VOLUME 80 NUMBER 4 November 2018

Current Issue

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

Impact Factor(2017)
 1.016

ORIGINAL PAPERS

Myanmar language version of the Revised Hasegawa’s Dementia Scale

Yu Mon Saw, Thet Mon Than, Ei Mon Win, Su Myat Cho, Moe Khaing, Nyi Nyi Latt, Zaw Zaw Aung, Nwe Oo, Hnin Nwe Ni Aye, Tetsuyoshi Kariya, Eiko Yamamoto, and Nobuyuki Hamajima
pg(s) 435 - 450

<Abstract> - < PDF >

Reduced cognitive function among the elderly is an important issue not only in developed countries, but also in developing countries. As a test to measure cognitive function, the Revised Hasegawa’s Dementia Scale (HDS-R) has been used in Asian countries including Japan, Korea, and China. Since there was no HDS-R version in Myanmar language, a questionnaire and manual for the HDS-R were developed. The translation from English to Myanmar language was done by two Myanmar researchers. Back-translation was conducted to confirm the accuracy of the translation by two other Myanmar researchers. Back-translated English was compared to the original by two Japanese researchers, and inconsistencies were discussed by all six researchers to reach consensus. Five Myanmar researchers independently read the questionnaire and manual to verify the expressions are familiar in Myanmar language. The modified points were as follows. 1) The date order in Question 2 is day/month/year. 2) The words to be memorized in Questions 4 and 7 are padauk tree, cat, and bullock cart for the first set, and tamarind tree, dog, and car for the second set. 3) The objects to be memorized in Question 8 are shown with pictures, not actual objects. 4) Like the Lao version, we introduced two new rules; a clear time definition for no reply (10 seconds), and repeating questions twice for those with hearing problems. The revised version of the HDS-R has been prepared to be an applicable standard questionnaire for use on assessment of cognitive function in suspected dementia cases in Myanmar, both in the clinical and public healthcare setting.
Perception and practice of ‘healthy’ diet in relation to noncommunicable diseases among the urban and rural people in northern Ethiopia: a community-based qualitative study

Lemlem Weldegerima Gebremariam, Atsuko Aoyama, Alemayehu Bayray Kahsay, Yoshihisa Hirakawa, Chifa Chiang, Hiroshi Yatsuya, and Akiko Matsuyama
pg(s) 451 - 464

<Abstract> - < PDF >

Dietary habits are related to the risks of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, of which burdens are increasing in low-income countries including Ethiopia. Although several epidemiological studies of NCD risk factors were conducted in Ethiopia, qualitative studies on people’s dietary habit in relation to NCDs have not been conducted yet. This study aims to describe people’s perception and practice of ‘healthy’ diet, and barriers to practice ‘healthy’ diet, paying attention to the dynamics between the perception and practice. We conducted 16 key informant interviews and eight focus group discussions in an urban and a rural areas in northern Ethiopia between November 2014 and January 2016. Audio-records in local language were transcribed word-for-word, and translated into English. English text data were analyzed qualitatively, through constant comparative analysis following the principles of the grounded theory. Three themes have emerged: (1) dietary habit perceived as ‘good’ or ‘bad’ for health; (2) reasons for continuing current ‘unhealthy’ dietary habit; and (3) current dietary habit perceived as ‘traditional.’ People’s practice was mostly consistent with their perception, while they sometimes practiced contrary to the perception because of personal preference and physical or financial obstacles. People were often indifferent of health implications of their habitual dietary practice, such as drinking a lot of sweet coffee. We showed dynamics between perception and practice of ‘healthy’ diet among people in northern Ethiopia. It is needed to increase awareness of NCDs both among the urban and rural people and to improve the social environment for removing the obstacles.
A Scottish and Japanese experience of patient-centred diabetic care: descriptive study of interprofessional education on live webinar

Mina Suematsu, Sundari Joseph, Keiko Abe, Hiroki Yasui, Noriyuki Takahashi, Kentaro Okazaki, Jenni Haxton, Morag McFadyen, Patrick Walker, and Lesley Diack
pg(s) 465 - 473

<Abstract> - < PDF >

To minimise the global burden of diabetes, the awareness of appropriate intervention methods for diabetes education and practice is essential. This project is the first international interprofessional education (IIPE) for the awareness of diabetes, with a focus on patient-centred care wherein three medical and four pharmacy students from Japan and one medical, two pharmacy, two nutrition and one occupational therapy (OT) student from Scotland participated. We described IIPE effects using interdisciplinary education perception scale (IEPS) before and after the programme among Scottish and Japanese students. University of Aberdeen/ Robert Gordon University and Nagoya University developed and established a shared online platform that provided knowledge to students on diabetes in both languages. We developed a case-based scenario that reflected diabetes care in each country using a standardised patient (SP). Lastly, a student-led live webinar was conducted on 14 November 2014 (the World Diabetes Day) to discuss and exchange care methods for SP. Each participating national team presented their care plan and all students discussed the diabetic care plan online. Both Japanese and Scottish teams were able to accurately assess the patient’s condition and empathise with the SP. In conclusion, all participants learned that interprofessional collaboration was clearly required for diabetes management focused on patient-centred care. All participants appreciated the differences in the approach of the two countries involved because of the cultural- and health related differences. This programme was significant in raising awareness regarding the need for international interprofessional intervention on diabetes towards developing a model for live webinar IIPE.
Problems in Ferrokinetics: extra radio-iron fixation to red cells

Hiroshi Saito
pg(s) 475 - 485

<Abstract> - < PDF >

Red cell radio-iron utilization (RCU) exceeds the ratio red cell iron per whole-body iron due to the extra red cell fixation of radio-iron refluxed from tissue. The extra red cell radio-iron fixation reduces the radio-iron distribution to non-erythron tissue. Affected by RCU, the red cell iron turnover rate (RCIT) becomes larger than the net red cell iron turnover rate, which is indicated by the red cell iron renewal rate (RCIR). To clarify the influences of such biased radio-iron distributions, the values assayed by ferrokinetics were compared with those assayed by the methods other than ferrokinetics. The results showed the underestimation of the tissue and storage iron turnover rates in all cases determined using RCIT by ferrokinetics. All the previous investigators of ferrokinetics probably misunderstood the excess of RCIT as an iron turnover rate of the reflux from a labile iron pool in erythroblasts in normal subjects. However, such a reflux from erythroblasts is unlikely to exist in normal subjects with rapid and effective erythropoiesis. Influences on the iron turnover rates by the extra radio-iron distribution to red cell mass in iron deficiency anemia and by the radio-iron fixation to storage in hereditary hemochromatosis were also discussed from a new perspective.
Analysis of late adverse events and their chronological changes after radiation therapy for cervical cancer

Takehiro Yamada, Shunichi Ishihara, Michiyasu Kawai, Yoshiyuki Itoh, Shinji Naganawa, and Mitsuru Ikeda
pg(s) 487 - 496

<Abstract> - < PDF >

Several late adverse events occur after radiation therapy (RT) for cervical cancer. However, there has been little reported about their chronological changes. It is still unclear whether concurrent chemoradiotherapy (CCRT) increases late complications. We aimed to evaluate the late adverse events and their chronological changes and whether CCRT increases their incidence and severity. For this purpose, we retrospectively analyzed 157 women with histologically proven cervical cancer. We reviewed all late adverse events and compared the frequency and severity between the patients who underwent CCRT and those who underwent RT alone. We calculated the cumulative occurrence rates of late adverse events stratified by the site and severity, and determined the chronological changes. With survivors’ median follow-up time of 74.3 months, late adverse events occurred in 49.0% and serious complications developed in 24.2% of all patients. There was no significant difference in the cumulative incidence rate of all late adverse events between the CCRT and RT-alone groups (p = 0.720). The incidence rate of rectal bleeding was 25.5%. Serious rectal bleeding developed in 5 patients, all within 20 months from the start of RT. Importantly, the symptoms of rectal bleeding disappeared or were relieved in most patients during follow-up. In conclusion, we evaluated the late adverse events and their chronological changes after RT for cervical cancer and showed that adding chemotherapy to RT did not affect the frequency and severity of late complications, and the symptoms of rectal bleeding were relieved over time.
A new laparoscopic triangle fixation technique for gastrostomy: a safe and effective procedure for reduction of the wound infection rate

Michimasa Fujiogi, Yujiro Tanaka, Hizuru Amano, Kyoichi Deie, Keisuke Suzuki, Hiroshi Kawashima, Naruhiko Murase, and Hiroo Uchida
pg(s) 497 - 503

<Abstract> - < PDF >

Gastrostomy is often performed with fundoplication in handicapped children. We devised a new laparoscopic triangle fixation technique for gastrostomy.
In this study, 100 patients underwent gastrostomy with fundoplication between January 2008 and January 2016. We retrospectively reviewed the early postoperative results between the new laparoscopic procedure (NLP) group (n = 63) and conventional procedure (CP) group (n = 37). In the CP, the gastrostomy tube was inserted with a purse-string ligature at the gastric wall, and the gastric wall was sutured to the peritoneum under a small laparotomy. In NLP, three sutures were placed on the gastric wall, forming the three sides of a triangle, and the tube was inserted into the center of the triangle. The ends of each suture were pulled directly through the abdominal wall using a laparoscopic percutaneous extraperitoneal closure needle to join the gastric wall and peritoneum. Both groups showed no significant differences in age, body weight, and external leakage rate. The wound infection rate was significantly lower in the NLP group. In conclusions, the NLP is straightforward and can achieve firm fixation between the stomach and abdominal wall by suturing in the form of a triangle. The NLP was associated with a lower complication rate, especially concerning infection.
Factors associated with concurrent sexual partnerships among men who have sex with men in Yangon, Myanmar

Thu Nandar Saw, Junko Yasuoko, Yu Mon Saw, Thet Mon Than, Ei Mon Win, Zaw Zaw Aung, Su Myat Cho, Akira Shibanuma, Krishna C. Poudel, Hla Hla Win, Shigemi Iriyama, and Masamine Jimba
pg(s) 505 - 518

<Abstract> - < PDF >

Men who have sex with men (MSM) are considered to be one of the groups most at risk of contracting HIV. However, to date, information regarding MSM’s sexual behaviors and the risk factors for their concurrent sexual partnerships (CSP) have not been known in Myanmar. This study aimed to identify factors associated with CSP among MSM.A cross-sectional study was conducted from September to October 2011 in Yangon, Myanmar. In total, 353 males who had self-reported sex with men were recruited using respondent-driven sampling method. Descriptive statistics and multivariate logistic regression analysis were performed. In total, 61.0% of the MSM reported having CSP. MSM who practiced sex trading in the past six months (adjusted odds ratio8.32; 95% confidence interval [CI]: 2.30–30.10), MSM who had diagnosed with STIs/HIV (AOR 6.71; 95% CI: 4.78–9.28), and MSM who engaged in unprotected insertive anal sex (AOR 1.27; 95% CI: 1.02–1.45) were more likely to have CSP. In contrast, MSM who used condoms consistently during the past six months (AOR = 0.27; 95% CI: 0.08–0.94), MSM who had a regular job (AOR = 0.21; 95% CI: 0.06–0.74), and MSM who initiated sexual activities later in their lives (AOR = 0.08; 95% CI: 0.03–0.25) were less likely to have CSP. Concurrent sexual partnerships are common among MSM in Myanmar. Findings suggest that interventions should focus on MSM who diagnosed with STIs/ HIV, do not have regular jobs, and initiated their sexual activities at an early age.
Editors' Choice
Ultrasound measurement of thigh muscle thickness for assessment of sarcopenia

Tetsuro Hida, Kei Ando, Kazuyoshi Kobayashi, Kenyu Ito, Mikito Tsushima, Tomonori Kobayakawa, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Shunsuke Kanbara, Sadayuki Ito, Naoki Ishiguro, Yukiharu Hasegawa, and Shiro Imagama
pg(s) 519 - 527

<Abstract> - < PDF >

Our aim of this study is to compare the thigh muscle thickness measurements obtained using ultrasound and bioelectrical impedance analysis (BIA) methods, and to investigate the validity and cutoff value of the ultrasonography. We analyzed a total of 201 participants (99 male and 102 female participants, mean age, 66.2 years) participated in the annual health checkup in the Yakumo Study, 2014. Thigh muscle thickness (TMT, sum of the rectus femoris and vastus intermedius muscle thickness) was measured using ultrasound at mid-thigh in the sitting position. Appendicular skeletal muscle mass (aSMI) was measured using BIA. Cutoff value of TMT was determined through the receiver operating characteristic analysis. We defined sarcopenia with the diagnostic algorithm of Asian Working Group for Sarcopenia. TMT was significantly reduced in subject with sarcopenia than in those without sarcopenia in both gender. Muscle measurements obtained using the BIA methods (aSMI) and ultrasound methods (TMT) showed a significant correlation, with a correlation coefficient of 0.38 (P < 0.001). Cutoff value, sensitivity, and specificity of TMT in diagnosis of muscle loss were 36 mm, 72.0%, and 73.9%, respectively, for the male participants, and 34 mm, 72.2%, and 72.4%, respectively, for the female participants. In conclusion, the ultrasonography for thigh muscle might be a simple diagnostic method for sarcopenia.
Polymorphisms in folic acid metabolism genes do not associate with cancer cachexia in Japanese gastrointestinal patients

Takuto Morishita, Asahi Hishida, Yoshinaga Okugawa, Yuuki Morimoto, Yumiko Shirai, Kyoko Okamoto, Sachiko Momokita, Aki Ogawa, Koji Tanaka, Ryutaro Nishikawa, Yuji Toiyama, Yasuhiro Inoue, Hiroyuki Sakurai, Hisashi Urata, Motoyoshi Tanaka, and Chikao Miki
pg(s) 529 - 539

<Abstract> - < PDF >

We used clinical data from Iga General Hospital to examine the association between polymorphisms in MTR (methionine synthase) A2756G (rs1805087), MTRR (methionine synthase reductase) His595Tyr (rs10380), MTHFR (methylenetetrahydrofolate reductase) C677T (rs1801133), MTHFR A1298C (rs1801131) and SHMT (serine hydroxymethyltransferase) C1420T (rs1979277), which are genes involved in folate metabolism, and the risk of weight loss in patients with gastrointestinal cancers, with the aim of establishing personalized palliative care for each patient based on genetic information. The data from 59 patients (37 males and 22 females) with gastrointestinal cancers who visited the outpatient clinic for cancer chemotherapy and palliative care at Iga General Hospital from December 2011 to August 2015 were analyzed. There was no significant association between the single nucleotide polymorphisms (SNPs) in the folate metabolizing genes examined and weight loss defined as weight loss of more than 5 percent or more than 10 percent during the first 6 months after initiation of chemotherapy. We did not detect any significant association between any of the SNPs examined and overall survival of patients. The present study indicated that these SNPs have relatively limited or no roles in the genesis of cachexia in patients with gastrointestinal cancers; however, further investigations into the roles of these folate metabolizing genes in the context of cancer palliative care, from clinical, biological and epidemiological viewpoints are warranted.
Clinical T staging is superior to fluorodeoxyglucose positron emission tomography for predicting local outcomes after intra-arterial infusion chemoradiotherapy for maxillary sinus squamous cell carcinoma

Hiroshi Doi, Masayuki Fujiwara, Kazuhiro Kitajima, Masao Tanooka, Tomonori Terada, Kazuma Noguchi, Reiichi Ishikura, Norihiko Kamikonya, and Koichiro Yamakado
pg(s) 541 - 550

<Abstract> - < PDF >

Concomitant intra-arterial infusion chemoradiotherapy (IA-CRT) has been used to treat locally advanced maxillary sinus squamous cell carcinoma (MSSCC) with positive outcomes. However, an optimal predictive prognostic factor for MSSCC treated with IA-CRT remains elusive. The aim of the present study was to assess the feasibility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), including volumetric parameters, to predict the prognosis of MSSCC treated with IA-CRT. Twenty-four patients with newly diagnosed MSSCC receiving FDG-PET imaging before IA-CRT treatment were analyzed in this retrospective study. All patients underwent radiotherapy with a total tumor dose of 60–66 Gy in a conventional fractionation schedule, using three-dimensional conformal radiation therapy or intensitymodulated radiation therapy. Radiotherapy was performed concurrently with concurrent intra-arterial infusion chemotherapy (cisplatin). The IA-CRT response rate was 83.33%. The 1- and 3-year survival rates were 81.30% and 64.34%, respectively. The 1- and 3-year local failure-free rates were 57.21% and 40.96%, respectively. Local failure was significantly associated with poor survival (P = 0.0152). Further, clinical T staging clearly stratified local control outcomes among patients with clinical T3 or less, T4a, and T4b (P = 0.0312). Moreover, patients with stage T4b showed a significantly poorer local control compared with T3 or less (P = 0.0103). However, FDG-PET parameters provided no significant predictive information regarding treatment outcome. To conclude, pretreatment T stage predicts local control by IA-CRT, which is associated with survival.
Usefulness of modified pigtail-shaped microguidewire guidance for microcatheter navigation in difficult vasculatures during neuroendovascular interventions

Tomotaka Ohshima, Shamim Ul Haq Siddiqi, Shigeru Miyachi, Naoki Matsuo, Reo Kawaguchi, Yoko Kato, and Masakazu Takayasu
pg(s) 551 - 557

<Abstract> - < PDF >

We previously reported using a microguidewire with a curved, pigtail-shaped tip as an anchor for navigating a microcatheter. However, we considered that the microcatheter could follow even if the tip of wire did not advance so far distally. The present study assessed the usefulness of a modified version of this pigtail-shaped microguidewire for navigating microcatheters to difficult vasculatures during neurointerventions. The microguidewire was repeatedly evaluated using a silicon tube vascular model. We also employed this method as the first choice for some patients. In both the in vitro tests and clinical use, the round curved tip could be used to position the microguidewire at the entry of a sharply angled vessel or aneurysmal neck, and the following catheter could then be advanced gently and easily. This technique allowed navigation of the microcatheter without inserting the guidewire into the distal vasculature.
Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study

Abubakr Ahmed Abdullah Al-Shoaibi, Akiko Matsuyama, Md. Khalequzzaman, Fariha Haseen, Sohel Reza Choudhury, Bilqis Amin Hoque, Chifa Chiang, Yoshihisa Hirakawa, Hiroshi Yatsuya, and Atsuko Aoyama
pg(s) 559 - 569

<Abstract> - < PDF >

The increasing burden of noncommunicable diseases (NCDs) in Bangladesh can be attributable to rapid urbanization and coinciding changes in lifestyle accompanied by nutrition transition. The objective of this study is to explore respondents’ lived experiences and perceptions relating to NCDs and nutrition change in an urban slum community in Dhaka.
Qualitative methods were employed to explore a general understanding of behavior related to NCDs among residents of the slum community. We conducted key informant interviews of six men and seven women of various backgrounds and five focus group discussions to focus salient topics emerged from the interviews. The transcriptions of the audio-recordings were thematically analyzed, using the constant comparison method.
Four major themes emerged: (1) financial hardship influencing health; (2) urbanized lifestyle affecting diet; (3) tobacco and sweetened tea as cornerstones of social life; and (4) health-seeking behavior utilizing local resources. One notable finding was that even with general economic improvement, respondents perceived poverty to be one of the major causes of NCDs. A promising finding for potentially curbing NCDs was the current trend for women to walk for exercise contrary to the commonly held notion that urban dwellers generally lead sedentary lifestyles.
This study described how urban slum dwellers in Dhaka, experiencing a transition from a traditional to urbanized lifestyle, perceived their daily practices in relation to NCDs and nutrition. Our research revealed both adverse and encouraging elements of perceptions and behavior related to NCDs, which may contribute to the optimal design of NCD prevention and health promotion programs.
Laboratory prognostic score for predicting 30-day mortality in terminally ill cancer patients

Natsuko Kawai and Norihiro Yuasa
pg(s) 571 - 582

<Abstract> - < PDF >

Conventional prognostic scores for terminally ill cancer patients may have less objectivity because they include subjective or categorical variables that do not consider intensity or severity. The aim of this study was to identify prognostic factors for 30-day mortality from routine blood examination of terminally ill cancer patients. A total of 1308 study patients in a hospice setting were divided into investigation (n=761) and validation (n=547) groups. Twenty laboratory blood parameters were analyzed. Multivariate analysis revealed that ten variables (C-reactive protein ≥5.4 mg/dL, serum albumin <2.8 g/dL, blood urea nitrogen ≥21 mg/dL, white blood cell count ≥8.600 × 103/μL, eosinophil percentage <0.8%, neutrophil-to-lymphocyte ratio ≥11.1, hemoglobin level ≥ 13.2 g/dL, mean corpuscular volume ≥ 93.7 fl, red cell distribution width ≥ 16, and platelet count < 159 × 103/μL) were significant independent prognostic factors for 30-day survival. The laboratory prognostic score (LPS) was calculated by the sum of blood indices among the ten variables. The LPS showed acceptable accuracy for 30-day mortality in the investigation and validation groups. LPS 5 (including any five factors) predicted death within 30 days, with a sensitivity of 85%, a specificity of 55%, a positive predictive value of 72%, and a negative predictive value of 74%. The predictive value of LPS was comparable to those of conventional prognostic scores, which include signs and symptoms. The LPS can provide additional information to conventional prognostic scores.
Evaluation of sagittal alignment and range of motion of the cervical spine using multi-detector- row computed tomography in asymptomatic subjects

Akinori Kobayakawa, Fumihiko Kato, Keigo Ito, Masaaki Machino, Shunsuke Kanbara, Daigo Morita, and Taro Matsumoto
pg(s) 583 - 589

<Abstract> - < PDF >

To evaluate the sagittal alignment and range of motion (ROM) of the cervical spine during cervical flexion and extension ,using multi-detector-row-computed tomography (MDCT) in asymptomatic subjects. Understanding the normal alignment and range of motion of the cervical spine is very important while evaluating patients with cervical spine instability and abnormal alignment. Several reports using plain radiographic data have assessed the alignment and ROM of the cervical spine during flexion and extension. However, there has been no such report using MDCT. Ninety-eight subjects who did not have cervical spine-related symptoms were enrolled. After myelography, all subjects underwent cervical MDCT in cervical flexion and extension. Sagittal alignment and ROM between C2 and C7 were measured.The sagittal alignment between C2 and C7 was -11.7°±8.3° (mean ± standard deviation) in flexion and 26.5°± 12.9° in extension. The C5/6 level showed maximum kyphosis in flexion. The C6/C7 level demonstrated maximum lordosis in extension. ROM between C2 and C7 was 37.9°±11.2°. The C2/3 level showed the lowest ROM and the C5/C6 level showed the highest ROM among the intervertebral levels evaluated.The sagittal alignment and ROM of the cervical spine during flexion and extension in asymptomatic subjects were measured using MDCT. Each level between C2 and C7 could be evaluated in detail without any influence due to degenerative changes in the spine or soft tissues of the shoulder. MDCT generated a more precise understanding of the dynamic changes at each evaluated intervertebral level in the cervical spine.
An open-label trial of the prophylactic administration of voriconazole in patients who undergo allogeneic hematopoietic stem cell transplantation: study protocol

Akane Kunitomi, Yuta Hasegawa, Hiroya Hashimoto, Akiko M. Saito, and Hiroatsu Iida
pg(s) 591 - 595

<Abstract> - < PDF >

Invasive fungal infections, especially those caused by Aspergillus, can be fatal in patients who have undergone allogeneic hematopoietic stem cell transplantation. Fluconazole, itraconazole and micafungin can be used to prevent fungal infections in patients undergoing allogeneic hematopoietic stem cell transplantation, but fluconazole is not effective against Aspergillus, and itraconazole has less tolerability from gastrointestinal toxicity. Micafungin is approved for prophylaxis at a dose of 50 mg/day, less than a therapeutic dose. Voriconazole, the current preferred agent for invasive Aspergillus infection, is available in both oral and intravenous preparations, and has recently been approved for prophylaxis in Japan. Some US and European studies have reported on the prophylactic use of voriconazole, but the efficacy and safety of this has not been confirmed in Japan. Hence, this prospective study of voriconazole as prophylaxis against invasive fungal infections in patients who have received allogeneic hematopoietic stem cell transplantation is being performed to evaluate its efficacy and safety, including incidence rate of proven/probable invasive aspergillosis and other fungal infections, and adverse event(s) due to voriconazole administration. We are also investigating potential interactions between voriconazole and immunosuppressive drugs by monitoring the blood concentration of a calcineurin inhibitor in Japanese patients. Further, this study aims to improve the clinical outcomes of allogeneic hematopoietic stem cell transplantation recipients.
Polymer coating on carbon nanotubes into Durobeads is a novel strategy for human environmental safety

Fumiya Ito, Hideyuki Hisashi, and Shinya Toyokuni
pg(s) 597 - 604

<Abstract> - < PDF >

Carbon nanotubes (CNTs) have attracted much business interest in industrial applications due to their high electrical and heat conductivities while being both durable and versatile. However, multiwall CNTs (MWCNTs) of ~50 nm diameter (NT50) have been shown to cause mesothelioma in rodents after direct exposure to mesothelial cells, and thus were classified as a Group 2B carcinogen to humans, which requires considerable regulations for use. In contrast, tangled MWCNTs of ~15 nm diameter (NTtngl) are not carcinogenic to rats, indicating that the physical dimension linked with mesothelial cellular uptake is an important factor for human environmental risk. In the present study, hypothesizing that dustability is another distinct risk factor, for the first time, we evaluated the toxicity of CNT granules (Durobeads) that were generated with a polymer coating to mesothelial cells. Polymer coating induced prominent agglomeration and significantly suppressed the dustability of CNTs in a dose-dependent manner, with a 10% polymer coating resulting in 730 times less dustability. These CNT granules revealed significantly lower mesothelial uptake and cytotoxicity in comparison to NT50 in in vitro assays. Similarly, in in vivo analyses, CNT granules induced limited peritoneal inflammation 4 weeks after intraperitoneal injection, whereas NT50 caused severe fibrosing inflammation. Previously, we demonstrated that the severity of inflammation by intraperitoneal injection in the subacute studies are in agreement with the mesothelial carcinogenicity by CNTs. Therefore, we suggest that adding a polymer coating to CNTs provides another smart strategy for the safe use of CNTs.

CASE REPORTS

A case of delayed hydrocephalus from cerebrospinal fluid leak after resection of a cervical spinal schwannoma

Kazuyoshi Kobayashi, Kei Ando, Kenyu Ito, Mikito Tsushima, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Naoki Ishiguro, and Shiro Imagama
pg(s) 605 - 609

<Abstract> - < PDF >

A 39-year old man underwent surgery for recurrence of a cervical schwannoma. At 6 months postoperatively, severe headache appeared and head CT showed marked ventricular dilation that was diagnosed as delayed hydrocephalus. Dural repair surgery using a fascia patch of the tensor fasciae latae muscle was performed after VP shunt. This case shows the importance of awareness of the possibility of delayed hydrocephalus in a patient with severe headache.
A pediatric case with parvovirus B19-associated uveitis without autoantibody formation

Takuma Ito, Takayuki Hoshina, Kazuyoshi Mizuki, Tomofumi Fukuda, Shingo Ishibashi, and Koichi Kusuhara
pg(s) 611 - 614

<Abstract> - < PDF >

Acute parvovirus B19 (B19) infection is often accompanied by autoantibody formation, including antinuclear antibodies and rheumatoid factor, and the symptoms of the infection are similar to those of several autoimmune diseases. Uveitis is a representative manifestation of autoimmune diseases and is rarely caused by B19. Autoantibody formation was confirmed in 2 previously reported cases with B19- associated uveitis. However, whether B19-associated uveitis is caused by the direct invasion of the virus or the induction of autoimmunity remains unclear. We herein report a pediatric case with B19-associated uveitis without autoantibody formation. We speculated that B19 might have directly invaded the eye in this patient because of the development of uveitis without antibody formation and the negative results for anti-B19-specific antibodies in the serum at the onset of the disease. Although the mechanism of invasion is unknown, B19 may have a high affinity for tissue in the eye.