Nakase K.,Mie University |
Kita K.,Japan Baptist Hospital |
Kita K.,Mie University |
Kyo T.,Red Cross |
And 3 more authors.
PLoS ONE | Year: 2015
A variety of cytokine/cytokine receptor systems affect the biological behavior of acute leukemia cells. However, little is known about the clinical relevance of cytokine receptor expression in acute myeloid leukemia (AML). We quantitatively examined the expression of interleukin-2 receptor α-chain (IL-2Rα, also known as CD25), IL-2Rβ, IL-3Rα, IL-4Rα, IL- 5Rα, IL-6Rα, IL-7Rα, the common β-chain (βc), γc, granulocyte-macrophage colony-stimulating factor (GM-CSF)Rα, G-CSFR, c-fms, c-mpl, c-kit, FLT3, and GP130 in leukemia cells from 767 adult patients with AML by flow cytometry and determined their prevalence and clinical significance. All cytokine receptors examined were expressed at varying levels, whereas the levels of IL-3Rα, GM-CSFRα, IL-2Rα, γc, c-kit, and G-CSFR exhibited a wide spectrum of ≥10,000 sites/cell. In terms of their French-American-British classification types, GM-CSFRα and c-fms were preferentially expressed in M4/M5 patients, G-CSF in M3 patients, and IL-2Rα in non-M3 patients. Elevated levels of IL-3Rα, GM-CSFRα, and IL- 2Rα correlated with leukocytosis. In patients ≤60 years old, higher levels of these 3 receptors correlated with poor responses to conventional chemotherapy, but only IL-2Rα was associated with a shorter overall survival. By incorporating IL-2Rα status into cytogenetic risk stratification, we could sort out a significantly adverse-risk cohort from the cytogenetically intermediate-risk group.Analyses with various phenotypical risk markers revealed the expression of IL-2Rα as an independent prognostic indicator in patients with intermediaterisk cytogenetics. These findings were not observed in patients >60 years old. Our results indicate that several cytokine receptors were associated with certain cellular and clinical features, but IL-2Rα alone had prognostic value that provides an additional marker to improve current risk evaluation in AML patients ≤60 years old. © 2015 Nakase et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Okoshi K.,Japan Baptist Hospital |
Nomura K.,Teikyo University |
Fukami K.,Kyoto University |
Tomizawa Y.,Tokyo Women's Medical University |
And 3 more authors.
Tohoku Journal of Experimental Medicine | Year: 2014
During the past three decades, the participation of women in medicine has increased from 10.6% (1986) to 19.7% (2012) in Japan. However, women continue to be underrepresented in the top tiers of academic medicine. We highlight gender inequality and discuss the diffculties faced by female surgeons in Japanese academic surgery. Using anonymous and aggregate employment data of medical doctors at Kyoto University Hospital from 2009 and 2013, and a commercially-published faculty roster in 2012-2013, we compared gender balance stratifed by a professional and an academic rank. The numbers of total and female doctors who worked at Kyoto University Hospital were 656 and 132 (20.1%) in 2009 and 655 and 132 (20.2%) in 2013, respectively. Approximately half the men (n = 281) were in temporary track and the rest (n = 242) were in tenure track, but only one ffth of women (n = 24) were in tenure track compared to 108 women in temporary track (p < 0.0001) in 2013. There were three female associate professors in basic medicine (8.1%), two female professors in clinical non-surgical medicine (3.9%) and one female lecturer in clinical surgical medicine (2.3%) in 2012. Fewer female doctors were at senior positions and at tenure positions than male doctors at Kyoto University Hospital. There were no female associate and full professors in surgery. The status of faculty members indicates the gender differences in leadership opportunities in Japanese academic surgery. © 2014 Tohoku University Medical Press.
PubMed | Fukuoka University, Tokyo Women's Medical University, Teikyo University, Japan Baptist Hospital and Kyoto University
Type: Journal Article | Journal: Surgery | Year: 2016
In Japan, gender inequality between males and females in the medical profession still exists. We examined gender gaps in surgeons incomes.Among 8,316 surgeons who participated in a 2012 survey by the Japan Surgical Society, 546 women and 1,092 men within the same postgraduation year were selected randomly with a female-to-male sampling ratio of 1:2 (mean age, 36 years; mean time since graduation, 10.6 years).Average annual income was 9.2 million JPY for women and 11.3 million JPY for men (P < .0001). A general linear regression model showed that the average income of men remained 1.5 million JPY greater after adjusting for gender, age, marital status, number of children, number of beds, current position, and working hours (Model 1). In Model 2, in which 2 statistical interaction terms between annual income and gender with marital status and number of children were added together with variables in Model 1, both interactions became significant, and the gender effect became nonsignificant. For men, average annual income increased by 1.1 million JPY (P < .0001) when they were married and by 0.36 million JPY per child (P = .0014). In contrast, for women, annual income decreased by 0.73 million JPY per child (P = .0005).Male surgeons earn more than female surgeons, even after adjusting for other factors that influenced a surgeons salary. In addition, married men earn more than unmarried men, but no such trend is observed for women. Furthermore, as the number of children increases, annual income increases for men but decreases for women.
Inoue T.,Gifu University |
Suzuki K.,Japan Baptist Hospital |
Maehara H.,Gifu University |
Shimizu K.,Gifu University
Connective Tissue Research | Year: 2011
Growth plate is a cartilaginous structure responsible for longitudinal growth and calcification of long bones. Aggrecan is initially expressed within the growth plate but is lost during the course of calcification. Calcium-activated proteinases are believed to play a primary role in aggrecanolysis. In this study, m-calpain was shown to be expressed in a limited area of the growth cartilage at the lower hypertrophic zone. Confocal immunostaining demonstrated colocalization of m-calpain and the aggrecan product within the lower hypertrophic chondrocytes and in limited region of the pericellular matrix. Immunoblotting analysis identified anti-VPGVA-positive aggrecan product within the dissociative fractions of A1D1-A1D6 (densities 1.65, 1.56, 1.52, 1.47, 1.41, and 1.37 g/cm 3, respectively). These findings indicated that limited expression of m-calpain is colocalized with the appearance of calpain-related aggrecan products at the sites of aggrecanolysis and calcification, and suggested an important role of m-calpain in regulation of the growth plate process. The G1-G2-containing fragment of aggrecan remaining within the extracellular matrix (ECM) of the growth plate may contribute to the mechanical properties of the growth plate between the chondrocyte cell layers until bony replacement takes place. © 2011 Informa Healthcare USA, Inc.
Nakase K.,Mie University |
Kita K.,Japan Baptist Hospital |
Kyo T.,Red Cross |
Tsuji K.,Red Cross |
Katayama N.,Mie University
Cancer Epidemiology | Year: 2012
Backgorund: Although increased serum levels of soluble interleukin-2 receptor (sIL-2R) and their clinical importance are well known in mature type lymphoproliferative disorders (LD), little data is available about such information in acute type hematological malignancies. Methods: We examined the serum levels of sIL-2R in 57 adult patients with acute type leukemias: 32 with acute myeloid leukemia (AML), 14 acute lymphoblastic leukemia (ALL) and 11 chronic myelocytic leukemia in blast crisis (CMLBC), and in 29 adult patients with mature type LD, and assessed their cellular and clinical relevance in acute type leukemias. Results: No significant differences were seen in the sIL-2R levels between acute type leukemias and mature type LD. In AML, serum sIL-2R levels were related to the cell surface CD4 expression on blast cells, and patients with higher levels ≧2000. U/ml had a poorer prognosis (lower response to chemotherapy and shorter overall survival). Conclusions: These results suggest that serum sIL-2R level elevates in acute type leukemias like mature type LD, and increased sIL-2R levels in adult AML are correlated with certain biological and clinical characteristics. © 2012 Elsevier Ltd.
Kawada K.,Kyoto University |
Hasegawa S.,Kyoto University |
Hida K.,Kyoto University |
Hirai K.,Kyoto University |
And 5 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2014
Methods: This was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL.Background: Laparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis.Results: The overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25–12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22–17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period.Conclusions: Using appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings. © 2014, The Author(s).
Mori H.,Kyoto University |
Fukuda R.,Kyoto University |
Fukuda R.,Osaka University |
Hayashi A.,St Lukes International Hospital |
And 3 more authors.
Psycho-Oncology | Year: 2012
Objective Little is known about caregiver experiences during the end-of-life period. Our objective was to characterize caregiver perceptions of their experiences in cancer survivorship with special reference to the end-of-life stage considering depression in bereavement. Methods Qualitative research using in-depth interviews of 34 caregivers from two palliative care units in Japan. Data were analyzed inductively using framework analysis. Depression and personality traits were measured using the Center for Epidemiological Studies Depression (CES-D) and Sense of Coherence (SOC) scales, respectively. Results Caregiver perceptions were characterized along two axes. One axis involved four caregiver-cancer patient relationships: strengthening, reconstruction, intimacy-maintained, and estrangement-maintained. The core concept was transformation of relationships: caregivers reappraised aspects of caregiver-patient interactions through caregiving. The other axis involved subjective caregiving experiences divided into five concepts: spontaneity of care, discussing death, sympathy for patient emotions, impressions on first witnessing death, and introspective reflections in bereavement. Strengthening and reconstruction relationships appeared similar among the four relationship types, but only the former tended to overcompensate by sacrificing private time. Although median CES-D scores in each relationship type were under the cutoff for possible depression, four of eight caregivers suspected to have depressive tendencies belonged to the strengthening type. The mean SOC score for all caregivers was intermediate relative to scores previously reported in Japanese studies. Conclusions While caregivers' subjective experiences can be classified, their relationship to depression in bereavement needs future research. The present findings indicate that caregivers should also be considered in clinicians' views of cancer survivorship. Copyright © 2011 John Wiley & Sons, Ltd.
A case of advanced gastric cancer with distant lymph node metastases in cervical, supraclavicular and superior mediastinum successfully treated with S-1/Cisplatin (CDDP)/lentinan combination chemotherapy
Kinoshita K.,Japan Baptist Hospital |
Kondo K.,Japan Baptist Hospital |
Watanabe K.,Japan Baptist Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2010
The patient was a 76-year-old Japanese woman suffering from a left cervical tumor. An endoscopic examination revealed type 3 gastric cancer in the middle body of the stomach. 18FDG-PET-CT demonstrated distant multiple lymph node metastases in cervical, supraclavicular and superior mediastinum. Histopathological study showed poorly-differentiated adenocarcinoma in both stomach and supraclavicular lymph node. Serum CA19-9 was 794 U/mL. Since a curative operation was deemed impossible, S-1 (100 mg/body) was administered orally for 21 consecutive days with a 14-day interval as one course combined with intraveneous Lentinan (2 mg/body) once a week. Cisplatin (CDDP 60 mg/m 2) was infused on day 8. The serum CA19-9 level decreased to 176 U/mL after a course of the regimen, to 39 U/mL after the second course, and to the normal level after the 3rd course finally. However, gastric endoscopic biopsy still showed a remnant malignant lesion. After 5 courses of the chemotherapy, both the primary lesion and the distant lymph node swelling disappeared on gastroscopy and PET-CT, respectively, which was a so-called complete response (CR). After that, only S-1 was administered for 3 weeks followed by a drug-free week as a course. The patient has now been in good health without a recurrence for 4 months after recognition of CR.
PubMed | Japan Baptist Hospital
Type: Case Reports | Journal: Asian journal of endoscopic surgery | Year: 2016
A 42-year-old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self-expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patients postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers.
PubMed | Japan Baptist Hospital
Type: Journal Article | Journal: Surgery today | Year: 2015
Although surgical smoke contains potentially hazardous substances, such as cellular material, blood fragments, microorganisms, toxic gases and vapors, many operating rooms (ORs) do not provide protection from exposure to it. This article reviews the hazards of surgical smoke and the means of protecting OR personnel. Our objectives are to promote surgeons acceptance to adopt measures to minimize the hazards. Depending on its components, surgical smoke can increase the risk of acute and chronic pulmonary conditions, cause acute headaches; irritation and soreness of the eyes, nose and throat; dermatitis and colic. Transmission of infectious disease may occur if bacterial or viral fragments present in the smoke are inhaled. The presence of carcinogens in surgical smoke and their mutagenic effects are also of concern. This review summarizes previously published reports and data regarding the toxic components of surgical smoke, the possible adverse effects on the health of operating room personnel and measures that can be used to minimize exposure to prevent respiratory problems. To reduce the hazards, surgical smoke should be removed by an evacuation system. Surgeons should assess the potential dangers of surgical smoke and encourage the use of evacuation devices to minimize potential health hazards to both themselves and other OR personnel.