The Showa University Journal of Medical Sciences
Online ISSN : 2185-0968
Print ISSN : 0915-6380
ISSN-L : 0915-6380
Volume 28, Issue 1
Displaying 1-9 of 9 articles from this issue
Original
  • Shinako OHTA, Erika SUGIYAMA, Kiyomi SAITO, Kohei NAGAFUJI, Vilasinee ...
    2016 Volume 28 Issue 1 Pages 1-8
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    This study examined the effect of thiotriazinone impurity on the generation of insoluble microparticles (IMPs) associated with ceftriaxone-calcium salt precipitation in original (Rocephin®) and Japanese generic ceftriaxone (A; Sawai, B; Nichi-Iko) products when mixed with Ca2+ 4.3mEq/l. We found that the generation rate of IMPs associated with ceftriaxone-calcium salt precipitation among the three ceftriaxone products tested was in the order of generic (A)<original<generic (B), as assessed by light obscuration particle counting. Typically, after 60 min, one of the generic ceftriaxone (B)-calcium mixtures was highly opaque with numerous aggregates of milky-white precipitates, the original ceftriaxone-calcium mixture exhibited noticeable IMPs, and the second generic ceftriaxone (A)-calcium mixture was transparent. The levels of thiotriazinone contaminants, known to be a major impurity in ceftriaxone products, were determined by HPLC and found to be in the order of generic A>original>generic B. Moreover, the addition of a small amount of thiotriazinone into the generic ceftriaxone (B)-calcium mixture significantly decreased the amount of IMPs, suggesting that the impurity retards ceftriaxone-calcium crystal growth. We thus concluded that the thiotriazinone impurity acts as a suppressive factor of ceftriaxone-calcium salt precipitation, and that the high level of thiotriazinone impurity in the ceftriaxone (B) product could underlie its lowest rate of IMP generation when mixed with calcium. We thus recommend caution regarding the clinical risk of ceftriaxone-calcium compatibility due to impurity contamination in ceftriaxone products.
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  • Kengo KIMURA, Yuya NAKAMURA, Hitomi HASEGAWA, Mayumi TSUJI, Tatsunori ...
    2016 Volume 28 Issue 1 Pages 9-17
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    Linagliptin is an anti-diabetic drug and the only bile-excreted dipeptidyl peptidase-4 inhibitor. Malnutrition-inflammation-atherosclerosis syndrome is an important prognostic factor for hemodialysis patients, and we previously reported anti-inflammatory effects of linagliptin in hemodialysis patients with diabetes. Inflammation can accelerate oxidative stress, vasoconstriction, and platelet aggregation. However, few studies have investigated the pleiotropic effects of linagliptin treatment on inflammation in hemodialysis patients. In this study, we have extended our previous investigations of these effects in a longer and more thorough follow-up of hemodialysis patients with diabetes. We examined 20 hemodialysis patients with diabetes who were not receiving oral diabetes drugs or insulin therapy and who exhibited inadequate glycemic control (glycated albumin levels>20%). Linagliptin (5mg) was administered daily, and we evaluated the patients’ superoxide dismutase, 8-hydroxydeoxyguanosine, nitric oxide, nitric oxide synthase, and asymmetric dimethylarginine levels in serum at baseline and after 1, 3, and 6 months of treatment. After 6 months of treatment, superoxide dismutase levels had significantly decreased from 8.8±0.5U/ml to 7.0±0.5U/ml. Nitric oxide synthase levels were significantly increased at 3 and 6 months (maximum, 94.2±13.2µg/ml; baseline, 31.6±5.5µg/ml). After 3 months of treatment, nitric oxide levels had significantly increased from 64.5±6.6µmol/l to 104±15.4µmol/l, and remained significantly elevated at 6 months. Asymmetric dimethylarginine and 8-hydroxydeoxyguanosine levels did not change during the 6-month treatment course, and no patients exhibited hypoglycemia or other significant adverse effects. Linagliptin treatment significantly changed various markers of inflammation relevant to the atherosclerosis in malnutrition-inflammation-atherosclerosis syndrome. Therefore, linagliptin monotherapy has pleiotropic effects on inflammation in hemodialysis patients with diabetes, and may improve their prognosis.
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  • Makoto WATANABE, Masahiko MURAKAMI, Yoshiaki OZAWA, Satoru GOTO, Akira ...
    2016 Volume 28 Issue 1 Pages 19-30
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    To evaluate prognostic factors for recurrence after tegafur-uracil plus leucovorin (UFT/LV) adjuvant chemotherapy in patients with colorectal cancer (CRC). Consecutive patients with CRC who received UFT/LV as adjuvant chemotherapy at Showa University Hospital between June 2005 and December 2008 were included in the study, 5-year disease-free survival (DFS) and overall survival (OS) rates were estimated, and prognostic factors for recurrence were analyzed using the Cox proportional hazards model for multivariate analysis. Of 92 patients included in the study, 17 (18.5%) had disease recurrence. The 5-year DFS and OS rates were 82.2% and 91.9%, respectively. In the multivariate analysis, preoperative CA19-9 level>37U/ml, emergency operation, and T4 lesions were independent significant prognostic factors after treatment with UFT/LV adjuvant chemotherapy. The three independent prognostic factors —T4 lesions, emergency operation, and high preoperative CA19-9 levels— may be useful for decision-making regarding whether patients should receive 5-fluouracil-based or L-oxaliplatin-based adjuvant chemotherapy. As this was a single-institution study with a small number of patients, our findings need to be confirmed in larger multicenter studies.
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  • Hiromi DATE, Masahiko MURAKAMI, Makoto WATANABE, Satoru GOTO, Kimiyasu ...
    2016 Volume 28 Issue 1 Pages 31-37
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    Maintaining a long transnasal ileus tube for a long period can be quite painful for patients such as in those with refractory intestinal obstruction and peritonitis carcinomatosa and it can markedly decrease quality of life (QOL) due to unexpected respiratory complications associated with the tube placement. To mitigate such complications, we undertook a trial insertion of a long ileus tube by gastrostomy in five patients with refractory intestinal obstruction (four cases of peritonitis carcinomatosa and one case of chronic intestinal pseudo-obstruction). We inserted the transgastric ileus tube using a percutaneous gastrostomy catheter kit after puncture with a plastic skin (PS) needle covered with a protective sheath, and then endoscopically placed the tube beyond the ligament of Treitz. Subsequently, we removed the long transnasal ileus tube, and comparable decompression was achieved. In all cases, the entire procedure was easily performed with no complications. Moreover, patients experienced reduced pain and stress and they were able to regain some freedom during activity.
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  • Eri KAWASHIMA
    2016 Volume 28 Issue 1 Pages 39-53
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    In vivo cryotechnique (IVCT) and cryobiopsy are useful to examine native immunolocalizations of serum proteins in tissues of animal organs, reflecting their living states. We used both methods to examine some immunolocalized proteins in living rat kidneys with nephropathy induced by puromycin aminonucleoside (PAN) administration. At day 3 or 9 after intraperitoneal PAN injection, IVCT was performed on the kidneys of anesthetized rats. Urinary proteins excretions increased at day 3 and exceeded 300mg/day at day 9. Moreover, blood chemistry analyses indicated hypoalbuminemia and renal dysfunction at day 9. At day 3, minimal morphological changes were detected by hematoxylin-eosin (HE) staining, but albumin and immunoglobulin G1 (IgG1) were immunolocalized along the cytoplasm of podocytes and in the apical parts of proximal convoluted tubule epithelial cell. At day 9, erythrocyte intravascular congestion was observed in almost all of the glomerular basement membranes (GBMs), with casts in some renal tubules also immunostained for albumin and IgG1. The relative immunoreactivities of albumin and IgG1 were weaker within GBMs, and the deposited renal tubule casts were strongly immunostained, indicating relatively different protein concentrations. Thus, these techniques revealed dynamically changing processes of protein excretion and reabsorption in various nephron segments that enable us to examine the morphofunctional features of animal kidneys in other renal diseases.
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  • Akifumi NIIYA, Yoshimitsu OHGIYA, Noritaka SEINO, Takehiko GOKAN
    2016 Volume 28 Issue 1 Pages 55-62
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    A final diagnosis of bladder cancer is made based on a pathological assessment using cystoscopy and biopsy. Recently, computed tomography (CT) and magnetic resonance imaging (MRI) have become widely used as screening tests for hematuria, and there are scattered reports of new imaging modalities such as CT urography (CTU) and diffusion-weighted MRI being useful in the detection of bladder cancer. However, there are no reports comparing CTU and MRI in this context. In the present study, we compared the bladder cancer detection abilities of CTU and MRI. We analyzed 58 cases of bladder cancer that had been examined by both CTU and bladder MRI. The objects of comparison were T2-weighted images and diffusion-weighted images for MRI and contrast CT images of the renal parenchyma and excretory phases for CTU. Bladder cancer was confirmed histopathologically via either biopsy or surgery for all cases. For patients with multiple bladder cancer, up to three lesions per case were included in the analysis. Two independent readers assessed all cases. Out of 91 lesions from 58 cases, Reader 1 detected 72 (79.1%) and 65 cases (71.4%), and Reader 2 detected 69 (75.8%) and 70 (76.9%), using MRI and CTU, respectively. The κ-values for Reader 1 versus Reader 2 were 0.780 for MRI and 0.857 for CT, showing high diagnostic consistency. MRI showed a higher lesion detection rate than CTU, but this difference was not statistically significant. This study showed no significant difference in bladder cancer detection rate between CTU and MRI, confirming the value of MRI in the clinical diagnosis of bladder cancer.
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  • Masahiro KOHMOTO, Masahiko MURAKAMI, Koji OTSUKA, Satoru GOTO, Tomotak ...
    2016 Volume 28 Issue 1 Pages 63-72
    Published: 2016
    Released on J-STAGE: November 30, 2016
    JOURNAL FREE ACCESS
    Esophagectomy for esophageal cancer is one of the most invasive gastrointestinal surgeries. In 1996, we introduced video-assisted thoracic surgery for esophageal cancer (VATS-E) to reduce surgical stress. In 2010, we started employing artificial pneumothorax (AP) using carbon dioxide gas in VATS-E to further reduce surgical stress. In this study, we evaluated interleukin-6 (IL-6) levels in pleural cavity lavage fluid (PLF) of patients undergoing VATS-E with or without AP, and examined the effect of AP on VATS-E-induced stress. This non-randomized study included patients who underwent VATS-E with or without AP at Showa University Hospital between 2009 and 2013 and from whom PLF could be collected. IL-6 concentrations in PLF were examined before and after the thoracic part of the operation. We compared IL-6 variation, defined as the difference between IL-6 concentrations in PLF before and after the thoracic part of the operation, between patients for whom AP was used and those for whom it was not used. A total of 52 patients were included in the study; 26 underwent VATS-E with AP (group AP), and 26 underwent VATS-E without AP (group NP). IL-6 concentrations in PLF were significantly elevated immediately after the thoracic part of the operation in both groups. IL-6 variation in PLF correlated with both thoracic operative time and blood loss, which were considered practical parameters of surgical stress, and was significantly lower in group AP than in group NP. In conclusion, IL-6 variation in PLF is a useful and sensitive maker of surgical stress during VATS-E. VATS-E with AP is less invasive than VATS-E without AP because AP lowers the perioperative systemic inflammatory response to thoracic surgery.
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Transactions of The Showa University Society: The 325th Meeting
Transactions of The Showa University Society: The 326th Meeting
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