Pseudomembranes, the typical evidence for CDAD, were not detected in any patients using immunosuppressive agents. Additional bacterial examination is therefore essential when UC becomes exacerbated and when patients present with diarrhea after hematopoietic stem cell transplantation, even in the absence of pseudomembranes.

The biological significance of CD56 antigen expression in patients with acute promyelocytic leukemia (APL) has been under investigation. We investigated the clinical and biologic features of CD56+APL. In our series, CD56 antigen was positive in 4 of 28 (14%) APL patients. No differences were found regarding age, gender, performance status (PS), initial leukocyte and platelet counts, lactate dehydrogenase (LDH) and fibrinogen (Fbg) levels according to CD56 expression. CD34 antigen was co-expressed in 3 of the 4 patients with CD56+ APL, in contrast to 2 of the 24 patients with CD56- APL (P = .01). Extramedullary relapse occurred in 3 of the 4 patients with CD56+ APL, in contrast to none of the 24 patients with CD56- APL (P = .001). Median remission duration was 4 months in CD56+ APL and was not reached in CD56- APL. The CD56+ population had a shorter remission duration (P < .0001) and disease-free survival (P < .0001). In contrast, no difference was found in overall survival. These results suggested that CD56 expression was associated with the leukemogenetic mutation at the primitive hematopoietic progenitor cell level and extramedullary relapse in APL patients treated with ATRA and chemotherapy.

The clinical efficacy did not differ between micafungin and voriconazole. Micafungin was generally better tolerated than voriconazole when given as an empirical antifungal therapy in patients with persistent fever and neutropenia.

PURPOSE Empiric antifungal therapy (EAT) is recommended for persistent febrile neutropenia (FN), but in most patients, it is associated with overtreatment. The D-index, calculated as the area surrounded by the neutrophil curve and the horizontal line at a neutrophil count of 500/μL, reflects both the duration and depth of neutropenia and enables real-time monitoring of the risk of invasive fungal infection in individual patients at no cost. We investigated a novel approach for patients with persistent FN called D-index–guided early antifungal therapy (DET), in which antifungal treatment is postponed until a D-index reaches 5,500 or the detection of positive serum or imaging tests, and compared it with EAT in this multicenter open-label noninferiority randomized controlled trial. PATIENTS AND METHODS We randomly assigned 423 patients who underwent chemotherapy or hematopoietic stem-cell transplantation for hematologic malignancies to the EAT or DET group. The prophylactic use of antifungal agents other than polyenes, echinocandins, or voriconazole was allowed. Micafungin at 150 mg per day was administered as EAT or DET. RESULTS In an intent-to-treat analysis of 413 patients, the incidence of probable/proven invasive fungal infection was 2.5% in the EAT group and 0.5% in the DET group, which fulfilled the predetermined criterion of noninferiority of the DET group (−2.0%; 90% CI, −4.0% to 0.1%). The survival rate was 98.0% versus 98.6% at day 42 and 96.4% versus 96.2% at day 84. The use of micafungin was significantly reduced in the DET group (60.2% v 32.5%; P < .001). CONCLUSION A novel strategy, DET, decreased the use and cost of antifungal agents without increasing invasive fungal infections and can be a reasonable alternative to empiric or preemptive antifungal therapy.

Objective: Aberrant expression of maspin protein related to DNA hypomethylation in the promoter region is frequently observed in gallbladder carcinomas, whereas the nontumorous gallbladder epithelium is maspin negative. We investigated maspin expression in non-tumorous gallbladder epithelium in patients with cholelithiasis. Methods: An immunohistochemical study of maspin expression was performed in 69 patients with cholelithiasis and 30 patients with gastric cancer without cholelithiasis. Results: Immunoreactivity for maspin was observed in focal and patchy regions of the gallbladder epithelium. Positive immunoreactivity for maspin was significantly associated with the presence of intestinal metaplasia in patients with cholelithiasis (p,0.05). Conclusion:The high incidence of aberrant maspin expression in both intestinal metaplasia and carcinoma of the gallbladder supports the assumption that intestinal metaplasia of the gallbladder may predispose to gallbladder carcinoma. Maspin is a protein of M r 42 000, showing sequence homology to the serpin family protease inhibitors. In several tumour types, maspin acts as a tumour suppressor capable of inhibiting cell motility, invasion, and metastasis.1 There is accumulated functional evidence that demonstrates that maspin blocks tumour metastasis, tumour cell motility and invasion, and apoptosis in vitro.1 However, some in vivo analyses have shown that gain of maspin expression is associated with malignant behaviour.2 3 Thus, the role of maspin in tumour biology remains controversial.We recently demonstrated that aberrant maspin expression is frequently present in intestinal metaplasia of gastric epithelium and carcinomas 4 and also in undifferentiated thyroid carcinomas, 5 whereas their normal tissue counterparts are negative. Futscher et al 6 demonstrated that in normal tissues the maspin gene is strictly regulated in a cell type-specific manner by promoter DNA methylation. Interestingly, aberrant maspin expression has also been observed in preneoplastic and/or dysplastic lesions in lung. Aberrant maspin expression appears to be closely associated with morphological changes such as metaplasia, dysplasia, and dedifferentiation, probably as a result of disruption of epigenetic expression mechanisms.We and other groups have reported a high incidence of aberrant maspin expression in pancreatobiliary tract carcinomas, including gallbladder carcinomas.3 8 9 We noticed that the background non-tumorous epithelium was also positive in restricted areas showing intestinal metaplasia. Several factors are associated with the aetiology of gallbladder carcinomas, and gallstones should be considered as a risk factor. In the present study, therefore, we immunohistochemically investigated maspin expression in patients with cholelithiasis. MATERIALS AND METHODSOur subjects comprised 69 patients with cholelithiasis and 30 patients with gastric cancer without gallstones. Permission for the study was obtained from the institutional review board