Nagoya Journal of Medical Science

The aim of this study was to investigate dental health status and oral health behavior and associated factors among university students in five ASEAN countries (Indonesia, Malaysia, Myanmar, Thailand and Vietnam). Using anonymous questionnaires, data were collected from 3,344 undergraduate university students (mean age 20.5, SD=1.6; 58.3% female) from five ASEAN countries. Results indicate that 27.7% of students reported to have sometimes, most of the time or always having tooth ache in the past 12 months, 39.4% reported to have one or more cavities, 20.3% did not brush their teeth twice or more times a day, and 30.9% had never been to a dentist (or did not know it). In multivariate logistic regression analysis, older age, living in a lower middle income country, consumption of chocolate or candy, having made a dental care visit, and poor mental health was associated with tooth ache in the past 12 months. Being male, being 20 to 21 years old, coming from a wealthier family background, living in a lower middle income country, frequent consumption of soft drinks, not having consulted with a dentist in the past 12 months and weak beliefs in the benefits of tooth brushing were associated with inadequate tooth brushing frequency (<twice a day). Further, being male, being 20 to 21 years old, inadequate tooth brushing frequency, infrequent consumption of chocolate or candy, frequent consumption of soft drinks and low physical activity was associated with inadequate or never dental care visit. Poor dental health status and oral health behaviors were found and various risk factors identified that can be utilized to guide interventions to improve oral health programs among university students.

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its “Free Maternal Health Services Policy” in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people’s education status and health care accessibility.

Visual dysfunction can be caused by several abnormalities, including dysfunctions in the visual cortex and retina. Our aim was to investigate changes in visual evoked brain responses in the primary visual cortex associated with Parkinson’s disease (PD). Sixteen healthy control subjects and ten patients with PD participated in this study. We assessed the visual evoked magnetic field (VEF) using magnetoencephalography (MEG). Checkerboard pattern reversal (CPR) and monotonous grating pattern (MGP) stimulations were used. Magnetic resonance imaging (MRI) was performed to analyze brain volume and generate a tractogram. Cognitive and olfactory function, and Unified Parkinson’s Disease Rating Scale (UPDRS) scores were evaluated in patients with PD. Four components of the VEF (1M, 2M, 3M, 4M) were observed following stimulation. For both stimuli, results from the 1M and 2M components were significantly greater and the latency of the 1M component was increased markedly in the PD group compared with the healthy control group. In the PD group, 1M latency correlated with the UPDRS score of 1 for both stimuli, and a correlation was observed between olfactory function and the UPDRS score of 3 for the CPR stimulation alone. We suggest that the conduction delay observed following visual stimulation occurs peripherally rather than in the primary visual cortex. Degeneration of selective elements of the visual system in the retina, possibly midget cells, may be involved.

Non-communicable diseases have been recognized as a serious threat to public health in Palau. To tackle the problem, different strategies might be necessary for populations with different ethnic backgrounds. This study aims to find the differences in the prevalence of metabolic risk factors of non-communicable diseases between Palauans and Filipinos living in Palau, and examine possible determinants of the differences. We selected data of 2,032 participants, including native Palauans and Filipinos, from the Palau STEPS Survey 2011–2013 for this study. Logistic regression models were used to inspect the association of each metabolic risk factor with ethnicity by calculating odds ratios adjusted for potential confounding factors. Palauans had higher age-standardized prevalence of overweight or obesity (84% vs. 45%), hypertension (50% vs. 38%) and diabetes (19% vs. 13%) than Filipinos. However, after adjusting for BMI and various lifestyle related factors, there are no statistical significant differences in the prevalence of hypertension and diabetes between these two ethnic groups. Palauan men were less likely to have elevated total cholesterol, especially after adjusting for BMI (odds ratio=0.55, 95% confidence interval: 0.33–0.91), while Palauan women were more likely to have elevated triglycerides than their Filipino counterparts (odds ratio=1.45, 95% confidence interval: 1.02–2.06). Our findings suggested that Palauans’ higher BMI distribution might be able to explain their higher prevalence of hypertension and partially explain their higher diabetes prevalence. Palauans were not consistently more likely to have all metabolic risk factors, namely dyslipidemia were less likely to be observed in Palauan men.

Arsenic created a serious public health problem in Bangladesh due to its presence in groundwater and dissemination of the toxic effects to millions of people. The scarcity of the treatment options to manage this affected population has made the situation much worse. To find a promising treatment option, this study was undertaken to examine the ameliorating roles of Syzygium cumini leaf extract (SLE) against arsenicinduced toxic effects in mice. Swiss albino mice were divided into four groups where ‘control’ group received pure water + normal feed, ‘arsenic (As)’ group received sodium arsenite (NaAsO2)-containing water (10 μg/g body weight/day) + normal feed, ‘As+SLE’ group received NaAsO2-containing water + feed supplemented with SLE (50 μg/g body weight/day) and finally the ‘SLE’ group received pure water + feed supplemented with SLE. A gradual increase in body weight gain was observed in control mice; however, the body weight gain in As-exposed mice was decreased. This decrease in body weight gain was prevented in As+SLE group mice that received SLE supplemented feed. Arsenic showed a secondary effect by causing enlargement of spleen, kidney and liver of ‘As’ group mice and this enlargement of the organs was minimized with SLE supplementation. In addition, SLE abrogated arsenic-mediated elevation of serum alkaline phosphatase (ALP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), uric acid and glucose. These results, therefore, suggest that SLE might have future therapeutic value for preventing or reducing arsenic-induced toxic effects.

Immunization is one of the most cost-effective interventions to reduce vaccine-preventable diseases morbidity and mortality. Vaccination coverage is very low in Afghanistan; National Risk and Vulnerability Assessment (NRVA) Survey 2008 estimated the coverage of fully immunized children to be 37%. The current study was designed to examine the factors influencing full immunization among children aged 12–23 months. Demographic and vaccination data of 2,561 children of 12–23 months was extracted from the Afghanistan Health Survey (AHS) 2012. The data was analyzed by logistic regression to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). The study found that 38.8% of the children were fully immunized. The coverage for specific vaccines was 80.9% for BCG, 72.0% for OPV3, 64.8% for measles, and 50.1% for Penta3. Urban residence (AOR = 0.60, 95% CI 0.40–0.90 relative to rural), children of poorer families (AOR = 1.36, 95% CI 1.10–1.67 relative to poorest), some education (AOR = 1.59, 95% CI 1.20–2.11 relative to no education) and antenatal care (AOR = 1.70, 95% CI 1.44–2.01 relative to not received) were found to be significant predicators of full immunization. This study indicated that the full-immunization rate in Afghanistan was quite low compared to the national target of 90% coverage. Therefore, strategies taking into account the identified factors seem to be vital to improve vaccination coverage.

The aim of this study was to investigate the prognostic value of dual-time-point (DTP) ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) imaging in primary oral tongue squamous cell carcinoma (OTSCC). The study included 52 patients who underwent preoperative ¹⁸F-FDG PET scans at two time points, namely 1 h and 2 h after injection. The following PET parameters were calculated: maximum standardized uptake value (SUVmax) for both time points (SUV early, SUV delayed); retention index (RI); and SUVmax increment (ΔSUVmax). Receiver operating characteristic (ROC) curve analysis was performed to define the optimal cutoff point for these parameters. Overall survival was calculated using the Kaplan–Meier method. Prognostic factors for patients with OTSCC were evaluated using the univariate log-rank test and a multivariate Cox proportional hazards model. ROC analysis revealed that the area under the curve was higher and more accurate for ΔSUVmax than for the other parameters. Additionally, patients with a ΔSUVmax ≥0.9 had significantly worse survival outcomes (28.9% vs 92.6%; p < 0.01). Univariate analysis showed that prognosis was significantly correlated with clinical T stage, local recurrence, perineural invasion, vascular invasion, and PET parameters (p < 0.05 for all). Multivariate analysis showed that local recurrence (hazard ratio = 3.60; p = 0.02) and ΔSUVmax (hazard ratio = 8.43; p < 0.01) were independent prognostic factors. ΔSUVmax determined using DTP ¹⁸F-FDG PET may be an additional prognostic factor in OTSCC patients.

In Lao People’s Democratic Republic (Lao PDR), the cause of death is not registered in death reports. As a result, the government cannot produce official reports that show mortality according to cause of death. This study aimed to report the underlying cause of death in a tertiary general hospital (Mittaphab Hospital) in Vientiane capital. Mittaphab hospital is a governmental teaching hospital with 300 beds for inpatient services specialized in orthopedics, neurology, and hemodialysis. Since a children hospital exists beside Mittaphab Hospital, severe pediatric cases are referred to the child hospital. HIV-positive cases and sputum positive tuberculosis are also transferred to the other specialized hospitals. All of the subjects in this study were patients who died in 2013–2015 at Mittaphab Hospital. Paper-based medical charts were examined by a medical doctor and staff from the medical records division. This chart review revealed that 1,509 patients (1,006 males and 503 females) died in this hospital during the study period. Of those, the number of patients aged <20 years and >80 years was small (6.2% and 7.7%, respectively). The most common underlying causes were injury (29.7%), cerebrovascular diseases (26.8%), renal disease (13.3%), infectious diseases (12.4%), and malignant neoplasm including brain tumor (4.8%). Among those aged 20–59 years, these percentages were 37.9%, 23.7%, 12.3%, 10.2%, and 5.0%, respectively. Although the patients visiting the hospital did not represent the whole population, the distribution of cause of death in the hospital was the only available information reported in Lao PDR.

The purpose of this retrospective study was to analyze data in patients with stage IB–IIB uterine cervical cancer who were treated with concurrent chemoradiotherapy (CCRT) with high dose cisplatin and fluorouracil as postoperative adjuvant therapy. Between February 2003 and November 2011, 76 patients with FIGO stage IB–IIB cervical cancer were analyzed. Seventy patients were treated with postoperative CCRT and 6 patients were treated with radiation therapy alone. Data related to overall survival (OS), disease-free survival (DFS), toxicity, and failure pattern were analyzed. The median patient age was 45 years (range, 20–80 years). The median follow-up duration was 63 months (range, 10–125 months). Fifty-eight patients (76.3%) had a squamous cell histologic type, 55 patients (72.4%) had lymphovascular invasion, 31 patients (40.8%) had parametrial invasion, and 28 patients (36.8%) had lymph node metastases. Five-year OS and DFS were 96% and 92%, respectively. Five-year DFS in stage IB1 patients was significantly higher than in stage IB2–IIB patients (p = 0.022). Nineteen patients (25%) had grade 3 or 4 neutropenia, 13 patients (17.1%) had grade 3 anemia, and 2 patients (2.6%) had grade 3 thrombocytopenia, but none of these patients died from the disease. Three patients experienced chronic toxicity: one had bladder perforation, one had hydronephrosis, and one experienced ileus. CCRT as postoperative adjuvant therapy resulted in good survival and outcome without severe toxicity.

Postoperative lymphedema is considered irreversible once it has developed, and significantly lowers the patient’s quality of life. However, lymphatic function has recently been clarified, and it is possible that lymphedema can be cured if early treatment is started. This two-arm randomized clinical trial (UMIN000026124) will prospectively evaluate 24 patients with early-stage breast cancer-related lymphedema at the Nagoya University Hospital and Aichi Cancer Center Hospital. The eligibility criteria will be patients who are diagnosed with stage 0–1 breast cancer-related lymphedema, as defined by the International Society of Lymphology, within 12 weeks after breast cancer surgery. The diagnosis of lymphedema will be confirmed using a bioimpedance spectroscopy device (L-Dex®). Participants will be randomized 1:1 into the intervention and control groups. The physicians and patients will be aware of their group assignment, although treatment efficacy will be evaluated by raters who are blinded to the group assignments. The intervention group will complete grasping exercises in the Hand Incubator device for 4 weeks. The primary outcome will be the change in the affected upper limb’s volume after the intervention, as measured using the water displacement method. This study may help establish a standard treatment for postoperative lymphedema.

Although one of the most important missions of end-of-life education is to ensure proper interprofessional education (IPE), in Japan, end-of-life care IPE has not been given enough attention especially in community settings. This study aims at developing an effective workshop facilitator training program on end-of-life care IPE and acquiring the know-how to set up and efficiently run administrative offices. We first developed a tentative facilitation training program and conducted it in five cities nationwide. The training strategy was as follows: (1) participating in the workshop, (2) attending a lecture on facilitation, (3) conducting a preparatory study, (4) attending one workshop session as a facilitator, and (5) reflecting on one’s attitude as a facilitator based on workshop participants’ questionnaire, peer-feedback, and video recording. A total of 10 trainees completed the training program. We assessed the level of improvement in the trainees’ facilitation skills and the efficacy of the training course using a qualitative approach. This formative study helped us identify several aspects needing improvement, especially in the areas of information technology and social media. Progress in these areas may have a positive impact on the education of community health care professionals whose study hours are limited, helping provide continued facilitation training.

With the aging of society, the number of elderly with reduced cognitive function has been increasing worldwide. As a test to measure the cognitive function, the Revised Hasegawa’s Dementia Scale (HDS-R) has been used in Japan, Korea, and China. Since there was no HDS-R version for Laotians, the questionnaire and manual were developed through the cooperation of Lao and Japanese researchers. Back-translation was conducted to confirm the accuracy of the translation. The score on the 9-item HDS-R ranges 0 to 30 points, and reduced cognitive function is usually defined as a score of 20 points or lower. After receiving explanation regarding the use of the tool and practicing its implementation, 3 female doctors interviewed 30 superficially healthy volunteers aged 31 to 84 years (12 males and 18 females) who lived with his/ her family in Vientiane Capital, Lao PDR. Their score distributed from 4 to 30 points, with an average of 24.7 (standard deviation 5.4) points. Six (20.0%) participants scored 20 points or lower. The discussion before and after the pilot interviews revealed that the following changes needed to be made in accordance to the culture of Lao people; 1) order of date in Question 2, 2) words to be memorized in Questions 4 and 7, 3) objects to be memorized using pictures, not actual objects, in Question 8. Additionally, we introduced new two rules; a clear time definition for no reply (10 seconds), and repetition of questions twice for those with ear problems. The revised version of the HDS-R was thought to be an appropriate standard questionnaire for use in studies on cognitive function among Laotians.

API2-MALT1 translocation-positive gastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) lymphoma is thought to transform to diffuse large B-cell lymphoma (DLBCL) rarely. A 69-year-old man presented with epigastralgia. Esophagogastroduodenoscopy showed multiple ulcerations in the stomach. Endoscopic biopsies revealed MALT lymphoma, with Helicobacter pylori infection. The patient underwent eradication therapy with no improvement, and was thereafter followed without additional therapy at his request. Twelve years after initial diagnosis, follow-up computed tomography (CT) showed multiple nodules in bilateral lungs, and a needle biopsy revealed MALT lymphoma, the same as in the stomach and API2-MALT1 translocation was found. Because he again refused additional therapy, follow-up was continued. 15 years after initial diagnosis, CT showed lymphadenopathy at the splenic hilum. At first we suspected disease progression of gastric MALT lymphoma, however a needle biopsy revealed DLBCL without API2-MALT1. Thus, the tumor at the splenic hilum was finally diagnosed as a de novo DLBCL as a second malignancy. Although treatment with rituximab given his age and his wishes was attempted, he died of DLBCL 15 years after the initial diagnosis. We experienced an API2-MALT1-positive gastric MALT lymphoma with concomitant DLBCL, not transformed to DLBCL over a 15-year clinical course.

Metachronous ovarian metastasis of colorectal adenocarcinoma is mostly identified within 3 years. Here we present a case of a 64-year-old woman with cecal cancer who underwent right oophorectomy for ovarian metastasis. Imaging was performed because of abdominal bloating; it detected a swollen right ovary with ascites. On laparotomy, a right ovarian tumor and cecal cancer were identified. After right oophorectomy, a diagnosis of unilateral ovarian metastasis from colon cancer was made. One month later, right hemicolectomy was performed. Eight years after initial surgery, the patient presented with vaginal bleeding. A computed tomography (CT) scan revealed a pelvic mass approximately 10 cm in diameter, but no mass was evident on a CT image taken 6 months before. The patient was diagnosed with left ovarian metastasis from colon cancer. A third laparotomy revealed a left ovarian tumor, but there was no evidence of other metastases or peritoneal dissemination. Left oophorectomy was performed. Oophorectomy is considered to be associated with a survival benefit in ovarian metastasis without other extensive metastasis. However, ovarian metastasis is often bilateral. Although complete resection was achieved in the present case, the findings support performing prophylactic bilateral oophorectomy if metastasis is identified in a unilateral ovary.

Stent migration is a complication associated with endovascular coil embolization of intracranial aneurysms. We report a case of anterior communicating artery (ACoA) aneurysm that was successfully treated after stent migration during endovascular coil embolization without retrieval of the stent. A 47-year-old man presented with sudden onset severe headache. Patient was noted to have subarachnoid hemorrhage from a ruptured ACoA aneurysm. Emergency endovascular coil embolization was performed. The second coil embolization was scheduled for the neck-remnant portion with a stent after 16 days from the initial operation. At first, a stent was deployed from the right perpendicular division of anterior cerebral artery (A2) to the left horizontal division of anterior cerebral artery (A1) entirely across the aneurysmal neck. Although the stent position looked fine, the stent migrated inferiorly to the proximal A1 portion when its delivery wire was withdrawn. Fortunately, the stent could be pushed into the distal A1 portion, when we trying to re-access the aneurysm thorough the stent with a pig-tail shaped microguidewire. Additional coil embolization was achieved using the assistance of distal tip of the stent as a scaffold of the coil. The patient was discharged without any complication on the postoperative day 6. Although there are various choices of rescue treatment after stent migration, this is the first reported case of stent repositioning with a microguidewire. Our technique may represent an effective option in case of stent migration.

Choline is a new PET tracer, which uptake may occur via a choline-specific transporter protein and be accelerated during the proliferation of tumor cells. We report a 61-year-old woman with a metastatic pancreatic tumor from renal cell carcinoma, measuring 35×40 mm. PET scans demonstrated accumulation of ¹¹C-choline in the metastatic pancreatic tumor, but no accumulation of ¹⁸F-FDG. Choline PET/CT may play a useful and complementary imaging modality, especially when FDG-PET/CT does not show expected findings or when the evaluation of tumor viability is needed, in patients with renal cell carcinoma.