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Volume 217 (2009)
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Volume 217, Issue 1
January
Displaying 1-11 of 11 articles from this issue
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Regular Contributions
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Tadayuki Okumoto, Akihiro Sato, Takayuki Yamada, Kei Takase, Toshio Ma ...2009 Volume 217 Issue 1 Pages 1-8
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSAccurate diagnosis of local invasion of hilar cholangiocarcinomas is challenging due to their small size and the anatomic complexity of the hepatic hilar region. On the other hand, the correct diagnosis of local invasion is essential for assuring the possibility of curative surgery. The purpose of this study was to evaluate the feasibility of four-channel multidetector-row computed tomography (MDCT) in the assessment of vascular and bile duct involvement, by which we could obtain useful information for the surgical management of hilar cholangiocarcinoma. The subjects were 18 patients for whom the extent of tumor invasion was surgically and pathologically confirmed. All patients underwent preoperative multiphasic CT scanning by MDCT. Arterial and portal dominant phases were acquired using a detector configuration of 1.25 mm × 4 mm, and both axial and multiplanar reconstructed images were interpreted. Longitudinal extension was evaluated up to second-order branches. Vascular invasion is considered to be the degree of tumor contiguity to the hepatic arteries and portal vein and was graded by CT. The longitudinal extension was correctly diagnosed in 14 patients (77.8%). Hepatic artery invasion was correctly diagnosed in 17 patients with sensitivity of 100% and specificity of 90%, respectively. Portal vein invasion was correctly diagnosed in 47 of 51 branches with sensitivity and specificity of 92.3% and 90.2%, respectively. Multiplanar reconstructed images contributed to the correct diagnosis for both vascular encasement and longitudinal tumor extension. In conclusion, MDCT is useful in preoperative evaluation of hilar cholangiocarcinoma, especially when combined with multiplanar reconstructed images.View full abstractDownload PDF (2543K) -
Tomoko Kutsuzawa, Sumie Shioya, Daisaku Kurita, Munetaka Haida2009 Volume 217 Issue 1 Pages 9-15
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSExercise capacity is frequently decreased in patients with chronic obstructive pulmonary disease (COPD), and muscle dysfunction is one factor in this reduction. Studies using 31-phosphorus magnetic resonance spectroscopy (31P-MRS) have shown that phosphocreatine (PCr) and muscle pH (pHi) are significantly decreased in patients with COPD during mild exercise, suggesting the early activation of anaerobic glycolysis in their muscles. Thus, muscle oxygenation states during exercise might differ between patients with COPD and healthy individuals. We simultaneously measured oxygenation state and pHi in the muscles of patients with COPD during the transition from rest to exercise (on-transition) using near infrared spectroscopy (NIRS) and 31P-MRS. Sixteen patients with COPD (aged 68.6 ± 7.5 years) and 7 healthy males (controls; aged 63.3 ± 7.5 years) performed dynamic handgrip exercise (lifting a weight by gripping at a rate of 20 grips per min for 3 min). Patients were classified based on pHi data at the completion of exercise as having a normal (≥ 6.9; n = 8) or a low (< 6.9; n = 8) pHi. The deoxygenated hemoglobin/myoglobin (deoxy-Hb/Mb) in NIRS recordings remained constant or slightly decreased initially (time delay), then increased to reach a plateau. We calculated the time delay and the time constant of deoxy-Hb/Mb kinetics during the on-transition. The time delay was shorter in the group with a low pHi than in the controls. These findings might reflect a slower increase in O2 delivery in patients with a low pHi, which might partly account for altered muscle energy metabolism.View full abstractDownload PDF (432K) -
Orhan Ates, Sedat Azizi, H. Hakan Alp, Ahmet Kiziltunc, Sukru Beydemir ...2009 Volume 217 Issue 1 Pages 17-22
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSAge-related macular degeneration (AMD) is one of the most common causes of vision loss. AMD has been classified into two forms: atrophic and exudative forms. The exudative form is associated with choroidal neovascularization of the subretinal macular region, resulting in a sudden loss of central vision. However, the exact cause of AMD remains unknown. Several risk factors have been postulated, including smoking, atherosclerosis, and low levels of antioxidant enzymes. Malondialdehyde (MDA), a lipid peroxidation product, is used as a marker of oxidative stress. Paraoxonase 1 (PON1) metabolizes lipid peroxides and prevents oxidation of low-density lipoprotein. Increased levels of homocysteine may cause vascular endothelial injury by releasing free radicals. The purpose of this study is to investigate the relationships between serum PON1 activity and the serum levels of homocysteine and MDA in AMD. Forty patients with exudative-type AMD (63.3 ± 5 years) and 40 controls (61± 4 years) were assessed in a cross-sectional study. The serum PON1 activity was significantly lower in the patients with AMD than that in the controls (p < 0.001). In contrast, the serum levels of MDA and homocysteine were significantly higher in the patients than those in the controls (p < 0.001, for both). In AMD patients, significant negative correlation was found between PON1 activity and MDA level (r = −0.493, p < 0.05) and between PON1 activity and homocysteine level (r = −0.557, p < 0.05). Increased serum homocysteine and MDA levels may be responsible for the decreased PON1 activity in patients with AMD.View full abstractDownload PDF (334K) -
Mitsutoshi Munakata, Masazumi Nishikawa, Noriko Togashi, Eiko Nio, Yas ...2009 Volume 217 Issue 1 Pages 23-28
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSCurrently, various formulas with different fatty acid compositions are used for enteral nutrition (EN). All formulas contain various concentrations of essential fatty acids: linoleic acid (LA) and α-linolenic acid (ALA); LA is biotransformed into arachidonic acid (AA) and ALA into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in vivo. Some formulas contain preformed EPA and DHA. However, the effects of the differences in the fatty acid composition on the fatty acid status of patients receiving long-term EN is not clear. We measured serum fatty acid concentrations in 50 patients with neurological diseases receiving long-term EN. The data were then compared retrospectively with reference to the fatty acid compositions of the formulas used. All of the patients received almost their entire nutritional intake via EN for at least 1 year. Blood samples were obtained just before injecting the EN solution. Among the formulas that did not include EPA or DHA, formulas with low ALA concentrations were associated with low serum EPA and DHA. Conversely, the ALA-enriched formulas with reduced LA concentrations significantly increased EPA and DHA levels, although the levels remained lower than the control values. With the formula containing EPA and DHA, the EPA and DHA levels reached control values. Therefore, the fatty acid composition of the EN formulas affected the fatty acid status of patients receiving long-term EN. Formulas containing preformed EPA and DHA with suitable amounts of essential fatty acids may benefit these patients.View full abstractDownload PDF (334K) -
Kazuaki Kuwabara, Shinya Matsuda, Kiyohide Fushimi, Makoto Anan, Koich ...2009 Volume 217 Issue 1 Pages 29-35
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSMany reports exist regarding the economic evaluation of evolving chemotherapeutic regimens or diagnostic images for lung cancer (LC) patients. However, it is not clear whether clinical information, such as pathological diagnosis or cancer stage, should be considered as a risk adjustment in lung cancer. This study compared the cost and practice patterns between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC) patients. 6,060 LC patients treated at 58 academic hospitals and 14,507 at 257 community hospitals were analyzed. Study variables included demographic variables, comorbid status, cancer stage, use of imaging and surgical procedures, type of adjuvant therapy (chemotherapy, radiation or chemo-radiation), use of ten chemotherapeutic agents, length of stay (LOS), and total charges (TC; US$1 = ¥100) in SCLC and NSCLC patients. The impact of pathological diagnosis on LOS and TC was investigated using multivariate analysis. We identified 3,571 SCLC and 16,996 NSCLC patients. The proportion of demographic and practice-process variables differed significantly between SCLC and NSCLC patients, including diagnostic imaging, adjuvant therapy and surgical procedures. Median LOS and TC were 20 days and US$6,015 for SCLC and 18 days and US$6,993 for NSCLC patients, respectively (p < 0.001 for each variable). Regression analysis revealed that pathological diagnosis was not correlated with TC. Physicians should acknowledge that pathological diagnosis dose not accounts for any variation in cost of LC patients but that should remain as an indicator of appropriate care like selection of chemotherapeutic agents.View full abstractDownload PDF (500K) -
Mirei Dochi, Kouichi Sakata, Mitsuhiro Oishi, Kumihiko Tanaka, Etsuko ...2009 Volume 217 Issue 1 Pages 37-43
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSThere have been few large longitudinal studies on the relationship between smoking and blood pressure and those results have been inconsistent. The aim of this study was to clarify the influence of smoking on the onset of hypertension. A 14-year longitudinal study was conducted in Japanese male workers at a steel company between 1991 and 2005. We adopted three different endpoints of observation, hypertension [systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg], systolic hypertension (SBP ≥ 140 mmHg), and diastolic hypertension (DBP ≥ 90 mmHg), with initiation of antihypertensive medication. The cohort for each endpoint (hypertension: n = 5,512, systolic hypertension: n = 5,765, diastolic hypertension: n = 6,063) was selected, excluding the subjects whose blood pressure was higher than above criteria at their first health examination from all 8,251 workers. The strict criteria for hypertension resulted in exclusion of more subjects, yielding smaller cohort for hypertension. The association between smoking and each endpoint was investigated adjusting for age, body mass index, drinking, habitual exercise, job schedule type, hemoglobin A1c, total cholesterol, creatinine, aspartic aminotransferase, γ-glutamyl transpeptidase, and uric acid by pooled logistic regression analyses. The significant odds ratios (and 95% confidence intervals) of smoking were 1.13 (1.03 to 1.23) for hypertension and 1.15 (1.05 to 1.25) for systolic hypertension. This study revealed that smoking is independently related to the onset of hypertension and systolic hypertension in Japanese male workers. These results provide important information necessary to define the effect of smoking on blood pressure.View full abstractDownload PDF (385K) -
Moawia Abdelgadir, Wafaa Shebeika, Mohamed Eltom, Christian Berne, Kar ...2009 Volume 217 Issue 1 Pages 45-50
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSQuality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.View full abstractDownload PDF (361K) -
Reiko Takano-Murakami, Kunihiko Tokunaga, Naoki Kondo, Tomoyuki Ito, H ...2009 Volume 217 Issue 1 Pages 51-58
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSIdiopathic osteonecrosis of the femoral head (ION) is a painful disease of the hip, the pathogenic mechanism of which is still unclear. The most common extraneous factor is steroid treatment. Steroids have inhibiting effects on bone formation and resorption. When bone regenerative treatments are indicated for ION patients who are exposed to steroids, we cannot ignore the effects of corticosteroid itself on bone healing. The aim of this study was to investigate the effects of glucocorticoid on bone regeneration after osteonecrosis of the femoral head in a rat model. Osteonecrosis was induced surgically on the left femoral heads of aged female rats (about 6 months old) on day 0. Methylprednisolone sodium succinate (MPSS) or normal saline was administrated at a dose of 100 mg/kg/day from day 7 to 11. Femoral heads were analyzed histologically. There were no pathological findings in the right femoral heads of the MPSS-treated and saline-treated rats, as control for the contralateral injury. The newly formed bone volume and the osteoclast number were significantly smaller in the MPSS-treated group. The normal bone marrow was regenerated in the saline-treated group, whereas most of the bone marrow space still contained fibroblast-like spindle-shaped cells in the MPSS-treated group on day 42. Alkaline phosphatase-positive cells were only seen in the areas around the regenerated bone marrow cavities. Thus, MPSS inhibits bone formation by suppressing osteoblast proliferation and resorption by suppressing the recruitment of osteoclast precursors. These findings may be useful when designing treatments for ION patients exposed to steroids.View full abstractDownload PDF (7733K) -
Peng Lin, Li Chen, Dong Li, Jinbo Liu, Nailong Yang, Yu Sun, Yuxin Xu, ...2009 Volume 217 Issue 1 Pages 59-65
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSDiabetes mellitus is a metabolic disorder characterized by elevated blood sugar and progressive failure of insulin-producing β-cells. Persistent hyperglycemia and blood sugar fluctuation are two general phenomena in diabetic patients, and both of them can result in an increased frequency of β-cell apoptosis. Therefore, rescuing pancreatic β-cells from glucotoxicity-induced β-cell apoptosis is increasing viewed as a promising means for curing. The aim of this study was to investigate whether adiponectin, an important cytokine expressed in adipose tissue, has a potential for the application as the antiapoptotic strategy. INS-1 rat insulin-secreting cell line was used in this study as a model of pancreatic β-cells, because INS-1 cells show the susceptibility to glucotoxicity, as seen in β-cells. INS-1 cells were cultured on a novel microfluidic chip with persistent perfusion and subsequently exposed to sustained high glucose (SHG) (25 mmol/l) or intermittent high glucose (IHG) (11.1 and 25 mmol/l glucose alternating every 12 h) in the absence or presence of adiponectin for 72 h. Using this device, we showed that IHG induced more serious impairment in INS-1 cells than did SHG, and adiponectin partially rescued INS-1 cells from glucotoxicity-induced apoptosis, dysfunction and reduction of insulin gene expression. Simultaneously, the mRNA expression of AMP-activated protein kinase (AMPK), which is a signaling protein that acts to modulate glucose uptake in skeletal muscle, was restored in the presence of adiponectin. Based on the above evidence, we suggest that adiponectin could reduce glucotoxicity-induced apoptosis of β-cells, at least in part, by transiently activating AMPK signaling pathway.View full abstractDownload PDF (1845K) -
Mari Oyama, Kazutoshi Nakamura, Yasuo Tsuchiya, Masaharu Yamamoto2009 Volume 217 Issue 1 Pages 67-72
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSInfants' rapid (catch-up) weight gain is associated with later obesity and chronic adult diseases. The aim of this study was to determine maternal and environmental factors related to rapid weight gain at one month and 18 months after full-term birth in Japan. Subjects were 1,524 infants and their mothers who visited the 18-month check-up in Niigata City between October 1, 2007 and September 30, 2008. An anonymous questionnaire elicited information on the infant's weight (at birth, 1 month, and 18 months), sex, feeding method, presence of food allergy, gestational age, and caregiver. Mother's information was height, pre-pregnancy weight, pregnancy weight gain, age at delivery, pregnancy toxicosis, number of daily meals during pregnancy, smoking and drinking habits. Some questionnaire items were obtained from a maternal and child health handbook. Independence of predictors for rapid weight gain (vs. slow or average weight gain), i.e. a score gain of 0.67 SD, during the first month and first 18 months was tested by multiple logistic regression analysis. In the first month, having a meal once or twice daily during pregnancy (P = 0.0016) and daily smoking in pre-pregnancy (P = 0.0175) were associated with rapid weight gain. In the first 18 months, use of daycare (P = 0.0083) and daily drinking in pre-pregnancy (P = 0.0130) were associated with rapid weight gain. We conclude that mother's pre-pregnancy smoking and drinking, dieting during pregnancy, and infant daycare attendance lead to rapid infant weight gain. Controlling these factors may prevent future chronic adult lifestyle-related diseases.View full abstractDownload PDF (399K) -
Yasuyuki Fujino, Satoshi Sasaki, Kumiko Igarashi, Naohito Tanabe, Clar ...2009 Volume 217 Issue 1 Pages 73-85
Published: 2009
Released on J-STAGE: January 20, 2009
JOURNAL FREE ACCESSThe large number of child deaths in developing countries is associated with delays in care-seeking by families, but the community-based efforts of the Integrated Management of Childhood Illnesses developed by WHO/UNICEF has remained ineffectual. To improve caregivers' ability to recognise potentially life-threatening symptoms of major childhood illnesses, we provided education about the importance of danger signs and immediate care-seeking practices through a community-based intervention of ‘the Growth Monitoring Programme Plus (GMP+)' in low-income areas of Lusaka, Zambia. Using repeated cross-sectional data from interviews, we compared attendance and non-attendance groups to assess the impacts of intervention on mothers' care-seeking. Of 1717 and 1546 attendance mothers in the baseline and the final survey, 1097 and 1035, respectively, sought care from a health centre after perceiving the danger signs. The proportion of mothers with immediate response increased from 35.7% (392/1097) to 51.5% (533/1035) (p < 0.01). In the final survey, the attendance mothers became more likely to respond immediately to the danger signs than the non-attendance mothers (adjusted odds ratio: 2.140, 95% confidence interval: [1.408-3.252]), and the higher educational level the attendance mothers had, the more likely they were to respond immediately to the danger signs (primary level: 2.067 [1.050-4.068], secondary level and above: 2.174 [1.098-4.306]). In conclusion, GMP+ with danger sign education can improve mothers' care-seeking for severely sick children. Therefore, GMP+ has the potential to reduce child death in developing countries, i.e., contribute to the Millennium Development Goal 4 aiming at reducing child mortality by two-thirds by 2015.View full abstractDownload PDF (1163K)
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