VOLUME 79 NUMBER 3 August 2017

Current Issue

ISSN 2186-3326
(Online ISSN)
ISSN 0027-7622
(Print ISSN--v.72no.3/4)


Sasa veitchii extract reduces obesity-induced insulin resistance and hepatic steatosis in obese mice fed a high-fat diet

Hiroki Yoshioka, Mihoko Mori, Hirohisa Fujii and Tsunemasa Nonogaki
pg(s) 279 - 290

<Abstract> - < PDF >

The aim of this study was to investigate the therapeutic effect of Sasa veitchii leaf extract (SE) on features of obesity induced by a high-fat diet (HFD), such as hyperglycemia, insulin resistance, and inflammatory response. Four-week-old male ddY mice were freely fed HFD or control normal diet for 12 weeks; half was given SE in addition twice per day in weeks 8–12. Glucose and insulin intolerance were estimated, and body weight measured, weekly throughout the study. Following the experiment, the mice were fasted for 16 h, euthanized, and plasma was collected. Liver and epididymal adipose tissue was collected and weighed. Treatment with SE significantly decreased body weight, adipose tissue weight, plasma glucose, insulin, leptin, and tumor necrosis factor α compared with HFD groups, and markedly reduced the impairment of glucose and insulin tolerance in obese mice. Furthermore, hepatic steatosis and hepatic insulin receptor substrate were improved by treatment with SE. Our findings demonstrate that SE may reduce obesity-induced glucose and insulin tolerance, not only by suppressing inflammatory responses but also by improving insulin signaling.
Incidence and characteristics of accidental falls in hospitalizations

Kazuyoshi Kobayashi, Shiro Imagama, Yuko Inagaki, Yusuke Suzuki, Kei Ando, Yoshihiro Nishida, Yoshimasa Nagao and Naoki Ishiguro
pg(s) 291 - 298

<Abstract> - < PDF >

Aging of the patient population has led to increased occurrence of accidental falls in acute care settings. The aim of this study is to survey the annual occurrence of falls in a university hospital, and to examine procedures to prevent fall. A total of 49,059 inpatients were admitted to our hospital from April 2015 to March 2016. A fall assessment scale was developed to estimate the risk of fall at admission. Data on falls were obtained from the hospital incident reporting system. There were fall-related incidents in 826 patients (1.7%). Most falls occurred in hospital rooms (67%). Adverse events occurred in 101 patients who fell (12%) and were significantly more frequent in patients aged ≥80 years old and in those wearing slippers. The incidence of falls was also significantly higher in patients in the highest risk group. These results support the validity of the risk assessment scale for predicting accidental falls in an acute treatment setting. The findings also clarify the demographic and environmental factors and consequences associated with fall. These results of the study could provide important information for designing effective interventions to prevent fall in elderly patients.
Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two district hospitals in Savannakhet Province, Lao PDR

Vongphoumy Inthanomchanh, Joshua A. Reyer, Joerg Blessmen, Ketkesone Phrasisombath, Eiko Yamamoto and Nobuyuki Hamajima
pg(s) 299 - 311

<Abstract> - < PDF >

Snakebite is a neglected condition and a common public health problem in Lao People’s Democratic Republic (Lao PDR), with a high incidence of up to 1,105 cases per 100,000 persons per year. Snakebite patients with systemic envenoming do not receive effective treatment at local health facilities. Healthcare providers have only limited knowledge in assessing and providing the correct treatment for venomous snakebites. A cross-sectional study was conducted among 119 healthcare providers in Savannakhet Province, Lao PDR, with respect to their socio-demographic characteristics, knowledge of snake identification, and management of snakebite. Data was analyzed using SPSS. Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) of adequate knowledge for treating snakebites among the healthcare providers. Among 119 participants, 27.7% and 45.4% had an adequate knowledge of snake identification and management of snakebites, respectively. Approximately 59% could correctly identify symptoms of envenomation, and 19.3% expressed confidence in treating snakebites. Study participants who had received training achieved significantly better snake identification results compared to those without training, with an OR of 2.54 (95% CI: 1.02–6.28). In particular, physicians achieved significantly better results compared to nurses in knowing how to manage snakebites, with an OR of 2.31 (95% CI: 1.04–5.12). Given the level of inadequate knowledge of snakebite management among healthcare providers in the province, more training in snakebite management is needed. University and Health Science Colleges should include snakebite management into the curriculum, to ensure that medical graduates have the appropriate knowledge and skills to treat snakebites.
Effect of text messages to improve health literacy on medication adherence in patients with type 2 diabetes mellitus: A randomized controlled pilot trial

Hideki Sugita, Ryoji Shinohara, Hiroshi Yokomichi, Kohta Suzuki and Zentaro Yamagata
pg(s) 313 - 321

<Abstract> - < PDF >

It has been suggested that low health literacy (HL) is associated with poor medication adherence. This study aimed to examine the effect of a text message-based HL intervention to promote medication adherence, compared with text messages that only sent medication reminders, in patients with type 2 diabetes. This was a single-center, open-label, randomized (1:1) controlled pilot study. The study period was 6 months. Intervention group was sent HL related text messages, compared to the reminder messages that were sent to the control group. The primary outcome was the difference in the change rate of scores on the Morisky Eight-Item Medication Adherence Scale (MMAS-8). Forty-one participants were randomized into the intervention (n = 21) and control (n = 20) groups and completed the 6-month follow-up. Although almost participants read and understood the information provided in the messages, no significant difference was observed between groups for the primary outcome (p = 0.78). Our results suggested that medication adherence at 6 months after discharge in patients with type 2 diabetes did not significantly change by text messages, which aimed to improve their HL levels.
Randomized controlled trial for assessment of Internet of Things system to guide intensive glucose control in diabetes outpatients: Nagoya Health Navigator Study protocol

Takeshi Onoue, Motomitsu Goto, Tomoko Kobayashi, Takashi Tominaga, Masahiko Ando, Hiroyuki Honda, Yasuko Yoshida, Takahiro Tosaki, Hisashi Yokoi, Sawako Kato, Shoichi Maruyama and Hiroshi Arima
pg(s) 323 - 329

<Abstract> - < PDF >

The Internet of Things (IoT) allows collecting vast amounts of health-relevant data such as daily activity, body weight (BW), and blood pressure (BP) automatically. The use of IoT devices to monitor diabetic patients has been studied, but could not evaluate IoT-dependent effects because health data were not measured in control groups. This multicenter, open-label, randomized, parallel group study will compare the impact of intensive health guidance using IoT and conventional medical guidance on glucose control. It will be conducted in outpatients with type 2 diabetes for a period of 6 months. IoT devices to measure amount of daily activity, BW, and BP will be provided to IoT group patients. Healthcare professionals (HCPs) will provide appropriate feedback according to the data. Non-IoT control, patients will be given measurement devices that do not have a feedback function. The primary outcome is glycated hemoglobin at 6 months. The study has already enrolled 101 patients, 50 in the IoT group and 51 in the non-IoT group, at the two participating outpatient clinics. The baseline characteristics of two groups did not differ, except for triglycerides. This will be the first randomized, controlled study to evaluate IoT-dependent effects of intensive feedback from HCPs. The results will validate a new method of health-data collection and provision of feedback suitable for diabetes support with increased effectiveness and low cost.
Optimized treatment strategy of radiotherapy for early glottic squamous cell carcinomas: An initial analysis

Kana Kimura, Yoshiyuki Itoh, Tohru Okada, Seiji Kubota, Mariko Kawamura, Rie Nakahara, Yumi Oie, Yuka Kozai, Yuuki Takase, Hidenori Tsuzuki, Naoki Nishio, Mariko Hiramatsu, Yasushi Fujimoto, Takefumi Mizutani and Shinji Naganawa
pg(s) 331 - 338

<Abstract> - < PDF >

The purpose of this study was to evaluate the clinical outcomes of radiotherapy for patients with T1/T2 glottic carcinoma. Patients with T1/T2 glottic carcinoma histopathologically diagnosed with squamous cell carcinoma and treated at our hospital between 2007 and 2015 were analyzed retrospectively. Our strategy for T1/T2 glottic carcinoma was as follows: radiotherapy alone with 2.25 Gy per fraction to a total of 25–28 fractions for patients with non-bulky T1 glottic carcinoma; concurrent chemoradiotherapy with oral S-1 and radiotherapy with 2 Gy per fraction to a total of 30 fractions for patients with T1 bulky/T2 favorable glottic carcinoma; or chemoradiotherapy with high-dose cisplatin and radiotherapy with 2 Gy per fraction to a total of 35 fractions for T2 unfavorable glottic carcinoma. Forty-eight patients were eligible. The median follow-up period among surviving patients was 38 months (range, 11–107). The disease was T1a in 23%, T1b in 13%, and T2 in 65% of patients. The 3-year local control rate in all patients, T1a, T1b, and T2 was 96.7%, 100%, 100%, and 96.0%, respectively. Of the 46 patients, one with T2 glottic carcinoma developed recurrent disease at the primary site, and one with T2 glottic carcinoma had lymph node recurrences in the neck. Acute Grade 3 dermatitis occurred in 8 (17%) patients and late Grade 2 hypothyroidism occurred in 2 (4%) patients. This retrospective study shows that our optimized treatment strategy of radiotherapy depending on the stage of early glottic carcinoma is not only effective but also well-tolerated.
Impact of self-efficacy and parenting practice on physical activity among school children

Seo Ah Hong, Karl Peltzer and Wanphen Wimonpeerapattana
pg(s) 339 - 349

<Abstract> - < PDF >

As insufficient engagement in physical activity (PA) is becoming a major health concern in Thailand, we aimed to investigate the impact of parenting practices and children’s self-efficacy on a child’s PA level and further in the subgroups, stratified by the child’s sex and weight status. A total of 609 primary school children recruited by cluster sampling in two schools were asked to complete questionnaires, and general familial factors and parenting practice related to activities were completed by parents. Multivariate linear regressions were conducted to calculate the standardized beta-coefficients (β). Children’s PA level was positively related to greater support seeking self-efficacy (β=0.281) for engaging in PA, and parenting practices, including less limit setting (β=–0.124) and more discipline (β=0.147) in the total sample. In the analyses of subgroups by a child’s sex and weight status, parenting practice, such as less limit setting and discipline played a more important role in children’s PA in normal weight children and girls as taking account of around 10% of variance of the child’s PA, while only seeking support self-efficacy showed great impact in overweight children and boys. In conclusion, impacts of children’s self-efficacy and parenting practices on children’s PA were different by child’s sex and weight status. This can suggest that future interventions to increase children’s PA might need to consider different strategies to increase children’s self-efficacy as well as parenting strategies when targeting different groups of children.
Yokukansankachimpihange increased body weight but not food-incentive motivation in wild-type mice

Takuya Hamaguchi, Iku Tsutsui-Kimura, Kenji F. Tanaka and Masaru Mimura
pg(s) 351 - 362

<Abstract> - < PDF >

Yokukansankachimpihange (YKSCH), a traditional Japanese medicine, is widely used for the amelioration of the behavioral and psychological symptoms of dementia with digestive dysfunction. Regardless of its successful use for digestive dysfunction, the effect of YKSCH on body weight was unknown. Furthermore, if YKSCH increased body weight, it might increase motivation according to Kampo medicine theory. Therefore, we investigated whether YKSCH had the potential to increase body weight and enhance motivation in mice. To address this, C57BL/6J mice were used to evaluate the long-term effect of YKSCH on body weight and food-incentive motivation. As part of the evaluation, we optimized an operant test for use over the long-term. We found that feeding mice YKSCH-containing chow increased body weight, but did not increase their motivation to food reward. We propose that YKSCH may be a good treatment option for preventing decrease in body weight in patients with dementia.
Development and validation of an educational program to enhance sense of coherence in patients with diabetes mellitus type 2

Yuki Odajima, Mariko Kawaharada and Norio Wada
pg(s) 363 - 374

<Abstract> - < PDF >

This study aimed to develop a group education program that facilitates a sense of coherence among patients with type 2 diabetes mellitus, which was provided four times, and to validate the effect of the program among the patients. Researchers allocated 40 patients with type 2 diabetes, who had been admitted to a general hospital in Japan for diabetes education for two weeks. Twenty-one patients were allocated to the intervention group and 19 to the control group. The control group undertook a lecture-based educational program that the facility offered. The intervention group received the program, in addition to the facility’s educational program. The sense of coherence scale and the Problem Areas in Diabetes Survey were used as evaluation indices. The average age of the intervention group was 59.1 years and that of the control group was 59.5 years. The intervention group showed a between-group effect of improvement in the sense of coherence score. Additionally, the intervention group showed a within-group effect of improvement in the sense of coherence score, as well as the comprehensibility and manageability scores, which are subdomains, and the Problem Areas in Diabetes Survey score. The within-group comparison showed a significant decrease in the early-morning FPG at both groups by an effect of treatment. The program suggested the possibility of improving the sense of coherence and the Problem Areas in Diabetes Survey. In order to enhance general use of the program, it is necessary to reach out to participating facilities and verify the effect of the program.
The poor quality and reliability of information on periacetabular osteotomy on the internet in Japan

Yasuhiko Takegami, Taisuke Seki, Takafumi Amano, Yoshitoshi Higuchi, Daigo Komatsu, Yoshihiro Nishida and Naoki Ishiguro
pg(s) 375 - 385

<Abstract> - < PDF >

Although many patients use the internet to access health-related information, the quality and the reliability of the information is highly inconsistent. Periacetabular osteotomy (PAO) is one of the surgical procedures for hip dysplasia. However, medical information on PAO is limited on the internet. This study aims to evaluate the quality and reliability of information available on PAO on the internet in Japan. A web search was conducted on two search engines for the following terms: “hip osteotomy,” “pelvic osteotomy,” and “osteotomy for hip preservation” in Japanese. In total, we found 120 websites. To determine the quality and reliability of information on each website, we used the Health on the Net Foundation (HON) score, the Brief DISCERN score, and an osteotomy-specific content (OSC) score. After eliminating duplicate websites, we reviewed 49 unique websites. Only three websites (6.1%) had good reliability, as indicated by their HON scores. Twelve websites (24.4%) had good-quality information, as measured by their Brief DISCERN scores. As evaluated by their OSC scores, physician websites were found to be biased toward etiology and surgical indication and did not provide information on the complications of procedures. Nonphysician websites were generally insufficient. The information about PAO on the internet is, therefore, unreliable and of poor-quality for Japanese patients.
Diagnostic performance of 11C-choline PET/CT and bone scintigraphy in the detection of bone metastases in patients with prostate cancer

Kazuhiro Kitajima, Kazuhito Fukushima, Shingo Yamamoto, Takashi Kato, Soichi Odawara, Haruyuki Takaki, Masayuki Fujiwara, Koichiro Yamakado, Yukako Nakanishi, Akihiro Kanematsu, Michio Nojima and Shozo Hirota
pg(s) 387 - 399

<Abstract> - < PDF >

The aim of this study was to compare 11C-choline PET/CT and bone scintigraphy (BS) for detection of bone metastases in patients with prostate cancer. Twenty-one patients with histologically proven prostate cancer underwent 11C-choline PET/CT and BS before (n = 4) or after (n = 17) treatment. Patient-, region-, and lesion-based diagnostic performances of bone metastasis of both 11C-choline PET/ CT and BS were evaluated using a five-point scale by two experienced readers. Bone metastases were present in 11 (52.4%) of 21 patients and 48 (32.7%) of 147 regions; 111 lesions were found to have bone metastases. Region-based analysis showed that the sensitivity, specificity, accuracy, and area under the receiver-operating-characteristic curves (AUC) of 11C-choline PET/CT were 97.9%, 99.0%, 98.6%, and 0.9989, respectively; those of BS were 72.9%, 99.0%, 90.5%, and 0.8386, respectively. Sensitivity, accuracy, and AUC significantly differed between the two methods (McNemar test, p = 0.0015, p = 0.0015, and p < 0.0001, respectively). 11C-choline PET/CT detected 110/111 metastatic lesions (99.1%); BS detected 85 (76.6%) (p < 0.0001). According to the CT morphological type, the visualization rates of 11C-choline-PET/ BS were 100%/90.3% for the blastic type, 91.7%/8.3% for the lytic type, 100%/100% for the mixed type, and 100%/53.3% for the invisible type, respectively. Significant differences in blastic, lytic, and invisible types were observed between the two methods (p = 0.013, p = 0.0044, and p = 0.023, respectively). In conclusion, 11C-choline PET/CT had greater sensitivity and accuracy than BS for detection of bone involvement in patients with prostate cancer.
Experimental evaluation and training of stent clot retrieval: the confront clot scrambling method

Tomotaka Ohshima, Shunsaku Goto, Taiki Yamamoto and Kojiro Ishikawa
pg(s) 401 - 406

<Abstract> - < PDF >

The introduction of stent retrievers has changed the methods used for acute intracranial thrombectomy, but the training approach has not been discussed enough. We, therefore, aimed to establish a simple skill up method which can be used to train anytime and anywhere with low costs. Also, we introduce our experimental confront clot scrambling method (CCSM) which makes a profitable visualization in how the stent retriever works. The CCSM involved a sham clot set in the middle of a polyvinyl chloride tube, after which two stent retrievers were navigated from each side before being simultaneously withdrawn with the same force. The stent that removes the sham clot is determined to have stronger clot retrieval ability. Several adjunctive techniques were also compared. The push and fluff adjunctive technique was the most effective among all the stents. Generally, the former deployed stent was stronger than later one. Therefore, the later deployed stent with the push and fluff technique lets us know whether the physician’s maneuver worked well or not. CCSM could directly evaluate the ability of adjunctive techniques with each stent retriever and demonstrate the physicians’ skills. Because the actual endovascular clot retrieval requires extreme fine maneuvers against invisible vessels, repeat training is very important especially in beginners.
Phase II trial of CH5424802 (alectinib hydrochloride) for recurrent or refractory ALK-positive anaplastic large cell lymphoma: study protocol for a non-randomized non-controlled trial

Hirokazu Nagai, Reiji Fukano, Masahiro Sekimizu, Akiko Kada, Akiko M. Saito, Ryuta Asada and Tetsuya Mori
pg(s) 407 - 413

<Abstract> - < PDF >

Currently, a standard therapy has not been established for recurrent or refractory anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. While there are many treatment options, such as hematopoietic stem cell transplantation, patients with resistant disease to conventional chemotherapies have particularly poor prognosis. There is urgent need to develop new drugs because of the lack of a standard therapy and poor prognoses. This phase II trial is designed for evaluating the efficacy and safety of alectinib hydrochloride for patients with recurrent or refractory anaplastic lymphoma kinase -positive anaplastic large cell lymphoma. The primary endpoint is the response rate according to the Revised Response Criteria for Malignant Lymphoma. The secondary endpoints are pharmacokinetics, safety in children, complete response rate, response duration, progression-free survival, event-free survival, overall survival, and adverse events. The results of this trial will be the pivotal data for the drug approval of alectinib hydrochloride for recurrent or refractory anaplastic lymphoma kinase-positive anaplastic large cell lymphoma.


Review of redo-Kasai portoenterostomy for biliary atresia in the transition to the liver transplantation era

Wataru Sumida, Hiroo Uchida, Yujiro Tanaka, Takahisa Tainaka, Chiyoe Shirota, Naruhiko Murase, Kazuo Oshima, Ryo Shirotsuki and Kousuke Chiba
pg(s) 415 - 420

<Abstract> - < PDF >

Portoenterostomy (PE) is the standard therapy for biliary atresia (BA). PE offers the chance of survival to children with BA. PE was the ultimate therapeutic modality for BA before liver transplantation (LT) was available. Failure of biliary drainage with PE was almost invariably fatal in children with BA. In such cases, redo-PE was performed to salvage patients following PE failure. PE remains the standard first treatment for BA despite the availability of LT. Further, redo-PE is also performed in a limited number of cases despite the development of LT as an alternative means of PE. However, there is concern that redo-PE increases morbidity at the time of subsequent LT. Laparoscopic redo-PE has recently been described. Laparoscopic redo-PE is expected to reduce complications of LT by preventing abdominal adhesion associated with repetitive surgery. In the present article, the future utility of redo-PE and the history of its changing roles are reviewed.


Anterior interosseous nerve palsy mimicking rupture of the index flexor digitorum profundus after volar locking plate fixation of a distal radius fracture

Takaaki Shinohara, Sayako Takahashi and Hitoshi Hirata
pg(s) 421 - 425

<Abstract> - < PDF >

We describe the case of a patient with distal radius fracture who became unable to flex the distal interphalangeal joint of the index finger after internal fixation using a volar locking plate. There was palpable crepitus with active thumb motion, and wrist radiographs showed prominence of the volar plate at the watershed line. Therefore, our initial diagnosis was plate-induced closed rupture of the flexor digitorum profundus tendon of the index finger. However, upon surgical removal of the plate, no tendon rupture was found. Magnetic resonance imaging after plate removal showed diffuse increased signal intensity in the index flexor digitorum profundus on T2-weighted fat-suppressed images, which indicated muscle denervation. Based on the above findings, we changed the diagnosis to anterior interosseous nerve palsy with isolated paralysis of the flexor digitorum profundus of the index finger. Finger flexion disability following volar plate fixation of distal radius fracture should always be investigated carefully.