The Journal of Medical Investigation
Online ISSN : 1349-6867
Print ISSN : 1343-1420
ISSN-L : 1343-1420
Volume 58 , Issue 1,2
Showing 1-23 articles out of 23 articles from the selected issue
Review
  • Tetsuya Tanioka, Mika Kataoka, Yuko Yasuhara, Misao Miyagawa, Isako Ue ...
    2011 Volume 58 Issue 1,2 Pages 1-10
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Psychiatric healthcare services in Japan demand continuous improvement to ensure quality care. Psychiatric nurse administrators and managers greatly influence the quality of services. To improve treatment, the following are considered necessary: clarification of service goal, proper assessment of treatment outcome, shortening of hospitalization, patient-centered care, establishment of trust relationships based on open communication with patients, and effective interdisciplinary teamwork. Additionally, administrators and managers must evaluate the clinical competence of individual nurses and appropriately assign them, especially when personnel shortage is an issue. Furthermore, in collaboration with other healthcare professionals, nurse managers must provide optimal care by setting goals of psychiatric services for patients in acute, sub-acute, or convalescent phases. This article presents the roles of nurse administrators and managers in improving the quality of Japanese psychiatric healthcare services. J. Med. Invest. 58: 1-10, February, 2011
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Originals
  • Machiko Kiyokawa, Toshiya Matsuzaki, Takeshi Iwasa, Rie Ogata, Masahir ...
    2011 Volume 58 Issue 1,2 Pages 11-18
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Objectives: Reproductive functions are influenced by various feeding regulators. Orexin, which is one of orexinergic peptides, suppresses the pulsatile secretion of luteinizing hormone (LH) in bilaterally ovariectomized (OVX) rats. However, the mechanism of this effect is still not clear. To investigate whether neuropeptide Y (NPY) is involved in the orexin A-mediated suppression of pulsatile LH secretion, we evaluated the effects of NPY antibody on the suppressive effect of orexin A. Methods: Orexin A was administered intracerebroventricularly (icv) and NPY antibody (NPY-Ab) was injected before icv administration of orexin A in OVX rats. Pulsatile LH secretion was analyzed by measuring serum LH concentrations in the next 2 h in blood samples drawn at 6-min intervals by radioimmunoassay. Results: Administration of orexin A significantly reduced the mean LH concentration and LH pulse frequency. Co-administration of NPY antibody with orexin A significantly restored the suppressive effect of orexin A on the mean LH concentration and LH pulse frequency. Conclusion: NPY mediated the suppressive effect of intracerebroventricularly injected orexin A on pulsatile LH secretion, suggesting that hypothalamic orexin suppressed pulsatile gonadotropin-releasing hormone (GnRH) secretion via NPY in the hypothalamus of female rats. J. Med. Invest. 58: 11-18, February, 2011
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  • Hai-Yan Pan, Mihiro Yano, Hiroshi Kido
    2011 Volume 58 Issue 1,2 Pages 19-28
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Severe influenza sometimes causes myocarditis. We recently found that influenza A virus (IAV) infection induces various cellular factors, such as proinflammatory cytokines IL-6, IL-1β and TNF-α, matrix metalloproteinases (MMPs) and ectopic trypsin in mice hearts and in H9c2 cardiomyocytes. The induction of these cellular factors in turn promotes viral replication, myocardial inflammation and cellular damage through their intracellular signal transductions in cooperation with the IAV-induced Toll-like receptors (TLRs) and proteinase-activated receptor-2 (PAR-2) signallings, although the precise nature of these interactions remain obscure. By using specific inhibitors of TLRs and PAR-2 signalings and trypsin inhibitor aprotinin, we analyzed the role of TLR signaling and PAR-2 signaling in the IAV-induced pathological changes in cardiomyocytes. Inhibitors of TLR7/8-Myeloid Differentiation factor 88-nuclear factor-κB signaling and aprotinin effectively suppressed IAV-induced upregulation of proinflammatory cytokines, MMPs, trypsinogen and viral replication. Inhibitor of TLR3-Toll/interleukin-1 receptor domain-containing adaptor inducing interferons-dependent signaling predominantly suppressed the upregulation of interferon-β, a key intracellular host immune response factor. In contrast to the suppressive effect of trypsin inhibitor aprotinin on IAV replication, PAR-2 inhibitor FSY-NH2, induced marginal upregulation of trypsinogen and subsequent stimulation of IAV replication. J. Med. Invest. 58: 19-28, February, 2011
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  • Khulood M Sayed, Takeshi Naito, Mahmoud M Farouk, Toshihiko Nagasawa, ...
    2011 Volume 58 Issue 1,2 Pages 29-38
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Purpose: To compare the incidence of wound sealing-related complications of 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) for proliferative diabetic retinopathy (PDR) versus non-diabetic simple macular pathology (SMP). Methods: A retrospective comparative study was conducted on 377 eyes that underwent 25-G TSV for PDR (n=189 eyes) or non-diabetic SMP (n=188 eyes). Both groups were compared retrospectively and followed for at least 1 month (range 1-6 months). Main outcome measure was the incidence of postoperative wound sealing-related complications in both groups. Results: We found a statistically significant lower incidence of wound sealing-related complications on the 1st postoperative day in the PDR than SMP group (P-value<0.05). The incidence were as follows: 9% vs 18% for hypotony, 0% vs 2% for choroidal detachment, 0% vs 2% for external leakage and 1% vs 8% for conjunctival bleb formation, for the PDR and SMP groups respectively. This was associated with a significantly higher postoperative inflammation and IOP in PDR group. The day 1 higher postoperative IOP and inflammation were correlated with the presence of PDR pathology. Conclusion: The higher postoperative inflammation and IOP following vitrectomy in diabetic eyes, especially when combined with endolaser photocoagulation, makes such eyes less susceptible to wound sealing-related complications following sutureless vitrectomy. J. Med. Invest. 58: 29-38, February, 2011
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  • Akiko Abe, Hiroyuki Furumoto, Kanako Yoshida, Takeshi Kato, Yasuyo Sai ...
    2011 Volume 58 Issue 1,2 Pages 39-45
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Aim: Particle-mediated transfection is known as an efficient method of non-viral gene transfer. Flt3 ligand (FL) is a growth factor for hematopoietic progenitors; it promotes the growth of dendritic cells (DC). DCs are powerful antigen-presenting cells (APCs) and show a remarkable capacity to stimulate antigen-specific T-cell responses. In this study, we intended to investigate the suppressive effect on tumor growth by gene gun-mediated transfer of FL in a murine model. Methods: C57BL/6J mice were injected intradermally with MCA205 cells. DNA (pNGVL-hFLex)-coated gold particles were delivered to the mouse skin surrounding the target tumor. The expression of FL was determined by RT-PCR. Analyses by immunohistochemistry and fluorescence-activated cell sorter (FACS) revealed an increase in the number of DC after treatment with FL. Results: Gene gun-mediated pNGVL-hFLex transfer significantly inhibited the growth of the MCA205 tumor. FL transfer markedly increased the number of CD11c+ DCs in the tumor tissue. Further, the FL-transfected mice exhibited a significantly higher number of CD80+ MHC-II cells. Conclusion: We successfully performed FL therapy using an in vivo gene gun in order to effectively mobilize DCs in situ and induce suppressive immunity. J. Med. Invest. 58: 39-45, February, 2011
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  • Abdellah Hamed Khalil Ali, Hiromitsu Takizawa, Kazuya Kondo, Yasushi N ...
    2011 Volume 58 Issue 1,2 Pages 46-55
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Purpose: To evaluate the accuracy of fluorescence bronchoscopy by precise histological analysis of the photodynamic therapy (PDT) treated lesions. Methods: A retrospective study was conducted on thirteen patients (16 lesions) with centrally located early lung cancer (CLELC) had been undergone photodynamic therapy and had been followed up by fluorescence bronchoscopy. Fluorescence bronchoscopy was performed between 1 and 60 months after photodynamic therapy. Results: Of the 16 early carcinomas treated, 14 (87.5%) had a CR, 2 (12.5%) had a NR after initial PDT. Among the 14 carcinomas achieving a CR, 4 (29%) recurred locally from 6 to 12 months after initial PDT. A total of 62 surveillance auto fluorescence bronchoscopies (average; 4.5/patient) and 47 biopsies (average; 4/patient) were performed after PDT. The addition of the SAFE-3000 examination to conventional bronchoscopy increased the sensitivity of screening from 69% to 100%, which yielded a relative sensitivity of 145% with a negative predictive value of 100%. Out of 14 CR lesions, 9 lesions finally reverted to normal fluorescence. CR cases that did not show normal fluorescence were relapsed cases or a patient with complete response whose treated lesion showed fibrosis in the sub mucosa. Histopathological finding of the complete response sites which demonstrated temporal fluorescent defect consisted of inflammatory lesions, goblet cell hyperplasia, basal cell hyperplasia, squamous metaplasia or dysplasia. Conclusion: our results confirm that SAFE-3000 allows accurate assessment of the quality and efficacy of PDT. J. Med. Invest. 58: 46-55, February, 2011
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  • Hiroko Kunikata, Yuko Shiraishi, Kazuo Nakajima, Tetsuya Tanioka, Masa ...
    2011 Volume 58 Issue 1,2 Pages 56-62
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    The purpose of this study was to demonstrate a causal model of the sense of having psychological comfortable space that is call ‘ibasho’ in Japanese and self-esteem in people with mental disorders who had difficulty in social activities. The subjects were 248 schizophrenia patients who were living in the community and receiving day care treatment. Data were collected from December 2007 to April 2009 using the Scale for the Sense of ibasho for persons with mentally ill (SSI) and the Rosenberg Self-Esteem Scale (RSES), and analyzed for cross-validation of construct validity by conducting covariance structure analysis. A relationship between the sense of having comfortable space and self-esteem was investigated. Multiple indicator models of the sense of having psychological comfortable space and self-esteem were evaluated using structural equation modeling. Furthermore, the SSI scores were compared between the high- and low-self-esteem groups. The path coefficient from the sense of having comfortable space to self-esteem was significant (0.80). High-self-esteem group scored significantly higher in the SSI subscales, ‘the sense of recognizing my true self’ and ‘the sense of recognizing deep person-to-person relationships’ than the low-self-esteem group. It was suggested that in order to help people with mental disorders improve self-esteem, it might be useful to support them in a way they can enhance the sense of having comfortable space. J. Med. Invest. 58: 56-62, February, 2011
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  • Naoko Moride, Akira Kuwahara, Mizuho Yamashita, Yu Tanaka, Toshiya Mat ...
    2011 Volume 58 Issue 1,2 Pages 63-66
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Aim: To examine whether the bromocriptine-rebound (BR) method improves pregnancy outcomes after previous unsuccessful assisted reproductive technology (ART) attempts. Patients/study design: In this study we retrospectively analyzed data from a total of 121 women with normal serum prolactin (PRL) levels and a history of repeated unsuccessful ART procedures. Pregnancy outcomes and hormonal data were compared between the long protocol and BR method. Both procedures were similar, except that in the BR method, bromocriptine was administered daily from day 5 of the preceding cycle until 7 days before ovarian stimulation. Results: The number of fertilized oocytes, cleaved embryos and transplant embryos were significantly higher with the BR method than with the long protocol even though the numbers of retrieved oocyte were same in both groups. The ratio of the good embryos, the clinical pregnancy rate was higher with the BR method than with the long protocol. The embryo score with the BR method were significantly higher than that with the long protocol. Conclusion: BR method could provide the better embryos and improve the transplantation rate in women with previous unsuccessful ART attempts J. Med. Invest. 58: 63-66, February, 2011
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  • Masanari Watanabe, Kazuhiro Kato, Kenichi Takeda, Tatsuya Konishi, Jun ...
    2011 Volume 58 Issue 1,2 Pages 67-74
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Objective: Health-care associated pneumonia (HCAP) is a new category of pneumonia. We investigated differences of epidemiology, pathogens, and outcomes between HCAP patients in large hospitals and those in small hospitals. Methods: This was a retrospective observational study of patients hospitalized with HCAP from December 2009 to March 2010. HCAP was defined according to ATS/IDSA criteria. A large hospital was defined as ≥200 beds and a small hospital was <200 beds. Results: Of 117 patients, 61 patients were admitted to large hospitals and 56 patients were admitted to small hospitals. There was a significant difference of HCAP diagnostic criteria between the two groups. The A-DROP severity class was worse in the large hospital group than the small hospital group (P<0.05). Respiratory failure and disturbance of consciousness were more frequent in the large hospital group (P<0.05). The mortality rate was 8.2% in the large hospital group versus 1.8% in the small hospital group. Patients in the very severe A-DROP class had a high mortality rate of 33% in both groups. Conclusion: Patients with severe HCAP were more likely to be admitted to large hospitals. Patients in the very severe A-DROP class should receive intensive antibiotic therapy, but not all patients need broad-spectrum therapy. J. Med. Invest. 58: 67-74, February, 2011
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  • Junichi Seike, Akira Tangoku, Yasuhiro Yuasa, Hiroshi Okitsu, Yukikiyo ...
    2011 Volume 58 Issue 1,2 Pages 75-80
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Background: Enteral nutrition (EN) is now used more frequently than total parenteral nutrition (TPN) for nutritional support after resection for esophageal cancer. But consensus regarding which type of nutrition should be used does not exist. We studied the effect of TPN and EN on patients’ nutritional status and immune function in the immediate postoperative period after esophageal cancer resection. Methods: We enrolled 30 patients (27 men and 3 women) who underwent subtotal esophagectomy. The patients were randomly assigned to TPN or EN group. Either TPN or EN was begun on postoperative day 1. On postoperative days 1, 3, and 7, three endpoints were measured: albumin, C-reactive protein, and Th1/Th2 balance. Results: All patients completed the study. Anastomotic leaks occurred in 6 patients in the TPN group and 7 patients in the EN group. Albumin, Th1/Th2 balance, and C-reactive protein did not differ between the groups. Th1/Th2 balance was not different regardless of the preoperative treatment or complications. Conclusions. No differences in immune function, nutritional state, or inflammatory response were seen between patients supported with TPN and those supported with EN. The results of our study suggest that perioperative nutritional support can be safely performed either with TPN or EN. J. Med. Invest. 58: 75-80, February, 2011
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  • Hiroaki Yanagawa, Minoru Irahara, Hitoshi Houchi, Yoshiyuki Kakehi, Ta ...
    2011 Volume 58 Issue 1,2 Pages 81-85
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Clinical trials leading to drug approval (registration trials) play a central role in the drug development process. Since the introduction of the Good Clinical Practice (GCP) standard in 1997, the Japanese infrastructure for registration trials has improved. The contribution of support staff, including clinical research coordinators (CRCs), to clinical trials is now widely recognized in Japan. Quality issues and career development for these support staff are being increasingly emphasized. The Shikoku Collaborative Group for Promotion of Clinical Trials was organized in 2008 to address these issues through communication with the personnel involved in clinical trials in regional areas of Japan. To understand the views and present status of personnel involved in clinical trials, we used questionnaires to survey the participants of the First Symposium of the Shikoku Collaborative Group for Promotion of Clinical Trials held in August 2009. Group discussions and special lectures occurred at the symposium. The questionnaire began with questions about basic patient characteristics, followed by practical questions. Of 110 participants, there were 68 respondents (62%), including clinical trial support staff (clinical research coordinators [n=36, 53%], administrative officers [n=9, 13%]), and medical staff [n=23, 34%]). Among the support staff, 36 (80%) had more than 5 years of experience. The most common questionnaire answer selected for participation in the symposium was “willing to contact staff from other medical institutions or organizations” for support staff and “to obtain further knowledge concerning clinical trials” for medical staff. The overall view of the discussion (“Was the discussion satisfactory?”) was favorable for 36 (53%) respondents. This survey revealed that the group discussion in the present symposium appears to be valuable for participants, using overall satisfaction as a surrogate. Based on the information obtained in the present study, further development of the clinical trial infrastructure, including training opportunities and career development for support staff, is required. Due to the limitations of this study, further analysis is warranted to determine the optimal strategy for training support staff. J. Med. Invest. 58: 81-85, February, 2011
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  • Miyako Kishimoto, Takehiro Sugiyama, Keiichiro Osame, Daisuke Takarabe ...
    2011 Volume 58 Issue 1,2 Pages 86-94
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Ezetimibe selectively inhibits dietary and biliary cholesterol absorption and reduces serum cholesterol levels when administered alone (monotherapy) and along with common lipid-regulating agents (combination therapy). To evaluate the effect of ezetimibe therapy on the lipid profile, glucose metabolism, and levels of cholesterol absorption and synthesis markers, we administered 10 mg ezetimibe to 50 hypercholesterolemic patients with or without diabetes. The serum levels of low-density lipoprotein cholesterol and total cholesterol were significantly reduced at 4 and 12 weeks of ezetimibe therapy in diabetic patients of both the monotherapy and combination-therapy groups and in nondiabetic patients of the combination-therapy group. The serum levels of the cholesterol absorption markers were significantly reduced, while those of the cholesterol synthesis markers were significantly increased at 12 weeks of ezetimibe therapy. No significant differences were noted in the values of the parameters of glucose metabolism in all patients. We also investigated the clinical characteristics of patients who exhibited a good response to ezetimibe (ezetimibe responders); however, multivariate regression analysis did not reveal a correlation between ezetimibe efficacy and patient characteristics such as gender, age, BMI, diabetic condition, method of ezetimibe administration, and the initial absolute values of cholesterol absorption/synthesis markers levels. In conclusion, ezetimibe therapy significantly improved the lipid profile without disturbing glucose metabolism. We were unable to identify the specific characteristics of ezetimibe responders among our subjects. However, we may interpret this result as suggesting that ezetimibe can be used in any population to lower low-density lipoprotein cholesterol levels. J. Med. Invest. 58: 86-94, February, 2011
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  • Hirotaka Nishisako, Toshitaka Ikehara, Tairoh Shiraishi, Yuki Minami, ...
    2011 Volume 58 Issue 1,2 Pages 95-105
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Effects of a time-varying magnetic field on cell volume regulation by hyposmotic stress in cultured bovine adrenal chromaffin cells were examined. Through regulatory volume decrease (RVD), cell volume of chromaffin cells that were incubated in a hypotonic medium initially increased, reached a peak and finally recovered to the initial value. Two hour exposure to a magnetic field and addition of cytochalasin D increased peak value and delayed return to initial value. Intracellular F-actin contents initially decreased but returned to normal levels after 10 sec. Two hour exposure to the magnetic field and addition of cytochalasin D continuously reduced the F-actin content. Results suggest that exposure to the magnetic field stimulated disruption of the actin cytoskeleton and that the disruption delayed the recovery to the volume prior to osmotic stress. J. Med. Invest. 58: 95-105, February, 2011
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  • Shuichi Iwahashi, Hiroki Ishibashi, Tohru Utsunomiya, Yuji Morine, Tov ...
    2011 Volume 58 Issue 1,2 Pages 106-109
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Background: Histone deacetylase (HDAC) is well known to be associated with tumorigenesis through epigenetic regulation, and its inhibitors (HDACIs) induce differentiation and apoptosis of tumor cells. We examined the therapeutic effects of valproic acid (VPA, a HDACI) with a combination of 5-fluorouracil (5-FU) in vitro. Methods: A human pancreas cancer cell line (SUIT-2) and a cholangiocarcinoma cell line (HuCCT1) were used. Cell viabilities were evaluated by a cell proliferation assay. We determined the anticancer effects of VPA combined with 5-FU in these cell lines. Results: Pancreas cancer (SUIT-2): No effect of 5-FU (1.0 µM) was observed, but 17% and 30% of proliferation-inhibitory effects were recognized in a dose of 2.5 or 5.0 µM, respectively. Cell viability was only weakly reduced by VPA (0.5 mM). However, in combination of 5-FU (1.0 µM) with VPA (0.5 mM), 19% of inhibitory effect was observed. Cholangiocarcinoma (HuCCT1): 5-FU (1.0 µM) did not suppress the cell viability, but 5-FU (2.5 µM) suppressed by 23%. VPA (0.5 mM) did not suppress the cell viability, while VPA (1.0 mM) weakly decreased it by 11%. Combination of 5-FU (1.0 µM) and VPA (0.5 mM) markedly reduced the cell viability by 30%. Conclusion: VPA augmented the anti-tumor effects of 5-FU in cancer cell lines. Therefore, a combination therapy of 5-FU plus VPA may be a promising therapeutic option for patients with pancreas cancer and cholangiocarcinoma. J. Med. Invest. 58: 106-109, February, 2011
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  • Yuka Kasai, Masahiko Maegawa, Satoshi Yamamoto, Masaharu Kamada, Toshi ...
    2011 Volume 58 Issue 1,2 Pages 110-117
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Purpose: The aims of this study were to determine the effects of raloxifene therapy on production of cytokines and in vitro effects of raloxifene on production of cytokines by whole blood cultures. Methods: We obtained samples of peripheral blood from 6 postmenopausal women with osteopenia at baseline and after 3 and 6 months of raloxifene therapy and 10 postmenopausal women who did not receive raloxifene therapy. Whole blood from raloxifene-treated women was stimulated with lipopolysaccharide (LPS) or phytohemeagglutinin (PHA). Whole blood from postmenopausal women who were not treated with raloxifene was preincubated with raloxifene at concentrations of 10-10-10-7 M and then stimulated with LPS or PHA. Concentrations of IL-1β, IL-4, IL-6, IL-12p40, IL-12p70, TNF-α and IFN-γ in the supernatant were measured by respective ELISAs. Results: In ex vivo cultures, raloxifene therapy inhibited LPS-stimulated production of IL-1β, IL-6, IL-12p40, IL-12p70 and TNF-α, but not PHA-stimulated production of IL-4 and IFN-γ. In in vitro cultures, raloxifene at a concentration (10-9 M) inhibited LPS-stimulated production of IL-1β, IL-6 and IL-12p40 and PHA-stimulated production of IFN-γ. Conclusions: Raloxifene therapy decreases the production of IL-1β, IL-6, IL-12 and TNF-α but not that of IL-4 and IFN-γ, suggesting that modulation of cytokines could play a role in the mechanisms of the osteoprotective effect of raloxifene. J. Med. Invest. 58: 110-117, February, 2011
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  • Yayoi Fukuhara, Koichiro Tsuchiya, Yuya Horinouchi, Soichiro Tajima, Y ...
    2011 Volume 58 Issue 1,2 Pages 118-126
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Recently, increasing evidence suggests that the antihypertensive drug nifedipine acts as a protective agent for endothelial cells, and that the activity is unrelated to its calcium channel blocking. Nitrosonifedipine (NO-NIF) is metabolically and photochemically produced from nifedipine, and NO-NIF has been recognized as a contaminant of nifedipine because it has no antihypertensive effect. Treatment of tumor necrosis factor-α (TNF-α) suppressed the cell viability and facilitated the expression of Inter-Cellular Adhesion Molecule 1(ICAM-1) in human glomerular endothelial cells (HGECs) though, pretreatment of NO-NIF significantly recovered the TNF-α-induced cell damage to the same extent as Trolox-C did, and suppressed the ICAM-1 expression in a concentration dependent manner. In addition, NO-NIF inhibited the cell toxicity induced by cumene hydroperoxide, which hampers the integrity of cell membrane through oxidative stress, as effective as Trolox-c. These data suggest that NO-NIF is a candidate for a new class of antioxidative drug that protect cells against oxidative stress in glomerular endothelial cells. J. Med. Invest. 58: 118-126, February, 2011
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  • Uranchimeg Dorjpurev, Akira Kuwahara, Yuya Yano, Tomoko Taniguchi, Yur ...
    2011 Volume 58 Issue 1,2 Pages 127-133
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Objective: To assess the effects of semen characteristics on the success of intrauterine insemination (IUI). Design: A retrospective study. Settings: The Department of Obstetrics and Gynecology, Tokushima University Hospital, Japan. Patients: Between 2004 and 2008, 1,177 IUI cycles in 283 couples were studied. Intervention: IUI cycles were preceded with ovarian stimulation. Main Outcome Measure: Clinical pregnancy. Result: A total of 82 clinical pregnancies were obtained (7.0% pregnancy rate per cycle, 28.9% per case). Their subsequent outcomes of pregnancies were 18 miscarriages (21.9%), 2 ectopic pregnancies (2.4%) and 60 live births (73.2%). Of the 82 clinical pregnancies, 2 were twin pregnancies (2.4%). There was no triple or higher order multiple pregnancies. At the end of the sixth cycle, 73 clinical pregnancies had been achieved (89.0%). After diagnostic laparoscopy, the pregnancy rate per cycle for patients ≤35 years age was 18%, which is significantly higher than that of patients >35 years of age. Pregnancies occurred up to the fifth cycle after laparoscopy. The pregnancy rate (PR) per cycle was significantly higher in cases of sperm movement rates more than 30% (PR 9.3%) and total motile sperm counts more than 10×106/ml (PR 8.2%). A study comparing the washed and unwashed cases did not reveal any differences. Conclusion: In male sub-fertility cases of sperm parameters as motility rates ≥30% and motile sperm concentration ≥10×106/ml, IUI could be a useful option for infertility treatment J. Med. Invest. 58: 127-133, February, 2011
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  • Nobuhiro Kurita, Mitsuo Shimada, Takashi Iwata, Masanori Nishioka, Shi ...
    2011 Volume 58 Issue 1,2 Pages 134-139
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Background: Intraperitoneal administration of taxanes revealed excellent anti-tumor effect for peritoneal metastasis of gastric cancer in some experimental models. The aim of this study is to determine maximum tolerated dose (MTD), dose limiting toxicity (DLT) and recommended dose (RD) of intraperitoneally infused paclitaxel (PTX) with S-1 as a phase I study. Patients and Methods: Eighteen patients with advanced gastric cancer in addition to confirmed peritoneal metastasis using laparoscopy were enrolled in this study. The regimen consists of oral administration of S-1 (Dose 80 mg: BSA<1.25 m2, 100 mg: 1.25<BSA<1.5 m2, 120 mg: BSA>1.5 m2) for 14 days and intraperitoneal infusion of PTX (Dose escalation: level I: 40, II: 60, III: 80, level IV: 90, V: 100 mg/m2) at day1 and 14. PTX concentrations in serum and ascites were determined at 4, 8, 12, 24, 48 hours after the infusion, which was repeated twice every 4 weeks. Results: The number of patients were as follows: Level I: 3, Level II: 6, Level III: 3, Level IV: 3, Level V: 3. Grade 3 leukocytopenia was confirmed in 1 (Level II) and 2 (Level V). MTD is 90 mg/m2, RD is 80 mg/m2 and DLT is Grade 3 leukocytopenia. The average serum PTX concentrations remained in optimal range except for all 3 of level V patients. In all cohorts, the PTX concentrations in the ascites were approximately 1000 folds higher than those in serum for 48 hours after the infusion. Conclusions: MTD and RD were PTX 90 mg/m2, 80mg/m2, respectively. These findings were supported by pharmocokinetics of PTX J. Med. Invest. 58: 134-139, February, 2011
    Mini-Abstract: In intraperitoneal infusion of PTX with S-1, DLT was leukocytopenia, MTD and RD were PTX 90 mg/m2, 80 mg/m2, respectively. These findings were supported by pharmocokinetics of PTX
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  • Ayako Tanimura, Fumiyo Yamada, Akihito Saito, Mikiko Ito, Toru Kimura, ...
    2011 Volume 58 Issue 1,2 Pages 140-147
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Type IIa sodium-dependent phosphate transporter (NaPi-IIa) can be localized in the apical plasma membrane of renal proximal tubule to carry out a rate-limiting step of phosphate reabsorption. For the apical localization, NaPi-IIa is required to form a macromolecular complex with some adaptor proteins such as Na+/H+ exchanger regulatory factor 1 (NHERF-1) and ezrin. However, the detail of macromolecular complex containing NaPi-IIa in the apical membrane of the renal proximal tubular cells has not been clarified. In this study, we identified at least four different complexes (220, 480, 920, 1,100 kDa) containing NaPi-IIa by using blue-native polyacrylamide gel electrophoresis. Interestingly, LC-MS/MS analysis and immunoprecipitation analysis reveal that megalin is a component of larger complexs (920 and 1,100 kDa). In addition, NaPi-IIa can be heterogeneously co-localized with ezrin and megalin on the apical membrane of renal proximal tubuler cells by fluorescence microscopy analysis. These results suggest that NaPi-IIa can form some different complexes on the apical plasma membrane of renal proximal tubular cells. J. Med. Invest. 58: 140-147, February, 2011
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Case reports
  • Ryo Miyagi, Toshinori Sakai, Nitin N. Bhatia, Koichi Sairyo, Shinsuke ...
    2011 Volume 58 Issue 1,2 Pages 148-153
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Although vertebroplasty (VP) using polymethylmethacrylate (PMMA) is thought to be an effective procedure for osteoporotic vertebral compression fractures, several complications have been reported. In this paper, we present three patients who developed local kyphotic deformity as a result of late collapse of the cemented vertebrae. In all patients we safely removed the PMMA block through an anterior approach and anterior reconstruction was performed successfully. In only one patient who had a three column unstable injury with fractured posterior elements was additional posterior spinal fixation needed. In conclusion, VP is thought to be an effective and minimal invasive technique to treat osteoporotic compression fractures in older patients. Once collapse or nonunion of the treated vertebral body occurs, however, removal of the cement and anterior reconstruction may be required to realign of the affected segments and reconstruct the spine. J. Med. Invest. 58: 148-153, February, 2011
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  • Shinji Kuratate, Motoya Chikakiyo, Yuji Kaneda, Yukari Harino, Toshiyu ...
    2011 Volume 58 Issue 1,2 Pages 154-158
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    A 58-year old man was referred to our hospital for treatment of an abdominal mass. As for him, tumor resection with right nephrectomy had been performed ten years ago for a giant well-differentiated perinephric liposarcoma. CT examination showed a huge tumor shadow in the abdominal cavity. Abdominal MRI examination showed a 15×8 cm tumor with almost high signal intensity on the T2 weighted images. At lapalotomy, a large bulky retroperitoneal tumor pointed out before an operation was found. Surgical extirpation of the tumor was performed. Besides, several tumors of the thumb head size were detected into right retroperitoneal fatty tissue. The right side mesocolon and the tumors were not able to exfoliate, therefore right hemicolectomy was performed. Histological features showed dedifferentiated liposarcoma. The postoperative course was uneventful. But eight months after surgery, he was admitted again for treatment of a 4×3 cm retroperitoneal tumor. Extirpation of the tumor was performed. Histological finding of this tumor also showed dedifferentiated liposarcoma. Dedifferentiation, occurring in 15% of the well-differentiated liposarcomas, sometimes may develop later. Long-term detailed follow-up is necessary for well-differentiated liposarcoma. J. Med. Invest. 58: 154-158, February, 2011
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  • Mitsuru Takaku, Ichiro Hashimoto, Hideki Nakanishi, Taeko Kurashiki
    2011 Volume 58 Issue 1,2 Pages 159-162
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    Calcifying aponeurotic fibroma is a rare soft tissue tumor that typically occurs in the distal extremities of children and adolescents. Because a calcifying aponeurotic fibroma is an ill-defined mass and has a tendency to infiltrate the surrounding tissue, local recurrence rates are 50%. We report a case of calcifying aponeurotic fibroma occurring in the elbow region, an uncommon site. The patient is followed up for 6 years without local recurrence of the tumor. J. Med. Invest. 58: 159-162, February, 2011
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  • Yoko Sakai, Yasuo M. Tsutsumi, Narutomo Wakamatsu, Tomohiro Soga, Kats ...
    2011 Volume 58 Issue 1,2 Pages 163-165
    Published: 2011
    Released: March 01, 2011
    JOURNALS FREE ACCESS
    We present a case where immediate muscle relaxation was needed following sugammadex administration. A 72 year-old female underwent surgery for a cerebral artery aneurysm. Upon conclusion of the operation sugammadex (9.3 mg/kg) was administered and the patient was noted to have left hemiplegia. Rocuronium (1.2 mg/kg×2 doses) was given in order to gain neuromuscular block approximately 25 minutes after sugammadex had been injected. Although TOF monitoring was not utilized in this case and assessing residual muscular block was difficult, spontaneous respirations continued and breathing had to be controlled with sevoflurane and remifentanil. Sugammadex is a potent reversal agent for rocuronium-induced neuromuscular block, however, certain situations require immediate neuromuscular blockade following sugammadex. In this case, rocuronium was unable to induce neuromuscular blockade immediately after sugammadex and that higher concentrations were necessary in addition to intravenous analgesics and inhaled anesthetics. J. Med. Invest. 58: 163-165, February, 2011
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