Objective  Donor countries either suspended or restricted development aid for Myanmar during the period of the military regime. However, the democratic movement, which began in 2011, gradually resolved this situation. The government of Myanmar organized a “Myanmar Development Cooperation Forum” in 2013, where the government demonstrated a path for the country’s future development to development partners, including donor countries, international organizations, and international funds. Furthermore, the government has increased the budget for the health sector and upheld universal health coverage (UHC), a target of Social Development Goals, as a goal for the future. To achieve that goal, the “National Health Plan 2017-2021” was recently formulated. This research attempts to identify issues that need to be considered by development partners in this changing environment.Methods  The research was conducted through field studies and literature reviews to investigate the movements of both the government of Myanmar and development partners. It identified issues that need to be considered to achieve UHC, as well as those that development partners should consider when providing aid.Results and conclusion  During the era of the Millennium Development Goals, development partners tended to focus their development aid on maternal and child health, control of specific diseases, and strengthening health services for those specific health problems. However, in order to extend health and medical services to all people, without financial risks on the part of patients under the goal of UHC, it is necessary for the government to formulate and execute comprehensive health policies based on an analysis of Myanmar’s health and medical problems. Aligning with this change, development partners need to concretize their support in response to Myanmar’s health policy issues.

Objective  Donor countries either suspended or restricted development aid for Myanmar during the period of the military regime. However, the democratic movement, which began in 2011, gradually resolved this situation. The government of Myanmar organized a “Myanmar Development Cooperation Forum” in 2013, where the government demonstrated a path for the country’s future development to development partners, including donor countries, international organizations, and international funds. Furthermore, the government has increased the budget for the health sector and upheld universal health coverage (UHC), a target of Social Development Goals, as a goal for the future. To achieve that goal, the “National Health Plan 2017-2021” was recently formulated. This research attempts to identify issues that need to be considered by development partners in this changing environment.Methods  The research was conducted through field studies and literature reviews to investigate the movements of both the government of Myanmar and development partners. It identified issues that need to be considered to achieve UHC, as well as those that development partners should consider when providing aid.Results and conclusion  During the era of the Millennium Development Goals, development partners tended to focus their development aid on maternal and child health, control of specific diseases, and strengthening health services for those specific health problems. However, in order to extend health and medical services to all people, without financial risks on the part of patients under the goal of UHC, it is necessary for the government to formulate and execute comprehensive health policies based on an analysis of Myanmar’s health and medical problems. Aligning with this change, development partners need to concretize their support in response to Myanmar’s health policy issues.

Abnormal lipid metabolism associated with various renal diseases has been known for a long time. Hypercholesterolemia is one of the characteristic features of nephotic syndrome, and hypertriglyceridemia is often observed in chronic renal failure (CRF). The role of lipid abnormalities in the pathogenesis of renal diseases has been variously discussed. However, direct evidence only recently became possible when more sophisticated analyses of renal histopathology as well as an application of molecular biology were introduced in the field of clinical nephrology. The recent identification of lipoprotein nephropathy (LPG), reported most often by Japanese authors since 1989, is particularly noteworthy. The detailed analysis of lipid profiles and renal histology has been instrumental in clarifying the relationship between lipids and the kidney not only in LPG but also in other disease entities such as familial-type dyslipidemias, CRF, focal glomerulosclerosis, and diabetic nephropathy. Dyslipidemias common to these diseases, together with the presence of hypertension, cause systemic atherosclerotic lesions (including lesions in the kidney) and terminal renal failure.
seconds ; Kidney Diseases ; lipid metabolism ; Abnormal ; Lipids

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

During the period of 25 years from January 1978 through December 2002, a total of 808 colorectal cancer cases were operated on in Shirakawa Kosei General Hospital. The number of sugical resection cases came to 713 (ratio : 88.25%). Curative resection was performed on 593 cases (ratio : 73.4%). The total number of cases was broken down into 446 cases of cancer of the colon and 369 cases of cancer of the rectum (7 multiple cancer cases included). By sex, male cases numbered 329 and female cases 379. Clinically or histologically, many cases were diagnosed as stage IIIa or stage II cancer. The 5-year-survival rate for the resection cases was calculated at 67.2% and that for the cure resection cases, at 79.5%.
Excision ; Malignant Neoplasms ; Colorectal Cancer ; Cases ; Review of

　　Placental abruption occurs suddenly and may cause maternal and fetal mortality. Forced delivery is the only way to improve perinatal outcome, but the aftereffects could be severe despite a high survival rate.　　Our hospital manages approximately 170 cases of maternal transport annually, including cases of severe placental abruption. Longer transport time can lead to undesirable maternal and fetal outcome. Hence this study, we compared the perinatal backgrounds and outcome of placental abruption retrospectively between the cases managed by maternal transport and by the local hospital (our hospital). The study included 54 cases of placental abruption during the period from January 2008 to December 2012, of which 27 cases were managed by our hospital, the other halves were managed by maternal transport. There were 6 intrauterine fetal deaths but not a single maternal death. There were no significant differences in the amount of blood lost and obstetric DIC (disseminated intravascular coagulopathy) score between two groups (p＝0.342, p＝0.649), and the number of cases that needed anti-DIC therapy and blood transfusion in each group was statistically similar (p＝0.807, p＝0.115). The time taken from the on-set of placental abruption to delivery was significantly shorter for the cases managed by our hospital (in-hospital management 143±133 minutes, maternal transport management 265±176 minutes, p‹0.05), while obstetric DIC score and Apgar score showed no significant differences (p＝0.336, p＝0.780) between the two groups. Thus, it could be said there were no correlations between the time taken from onset to delivery and perinatal outcome. It should be noted, however, maternal and fetal outcome of placental abruption could be fatal even with the rapid intervention, so quick diagnosis and management at the first contact are crucial. Thus, we concluded that forced delivery managed by the local hospitals is necessary for the potential better perinatal outcome, and an ideal system to manage maternal and/or neonate transport after the delivery should be established immediately.

　　Adhesion formation after abdominal surgery is a commonly recognized entity. Many studies have shown that women giving birth by cesarean section are at the risk of developing complications related to the postoperative formation of adhesions including ileus, bowel obstructions, impaired fertility, and chronic abdominal pain. Among several adhesion barriers, one that has been tested in randomized, controlled trials is the hyaluronic cid-carboxymethylcellulose (HA/CMC) membrane (Seprafilm®: Genzyme, Cambridge, MA, USA). This bioresorbable membrane serves as a mechanical barrier between surgically damaged tissues and resorbs afterwards. At our institution, we have used HA/CMC in cesarean sections. We report our experience with this patient population using placement of HA/CMC.　　This study enrolled 45 women who had undergone cesarean sections twice or more who had received HA/CMC during the previous cesarean section between January 2013 and November 2014. The incidence of adhesions to the area of abdominal wall incisions and uterine surface, intestinal obstructive symptoms, and adverse events were studied. The incidence of adhesions to midline incisions was 4.4% (n＝2). The filmy adhesion by major omentum was detected in these two cases. The incidence of adhesions to uterine surface was 2.2% (n＝1). The moderate thickness adhesion was detected at the left side of the vesico-uterine peritoneal incision by pelvic peritoneum which did not affect the operative procedure. No symptoms related to intestinal obstructions such as abdominal pains, nausea and vomiting were observed. No adverse events were observed. These three cases had fever which had nothing to do with HA/CMC applications but was attributable respectively to influenza infection, mastitis, phlebitis associated with a needle procedure.　　HA/CMC was considered a useful adhesion barrier membrane for use in cesarean sections as an adjunct intended to reduce the incidence of postoperative adhesions between the abdominal wall and the underlying viscera such as omentum, small bowel, and between the uterus and surrounding structures.

Green tea catechins are well known to be one of polyphenols, and its regular ingestion induces body fat reduction in obese individuals. Cocoa polyphenols of high-cocoa chocolate can also improve arterial stiffness. However, it is unclear whether green tea catechins improve body fat and arterial stiffness even in healthy young adults. Therefore, this study aimed to examine the effects of regular green tea intake on body fat and arterial stiffness in young adults. This randomized, controlled, parallel-group intervention study included 53 Japanese college students (mean age, 21.1 ± 0.1; men, n = 40; women, n = 13). They were randomly divided into three groups: control group (n = 14), intervention I group (n = 19), and intervention II group (n = 20). The participants ingested 500 ml/day of commercially available natural water (0 mg of catechin/day) or green tea (intervention I group, 200 mg of catechin/day; intervention II group, 400 mg of catechin/day) for 4 weeks. After 4 weeks of intervention period, no significant changes in body weight, body mass index, pulse wave velocity, and cardio-ankle vascular index were observed in all groups. However, body fat and carbon dioxide output significantly reduced only in the intervention II group. With the level of catechin concentrations increasing, significant decreasing trends were found in body fat changes and respiratory exchange ratio changes. Therefore, these findings suggest that four weeks of regular green tea intake would reduce body fat, but not arterial stiffness, in young adults.

OBJECTIVE: Palonosetron is effective for the management of acute and delayed chemotherapy-induced nausea and vomiting (CINV). While emetogenic carboplatin-based chemotherapy is widely used to treat gynecologic cancers, few studies have evaluated the antiemetic effectiveness of palonosetron in this setting. METHODS: A multicenter, single-arm, open-label phase II trial was conducted to evaluate the safety and effectiveness of palonosetron in controlling CINV in patients with gynecologic cancer. Chemotherapy-naïve patients received intravenous palonosetron (0.75 mg/body) and dexamethasone before the infusion of carboplatin-based chemotherapy on day 1. Dexamethasone was administered (orally or intravenously) on days 2–3. The incidence and severity of CINV were evaluated using the patient-completed Multinational Association of Supportive Care in Cancer Antiemesis Tool and treatment diaries. The primary endpoint was the proportion of patients experiencing complete control (CC) of vomiting, with “no rescue antiemetic medication” and “no clinically significant nausea” or “only mild nausea” in the delayed phase (24–120 hours post-chemotherapy). Secondary endpoints were the proportion of patients with a complete response (CR: “no vomiting” and “no rescue antiemetic medication”) in the acute (0–24 hours), delayed (24–120 hours), and overall (0–120 hours) phases, and CC in the acute and overall phases. RESULTS: Efficacy was assessable in 77 of 80 patients recruited. In the acute and delayed phases, the CR rates the primary endpoint, were 71.4% and 59.7% and the CC rates, the secondary endpoint, were 97.4% and 96.1%, respectively. CONCLUSION: While palonosetron effectively controls acute CINV, additional antiemetic management is warranted in the delayed phase after carboplatin-based chemotherapy in gynecologic cancer patients (Trial registry at UMIN Clinical Trials Registry, UMIN000012806).
Antiemetics ; Carboplatin ; Dexamethasone* ; Drug Therapy* ; Female ; Genital Neoplasms, Female ; Humans ; Incidence ; Japan* ; Nausea* ; Vomiting*