OBJECTIVE: The aim of the present study was to assess prognostic factors for patients with locally advanced cervical cancer treated with radiotherapy as the primary treatment and to assess the posttreatment cut-off levels of squamous cell carcinoma antigen (SCC-Ag) to predict three-year overall survival (OS) rates. METHODS: One hundred and twenty-eight patients with cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IIB-IVA) treated using radiotherapy or concurrent chemoradiotherapy were identified. Of these patients, 116 who had SCC-Ag levels >1.5 ng/mL prior to treatment were analyzed retrospectively. RESULTS: Median age was 68 years (range, 27 to 79 years). The complete response rate was 70.7% and the three-year OS rate was 61.1%. The median levels of pretreatment and posttreatment SCC-Ag were 11.5 ng/mL (range, 1.6 to 310.0 ng/mL) and 0.9 ng/mL (range, 0.4 to 41.0 ng/mL), respectively. Multivariate analysis showed that pretreatment anemia (p=0.041), pelvic lymph node metastasis (p=0.016) and posttreatment SCC-Ag levels (p=0.001) were independent prognostic factors for three-year OS. The SCC-Ag level cut-off point for three-year OS rates, calculated using a receiver operating characteristic curve, was 1.15 ng/mL (sensitivity, 80.0%; specificity, 74.0%). CONCLUSION: Pretreatment anemia and pelvic lymph node metastasis are poor prognostic factors in locally advanced cervical cancer. Furthermore, posttreatment SCC-Ag levels <1.15 ng/mL predicted better three-year OS rates.
Anemia ; Antigens, Neoplasm ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Gynecology ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; ROC Curve ; Sensitivity and Specificity ; Serpins ; Uterine Cervical Neoplasms

OBJECTIVES: Cesarean section is associated with an increased risk for venous thromboembolism (VTE). The safety and efficacy of primary prophylaxis of fondaparinux, a synthetic sulfated pentasaccharide heparin analog, in women at risk after cesarean section is uncertain. METHODS: This was a retrospective study of 295 cases of pregnant women presenting to a tertiary referral center of Nara, Japan, to evaluate the usefulness of thromboprophylaxis with fondaparinux after cesarean delivery between 2011 and 2012. Patients were initially received unfractionated heparin (once 5,000 IU subcutaneously, twice a day), starting 6 hours after cesarean section for 24 hours, and then treated with fondaparinux (once 2.5 mg daily, subcutaneously) for 5 days. The primary efficacy end-point was an improvement in the incidence of symptomatic VTE or fatal post-cesarean pulmonary thromboembolism. The primary safety end-point was major bleeding during treatment. RESULTS: There were neither any episodes of symptomatic VTE cases nor maternal deaths. A total of 10 patients had a bleeding event. Major bleeding complication was observed in 2 (0.68%) of 295 patients receiving fondaparinux. Non-major bleeding into critical sites was observed in 8 patients, often at surgical sites, and recovery was not delayed. CONCLUSION: This study demonstrates the safety and efficacy of fondaparinux in women at high risk of VTE after cesarean section. Large phase trials comparing clinical outcomes with fondaparinux across a wide spectrum of patients are needed to confirm these observations.
Cesarean Section* ; Female ; Hemorrhage ; Heparin ; Humans ; Incidence ; Japan ; Maternal Death ; Pregnancy ; Pregnant Women ; Pulmonary Embolism ; Retrospective Studies ; Tertiary Care Centers ; Venous Thromboembolism*

OBJECTIVE: The purpose of the present study was to elucidate the incidence of deep venous thrombosis (DVT) before treatment in ovarian cancer and the appropriate cut-off value of D-dimer (DD) for the diagnosis of DVT. METHODS: Between July 2007 and October 2008, eighty seven patients with presumed ovarian cancer (final diagnosis: ovarian cancer, n=59; borderline malignancy, n=28) were enrolled. Measurement of DD levels and subsequent venous ultrasonography were performed before treatment. RESULTS: The mean DD level was 4.1 microg/mL. Subsequent venous ultrasonography revealed DVT in 14 of 87 (16.1%) patients (ovarian cancer, 12 cases; borderline malignancy, 2 cases). None were found to have developed DVT if they had a DD level of <1.5 microg/mL. If 1.5 microg/mL was used as a cut-off value for DD levels to diagnose DVT, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 61.6%, 33.3%, and 100%. There was noclinical onset of postoperative pulmonary thromboembolism. CONCLUSION: Our data suggest that presumed ovarian cancer patients with at least more than 1.5 microg/mL should be examined using venous ultrasonogaphy to detect DVT.
Fibrin Fibrinogen Degradation Products ; Humans ; Incidence ; Ovarian Neoplasms ; Sensitivity and Specificity ; Venous Thrombosis

OBJECTIVE: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. METHODS: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. RESULTS: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. CONCLUSION: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Odds Ratio ; Ovarian Neoplasms ; Retrospective Studies ; ROC Curve

In the present study, we investigate the expression profile of the epidermal growth factor receptor family, which comprises EGFR/ErbB1, HER2/ErbB2, HER3/ErbB3 and HER4/ErbB4 in oral leukoplakia (LP). The expression of four epidermal growth factor receptor (EGFR) family genes and their ligands were measured in LP tissues from 14 patients and compared with levels in 10 patients with oral lichen planus (OLP) and normal oral mucosa (NOM) from 14 healthy donors by real-time polymerase chain reaction (PCR) and immunohistochemistry. Synchronous mRNA coexpression of ErbB1, ErbB2, ErbB3 and ErbB4 was detected in LP lesions. Out of the receptors, only ErbB4 mRNA and protein was more highly expressed in LP compared with NOM tissues. These were strongly expressed by epithelial keratinocytes in LP lesions, as shown by immunohistochemistry. Regarding the ligands, the mRNA of Neuregulin2 and 4 were more highly expressed in OLP compared with NOM tissues. Therefore, enhanced ErbB4 on the keratinocytes and synchronous modulation of EGFR family genes may contribute to the pathogenesis and carcinogenesis of LP.
Adult ; Aged ; Amphiregulin ; Betacellulin ; EGF Family of Proteins ; Epidermal Growth Factor ; metabolism ; Epiregulin ; Female ; Gene Expression Profiling ; Glycoproteins ; metabolism ; Heparin ; metabolism ; Heparin-binding EGF-like Growth Factor ; Humans ; Intercellular Signaling Peptides and Proteins ; metabolism ; Keratinocytes ; metabolism ; Leukoplakia, Oral ; metabolism ; Lichen Planus, Oral ; metabolism ; Ligands ; Male ; Middle Aged ; Mouth Mucosa ; metabolism ; Nerve Growth Factors ; Neuregulins ; metabolism ; RNA, Messenger ; metabolism ; Real-Time Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor ; metabolism ; Receptor, ErbB-2 ; metabolism ; Receptor, ErbB-3 ; metabolism ; Receptor, ErbB-4 ; Receptors, Cell Surface ; metabolism ; Transforming Growth Factor alpha ; metabolism ; Up-Regulation ; physiology

No abstract available.
Transcatheter Aortic Valve Replacement

Purpose：The Assessment of readiness for mobility transition (ARMT) is a self-administered questionnaire that assesses individuals' emotional and attitudinal readiness when they need to change their means of mobility, such as driving due to old age. This study aimed to examine the linguistic validity of the Japanese version of the ARMT (ARMT-J).Methods：The translation was carried out for the “Basic Guidelines for Scale Translation.” Three occupational therapists in Japan conducted forward translation and adjustment, and a translation company conducted back translation. In addition, the original authors reviewed the back translation and the cognitive debriefing. The cognitive debriefing was conducted with five older people living in the community.Results：Disagreements were identified on five items in the forward translation and three in the review of back translation. In particular, item 11, “retirement community,” is not widely used in Japan and the Japanese translation differed among translators. A “retirement community” is defined as a residential area or building for the older people in other countries. The three occupational therapists who performed the translation discussed with the original author and changed the Japanese translation to “housing for the elderly.” In addition, a supplementary document was added to the translation, stating that it includes the meaning of “the need to change one's living area when one changes their means of transportation due to aging.Conclusion：In this study, we examined the linguistic validity of the ARMT-J and developed a Japanese translation that we believe is appropriate.

Purpose：The Assessment of readiness for mobility transition (ARMT) is a self-administered questionnaire that assesses individuals' emotional and attitudinal readiness when they need to change their means of mobility, such as driving due to old age. This study aimed to examine the linguistic validity of the Japanese version of the ARMT (ARMT-J).Methods：The translation was carried out for the “Basic Guidelines for Scale Translation.” Three occupational therapists in Japan conducted forward translation and adjustment, and a translation company conducted back translation. In addition, the original authors reviewed the back translation and the cognitive debriefing. The cognitive debriefing was conducted with five older people living in the community.Results：Disagreements were identified on five items in the forward translation and three in the review of back translation. In particular, item 11,“ retirement community,” is not widely used in Japan and the Japanese translation differed among translators. A “retirement community” is defined as a residential area or building for the older people in other countries. The three occupational therapists who performed the translation discussed with the original author and changed the Japanese translation to “housing for the elderly.” In addition, a supplementary document was added to the translation, stating that it includes the meaning of “the need to change one's living area when one changes their means of transportation due to aging.Conclusion：In this study, we examined the linguistic validity of the ARMT-J and developed a Japanese translation that we believe is appropriate.

We investigated the actual condition of patients treated by acupuncture and moxibution in Ibaragi Prefecture.
Subjects were 1823 patients (846 men, 977 women) under the treatment of 14 acupuncture clinics in September to November, 1985.
We prepared the evaluated list that consisted of 11 levels of activities of daily life and 8 degrees of pain.
In every treatment, we wrote down the patient's clinical progress in relation with the list.
The following results were obtained
1. There were many patients in thier forties and fifties.
2. There were many patients who received only one treatment.
3. The chief complaints were low back pains (509 patients), shoulder discomfort (273) knee joint pain (132), etc.
4. Most of the patients could still go on with thier daily lives in spite of the pains.
5. The effects of treatment were rated as follows; better 69.5%, no change 23.9%, worse 5.9%.