A preexisting nomogram for predicting disease-free survival (DFS) of EGC after surgery was externally validated. The nomogram is useful for accurate and individual prediction of DFS, patient prognostication, counseling, and follow-up planning.

Lateral neck node metastasis is an important prognostic factor in thyroid carcinoma. We developed a scoring system for use in prediction of lateral neck node metastasis from papillary thyroid cancer. In this study, 161 consecutive patients were included in the training data set. This scoring system, named the Yonsei Estimated Value (YEV) for lymph node metastasis in papillary thyroid cancer, was developed on the basis of results from multivariate logistic regression analysis of preoperative clinical and radiologic data. Sixty eight consecutive patients were included for testing of the validity of the scoring system. The equation for prediction of lateral neck node metastasis was follows:YEV (Yonsei Estimated Value) = 1/(1+X)X = Exp (5.333-[0.902 × sex]+[0.036 × age]-[1.020 × tumor size]-[0.177 × lymph node size]-[0.032 × lymph node density])When the YEV was 0.3 or more, the probability of lateral neck node metastasis was 79.0%, with sensitivity of 76.3%, specificity of 69.8%, positive predictive value of 56.7%, and negative predictive value of 85.1% in the training set. When fine needle aspiration biopsy for suspicious lateral neck nodes is not possible, or the results are inadequate, our scoring system for prediction of lateral neck node metastasis can be helpful in optimization of the surgical extent for each patient.

Aggression in MDD patients is more susceptible to an excess of TPH1 CC homozygote than in undifferentiated somatoform disorder patients, though the 2 disorders are high risk groups for aggression. In addition, TPH1 gene is most likely to have a shared effect on aggression and MDD.

The effects of stress, which varies throughout an academic year, on proinflammatory and antiinflammatory cytokines were examined in 44 medical students. This was tested by comparing stimulated cytokines during a baseline period, stress period, and poststress vacation period. During the stress period, compared with the baseline period, levels of IL‐6 were reduced, while levels of IL‐10 were elevated. During the poststress vacation period, compared with the stress period, levels of IL‐6 and TNF‐α were increased. However, the changes in stress‐related psychological and physiological variables were not significantly associated with changes in levels of proinflammatory and antiinflammatory cytokines. These results suggest that vacation is more likely to have a counterstress effect on proinflammatory cytokines than on an antiinflammatory cytokine and that a stressor may affect changes in immune function independently of self‐reported stress.

Cefepime has recently drawn much attention, due mostly to a meta-analysis reported by Yahav et al. (3). They observed higher all-cause mortality for cefepime than for other betalactam antibiotics (risk ratio, 1.26; 95% confidence interval [CI], 1.08 to 1.49) and described neurotoxic adverse effects and inadequate in vivo antimicrobial efficacy as plausible reasons for increased mortality.Bhat et al.(1) observed increased mortality among cefepime-treated patients with bacteremia caused by gramnegative organisms when the cefepime MIC was Ն8 g/ml (54.8%; 17 of 31 died) than when the MIC was Ͻ8 g/ml (24.1%; 35 of 145 died). Based on pharmacodynamic and clinical grounds, they suggested that the current breakpoints (according to which organisms are considered susceptible if the MIC is Յ8 g/ml by Clinical and Laboratory Standards Institute standards) for cefepime be lowered in countries where cefepime dosages of 1 to 2 g every 12 h is the licensed therapy for serious infections.However, we suppose that subgroup analysis excluding Pseudomonas aeruginosa and Acinetobacter spp. should reveal consistent results with statistical evidence to generalize their contention for other gram-negative organisms, because the MICs for P. aeruginosa and Acinetobacter spp. have been revealed to be much higher than those for other gram-negative organisms. Bhat et al. presented details on 204 bloodstream isolates from individual patients (the clinical outcomes for only 176 patients were analyzed because 21 patients were discharged within 28 days and 7 patients had two episodes of bacteremia), and P. aeruginosa and Acinetobacter spp. accounted for 79.4% (27 of 34) of the isolates for which the MICs were Ն8 g/ml while they constituted only 15.9% (27 of 170) of those for which the MICs were Ͻ8 g/ml. We could not identify the exact proportions of these two pathogens among isolates from nonsurvivors for which MICs were Ն8 g/ml. However, Bhat et al. observed a high odds ratio (OR) for mortality among P. aeruginosa bacteremic patients through a subgroup analysis that compared outcomes associated with MICs of Ն8 g/ml (mortality, 59.1%; 13 of 22 patients died) and those associated with MICs of Յ4 g/ml (mortality, 20.8%; 5 of 24 patients died), and when a reconstituted population excluding P. aeruginosa was analyzed on the basis of MICs of Ն8 g/ml versus MICs of Յ4 g/ml, the analysis did not reveal statistical significance (4 of 9 patients [44.8%] with isolates for which MICs were Ն8 g/ml died, and 30 of 121 [24.8%] with isolates for which MICs were Ͻ8 g/ml died; OR ϭ 2.4; 95% CI, 0.6 to 9.6). It seems quite reasonable to reconsider the current breakpoint MIC of cefepime (8 g/ml) for P. aeruginosa. However, additional verification is required to resettle the cefepime MIC breakpoint for gram-negative pathogens other than P. aeruginosa and Acinetobacter spp. We believe that this verification may be accomplished through a subgroup analysis excluding P. aeruginosa and Acinetobacter spp. and providing statistical evidence.In 2006, the probability of targ...