Physiological and morphological changes of small intestine after hyperosmolar glucose infusions into canine jejunum were studied using in vivo perfusion model. Infusions of 40 ml of 50% and 20% glucose solution into the jejunal loops induced biphasic osmolar degression in the lumen. Osmolarity of jejunal venous blood was rapidly increased and maintained the maximal level (approximately 320 mOM/L). Blood flow to the jejunal loop was significantly increased after 50% glucose infusion compared to 5% glucose infusion. Most characteristic electron microscopic change of jejunal epithelial cell was pseudo-pod like process projected into the jejunal lumen, which was very similar to that of cholera.

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OBJECTIVES: The recent approval of novel immuno-oncology (IO) therapies has altered the standard of care for patients with metastatic MCC. The objective of this study was to evaluate treatment patterns and associated healthcare costs among patients with newly diagnosed MCC. METHODS: Patients with newly diagnosed MCC were identified by between July 2010 and December 2014 in MarketScan administrative claims databases. Per-patient per-year (PPPY) costs were estimated and adjusted to 2017 US dollars. RESULTS: 2355 patients met the selection criteria with requisite continuous plan enrolment 6 months before the index date, defined as the first occurrence of a medical claim for an eligible ICD-9 code, of whom 2177 had no enrolment gap 30 days during follow-up. The mean age at diagnosis was 68.8 years; 60.3% were male. In the post-index period, surgery alone was the most common treatment (34.5%), followed by a combination of surgery and radiation (22.0%) and triple therapy with surgery, radiation, and chemotherapy (14.7%). Overall, 27.5% received chemotherapy, and 14.5% did not receive any treatment. The highest total costs PPPY were observed in patients receiving chemotherapy alone (mean, $154,506; median, $101,487) and in those receiving chemotherapy and radiation (mean, $150,157; median, $129,041). The lowest healthcare PPPY costs were incurred by patients who only underwent surgery (mean, $56,124; median, $22,999) and by those who did not receive any treatment (mean, $28,442; median, $8998). CONCLUSIONS: These results provide useful insights into real-world treatment patterns of patients with newly diagnosed MCC. Costs of managing MCC are high irrespective of the type of treatment received. The use of chemotherapy potentially indicates greater disease severity and increasing burden on healthcare resources. Further analyses will facilitate better understanding of the value of IO therapy in treating this mainly elderly patient population and alleviating the associated economic burden.

Yoshiki Hiki*6), Akihiko Matsumoto*7), Tatsurou Yamakawa*8), Minoru Sugita*9), Kyoji Ogoshi*1) and The Kanagawa cooperative study group for gastric cancer with peritonitis carcinomatosis We evaluated the effect of immunotherapy using OK-432 in 67 gastric cancer patients with peritonitis carcinomatosis and investigated markers predicting the response to immunotherapy. All patients were followed up until death. The study enrolled 67 patients with biopsy-proved adenocarcinoma of the stomach associated with peritonitis carcinomatosis, of whom 56 underwent operation and 29 underwent gastrectomy. Seven were inoperative and 4 had recurrence with ascites due to peritonitis carcinomatosis. They were randomly assigned to receive chemotherapy with or without a streptococcal biological response modifier, OK-432. Overall survival was not improved by OK-432. However, among the patients with a negative SUPS skin reaction before treatment, those who received OK-432 had a significantly better outcome than those without OK-432. Cox multivariate regression analysis indicated that postoperative therapy with or without OK-432 was a significant prognostic factor for patients receiving chemotherapy and immunochemotherapy who had a positive and negative SU-PS skin reaction, respectively. These results indicate that the pretreatment SUPS skin reaction is a possible predictor of the effectiveness of immunotherapy using OK-432.