Tokyo University Hospital Research Articles

Prevalence of High-Level Aminoglycoside Resistance and Genes Encoding Aminoglycoside-Modifying Enzymes in Enterococcus faecalis and Enterococcus faecium Isolated in a University Hospital in Tokyo.

High-level aminoglycoside resistance (HLAR) limits treatment options for invasive enterococcal infections. We examined the prevalence of HLAR, carriage of genes encoding aminoglycoside-modifying enzymes, and production of β-lactamase using the disk diffusion method, polymerase chain reaction, and a nitrocefin-based test, respectively, in Enterococcus faecalis and Enterococcus faecium isolated from patients at a university hospital in Tokyo in 2010. Of the 100 E. faecalis isolates analyzed, 30 isolates had high-level resistance (HLR) to gentamicin, and 22 isolates had HLR to streptomycin. Of the 40 E. faecium isolates analyzed, 9 isolates had HLR to gentamicin, and 9 isolates had HLR to streptomycin. Of the 39 gentamicin-HLR enterococcal isolates, 24 isolates were non-HLR to streptomycin. All 39 isolates with HLR to gentamicin as well as 19 of 101 without HLR carried aac(6')-Ie-aph(2'')-Ia. Carriage of ant(6')-Ia was confirmed in 25 of 31 streptomycin-HLR isolates. Production of β-lactamase was documented in none of the E. faecalis and E. faecium isolates. Whole-genome sequencing analysis revealed that all but one E. faecalis isolate that carried aac(6')-Ie-aph(2'')-Ia and ant(6')-Ia belonged to sequence type (ST) 4 (n = 8), ST16 (n = 4), or ST179 (n = 9). Nevertheless, most of the pairs of isolates had > 10 single-nucleotide polymorphisms even among the isolates of the same ST.

Assessing lifestyle-related diseases with body and muscle mass using bioelectrical impedance analysis

ObjectivesTo investigate the correlation between imbalance of muscle mass to body weight and lifestyle-related diseases using bioelectrical impedance analysis (BIA) among Japanese population. MethodsThis was a retrospective, cross-sectional study conducted at Juntendo University Hospital in Tokyo, Japan, from May 2015 to November 2017. Their muscle-to-weight ratio were stratified into “muscle-to-weight ratio” quartiles as follows: men, Q1 (≥0.79), Q2 (0.75 to <0.79), Q3 (0.72 to <0.75), and Q4 (<0.72); women, Q1 (≥0.73), Q2 (0.68 to <0.73), Q3 (0.63 to <0.68), and Q4 (<0.63). The primary outcome was prevalence of ≥2 lifestyle-related diseases, including hypertension, dyslipidemia, type 2 diabetes mellitus, and hyperuricemia. ResultsData from 2009 individuals (men, 55%; mean age, 62 years) were analyzed. Compared to the lowest quartile, risk for the presence of ≥2 lifestyle-related diseases, in a multivariable regression model for men was as follows: Q2 (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.31–2.87), Q3 (OR, 2.85; 95% CI, 1.89–4.29), and Q4 (OR, 6.00; 95% CI, 4.07–8.84). For women, an increased risk was seen in Q2 (OR, 2.31; 95% CI, 1.20–4.46), Q3 (OR, 4.45; 95% CI, 2.40–8.26), and Q4 (OR, 12.6; 95% CI, 6.80–23.5). Cutoff values of muscle-to-weight ratio correlated with lifestyle-related diseases (≥2) were 0.76 for men and 0.68 for women. ConclusionsOur results showed that an imbalance of muscle mass to body weight confers an independent and stepwise increased risk for lifestyle-related diseases.

Characteristic cerebral structural changes identified using voxel-based morphometry in patients with post-surgical chronic myelopathic pain.

Cross-sectional study. Patients who undergo intramedullary spinal surgery occasionally experience post-surgical chronic pain; however, the underlying mechanisms are not yet completely understood. Therefore, this study aimed to identify the cerebral structural changes in patients with post-surgical chronic myelopathic pain using voxel-based morphometry. Single university hospital in Tokyo, Japan. Forty-nine patients who had undergone intramedullary spinal surgery between January 2002 and April 2014 participated in this study. Participants were classified into two groups based on their post-surgical chronic pain intensity: control (numeric rating scale score of <3) and pain (numeric rating scale score of ≥3) groups. We compared pain questionnaire and brain MRI between two groups. Brain MRI data of each participants was analyzed using voxel-based morphometry. Voxel-based morphometry revealed that the gray matter volume in the left supplementary motor area, left primary motor area, and left posterior cingulate cortex was higher in the pain group than that in the control group. In addition, the numeric rating scale score was significantly correlated with increased gray matter volume in the left primary motor area, left posterior cingulate cortex, and right superior parietal lobule. Present study elucidates the characteristic cerebral structural changes after an intramedullary spinal surgery using voxel-based morphometry and indicates that the structural changes in specific cerebral areas are associated with post-surgical chronic myelopathic pain.

443P - The effectiveness of individual nutritional counselling for patients with advanced cancer undergoing chemotherapy: A preliminary study

BackgroundMany patients with advanced cancer have difficulty eating and need nutritional support. This preliminary study examined the effects of individual nutritional counselling sessions on quality of life (QOL), nutritional status and eating-related distress (ERD) among patients with advanced cancer undergoing chemotherapy. MethodsA survey was conducted in the outpatient chemotherapy center at a university hospital in Tokyo, Japan. Patients were offered individual nutritional counselling by a dietitian specializing in cancer. For the participants who completed at least two counselling sessions, we evaluated changes in their QOL (EORTC-QLQ C30), symptoms and nutritional status (PG-SGA SF) and ERD. Data were analyzed using the Wilcoxon signed rank test to compare mean differences. The ethics committee approved the study (Ethical Review No. M2015-578). ResultsOf 42 patients who applied for nutritional counselling, 8 underwent two sessions. The mean age was 70.6±5.9 years and females accounted for 25.0%. Primary diseases were gastrointestinal cancer (n = 6) and lung cancer (n = 2). “Although family members and friends recommend foods to me, I am just confused” on the ERD and “fatigue” on the EORTC-QLQ C30 significantly improved (p < 0.05, respectively). There were no significant differences in the other items of the EORTC-QLQ C30 or symptoms and nutritional status on the PG-SGA SF. In total, 34 patients did not receive nutritional counselling twice because of death, changing hospitals, disease progression, or lack of coordination among researchers. ConclusionsOur study suggests that individual nutritional counselling is slightly beneficial for patients with advanced cancer receiving chemotherapy. Further research is needed to demonstrate the effectiveness of this intervention in the future. Clinical trial identificationUMIN registration No. UMIN000021540; was carried out prior to the start of the study. Legal entity responsible for the studyTokyo Medical and Dental University. FundingSasakawa Memorial Health Foundation. DisclosureS. Koshimoto: Research grant / Funding (institution): Sasakawa Memorial Health Foundation. All other authors have declared no conflicts of interest.

Maternal Undernutrition and Breast Milk Macronutrient Content Are Not Associated with Weight in Breastfed Infants at 1 and 3 Months after Delivery.

This study examined whether maternal nutritional intake and breast milk macronutrient content influence the weight of breastfed infants. We investigated 129 healthy mothers with singleton babies born from July 2016 to December 2017 in a university hospital in Tokyo, Japan. Information was obtained by a self-administered food frequency questionnaire at 1 (valid response n = 92; mean age, 34 years) and 3 (n = 57) months after delivery. Breast milk was sampled at 1 and 3 months and the macronutrient contents were analyzed. The average pre-pregnancy body mass index and weight gain during pregnancy were 20.7 ± 2.6 kg/m2 and 9.6 ± 3.7 kg, respectively. At 1 month, average maternal calorie intake was 1993 ± 417 kcal/day, which was lower than the intake recommended by Japanese Dietary Reference Intakes for breastfeeding mothers. There were no significant differences with regard to maternal calorie and protein intake, and breast milk macronutrient content between breastfed infants with weight above and below the 25th percentile of its distribution at both 1 and 3 months. This study suggests that suboptimal calorie intake by breastfeeding mothers and breast milk macronutrient content were not associated with weight of their infants at 1 and 3 months after delivery.

In Memoriam: Kenji Tadokoro, MD, PhD: 1947 - 2018

Kenji Tadokoro was born on 14 April 1947 in Sapporo, Japan. He graduated from Tokyo University School of Medicine in 1973. He worked as a senior resident and subsequently a research associate in the Department of Medicine and Physical Therapy of Tokyo University Hospital from 1973 to 1981, focusing his research on the mechanisms of allergic reactions. From 1981 to 1984, Kenji was a Research Fellow, Institute of Clinical Immunology at the University of Bern, Switzerland. He returned to Japan in 1984 as a Research Associate in the post-graduate Division of the School of Medicine at the University of Tokyo and Tokyo University Hospital where he earned his PhD degree in 1992. In 1992, he joined the Japanese Red Cross (JRC) Central Blood Center in Tokyo as the Director of Research. Since then he worked diligently on improving donor screening systems for infectious diseases within the JRC and internationally including establishing the hemovigilance department in 1993. He served as an Executive Officer since 2004 and was appointed Chief Executive Officer for Blood Services in 2014, which he retained until early 2017. Although he made many other contributions in the areas of blood services management, transfusion-related GVHD and hemovigilance, Kenji's career was highlighted by his leadership in the rational introduction of new donor screening assays, focusing on the introduction of nucleic acid testing (NAT). Step by step, based on modelled projections, pilot studies and observed yield, he advanced on-going implementation and demonstrated the efficacy of NAT, which successfully decreased the risk of transfusion-related HIV, HBV and HCV in Japan. The hemovigilance department he established, includes a large specimen repository, likely the largest in the world, enabling unique look-back studies confirming transfusion transmission, documenting their rates and establishing correlates and linkage to disease outcomes. The programme has shown the importance of a comprehensive blood testing and patient outcome system in improving blood safety. He has published over 100 peer-reviewed articles informing the global transfusion medicine community of the implications of the JRC research findings. Kenji enthusiastically nurtured warm relationships with international colleagues engaged in blood programmes. He invited staff from many Asian countries to JRC for training and was instrumental in convening Red Cross and Red Crescent symposia in the Asian region every three years. He chaired the Asia Pacific Blood Network for four years until 2017 and also held the position of Zone Coordinator of the Global Advisory Panel of Blood Services in Red Cross and Red Crescent Societies. He was a very active member of the AABB and ISBT and other related societies (IPFA/PEI), attending many Congresses and participating in numerous working parties and committees. Through these activities, he continued to express the opinions of an Asian country both scientifically and related to policy. Kenji resigned as CEO of JRC in 2017 due to health reasons and assumed a special senior advisor role for the JRC blood programme. Kenji passed away on 20 October 2018. Those who knew him will cherish his memory as a man of integrity, earnestness and kindness, and a great leader of the JRC and international community. He was a friend and cherished colleague; his wisdom and fellowship will be sorely missed.

Effects of skipping breakfast on dietary intake and circulating and urinary nutrients during pregnancy.

More than 20% of pregnant Japanese women regularly skip breakfast, thereby resulting in a low intake of several nutrients that are required for fetal development and prevention of pregnancy complications. However, whether skipping breakfast affects circulating levels of these nutrients remains unclear. We investigated whether skipping breakfast during pregnancy was associated with decreases in dietary intake and circulating and urinary levels of several nutrients, including fatty acids and vitamins. This cross-sectional study was conducted at a university hospital in Tokyo, Japan, between June and October 2010. Nutrient intakes were assessed using a validated diet history questionnaire. Blood and 24-hour urinary samples were collected for assessing circulating and urinary excretion levels of nutrients. Skipping breakfast was defined as forgoing breakfast including a staple food, such as rice or bread, two or more times per week. Multiple linear regression analyses were used to compare nutrient levels between breakfast skippers and non-skippers after adjusting for confounders. Of 97 healthy pregnant women in the second trimester, 37 (38.1%) skipped breakfast two or more times per week. In multiple linear regression analysis, breakfast skippers had significant lower energy-adjusted intakes of protein than non-skippers (p=0.019). In addition, breakfast skippers had significantly lower levels of plasma eicosapentaenoic acid (p=0.008), plasma docosahexaenoic acid (p=0.027), serum β- carotene (p=0.013), urinary urea nitrogen (p=0.027), and urinary potassium (p=0.006), compared to non-skippers. Healthcare professionals need to suggest effective strategies for encouraging breakfast skippers to have breakfast regularly and to increase the intake of these nutrients.

What causes patients with breast cancer to change employment?: evidence from the health insurance data in a medical facility.

This study aims to make clear the following aspects of breast cancer patients and their occupation. 1. What percentage of patients have changed their working status around surgery? 2. When did patients change their employment? 3. What is the cause of the employment change? We investigated 269 patients who underwent curative surgery for primary breast cancer at one university hospital in Tokyo. Patients who were under the age of 58 at the time of surgery and had the experience of being a company or government employee during a year prior to the surgery were used as sample for analysis. To determine factors related to the employment change, multiple logistic regression analysis was performed. Nineteen percent patients changed the employment status before and after surgery. Of those, 19% changed the employment by the end of surgery month while 42% did by the fourth month after surgery. Treatment-related factors such as mastectomy and the combination of chemotherapy and hormone therapy affected changes in employment. We believe that the validity of our study can be confirmed by comparing with the previous study results. We show the potential large effects of cancer treatment on patients’ daily lives.

Factors related to vegetable intake among pregnant Japanese women: A cross-sectional study

IntroductionVegetable intake (VI) is important for both fetal and maternal health. However, VI is insufficient among many pregnant Japanese women. This study aimed to identify the factors related to VI during pregnancy. MethodsA cross-sectional study was conducted in 2014, at a university hospital in Tokyo, Japan. Dietary intake was assessed using a brief-type self-administered diet history questionnaire. Demographic, physical, and psychological characteristics, dietary habits, and health-related behaviors were investigated using another questionnaire. Multiple linear regression analysis was used to identify factors related to VI. ResultsData of 273 healthy pregnant women was analyzed. The median value of energy-adjusted VI was 140.4 g/1000 kcal. Severe pregnancy-associated nausea (β = −0.148), a habit of eating out (β = −0.174), a habit of eating confectioneries (β = −0.158), and perceived barriers to obtaining vegetables (β = −0.149) were negatively associated with the energy-adjusted VI. In contrast, exercise habits (β = 0.193), knowledge of the recommended VI amounts for non-pregnant adults (β = 0.105), and the Vegetable Intake Self-Efficacy scale scores (β = 0.193) were positively associated with the energy-adjusted VI. ConclusionsPregnant women with severe pregnancy-associated nausea, or those who habitually eat out or eat confectioneries, may be a potential high-risk population for low VI. Enhancing knowledge and self-efficacy regarding VI would be effective in increasing VI during pregnancy.

A novel and simply calculated nutritional index serves as a useful prognostic indicator in patients with coronary artery disease

ObjectiveNo nutritional index has been firmly established yet in patients with coronary artery disease (CAD). In this study, we propose a simple to calculate nutritional indicator in patients who underwent percutaneous coronary intervention (PCI) by using parameters routinely measured in CAD and evaluated its prognostic implication. MethodsThis study is a retrospective observational analysis of a prospective database. The subjects were consecutive 3567 patients underwent their first PCI between 2000 and 2013 at Juntendo University Hospital in Tokyo. The median of the follow-up period was 6.3 years (range: 0–13.6 years). The novel nutritional index was calculated by the formula; Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI) = TG × TC × BW / 1000 (TG and TC: mg/dl, and BW: kg). ResultsThe Spearman non-parametric correlation coefficient between TCBI and the most often used conventional nutritional index, Geriatric Nutritional Risk Index (GNRI), was 0.355, indicating modest correlation. Moreover, Unadjusted Kaplan-Meier analysis showed higher all-cause mortality, cardiovascular mortality, and cancer mortality in patients with low TCBI. Consistently, elevation of TCBI was associated with reduced all-cause (hazard ratio: 0.86, 95%CI: 0.77–0.96, p < 0.001), cardiovascular (0.78, 0.66–0.92, p = 0.003), and cancer mortality (0.76, 0.58–0.99, p = 0.041) in patients after PCI by multivariate Cox proportional hazard analyses. ConclusionTCBI, a novel and easy to calculate nutrition index, is a useful prognostic indicator in patients with CAD.

Changes in patient-centered attitude and confidence in communicating with patients: a longitudinal study of resident physicians

BackgroundPatient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians’ patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits.MethodsThe study participants were resident physicians at a university hospital in Tokyo. Participants’ patient-centered attitudes (as measured by the Patient–Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95).ResultsPPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients’ expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score.ConclusionsAs seen in previous studies of medical students, resident physicians’ patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians’ confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians’ attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.

Pre-pregnancy BMI, gestational weight gain and body image are associated with dietary under-reporting in pregnant Japanese women.

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25% of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19-23 weeks of gestation, thirty-five participants (12·9%) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR)=0·81) and lower gestational weight gain (AOR=0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR=2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

Prognostic value of ALDH2 polymorphism for patients with oropharyngeal cancer in a Japanese population

BackgroundHalf of Japanese possess a polymorphism of aldehyde dehydrogenase 2(ALDH2), while few white individuals possess this mutation. The purpose of this study was to investigate the possibility of ALDH2 polymorphism as a prognostic factor for oropharyngeal cancer (OPC) among Japanese population.MethodsWe analyzed 82 Japanese patients with OPC treated between 2006 and 2011. The median observation period was 50 months. P16-staining and ALDH2 polymorphisms were investigated. To examine the frequencies of second primary pharyngeal and esophageal cancers (SPPEC),37 Japanese patients with OPC treated at Tokyo University Hospital were included for statistical analysis.ResultsStatistically significant differences were noted in OS among sex, age, N classification, and p16 (p = 0.045, 0.024, 0.020, 0.007, respectively). In addition, OS and DSS rates of the patients with heterozygous ALDH2 tended to be worse than those of the patients with homozygous ALDH2 (p = 0.21, 0.086, respectively). Of note, OS and DSS of the patients with p16-negative OPC and heterozygous ALDH2 was significant poorer than those of the patients with p16-positive OPC (p = 0.002, 0.006, respectively), while there was no significant difference in OS and DSS between patients with p16-positive OPC and patients with p16-negative OPC and homozygous ALDH2.ConclusionsALDH2 polymorphism might be a promising prognostic factor for Japanese patients with p16-negative OPC.

Removal of Peripheral Intravenous Catheters Due to Catheter Failures Among Adult Patients.

This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.

Nomogram predicting long-term survival after the diagnosis of intrahepatic recurrence of hepatocellular carcinoma following an initial liver resection.

The aim of this study was to construct and validate a nomogram for predicting survival after the intrahepatic recurrence of hepatocellular carcinoma (HCC) following an initial hepatectomy. A primary cohort of 268 patients who underwent curative hepatectomy for HCC at Shinshu University Hospital between 1990 and 2010 was retrospectively studied. A nomogram was constructed based on independent prognostic factors for overall survival after recurrence. The predictive performance was evaluated using the concordance index (c-index) and a calibration curve. The nomogram was then externally validated in a cohort of patients from Tokyo University Hospital (n=296). In multivariate analysis, the following 5 variables were identified as independent predictors of overall survival and incorporated into the nomogram-Japan Integrated Stage score at initial liver resection, platelet count at initial liver resection, time until intrahepatic recurrence, vascular invasion at recurrence, and type of treatment used for intrahepatic recurrence. The nomogram had a c-index of 0.75 (95% confidence interval 0.60-0.85) for the Shinshu cohort and 0.71 (0.57-0.81) for the Tokyo cohort. The predicted 3- and 5-year survival probabilities corresponded well with the actual outcomes. The established nomogram might be useful for estimating survival after the intrahepatic recurrence of HCC.

Impact of Epinephrine Contained in Local Anesthetic Solution on Serum Lactate Level During Orthognathic Surgery

There have been many discussions of a relation between endogenous and exogenous epinephrine and hyperlactatemia. This study aimed to identify the impact of epinephrine contained in a local anesthetic solution on serum lactate levels in patients who underwent orthognathic surgery. This study was a retrospective record review of cases of maxillary and mandibular osteotomy at the Tokyo University Hospital (Tokyo, Japan) from January 2006 through December 2014. One hundred ninety-three patients were enrolled in this study. The maximum intraoperative serum lactate level was 22.3 ± 14.7mg/dL. Of 193 patients, 91 showed an intraoperative serum lactate level that was higher than the normal maximum of 19.8mg/dL (2.2mmol/L), and 16 of these had a level that was at least 40mg/dL (≥4.49mmol/L). Multiple logistic regression analysis showed 2 factors that could increase the serum lactate level: the amount of epinephrine contained in the local anesthetic solution injected into the oral cavity (odds ratio [OR]= 1.014; 95% confidence interval [CI], 1.006-1.022; P= .0001) and the absence of intraoperative treatment with propranolol (OR, 0.105; 95% CI, 0.019-0.434; P= .0013). Patients with severe serum lactate concentrations (ie, ≥40mg/dL [≥4.49mmol/L]) had slight metabolic acidosis. All patients survived 90days. The number of postoperative hospitalization days for patients with severe serum lactate concentrations was 12.8±2.6days and that for patients without severe serum lactate concentration was 16.0 ± 8.6days. Increases in intraoperative serum lactate levels during orthognathic surgery are associated, at least in part, with increased aerobic glycolysis because of β2-adrenergic signaling. Lactate increase caused by epinephrine contained in a local anesthetic solution does not result in a poor postoperative outcome.

A clinical prediction model for infusion-related reactions to rituximab in patients with B cell lymphomas.

Background Infusion-related reactions (IRRs) are a major adverse event of rituximab. Objective To develop a prediction model for IRRs to rituximab among patients with B cell non- Hodgkin's lymphomas (B-NHL). Setting A 1000-bed university hospital in Tokyo. Methods Patients with B-NHL treated with rituximab at our institution from 2004 to 2014 were retrospectively analysed. Chills, fever, rash, nausea, asthenia, headache, cardiovascular symptoms, and respiratory symptoms of any grade, in association with rituximab infusion, were identified as IRRs. Risk factors for IRRs to rituximab found in the intergroup analysis were subsequently evaluated by using multivariate analysis. Main outcome measure Occurrence of IRRs to rituximab. Results A total of 140 patients with various types of B-NHL, including 74% with diffuse large Bcell lymphoma, were analysed. Among them, 55 and 85 patients were assigned to the IRR group and the non-IRR group, respectively. Indolent histological subtypes, bulky disease (>10cm), B symptoms, higher serum soluble interleukin-2 receptor concentration, and bone marrow involvement were more common in the IRR group. The multivariate logistic regression analysis identified low-grade lymphomas [odds ratio (OR) 2.81, p=0.017] and bulky disease (OR 2.52, p=0.037) as independent risk factors for IRRs to rituximab. The incidence rates of IRRs to rituximab among patients with neither, one, or both of these risk factors were 26, 54, and 78%, respectively (χ2=16.4, p<0.001). Conclusions A simple combination of histopathological subtype and bulkiness of disease could predict the risk of IRRs to rituximab among patients with B-NHL.

Availability of two self-administered diet history questionnaires for pregnant Japanese women: A validation study using 24-hour urinary markers.

BackgroundAccurate and easy dietary assessment methods that can be used during pregnancy are required in both epidemiological studies and clinical settings. To verify the utility of dietary assessment questionnaires in pregnancy, we examined the validity and reliability of a self-administered diet history questionnaire (DHQ) and a brief-type self-administered diet history questionnaire (BDHQ) to measure energy, protein, sodium, and potassium intake among pregnant Japanese women.MethodsThe research was conducted at a university hospital in Tokyo, Japan, between 2010 and 2011. The urinary urea nitrogen, sodium, and potassium levels were used as reference values in the validation study. For the reliability assessment, participants completed the questionnaires twice within a 4-week interval.ResultsFor the DHQ (n = 115), the correlation coefficients between survey-assessed energy-adjusted intake and urinary protein, sodium, and potassium levels were 0.359, 0.341, and 0.368, respectively; for the BDHQ (n = 112), corresponding values were 0.302, 0.314, and 0.401, respectively. The DHQ-measured unadjusted protein and potassium intake levels were significantly correlated with the corresponding urinary levels (rs = 0.307 and rs = 0.342, respectively). The intra-class correlation coefficients for energy, protein, sodium, and potassium between the time 1 and time 2 DHQ (n = 58) and between the time 1 and time 2 BDHQ (n = 54) ranged from 0.505 to 0.796.ConclusionsBoth the DHQ and the BDHQ were valid and reliable questionnaires for assessing the energy-adjusted intake of protein, sodium, and potassium during pregnancy. In addition, given the observed validity of unadjusted protein and potassium intake measures, the DHQ can be a useful tool to estimate energy intake of pregnant Japanese women.

ANGIOGRAPHIC FINDINGS OF RANIBIZUMAB-RESISTANT POLYPOIDAL CHOROIDAL VASCULOPATHY AFTER SWITCHING TO A TREAT-AND-EXTEND REGIMEN WITH INTRAVITREAL AFLIBERCEPT.

The aim of this study was to study the angiopathic findings of ranibizumab-resistant polypoidal choroidal vasculopathy after switching to a treat-and-extend regimen with intravitreal aflibercept. The authors retrospectively reviewed 17 eyes of 17 Japanese patients with polypoidal choroidal vasculopathy (10 men and 7 women, age: 73.8 ± 7.4 years) who were treated with intravitreal aflibercept (2 mg/0.05 mL) injections from February 2013 to August 2014 at Tokyo University Hospital. All patients had switched to aflibercept because their polypoidal choroidal vasculopathy had been refractory to ranibizumab. The mean logMAR best-corrected visual acuity at baseline and after 12 months of therapy was 0.30 ± 0.29 (Snellen equivalent: 20/40) and 0.17 ± 0.26 (20/30) (paired t-test P < 0.001). Visual acuity remained stable in 5 cases (29%), deteriorated in 3 (18%), and improved in 9 (53%). Branching vascular networks persisted in all 17 eyes but shrank in 15 (88%). The mean lesion diameter was 3329 ± 1261 μm at baseline and 3180 ± 1247 μm after 12 months (P = 0.0002). A treat-and-extend regimen with intravitreal aflibercept for ranibizumab-resistant patients resulted in branching vascular network shrinkage over a 1-year period.

MP39-20 ARE THERE ANY APPROPRIATE CRITERIA FOR RECOMMENDING PROSTATE BIOPSY IN PATIENTS OVER 75 YEARS OLD?

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2016MP39-20 ARE THERE ANY APPROPRIATE CRITERIA FOR RECOMMENDING PROSTATE BIOPSY IN PATIENTS OVER 75 YEARS OLD? Yu Teranishi, Takeo Kosaka, Kazuhiro Matsumoto, Shinya Morita, Kazunobu Shinoda, Ryuichi Mizuno, Toshiaki Shinojima, Eiji Kikuchi, Hiroshi Asanuma, Akira Miyajima, and Mototsugu Oya Yu TeranishiYu Teranishi More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Shinya MoritaShinya Morita More articles by this author , Kazunobu ShinodaKazunobu Shinoda More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Toshiaki ShinojimaToshiaki Shinojima More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Hiroshi AsanumaHiroshi Asanuma More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.145AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Appropriate criteria for recommending prostate biopsy are controversial, especially in elderly men. In this study, we investigated the diagnostic value of prostate-specific antigen (PSA) and its multiple factors in men over 75 years of age to avoid overdiagnosis and reduce unnecessary biopsy procedures. METHODS A total of 2498 men underwent a transrectal prostate biopsy between 2004 and 2011 at Keio University Hospital in Tokyo. We retrospectively reviewed the records of 458 men who were over 75 years old. Patients with PSA levels between 4.0 and 10.0 ng/ml were divided into two groups: one with a negative biopsy and Gleason score of 6 or less, the other with a Gleason score of 7 or more. The clinical values of age, prostate volume (P vol), prostate transition zone volume (Tz vol), prostate-specific antigen density (PSAD), and prostate-specific antigen density of the transition zone (PSATzD) for the detection of prostate cancer were compared using receiver operating characteristic (ROC) curves and by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. The same was conducted for PSA levels between 10.0 and 20.0 ng/ml and over 20.0 ng/ml. RESULTS Among the patients with PSA levels between 4.0 and 10.0 ng/ml, the mean (± SD) age, PSA, P vol, Tz vol, PSAD, and PSATzD were 77.7 ± 2.5 years, 6.7 ± 1.6 ng/ml, 38.2 ± 21.5 cm3,19.0 ± 14.9 cm3, 0.22 ± 0.12, and 0.54 ± 0.39, respectively, in men with positive biopsy. There were significant differences in PSA (P=0.001), P vol (P<0.001), Tz vol (P<0.001), PSAD (P<0.001), and PSATzD (P<0.001). A total of 153 men had a negative biopsy and Gleason score 6 or less, and 92 a Gleason score 7 or more. Statistical analysis to compare these 153 men and 92 men revealed a significant difference in PSAD only (P<0.001). The area under the curve of ROC of PSAD was 0.711. The sensitivity, specificity, positive predictive value, and negative predictive value were 76.1%, 52.69%, 49.3%, and 78.6%, respectively, by setting the cut-off value to PSAD 0.15. Among the patients with PSA levels between 10.0 and 20.0 ng/ml and with PSA levels over 20.0 ng/ml, there was no difference in PSAD. CONCLUSIONS Patients 75 or older with a PSA level between 4.0 and 10.0 ng/ml and PSAD less than 0.15 are unlikely to have prostate cancer and therefore it may be possible to avoid overdiagnosis, thereby reducing unnecessary biopsies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e549 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yu Teranishi More articles by this author Takeo Kosaka More articles by this author Kazuhiro Matsumoto More articles by this author Shinya Morita More articles by this author Kazunobu Shinoda More articles by this author Ryuichi Mizuno More articles by this author Toshiaki Shinojima More articles by this author Eiji Kikuchi More articles by this author Hiroshi Asanuma More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...