Objective : To examine the cost-effectiveness of interferon αcon-1 [consensus interferon (CIFN)] for chronic hepatitis C patients with genotype lb and high-titer.
Design : Cost-effectiveness analysis.
Methods : Data from a randomized clinical trial comparing the efficacy of CIFN to interferon-αn 1 (IFN-αn 1) for chronic hepatitis C patients were applied to a cohort simulation by Markov model to project lifelong clinical and economic outcomes from the payer's perspective. Natural history model and decision analytical model were built based on published literature and actual healthcare reimbursement data.
Results : From the randomized trial, sustained response proportion and biochemical response proportion were 16.7%and 18.2%for patients receiving CIFN, compared with 3.3%and 18.0%for IFN-αn 1, respectively. The simulation model showed that CIFN should prolong life expectancy by 0.4 year at negative incremental costs, compared to IFN-αn 1 strategy. Compared to no IFN strategy, CIFN should prolong life expectancy by 1.2year at an incremental cost-effectiveness ratio of ¥1, 320, 000 per life year gained. The results were robust, with CIFN remaining cost-effective in sensitivity analysis compared to IFN-αn 1 and no IFN treatment.
Conclusion : For chronic hepatitis C patients with genotype 1b and high-titer, CIFN should prolong life and be cost effective in comparison with IFN-αn 1 and no IFN treatment.

　　We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

A 75-year-old male with an aneurysm in the transverse aortic arch with aberrant right subclavian artery was surgically treated successfully. Preoperative angiograms suggested abnormal expansion of neck vessels but this was not confirmed before operation. At operation, right aberrant subclavian artery was confirmed and the transverse aortic arch was replaced with a 22mm woven Dacron graft and four brachiocephalic vessles were reconstructed by interposition of four 8mm Dacron grafts between those vessels and the arch prosthesis. The postoperative course was uneventful and the postoperative angiograms indicated successful transverse aortic arch reconstruction.

The World Health Organization (WHO) standard assay for determining antibody level is the rapid fluorescent focus inhibition test (RFFIT) and is used to determine the degree of immunity after vaccination against rabies.To compare the difference in RFFIT results between the laboratories of The National Institute of Infectious Disease in Japan (NIID) and the Chinese Centre for Disease Control (CCDC) as well the influence of the choice of standard serum (STD) for the detection,the two laboratories detection methods were simultaneously manipulated by RFFIT.The reference serums used in NIID and the WHO standard serum used in CCDC were compared in the same RFFIT detection to determine the titer of four sera samples C1,S1,S2 and S4 in parallel,and the titers of the detected sera samples were calculated using the standard formula for neutralizing antibody titer.No significant difference was found in RFFIT methods from the two laboratories and the RFFIT testing procedures of the two laboratories have good consistency.However,different titers were obtained with the tentative internal standard serum (TI-STD) produced by adjusting to 2.0 IU of WHO standard serum in NIID and the WHO STD.The titer determined with the TI-STD was higher than that determined with WHO STD,This difference appears to be significant and requires further investigation.

Spontaneous rupture of the thoracic aorta without trauma, aneurysm or dissection is a rare but fatal disease. We reported successful endovascular aortic repair of thoracic aortic spontaneous rupture in 3 patients. Generally, it is difficult to accurately identify the rupture site in the spontaneous rupture. However, by detailed planning based on the data of preoperative CT images, thoracic endovascular aortic repair (TEVAR) can be successfully performed, like surgical repair of spontaneous rupture of the distal aortic arch or descending thoracic aorta. TEVAR should be considered as a first-line therapy, especially, in patients with advanced age or significant comorbidities.

Purpose and Methods: Infection and neoplastic fever is one of the common complication in patients with advanced cancer. To develop a novel method to differentiate neoplastic fever from infection, we performed a retrospective study of hospitalized terminally ill cancer patients at Seirei Hospice from April 2009 to August 2011. Results: We identified a consecutive sample of 12 patients with neoplastic fever and 12 patients with infection as a control. We extracted demographic data, laboratory data, vital signs and symptoms from medical charts. We found significant differences in difference in C-reacive protein value between afebrile and febrile period (p＜0.001), difference of white blood cell count between afebrile and febrile period (p=0.0017), percentages in neutrophil counts (p=0.023), percentages in lymphocyte counts at base line (p=0.011) and the presence of delirium (p=0.012). Conclusion: These findings suggest that we might differentiate neoplastic fever from infection with common laboratory data and their longitudinal change.

Ceftriaxone is one of the easily administrative antibiotics, but little is known about their role in palliative care settings. The aim of this study is to show the effect and the safety of ceftriaxone subcutaneous infusion to infection among advanced cancer patients. Consecutive patients who received ceftriaxone subcutaneous infusion at the Seirei Hospice from January 2013 to January 2014 were enrolled in this retrospective analyses. Primary outcome was the response rate of ceftriaxone, determined by improvement of symptoms within 3 days of ceftriaxone use. Secondary outcomes are inflammatory site reaction, and a comparison of the response rate between ceftriatone and other antibiotics. Among a total of 100 admitted patients, 10 patients used ceftriaxone subcutaneous infusion (4 for urinary tract infection, 4 for pneumonia, 2 for soft tissue infection). The response rate was 70% (95% confidence interval, 39－89). There was no inflammatory symptom at the insertion site observed. For comparisons, 16 patients used other antibiotics with the response rate of 74% (51－88).In conclusion, subcutaneous infusion of ceftriaxone can be useful in the treatment of infections of end－of－life cancer patients, and randomized controlled trial is promising.

Oxidative stress is considered to contribute to degenerative disease. The urinary excretion of the DNA repair product 8-hydroxy-2′-deoxyguanosine (8-OHdG) is proposed as a noninvasive biomarker of current oxidative stress in vivo. We investigated the effect of an antioxidant mixture on urinary 8-OHdG excretions in 12 otherwise healthy smokers. During the intervention period for 2 weeks, subjects consumed four capsules of PICACE^® (Pycnogenol^® 15 mg/capsule, Vitamin E; 56.1 mg/capsule, Squalene; 138.9 mg/capsule) per day. On days 0 (pre-internal use), 3, 7, 14, and 44, morning urine samples were collected. The urinary 8-OHdG was measured using high-performance liquid chromatography (HPLC). The urinary 8-OHdG level on day 3 was significantly reduced compared to day 0. The level of 8-OHdG after a washout period for PICACE^® (days 44) returned to day 0 baseline. These preliminary data suggest that PICACE^® supplements can protect smokers from oxidative stress and possibly reduce disease risk caused by free radicals associated with smoking.

A 55-year-old man was admitted with a thoracic aortic aneurysm causing wheezing. Computed tomography and angiography revealed a large distal aortic saccular aneurysm, occupying the retrotracheal space and compressing the trachea. There has been only one report of this type of aneurysm. This patient needed emergency intubation because of severe dyspnea caused by premedication for surgery. Replacement of the distal arch was performed via left posterolateral thoracotomy. Profound hypothermia was used during open proximal anastomosis, which helped to make this procedure safe and simple. This patient recovered uneventfully.