JaLCDOI 10.18926/AMO/52409
FullText URL 68_2_125.pdf
Author Young Jin Chang| Wol Seon Jung| Woon Rak Son| Youn Yi Jo|
Abstract A 47-year-old woman with amyotrophic lateral sclerosis was scheduled for total thyroidectomy with cervical node dissection. During anesthetic management by total intravenous anesthesia using remifentanil, propofol, and rocuronium, train-of-four (TOF) monitoring findings were not consistent with clinical signs. Sugammadex successfully reversed shallow respiration.
Keywords amyotrophic lateral sclerosis train-of-four sugammadex
Amo Type Case Report
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 125
End Page 127
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743788
Web of Science KeyUT 000334652700008
JaLCDOI 10.18926/AMO/52408
FullText URL 68_2_119.pdf
Author Takeda, Akiko| Shimada, Akira| Hamamoto, Kazuko| Yoshino, Syuuji| Nagai, Tomoko| Fujii, Yousuke| Yamada, Mutsuko| Nakamura, Yoshimi| Watanabe, Toshiyuki| Watanabe, Yuki| Yamamoto, Yuko| Sakakibara, Kanae| Oda, Megumi| Morishima, Tsuneo|
Abstract Acute megakaryocytic leukemia (AMKL) with t(1;22)(p13;q13) is a distinct category of myeloid leukemia by WHO classification and mainly reported in infants and young children. Accurate diagnosis of this type of AMKL can be difficult, because a subset of patients have a bone marrow (BM) blast percentage of less than 20% due to BM fibrosis. Therefore, it is possible that past studies have underestimated this type of AMKL. We present here the case of a 4-month-old female AMKL patient who was diagnosed by presence of the RBM15-MKL1 (OTT-MAL) fusion transcript by RT-PCR. In addition, we monitored RBM15-MKL1 fusion at several time points as a marker of minimal residual disease (MRD), and found that it was continuously negative after the first induction chemotherapy even by nested RT-PCR. Detection of the RBM15-MKL1 fusion transcript thus seems to be useful for accurate diagnosis of AMKL with t(1;22)(p13;q13). We recommend that the RBM15-MKL1 fusion transcript be analyzed for all suspected AMKL in infants and young children. Furthermore, monitoring of MRD using this fusion transcript would be useful in treatment of AMKL with t(1;22)(p13;q13).
Keywords AMKL infant RBM15-MKL1 OTT-MAL
Amo Type Case Report
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 119
End Page 123
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743787
Web of Science KeyUT 000334652700007
JaLCDOI 10.18926/AMO/52407
FullText URL 68_2_111.pdf
Author Shirakawa, Yasuhiro| Noma, Kazuhiro| Maeda, Naoaki| Katsube, Ryoichi| Tanabe, Shunsuke| Ohara, Toshiaki| Sakurama, Kazufumi| Fujiwara, Toshiyoshi|
Abstract Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n=37) and a post-standardization group (n=28). The thoracoscopic operative time was significantly shorter (p=0.0037) in the post-standardization group (n=28; 267±31min) than in the pre-standardization group (n=37;301±53min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy.
Keywords thoracoscopic esophagectomy prone position standardization
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 111
End Page 117
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743786
Web of Science KeyUT 000334652700006
JaLCDOI 10.18926/AMO/52406
FullText URL 68_2_101.pdf
Author Izutsu, Masato| Suzuki, Etsuji| Izutsu, Yukako| Doi, Hiroyuki|
Abstract The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.
Keywords health policy inequality Japan multilevel Poisson model nursing staff
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 101
End Page 110
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743785
Web of Science KeyUT 000334652700005
Related Url http://ousar.lib.okayama-u.ac.jp/metadata/52523
JaLCDOI 10.18926/AMO/52405
FullText URL 68_2_89.pdf
Author Sako, Shinichi| Kariyama, Reiko| Mitsuhata, Ritsuko| Yamamoto, Masumi| Wada, Koichiro| Ishii, Ayano| Uehara, Shinya| Kokeguchi, Susumu| Kusano, Nobuchika| Kumon, Hiromi|
Abstract We conducted a study on molecular epidemiology and clinical implications of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa isolated from urine. Over a 10-year period from 2001 through 2010, a total of 92 MBL-producing P. aeruginosa urine isolates were collected from patients (one isolate per patient) who were admitted to 5 hospitals in Okayama Prefecture, Japan. When cross-infection was suspected in the hospital, pulsed-field gel electrophoresis was performed. In the resulting dendrogram of 79 MBL-producing P. aeruginosa urine isolates, no identical isolates and 7 pairs of isolates with ≥80% similarity were found. The biofilm-forming capabilities of 92 MBL-producing P. aeruginosa urine isolates were significantly greater than those of 92 non-MBL-producing urine isolates in a medium of modified artificial urine. The imipenem resistance transferred in 16 of 18 isolates tested, and these frequencies were in the range of 10-3 to 10-9. All of 18 isolates tested belonged to internationally spread sequence type 235 and had 3 gene cassettes of antimicrobial resistance genes in the class 1 integron. The strong biofilm-forming capabilities of MBL-producing P. aeruginosa urine isolates could be seriously implicated in nosocomial infections. To prevent spread of the organism and transferable genes, effective strategies to inhibit biofilm formation in medical settings are needed.
Keywords Pseudomonas aeruginosa metallo-β-lactamase molecular epidemiology biofilm urinary tract infection
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 89
End Page 99
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743784
Web of Science KeyUT 000334652700004
Related Url http://ousar.lib.okayama-u.ac.jp/metadata/52504
JaLCDOI 10.18926/AMO/52404
FullText URL 68_2_79.pdf
Author Mu-Mu-Shwe| Harano, Teruo| Okada, Shigeru| Aye-Aye-Win| Khin-Saw-Aye| Hlaing-Myat-Thu| Mo-Mo-Win| Khin-Khin-Oo| Myo-Khin|
Abstract This study aimed to determine the prevalence of normal and abnormal cervical cytology in women who attended the cervical cancer screening clinic of the Department of Medical Research in Lower Myanmar, and to determine the proportion of high-risk (HR) human papillomavirus (HPV) infection and HPV genotypes in women with normal and abnormal cervical cytology. A total of 1,771 women were screened from 2010 to 2011. Among them, 762 women (43.0%) had a normal smear, and 866 (48.9%) and 87 (4.9%) were diagnosed with inflammatory smears and atypical squamous cells of undetermined significance (ASCUS), respectively. Diagnoses of low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) numbered 42 (2.3%) and 11 (0.6%) respectively. Three cases of squamous cell carcinoma (SCC) (0.2%) were detected. Cervical swabs were collected from 96 women with abnormal cervical cytology and 20 with normal cytology. HR-HPV DNA testing was performed by polymerase chain reaction (PCR) with pU1M/pU2R primers. HR-HPV were identified in 35.5% (22/62) of inflammatory smears, 60% (6/10) of ASCUS, 86.7% (13/15) of LSIL, 50% (3/6) of HSIL, 100% (3/3) of SCC and 5% (1/20) of normal cytology. In PCR-positive cases, HPV genotyping was analyzed by the cleaved amplification polymorphism method. The most prevalent HPV genotypes were HPV-16 (60.4%) followed by HPV-31 (14.6%), HPV-18 (12.5%) and HPV-58 (12.5%). Women with abnormal cervical cytology were 10 times more likely to be HR-HPV positive than those with normal cytology (p=0.0001). This study suggests that the implementation of a cervical cytology screening program and routine vaccination against HPV in preadolescent and adolescent groups are needed to reduce the burden of HPV-associated cervical cancer.
Keywords human papillomavirus cervical neoplasia genotyping Myanmar
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 79
End Page 87
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743783
Web of Science KeyUT 000334652700003
JaLCDOI 10.18926/AMO/52403
FullText URL 68_2_63.pdf
Author Fujii, Yasuyuki| Hoshino, Tyuji| Kumon, Hiromi|
Abstract Dickkopf (DKK) proteins interact with low-density lipoprotein receptor-related protein 5/6 (LRP5/6) to modulate WNT signaling. The interaction is mediated by a cysteine-rich domain (C2) in the DKK protein and β-propeller domains (PD) of LRP5/6. However, the third member of the DKK family (DKK3) does not bind to LRP5/6. To determine why DKK3 does not bind to the receptor domains, we performed a molecular modeling simulation study including homology modeling, protein-protein docking and molecular dynamics (MD). The computed affinities (ΔGbinding) between the C2 and PD models were consistent with the previously reported experimental results. The C2 model of DKK3 showed the lowest affinity for PD models. Multiple sequence alignment of C2 domains revealed that the DKK3 genes have a unique 7-amino-acid insertion (L249-E255 in human DKK3) and P258 in a finger loop 1 (FL1). Interestingly, the insertion sequence is evolutionally conserved. MD simulations of high-affinity complex models of C2 and PD showed that FL1 directly interacts with the PD models and stabilizes the complex models. We also built a 7-amino-acid-deletion/P258G mutant model of DKK3C2 and estimated its affinities for the PD models. The affinity for human LRP5PD2 was increased by the substitution (ΔGbinding=-48.9kcal/mol) and the affinity was compatible with that of high-affinity ligands. The results suggested that the lack of affinity between human DKK3 and human LRP5/6 results from: i) insertion of the 7 amino acids, and ii) P258 in human DKK3. The sequence differences thus suggest an explanation for this unique property of DKK3.
Keywords DKK3 molecular modeling protein-protein docking LRP5/6
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 63
End Page 78
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743782
Web of Science KeyUT 000334652700002
JaLCDOI 10.18926/AMO/52402
FullText URL 68_2_57.pdf
Author Hagiya, Hideharu| Naito, Hiromichi| Hagioka, Shingo| Okahara, Shuji| Morimoto, Naoki| Kusano, Nobuchika| Otsuka, Fumio|
Abstract The effect of antibiotics during the perioperative period of percutaneous dilatational tracheostomy (PDT) is still controversial. A total of 297 patients who underwent the PDT procedure were divided into 2 groups:those administered antibiotics perioperatively and those not administered antibiotics. Wound infections were noted in 7 cases (incidence rate, 2.36%) and no death was recorded. Of the 69 patients without antibiotics, 5 developed wound infections (incidence rate, 7.25%), while only 2 of the 228 patients with antibiotics developed wound infections (incidence rate, 0.88%) (p=0.002;risk ratio, 8.82;95% confidence interval, 1.67-46.6). Of the 7 cases of wound infection, 5 cases occurred during the early period after PDT (within 7 days). Collectively, the present results suggest that prophylactic administration of antibiotics may prevent the incidence of PDT-induced wound infection, especially in the early phase after the PDT procedures. The need for antibiotics in PDT should be reconsidered.
Keywords airway management critically ill patient percutaneous dilatational tracheostomy surgical site infection
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2014-04
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 57
End Page 62
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743781
Web of Science KeyUT 000334652700001