Kagoshima-shi, Japan
Kagoshima-shi, Japan

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Kadooka M.,Kagoshima City Hospital | Kato H.,Nanpuh Hospital | Kato A.,Imakiire General Hospital | Ibara S.,Kagoshima City Hospital | And 2 more authors.
Early Human Development | Year: 2014

Background: Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied. Aims: To determine which FMH infants are likely to have neurological sequelae. Study design: A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer-Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes. Subjects: All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] <. 7.5. g/dL and 15 of 17 neonates tested had Kleihauer-Betke test result >. 4.0%. Outcome measures: Poor long-term outcome was defined as any of the following determined at 12. month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy. Results: Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6. ±. 1.4 vs. 5.4. ±. 1.1. g/dL, P=. 0.01), pH (7.09. ±. 0.11 vs. 7.25. ±. 0.13, P=. 0.02) and base deficits (17.5. ±. 5.4 vs. 10.4. ±. 6.0. mmol/L, P=. 0.02) in neonatal blood, and a number of infants with [Hb]. ≤. 4.5. g/dL (78%[7/9] vs. 22%[2/9], P=. 0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb]. Conclusions: Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants. © 2014 Elsevier Ltd.


Nakajo M.,Kagoshima University | Nakajo M.,Nanpuh Hospital | Nakayama H.,Kagoshima University | Jinguji M.,Kagoshima University | And 5 more authors.
Radiology | Year: 2016

Purpose: To examine whether dexamethasone suppression can reduce fluorine 18 fluorodeoxyglucose (FDG) uptake in false-positive (FP) findings in pulmonary and mediastinal lymph nodes in non-small cell lung cancer (NSCLC). Materials and Methods: Institutional ethics review board approved this prospective study with written informed consent. The study population was composed of 17 patients with NSCLC who underwent both baseline and dexamethasone suppression (24 hours after oral administration of 8 mg dexamethasone) FDG positron emission tomography/ computed tomography and surgery. FDG uptake was evaluated by using a five-point visual scoring system (negative findings, score of 0-1; positive findings, score of 2-4) and maximum standardized uptake value (SUVmax). The Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis, or Spearman rank correlation tests were used as necessary for statistical evaluations. Results: In 17 primary lesions, no significant difference was noted in visual score between baseline (mean, 3.4 ± 1.2) and dexamethasone suppression scans (mean, 3.3 ± 1.2; P = .16), although SUVmax was significantly lower on dexamethasone suppression scans (mean, 7.1 ± 5.2) than on baseline scans (mean, 8.6 ± 6.6; P = .005). In eight nodes with true-positive (TP) findings, there were no significant differences in visual score (mean for both, 3.8 ± 0.5) and SUVmax (mean, 5.3 ± 2.3 vs 5.5 ± 2.5, respectively; P = .81) between baseline and dexamethasone suppression scans. In 19 nodes with FP findings at baseline, dexamethasone suppression resulted in significantly lowered visual score (mean, 3.4 ± 0.6 vs 2.4 ± 0.8, respectively; P < .001) and SUVmax mean, 3.5 ± 0.8 vs 2.7 ± 0.7, respectively; P < .001), and four nodes with FP findings were rated as truenegative findings on dexamethasone suppression scans, which resulted in a significant difference in SUVmax between nodal lesions with TP and FP findings (P = .014). Conclusion: Oral dexamethasone has the potential to reduce FDG uptake in pulmonary and mediastinal nodes with FP findings in NSCLC. © 2015 RSNA.


PubMed | National Hospital Organization, Okayama Rousai Hospital, Kumamoto University, Nanpuh Hospital and 7 more.
Type: Clinical Trial, Phase II | Journal: International journal of clinical oncology | Year: 2016

Combination chemotherapy with S-1 and irinotecan is one of the standard treatments for metastatic colorectal cancer (mCRC) in Japan. However, there are few alternative practical second-line therapies. We conducted a phase II trial to evaluate the efficacy and safety of the combination of S-1 and irinotecan plus bevacizumab as a second-line treatment for oxaliplatin-refractory mCRC.Patients with mCRC who were previously treated with oxaliplatin-containing regimens were enrolled. Oral S-1 at a dose of 80mg/m(2) was administered twice daily for 2weeks, followed by a 1-week drug-free interval. Irinotecan at a dose of 150mg/m(2) and bevacizumab at a dose of 7.5mg/kg were administered on day 1. The primary endpoint was progression-free survival (PFS).Thirty-seven patients were enrolled, and 34 and 36 patients were assessed for response and safety, respectively. The overall response rate was 20.6% (95% confidenceinterval [CI] 8.7-37.9), and thedisease control rate was 76.5% (95% CI 58.8-89.3). The median PFS was 5.6months (95% CI 3.8-7.0).The median overall survival was 16.4months (95% CI 8.1-20.0). The most common grade 3/4 adverse events included neutropenia (25.0%), anorexia (22.2%), anemia (16.7%), and fatigue/malaise (16.7%). The most common grade 3/4 adverse event of special interest forbevacizumabwas hypertension (30.6%). One treatment-related death caused by gastrointestinal bleeding occurred.The findings suggest that the combination of S-1 and irinotecan plus bevacizumab is effective and tolerable as second-line chemotherapy for patients with oxaliplatin-refractory mCRC.


Sakaida I.,Yamaguchi University | Yamashita S.,Shimonoseki Kosei Hospital | Kobayashi T.,Tohoku Rosai Hospital | Komatsu M.,Akita | And 4 more authors.
Journal of International Medical Research | Year: 2013

Objective: To investigate the efficacy and safety of 14 days' orally administered tolvaptan as adjunctive treatment for hepatic oedema in Japanese liver cirrhosis patients with insufficient response to conventional diuretics, with the option to increase dose in those who did not respond initially. Methods: This multicentre, single-arm, phase 3 study allocated patients with liver cirrhosis and persistent ascites to 7-day treatment with 7.5 mg/day tolvaptan followed by an additional 7 days' treatment. Responders at day 7 (achieving ≥1 kg body-weight reduction) continued on 7.5 mg/day tolvaptan; nonresponders (<1 kg body-weight reduction) received 15 mg/day tolvaptan. Conventional diuretic treatment continued throughout. The primary endpoint was change in body weight from baseline, as a marker of ascites volume. Results: A total of 51 patients received 7.5 mg/day tolvaptan for 7 days, which caused a significant reduction in mean body weight (55% response rate). During the second 7-day treatment period, 30 patients received 7.5 mg/day tolvaptan and 13 patients received tolvaptan 15 mg/day: response rates were 43% and 23%, respectively. Two serious adverse events were observed. Serum sodium was within normal range. © The Author(s) 2013.


Nakajo M.,Nanpuh Hospital | Nakajo M.,Kagoshima University | Kajiya Y.,Nanpuh Hospital | Kaneko T.,Kaneko Clinic | And 5 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010

Purpose: To correlate both primary lesion 18F-fluorodeoxyglucose (FDG) maximum standardized uptake value (SUVmax) and diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) with clinicopathological prognostic factors and compare the prognostic value of these indexes in breast cancer. Methods: The study population consisted of 44 patients with 44 breast cancers visible on both preoperative FDG PET/CT and DWI images. The breast cancers included 9 ductal carcinoma in situ (DCIS) and 35 invasive ductal carcinomas (IDC). The relationships between both SUVmax and ADC and clinicopathological prognostic factors were evaluated by univariate and multivariate regression analysis and the degree of correlation was determined by Spearman's rank test. The patients were divided into a better prognosis group (n=24) and a worse prognosis group (n=20) based upon invasiveness (DCIS or IDC) and upon their prognostic group (good, moderate or poor) determined from the modified Nottingham prognostic index. Their prognostic values were examined by receiver operating characteristic analysis. Results: Both SUVmax and ADC were significantly associated (p<0.05) with histological grade (independently), nodal status and vascular invasion. Significant associations were also noted between SUVmax and tumour size (independently), oestrogen receptor status and human epidermal growth factor receptor-2 status, and between ADC and invasiveness. SUVmax and ADC were negatively correlated (ρ=-0.486, p=0.001) and positively and negatively associated with increasing of histological grade, respectively. The threshold values for predicting a worse prognosis were ≥4.2 for SUVmax (with a sensitivity, specificity and accuracy of 80%, 75% and 77%, respectively) and ≤0.98 for ADC (with a sensitivity, specificity and accuracy of 90%, 67% and 77%, respectively). Conclusion: SUVmax and ADC correlated with several of pathological prognostic factors and both indexes may have the same potential for predicting the prognosis of breast cancer. © 2010 Springer-Verlag.


Jinguji M.,Nanpuh Hospital
Clinical Nuclear Medicine | Year: 2016

ABSTRACT: A 62-year-old man underwent a whole-body FDG PET/CT for annual cancer screening. By an interview, he had an epigastric pain, and his body temperature was 37.0°C on the day. He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6°C), arthralgia, myalgia, and skin rash a few days before. Dengue fever was diagnosed by detecting dengue virus type 1 genome and antibody to the virus accompanied by thrombocytopenia and leukopenia. PET/CT examination revealed increased FDG uptake in the spleen and multiple lymph nodes. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Tabata S.,Keio University | Ikeda R.,Kagoshima University | Yamamoto M.,Kagoshima University | Shimaoka S.,Nanpuh Hospital | And 6 more authors.
Oncotarget | Year: 2014

Thymidine phosphorylase (TP) promotes angiogenesis and metastasis, and confers resistance to anticancer agents in some cancer cell types. We previously reported that TP stimulates the expression of interleukin (IL)-8 in human KB cancer cells by an unknown mechanism. A mutation in the nuclear factor (NF)κB binding site of the IL-8 promoter suppressed promoter activity in KB/TP cells that overexpress TP. Specifically inhibiting NFκB by using BY11-7082 also suppressed TP-induced IL-8 promoter activity and IL-8 expression. Moreover, TP overexpression led to the activation of NFκB and an upregulation in the expression of its target genes, and increased phosphorylated IKKa/β protein levels, while promoting IκBa degradation as well as p65 phosphorylation and nuclear localization. The activation of NFκB in KB/TP cells was suppressed by the antioxidants N-acetylcysteine and EUK-8. In addition, in gastric cancer tissue samples, the expression of the NFκB-regulated genes, including IL-8, IL-6, and fibronectin-1 was positively correlated with TP expression. These findings indicate that reactive oxygen species mediated NFκB activation by TP increases the expression of genes that promote angiogenesis and metastasis in gastric cancer.


Ijyuuin T.,Nanpuh Hospital | Umehara F.,Nanpuh Hospital
Clinical Neurology | Year: 2012

A 73-year old man was brought to our hospital because of acute onset of fever and consciousness disturbance. He had been hemodialyzed three times a week because of chronic renal failure since 13 years ago. Neurological examination revealed deteriorated consciousness and neck stiffness. A lumbar puncture yielded clouded fluid with a WBC 7,912/mm3 (polymorphonuclear cells 88%, mononuclear cells 12%), 786 mg/dl of protein and 4 mg/dl of glucose (blood glucose 118 mg/dl). Brain CT and MRI were unremarkable. He was treated with ceftriaxone and ampicillin. Streptococcus salivarius was isolated from the blood sample, but not from cerebrospinal fluid. The patient responded promptly to antibiotics therapy (ampicillin 3 g/day, ceftriaxone 1 g/day), and within several days he became lucid and afebrile. Isolated S. salivarius was sensitive for ampicillin and ceftriaxone. We diagnosed this case as S. salivarius bacteremia/meningoencephalitis. A gastrointestinal diagnostic workup revealed an asymptomatic gastric adenocarcinoma. S. salivarius is a common inhabitant of the oral mucosa that has been associated with infection in different sites. Meningeal infection by S. salivarius generally related to neoplasia of colon or iatrogenia, has been described on few occasions. This is the first report of S. salivarius bacteremia/meningoencephalitis associated with gastric neoplasm. Neurologist should be aware of the association of S. salivarius bacteremia/meningoencephalitis and gastrointestinal disease.


Yoshinaga T.,Kagoshima University | Yoshinaga T.,Nanpuh Hospital | Shigemitsu T.,Kagoshima University | Nishimata H.,Nanpuh Hospital | And 2 more authors.
Molecular Medicine Reports | Year: 2015

Globally, gastric cancer is one of the most common types of cancer and is the second leading cause of cancer-induced mortality. Early detection of gastric cancer is able to contribute to a reduction of its mortality. For early detection, more specific and sensitive biomarkers than the classic biomarkers, including carcinoembryonic antigen, carbohydrate antigen 19-9 and C-reactive protein, are required. The present study focused on the evaluation of the potential of angiopoietin-like protein 2 (ANGPTL2) as a novel biomarker for gastric cancer. The expression levels of ANGPTL2 in undifferentiated and differentiated gastric cancer cell lines (HGC-27 and MKN7, respectively) were therefore investigated. Additionally, ANGPTL2 levels in the serum of gastric cancer patients were compared with those of healthy individuals to evaluate the possibility of the protein as a predictive biomarker for gastric cancer. It was established that the expression levels of ANGPTL2 mRNA and protein were higher in undifferentiated HGC-27 cells than those in differentiated MKN7 cells. In a patient study, it was indicated that the levels of ANGPTL2 in the serum of gastric cancer patients were higher than those in healthy controls. The diagnostic performance of ANGPTL2 was assessed by constructing a receiver operating characteristic (ROC) curve and was evaluated by calculating the area under each ROC curve (AUC). For the discrimination of patients with gastric cancer from healthy individuals, the AUC for ANGPTL2 was 0.774 (P=0.005) (95% confidence interval, 0.615-0.933). These results suggested that ANGPTL2 was a potential biomarker for gastric cancer.


Nakajo M.,Kagoshima University | Nakajo M.,Nanpuh Hospital | Jinguji M.,Nanpuh Hospital | Tani A.,National Hospital Organization Kagoshima Medical Center | And 5 more authors.
Radiology | Year: 2013

Purpose: To compare positron emission tomography (PET)/computed tomography (CT) studies performed with the glucose analog fluorine 18 (18F) fluorodeoxyglucose (FDG) and the cell proliferation tracer 18F fluorothymidine (FLT) in the diagnosis of metastases from postoperative differentiated thyroid cancer. Materials and Methods: The institutional ethics review board approved this prospective study. From March 2010 to February 2012, 20 patients (mean age, 53 years; age range, 22-79 years) with postoperative differentiated thyroid cancer underwent both FDG and FLT PET/CT as a staging work-up before radioiodine therapy. In each patient, 28 anatomic areas were set and analyzed for lymph node and distant metastases. The McNemar exact or χ2 test was used to examine differences in diagnostic indexes in the detection of lymph node and distant metastases between both tracer PET/CT studies. Results: There were 34 lymph node metastases and/or 73 distant metastases (70 metastases in lung and one each in bone, nasopharynx, and brain) in 13 patients. At patient-based analysis, the sensitivity, specificity, and accuracy were 92% (12 of 13 patients), 86% (six of seven patients), and 90% (18 of 20 patients), respectively, for FDG PET/CT and 69% (nine of 13 patients), 29% (two of seven patients), and 55% (11 of 20 patients) for FLT PET/CT. The accuracy of FDG PET/CT was significantly better than that of FLT PET/CT (P = .023). At lesion-based analysis, the sensitivity, specificity, and accuracy for diagnosing lymph node metastases were 85% (29 of 34 lesions), 99.6% (245 of 246 lesions), and 97.9% (274 of 280 lesions), respectively, for FDG PET/CT and 50% (17 of 34 lesions), 90.7% (223 of 246 lesions), and 85.7% (240 of 280 lesions) for FLT PET/CT. The sensitivity, specificity, and accuracy for diagnosing distant metastases were 45% (33 of 73 lesions), 100% (207 of 207 lesions), and 85.7% (240 of 280 lesions), respectively, for FDG PET/CT and 6.8% (five of 73 lesions), 100% (207 of 207 lesions), and 75.7% (212 of 280 lesions) for FLT PET/CT. The sensitivity (P = .002), specificity (P < .001), and accuracy (P < .001) of FDG PET/CT in the diagnosis of lymph node metastases were superior to those of FLT PET, as were the sensitivity (P < .001) and accuracy (P < .001) in the diagnosis of distant metastases. Conclusion: FDG PET/CT is superior to FLT PET/CT in the diagnosis of postoperative differentiated thyroid cancer lymph node and distant metastases. Thus, FDG PET/CT is more suitable than FLT PET/CT for examining recurrence of postoperative differentiated thyroid cancer. © RSNA, 2013.

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