Multi-institutional retrospective analysis of ultrahypofractionated radiotherapy for Japanese prostate cancer patients.

To report outcomes and risk factors of ultrahypofractionated (UHF) radiotherapy for Japanese prostate cancer patients. This multi-institutional retrospective analysis comprised 259 patients with localized prostate cancer from 6 hospitals. A total dose of 35-36 Gy in 4-5 fractions was prescribed for sequential or alternate-day administration. Biochemical failure was defined according to the Phoenix ASTRO consensus. Toxicities were assessed using National Cancer Institute Common Toxicity Criteria version 4. Tumor control and toxicity rates were analyzed by competing risk frames. Median follow-up duration was 32 months (range 22-97 months). 2- and 3-year biochemical control rates were 97.7% and 96.4%, respectively. Initial prostate-specific antigen (p < 0.01) and neoadjuvant androgen deprivation therapy (p < 0.05) were identified as risk factors for biochemical recurrence. 2- and 3-year cumulative ≥ Grade 2 late genitourinary (GU) toxicities were 5.8% and 7.4%, respectively. Corresponding rates of gastrointestinal (GI) toxicities were 3.9% and 4.5%, respectively. Grade 3 rates were lower than 1% for both GU and GI toxicities. No grade 4 or higher toxicities were encountered. Biologically effective dose was identified as a risk factor for ≥ Grade 2 late GU and GI toxicities (p < 0.05). UHF radiotherapy offered effective, safe treatment for Japanese prostate cancer with short-term follow-up. Our result suggest higher prescribed doses are related to higher toxicity rates.

[A Case of Amusia Following Right Temporal Subcortical Hemorrhage].

A woman in her 60s presented with amusia due to a localized subcortical hemorrhage of the right temporal lobe. No other symptoms of higher brain dysfunction or body paralysis were observed. One characteristic symptom in this case was rhythm impairment. Few cases of this impairment have been previously reported, and the responsible lesion and underlying mechanisms are still a matter of speculation. However, in this case, a relationship with the right temporal lobe was indicated.

Effects of low-frequency repetitive transcranial magnetic stimulation combined with intensive speech therapy on cerebral blood flow in post-stroke aphasia.

We provided an intervention to chronic post-stroke aphasic patients using low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) guided by a functional magnetic resonance imaging (fMRI) evaluation of language laterality, combined with intensive speech therapy (ST). We performed a single photon emission-computed tomography (SPECT) scan pre- and post-intervention and investigated the relationship between cerebral blood flow (CBF) and language function. Fifty right-handed chronic post-stroke aphasic patients were enrolled in the study. During their 11-day hospital admission, the patients received a 40-min session of 1-Hz LF-rTMS on the left or right hemisphere, according to language localization identified by the fMRI evaluation, and intensive ST daily for 10 days, except for Sunday. A SPECT scan and language evaluation by the Standard Language Test of Aphasia (SLTA) were performed at the time of admission and at 3 months following discharge. We calculated laterality indices (LIs) of regional CBF (rCBF) in 13 language-related Brodmann area (BA) regions of interest. In patients who received LF-rTMS to the intact right hemisphere (RH-LF-rTMS), the improvement in the total SLTA score was significantly correlated with the pre- and post-intervention change of LI (ΔLI) in BA44. In patients who received LF-rTMS to the lesional left hemisphere (LH-LF-rTMS), this association was not observed. Analyses of the SLTA subscales and rCBF ΔLI demonstrated that in the RH-LF-rTMS group, the SLTA Speaking subscale scores were significantly correlated with ΔLIs in BA11, 20, and 21, and the SLTA Writing subscale scores were significantly correlated with ΔLIs in BA6 and 39. Conversely, in the LH-LF-rTMS group, the SLTA Speaking subscale scores were correlated with ΔLI in BA10, and the SLTA Reading subscale scores were significantly correlated with ΔLIs in BA13, 20, 22, and 44. Our results suggest the possibility that fMRI-guided LF-rTMS combined with intensive ST may affect CBF and contribute to the improvement of language function of post-stroke aphasic patients. LF-rTMS to the non-lesional and lesional hemispheres showed a difference in the associations between language performance and CBF. The results indicate that more effective rTMS intervention needs to be explored for patients who show right hemisphere language activation in an fMRI language evaluation.

[Relationships between prevalence of youth risk behaviors and sleep duration among Japanese high school students].

OBJECTIVES: This study aimed to clarify relationships between prevalence of risk behaviors and sleep duration among Japanese high school students. METHODS: Data from a national survey, the Japan Youth Risk Behavior Survey 2011 (the subjects were 9,778 students: 5,027 males, 4,751 females, in the first grade to the third grade of 102 schools randomly selected among high schools throughout Japan) was used for this analysis. We focused on nine items of risk behavior in JYRBS: "lack of vigorous physical activity," "skipping breakfast," "current cigarette use," "current alcohol use," "lifetime thinner use," "ever had sexual intercourse," "rarely or never wore seatbelts," "in a physical fight," and "seriously considered attempting suicide." RESULTS: Students with less than six hours of sleep duration accounted for approximately 40% of males and females. The odds ratios of prevalence of each of the nine risk behaviors were calculated on the basis of the group "six hours or more and less than eight hours" of sleep, whose prevalence of risk behaviors was the lowest. In the group with "four hours or more and less than six hours," the odds ratios of "lack of vigorous physical activity" and "skipping breakfast" for both males and females were significantly high. Furthermore, in the group with shorter sleep duration of "less than four hours," the odds ratios of all nine risk behaviors for males (odds ratios: 1.47-3.28) and eight risk behaviors (except for "rarely or never wore seatbelts") for females (1.54-4.68) were significantly high. On the other hand, in the group with long sleep duration of "10 hours or more," the odds ratios of "current cigarette use" and "lifetime thinner use" for both males and females were significantly high. CONCLUSION: It was shown that short sleep duration of less than six hours and long sleep duration of 10 hours or more related to the prevalence of youth risk behaviors among Japanese high school students. It was suggested that sleep duration should be considered as an important category of youth risk behaviors.

Effectiveness of low-frequency rTMS and intensive speech therapy in poststroke patients with aphasia: a pilot study based on evaluation by fMRI in relation to type of aphasia.

AIM: To assess the safety and clinical efficacy of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with intensive speech therapy (ST) in poststroke patients with aphasia. SUBJECTS AND METHODS: Twenty-four patients with left-hemispheric stroke and aphasia were subjected. During 11-day hospitalization, each patient received 10 treatment sessions consisting of 40-min 1-Hz LF-rTMS and 60-min intensive ST, excluding Sundays. The scalp area for stimulation was selected based on the findings of fMRI with language tasks and the type of aphasia. LF-rTMS was applied to the inferior frontal gyrus (IGF) for patients with nonfluent aphasia and to the superior temporal gyrus (STG) for patients with fluent aphasia. RESULTS: On pretreatment fMRI, the most activated areas were in the left hemisphere (n=16) and right hemisphere (n=8). The types of aphasia were nonfluent (n=14) and fluent (n=10). The LF-rTMS was applied to the right STG (n=5), left STG (n=5), right IFG (n=11) and left IFG (n=3). Nonfluent aphasic patients showed significant improvement of auditory comprehension, reading comprehension and repetition. Fluent aphasic patients showed significant improvement in spontaneous speech only. CONCLUSION: The fMRI with aphasic type-based therapeutic LF-rTMS/intensive ST for chronic aphasia seems feasible and a potentially useful neurorehabilitative protocol.

Low-frequency rTMS with language therapy over a 3-month period for sensory-dominant aphasia: case series of two post-stroke Japanese patients.

PURPOSE: To examine the safety and feasibility of therapeutic application of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with language therapy for post-stroke patients with sensory-dominant aphasia. SUBJECTS AND METHODS: Two post-stroke Japanese patients with sensory-dominant aphasia were studied. In both patients, 10 sessions of 20-minute low-frequency rTMS with 1 Hz to the Wernicke's area were provided throughout 6-day hospitalization, followed by weekly outpatient rTMS treatment for 3 months. The language therapy was also provided through the period of in- and out-patient treatment. Language function was evaluated using the Token test and the Standard Language Test of Aphasia (SLTA) at the start and end of the in-patient treatment and the end of the outpatient treatment. RESULTS: The therapeutic protocol was well tolerated throughout the in- and out-patient treatments, without any adverse effects. The scores of the Token test and certain sub-categories of SLTA increased in both patients after the in-patient rTMS treatment. Persistent improvement of the score was noted over the 3-month post-discharge period. CONCLUSIONS: The proposed protocol of long-term application of low-frequency rTMS to the Wernicke's area and language therapy is considered a safe and feasible therapeutic approach for post-stroke patients with sensory-dominant aphasia.

Functional MRI-based therapeutic rTMS strategy for aphasic stroke patients: a case series pilot study.

Four poststroke patients with motor-dominant aphasia received 10 treatment sessions of low-frequency repetitive transcranial magnetic stimulation (rTMS). Each treatment session consisted of 1,200 pulses of stimulation and the site of stimulation was an area homologous to the most activated site on functional MRI performed prior to rTMS. Consequently, rTMS was applied to the right frontal lobe in two patients and to the left frontal lobe in two patients. Treatment resulted in improvement of language function in all four patients. Our therapeutic rTMS strategy seems to be a clinically feasible neurorehabilitative approach for poststroke aphasic patients.

[Influence of position of ionization chamber and leaf-end on verification value in IMRT verification for prostate cancer].

In IMRT for prostate cancer, MU verification is performed by the actual measurement. We have experienced a remarkable improvement in results, once succeeding in finding out the more suitable and optimal evaluation dose point in some cases even though the deviation between a designed MU score and our actual record gained at the iso-center was more than 3%. In this study, we tried to demonstrate how much influence would be given to the point dose verification by the 3D arrangement between an ion chamber and tips of the MLC. The five cases in which the bias between each actual datum and planed MU score showed that about 3% were picked up and through these MLC configurations, 8 leaf-ends around the chamber were highlighted as the influential ones. After each distance from 4 pairs, a total of 8 leaves to the axis (the mid-line) of our ion chamber were mapped. The indexes (PlanLeafScores) were computed through these distances and segmental MU scores. The ratio of these scores and results obtained at the 12 sites within 1 cm from the iso-center were carried out by single regression analysis. In all cases the ratios of planed MU values to the actual ones tended to go down in inverse proportion to the increase in PlanLeafScores (r<-0.77, p<0.002). As the dimensional arrangement between the ion chamber and the edges of the MLC were thought to determine the result of the verification. PlanLeafScores will enable us to determine the optimal evaluation of the dose point.

[Development of a respiratory monitoring device for truncal stereotactic radiotherapy using an abdominal pressure-detecting system with Stereotactic Body Frame].

The Stereotactic Body Frame, which was devised as a fastening unit for the irradiation of various truncal lesions, has obtained a good reputation for its high-precision reproductivity. This device is accessorized with 'Diaphragm Control', which can reduce the respiratory movement of intra-thoracic organs. In this study, to investigate the possibility of a respiratory monitor using our device, we try to clarify the relationship between the pressure against the abdominal board of 'Diaphragm Control' and each constrained tidal respiratory movement. Our original software was programmed to detect and analyze these data with our personal computer from some ready-made highly sensitive pressure detectors. In any fundamental performance of this system, response time is less than 1 msec at 115,200 bps, minimum detectable weight is 420 g, linearity correlation between loading weight and pressure index value is seen from 1000 g to 6000 g loading, and reproducibility of measurement is evaluated by coefficient of variation (CV=0.95% at 3000 g loading). It has sufficient capability to be used as a respiratory monitoring device during radiation therapy. In an experiment with three volunteers, the results revealed a positive correlation between pressure index value and ventilation air volume by spirometer. The decision coefficients (R(2)) were 0.7717, 0.7995, and, 0.8684, respectively. Our original respiratory monitoring device can be used for quantitative respiratory suppression and unexpected breathing detection without loading additional stress on the patient.

[Technical considerations on the usage of a general-purpose flatbed image scanner when making a dose-density table].

The DD-System is a dose-distribution system for analyzing the film method with a general-purpose flatbed image scanner. By analyzing the analogue digital conversion(ADC)value of each pixel acquired by the DD-system, we examined the technical problems of measurement with the scanner when making a dose-density table. When film of uniform density was measured, the ADC values distributed normally. Deviation of the values at the same pixel point on another time was about one-ten thousandth of the average. Deviation of the values from the time the scanner was turned on was in the same range. Although it may be negligible, the values measured at a peripheral area on the flatbed deviated about 2SD from the average measured at the central area. Further, deviation of the value obtained with a shade covering the outside of the irradiation field from that taken without the shade was about one thousandth. These deviations are not negligible. In the case of making a dose-density table with a DD-System and a general-purpose flatbed image scanner, the film should be set in the center of the flatbed, and the sampling area should be selected from those areas where the ADC values are distributed normally. Then proper data can be obtained and more accurate tables can be made.

Effectiveness of drug abuse prevention program focusing on social influences among high school students: 15-month follow-up study.

OBJECTIVE: To examine the effectiveness of a drug abuse prevention program focusing on social influences for drug education classes in high school. METHODS: The social influence program in the experimental group used role-playing led by a pharmacist, a police officer and a teacher. The intervention evaluation used a quasi-experimental design. The subjects were first-year students from 10 high schools assigned to the experimental group (6 schools, 828 students) and the control group (4 schools, 408 students). In the control group, a pharmacist used a conventional information program in a lecture format. RESULTS: Regarding knowledge about drug abuse, in both the experimental and control groups, and for both males and females, a long-term effect was observed immediately after the program and lasted up to 15 months. For three other measures, attitudes toward drug abuse problem, self-efficacy regarding drug abuse prevention, and perception of social support for preventing drug abuse, a short-term effect was generally observed in the experimental group beginning immediately after the program and lasting for 3 months. A long-term effect was evident in high-risk students with positive opinions regarding drugs. In the control group and for both males and females, although an effect was generally evident immediately after the program, neither a short-nor a long-term effect was observed in males, suggesting the difficulty in achieving lasting effects. CONCLUSIONS: The social influence program in the experimental group showed remarkable effectiveness. Thus, the program may be useful for preventing drug abuse among high school students in Japan.

Prevention of upper respiratory tract infections by gargling: a randomized trial.

BACKGROUND: Gargling to wash the throat is commonly performed in Japan, and people believe that such hygienic routine, especially with gargle medicine, prevents upper respiratory tract infections (URTIs). Its effectiveness, however, has not been established by clinical trials. DESIGN: Randomized controlled trial carried out in 2002-2003 winter season and analyzed in 2003 and 2004. PARTICIPANTS: Healthy volunteers (387) aged 18 to 65 years. INTERVENTION: Participants were randomly assigned to water gargling, povidone-iodine gargling, and usual care (control). Subjects in the two gargling groups were requested to gargle with water or diluted povidone-iodine at least three times a day. Participants were followed for 60 days. MAIN OUTCOME MEASURES: The primary outcome measure was first URTI incidence. Severity of URTI symptoms among incident cases was also evaluated. Both outcomes were assessed with a self-administered symptom record. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 130 participants contracted URTIs. The incidence rate of first URTI was 0.26 episodes/30 person-days among control subjects. The rate decreased to 0.17 episodes/30 person-days in the water gargling group, and 0.24 episodes/30 person-days in the povidone-iodine gargling group. Respective incidence rate ratios against controls were 0.64 (95% confidence interval [CI]=0.41-0.99) and 0.89 (95% CI=0.60-1.33). A Cox regression (proportional hazard model) revealed the efficacy of water gargling (hazard ratio=0.60, 95% CI=0.39-0.95). Even when a URTI occurred, water gargling tended to attenuate bronchial symptoms (p=0.055). CONCLUSIONS: Simple water gargling was effective to prevent URTIs among healthy people. This virtually cost-free modality would appreciably benefit the general population.