The five-year survival rate for prostate cancer is relatively good, as the progress is slow. Complications for prostate cancer treatment are related to excretion and sexuality. Therefore, it is not only the extension of life, but also the QOL becomes important; it is necessary to consider how to support the maintenance and improvement of QOL related to excretion and sexuality from the viewpoint of nursing. The purpose of this study was to examine Japanese nursing literature on excretion and sexuality in patients with prostate cancer, to organize the available information, and to consider future types of treatment. As a result, 11 reported nursing studies from 2003 through 2013 were surveyed, few details were reported regarding excretion and sexuality of prostate cancer patients. In addition many studies were quantitative studies; in particular there were descriptive studies and correlational studies. Types of study contents were classified as follows: “reality of excretory and sexual dysfunction and bother”, “coping with excretory and sexual dysfunction and bother”, “influence on sexuality of excretory and sexual dysfunction and bother”, “nursing for excretory and sexual dysfunction and bother”. “Coping with excretory and sexual dysfunction and bother” were the most numerous contents. On the other hand, the studies on “influence on sexuality of excretory and sexual dysfunction and bother” were few, and they did not lead to studies on the basis of Japanese national traits. In order to make recommendations for nursing practice, it is also necessary to address a target person, and use experimental and qualitative study methods.

View full abstract

Diet/exercise is the first choice for treating diabetes, while medications are considered for inadequate glycemic control. Biguanides (BGs) are considered as the first-line agents in the USA; in Japan, however no first-line therapy has been designated. We were interested in the current use of BGs and dipeptidyl peptidase-4 (DPP-4) inhibitors in Japan, as well as the differences in prescribing practice between specialists and general practitioners (GPs). Accordingly, we undertook a questionnaire survey on antidiabetic medications among physicians in Tokyo. The survey was performed between January and June 2013. It included questions to physicians regarding the following: (1) current diabetes treatment; (2) first-, second-, and third-line antidiabetic drugs for 4 hypothetical patients (Case 1: 56-year-old woman, body mass index (BMI) 23.9, HbA1c 7.2%; Case 2: 56-year-old man, BMI 26.0, HbA1c 7.2%; Case 3: 56-year-old man, BMI 22.9, HbA1c 8.5%; and Case 4: 67-year-old man, BMI 23.9, HbA1c 8.5%); and (3) first-, second-, and third-line countermeasures for deterioration of HbA1c. The responses were compared between specialists and GPs. Question 1 was answered by 1,086 physicians (collection rate: 85.5%), including 290 diabetes specialists and 796 GPs. Insulin was more commonly prescribed by specialists (30% vs. 8%). Both groups used an HbA1c of 7% for initiating drug therapy. Regarding Question 2, BGs were most commonly prescribed by specialists for non-obese patients with a relatively good HbA1c, whereas DPP-4 inhibitors were prescribed by GPs. Both groups used low-dose sulfonylureas as third-line therapy and commonly selected DPP-4 inhibitors as first-line therapy for Cases 3 and 4. Interestingly, specialists tended not to choose low-dose sulfonylureas for patients with poor glycemic control. Regarding Question 3, the main first-line countermeasure was “confirming compliance with diet/exercise,” followed by “adding metformin.” Tokyo specialists favored BGs even for patients with relatively good glycemic control, whereas low-dose sulfonylureas were less common. GPs used DPP-4 inhibitors more often than specialists.

View full abstract

No molecular target drug has been established for poor-prognostic triple-negative breast cancer (TNBC) because it has no hormone sensitivity. In addition, TNBC has recently been sub-classified into 6 types: BL1, BL2, IM, M, MSL, and LAR. Thus, the establishment of a target for each subtype is desired. In this study, we analyzed the expression of actin-binding protein, Fascin, associated with the breast cancer stage in 90 breast cancer patients. In addition, the tissue-specific Fascin expression was investigated in 22 TNBC cases classified as basal-like type (accounting for 50% of the overall expression rate) and other non-basal-like subtypes. In the 90 breast cancer patients, the Fascin-positive rate was 0% in Luminal A, 6% in Luminal B (HER2-negative), 14% in Luminal B (HER2-positive), 13% in HER2-positive (non-luminal), and 73% in TNBC. In the 22 TNBC patients, regarding the relationship with clinicopathological factors, the frequency of a Fascin-positive breast cancer mass with a Ki-67 index of 30% or above was significantly higher, showing a high-level malignancy. The Fascin expression rate in the basal-like type of TNBC sub-classification was higher than that in the non-basal-like types. These findings clarified the relationship between Fascin protein expression and the basal-like type of TNBC. These findings suggest that Fascin can serve as a new diagnostic criterion to assess malignancy and the prognosis of TNBC patients, and as a target of TNBC treatment.

View full abstract

We report a case of a pineal parenchymal tumor of intermediate differentiation (PPTID) with intratumoral hemorrhage during follow-up period after endoscopic tumor biopsy. A 57-year-old man was found to have a pineal mass lesion by medical examination of the brain; he was admitted to our hospital with no complaint. Endoscopic tumor biopsy and third ventriculostomy were performed. He was diagnosed as PPTID WHO Grade II according to the histopathological examination. Although some treatment was recommended, he refused treatment and was discharged. Although the size of the tumor remained unchanged during the follow-up observation, a sudden headache and double vision appeared about one and half years later, and intratumoral hemorrhage was observed on the head CT. He was emergently admitted to our hospital. Surgical treatment was required for the prevention of re-bleeding, and the subtotal removal of the tumor by occipital transtentorial approach was performed. The result based on the histological examination was PPTID WHO Grade II, which was the same diagnosis as previously. Postoperatively, radiotherapy was performed, and no recurrence has been observed to date. Previously, a few authors have reported spontaneous intratumoral hemorrhage of PPTID. In this case, histopathological examination revealed several deposits of hemosiderin and the surrounding intratumoral hyalinized vessels showed thickening of the walls. Although the mechanism is unclear, it is hypothesized that the tumor vessels showing focal sinusoidal dilatation and hyaline thickening of the walls lead to spontaneous thrombosis with consequent necrosis, and frequent hemorrhaging.

View full abstract

This is a report on the successful periodontal treatments, in a patient with severe chronic periodontitis, which included periodontal regeneration and tooth transplantation. A 54-year-old woman visited our dental hospital with the chief complaint of gingival swelling on the lower right molar. The percentage of periodontal pockets with a probing depth of ≧4mm was 43.3%, and the rate of bleeding on probing (BOP) was 24.0%. After the initial periodontal therapy, we performed periodontal regeneration to some intrabony defects. As the mandibular right second premolar was diagnosed as a non-restorable tooth, we performed transplantation from the mandibular right third molar to part of the mandibular right second premolar. The patient refused orthodontic therapy and prosthetic treatment accompanied by bite-raising treatment to stabilize the occlusion. We managed the occlusal force using prosthetics without interference and an occlusal splint. She was placed on supportive periodontal therapy, and then maintained with an uneventful follow-up for 8 months. This case suggests that the control of both inflammation and occlusal force are necessary for achieving successful results of periodontal treatment.

View full abstract