a total of 129 patients who diagnosed as seropositive NMOSD [64], seronegative NMOSD [8], multiple sclerosis (MS) [38], tumefactive demyelinating disease (TDD) [13], or neuro-Bechet’s disease [5]. CSF-GFAP was measured by a sandwich ELISA. RESULTS: CSF-GFAP levels during relapse in NMOSD were 19413 +- 17954, and the frequencies of elevated CSF-GFAP (1.9ng/ml) in optic, cerebral, and spinal cord lesions were 47%, 100%, 89%, respectively. Higher CSF-GFAP levels (>424.2 ng/mL) were associated with poorer prognosis in myelitis of NMOSD. CSF-GFAP was elevated in 4 cases of seronegative NMO, but positive seroconversion occurred in one of them and CSF-NMO-IgG was positive in another one of them. There were no elevation of CSF-GFAP levels in MS, TDD, and neuro-Behcet ‘s disease. CONCLUSIONS: CSF-GFAP reflects not simply the size of the lesion in inflammatory diseases but the acute astrocytic damage. Some cases in seronegative NMOSD may be false negative for the diagnosis of NMO. CSF-GFAP level is a useful biomarker of acute astrocytic damage in inflammatory CNS diseases, and has clinical and prognostic implications in NMOSD.

OBJECTIVE: This study contrasts the clinical features between seropositive and seronegative patients who have been diagnosed with neuromyelitis optica (NMO).

To evaluate the effectiveness of traditional Chinese medicine, specifically the traditional herbal formulation Bu-yang-huan-wu-tang, for treating epilepsy stemming from cerebrovascular dysfunction. Three adult patients with epilepsy refractory to standard antiepileptic medications were involved. All three showed substantial improvement in the frequency and severity of seizures after Bu-yanghuan- wu-tang was added to conventional medical treatment. Decrease of seizure frequency and severity in three epileptic patients was achieved by adding Bu-yang-huan-wu-tang to conventional therapy according to the principles of Traditional Chinese Medicine (TCM) theory. This treatment mainly relied on the resolution of blood stagnation in cerebrovascular systems. Blood stagnation is an important underlying pathology of many disease processes according to TCM theory.