High Count Group Research Articles

Relationship between oral mucositis and the oral bacterial count in patients with head and neck cancer undergoing carbon ion radiotherapy: A prospective study

Background and purposeAcute adverse events, such as oral mucositis, can affect treatment success in patients undergoing head and neck radiotherapy. In this study, we aimed to identify the relationship between oral mucositis and oral bacterial counts during carbon ion radiotherapy (C-ion RT) in patients with head and neck cancer. Materials and methodsThis prospective study included patients with head and neck tumors treated with C-ion RT between 2017 and 2019. C-ion RT consisted of treatment at 57.6, 64.0, or 70.4 Gy (relative biological effectiveness) in 16 fractions. Bacterial counts in the saliva and the back of the tongue were measured using a rapid oral bacteria quantification system. The relationship between the oral bacterial count and oral mucositis was subsequently analyzed. ResultsIn total, 46 patients were included in the analysis. The bacterial count in the saliva gradually increased from the commencement of C-ion RT and peaked at 16 fractions. Bacterial counts at the back of the tongue were already high at the beginning of C-ion RT; however, they decreased with continued treatment, peaked at 16 fractions, and subsequently decreased again. Patients with bacterial counts exceeding the mean before C-ion RT (high-count group) did not experience more severe mucositis than those with counts below the mean (low-count group). However, patients in the high-count group tended to experience faster-onset mucositis and slower healing than those in the low-count group. ConclusionBacterial counts may aid in the development of clinical strategies for C-ion RT-induced oral mucositis.

Clinical features and outcome of pediatric acute lymphoblastic leukemia with low peripheral blood blast cell count at diagnosis.

Peripheral blood (PB) blast cell count on day 8 of prednisone therapy has been considered one of the strongest predictors of outcome in children with acute lymphoblastic leukemia (ALL). However, little is known about the clinical features and prognostic impact of PB blast cell count at diagnosis in these patients. The aim of this study was to evaluate the relationship between initial PB blast cell count and clinical prognosis of pediatric ALL.The study comprised 367 patients with ALL, aged 0 to 14 years, enrolled and treated using the Chinese Children's Leukemia Group-ALL 2008 protocol between 2011 and 2015. The majority (91.6%) of patients were B-cell precursor ALL (BCP ALL), and 8.4% were T-cell ALL (T-ALL).Patients with BCP ALL in the low PB blast cell count group (<1 × 109/L) had significantly superior survival rates to those in the high count group (≥30 × 109/L). In T-ALL, the low count group showed significantly inferior survival rates compared to both the intermediate count group (1–29.9 × 109/L) and high count group. Multivariate analysis revealed that the initial white blood cell count and minimal residual disease at the end of induction therapy were independently predictive of BCP ALL outcome, while risk stratification was shown to be an independent prognostic factor for T-ALL outcome.These results indicated that low blast cell count in PB at diagnosis was associated with different clinical outcomes in patients with BCP ALL and T-ALL, although it was not an independent outcome predictor by multivariate analysis.

VASOVAGAL SYNCOPE RECURS RANDOMLY OVER TIME WITH PATIENT-SPECIFIC RATES

VASOVAGAL SYNCOPE RECURS RANDOMLY OVER TIME WITH PATIENT-SPECIFIC RATES

Treatment interruption after delivery in HIV‐infected women without HAART indications is not safe if initial CD4+ count is less than 700 cells/mm3

Purpose of the studyTo determine safety for the mother of termination after delivery of HAART, initiated with the aim to prevent mother to child transmission.Methods640 HIV‐infected women were randomly selected and evaluated at baseline as not having standard HAART indications [1]. 32 of them got pregnant and short termed HAART (with one boosted protease inhibitor and two nucleoside reverse transcriptase inhibitors) was started at 14–26 week of gestation. It was stopped after delivery and women were additionally followed up for 3 years. Women were divided into 2 groups according to initial CD4+ T‐lymphocyte count: the High Count Group (16 women) 700 to 1200 CD4+cells/mm3, and the Low Count Group (16 women) 500 to 700 CD4+ cells/mm3. Data was subjected to statistical analisys by least square regression and Kaplan‐Meier's method by means of SPSS software [2].Summary of resultsWomen in the High Count Group had stable disease duration and lost at average only 9 CD4+ cells per year (0,9% of CD4+ cell count per year). The average elevation of viral load was 4306 copies per year. Only 6,3% (1 of 16) of women reinitiated HAART in 3 years. Women in the Low Count Group demonstrated immunological disease progression with outstanding loss of 80 CD4+ cells per year (12% of CD4+ cell count per year). Velocity of virological progression was 34940 HIV copies per year. 50% (8 from 16) of women reinitiated HAART in 3 years. 12,5% (2 of 16) of women had symptoms on viral rebound (acute pharyngitis, pneumonia).Kaplan‐Meier curves, indicating women remaining without HAART indications after delivery.imageDifferences in above mentioned indices were statistically significant. Both groups did not differ significantly in age, HIV infection duration, duration of short termed HAART during pregnancy, initial viral load. Even mild immune deficiency 500–700 CD4+ cells/ml results in evidently high velocity of immunological and virological HIV disease progression, leading to soon (within 3 years) HAART reinitiation. Termination of HAART in this case is considered to be not safe. Comparison of High and Low CD4+ Count Groups Index Measure High (700–1200 cells/mm3) CD4+ T‐lymphocyte Count Group Low (500–700 cells/mm3) CD4+ T‐lymphocyte Count Group t Significance (2‐tailed) Average CD4+ Cell Loss cells per year 9,30 79,6 2,312 0,028 Average% CD4+ Cell loss % per year 0,88 12,4 2,727 0,011 Proportion of women, initiated HAART at year 3 % 6,3 50 1,830 0,050 Average Viral Load Year copies/ml 4306 34940 1,378 0,178 Elevation Age years 25,84 26,22 0,278 0,783 Disease duration years 2,43 3,17 0,759 0,454 Short Time HAART Duration days 83,44 77,75 0,461 0,648 Initial Viral Load Log10 copies/ml 4,09 4,25 0,602 0,551 Conclusions1. In case initial CD4+ cell count is less then 700 cells/ml termination of HAART after delivery is not safe and should not be recommended in practice. 2. If initial CD4+ cell count is more then 700 cells/ml HAART may be terminated after delivery but additional studies are needed to evaluate the best appropriate time of termination.

Clinical features and outcome of T-lineage acute lymphoblastic leukemia in adults: A low initial white blood cell count, as well as a high count predict decreased survival rates

Although biological and clinical features differ between B-lineage acute lymphoblastic leukemia (ALL) and T-lineage ALL (T-ALL), there have been few reports that focused on the prognosis for T-ALL in adults, primarily due to its rarity. Here, we studied the long-term outcomes and prognostic factors specific for adult T-ALL by combining patient data from the three prospective trials conducted by the Japan Adult Leukemia Study Group (JALSG). Among 559 patients whose immunophenotypes could be evaluated, 87 (15.6%) were identified as T-ALL. Of them, 66 patients (75.8%) achieved complete remission, and relapse occurred in 41 patients. With a median follow-up for surviving patients of 7.5 years, the probability of overall survival was 35.0% at 5 years. Risk factor analysis revealed that serum albumin levels, initial white blood cell (WBC) counts, and age had independent values for predicting survival. For WBC, not only the high-count group (50 × 10 9 l −1 or higher), but also the low-count group (less than 3 × 10 9 l −1) showed a significantly lower survival rates than the intermediate-count group ( p = 0.0055 and 0.0037, respectively). Although our findings need confirmation, these results will be helpful in the identification of prognostically distinct subgroups within adult T-ALL.

Characterization of the prostaglandin biosynthetic pathway in non-small cell lung cancer: A comparison with small cell lung cancer and correlation with angiogenesis, angiogenic factors and metastases

To investigate the components of the prostaglandin biosynthetic pathway, the characteristics of cyclooxygenase (COX)-1, COX-2, hematopoietic prostaglandin D synthase (hPGDS), microsomal prostaglandin E synthase (mPGES), and thromboxane synthase (TXS) were examined for autopsied cases with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Autopsied patients (n=120) with lung cancer were examined, of whom 25 had SCLC and 95 had NSCLC. Immunostaining was performed for COX-1, COX-2, hPGDS, mPGES, TXS, CD34, vascular endothelial growth factor (VEGF), and basic fibroblastic growth factor (bFGF). The immunostaining scores of the prostaglandin biosynthetic pathway markers were significantly higher for adenocarcinoma than for SCLC (p<0.0001). In addition, there were significant correlations between two markers of the prostaglandin biosynthetic pathway for cases with SCLC and NSCLC. For NSCLC, the mean immunostaining scores for the prostaglandin biosynthetic pathway markers were significantly higher for cases with high count groups than low count groups for MVD, VEGF and bFGF, except COX-2 and MVD, and COX-2 and bFGF. The mean immunostaining scores for COX-1, COX-2, mPGES, and TXS were significantly higher for cases with more metastatic organs who had NSCLC. Prostaglandin biosynthetic pathway markers may act synergistically and enhance tumor angiogenesis, the expression of angiogenic factors, and metastases in patients with NSCLC.

Repeatability of left ventricular ejection fraction and volume measurement for 99mTc-tetrofosmin gated single photon emission computed tomography (SPECT)

This study was carried out to assess the repeatability of left ventricular ejection fraction (EF) and volume values obtained using Cedars-Sinai quantitative gated single photon emission computed tomography (SPECT) (QGS) software and relatively low doses of 400-600 MBq of 99mTc-tetrofosmin. Repeatability was assessed in a group of 75 patients, with both normal and reduced EF, who underwent repeat 99mTc-tetrofosmin gated SPECT studies and showed no clinical change in cardiac status. Gated SPECT data were acquired 1 h after injection at rest of 400-600 MBq of 99mTc-tetrofosmin. The standard patient dose was 400 MBq; however, some patients with a weight of >90 kg were given increased doses up to a maximum of 600 MBq. There was good correlation of EF and volumes between the first and repeat measurements, and no significant difference between the mean EF and volumes for both the initial and repeat measurements. Background-corrected counts in the left ventricle were calculated and patients were divided into two groups: one with low counts and one with high counts. The mean difference in EF between the first and repeat measurements was significantly higher for patients in the low count group compared with those in the high count group, but there was no significant change in volume. Similarly, the mean sequential difference in EF was significantly higher for patients with normal EF, but there was no significant difference in volume. We have demonstrated that EF measured using 99mTc-tetrofosmin gated SPECT is repeatable, particularly for patients with low EF, provided that adequate left ventricular counts are obtained. This will require doses greater than 400 MBq in larger patients. Ventricular volumes calculated using QGS may not be sufficiently repeatable for clinical use.

Chymase-positive mast cells in small sized adenocarcinoma of the lung.

Mast cells accumulate in angiogenesis-dependent situations of lung adenocarcinoma. Human mast cells are divided into two major subsets: MCT (mast cells with immunoreactivity for tryptase but not chymase) and MCTC (reactive for tryptase and chymase). Chymase is an important mediator of tissue remodeling, but research into chymase-containing mast cell subpopulations has been hampered by the lack of reagents suitable for use with formalin-fixed tissue. We stained chymase using CC1 antibody in 66 cases of small sized lung adenocarcinoma as well as CD34 and tryptase. There were significant positive correlations of microvessel counts with MCT-type and MCTC-type mast cell counts in lung adenocarcinomas. When analyzed according to Noguchi's classification, MCT-type and MCTC-type mast cells were significantly increased in Noguchi type-C tumors [localized bronchioloalveolar carcinoma (LBAC) with active fibroblastic proliferation] compared with in Noguchi type-A (LBAC) plus type-B tumors (LBAC with alveolar collapse). Members in the high-count group of MCTC-type but not MCT-type mast cells showed a significantly worse outcome than those in the low-count group in LBACs. Counting chymase-positive (MCTC-type) mast cells in tumor stroma may be a good prognosis predictor for LBACs, especially Noguchi type-C tumors.

Different patterns of faecal egg output following infection of Scottish Blackface lambs with Ostertagia circumcincta

Faecal nematode egg counts were monitored in 184 Scottish Blackface lambs during natural exposure to a mixed, predominantly Ostertagia circumcincta infection and 12 lambs were selected which showed consistently zero (low count group; nine lambs) or consistently positive faecal egg counts (high count group; three lambs). These lambs were then treated with anthelmintic and challenged with 50 000 infective larvae of O. circumcincta and monitored thrice-weekly for 38 weeks; they were then re-challenged with another 50 000 infective larvae of O. circumcincta and monitored for a further 8 weeks. All sheep gave positive egg counts following deliberate infection. However, there was considerable variation among sheep in the size and timing of the peak in egg production. In particular, the pattern of mean values for faecal egg counts was different in the two groups. Egg counts were lower in the later periods of the extended infection in both groups of sheep. During the first half of the extended infection, egg counts were lower in sheep from the low count group, but during the second half of the infection the pattern was reversed and egg counts were lower in sheep from the high count group. There was a weak positive correlation between egg counts following anthelmintic treatment and 28 days exposure to natural infection and egg counts 28 days after a deliberate infection. Egg counts in the later stages of the deliberate infection were strongly but negatively correlated with egg counts following natural infection. The results of these studies show that differences in egg count following natural infection can be reproduced in experimental infections and that there is substantial variation in the pattern of egg production over time in different sheep. They also suggest that naturally resistant lambs are better able to delay worm development than naturally susceptible lambs.

DNA ploidy pattern and cell cycle stage of tumor cells in soft-tissue sarcomas: clinical implications.

Staining and counting of argyrophilic nucleolar organizer region (AgNOR), segments of DNA with ribosomal genes, is useful for estimation of the proliferative activity in soft tissue sarcoma (STS). The precise role of AgNOR in STS, however, is still uncertain. In the present study, ploidy pattern and stage of cell cycle were analyzed in 151 cases of STS in the extremities and trunk, and their correlation with AgNOR and utility as independent prognostic factors were estimated. For this, microspectrophotometric and flow-cytometric analyses were done on paraffin-embedded material from 84 and 111 cases, respectively. Fifty-five percent cases showed an aneuploid pattern with a less favorable prognosis. The range of the DNA index and percentage of cells in S + G2M phase were 0.89-2.04 (mean +/- SD, 1.23 +/- 0.32) and 5.4-83.7% (mean +/- SD, 32.95 +/- 17.92), respectively. Tumors having less than 40% cells in the S + G2M phase showed a favorable prognosis compared to those over 40%. Both the ploidy pattern and stage of the cell cycle showed a good correlation with the AgNOR count: a high frequency of cases having aneuploidy and S + G2M phase in the AgNOR high count group. These findings provide a theoretical base for explaining the utility of AgNOR for the estimation of proliferative activity. In multivariate analysis, only AgNOR counts were a prognostic factor among histologic factors reflecting proliferative activity of tumors. The DNA ploidy pattern and the stage of the cell cycle was proved not to be an independent factor for prognosis.

Usefulness of argyrophilic nucleolar organizer staining for histologic grading of soft-tissue sarcomas.

Accurate histologic grading is essential for making a proper therapy decision in soft-tissue sarcomas (STS). The usefulness of the argyrophilic stain for nucleolar organizer region (AgNOR) in assessing the histologic grade of STS has been examined. One hundred and forty-two patients with STS confined to the extremity and trunk were selected. Tumors were classified based on the criteria of Enzinger and Weiss ["Soft-Tissue Tumors." St. Louis: C. V. Mosby, 1983]. In addition, non-specific classification was made based on the shape of proliferating cells occupying more than 50% of the field in the sections such as pleomorphic cell, small round cell, spindle cell, epithelioid cell, myxoid, and unclassified tumors. The mean number of AgNOR dots per nucleus of tumor cells was calculated in 200 cells (AgNOR count). Each category of non-specific classification was divided into a high-count group (< 8 AgNOR count) and a low-count group (> 8 NOR). The low-count group showed a significantly better prognosis than the high-count group in small round cell and spindle cell tumors (P < 0.007 and P < 0.0005, respectively). Similar results were obtained in pleomorphic cell tumors, though they were statistically not significant because of the relatively small number of examined cases. Most patients with epithelioid cell and myxoid tumors were in the low-count group. These findings suggest that the assessment of histologic grading of STS could be made effectively by the non-specific classification and the aid of AgNOR staining.

Prognostic significance of argyrophilic nucleolar organizer staining in soft‐tissue sarcomas

The utility of argyrophilic stain for nucleolar organizer region (AgNOR) for estimating proliferative activity and prognosis of soft-tissue sarcomas (STS) was examined. Formalin-fixed and paraffin-embedded sections of 38 cases with STS were used; the reaction product of AgNOR stain was observed as dots mainly in the nucleoli. The mean number of AgNOR dots per nucleus of tumor cells was calculated in 200 cells (AgNOR count). The AgNOR count, ranging from 1.4 to 16.1 (mean, 7.5), showed a good correlation with cellularity (r = 0.483, p less than 0.003) and histologic grade (r = 0.626, p less than 0.00005), but less shown with mitotic counts (r = 0.350, p less than 0.04). The prognosis of cases with AgNOR low-count group (5-year survival rate was 74.6%) was much better than those in high count group (33.3%) (p less than 0.0005). The AgNOR count correlated well with reactivity of tumor cells for Ki-67 staining, which was available only in freshly prepared sections. These findings suggested that the AgNOR staining is a simple and useful method for estimating tumor-cell proliferation and prognosis of patients with STS.

Study of asbestos bodies in japanese urban patients

To study whether low-level exposure to asbestos contributes to lung cancer risk, the asbestos body (AB) content in lung tissue was measured in 476 patients with lung cancer and 369 patients with other diseases, all from a Japanese industrialized city. Eleven patients with histologically confirmed asbestosis were included. The findings were stratified into four groups. A significant number of patients with lung cancer were seen in the groups with high counts, as compared to controls. There was no significant difference in histologic type and site of lung cancer among four groups. The patients with lung cancer in high count groups were significantly younger than those with lower counts. A significant number of smokers were seen in the groups with high AB counts among patients with lung cancer as compared to controls, even if the patients with asbestosis were excluded. These findings suggest that there may be a positive interaction of smoking and exposure to asbestos relative to the incidence of lung cancer even at a low exposure level.