Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Erratum for Vol. 69, No. 6, pp339-348, Anxiety and Feelings toward Their Baby among Pregnant Women with Uterine Leiomyomas6768ENMikiSenooMikiyaNakatsukaErratum10.18926/AMO/54008Pregnant women with uterine leiomyomas may experience anxiety toward their pregnancies and unfavorable feelings toward their infants. From March to July 2010, we distributed anonymous self-recorded questionnaires to 200 pregnant women who visited Okayama Central Hospital for an antenatal check-up after informed consent was provided, and 132 women (23 pregnant women with uterine leiomyomas) were included in our study. Among the multiparous women in their first trimester, the women with uterine leiomyomas had a higher rate of anxiety than those without uterine leiomyomas. ʻAvoidanceʼ scores on the Feeling Toward the Baby Scale were significantly higher in the leiomyoma group. The conflict index scores tended to be higher in the leiomyoma group. A multivariate analysis revealed no factors associated with trait-anxiety scores, whereas high state-anxiety scores were correlated with low age;however, there was no correlation between these scores and uterine leiomyomas. Although no factors were associated with State-Trait Anxiety Inventory (STAI) and approach scores toward the baby, avoidance and conflict index scores were associated with the existence of uterine leiomyomas. In pregnant women with uterine leiomyomas, efforts should be made to reduce anxiety in the first trimester, and support should be provided to help these women develop positive feelings toward their babies.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Induction S-1+Concurrent Radiotherapy Followed by Surgical Resection of Locally Advanced Non-small-cell Lung Cancer in an Elderly Patient6365ENHidejiroTorigoeShinichiToyookaKuniakiKatsuiJunichiSohYuhoMakiKatsuyukiKiuraShinichiroMiyoshiCase Reports10.18926/AMO/54007We present the case of a 77-year-old Japanese man diagnosed with lung squamous cell carcinoma with mediastinal lymph node metastasis. He was treated with induction chemoradiotherapy for T1bN2M0 stage IIIA disease. Considering his age, we selected S-1 as the chemotherapeutic drug. Observing an objective response with no severe adverse events, we performed a left upper lobectomy with sleeve resection of the pulmonary artery. No residual tumor cells were found in the resected specimens, and no critical complication was observed in the clinical course. This case suggests that induction chemoradiotherapy using S-1 combined with concurrent radiation followed by surgery can be a therapeutic option for elderly patients with locally advanced non-small-cell lung cancer.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Orthodontic Treatment of a Patient with Bilateral Congenitally Missing Maxillary Canines: The Effects of First Premolar Substitution on the Functional Outcome5762ENKumiSumiyoshiYoshihitoIshiharaHirokiKomoriTakashiYamashiroHiroshiKamiokaCase Reports10.18926/AMO/54005Permanent canines are thought to play a pivotal role in obtaining an ideal occlusion. Dentists occasionally encounter patients who lack canines and are therefore missing a key to harmonious guidance during functional mandibular excursions. This case report describes the substitution of maxillary first premolars for congenitally missing canines in the context of an orthodontic treatment plan. A boy, age 10 years and 11 months, with a chief complaint of crooked teeth was diagnosed with Class II division 2 malocclusion associated with a high mandibular plane angle and deep overbite. A stable occlusion with a satisfactory facial profile and functional excursions without interference were achieved after a comprehensive two-stage orthodontic treatment process. The resulting occlusion and satisfactory facial profile were maintained for 12 months. These results indicate that substituting the first premolars for the canines is an effective option in treating patients with missing canines while maintaining functional goals.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Computer-assisted Minimally Invasive Posterior Lumbar Interbody Fusion without C-arm Fluoroscopy5155ENMasatoTanakaYoshiharuSugimotoShinyaAratakiTomoyukiTakigawaToshifumiOzakiCase Reports10.18926/AMO/54004Computer-assisted spinal surgery is becoming more common; however, this is the first technical report to describe the technique of minimally invasive spinal posterior lumbar interbody fusion (MIS-PLIF) without using C-arm fluoroscopy. The authors report 2 years of follow-up of a 49-year-old female patient with L4 degenerative spondylolisthesis. The patient suffered from low back pain and intermittent claudication for more than 6 years. The authors performed computer-assisted MIS-PLIF without C-arm fluoroscopy. Instead, O-arm® navigation, the use of which reduces radiation exposure to patients as well as others in the operating room, was employed. Surgery was successful, and correct lumbar alignment was maintained. She had neither neurological deficits nor low back pain at her 12-month final follow-up. In conclusion, computer-assisted MIS-PLIF without C-arm fluoroscopy is a useful technique that reduces radiation exposure to the surgeon and operating room staff.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Importance of Milk Expression for Preterm Infants4549ENHidehikoMaruyamaYuseiNakataAkaneKanazawaKiyoshiKikkawaOriginal Article10.18926/AMO/54003Mothers of preterm infants may find it difficult to express breast milk. There is a low breast milk rate among preterm infants at discharge at our hospital, and here we tested the hypothesis that milk expression factors were the cause of the low rate. The study subjects were born before 33 gestational weeks at our hospital between March 2005 and June 2014. Nutritional evaluation was performed at discharge and noted whether breast milk, infant formula, or a mix of the 2 was being given. We compared the group given breast milk or the mix versus the group given formula. Of the 337 infants, 40 cases were excluded. Data from 297 infants were analyzed. The mean (SD) gestational age and birth weight were 29.5 (2.4) weeks and 1,230 (391) g, respectively. At discharge, 26 (8.8%), 102 (33.3%), and 174 (57.9%) infants were given breast milk, formula, and the mix, respectively. A multivariate logistic regression analysis showed that the first milk expression (h) was the risk factor for the formula group: adjusted odds ratio (95% confidence interval) 1.06 (1.02-1.09) and p=0.002. Delayed first milk expression could affect the low breast milk rate at discharge. Improvement of milk expression should be achieved to promote breastfeeding.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia3743ENSo HuiYunJong CookParkSang RimKimYun SukChoiOriginal Article10.18926/AMO/54002The beneficial effects of dexmedetomidine (DEX) have not been extensively investigated in elderly patients receiving spinal anesthesia. This study evaluated the effects of intravenous DEX infusion on stress and hemodynamic response, as well as on postoperative analgesia in elderly patients undergoing total knee arthroplasty (TKA). We randomly allocated 45 adult patients to 3 patient groups (n=15 each): uni-saline group patients underwent unilateral TKA with saline administration, uni-DEX group patients underwent unilateral TKA with DEX administration, and bilateral-DEX group patients underwent bilateral TKA with DEX administration. Serum interleukin-6 (IL-6) levels were significantly lower in the bilateral-DEX group than in the uni-saline group 6 and 24h postoperatively, and were negatively correlated with total DEX dosage 24h postoperatively. Bradycardia occurred more frequently in the uni-DEX and bilateral-DEX groups than in the uni-saline group. The total dose of required supplementary analgesics was significantly higher in the uni-saline group than in the uni-DEX and bilateral-DEX groups 6h postoperatively. The results indicate that perioperative intravenous DEX administration decreases postoperative serum IL-6 levels in patients undergoing bilateral TKA, and has a postoperative analgesic effect in patients undergoing unilateral or bilateral TKA.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016A Long-term Survivor after Congenital Acute Myeloid Leukemia with t(8 ; 16)(p11 ; p13)3135ENTakaeHanadaKiichiroKanamitsuKosukeChayamaTakakoMiyamuraYuiKanazawaMichikoMuraokaKanaWashioMasahideImadaMisaoKageyamaAkihitoTakeuchiKeiTamaiMegumiOdaAkiraShimadaOriginal Article10.18926/AMO/54001The treatment of patients with congenital leukemia is difficult and often results in a poor prognosis. We present here the case of a female child with congenital acute myeloid leukemia (AML) with t(8 ; 16) (p11 ; p13) who received chemotherapy and survived for more than 10 years without relapse. A novel MOZ-CBP chimera was found in her diagnostic sample. Although adult AML patients with MOZ-CBP have mainly been reported as having therapy-related AML and showed poor prognoses, the present case supports the idea that AML with MOZ-CBP in the pediatric population might show better prognoses.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Calcium Phosphate Composition Affects Ureteroscopic Laser Lithotripsy2529ENHideoOtsukiTakashiYoshiokaToshihiroShimizuYusukeNakanishiKeiFujioWataruMuraoShinyaUeharaHirosatoKikuchiKojiFujioOriginal Article10.18926/AMO/54000The effects of stone composition on transurethral lithotripsy (TUL) have not been sufficiently elucidated. The purpose of this study was to identify how calcium phosphate stone composition impacts TUL. Two hundred eighty-nine cases of semi-rigid and/or flexible TUL for upper urinary tract calculi were reviewed retrospectively. Inclusion criteria were a preoperative assessment by noncontrast computed tomography (NCCT) and a stone composition analysis. Small stones and those without calcium composition were excluded. Stone core radiodensity (SCR) was measured by taking the average of the upper 3 of 5 points in the proximity of the center of the stone on NCCT. Fifty-three patients with calcium phosphate composition (CaP) and 118 patients with calcium oxalate and without phosphate composition were eligible for analysis. SCR was significantly higher in the CaP group (p<0.01). The CaP patient group needed a significantly longer operation time (p=0.014) and more laser energy (p=0.085), and tended to have a lower rate of complete lithotripsy (p=0.096) and higher incidence of postoperative pyelonephritis (p=0.181). Stones containing calcium phosphate are harder, demand more laser energy, and require a longer operating time. NCCT evaluation can estimate stone composition preoperatively, and may be a useful tool for predicting operative outcomes.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016The Function of ƒÀ2-glycoprotein I in Angiogenesis and Its in Vivo Distribution in Tumor Xenografts1324ENArum Tri WahyuningsihLianhuaShenKazukoKobayashiTakanoriSasakiFumiakiTakenakaTakahisaHanadaMasaruAkehiAkiyaAkahoshiEiichiOzekiEijiAndoEijiMatsuuraOriginal Article10.18926/AMO/53999Intact ƒÀ2-glycoprotein I (iƒÀ2GPI) is a glycoprotein that regulates coagulation and fibrinolysis. Nicked ƒÀ2GPI (nƒÀ2GPI) possesses an angiogenic property at a relatively low concentration, and an antiangiogenic property at a high concentration. Here we investigated the functions of ƒÀi 2GPI and nƒÀ2GPI in vascular endothelial growth factor (VEGF)-A-induced endothelial cell proliferation and tube formation. We used noninvasive PET imaging to analyze the in vivo distribution of intravenously injected ƒÀ2GPI variants in tumor lesions in mice. iƒÀ2GPI was incubated with plasmin to obtain nƒÀ2GPI, and its N-terminal sequence was analyzed. nƒÀ2GPI had at least one other cleavage site upstream of the ƒÀ2GPIʼs domain V, whereas the former plasmin-cleavage site locates between K317 and T318. Both of intact and nicked ƒÀ2GPI significantly inhibited the VEGF-A-induced cell proliferation and the tube formation of human umbilical vein endothelial cells (HUVECs). PET imaging visualized considerably distributed intensities of all tested ƒÀ2GPI variants in tumor lesions of pancreatic tumor cell-xenografts. These results indicate that ƒÀ2GPI may be physiologically and pathophysiologically important in the regulation of not only coagulation and fibrinolysis, but also angiogenesis.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7012016Entecavir Reduces Hepatocarcinogenesis in Chronic Hepatitis B Patients112ENTetsuyaYasunakaFusaoIkedaNozomuWadaYukiMorimotoShin-ichiFujiokaJunichiToshimoriHaruhikoKobashiKazuyaKariyamaYoichiMorimotoHirokiTakayamaTomonoriSenoKoichiTakaguchiAkioMoriyaHirokazuMiyatakeRyoichiOkamotoKazuhisaYabushitaAkinobuTakakiKazuhideYamamotoOriginal Article10.18926/AMO/53996Chronic hepatitis B (CHB) leads to cirrhosis and hepatocellular carcinoma (HCC). With a cohort of 1,206 CHB patients who visited Okayama University Hospital and related hospitals in 2011 and 2012, we compared the incidence rates of HCC among the patients grouped by age, hepatitis B virus (HBV) DNA, hepatitis B e antigen (HBeAg), and treatment. HCCs were observed in 115 patients with the median observation period of 1,687 days. Among the HCC patients aged ≥ 35 years, HBV DNA ≥ 4 log copies/mL and positive HBeAg at diagnosis (n=184), the HCC incidence rate was 8.4% at 5 years in the entecavir (ETV)-treated patients, 21.8% in the lamivudine (LVD)-treated patients, and 26.4% among the patients not treated with drugs. The cumulative HCC incidence was significantly reduced in the ETV-treated patients compared to those treated with LVD or not treated (p=0.013). Among the patients aged ≥ 35 years with HBV DNA ≥ 4 log copies/mL and negative HBeAg (n=237), the cumulative HCC incidence was 14.6% in 5 years in ETV group and 13.9% among those not treated with a drug (p>0.05). Only small numbers of HCCs occurred in other patients. In CHB patients aged≥35 years with HBV DNA ≥4 log copies/mL and positive HBeAg, ETV treatment is recommended for the suppression of HCC development.No potential conflict of interest relevant to this article was reported.