[Show abstract][Hide abstract] ABSTRACT: To the Editor: The global population is aging.1 Pneumonia
is a leading cause of death in elderly adults, especially
those with dysphasia and microaspiration.2 Because aspiration
pneumonia is related to impairment of the swallowing
and cough reflex,3 the development of preventive strategies
is needed to improve such protective reflexes to reduce the
incidence of pneumonia in older people. In Japan, pneumonia
is the third leading cause of death.4 It was previously
reported that acupuzncture at two points on the legs
(ST36 and KI3) improved the swallowing reflex after
stroke5 and reduced pharyngeal retention and aspiration.6
To investigate the effectiveness of acupuncture with
press needles in improving the swallowing reflex in elderly
adults with cerebrovascular disease, a three-arm randomized
double-blind controlled multicenter trial was conducted
by incorporating sham patches and sham points.
Individuals aged 65 and older who had had a stroke and
had dysphasia were recruited consecutively from two hospitals
and two nursing homes in Sendai, Japan. The purpose
and design of the study were explained to each
individual, and informed consent was obtained. The
Tohoku University ethics committee approved the study
Twenty-nine individuals (10 men, 19 women; mean
age � SD 82.2 � 7.1) were recruited and assigned randomly
to three groups: group 1, press needles (Pyonex;
Seirin Corporation, Shizuoka, Japan) on the ST36 and
KI3; group 2, sham patches on the acupuncture points;
and group 3, press needles on sham points. The needles
were 0.2 mm in diameter and 0.6 mm long. The design of
the sham patch was identical to that of the press needle
except most of the needle had been cut off, so that only
the head of the needle remained in the resin. Patches were
applied and changed every day for 4 weeks. Latent time of
swallowing reflex (LTSR), plasma substance P (SP), Barthel
Index, Mini-Mental State Examination, and days of fever
were measured at baseline and 4 weeks later.
Table 1 shows the outcomes of this study. The primary
outcome was change in LTSR. A statistically significant
shortening of LTSR was evident in Group 1
(6.9 � 2.3 vs 2.5 � 0.3 seconds, P = .005), whereas no
statistically significant difference was observed in the other
two groups. There was a significant difference between the
three groups in change in LTSR (P = .009). Change in
LTSR in Group 1 was significantly different from that in
Group 2 (P = .008) but not Group 3 (P > .99). There was
a significant difference in LTSR at day 28 between Groups
1 and 2 (P = .001), but no significant difference between
Groups 1 and 3 (P = .51). Plasma SP did not change significantly
during the study in any group, and no differences
in secondary outcomes were observed in any group. between baseline and Day 28. Peripheral blood tests were
performed to assess inflammatory and nutritional status.
No statistically significant differences were observed in
white blood cell count, C-reactive protein, total protein,
albumin, or total cholesterol between baseline and Day 28.
There were no significant differences in any parameters.
Neither press needle nor sham needle treatment caused
any side effects.
Attachment of press needles at the two leg acupuncture
points improved the swallowing reflex of elderly
adults with cerebrovascular disease. Lack of a significant
difference between acupuncture points and sham points
indicates that the attachment of the fine needle itself has
some effect on the swallowing reflex. Even if the press needles
are placed at positions that deviate from the acupoints
(e.g., sham points in this study), LTSR may improve,
which is clinically convenient. This type of acupuncture
may become a new adjuvant method for the prevention
and treatment of pneumonia in elderly adults.
The limitations of the present study were the small
sample size and short follow-up time. In addition, only
Group 3 included participants with extremely poor LTSR
at baseline, which could have been why there was no difference
between Groups 1 and 3 in LTSR at Day 28. Further
studies are required to investigate the effect of the
press needle on swallowing function.
Journal of the American Geriatrics Society 12/2014; 62(12):2438. · 4.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate surgical, pregnancy, and prognostic outcomes of radical abdominal trachelectomy (RAT) for Japanese patients with early-stage cervical cancer.
International Journal of Clinical Oncology 11/2014; · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimThe aim of this study was to investigate the long-term fertility prognosis after B-Lynch sutures for post-partum hemorrhage (PPH).MethodsA retrospective observational study was conducted on patients who underwent B-Lynch sutures in our hospital between 2005 and 2010. Patient data was collected from hospital records. Information regarding subsequent pregnancies and menstrual complications were obtained by posted questionnaires and telephone interviews with patients who avoided hysterectomy.ResultsA total of 28 B-Lynch sutures were performed in 3976 deliveries, all in patients that underwent cesarean section. Twenty-two of the 26 patients who avoided hysterectomy answered our questionnaire or took part in an interview. All patients recovered regular menstruation with no severe complications. Of the 19 patients who wanted another child, 12 patients (63.2%) had 14 subsequent pregnancies in a mean follow-up period of 52.1 months. The results of pregnancies were nine uncomplicated term pregnancies, all delivered by elective cesarean section, two artificial abortions and three miscarriages. A significant difference was observed in the age of patients with subsequent pregnancies and those without pregnancies (30.8 vs 34.6 years, P = 0.04).ConclusionB-Lynch sutures for PPH do not appear to jeopardize fecundity. An older age was a risk factor for achieving subsequent pregnancies.
Journal of Obstetrics and Gynaecology Research 11/2014; · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study explores the correlation between the impact of the Great East Japan Earthquake and the incidence of postpartum depression in Miyagi prefecture, Japan. The design used was a cross-sectional study with self-administered questionnaires, 6-9 months after the disaster. The results showed the prevalence of postnatal women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥9 to be 21.3 %. Multivariate analysis showed that exposure to tsunami (odds ratio, 1.80; 95 % confidence interval, 1.16-2.78) was significantly and independently associated with an EPDS score of ≥9. Postnatal women and their children should be treated as a vulnerable population, and a protective framework must be established to prepare for future devastating disasters.
Archives of Women s Mental Health 09/2014; · 2.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To improve lymph node (LN) metastasis identification for patients with endometrial cancer (EC), this study assessed the usefulness of molecular biologic techniques using a one-step nucleic acid amplification (OSNA) assay.
Annals of Surgical Oncology 09/2014; · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Treatment of intrauterine infection is likely key to preventing a significant proportion of preterm deliveries before 32 weeks' gestation. Azithromycin (AZ) may be an effective antimicrobial in pregnancy; however, few gestation-appropriate data are available to inform the design of AZ-based treatment regimens in early pregnancy. We aimed to determine whether a single intraamniotic AZ dose, or repeated maternal IV AZ doses, would safely yield therapeutic levels of AZ in an 80 d gestation (term=150 d) ovine fetus.
Antimicrobial Agents and Chemotherapy 08/2014; · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We have developed a collaborative hospital-based approach to monitoring the impact of a human papillomavirus vaccine on cervical cancer, its precursor lesions and human papillomavirus type-specific prevalence in Japan. The monitoring will be conducted for a total period of 21 years on women aged <40 who are newly diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia or adenocarcinoma in situ at 21 participating institutes. Women are monitored to determine their vaccine history and will be human papillomavirus-genotyped each year. The primary endpoint is the human papillomavirus16/human papillomavirus18-positive rate in women aged 16-25 who are diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia grade 2/3 and adenocarcinoma in situ. The major secondary endpoints are the number of women aged <40 who are diagnosed with invasive cervical cancer, cervical intraepithelial neoplasia grade 2/3 and adenocarcinoma in situ, the human papillomavirus type-specific prevalence, and the number of deaths from invasive cervical cancer in women aged <40. Long-term surveillance for human papillomavirus-associated cervical diseases in young females is important for the development of future strategies for cervical cancer prevention in Japan.
Japanese Journal of Clinical Oncology 08/2014; · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Predictive factors of the efficacy of chemotherapy for Japanese patients with recurrent cervical cancer who have been previously treated with concurrent chemoradiotherapy (CCRT) are currently unknown, and hence we aimed to investigate this.
International journal of clinical oncology. 07/2014;
[Show abstract][Hide abstract] ABSTRACT: Aims and background. Whilst most uterine smooth muscle neoplasms are benign, uterine leiomyosarcoma (Ut-LMS) is extremely malignant with a high incidence of metastasis and recurrence. Gynecological tumors are often associated with female hormone secretion, but no strong link has been detected between human Ut-LMS and the hormonal environment. In fact, the risk factors for Ut-LMS are poorly understood. In addition, no diagnostic biomarkers for differentiating between leiomyoma, a benign tumor, and malignant Ut-LMS have been found. Interestingly, mice that were homozygously deficient for LMP2/β1i were found to spontaneously develop Ut-LMS and exhibited a Ut-LMS prevalence of ~40% by 14 months of age. Thus, analyzing potential risk factors for Ut-LMS (such as LMP2/β1i) might aid the development of diagnostic biomarkers and clinical treatments for the condition. Methods and study design. Fifty-seven patients (age range: 32-83 years) who had been diagnosed with uterine mesenchymal tumors were chosen from a pathological archive. Tissue samples from these patients were fixed in 10% buffered formalin, incubated in 4% paraformaldehyde for 8 hours, and embedded in paraffin. Tissue sections were stained with hematoxylin and eosin for standard histological examination or were subjected to further processing for immunohistochemical (IHC) examination. Serial Ut-LMS, bizarre leiomyoma, leiomyoma, and myometrium sections were subjected to IHC staining of β-smooth muscle actin, estrogen receptor, cyclin B1, LMP2/β1i, calponin h1, ki-67, tumor protein p53, and progesterone receptor. Results. The Ut-LMS samples were positive for cyclin B1 and negative for LMP2/β1i, while the opposite result was obtained for bizarre leiomyoma, leiomyoma, and myometrium samples. Conclusions. The expression pattern of LMP2/β1i and cyclin B1 might be a diagnostic biomarker for human Ut-LMS. Studies of the biological roles of LMP2/β1i and/or cyclin B1 could lead to the elucidation of new targets for therapies against Ut-LMS.
[Show abstract][Hide abstract] ABSTRACT: The present study was performed to evaluate pregnancy outcomes in women with type 1 and type 2 diabetes mellitus (DM) in Japan. This multi-institutional retrospective study was conducted in 40 general hospitals in Japan during 2003-2009. We evaluated 369 and 579 pregnant women with type 1 and type 2 DM, respectively, and compared pregnancy outcomes between the two groups. Glycosylated hemoglobin levels in the first trimester did not differ significantly between the studied groups. Gestational weight gain was lower in type 2 DM than in type 1 DM. Although there were no significant differences in perinatal outcomes between the groups, the primary cesarean section rate was higher in type 2 DM than in type 1 DM. Multiple logistic regression analysis revealed that primigravida status, pre-gestational body mass index (BMI), gestational weight gain, chronic hypertension, and microvascular disease including diabetic retinopathy or nephropathy were associated with onset of pregnancy-induced hypertension. Further, pre-gestational BMI was associated with the need for primary cesarean section. This study demonstrated that no differences were observed in the rates of perinatal mortality and congenital malformation between pregnant women with type 1 DM and type 2 DM; however, women with type 2 DM displayed a higher risk of primary cesarean section.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Prenatal programming secondary to maternal protein restriction renders an inherent susceptibility to neural compromise in neonates and any addition of glucocorticosteroids results in further damage. This is an investigation of consequent global gene activity due to effects of antenatal steroid therapy on a protein restriction mouse model. Methods. C57BL/6N pregnant mice were administered control or protein restricted diets and subjected to either 100 íµí¼g/Kg of dexamethasone sodium phosphate with normosaline or normosaline alone during late gestation (E10–E17). Nontreatment groups were also included. Brain samples were collected on embryonic day 17 and analyzed by mRNA microarray analysis. Results. Microarray analyses presented 332 significantly regulated genes. Overall, neurodevelopmental genes were overrepresented and a subset of 8 genes allowed treatment segregation through the hierarchical clustering method. The addition of stress or steroids greatly affected gene regulation through glucocorticoid receptor and stress signaling pathways. Furthermore, differences between dexamethasone-administered treatments implied a harmful effect during conditions of high stress. Microarray analysis was validated using qPCR. Conclusion. The effects of antenatal steroid therapy vary in fetuses according to maternal-fetal factors and environmental stimuli. Defining the key regulatory networks that signal either beneficial or damaging corticosteroid action would result in valuable adjustments to current treatment protocols.
[Show abstract][Hide abstract] ABSTRACT: Uterine serous carcinoma (USC) is a biologically aggressive cancer with a high relapse rate and poor prognosis. USC is characterized by frequent TP53 gene mutations. Identical TP53 mutations are conserved during progression from precursor lesions, indicating that mutation of the TP53 gene plays an important role in USC progression and is considered a key event in the initiation of USC. A high frequency of HER2/neu overexpression has also been reported, suggesting the possibility of therapeutic targeting of HER2/neu. In addition, USC is reported to have a high frequency of genomic alterations affecting PIK3CA, PPP2R1A, FBXW7, CHD4/Mi2b, and TAF1. Recent studies investigating microRNAs have presented new information on tumor progression. The molecular genetic profiles of USC differ from those of endometrioid subtypes; thus, understanding genetic alterations in USC will help to explain differences in the behaviors of these cancers and may provide possible novel therapeutic targets for USC.
Current Obstetrics and Gynecology Reports. 03/2014; 3(1).
[Show abstract][Hide abstract] ABSTRACT: The standard postoperative chemotherapy for epithelial ovarian cancer is a combination therapy including platinum and taxanes. The aim this study was to investigate the degree of platinum sensitivity in patients with relapsed epithelial ovarian cancer according to the treatment-free interval (TFI) and the histological tumor type. The medical records of 405 patients diagnosed with stage III/IV ovarian cancer, including 107 patients who relapsed after attaining a clinical complete response with first-line treatment, were retrospectively reviewed. The degree of platinum sensitivity was assessed by comparing the progression-free survival (PFS) following the second-line treatment. In patients with serous/endometrioid adenocarcinoma who were treated with platinum following relapse, there were significant differences in the PFS between the following groups of patients: those who relapsed within 6 months and those who relapsed between 6 and 12 months; those who relapsed between 6 and 12 months and those who relapsed between 12 and 18 months; and those who relapsed between 12 and 18 months and those who relapsed after 18 months. By contrast, in patients with clear cell/mucinous adenocarcinoma who were treated with platinum following a relapse, there were no significant differences in the PFS between patients who relapsed within 6 months and those who relapsed between 6 and 12 months, while there were significant differences in the PFS between those who relapsed between 6 and 12 months and those who relapsed after 12 months. With regard to the patients who relapsed after 12 months, the PFS of those with clear cell/mucinous adenocarcinoma was significantly shorter compared with the PFS of those with serous/endometrioid adenocarcinoma. Therefore, we considered it justified to classify patients with clear cell/mucinous adenocarcinoma who relapsed within 12 months as platinum-resistant and those who relapsed after 12 months as platinum-sensitive.
Molecular and Clinical Oncology 03/2014; 2(2):212-218.
[Show abstract][Hide abstract] ABSTRACT: A phase I clinical study was conducted to determine the maximum tolerated dose (MTD) and the recommended dose (RD) of irinotecan hydrochloride (CPT-11) in CPT-11/pegylated liposomal doxorubicin (PLD) combination therapy, a novel treatment regimen for platinum- and taxane-resistant recurrent ovarian cancer.
Pegylated liposomal doxorubicin was administered intravenously on day 3 at a fixed dose of 30 mg/m(2). CPT-11 was administered intravenously on days 1 and 15, at a dose of 50 mg/m(2) on both days. One course of chemotherapy was 28 days, and patients were given a maximum of six courses, with the CPT-11 dose being increased in increments of 10 mg/m(2) (level 1, 50 mg/m(2); level 2, 60 mg/m(2); level 3, 70 mg/m(2); level 4, 80 mg/m(2)) to determine MTD and RD.
During the period from April 2010 to March 2013, three patients were enrolled for each level. In the first course, no dose-limiting toxicity occurred in any of the patients. Grade 4 neutropenia was observed in two of three patients at level 4. At level 4, the antitumor effect was a partial response (PR) in two of the three patients and stable disease (SD) in one. At level 3, one of the three patients showed PR and two had SD. At level 4, the start of the next course was postponed in two of three patients. In addition, one patient at level 4 experienced hemotoxicity that met the criteria for dose reduction in the next course. The above results suggested that administration of CPT-11 at dose level 5 (90 mg/m(2)) would result in more patients with severe neutropenia and in more patients requiring postponement of the next course or a dose reduction. Based on the above, the RD of CPT-11 was determined to be 80 mg/m(2).
The results suggest that CPT-11/PLD combination therapy for recurrent ovarian cancer is a useful treatment method with a high response rate and manageable adverse reactions. In the future phase II study, the safety and efficacy of this therapy will be assessed at 80 mg/m(2) of CPT-11 and 30 mg/m(2) of PLD.
Cancer Chemotherapy and Pharmacology 03/2014; · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims
To determine whether treating mild gestational diabetes mellitus (GDM) is associated with improvement of pregnancy outcomes in Japan.
In a multi-institutional retrospective study, we examined pregnant women meeting the criteria for mild GDM (i.e., only one abnormal value [OAV] for 75-g OGTT; fasting glucose ≥100 mg/dL, 1-h postprandial glucose ≥180 mg/dL, and 2-h postprandial glucose ≥150 mg/dL), receiving either routine prenatal care (non-treatment group) or dietary intervention alone or dietary intervention with self-monitoring of blood glucose and/or insulin therapy, if necessary (treatment group). Pregnancy outcomes were compared between these groups.
Data from 893 eligible women were collected from 30 institutions. Participants included 542 untreated and 351 treated women. Although there were no significant differences in baseline clinical characteristics or maternal and perinatal outcomes between these groups, the incidence of large-for-gestational-age (LGA) infants was lower in the treatment group (p = 0.07). Multiple logistic regression analysis (MLRA) revealed that pre-pregnancy BMI and gestational weight gain were associated with LGA infants, while 75-g OGTT results were unrelated to LGA. When overweight and obese women were the subjects, the number of LGA infants was significantly lower in the intervention than in the control group, and gestational weight gain was significantly lower in the treatment than in the control group. MLRA showed that intervention was significantly related to a lower incidence of LGA infants.
Our study suggests that maternal BMI impacts fetal growth and that treatment for overweight or obese mothers with OAV is associated with a lower frequency of LGA infants.
Diabetes research and clinical practice 03/2014; · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the effects of pre-gestational body mass index on pregnancy outcomes of women with gestational diabetes in Japan. A multi-institutional retrospective study was performed. We examined pregnant women who met the former criteria for gestational diabetes in Japan, receiving dietary intervention with self-monitoring of blood glucose with or without insulin therapy. Women with gestational diabetes were divided into three groups according to pre-gestational body mass index: body mass index <25 (control group), 25 ≤ body mass index <30 (overweight group), body mass index ≥30 (obese group). Data from a total of 1,758 eligible women were collected from 40 institutions. Participants included 960 controls, 426 overweight women, and 372 obese women with gestational diabetes. Gestational weight gain was highest in the control and lowest in the obese group. The prevalences of chronic hypertension and pregnancy induced hypertension were higher in the overweight and obese groups than in the control group. Multiple logistic regression analysis revealed pre-gestational body mass index, gestational weight gain, chronic hypertension, and nulliparity to be associated with the onset of pregnancy induced hypertension, while the 75-g OGTT results were unrelated to pregnancy induced hypertension. The prevalence of large-for-gestational age was lower in infants born to obese women than in those born to overweight or control women. The present results suggest that medical interventions for obese women with gestational diabetes may contribute to reducing the prevalence of large-for-gestational age but would not achieve marked reductions in maternal complications.