Aim: The effects of or al orenteral administration of eicosapentaenoic acid (EPA) on suppression of the immune function induced by postoperative chemo-radiation therapy in patients with esophageal cancer were studied.Methods: Thirteen patients received TPN, including Intralipid, from 1 week before the operation until 2 weeks after the operation and were then switched to enteral feeding containing 17.5% MCT and 7.5% safflower oil. EPA methyl esther was administered orally at a dose of 1.8g/day with the parenteral or the enteral diet to the “EPA” group (n=5) from 1 week before the operation until discharge. EPA was not given to the “Control” group (n=8). PHA-and ConA-stimulated lymphocyte proliferation, NK activity, and total lymphocyte and T cell counts were measured on admission as well as in the 3rd, 7th, and 10th postoperative weeks. Starting after 3 to 4 postoperative weeks, postoperative chemoradiation therapy (CBDCA 30mg/day, 5-FU 250mg/day, radiation 1.8Gy/day) was performed for 5 consective day each week for 4 to 5 weeks.Results: Both ConA-and PHA-stimmulated lymphocyte proliferation decreased significantly on the 10th postoperative day in both groups. Improvement in cell-mediated immune function in the 3rd postoperative week was marked in the “EPA” group (p<0.01 in PHA and p<0.02 in ConA) when compared to the “Control” group. Improvement in lymphocyte proliferation was higher in the “EPA” group followong the completion of chemoradiation therapy (p<0.005 “EPA” vs. “Contro” in ConA after 10 weeks). NK activity was also higher in the “EPA” group following the completion of chemoradiation therapy (p<0.004 “EPA” vs. “Control” after 10 weeks). There were no significant differences, however, in WBC, total lymphocyte count, and T cell count.Conclusion: The results suggest that enteral/oral EPA reduced immunosuppression induced by postoperative chemo-radiation therapy in patients who underwent an operation for esophageal cancer.
week ; Postoperative Period ; Therapeutic procedure ; Malignant neoplasm of esophagus ; /day

Background : The safety of newly approved drugs must be assessed using postmarketing surveillance data. One of the difficulties in assessing the hazard rates of adverse events induced by the anti-cancer drug TS-1 was that the time to event was not exactly identified due to the interval censoring. Most patients were outpatients who underwent clinical laboratory tests almost periodically at 1- or 2-week intervals and therefore, the occurrence of an adverse event was confirmed at the time of testing days after the event occurrence.
Objective : The purpose of this study was to propose a new model of hazard functions for each of 4 items of adverse event induced by TS-1 using post-marketing surveillance data considering the interval censoring.
Methods : The data obtained from 3, 294 patients with gastric cancer who received an initial 4-week course of therapy with TS-1 administered orally twice a day, followed by a 4-week second course with a 2-week no-treatment period after the initial course, were used to estimate hazard functions. Four items of adverse event--hemoglobin level (HB), white blood cell (WBC), neutrophil (NEUT) and platelet counts (PLT) --were graded, respectively, using the criteria established by the Japan Society of Clinical Oncology. Slip-mixed log-logistic and slip-mixed Weibull models were proposed as candidate models for estimating hazard functions. The goodness of fit of the two candidate models was evaluated by applying them to the above-mentioned data. The hazard functions for each of 4 items were assessed using the model with the better fit.
Results : The initial occurrence of adverse event was shown to follow the slip-mixed log-logistic model for each of 4 items. Although most events occurred early on in the initial course of therapy, a small peak in HB was also observed in the second course, while no such peak appeared for the other items.

Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.
Adenomatous Polyps ; Capillaries ; Classification ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Education ; Mass Screening ; Narrow Band Imaging ; Pathology ; Polyps*

Objective : The incidence rate is used frequently in drug safety assessment. The incidence rate of adverse events is defined as the number of patients experiencing a certain adverse event divided by the number of patients administered a drug in spite of duration of administration (observation). In post-marketing surveillance, the duration of administration (observation) typically differs by patient and most of the analyses fail to take into account the differences in duration of administration (observation). Therefore, we investigated the usefulness of hazard functions in a drug safety assessment using the interim results from Clinical Experience Investigation of the oral anticancer drug, TS-1.
Methods : About three thousand patients with gastric cancer were enrolled in this Clinical Experience Investigation. TS-1 was administrated orally twice daily. One course consisted of consecutive administration for 28 days and 14 days rest. Administration was repeated in two courses. Hematological measurements, stomatitis, anorexia, nausea/vomiting, diarrhea, malaise were analyzed. Adverse events were evaluated in accordance with the criteria of the Japan Society for Cancer Therapy, which were established based on criteria established by the WHO. Time to occurrence of an adverse event was calculated from the first day of administration until the adverse event was first observed. Hazard functions were estimated by smoothing methods using kernel functions.
Results : The occurrence of adverse events using smoothed hazard functions had one peak around 10 days in the first course and decreased by administration rest. With the resumption of administration, the occurrence increased again. The occurrence in the second course were less than that of the first course.
Conclusion : The occurrence peaks of adverse events were estimated graphically by smoothed hazard functions. We conclude that hazard functions are useful as an analytical tool in drug safety assessment.