The Kobe Journal Of Medical Sciences[JOURNAL]
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200 papers
Exploring a Novel Screening Method for Patients with Oral Squamous Cell Carcinoma: A plasma Metabolomics Analysis.
Enomoto Y, Kimoto A, Suzuki H … +3 more , Nishiumi S, Yoshida M, Komori T
Kobe J Med Sci · 2018 Sep · PMID 30282895
AIM: This study aimed to explore novel metabolite biomarker candidates for screening oral squamous cell carcinoma (OSCC). PATIENTS & METHODS: We collected plasma samples from 48 patients with OSCC and 29 with an oral dis...
AIM: This study aimed to explore novel metabolite biomarker candidates for screening oral squamous cell carcinoma (OSCC). PATIENTS & METHODS: We collected plasma samples from 48 patients with OSCC and 29 with an oral disease and conducted a plasma metabolomics analysis of patients with OSCC using gas chromatography mass spectrometry. Then, we used the cross-validation procedure to ensure the accuracy of biomarker candidates. RESULTS: We selected four biomarker candidates against OSCC. Their sensitivity was more than 90%, and the AUC was over 0.9 according to the receiver operating characteristic curve analysis. CONCLUSIONS: The findings of this study suggest four potential metabolites as biomarkers for OSCC screening.
Hyperbilirubinemia in Term Newborns Needing Phototherapy within 48 Hours after Birth in a Japanese Birth Center.
Tsujimae S, Yoshii K, Yamana K … +3 more , Fujioka K, Iijima K, Morioka I
Kobe J Med Sci · 2018 Sep · PMID 30282894
BACKGROUND: Hyperbilirubinemia in term newborns needing phototherapy within 48 hours after birth, early-onset hyperbilirubinemia, has not been evaluated in recent Japanese healthy birth centers. In this study, we sought...
BACKGROUND: Hyperbilirubinemia in term newborns needing phototherapy within 48 hours after birth, early-onset hyperbilirubinemia, has not been evaluated in recent Japanese healthy birth centers. In this study, we sought to determine the cause of early-onset hyperbilirubinemia in a Japanese healthy birth center and to evaluate the 1992 Kobe University phototherapy treatment criterion requiring total serum bilirubin (TSB) and unbound bilirubin (UB). METHODS: In this retrospective observational study, we collected data on newborns diagnosed with early-onset hyperbilirubinemia between 2009 and 2016 at the Chibune General Hospital. Causes of the disease were investigated, as well as which index (TSB or UB) was used for treatment decisions. RESULTS: Overall, 76 term newborns were included in the analysis. Twenty-seven newborns (36%) found the cause (ABO blood type incompatibility [n=17, 22%], polycythemia [n=8, 11%], and cephalohematoma [n=2, 3%]). However, 49 newborns (64%) did not find any causes (i.e., idiopathic hyperbilirubinemia). Of these, 27 observed more than 5% weight loss from birth weight. Seventy (92%) newborns had abnormal TSB only, and 5 (7%) had abnormal TSB and UB values. Only 1 (1%) newborn with only abnormal UB values received phototherapy. CONCLUSIONS: Altogether, data from this Japanese healthy birth center suggest that many apparently healthy newborns with or without excessive weight loss develop early-onset hyperbilirubinemia. In the 1992 Kobe University phototherapy treatment criterion, TSB, not UB, was the main index used to make treatment decisions in these patients.
Associated Factors of Psychological Distress among Japanese NICU Nurses in Supporting Bereaved Families Who Have Lost Children.
Kitao M, Setou N, Yamamoto A … +1 more , Takada S
Kobe J Med Sci · 2018 Jun · PMID 30282893
PURPOSE: This study aimed (1) to examine the current status of psychological distress experienced by neonatal intensive care unit (NICU) nurses in supporting bereaved families, (2) to identify the factors associated with...
PURPOSE: This study aimed (1) to examine the current status of psychological distress experienced by neonatal intensive care unit (NICU) nurses in supporting bereaved families, (2) to identify the factors associated with psychological distress, and (3) to understand the professional characteristics of nurses experiencing high psychological distress by comparing the study results with those of pediatricians. METHODS: We sent questionnaires to 64 NICUs. The psychological distress of nurses was classified into two groups based on the frequency of psychological distress experienced and analyzed using the χ2 test and Fisher's exact test. A multiple logistic regression analysis was used to investigate the factors related to psychological distress. RESULTS: Of the 384 nurse respondents, 190 (49.5%) reported having supported bereaved families, 169 of who were included in the analysis. A total of 123 nurses (72.8%) reported high levels of psychological distress. Our study revealed that the use of coping methods is associated with high psychological distress. The comparison with pediatricians revealed that nurses were significantly more likely to be female and had fewer years of working experience. Nurses were also significantly more likely to use coping methods and to experience high psychological distress. CONCLUSION: Clarifying the coping methods for psychological distress in supporting bereaved families may be necessary, and nurses need to identify appropriate coping methods. In nursing education, information on psychological distress related to children's deaths and bereavement care should be conveyed from the early stage and nurses must obtain preliminary knowledge. The creation of a bereavement follow-up system is recommended.
The Correlation Between Length of Work and Nasal Mucociliary Transport Time of Gas/Fuel Station Workers.
Rianto BUD, Yudhanto D, Herdini C
Kobe J Med Sci · 2018 May · PMID 30282892
Gasoline contains toxic substances such as benzene, toluene, ethylbenzene, xylene (BTEX) that negatively influence gas/fuel station workers' health via continuous inhalation, causing loss of cilia and epithelial cell nec...
Gasoline contains toxic substances such as benzene, toluene, ethylbenzene, xylene (BTEX) that negatively influence gas/fuel station workers' health via continuous inhalation, causing loss of cilia and epithelial cell necrosis of the nasal mucosa. The aim of this study is to determine the correlation between length of work with nasal mucociliary transport time (NMCTT) of the gas/fuel station workers This study used a cross sectional design. The data were obtained from anamnesis, physical and NMCTT examinations of gas station workers in Yogyakarta, during November 2013. Inclusion criteria were: 1) 18-55 years old, 2) free of nasal topical medication for 10 days. Exclusion criterion: 1) acute rhinitis, 2) chronic sinusitis, 3) ever had nasal trauma, 4) ever had nasal surgery, 5) allergic rhinitis, and/or 6) septal deviation. Correlation analyses between length of work and NMCTT of gas station workers used Spearman correlation test with α 5% level of significance (p < 0.05). From 38 subjects, 27 (71.1%) were men and 11 (28.9%) women. Median length of work was 7.37 years, and NMCTT: 10.84 ± 5.60 minutes. Spearman's correlation test results between length of work and NMCTT showed (R): 0.578 (p = 0.001). Based on the results of this study, it can be concluded that there is a positive correlation between length of work with NMCTT of gas station workers.
Ultrasound and MRI Findings of Twin Pregnancies with Complete Hydatidiform Mole and Coexisting Normal Fetus: Two Case Reports.
Imafuku H, Miyahara Y, Ebina Y … +1 more , Yamada H
Kobe J Med Sci · 2018 May · PMID 30282891
BACKGROUND: Both twin pregnancies with complete hydatidiform mole and coexisting normal fetus (CHMCF) and partial hydatidiform mole can be found in association with a live fetus and a placenta displaying a molar degenera...
BACKGROUND: Both twin pregnancies with complete hydatidiform mole and coexisting normal fetus (CHMCF) and partial hydatidiform mole can be found in association with a live fetus and a placenta displaying a molar degeneration. Two cases of CHMCF using magnetic resonance imaging (MRI) for a diagnosis are reported. CASE: In the first, CHMCF was suspected at 12 weeks of gestation. At 18 weeks of gestation, the existence of molar placenta and a sac separating from fetus and normal placenta was clearly depicted on MRI. At 19 weeks of gestations, she had termination of pregnancy because of a development of gestational trophoblastic neoplasia (GTN) and started chemotherapy. In the second case, CHMCF was suspected at 14 weeks of gestation. MRI demonstrated the existence of molar placenta and a sac separating from fetus and normal placenta. She chose induced abortion and there was no evidence of GTN during the 1 year-follow up period. Pathological examination in both cases was consistent with a complete hydration mole and a coexisting normal female fetus. CONCLUSION: MRI was useful for an accurate diagnosis for CHMCF.
Essential Role of Sphingosine Kinase 2 in the Regulation of Cargo Contents in the Exosomes from K562 Cells.
Mohamed NNI, Okada T, Kajimoto T … +1 more , Nakamura SI
Kobe J Med Sci · 2018 May · PMID 29955024
Sphingosine 1-phosphate (S1P) is a bioactive phosphorylated product of sphingosine catalyzed by sphingosine kinase (SphK) and implicated in diverse cellular functions including vesicular trafficking. In the present study...
Sphingosine 1-phosphate (S1P) is a bioactive phosphorylated product of sphingosine catalyzed by sphingosine kinase (SphK) and implicated in diverse cellular functions including vesicular trafficking. In the present study we have shown the importance of one of the subtypes of SphK, SphK2, in the regulation of cargo content in exosomes released from human myeloid leukemia K562 cells. First, SphK2 has been shown to localize with N-Rh-PE-positive late endosomes in the cells. Next, siRNA-mediated knockdown of Sphk2 but not SphK1 resulted in a reduction of cargo content in purified exosomes. The involvement of SphK2 in this phenomenon was further investigated by pharmacological approaches. When cells were treated with N,N-dimethylsphingosine (DMS), one of the most frequently used inhibitors for SphK, cargo contents in purified exosomes were enhanced unexpectedly. Finally, it has been shown that DMS has a potency to stimulate SphK2 activity depending on the substrate sphingosine- and the inhibitor-doses as estimated by in vitro assay systems using a purified SphK2. These findings suggest that SphK2/S1P signaling plays an important role in the regulation of cargo content in exosomes in K562 cells.
Modified TALK Score for Japanese Patients with Laryngeal and Hypopharyngeal Cancers to Predict the Possibility of Laryngeal Preservation by Concurrent Chemoradiotherapy.
Otsuki N, Matsui M, Takahashi M … +4 more , Sasaki R, Kiyota N, Usami M, Nibu KI
Kobe J Med Sci · 2018 Apr · PMID 29955023
OBJECTIVE: TALK score has been developed as an index for predicting the possibility of larynx preservation and prognosis of the patients with advanced laryngeal and hypopharyngeal cancers treated by concurrent chemoradio...
OBJECTIVE: TALK score has been developed as an index for predicting the possibility of larynx preservation and prognosis of the patients with advanced laryngeal and hypopharyngeal cancers treated by concurrent chemoradiotherapy (CCRT). In this study, we validated the original TALK score in our clinical setting and modified the score for Japanese population. METHODS: The subjects were 21 patients with laryngeal cancer and 50 patients with hypopharyngeal cancer who underwent CCRT at Kobe University Hospital between April 2007 and August 2012. Data regarding T stage, serum albumin level just before treatment, maximum alcohol use, Karnofsky Performance Status (KPS), 3-year overall survival rate and 3-year larynx-preservation rate were collected from medical records. In the revised TALK score (JTALK), the following scoring criteria were modified to adjust Japanese population: T stage of the primary tumor (≥T3), serum albumin level (<3.5 g/dl), maximum alcohol use (≥one 350-ml can of beer/day or an equivalent amount), and KPS (<80%). RESULTS: The original TALK score was not significantly associated with the larynx preservation rates or survival rates for laryngeal cancer or hypopharyngeal cancer. Instead, JTALK score was significantly associated with the 3-year larynx preservation rates and 3-year survival rates of the patients with hypopharyngeal and laryngeal cancer. CONCLUSION: These results indicate that JTALK score could be a useful index for predicting the possibility of larynx preservation and prognosis of Japanese patients with advanced laryngeal and hypopharyngeal cancer treated by CCRT.
A Case of Congenital Complete Atrioventricular Block Treated with Transdermal Tulobuterol.
Ikuta T, Fujioka K, Sato Y … +11 more , Ashina M, Fukushima S, Ohyama S, Okubo S, Yamana K, Morizane M, Tanimura K, Deguchi M, Iijima K, Morioka I, Yamada H
Kobe J Med Sci · 2018 Apr · PMID 29955022
Congenital complete atrioventricular block (CCAVB) is a condition in which the atria and ventricles beat independently of each other. CCAVB cases require permanent pacemaker implantation until adulthood. Nevertheless, co...
Congenital complete atrioventricular block (CCAVB) is a condition in which the atria and ventricles beat independently of each other. CCAVB cases require permanent pacemaker implantation until adulthood. Nevertheless, consensus regarding postnatal medical therapy for bradycardia has not been reached. Here we report the case of a newborn with CCAVB, whose intractable bradycardia was successfully treated with transdermal tulobuterol. Tulobuterol is a selective β2-adrenoceptor agonist, widely used safely as bronchodilator in children. It also has positive inotropic and chronotropic effect via β1-adrenoceptors. We believe the tulobuterol patch can be used as an optional therapy for CCAVB where pacemaker implantation is not available.
Nontypeable Haemophilus Influenzae Sepsis in a Term Neonate.
Okubo S, Fujioka K, Yamane M … +8 more , Ashina M, Fukushima S, Ikuta T, Ohyama S, Yamana K, Kobayashi A, Iijima K, Morioka I
Kobe J Med Sci · 2018 Apr · PMID 29955021
We reported a term newborn case of early onset sepsis caused by nontypeable Haemophilus Influenzae (NTHi) with massive bacterial invasion in the placenta. Based on the consistent results of maternal placental pathology a...
We reported a term newborn case of early onset sepsis caused by nontypeable Haemophilus Influenzae (NTHi) with massive bacterial invasion in the placenta. Based on the consistent results of maternal placental pathology and neonatal bacterial culture, we diagnosed this as vertical transmission of NTHi via vaginal delivery. In general, NTHi infections occur in preterm infants, and our term infant case is very unusual. In conclusion, clinicians should consider NTHi as a cause of neonatal sepsis, even in term infants.
Bronchoscopy Using Virtual Navigation and Endobronchial Ultrasonography with a Guide Sheath (EBUS-GS) with or without Fluoroscopy for Peripheral Pulmonary Lesions.
Tachihara M, Tamura D, Kiriu T … +9 more , Tokunaga S, Hatakeyama Y, Shinke H, Nagano T, Nakata K, Hazeki N, Kamiryo H, Kobayashi K, Nishimura Y
Kobe J Med Sci · 2018 Mar · PMID 29955020
OBJECTIVE: Endobronchial ultrasonography and guide sheath (EBUS-GS) technique has high diagnostic yield in lung nodules. Virtual bronchoscopic navigation (VBN) can lead bronchoscope to the target bronchi. The aim of this...
OBJECTIVE: Endobronchial ultrasonography and guide sheath (EBUS-GS) technique has high diagnostic yield in lung nodules. Virtual bronchoscopic navigation (VBN) can lead bronchoscope to the target bronchi. The aim of this prospective study was to compare the diagnostic yield of two bronchoscopic procedures: bronchoscopy under EBUS-GS and VBN with or without x-ray fluoroscopy in small peripheral pulmonary lesions (PPLs, ≤30mm) with apparent CT-bronchus sign. METHODS: 31 patients with PPLs which had apparent CT-bronchus sign were randomly assigned to the X-ray or the non-X-ray groups (18 with and 13 without fluoroscopy) between September 1, 2012, and September 30, 2015. A bronchoscope was introduced into the target bronchus using the VBN system. Sites of specimen sampling were verified using EBUS-GS with or without fluoroscopy. RESULTS: The overall diagnostic yield was 83.3% in the X-ray and 69.2% in the non-X-ray group. The diagnostic yield of malignancy was 88.2% and 81.8%, respectively. The duration of the examination and time elapsed until the first EBUS visualization were similar in the X-ray and the non-X-ray group (9.0 (5.8-20.) min vs 11.0 (5.3-17.3) min, and 2.5 (1.3-14.2) min vs 4.1 (1.4-8.1) min, respectively). The fluoroscopy exposure time was 3.7 (2.9-10.56) min. The only adverse event was mild pneumothorax in a patient from the non-X-ray group, who had consequent TBB under fluoroscopy. CONCLUSIONS: There was a possibility that VBN-guided EBUS-transbronchial diagnosis without fluoroscopy might be equivalent to that under fluoroscopy. Further multi-center randomized study may be desired. (UMIN000008592).
Efficacy of Hepatitis B Vaccination among Children in Special Region of Yogyakarta, Indonesia: Evaluation of Humoral and Cellular Immunity.
Pronocitro C, Mulyani NS, Ghufron AA … +3 more , Hazazi YH, Ardianto B, Heriyanto DS
Kobe J Med Sci · 2018 Jan · PMID 29434181
Hepatitis B remains a global burden, with estimated 15 to 40 percents of infected individuals eventually suffer from liver cirrhosis, liver failure, and hepatocellular carcinoma. Vaccination aims to form anti-HBs antibod...
Hepatitis B remains a global burden, with estimated 15 to 40 percents of infected individuals eventually suffer from liver cirrhosis, liver failure, and hepatocellular carcinoma. Vaccination aims to form anti-HBs antibody with protective titer to prevent infection. CD4 T cell lymphocytes are known to play a major role in establishing immunity after vaccination. This study aimed to investigate protective titer rate among Indonesian children in Special Region of Yogyakarta following hepatitis B vaccination and correlation between anti-HBs titer and CD4 count. This is a cross-sectional study with 52 subjects between 8 months to 5 years of age in Bungas Community Health Service, Special Region of Yogyakarta, Indonesia. Anti-HBs titer was examined using enzyme immunoassay and CD4 count was examined using immunocytochemistry method. Of 52 subjects, median anti-HBs titer was 72.965 IU/L (interquartile range 360.98), mean CD4 count was 49.73% ± 29.75. Protective level of antibody was found in 73.1% of subjects. Correlation test was conducted and no correlation was found between anti-HBs titer and CD4 count (r=-0.104, p=0.464). Age was found to have a weak negative correlation with anti-HBs titer (r=-0.367, p=0.007). We found high rate of protective titer among children in Special Region of Yogyakarta who have completed hepatitis B vaccination series. No correlation was established between anti-HBs titer and CD4 count.
Evaluation of a Small Animal Irradiation System for Animal Experiments Using EBT3 Model GAFCHROMIC™ Film.
Shimizu Y, Akasaka H, Miyawaki D … +10 more , Mukumoto N, Nakayama M, Wang T, Osuga S, Inubushi S, Yada R, Ejima Y, Yoshida K, Ishihara T, Sasaki R
Kobe J Med Sci · 2018 Jan · PMID 29434180
In cancer research, small animal models, for example, mice, rats, or rabbits, facilitate the in-depth study of biological processes and the effects of radiation treatment that can lead to breakthrough discoveries. Howeve...
In cancer research, small animal models, for example, mice, rats, or rabbits, facilitate the in-depth study of biological processes and the effects of radiation treatment that can lead to breakthrough discoveries. However, the physical quality of small animal irradiation systems has not been previously evaluated. In this study, we evaluate the quality of a small animal irradiation system using GAFCHROMIC™ film and a Tough Water Phantom. The profiles and percentage depth dose curves for several irradiation conditions were measured to evaluate the quality of the irradiation system. The symmetry ratios when the table was rotated were 1.1 (no filter), 1.0 (0.5 mm Al filter), 1.0 (1.0 mm Al filter), 1.1 (2 mm Al filter), and 1.0 (filter consisting of 0.5 mm Al combined with 0.1 mm Cu). The results of measuring the percentage depth dose curve showed that the relative doses were 17.5% (10 mm depth), 12.4% (20 mm depth), 9.5% (30 mm depth), and 7.4% (40 mm filter) with no filters inserted, 78.0% (10 mm depth), 61.1% (20 mm depth), 46.9% (30 mm depth), and 35.3% (40 mm depth) when a 1.0 mm Al filter was inserted, and 94.4% (10 mm depth), 81.7% (20 mm depth), 68.1% (30 mm depth), and 54.7% (40 mm depth) when a filter consisting of 1.0 mm Al combined with 0.2 mm Cu was inserted. These physical assessments seem to be necessary especially in vivo experiments because those increase reliability of data obtained from small animal irradiation systems.
SMA Diagnosis: Detection of SMN1 Deletion with Real-Time mCOP-PCR System Using Fresh Blood DNA.
Niba ETE, Ar Rochmah M, Harahap NIF … +10 more , Awano H, Morioka I, Iijima K, Saito T, Saito K, Takeuchi A, Lai PS, Bouike Y, Nishio H, Shinohara M
Kobe J Med Sci · 2017 Dec · PMID 29434179
BACKGROUND: Spinal muscular atrophy (SMA) is one of the most common autosomal recessive disorders. The symptoms are caused by defects of lower motor neurons in the spinal cord. More than 95% of SMA patients are homozygou...
BACKGROUND: Spinal muscular atrophy (SMA) is one of the most common autosomal recessive disorders. The symptoms are caused by defects of lower motor neurons in the spinal cord. More than 95% of SMA patients are homozygous for survival motor neuron 1 (SMN1) deletion. We previously developed a screening system for SMN1 deletion based on a modified competitive oligonucleotide priming-PCR (mCOP-PCR) technique using dried blood spot (DBS) on filter paper. This system is convenient for mass screening in the large population and/or first-tier diagnostic method of the patients in the remote areas. However, this system was still time-consuming and effort-taking, because it required pre-amplification procedure to avoid non-specific amplification and gel-electrophoresis to detect the presence or absence of SMN1 deletion. When the fresh blood samples are used instead of DBS, or when the gel-electrophoresis is replaced by real-time PCR, we may have a simpler and more rapid diagnostic method for SMA. AIM: To establish a simpler and more rapid diagnostic method of SMN1 deletion using fresh blood DNA. METHODS: DNA samples extracted from fresh blood and stored at 4 ℃ for 1 month. The samples were assayed using a real-time mCOP-PCR system without pre-amplification procedures. DNA samples had already been genotyped by PCR-restriction fragment length polymorphism (PCR-RFLP), showing the presence or absence of SMN1 exon 7. The DNA samples were directly subjected to the mCOP-PCR step. The amplification of mCOP-PCR was monitored in a real-time PCR apparatus. RESULTS: The genotyping results of the real-time mCOP-PCR system using fresh blood DNA were completely matched with those of PCR-RFLP. In this real-time mCOP-PCR system using fresh blood-DNA, it took only four hours from extraction of DNA to detection of the presence or absence of SMN1 deletion, while it took more than 12 hours in PCR-RFLP. CONCLUSION: Our real-time mCOP-PCR system using fresh blood DNA was rapid and accurate, suggesting it may be useful for the first-tier diagnostic method of SMA.
A Case Series of Fibro-Osseous Lesions of the Jaws.
Akashi M, Matsuo K, Shigeoka M … +5 more , Kakei Y, Hasegawa T, Tachibana A, Furudoi S, Komori T
Kobe J Med Sci · 2017 Dec · PMID 29434178
The aim of this case series was to reveal the difficulties in diagnosing fibro-osseous lesions with radiological and histopathological examinations and quantify the potential risk of infection to fibro-osseous legions. T...
The aim of this case series was to reveal the difficulties in diagnosing fibro-osseous lesions with radiological and histopathological examinations and quantify the potential risk of infection to fibro-osseous legions. To analyze the concordance between radiological and histopathological diagnoses, this retrospective case series included patients who were clinically diagnosed with fibro-osseous lesions via radiological findings and excluded the patients who did not undergo histopathological examinations. This study also included the patients in whom histopathological results confirmed fibro-osseous legions when preoperative radiological diagnosis did not include fibro-osseous legions. Eleven patients (three men, eight women; median age 24.5 years, range 15-57 years) were enrolled. Although radiological diagnoses of fibrous dysplasia (FD) corresponded with histopathological diagnoses in seven patients, mismatches between radiological findings and histopathological results were found in three patients. In one patient, suspected diagnosis with radiological examinations was malignant lymphoma or FD. In two patients, the histopathological differentiation between FD and ossifying fibroma (OF) was difficult. One patient had lesion recurrence which was suspected to be OF with surgical findings and postoperative course after the initial surgery. In three patients, infections of FD were found. Preoperative diagnosis of OF with radiographic feature of unilocular radiolucency is difficult. In cases in which histopathological differentiation between FD and OF is difficult, operative findings should be used because OF is often found to be well-encapsulated and easily enucleated. Bone in FD showing mixed radiolucent-radiopaque may be vulnerable to infection.
The Role of Electrophysiological Severity Scales for Decision-making with Regard to Surgery in Idiopathic Carpal Tunnel Syndrome.
Kanatani T, Nagura I, Harada Y … +1 more , Sumi M
Kobe J Med Sci · 2017 Dec · PMID 29434177
The distribution of electrophysiological severity of carpal tunnel syndrome (CTS) in an outpatient setting and whether electrophysiological severity could be an objective tool for decision-making regarding choice of surg...
The distribution of electrophysiological severity of carpal tunnel syndrome (CTS) in an outpatient setting and whether electrophysiological severity could be an objective tool for decision-making regarding choice of surgery were investigated. During conservative treatment, 1079 outpatients with idiopathic CTS were classified according to the electrophysiological severity scale (Stage 1-5). The results were provided to the patients and explained, but they were not indicated a treatment protocol intentionally. We recommended surgery to those outpatients who presented with difficulty in pinching due to severe thenar atrophy and/ or showing poor response to conservative treatment. However, the decision-making of surgical or nonsurgical treatment remained with patients. In the distribution of severity stages, Stage 4 was the most common (34%). Two hands were not classifiable. Surgery was chosen in 443 of 1077 hands (41.1%): The operation selection rate increased with severity of the stage and the patients with Stage 5 showed the greatest preference among Stage 1-5 (p<0.0001). This was shown in both female and male groups in gender analysis, and in both ≤ 69 y.o. and ≥70 y.o. groups in the age analysis. There was no significant difference between female and male hands, and ≤ 69 y.o. and ≥70 y.o. hands. Among varied reasons for the decision-making process for surgical treatment in CTS, electrophysiological severity scale plays an important role as an objective tool without being influenced by subjective elements; gender and age.
Associations Between CagA, VacA, and the Clinical Outcomes of Helicobacter Pylori Infections in Okinawa, Japan.
Inagaki T, Nishiumi S, Ito Y … +4 more , Yamakawa A, Yamazaki Y, Yoshida M, Azuma T
Kobe J Med Sci · 2017 Nov · PMID 29434176
Helicobacter pylori, which is involved in the pathogenesis of gastroduodenal disease, produces CagA and VacA as major virulence factors. CagA is classified into East Asian and Western types based on the number and sequen...
Helicobacter pylori, which is involved in the pathogenesis of gastroduodenal disease, produces CagA and VacA as major virulence factors. CagA is classified into East Asian and Western types based on the number and sequences of its Glu-Pro-Ile-Tyr-Ala motifs. The vacA gene has three polymorphic regions: the signal (s), intermediate (i), and middle (m) regions. The lowest gastric cancer mortality rate is seen in Okinawa. On the Japanese mainland (Honshu), most H. pylori produce s1/m1-VacA, which exhibits strong toxicity, and East Asian-type CagA. However, the H. pylori detected in Okinawa produces s1/m2-VacA, which exhibits weak toxicity, or s2/m2-VacA, which is non-toxic, and Western-type CagA. Studies about the i-region of vacA have been performed around the world, but there have been few such studies in Japan. Therefore, the aim of this study was to assess the relationships between the clinical outcomes of H. pylori infections in Okinawa, vacA (especially the i-region genotype), and cagA. H. pylori strains that were collected from patients with gastric cancer or gastric ulcers in Okinawa only produced the i1-type VacA virulence factor. The vacuolating cytotoxin activity of i1-type VacA was stronger than that of i2-type VacA, suggesting that the i-region genotype of vacA is closely associated with vacuolating cytotoxin activity. These results indicate that the i-region genotype of vacA is a useful marker of both H. pylori virulence and the clinical outcomes of H. pylori infections in Okinawa, Japan.
Can Hybrid Educational Activities of Team and Problem Based Learning Program be Effective for Japanese Medical Students?
Iwata K, Doi A
Kobe J Med Sci · 2017 Nov · PMID 29434175
BACKGROUND: The purpose of this study is to investigate the medical students'perceptions of the Hybrid Educational Activities between team based learning (TBL) and problem based learning (PBL) Program (HEATAPP), a novel...
BACKGROUND: The purpose of this study is to investigate the medical students'perceptions of the Hybrid Educational Activities between team based learning (TBL) and problem based learning (PBL) Program (HEATAPP), a novel educational program that combines characteristics of PBL and TBL. METHODS: A five-day HEATAPP on infectious diseases was provided to 4th year medical students at Kobe University School of Medicine, Kobe, Japan. After the program, a focus group discussion was held among 6 medical students who participated in HEATAPP. We qualitatively analyzed the recorded data to delineate the effectiveness of, and the perceptions on, HEATAPP. RESULTS: Some students considered HEATAPP being effective as an active learning, and in developing questions. However, some students found active learning difficult to execute, since they were so familiar with passive learning such as lectures and examinations. They also found it difficult to identify important points by reading authentic textbooks on given issues, particularly English textbooks. CONCLUSIONS: Even though active learning and group discussion are underscored as important in medicine, some Japanese medical students may be reluctant to shift towards these since they are so used to passive learning since childhood. English language is another barrier to active learning. The introduction of active learning in the earlier stages of education might be an effective solution. Teachers at medical schools in Japan should be mindful of the students'potentially negative attitudes towards active learning, which is claimed to be successful in western countries.
Macrophages Highly Express Carbonic Anhydrase 2 and Play a Significant Role in Demineralization of the Ectopic Calcification.
Barinda AJ, Ikeda K, Hirata KI … +1 more , Emoto N
Kobe J Med Sci · 2017 Oct · PMID 29434174
Vascular calcification is an important risk factor for cardiovascular disease, and is closely associated with all-cause mortality. Recently, it has been revealed that vascular calcification is not a passive precipitation...
Vascular calcification is an important risk factor for cardiovascular disease, and is closely associated with all-cause mortality. Recently, it has been revealed that vascular calcification is not a passive precipitation of circulating minerals, but is a process actively regulated through machinery similar to bone formation. During the bone remodeling, osteoclasts execute the bone resorption by releasing hydrogen ions to dissolve minerals; however, molecular mechanisms underlying decalcification of ectopically calcified lesions remain largely unknown. Here, we identified a significant role of macrophages in decalcifying the ectopic calcification. Since carbonic anhydrase-2 (CA2) is critically involved in synthesizing hydrogen ions, we investigated its expression in various cells, and found that macrophages highly express CA2. We established a cell free assay system in which ectopic calcification is quantitatively analyzed in vitro, and using this assay system, we revealed that macrophages efficiently decalcify the ectopic calcification. Interestingly, M1 polarized macrophages showed reduced CA2 expression, whereas treatment with inflammatory cytokines and vasoactive peptides decreased CA2 expression in macrophages. Of note, treatment with angiotensin II significantly reduced the decalcification capacity in macrophages in association with reduced CA2 expression. Furthermore, overexpression of CA2 enhanced decalcification capacity in C2C12 myoblast cells. Together, we unveiled a potential role of macrophages in decalcifying the ectopic calcification, and identified that CA2 is critically involved in the cellular decalcification capacity. Activating cellular CA2 has a therapeutic potential in the treatment of ectopic calcification, especially in regressing vascular calcification.
Gender Effects on the Clinical Phenotype in Japanese Patients with Spinal Muscular Atrophy.
Ar Rochmah M, Shima A, Harahap NIF … +12 more , Niba ETE, Morisada N, Yanagisawa S, Saito T, Kaneko K, Saito K, Morioka I, Iijima K, Lai PS, Bouike Y, Nishio H, Shinohara M
Kobe J Med Sci · 2017 Oct · PMID 29434173
BACKGROUND: Spinal muscular atrophy (SMA) is a neuromuscular disease caused by a mutation in SMN1. SMA is classified into three subtypes (types 1, 2, 3) based on achieved motor milestones. Although NAIP and SMN2 are wide...
BACKGROUND: Spinal muscular atrophy (SMA) is a neuromuscular disease caused by a mutation in SMN1. SMA is classified into three subtypes (types 1, 2, 3) based on achieved motor milestones. Although NAIP and SMN2 are widely accepted as SMA-modifying factors, gender-related modifying factors or gender effects on the clinical phenotype are still controversial. METHODS: A total of 122 Japanese patients with SMA, of which SMN1 was homozygously deleted, were analyzed from the perspective of the achieved motor milestone, NAIP status and SMN2 copy number. RESULTS: A predominance of male patients was observed in SMA type 3 (the walker group) without NAIP-deletion or with high SMN2 copy number (3 or 4 copies). CONCLUSION: We suggest the presence of gender-related modifiers on disease severity in SMA patients. The modifiers may contribute only in the presence of NAIP and a high copy number of SMN2.
New, Improved Version of the mCOP-PCR Screening System for Detection of Spinal Muscular Atrophy Gene (SMN1) Deletion.
Shinohara M, Ar Rochmah M, Nakanishi K … +7 more , Harahap NIF, Niba ETE, Saito T, Saito K, Takeuchi A, Bouike Y, Nishio H
Kobe J Med Sci · 2017 Sep · PMID 29434172
BACKGROUND: Spinal muscular atrophy (SMA) is a frequent autosomal recessive disorder, characterized by lower motor neuron loss in the spinal cord. More than 95% of SMA patients show homozygous survival motor neuron 1 (SM...
BACKGROUND: Spinal muscular atrophy (SMA) is a frequent autosomal recessive disorder, characterized by lower motor neuron loss in the spinal cord. More than 95% of SMA patients show homozygous survival motor neuron 1 (SMN1) deletion. We previously developed a screening system for SMN1 deletion based on a modified competitive oligonucleotide priming-PCR (mCOP-PCR) technique. However, non-specific amplification products were observed with mCOP-PCR, which might lead to erroneous interpretation of the screening results. AIM: To establish an improved version of the mCOP-PCR screening system without non-specific amplification. METHODS: DNA samples were assayed using a new version of the mCOP-PCR screening system. DNA samples had already been genotyped by PCR-restriction fragment length polymorphism (PCR-RFLP), showing the presence or absence of SMN1 exon 7. The new mCOP-PCR method contained a targeted pre-amplification step of the region, including an SMN1-specific nucleotide, prior to the mCOP-PCR step. mCOP-PCR products were electrophoresed on agarose gels. RESULTS: No non-specific amplification products were detected in electrophoresis gels with the new mCOP-PCR screening system. CONCLUSION: An additional targeted pre-amplification step eliminated non-specific amplification from mCOP-PCR screening.
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