We investigated the relationship between renal function assessment based on cystatin C (CsyC) and serum creatinine levels and the status of chemotherapy use in patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. A significant positive correlation was found between estimated glomerular filtration rate from creatinine (eGFRcre) and eGFR from CsyC (eGFRcys) in the 98 patients included in the study. When eGFRcre and eGFRcys values were grouped according to GFR categories in the CKD severity classification, severe cases (eGFRcys < eGFRcre) were of more advanced age (P < 0.05) and had lower albumin levels (P < 0.01) than matched cases. Although no clear relationship was found between renal function assessment and chemotherapy status, the CysC and eGFRcys values tended to be higher and lower, respectively, in patients whose chemotherapy was deferred (P < 0.01 for CysC, P = 0.07 for eGFRcys). These results suggest that eGFRcre-based renal function assessment is overestimated compared with eGFRcys-based assessment in patients with gynecological cancer and may lead to carboplatin overdose or treatment deferral in elderly patients and patients with hypoalbuminemia.

Purpose: This study aimed to report on the multidisciplinary web conferences for patients with heart failure to strengthen medical collaboration and provide seamless support. Method: We described and analyzed the web conferences by retrospectively collecting data on the conferences. Result: Main subjects of the conferences were those who lived alone and had inadequate nursing care, and those to whom the intervention of multidisciplinary professionals needed to be strengthened to prevent readmission. Using web conferencing tools, we shared issues and solutions for discharge with considering the anonymity of the patient’s personal information. The conferences were held once weekly for 30 minutes when the patients were in the stages of preliminary discharge planning. Participating physicians and healthcare professionals included cardiologists, nurses, pharmacists, physical therapists, nutritionists, palliative care physicians, and home doctors. The cardiology staff used a multifaceted checklist to clarify issues while sharing the patient’s condition and treatment plan. The palliative care physicians made suggestions about value-based treatment plans and decision support, and the home doctor made suggestions about home services, drug adjustment, and lifestyle guidance necessary to prevent readmission. Discussion: Further improvement in the web conferences and evaluation on the effect of the conferences are needed.

Objective: Peritoneal function during peritoneal dialysis (PD) declines over time due to peritoneal inflammation; however, the immunological mechanism has not been fully clarified. Here, we examined changes in each cellular fraction in the peritoneal dialysis effluent by flow cytometry and their relationship to peritoneal damage.Patients and Methods: We enrolled 23 patients who began PD between 2006 and 2017 and had available datasets of the peritoneal equilibration test and flow cytometric analysis for at least three consecutive visits, with an interval of six months from six months after introducing PD. The levels and changes in each cellular fraction, dialysate/plasma (D/P) creatinine ratio, and the forward scatter (FSC) ratio of mesothelial cells to lymphocytes were compared using a simple linear regression analysis.Results: Among the examined variables, only the fraction of CD8+ TCM cells during the first observation was significantly correlated with the change rate in the D/P creatinine ratio (β=1.47, P=0.001, adjusted R2=0.379). The CD8+ naïve T and CD8+ TCM cell fractions were negatively correlated with the change rate of the D/P creatinine ratio (naïve T cells: β=−0.058, P=0.022, adjusted R2=0.188; TCM cells: β=−0.096, P=0.046, adjusted R2=0.137). In addition, the change rates of the D/P creatinine ratio tended to be higher, though not significantly (one way ANOVA; P=0.080), in accordance with the increase in the change rate of the CD8+ effector memory T cells (TEM).Conclusion: The CD8+ naïve T and TCM cells may transition into TEM cells by repeated exposure to the dialysate over time. The TEM cells residing in the peritoneum may play a significant role in the progression of peritoneal damage.

Ankylosing spondylitis is chronic, progressive, inflammatory disease involving the spine, peripheral joints, and periarticular structures. Cardiac abnormalities associated with ankylosing spondylitis are well recognized, but a case with DDD pacemaker implantation for complete atrioventricular block and aortic valve replacement for aortic regurgitation has not been previously reported. We report a case of a 66-year-old man with ankylosing spondylitis who was successfully treated by DDD pacemaker implantation for complete atrioventricular block and aortic valve replacement for severe aortic regurgitation.

OBJECTIVES: The number of patients with bilateral cochlear implant (CI) has gradually increased as patients and/or parents recognize its effectiveness. The purpose of this report is to evaluate the efficacy of 29 bilateral CI out of 169 pediatric CI users, who received auditory-verbal/oral habilitation at our hearing center. METHODS: We evaluated the audiological abilities 29 Japanese children with bilateral CIs including wearing threshold, word recognition score, speech discrimination score at 1 m from front speaker (SP), 1 m from second CI side SP, speech discrimination score under the noise (S/N ratio=80 dB sound pressure level [SPL]/70 dB SPL, 10 dB) at 1 m from front SP, word recognition score under the noise (S/N ratio=80 dB SPL/70 dB SPL, 10 dB) at 1 m from front SP. RESULTS: Binaural hearing using bilateral CI is better than first CI in all speech understanding tests. Especially, there were significant differences between the results of first CI and bilateral CI on SDS at 70 dB SPL (P=0.02), SDS at 1 m from second CI side SP at 60 dB SPL (P=0.02), word recognition score (WRS) at 1 m from second CI side SP at 60 dB SPL (P=0.02), speech discrimination score (SDS) at 1 m from front SP under the noise (S/N=80/70; P=0.01) and WRS at 1 m from front SP under the noise (S/N=80/70; P=0.002). At every age, a second CI is very effective. However, the results of under 9 years old were better than of over 9 years old on the mean SDS under the noise (S/N=80/70) on second CI (P=0.04). About use of a hearing aid (HA) in their opposite side of first CI, on the WRS and SDS under the noise, there were significant differences between the group of over 3 years and the group of under 10 months of HA non user before second CI. CONCLUSION: These results may show important binaural effectiveness such as binaural summation and head shadow effect. Bilateral CI is very useful medical intervention for many children with severe-to-profound hearing loss in Japan as well as elsewhere.
Asian Continental Ancestry Group ; Child ; Cochlear Implantation ; Cochlear Implants ; Head ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Japan ; Noise ; Parents ; Speech Perception

OBJECTIVES: We conducted multi-directional language development tests as a part of the Research on Sensory and Communicative Disorders (RSVD) in Japan. This report discusses findings as well as factors that led to better results in children with severe-profound hearing loss. METHODS: We evaluated multiple language development tests in 33 Japanese children with cochlear implants (32 patients) and hearing aid (1 patient), including 1) Test for question and answer interaction development, 2) Word fluency test, 3) Japanese version of the Peabody picture vocabulary test-revised, 4) The standardized comprehension test of abstract words, 5) The screening test of reading and writing for Japanese primary school children, 6) The syntactic processing test of aphasia, 7) Criterion-referenced testing (CRT) for Japanese language and mathematics, 8) Pervasive development disorders ASJ rating scales, and 9) Raven's colored progressive matrices. Furthermore, we investigated the factors believed to account for the better performances in these tests. The first group, group A, consisted of 14 children with higher scores in all tests than the national average for children with hearing difficulty. The second group, group B, included 19 children that scored below the national average in any of the tests. RESULTS: Overall, the results show that 76.2% of the scores obtained by the children in these tests exceeded the national average scores of children with hearing difficulty. The children who finished above average on all tests had undergone a longer period of regular habilitation in our rehabilitation center, had their implants earlier in life, were exposed to more auditory verbal/oral communication in their education at affiliated institutions, and were more likely to have been integrated in a regular kindergarten before moving on to elementary school. CONCLUSION: In this study, we suggest that taking the above four factors into consideration will have an affect on the language development of children with severe-profound hearing loss.
Aphasia ; Asian Continental Ancestry Group ; Child ; Child Development Disorders, Pervasive ; Cochlear Implants ; Communication Disorders ; Comprehension ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Japan ; Language Development ; Mass Screening ; Mathematics ; Rehabilitation Centers ; Vocabulary ; Weights and Measures ; Writing