In late years the prevalence of the Japanese cedar pollinosis increases in 26%, and importance of allergic rhinitis treatment increases more and more. We got possible to conduct standard treatment based on a guideline. However, the satisfaction of patients with pollinosis has a report not to be high at all. When it aims for a high medical care of the patients satisfaction, it is important to evaluate a therapy objectively. Standard QOL (Quality of life) questionnaire for the allergic rhinitis (JRQLQ) was completed in 2002. We can compare degree of improvement degree of the QOL if we use this QOL questionnaire. Also, the reduction of the labor productivity due to the allergic rhinitis is recognized as a social issue, too. As new therapy for Japanese cedar pollinosis, sublingual immunotherapy attracts attention. After 2003, clinical studies were conducted led by a research group of Ministry of Health, Labour and Welfare. Improvement of the QOL of patients with allergic rhinitis and improvement of the satisfaction are expected by the development of the new regimen advancing.
Various molecularly targeted drugs are now in clinical use in Japan. These agents are generally more effective than previous drugs but are more expensive. Several recent studies have examined the cost-effectiveness of using molecularly targeted drugs in cancer treatment. Herein, we discuss reports about the use of trastuzumab for early-stage breast cancer, lapatinib for advanced breast cancer, and bevacizumab for advanced non-small cell lung cancer.
We launched the Inba Clinical Pathway for local Stroke network (InCliPS) as a stroke liaison critical pathway (SLCP) in northwest Chiba Prefecture on March 10, 2008. The aim of this study was to investigate the effects of the InCliPS on the length of hospitalization and on outcomes in stroke patients. We reviewed 1,599 consecutive patients with acute stroke admitted to Nippon Medical School Chiba Hokusoh Hospital from January 2007 through December 2009. The InCliPS was applied to 24.4% of patients in 2008 and to 32.7% of patients in 2009. The mean length of acute hospitalization was 20.8±15.2 days in 2007, 19.8±14.5 days in 2008, and 19.1±12.5 days in 2009 and had, therefore, decreased by 1.7 days over 3 years. In patients for whom the InCliPS path sheets were used, the mean length of hospitalization was 30.3±17.2 days in 2008 and 26.6±13.5 days in 2009. In 181 cases, the patients satisfied the applicable criteria for the InCliPS but the path sheets were not used. The mean length of hospitalization of these patients was 19.7±12.8 days in 2008 and 20.9±12.2 days in 2009. The modified Rankin scale at discharge from the acute hospital and the rehabilitation hospitals did not differ significantly between 2008 and 2009. Our data show that the SLCP contributes to the efficiency of regional stroke care. For constructing evidence for a medical network, however, better systems are needed to evaluate the efficacy of the SLCP.
A 70-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopy revealed an advanced tumor at the middle and lower third of the esophagus, and pathological examination of the biopsy specimens revealed a moderately-differentiated squamous cell carcinoma. Computed tomography of the chest showed cT3N1M0, cStage III. The patient rejected radical esophagectomy, and received definitive chemoradiotherapy (CRT) with docetaxel, nedaplatin and 5-FU. Follow-up examinations after CRT evaluated a partial response. However, an endoscope could not pass through the stricture in the esophagus. The patient underwent single-port gastrostomy to improve nutritional status and hypoproteinemia. On 5 months after CRT, the patient has improved nutritional condition, and laparoscopy assisted esophageal bypass operation was performed. Postoperatively, the patient was able to eat most foods for 9 months. The patient died by the carcinomatosis 10 months after bypass operation.
Phototrophic organisms including land plants, algae, and photosynthetic bacteria can synthesize carotenoids for photosynthesis. A part of bacteria and fungi also synthesize carotenoids. On the other hand, animals cannot synthesize carotenoids, and they ingest carotenoids from foods. Most animals can modify the carotenoids, such as oxidation and reduction. Humans contain usually six kinds of carotenoids: β-carotene, α-carotene, lycopene, β-cryptoxanthin, zeaxanthin, and lutein. Furthermore in this paper, functions of carotenoids in animals especially humans are briefly summarized: Carotenoids are essential for organisms living under oxygen to prevent active oxygen. β-Carotene is cleaved into retinal by β-carotene-15,15'-monooxygenase. Retinal is used as photoreceptor in eye. Lutein and zeaxanthin are accumulated in macula of eye for prevent blue light. From epidemiology, carotenoids in vegetables have anticancer activities. Lycopene might prevent prostatic cancer. Some carotenoids have also functions, such as antioxidant, anticancer, and anti-obesity.
Remarkable progress has been recently achieved in neuroimaging of Alzheimer's disease prominently in MRI and amyloid PET imaging. We reviewed current morphological and functional MRI and amyloid PET imaging with attention to Pittsburgh compound-B (PiB), the most extensively investigated and validated tracer. Automated voxel-based morphometry of brain MRI has been prevailed in Japan using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) for the sensitive detection of selective atrophy in medial temporal structures. Arterial spin labeling technique for the evaluation of brain perfusion without any contrast material may replace FDG-PET or brain perfusion SPECT. PiB specifically binds to fibrillar beta-amyloid deposits in such as those found in the cerebral cortex and striatum. PiB-PET imaging is a sensitive and specific biological marker for underlying amyloid deposition that is an early event on the path to dementia. Amyloid imaging in healthy controls and mild cognitive impairment patients may offer the possibility detecting those at high risk of future AD, as so candidates for early preventive measures if and when they become available.