Kinki University Research Articles

Optical coherence tomographic findings at the fixation point in a case of bilateral congenital macular coloboma

BackgroundCongenital macular coloboma is a rare ocular disease that consists of atrophic lesions in the macula with well-circumscribed borders. We report the findings of spectral domain optical coherence tomography (SD-OCT) at the fixation point in a case of bilateral macular coloboma.Case reportThe subject is a 4-year-old boy. He visited our hospital at age 1 year and 4 months for the evaluation of strabismus. The fundus examination of both eyes showed round-shaped sharply-demarcated atrophic lesions involving the macula with large choroidal vessels and bared sclera at the base. Immunologic tests including toxoplasmosis, rubella, varicella, herpes virus, and human T-cell leukemia virus were all negative. At age 4 years and 1 month, cycloplegic refraction showed insignificant refractive errors and his best corrected visual acuity was 0.6 bilaterally. The SD-OCT showed a crater-like depression accompanying atrophic neurosensory retina, and the absence of retinal pigment epithelium and choroid. Examination of the fixation behavior by visuscope showed steady fixation with an area 0.5° nasal to the nasal edge of the atrophic lesion bilaterally. The SD-OCT findings at fixation area showed remaining normal retinal structures involving inner segment-outer segment (IS/OS) junction line.ConclusionThe findings of SD-OCT have been shown to be useful in the diagnosis of macular coloboma. In the fixation point, the structure of retina and choroid were well preserved.

Objective structured skill examination in physiology education (531.6)

We tested the efficacy of objective structured skill examination (OSSE) as a new and useful examination. The second grade students at Kinki University Faculty of Medicine were prospectively eligible. Students took problem‐based learning (PBL) tutorials in addition to classroom lectures and laboratory practice in each session. The sessions were on: cardiac, circulation, hematological, and renal systems. After all sessions, OSSE was performed to evaluate the students’ performance. The technical skills evaluated in OSSE were as follows: electrocardiogram recording, blood pressure measuring, use of centrifuge, pipette technique, hematocrit measurement, urinary specific gravity determination, and measurement of urine volume. One order sheet and the experimental apparatus for OSSE were positioned at each station and students terminate the maneuver in 2 min. The score from OSSE was compared to that from the conventional evaluation. Significant positive correlation was not observed. More than half of the students considered OSSE to be meaningful. In conclusion, we developed a new structured examination to objectively assess the students' technical skills in laboratory practice.Grant Funding Source: None

P552 PROTEOMIC ANALYSIS IN PATIENTS WITH HEPATOCELLULAR CARCINOMA AFTER LIVER RADIOEMBOLIZATION. PRELIMINARY RESULTS

Background and Aims: TACE is recommended as the first-line therapy for HCC patients who are not eligible for curative therapy and without portal invasion. Recently, a new scoring system, the ART score, had been proposed for discriminating patients who would not show an enough survival benefit from repeated TACE. The purpose of the study is to clarify the usability of ART for HCC cohort in Japan, where selective procedure of TACE is prevailing. Methods: Number of patients with advanced HCC treated with TACE at Kinki University hospital, and, 627 received three or more TACE during the clinical courses. Among them, 76 patients who underwent two TACE sessions within 90 days were investigated for the usability of the ART on OS. Results: Only 12% (76/627) of the patients received two or more TACE sessions within 90 days in Japanese cohort. Fifty three patients were classified as low-ART (0–1.5 points) group and 23 were the members of the high-ART (≥2.5 points) group; the median OS was 25.8 months (25th-75th percentile: 8.4–28.2) and 15.4 months (26.2–15.4), respectively. Although the patients with low-ART score revealed longer OS than those with the high-ART, it did not show significant impact on OS among Japanese cohort of HCC (P = 0.173). Conclusions: ART scoring system did not show enough predictive impact on OS in the Japanese HCC cohort, where only about 10% of the patients could be eligible. Application of ART score should be carefully considered because different TACE procedure and postTACE treatment might be influence the result of evaluating OS.

Biomarkers of reactive resistance and early disease progression during chemotherapy plus bevacizumab treatment for colorectal carcinoma.

Molecular markers for predicting or monitoring the efficacy of bevacizumab in patients with metastatic colorectal cancer (mCRC) remain to be identified. We have now measured the serum concentrations of 25 angiogenesis-related molecules with antibody suspension bead array systems for 25 mCRC patients both before and during treatment in a previously reported phase II trial of FOLFIRI chemotherapy plus bevacizumab. The serum concentration of vascular endothelial growth factor-A (VEGF-A) decreased after the onset of treatment (P < 0.0001), whereas that of placental growth factor increased (P < 0.0001). Significant differences in the levels of several factors (such as VEGF-A, soluble VEGF receptor-2, and interleukin-8) were apparent between responders and nonresponders during treatment. The rapid and pronounced decrease in serum VEGF-A level after treatment onset was apparent in all subjects and was independent of the baseline concentration. However, four of nine nonresponders showed a subsequent early increase in the serum VEGF-A level. Our results thus suggest that an early increase in the serum VEGF-A concentration after the initial decrease is a potential predictive marker of a poor response and reactive resistance to bevacizumab plus chemotherapy.

近畿大学先端技術総合研究所&lt;br/&gt;高圧力蛋白質研究センター&lt;br/&gt;（高圧生物科学）

近畿大学先端技術総合研究所&lt;br/&gt;高圧力蛋白質研究センター&lt;br/&gt;（高圧生物科学）

Survey of radioactive contamination in Fukushima Naka-dori region, Fukushima, Japan

Due to the Fukushima Daiichi Nuclear Plant Accident, a large area of Tohoku & Kanto regions contaminated with radioactive materials. Kinki University Atomic Energy Research Institute (Kinki Univ. AERI) started researches for the radioactive contamination in Fukushima Naka-dori region from the early April 2011. As the result of the research, some conditions of the contaminations become clear. The first one is that air dose rate depends on the condition of the ground surface. The second one is that some radioisotopes from Fukushima Daiichi NPP can be easily found in Naka-dori region at April 2011, but the radioisotopes decayed and became negligible at the middle of July 2011, except for 134 Cs & 137 Cs. The last one is that the decay of radioactive Cesium at urban area of Naka-dori region is faster than the physical half-life.

Frequent amplification of ORAOV1 gene in esophageal squamous cell cancer promotes an aggressive phenotype via proline metabolism and ROS production.

Chromosomal band 11q13 seems to be one of the most frequently amplified lesions in human cancer, including esophageal squamous cell cancer (ESCC). The oral cancer overexpressed 1 (ORAOV1) gene has been identified within this region, but its detailed biological function in human ESCC remains largely unclear. In our clinical samples of stage III ESCC, ORAOV1 amplification was observed in 49 of 94 cases (53%). ORAOV1 amplification was significantly associated with a poorly differentiated histology and tumors located in the upper or middle esophagus. Patients with ORAOV1 amplification tended to have a shorter survival period, although the difference was not significant. To investigate the function of ORAOV1, we created ORAOV1--overexpressed ESCC cell lines that exhibited increased cellular proliferation and colony formation, compared with in vitro controls. In vivo, ORAOV1-overexpressed cells exhibited a significantly increased tumorigenicity and a significantly larger tumor volume and poorer differentiation than controls. The peptide mass fingerprinting technique demonstrated that ORAOV1 bound to pyrroline-5-carboxylate reductase (PYCR), which is associated with proline metabolism and reactive oxygen species (ROS) production. Then, ORAOV1-overexpressed cell lines were resistant to stress treatment, which was cancelled by PYCR-knockdown. In addition, the ORAOV1-overexpressed cell line had a higher intracellular proline concentration and a lower ROS level. Our findings indicate that the ORAOV1 gene is frequently amplified in ESCC, enhances tumorigenicity and tumor growth, and is associated with a poorly differentiated tumor histology via proline metabolism and ROS production. ORAOV1 could be a novel target for the treatment of ESCC.

Vitiligo after combination therapy of pegylated interferon-α-2a, ribavirin and vitamin D in a patient with chronic hepatitis C

The Journal of DermatologyVolume 40, Issue 9 p. 772-773 Letters to the Editor Vitiligo after combination therapy of pegylated interferon-α-2a, ribavirin and vitamin D in a patient with chronic hepatitis C Naoki Oiso, Corresponding Author Naoki Oiso Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, JapanCorrespondence: Naoki Oiso, M.D., Ph.D., Department of Dermatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. Email: [email protected]Search for more papers by this authorMasako Sato, Masako Sato Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, JapanSearch for more papers by this authorAkira Kawada, Akira Kawada Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, JapanSearch for more papers by this author Naoki Oiso, Corresponding Author Naoki Oiso Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, JapanCorrespondence: Naoki Oiso, M.D., Ph.D., Department of Dermatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. Email: [email protected]Search for more papers by this authorMasako Sato, Masako Sato Department of Internal Medicine, Osaka Rosai Hospital, Sakai, Osaka, JapanSearch for more papers by this authorAkira Kawada, Akira Kawada Department of Dermatology, Kinki University Faculty of Medicine, Osaka-Sayama, JapanSearch for more papers by this author First published: 16 July 2013 https://doi.org/10.1111/1346-8138.12234Citations: 5 Conflict of interest: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue9September 2013Pages 772-773 RelatedInformation

Diagnostic usefulness of ultrasonography for plantar angioleiomyoma

ejd.2013.2093 Auteur(s) : Naoki Oiso naoiso@med.kindai.ac.jp, Tomohiko Narita, Akira Kawada Department of Dermatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan Leiomyomas are benign tumors that arise from smooth muscle. Cutaneous leiomyomas occur in three main forms: pilar leiomyoma derived from the arrector pili muscle; genital leiomyoma from smooth muscle of the scrotum, labia major or nipples; and angioleiomyoma from the media of blood vessels [...]

Three-dimensional trajectories of cultivated Pacific bluefin tuna Thunnus orientalis in an aquaculture net cage

AEI Aquaculture Environment Interactions Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsTheme Sections AEI 4:81-90 (2013) - DOI: https://doi.org/10.3354/aei00075 Three-dimensional trajectories of cultivated Pacific bluefin tuna Thunnus orientalis in an aquaculture net cage Kazuyoshi Komeyama1,*, Minoru Kadota2,3,*, Shinsuke Torisawa2, Tsutomu Takagi2,** 1Faculty of Fishery, Kagoshima University, 4-50-20 Shimoarata, Kagoshima 890-0056, Japan 2Department of Fisheries, Faculty of Agriculture, Kinki University, 3327-204 Naka-machi, Nara 631-8505, Japan 3Temple University, 4-1-27 Mita, Minato-ku, Tokyo 109-0073, Japan *These authors contributed equally to this work**Corresponding author. Email: tutakagi@nara.kindai.ac.jp ABSTRACT: Swimming trajectories of aquatic animals that are estimated using the dead-reckoning technique below the sea surface tend to have very large associated observational errors. Therefore, the aim of the present study was to develop a technique for removing accumulated errors from such trajectories for Pacific bluefin tuna Thunnus orientalis. Horizontal and vertical speeds and heading angle were measured in an aquaculture net cage using 2 types of data loggers, and current velocity was recorded at a depth of 12 m to measure the tidal current speed around the net cage. Fourier analysis indicated that the primary source of error in trajectory estimates was the effect of ocean currents, which resulted in drift, and further analysis revealed that the frequency contributing to drift was consistent with the low-frequency signal in a spectrum analysis of horizontal speed. Therefore, a high-pass filter was applied to horizontal speed data to remove any frequencies lower than the cut-off frequency (0.0015 Hz), following which these data were back-transformed into a time domain that no longer included the drift effect caused by the current. The reconstructed trajectories fit within the inner diameters of the net cage, indicating that they were realistic. To confirm the validity of the resultant swimming trajectories, a flume tank experiment was conducted, which demonstrated that the high-pass filter effectively removed current drift from the estimated trajectory. Furthermore, since the method was estimated to have a precision of approximately 0.20 m, it not only allows the 3-dimensional trajectories of circling tuna to be estimated but can also be applied to the behavior of fish in the wild. KEY WORDS: Dead reckoning · Behaviour · Submerged net cage Full text in pdf format PreviousCite this article as: Komeyama K, Kadota M, Torisawa S, Takagi T (2013) Three-dimensional trajectories of cultivated Pacific bluefin tuna Thunnus orientalis in an aquaculture net cage. Aquacult Environ Interact 4:81-90. https://doi.org/10.3354/aei00075 Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in AEI Vol. 4, No. 1. Online publication date: June 26, 2013 Print ISSN: 1869-215X; Online ISSN: 1869-7534 Copyright © 2013 Inter-Research.

AB0321 Usefulness of tocilizumab therapy and changes in bone and cartilage metabolism markers in ra patients

BackgroundSome cases in RA, the use of biologics improved bone quality and formation. We try to demonstrate the TCZ suppresses RA activity and promotes bone formation.ObjectivesTCZ was administered to RA...

Spatial and Temporal Variations of Atmospheric Aerosol in Osaka

It is well known that the aerosol distribution in Asia is complex due to both the increasing emissions of the anthropogenic aerosols associated with economic growth and the behavior of natural dusts. Therefore, detailed observations of atmospheric particles in Asian urban cities are important. In this work, we focus on the spatial and temporal variations of atmospheric particles around Higashi-Osaka in Japan. Higashi-Osaka is located in the eastern part of Osaka, the second-largest city in Japan, and is famous for small- and medium-sized manufacturing enterprises. For this study, we placed various ground measurement devices around the Higashi-Osaka campus of Kinki University including a Cimel sunphotometer supported by NASA/AERONET (Aerosol robotics network), suspended particulate matter (SPM) sampler and LIDAR (light detection and ranging). Individual particle analyses with a SEM (scanning electron microscope)/EDX (energy-dispersive X-ray analyzer) show the temporal variations of particle properties, such as size, shape and components, during a dust event on 21 March 2010. The simultaneous measurement using a portable sun photometer with AERONET was conducted from April to November 2011. A comparison of the data at each site and the combination of the observed LIDAR data and model simulations indicate the difference in the transportation processes between dust and anthropogenic particles. We suppose this difference is attributed to the differences in the vertical aerosol profiles, where one aerosol is transported over Mount Ikoma and the other is blocked by it.

Eruptive vellus hair cysts of the labia majora: detection of openings of the cysts to the epidermis by dermoscopy

ejd.2013.2036 Auteur(s) : Naoki Oiso naoiso@med.kindai.ac.jp, Hiromasa Matsuda, Akira Kawada Department of Dermatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan Eruptive vellus hair cysts (EVHC) are clinically characterized by multiple, asymptomatic, small, skin-colored or yellowish papules, with a smooth or centrally umbilicated surface, commonly on the chest or upper extremities [1, 2]. EVHC consist histopathologically of epidermoid cysts [...]

Clinical outcome of incidentally discovered small renal cell carcinoma after delayed surgery

BackgroundThis study was undertaken to investigate the growth rate and clinical outcome of patients with a small renal mass (SRM) after delayed surgery.MethodsWe reviewed the clinical records of 34 patients with SRMs ≤ 4 cm at diagnosis, who underwent delayed surgical intervention during surveillance from January 2000 to December 2011. Radiographic evaluations using computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed at least every 6 months, and the tumor size was determined at least twice.ResultsThe mean follow-up time was 26.6 ± 18.6 months and mean tumor doubling time was 23.4 ± 16.0 months. Histopathological analysis revealed that 32 of the 34 patients were malignant in pT1aN0M0. Only one patient showed tumor recurrence, who subsequently died due to tumor progression.ConclusionThe growth rate of the small renal mass was slow in the majority of our patients. Delayed intervention does not have a detrimental effect on cancer-specific outcomes.

DEVELOPMENT OF AN OBJECTIVE STRUCTURED SKILL EXAMINATION IN PHYSIOLOGY EDUCATION

The efficacy of objective structured skill examination (OSSE) was evaluated as a new and useful examination. The second grade students at Kinki University Faculty of Medicine were prospectively eligible. Students took problem-based learning (PBL) tutorials in addition to classroom lectures and laboratory practice in each session. The sessions were on: cardiac, circulation, hematological, and renal systems. At the end of each session, students took the paper examination as a part of conventional evaluation. After all sessions, OSSE was performed to evaluate the students’ performance. The technical skills evaluated in OSSE were as follows: electrocardiogram recording, blood pressure measuring, use of centrifuge, pipette technique, hematocrit measurement, urinary specific gravity determination, and measurement of urine volume. One order sheet and the experimental apparatus for OSSE were positioned at each station and students terminate the maneuver in 2 min. The score from OSSE was compared to that from the conventional evaluation. Significant positive correlation was not observed. More than half of the students considered OSSE to be meaningful. In conclusion, we developed a new structured examination to objectively assess the students' technical skills in laboratory practice. Key words: curriculum reform, laboratory practice, objective structured skill examination, physiology.

A scoring algorithm for predicting the presence of adult asthma: a prospective derivation study

Background:To predict the presence of asthma in adult patients with respiratory symptoms, we developed a scoring algorithm using clinical parameters.Methods:We prospectively analysed 566 adult outpatients who visited Kinki University Hospital for the first time with complaints of nonspecific respiratory symptoms. Asthma was comprehensively diagnosed by specialists using symptoms, signs, and objective tools including bronchodilator reversibility and/or the assessment of bronchial hyperresponsiveness (BHR). Multiple logistic regression analysis was performed to categorise patients and determine the accuracy of diagnosing asthma.Results:A scoring algorithm using the symptom-sign score was developed, based on diurnal variation of symptoms (1 point), recurrent episodes (2 points), medical history of allergic diseases (1 point), and wheeze sound (2 points). A score of ≥3 had 35% sensitivity and 97% specificity for discriminating between patients with and without asthma and assigned a high probability of having asthma (accuracy 90%). A score of 1 or 2 points assigned intermediate probability (accuracy 68%). After providing additional data of forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.7, the post-test probability of having asthma was increased to 93%. A score of 0 points assigned low probability (accuracy 31%). After providing additional data of positive reversibility, the post-test probability of having asthma was increased to 88%.Conclusions:This pragmatic diagnostic algorithm is useful for predicting the presence of adult asthma and for determining the appropriate time for consultation with a pulmonologist.

Scope and Editorial Board

Food Safety – The Official Journal of Food Safety Commission of Japan is a peer-reviewed open-access electronic online journal of English published quarterly by the FSCJ. The journal will feature four types of articles: Original Articles, short communications, reviews, and risk assessments conducted by FSCJ. Scope of the journalThe aim of the publication of Food Safety is to gather and disseminate scientific and technological information in the field of food safety on human health, and thereby facilitate the development of science and technology for risk assessments of foods. The journal publishes original articles, short communications, and reviews covering broad areas of food safety related to the risk assessment of foods as well as risk assessments conducted by FSCJ. Papers dealing with the following areas are particularly welcome: (1) pathogenicity or toxicity of biological, physical, or chemical agents concerning food safety; (2) occurrence of biological, physical, or chemical agents in the food chain with emphasis on food safety; (3) epidemiology or control of food-borne illnesses; and (4) safety evaluation of novel foods including nanomaterials, genetically modified organisms, etc. In addition to these areas, papers on the methodology of risk assessments concerning food safety are encouraged. DisclaimerThe publication of original articles, short communications and reviews in Food Safety does not mean that the FSCJ condones, endorses, approves, or recommends the use of any products, services, materials, methodology, or policies stated therein. Conclusions and opinions in these articles are those of the individual authors only and do not reflect the policies or view of the FSCJ. Editor in Chief Susumu Kumagai (FSCJ) Associate Editors Katsue Ishii (FSCJ), Kiyoko Kamiyasuhira (FSCJ), Kunitoshi Mitsumori (FSCJ), Masatsune Murata (FSCJ), Hiroshi Satoh (FSCJ), Yasushi Yamazoe (FSCJ) Editorial Board G. Endo (Osaka City University Medical School, Japan), R. Hasegawa (Pharmaceuticals and Medical Devices Agency, Japan), T. Hayakawa (Kinki University, Japan), A. Hirose (National Institute of Health Sciences, Japan), K. Imaida (KagawaUniversity, Japan), H. Kamada (University of Tsukuba, Japan), H. Karaki (Kurashiki University of Science and the Arts, Japan), A.-K. Lundebye (National Institute of Nutrition and Seafood Research, Norway), A. Martin (European Food Safety Authority, Italy), S. Miyazaki (National Institute of Animal Health, japan), H. Mizusawa (Tokyo Medical and Dental University, Japan), M. Naya (BioSafety Research Center, Japan), A. Nishikawa (National Institute of Health Sciences, Japan), T. Nohmi (National Institute of Biomedical Innovation, Japan), K. Ogawa (National Institute of Health Sciences, Japan), H. Ozaki (University of Tokyo, Japan), T. Sakai (Azabu University, Japan), J. Sawada (Pharmaceuticals and Medical Devices Agency, Japan), T. Sekizaki (University of Tokyo, Japan), M. Shimizu (University of Tokyo, Japan), K. Shinagawa (Iwate University, Japan), V. Silano (Medical School, II University of Rome, Italy), Y. Sugita-Konishi (Azabu University, Japan), H. Tsubone (University of Tokyo, Japan), S. Tsuda (Iwate Institute of Environmental Health Sciences, Japan), T. Umemura (National Institute of Health Sciences, Japan), H. Verhagen (National Institute for Public Health and the Environment, The Netherlands), J. Yamate (Osaka Prefecture University, Japan), T. Yoshizawa (Ehime University, Japan). Editorial OfficeChief Staff Hideki Hongo (FSCJ)Staff Ryusuke Matsuoka (FSCJ), Ayako Kabamoto (FSCJ)For further information Yuka Takeuchi (FSCJ), E-mail: fs-journal@cao.go.jp

Co-operative study group on rheumatic diseases of Kinki University hospital-and-clinics: Evaluation from patients with rheumatoid arthritis using tacrolimus treatment

Co-operative study group on rheumatic diseases of Kinki University hospital-and-clinics: Evaluation from patients with rheumatoid arthritis using tacrolimus treatment

Fixed drug eruption due to garenoxacin mesilate hydrate

ejd.2012.1892 Auteur(s) : Muneharu Miyake, Naoki Oiso naoiso@med.kindai.ac.jp, Eiji Yoshinaga, Akira Kawada Department of Dermatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan Fixed drug eruption (FDE) is a common adverse drug reaction. It manifests with suddenly-occurring, single or multiple, round- or oval-shaped, edematous, erythemato-violaceous plaques, with well-demarcated borders, within 48-hours of drug intake, and usually regresses as [...]

&lt;b&gt;4．現場から臨床薬理学に望むこと&lt;/b&gt;

We retrospectively investigated the status of transfusional iron overload at Kinki University Hospital. One hundred and sixty three patients received more than 10 red blood cell (RBC) units per year in 2009 and 2010. Myelodysplastic syndrome (37.4%) and aplastic anemia (11.0%) accounted for about 50% of the underlying diseases. At the time of receiving a total of 20 RBC units, 90.8% and 66.2% of the 65 patients evaluated had more than 500 and 1,000 ng/ml of serum ferritin, respectively. The frequency of organ dysfunction associated with iron overload was 56.9% of all the patients assessed, 37.8% of patients with serum ferritin levels of 500∼999 ng/ml, and 67.4% of patients with serum ferritin levels >1,000 ng/ml. Although the Japanese guidelines propose 40 units of RBC transfusion and/or a serum ferritin level of 1,000 ng/ml as a good point to start iron chelation therapy, our results suggest that iron overload and consequent organ dysfunction may occur earlier than this. Therefore, it may be necessary to start iron chelation therapy earlier than that suggested by the Japanese guidelines.