Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) is defined as locally advanced tumor of the pancreas without metastasis that is, although potentially resectable (R), at high risk for positive resection margin following surgery. The therapeutic strategy has remained unestablished because BR-PAC is biologically a heterogeneous subset in which the preoperative prognostic factors are undetermined. Recently, several prognostic factors related to systemic inflammation have been explored in various kinds of cancers: the combination of serum C-reactive protein (CRP) and albumin as the modified Glasgow prognostic factor; a combination of CRP and white blood cell count in the prognostic index; a combination of albumin and lymphocyte counts in Onodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR); and the platelet-lymphocyte ratio (PLR). Although these prognostic factors have been explored in some small cohort studies of PAC patients, the results still remain controversial especially because PAC patients with diverse clinical stages were included in the cohorts. It has never been reported whether or not the systemic inflammatory response is validated as a predictive risk factor in cohorts of only advanced BR-PAC patients. Method: Between January 2003 and June 2012 at Kobe University Hospital, 136 consecutive pancreatic adenocarcinoma (PAC) patients who underwent surgical curative resection were retrospectively studied. Prior to surgery, the PAC patients were stratified into R- and BR-PAC patients according to the National Comprehensive Cancer Network guidelines. To evaluate the independent prognostic significance of NLR and PLR, univariate and multivariate Cox proportional-hazard models were applied. Results: The median survival in PAC patients with preoperative NLR > 3 (n=45) and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037). However, the median survival in PAC patients with PLR > 225 (n=32) and PLR < 225 (n=104) was 21.8 months and 26.2 months, showing no significant difference in overall survival between the two groups (P=0.2526). The median survival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1 months and 33.1 months, respectively (P=0.0138). However, the median survival in the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1 months and 25.8 months, showing no significant difference in overall survival between the two groups (P=0.6533). The median survival in BR-PAC patients with preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2 months, respectively (P=0.0068). In addition, median survival in BR-PAC patients with preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and 26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95% CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844- 384.831; P=0.0009) were the only independent prognostic factors in BR-PAC patients. Conclusion: Preoperative NLR and PLR offer independent prognostic information regarding overall survival in BR-PAC patients following curative resection. The workup is only to obtain a blood sample of 3 mL from PAC patients immediately before treatment. In the near future, these factors associated with the systemic inflammatory response may have the potential to become criteria for BRPAC candidates to undergo neoadjuvant chemotherapy and/or neoadjuvant chemoradiation followed by surgical resection

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) isdefined as locally advanced tumor of the pancreas without metastasis that is,although potentially resectable (R), at high risk for positive resection marginfollowing surgery. The therapeutic strategy has remained unestablished becauseBR-PAC is biologically a heterogeneous subset in which the preoperativeprognostic factors are undetermined. Recently, several prognostic factors relatedto systemic inflammation have been explored in various kinds of cancers: thecombination of serum C-reactive protein (CRP) and albumin as the modifiedGlasgow prognostic factor; a combination of CRP and white blood cell countin the prognostic index; a combination of albumin and lymphocyte counts inOnodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR);and the platelet-lymphocyte ratio (PLR). Although these prognostic factors havebeen explored in some small cohort studies of PAC patients, the results still remaincontroversial especially because PAC patients with diverse clinical stages wereincluded in the cohorts. It has never been reported whether or not the systemicinflammatory response is validated as a predictive risk factor in cohorts of onlyadvanced BR-PAC patients.Method: Between January 2003 and June 2012 at Kobe University Hospital,136 consecutive pancreatic adenocarcinoma (PAC) patients who underwentsurgical curative resection were retrospectively studied. Prior to surgery, the PACpatients were stratified into R- and BR-PAC patients according to the NationalComprehensive Cancer Network guidelines. To evaluate the independentprognostic significance of NLR and PLR, univariate and multivariate Coxproportional-hazard models were applied.Results: The median survival in PAC patients with preoperative NLR > 3 (n=45)and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037).However, the median survival in PAC patients with PLR > 225 (n=32) and PLR< 225 (n=104) was 21.8 months and 26.2 months, showing no significantdifference in overall survival between the two groups (P=0.2526). The mediansurvival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1months and 33.1 months, respectively (P=0.0138). However, the median survivalin the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1months and 25.8 months, showing no significant difference in overall survivalbetween the two groups (P=0.6533). The median survival in BR-PAC patientswith preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2months, respectively (P=0.0068). In addition, median survival in BR-PAC patientswith preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95%CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844-384.831; P=0.0009) were the only independent prognostic factors in BR-PACpatients.Conclusion: Preoperative NLR and PLR offer independent prognostic informationregarding overall survival in BR-PAC patients following curative resection. Theworkup is only to obtain a blood sample of 3 mL from PAC patients immediatelybefore treatment. In the near future, these factors associated with the systemicinflammatory response may have the potential to become criteria for BRPACcandidates to undergo neoadjuvant chemotherapy and/or neoadjuvantchemoradiation followed by surgical resection

School lunches serve to improve nutritional status and to promote the health of children. The purpose of this study was to investigate the portion sizes of school lunches served and consumed in Japanese elementary schools. In addition, gender difference in servings and consumption were also studied. A cross-sectional study was undertaken between October 2007 and February 2008 in schools located in Tokyo and Okayama, Japan. A total of 192 fifth-grade children attending four elementary schools participated in this study. Weighed plate waste methods and observation were used to collect dietary data for two non-consecutive days. The proportion of children who chose staple foods along with main dishes and/or side dishes for at least one day was higher in boys than in girls (respectively, for staple food: 42.1% vs. 9.3%, for main dish and/or side dish: 68.4% vs. 44.3%, P < 0.001). The ratio of initial amount served to amount offered was 0.88 +/- 0.11 for boys and 0.84 +/- 0.10 for girls (P < 0.05). The ratio of amount consumed to amount offered was 1.04 +/- 0.19 for boys and 0.88 +/- 0.12 for girls (P < 0.001). Weight was related to amount consumed both in boys (r = 0.222, P < 0.05) and in girls (r = 0.201, P < 0.05). These findings suggest that the nutritional standards of school lunch programs should take into account gender differences. Clearly, boys were more likely to consume more than the initial amounts served due to their higher propensity to take second helpings. Boys feel few reservations about taking second helpings to adjust their total intake. However, school lunch plans should take into consideration girls' reluctance to do so, by serving appropriate initial portion sizes.
Asian Continental Ancestry Group ; Child ; Cross-Sectional Studies ; Humans ; Japan ; Lunch ; Nutritional Status ; Tokyo

OBJECTIVETo clarify whether the acupoints of Zusanli (ST36) and Sanyinjiao (SP6) have specific actions other than non-acupoints to bone.

METHODSForty Sprague-Dawley female rats were divided into five groups: Sham operated (sham) group; Ovariectomized (OVX, model) group; non-acupuncture group; OVX, needling on Zusanli and Sanyinjiao (Acp-A) group; OVX, needling on the reverse sides of Zusanli and Sanyinjiao (Acp-B) group; OVX, periostineal stimulation on the same height as points of Zusanli and Sanyinjiao (Acp-C) group. The experiment was continued for 23 weeks and then all animals were sacrificed.

RESULTSOVX had a significantly higher body weight and lower bone mineral density (BMD) on the lumbar vertebrae, total femora and tibiae than sham rats, however, Acp-A showed a higher BMD compared with the other OVX groups. On the other hand, bone weights, bone strength and bone morphometry such as trabecular volume, trabecular separation, labeled width and bone formation rate also showed the same improvements in Acp-A as compared to the other OVX rats.

CONCLUSIONThe stimulation on Zusanli and Sanyinjiao specifically prevented the development of osteopenic rats compared with non-acupoints.

Acupuncture Points ; Animals ; Bone Density ; Bone Diseases, Metabolic ; prevention & control ; Female ; Ovariectomy ; Rats ; Rats, Sprague-Dawley