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Hiyama T.,University of Tsukuba | Masumoto T.,University of Tsukuba | Shiigai M.,Tsukuba Medical Center Foundation | Akutsu H.,University of Tsukuba | And 2 more authors.
Japanese Journal of Radiology | Year: 2015

Purpose: To evaluate the clinical significance of optic chiasmal edema (OCE) observed in hydrocephalus.Materials and methods: Twenty patients with obstructive hydrocephalus and eight patients with communicating hydrocephalus were recruited. We classified both groups into OCE-positive and negative subgroups on three-dimensional T2-weighted images. In the obstructive hydrocephalus group, the pre- and postoperative periventricular hyperintensity (PVH) grade, Evans index, and third ventricle diameter were compared between the subgroups. The visual disturbances were reviewed in the medical records.Results: Eleven obstructive hydrocephalus patients (55 %) had OCE, while none of communicating hydrocephalus patients did. OCE was improved in all patients postoperatively. Preoperative PVH grade was significantly higher in the OCE-positive subgroup (p < 0.01). There were no statistically significant differences in the other indices. Visual disturbances were observed in two OCE-negative patients alone.Conclusion: OCE is a reversible finding frequently observed in obstructive hydrocephalus and may not be associated with visual disturbances. © 2015, Japan Radiological Society. Source


Baba M.,Saito Yukoukai Hospital | Maeda I.,Osaka University | Morita T.,Seirei Mikatahara General Hospital | Hisanaga T.,Tsukuba Medical Center Foundation | And 18 more authors.
Journal of Pain and Symptom Management | Year: 2015

Context Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative Care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams. Objectives The primary aim of this study is to examine the accuracy and to validate the modified PiPS (using physician-proxy ratings of mental status instead of patient interviews) in three palliative care settings, namely palliative care units, hospital-based palliative care teams, and home-based palliative care services. Methods This multicenter prospective cohort study was conducted in 58 palliative care services including 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services in Japan from September 2012 through April 2014. Results A total of 2426 subjects were recruited. For reasons including lack of followup and missing variables (primarily blood examination data), we obtained analyzable data from 2212 and 1257 patients for the modified PiPS-A and PiPS-B, respectively. In all palliative care settings, both the modified PiPS-A and PiPS-B identified three risk groups with different survival rates (P < 0.001). The absolute agreement ranged from 56% to 60% in the PiPS-A model and 60% to 62% in the PiPS-B model. Conclusion The modified PiPS was successfully validated and can be useful in palliative care units, hospital-based palliative care teams, and home-based palliative care services. © 2015 American Academy of Hospice and Palliative Medicine. Source


Miura T.,National Cancer Center Hospital East | Matsumoto Y.,National Cancer Center Hospital East | Hama T.,Japan National Cardiovascular Center Research Institute | Amano K.,Osaka City General Hospital | And 16 more authors.
Supportive Care in Cancer | Year: 2015

Purpose: The Glasgow prognostic score (GPS), which uses C-reactive protein and albumin levels, is a good predictor of prognosis in cancer patients undergoing anti-tumor therapy. The objective of this study was to investigate the correlation between GPS and survival among cancer patients in palliative settings, as findings in such populations have not been well described. Methods: This was a subanalysis of a multicenter, prospective, cohort study in patients who were adults, diagnosed with advanced cancer, and first referred to palliative care service in Japan. Patients who were not receiving anti-tumor therapy and who had undergone laboratory examinations were eligible. Clinical features were analyzed to investigate prognostic factors. Results: A total of 1160 patients were enrolled (41.6 % female; median age, 72 years). The independent predictors were Eastern Cooperative Oncology Group performance status (ECOG PS) score of 4 (hazard ratio (HR), 1.54), liver metastasis (HR, 1.21), dyspnea (HR, 1.35), edema (HR, 1.25), prognostic performance index (HR, 1.56), neutrophil-lymphocyte ratio (HR, 1.43), and GPS of 2 (HR, 1.36). The sensitivity and specificity for 3-week prognosis of a GPS of 2 were 0.879 and 0.410. Median survival time with GPS of 0, 1, and 2 was 58 days (95 % confidence interval, 48–81), 43 days (37–50), and 21 days (19–24), respectively (log-rank test, p < 0.001). Conclusion: The GPS was a good prognostic indicator for cancer patients in palliative settings. © 2015, Springer-Verlag Berlin Heidelberg. Source


Ueno E.,Tsukuba Medical Center Foundation | Tohno E.,Total Health Evaluation Center Tsukuba | Morishima I.,Tsukuba Medical Center Foundation | Umemoto T.,Tsukuba Medical Center Foundation | Waki K.,Hitachi Ltd.
Journal of Medical Ultrasonics | Year: 2015

Objectives: The objectives of this study were to demonstrate the non-inferiority of assist strain ratio (ASR)—a newly developed application tool—to manual strain ratio (MSR)—a currently available standard diagnostic tool—and to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSR and ASR. Methods: Ninety-eight mass lesions in the mammary gland (30 malignant and 68 benign) were included in the study. Skilled physicians performed the elastography scanning by applying minimal vibration. MSRs were obtained and compared with ASRs calculated from the same elastography image to test the correlation between the two groups of data. Results: Diagnostic performance of MSR at a cut-off of 5.0 showed a sensitivity of 84.4 %, a specificity of 80.4 %, an accuracy of 81.6 %, a PPV of 65.5 %, and an NPV of 92.1 %. Diagnostic performance of ASR at a cut-off of 5.0 showed a sensitivity of 74.4 %, a specificity of 84.3 %, an accuracy of 81.3 %, a PPV of 67.7 %, and an NPV of 88.2 %. The areas under the curve (AUCs) for MSR and ASR were found to be 0.885 and 0.875, respectively. Conclusion: ASR demonstrated excellent diagnostic potential and was highly correlated with MSR performed by skilled physicians (r = 0.69, p < 0.05). © 2015, The Japan Society of Ultrasonics in Medicine. Source


Umemoto T.,Tsukuba Medical Center Foundation | Umemoto T.,University of Tsukuba | Ueno E.,Tsukuba Medical Center Foundation | Ueno E.,University of Tsukuba | And 5 more authors.
Ultrasound in Medicine and Biology | Year: 2014

The aim of this study was to reveal the background to the image variations in strain elastography (strain imaging [SI]) depending on the manner of manipulation (compression magnitude) during elasticity image (EI) acquisition. Thirty patients with 33 breast lesions who had undergone surgery followed by SI assessment in vivo were analyzed. An analytical approach to tissue elasticity based on the stress-elastic modulus (Young's modulus) relationship was adopted. Young's moduli were directly measured ex vivo in surgical specimens ranging from 2.60 kPa (fat) to 16.08 kPa (invasive carcinoma) under the weak-stress condition (<0.2-0.4 kPa, which corresponds to the appropriate "light touch" technique in SI investigation. The contrast (ratio) of lesion to fat in elasticity ex vivo gradually decreased as the stress applied increased (around 1.0 kPa) on the background of significant non-linearity of the breast tissue. Our results indicate that the differences in non-linearity in elasticity between the different tissues within the breast under minimal stress conditions are closely related to the variation in EI quality. The significance of the "pre-load compression" concept in tissue elasticity evaluation is recognized. Non-linearity of elasticity is an essential attribute of living subjects and could provide useful information having a considerable impact on clinical diagnosis in quantitative ultrasound elastography. © 2014 World Federation for Ultrasound in Medicine & Biology. Source

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