Juntendo Medical Journal
Online ISSN : 2188-2134
Print ISSN : 0022-6769
ISSN-L : 0022-6769
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Volume 55, Issue 4
Displaying 1-25 of 25 articles from this issue
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Contents
  • Recent Advances in Hepatitis B Research
    TSUNEO KITAMURA
    2009 Volume 55 Issue 4 Pages 443-449
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.443
    JOURNAL FREE ACCESS
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    The hepatitis B virus (HBV) is one of the most common serious infections in humans. Chronic infection with HBV is estimated to affect 5% of the world population and is a major cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma (HCC). The first era of modern hepatitis B research began with the description of the Australia antigen by Blumberg and coworkers in 1965. HBV is a small DNA virus with unusual features similar to retroviruses and, based on sequence comparison, it has been classified into eight genotypes, A to H. Since HBV replicates through an RNA intermediate and can integrate into the host genome, clearance of HBV infection is rarely achievable. This review will focus on recent advances in HBV research and standard therapies for hepatitis B, including nucleoside analog.
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  • The Treatment Strategy of Hepatitis C
    SATOKO SUZUKI
    2009 Volume 55 Issue 4 Pages 450-455
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.450
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    Treatment of chronic hepatitis C (CHC) began with interferon (IFN) monotherapy in 1992. Sustained virological response (SVR) in patients with genotype 1 virus is known to be difficult to achieve and has been attained in only about 5% of such patients. The SVR rate has increased with administration of the antiviral drug ribavirin (RBV), and with the development of the pegylated interferon (Peg-IFN). Peg-IFN plus RBV combination therapy was accepted in December 2004 in Japan, and has also become an international standard therapy for CHC. We examined factors that determine SVR with Peg-IFN plus RBV combination therapy. The SVR rate was 44.9% following Peg-IFN plus RBV combination therapy for 48 weeks. Multivariate logistic regression analysis demonstrated that older age, degree of progression of hepatic fibrosis, low platelet count, and high viral load are factors promoting resistance to SVR. We also compared the SVR rate between 48-week and 72 -week treatment in patients with late virological response (LVR). The SVR rate in the 72 -week treatment group (67.1%) was significantly higher than that in the 48-week treatment group (46.2%). CHC patients with genotype 1 virus infection should be treated with Peg-IFN plus RBV combination therapy as early as possible, and 72 weeks of treatment is recommended in patients with LVR.
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  • Progress in Hepatocellular Carcinoma Diagnosis and Therapy
    MASAFUMI SUYAMA
    2009 Volume 55 Issue 4 Pages 456-460
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.456
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    In the diagnosis of HCC, US and sonazoid-enhanced US are more useful for characterizing hepatic tumors than multidetector-row computed tomography (MDCT). Gd-EOB DTPA is a new contrast medium for MRI. In the hepatobiliary phase, 90% of HCCs are detected as low intensity areas. Sorafenib is a multikinase inhibitor that is already used for renal cell carcinoma. In the SHARP trial, sorafenib was established as the first choice of treatment for standard of care advanced HCC patients with preserved liver function.
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  • Current Status of Liver Transplantation
    YOICHI ISHIZAKI, SEIJI KAWASAKI
    2009 Volume 55 Issue 4 Pages 461-471
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.461
    JOURNAL FREE ACCESS
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    Over the past quarter-century, liver transplantation has been established as a durable therapy for all forms of end-stage liver disease. Hepatitis C virus (HCV) infection remains the most common cause of hepatic failure requiring liver transplantation. Unfortunately however, without viral eradication before transplantation, HCV recurrence is universal and associated with poor graft and patient survival. Despite attempts to suppress HCV activity with various pretransplant and posttransplant antiviral therapies, many questions remain. Moreover, liver transplantation is considered the optimal treatment for small HCC, especially in patients with underlying chronic liver disease, since liver transplantation based on the Milan criteria has been shown to provide good disease-free survival. Living donor liver transplantation (LDLT) has been controversial since its inception. Begun in response to deceased donor organ shortage and waiting list mortality, LDLT was initiated in 1989 for pediatric cases, and then grew rapidly after its first general application in adults in Japan in 1993;however, systematic data collection using a consistent and accepted classification system in the large multicenter study has documented the frequency and severity of complications among adult LDLT donors and its use has declined since 2001 in the US. In Japan LDLT comprises about 99% of liver transplantation. Although left-lobe grafts can sometimes be small-for-size and the concept of left-lobe donation for adult recipients has now been almost completely abahdoned in Western countries, the optimal graft size for adult patients remains unclear.We have used a left-lobe graft exclusively, and have not performed right-lobe LDLT, as there is no doubt that right hepatic lobectomy places a serious burden on the donor.Thirty-three adult patients made good progress and the 1-year and 5-year patient survival rates were 100% and 95%.Left-lobe graft LDLT is still an important treatment option for adult patients.
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  • Current Status of Fundamental Palliative Care Education in Japan
    from experience of the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) project
    YOSHIYUKI KIZAWA
    2009 Volume 55 Issue 4 Pages 472-477
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.472
    JOURNAL FREE ACCESS
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    Although palliative care is assuming an increasingly important role in patient care, most physicians did not learn to provide palliative care during their medical training. To address these serious deficiencies in physician training in palliative care, the Japanese Society for Palliative Medicine has started the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) program in cooperation with the new policies of the Japanese Government, Cancer Control Act The overall goals of this project are to enhance physician competence in palliative care, foster a commitment to improving care for cancer patients, and improve the training curricula related to palliative care. The authors provide descriptions of curriculum and faculty development programs that have successfully prepared over 700 physicians as palliative care educators at institutions across Japan within a 14-month period. The PEACE Curriculum has set a standard of knowledge in the field and is an example of disseminating new information to physicians in practice.
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  • Analysis of Asbestos Research Conducted in Japan
    Analyses of The Thesaurus Found in The Literature and Free Terms Contained in The Titles
    MANABU AOKI, KIYOKO AOKI
    2009 Volume 55 Issue 4 Pages 478-486
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.478
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    Purpose : The thesaurus assigned to asbestos-related literature published in Japan was quantitatively investigated and the free terms contained in the titles of these articles were analyzed through text mining to delineate sequential trends in asbestos research. Methods : For basic data, the domestic literature was searched using the Ichushi-Web (Japan Medical Abstracts Society); and English-language literature was searched via PubMed. For analysis, text mining was conducted with the aid of Trend Search 2008 (Social Survey Research Information Co., Ltd.). Results : Since 2005, the volume of domestic literature has rapidly increased and this phenomenon can be explained by the increasing numbers of proceedings and commentaries on the subject. Using the thesaurus, a number of terms related to the ill effects on human health were extracted (e. g., “mesothelioma”, “pleural tumor”, “occupational exposure” and “lung tumor”). Among the related key words, analysis by text mining frequently detected “malignant pleural mesothelioma”, “asbestos (in a Japanese equivalent) ”, “asbestos”, “screening” and “mesothelioma”. Five subject fields were identified from network charts. Conclusion : Triggered by the “Kubota Shock” of 2005 and the implementation of the “Ordinance to Prevent Asbestosis”, the number of Japanese reports on asbestos suddenly increased. With the elaboration of the relationship between the toxicity of asbestos and mesothelioma, terms such as the latter came to appear more frequently in the thesaurus. From the network charts developed through text mining, the relationship among free terms (with special reference to malignant pleural mesothelioma) was elaborated.
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  • Assessment of Constructive Factors which May Contribute to Improve Hand Washing Compliance by Healthcare Workers in Ordinal Wards.
    YUICHI SAKIMURA, SATOSHI HORI, SYOICHI MORIMOTO, AKIRA ITO, KEIICHI HI ...
    2009 Volume 55 Issue 4 Pages 487-493
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.487
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    Objective: Hand hygiene is the most important measure in preventing the spread of infections in hospital wards. However, standards and guidelines for the number or position of hand-washing facilities used by health care providers have not been established for hospitals that plan to install or upgrade such facilities. Therefore, in this study, the behavior of ward nursing staff was examined and analyzed in hospitals with various layouts to verify the places where hand-washing facilities are necessary and to determine the optimal layout for hand-washing facilities. Subjects: Two nurses were selected for each working hour in the internal medicine wards of two acute care hospitals. Methods: The researchers followed the selected nurses to determine the flow lines, assigned duties, and rates of compliance with hand hygiene procedures. Based on the results, reallocation of the hand-washing facilities was examined. Results: Comparison of workplace-time ratios in the wards and the destination of nurses did not show any significant differences among different ward plans and among nurses. However, significant differences were observed in the rates of compliance with hand hygiene procedures. Discussion: Differences in the numbers of installed hand-washing facilities and in the education of personnel regarding the prevention of infection may be factors associated with the results. Moreover, the behavior patterns of nurses indicated that a failure to follow the prescribed hand hygiene procedures was due to the lack of hand-washing facilities on the flow line. Therefore, improvement in the allocation of funds to install hand-washing facilities in both wards was examined, and the effects after improvement were estimated. As a result, up to + 16.3 % improvement in the rate of compliance with hand hygiene procedures can be expected. Conclusion: Examination and analysis of the behaviors of nurses, clarification of the impact of the location and availability of washing facilities on hand hygiene, and the installation of hand-washing facilities in appropriate places improved the rate of compliance with hand hygiene procedures. In addition, appropriate allocation of sanitary areas and preparation areas in patients' rooms may contribute to a reduction in the risk of spreading infection.
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  • Clinical significance of trace quantities of tumor cells detected by real-time RT-PCR in bone marrow from patients with esophageal cancer
    KUNIHIRO SHINJO, YUKO (TSUTSUMI) ISHII, ISAO NAGAOKA, YOSHIAKI KAJIYAM ...
    2009 Volume 55 Issue 4 Pages 494-501
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.494
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    Objective : Esophageal cancer is still regarded as a disease with a poor prognosis. In some patients who undergo macroscopically and histopathologically curative resection, metastasis and/or recurrence have been reported. In addition, patients with identical TNM stages do not always show the same prognosis. This suggests that a trace quantity of tumor cells, undetectable by conventional clinicopathological procedures, may be present. While reports describing the detection of trace quantities of tumor cells from esophageal cancer patients have been published, the clinical significance remains unclear at present. In this study, we describe the use of real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of CEA mRNA to identify trace quantities of tumor cells in the bone marrow of patients with esophageal cancer and review the clinical significance of these findings. Materials : We studied 65 patients who underwent esophageal cancer resection with a 2- or 3-field regional lymph node dissection in our department between March 2003 and February 2004. The subjects consisted of 54 men and 11 women, aged between 39 and 80 (mean age 63.7 yrs). The postoperative follow-up period ranged from 82 to 564 days (316.6 days on average). Methods : A bone marrow sample was taken from the 4 th or 5 th rib during thoracotomy just after the initiation of surgery. Total RNA was extracted from the sample and purified, then dissolved in RNase-free water. Purity and concentration of the extracted total RNA was determined by UV absorption spectrophotometry. As a positive control for CEA mRNA, TE-9 cells were used. For the quantitative detection of CEA mRNA, reverse transcription and real-time PCR were performed using total RNA from TE-9 cells and a standard curve was drawn. The amount of CEA mRNA in the bone marrow specimen was corrected by the ratio of GAPDH mRNA, the internal standard, based on the standard curve, and the number of the cells converted to TE-9 cells was calculated. Quantitative PCR was performed in duplicate to confirm reproducibility. In addition, PCR products of the patients who were positive for CEA mRNA were subjected to 2% agarose gel electrophoresis and the presence of a 131 bp band specific to the amplification of CEA was confirmed to eliminate a false-positive reaction. Measurement and Results : Fourteen of 65 patients (21.5 %) were positive for CEA mRNA. Although there was no significant correlation between positivity for CEA mRNA and any clinicopathological factors, the positive group showed significantly poorer survival (p=0.0369). Prognosis analysis by multivariate Cox proportional-hazards model suggested that CEA mRNA positivity (p=0.031) and the number of lymph node metastases (p=0.004) were the prognostic factors. On logistic regression analysis, CEA mRNA was not a risk factor. Conclusions : The detection of a trace quantity tumor cells in bone marrow could be used as a new prognostic factor for esophageal cancer.
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  • Relationship between Negative Spillover and Depression among University Athletes
    YASUYUKI YAMADA, KODAI OKA, YUJIRO KAWATA, MOTOKI MIZUNO, MASATAKA HIR ...
    2009 Volume 55 Issue 4 Pages 502-510
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.502
    JOURNAL FREE ACCESS
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    Objective : Since university athletes must function as both students and athletes, we can assume negative Spillover will occur when a stresSful condition arises in one of these roles.This study investigated negative spillover (pilot study) and its influence on the severity of depression symptoms (main study). Participants : The participants were Japanese athletes belonging to a competitive sports club at a sports university (Pilot study=67, Main study=254). Methods : In the pilot study, we collected free descriptions of competitive stressors from Japanese university athletes.In the main study, we conducted a questionnaire survey based on these NSP items and depression scale (SDS). Results : In the pilot study, we collected descriptions relating to NSP from 38 (56.7%) reports of stress.In the main study, a factor analysis classified NSP items into psychological or physical phenomenon. In our data, the student-to-athlete psychological NSP (S-A-PsNSP) and the physicalNSP (S-A-PhNSP) were correlated with depression in all samples (r>.20, p<.05).Furthermore, in addition to these spillovers, the athlete-to-student NSP (A-S-PsNSP and A-S-PhNSP) were correlated with depression in the samples with the same competitive profile (r>.20, p<.05). Conclusions : In conclusion, our two main findings were : 1) NSP in the stress reported by university athletes was confirmed;2) NSP was one of the stress phenomena related to depression.
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  • Recognition of malfunction of implantable cardiac pacemaker due to X-ray irradiation by medical radiological technologists
    Analysis of the questionnaire survey by new graduate from schools of technologists
    TOHRU NISHIZAWA, ATSUSHI NISHIYAMA, KAZUO KEMPE, TAKASHI DAMBARA
    2009 Volume 55 Issue 4 Pages 511-514
    Published: December 31, 2009
    Released on J-STAGE: November 21, 2014
    DOIhttps://doi.org/10.14789/pjmj.55.511
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    Background : Malfunction of an implantes cardiac pacemaker may be coused by X-ray irradiation techniques such as CT scan. However, it is not clear whether this phenomenon is well recognized by medical radiological technologists. However, this issue was included on the 2008 examinations for national board of the medical radiological technologist. Purpose : To determine the percentage of radiological technologists who recognize this cause of pacemaker malfunction, we conducted questionnaire survey regarding pacemaker malfunction among new graduates undergoing the national board examination. Subjects and methods : A total of 296 graduates from 7 schools for medical radiological technologists were surveyed. The questionnare item was “what did you choose as the answer to the question related to this issue on the 2008 examination for national board.”. Results : Of 296 graduates, only 167 (56.4%) could answer correctly. The percentage of graduates answering correctly ranged from 11 to 96% among the 7 schools. Conclusion : Tmplanted cardiac pacemaker malfunction following X-ray irradiation is one of the important adverse effects of irradiation and is essential knowledge for radiological technologists. Although the percentage of correct responses to this question from the national board was not announced, our survey indicated a very important finding, and the teaching method regarding this issue requires immediate revision.
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