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Fukuoka-shi, Japan

Mitsuzuka K.,Tohoku University | Koga H.,Hara Sanshin Hospital | Sugimoto M.,Kagawa University | Arai Y.,Tohoku University | And 3 more authors.
International Journal of Urology | Year: 2015

Objective: To understand the current practice pattern of active surveillance using a nationwide survey among Japanese urologists. Methods: A new questionnaire about active surveillance was developed and mailed to 863 training institutes in January 2014. The questionnaire included indications for active surveillance, percentage of active surveillance for localized prostate cancer, problems with active surveillance, which protocol was used, timing of first repeat biopsy, use of prostate-specific antigen or doubling time and use of magnetic resonance imaging. Results: A total of 2133 Japanese urologists in the 632 training institutes answered the questionnaire. The median age was 42years (26-84years). Of the responders, 26.9% had no use of active surveillance for localized prostate cancer. The Prostate Cancer Research International: Active Surveillance criteria were most frequently used (29.7%), followed by a low-risk group without a definitive follow-up protocol (29.4%). Regarding repeat biopsy, 40.6% carried it out at 1year after active surveillance initiation, but 24.1% did not usually carry it out and 31.8% carried it out only when they considered it necessary. Magnetic resonance imaging was used routinely in 22.2% and as required in 67.6%. Re-biopsy or magnetic resonance imaging was less carried out in general hospitals than in universities. The percentage of no usual repeat biopsy was significantly higher in urologists who had more than 10years of experience. Repeat biopsies (60.3%), inadequate inclusion criteria (49.9%), psychological burden for patients (43.7%), unexpected progression (41.1%) and unknown long-term outcomes (40.6%) were considered the major problems of active surveillance in the responders. Conclusions: The practice pattern of active surveillance varies widely among Japanese urologists. It is necessary to gain a correct understanding of active surveillance. © 2015 The Japanese Urological Association. Source


Ohguri T.,University of Occupational and Environmental Health Japan | Yahara K.,University of Occupational and Environmental Health Japan | Moon S.D.,University of Occupational and Environmental Health Japan | Yamaguchi S.,University of Occupational and Environmental Health Japan | And 3 more authors.
International Journal of Hyperthermia | Year: 2011

Purpose: To assess the relationship between the radiofrequency (RF) output power and the intra-oesophageal temperature for hyperthermia of the whole thoracic region, and also to evaluate the patients' characteristics associated with adequate heating. Materials and methods: Fifty-nine patients with thoracic cancer treated with radiotherapy plus hyperthermia were retrospectively analysed. The 8-MHz RF capacitive heating device was applied, both the upper and lower electrodes were 300 mm in diameter, placed on opposite sides of the whole thoracic region. All the patients also underwent intra-oesophageal temperature measurements. Results: All thermal parameters, Tmin, Tmax, Tave, and %T ≥ 41°C, of the intra-oesophageal temperature highly correlated with the median RF output power (p < 0.0001), and the relations were independent in the multivariable analyses including clinical characteristics (p < 0.01). The performance status showed a statistically significant association on Tmax, Tave and %T ≥ 41°C (p < 0.05). The patient age and subcutaneous fat at some levels were inversely correlated with the thermal parameters (p < 0.05). Conclusion: The RF output power was significantly correlated with the intra-oesophageal temperature; it could be used as a promising parameter to assess the efficacy of hyperthermia for the whole thoracic region. Higher intra-oesophageal temperature may be achieved in patients with good performance status, younger age and thinner subcutaneous fat. © 2011 Informa UK Ltd. All rights reserved. Source


Chong Y.,Hara Sanshin Hospital | Yakushiji H.,Clinical Laboratory | Ito Y.,Hara Sanshin Hospital | Kamimura T.,Hara Sanshin Hospital
International Journal of Infectious Diseases | Year: 2010

Objectives: This study was performed to determine the local etiologic pattern of blood culture isolates and antibiotic resistance in febrile neutropenic patients with hematological malignancies. Methods: A total of 142 blood culture isolates from febrile neutropenic patients admitted to our hematology unit were examined, particularly for the detection of cefepime resistance, because cefepime, a fourth-generation cephalosporin, has been used in our unit as initial therapy for febrile neutropenia. Results: Among all isolates, 67 (47.2%) were Gram-positive bacteria, the majority of which were fully sensitive to vancomycin. Gram-negative bacteria accounted for 68 (47.9%) of the isolates. Cefepime resistance was seen in 24 (35.3%) of the Gram-negative isolates, and had significantly increased in 2007. The cefepime-resistant isolates primarily consisted of Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Approximately 60% of the cefepime-resistant isolates were extended-spectrum β-lactamase (ESBL)-producing organisms. Molecular analysis showed the predominant emergence of CTX-M types. Most of the cefepime-resistant isolates were resistant to third- and various fourth-generation cephalosporins, while having a high susceptibility to carbapenems, particularly meropenem. Conclusions: Cefepime resistance was often detected in the blood culture isolates from febrile neutropenic patients. This result suggests that therapeutic strategies for febrile neutropenia should be modified based on the local antibiotic resistance patterns. © 2010 International Society for Infectious Diseases. Source


Chong Y.,Kyushu University | Shimoda S.,Kyushu University | Ito Y.,Hara Sanshin Hospital | Miyamoto T.,Kyushu University | And 3 more authors.
Journal of Medical Microbiology | Year: 2013

Community-acquired infections caused by extended-spectrum b-lactamase (ESBL)-producing bacteria, particularly CTX-M-producing Escherichia coli, are a rising concern worldwide. There are few data from Japan on the acquisition of ESBLs in the community or the influx of these bacteria into hospitals. Therefore, we examined the prevalence of ESBL carriage in outpatients, in order to estimate the spread of ESBLs in community settings. We analysed bacterial isolates from outpatient samples at our institution over a 9-year period from 2003 to 2011, with respect to epidemiological data on ESBL-producing bacteria and their genotypic features. Out of 5137 isolates, 321 (6.3%) were ESBL producers, including E. coli, Klebsiella pneumoniae and Proteus mirabilis. The detection rates of the ESBL-producing isolates gradually increased and reached 14.3, 8.7 and 19.6% for E. coli, K. pneumoniae and P. mirabilis strains, respectively, in 2011. Genotyping analysis showed that many of the strains produced multiple b-lactamases, including TEM, SHV and CTX-M, rather than just CTX-M. The CTX-M-9 group was dominant among the CTX-M genotypes; further, the CTX-M-1 and M-2 groups were also detected (~30%). This is believed to be the first report from Japan showing a definite increase in ESBL detection in outpatients. In addition, our findings suggest the simultaneous community spread of diverse ESBL genotypes, not an expansion of particular ESBL genes. © 2013 SGM. Source


Komori M.,Clinical Research Institute | Yasaka M.,Clinical Research Institute | Kokuba K.,Clinical Research Institute | Matsuoka H.,National Hospital Organization Kagoshima Medical Center | And 8 more authors.
Circulation Journal | Year: 2014

Background: The incidence of intracranial bleeding during dabigatran treatment is lower than that during warfarin treatment. The characteristics of intracranial hemorrhage during dabigatran therapy, however, remain unclear. Methods and Results: The clinical data and treatment summaries of 9 intracranial bleeds that developed during dabigatran treatment in 8 patients with non-valvular atrial fibrillation were retrospectively reviewed. Five patients had small-moderate subdural hematomas, 2 had intracerebral hemorrhage and 1 had traumatic subarachnoid and parenchymal hemorrhage associated with cerebral contusion. Activated partial thromboplastin time upon admission ranged from 31.6 to 72.4 s. After admission, systolic blood pressure in the 2 patients with intracerebral hemorrhage was maintained below 140 mmHg, and the subdural hematomas in 4 patients were surgically treated. None of the hematomas became enlarged and outcome was good in most cases. Conclusions: Hematomas that arise due to acute intracranial bleeding during dabigatran treatment seem to remain small to moderate, hard to expand, and manageable. Source

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