High hepatitis B virus screening rate among patients receiving systemic anticancer treatment in Japan.

BACKGROUND: Patients with hepatitis B virus (HBV) infection have a risk of reactivation after chemotherapy. All patients undergoing chemotherapy should be screened for HBV infection. No large-scale studies have been conducted to examine HBV screening practice in Japan. METHODS: We analyzed health insurance claims equivalent data linked with a nationwide hospital-based cancer registry. Patients diagnosed with cancer in 2014, who were aged 20 years and older and those who underwent systemic anticancer treatment in 2014-15 were included. We assessed the HBV screening rates by the HBsAg or anti-HBc tests, HBV-DNA tests, and entecavir prescriptions. Multiple logistic regression models were used to identify factors related to the receipt of screening. RESULTS: Of 177,597 patients (mean [SD] age, 65.6 [12.2] years), 82.6% and 12.9% patients had a solid tumor and hematologic malignancy, respectively. Among them, 88.1%, 6.3%, and 5.5% received cytotoxic chemotherapy, targeted therapy, and anti-CD20 antibodies, respectively. Overall, 70.6% of patients were screened. The positive predictor of HBV screening was receiving anti-CD20 antibodies [odds ratio (OR); 2.23, 95% confidence interval (CI) 2.06-2.41, p < 0.001] and negative predictors were age ≥ 85 (OR 0.76, 95% CI 0.71-0.81), age 75-84 (OR 0.77, 95% CI 0.75-0.79) and targeted therapy (OR 0.69, 95% CI 0.67-0.72). Among the screened patients, 13.2% were tested for HBV-DNA, and 1.49% were prescribed entecavir. CONCLUSIONS: The HBV screening rate in Japan is higher than in other countries. Further improvement of the HBV screening rate is needed to prevent reactivation and avoidable deaths of patients with HBV infection.

Dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification.

Three cases operated for spinal canal stenosis induced by dialysis-related amyloidosis (DRA) were investigated clinicopathologically. Cases were all-male, and had undergone hemodialysis around 20 years. In two cases, cervical plain X-rays showed only minor spondylotic changes. However, magnetic resonance imaging (MRI), myelography, and computed tomography (CT) showed extradural thickness with compression on the cervical spinal cord and cauda equina. In one case cervical X-rays showed typical destructive spondyloarthropathy (DSA), and MRI showed compression myelopathy. Surgical treatment on both cervical and lumbar spine in two cases and on cervical spine only in one case successfully reduced the symptoms. Extradural thickened tissue and ligament flavum obtained during surgery were studied histopathologically and immunostained by using anti-CD68, anti-beta2-microglobulin (beta2m), and anti-advanced glycation end product (AGE) antibody. Congo red stain showed diffuse or nodular amyloid deposition, and immunostaining with anti-beta2m and anti-AGE antibodies also demonstrated the same distribution pattern. Thus, beta2m-positive amyloid tissue in the extradural thickness (extradural amyloid deposition) was immunohistochemically demonstrated to be modified with AGE. Inflammatory reaction with histiocytic and giant cell infiltration was also shown around the amyloid tissues. There were CD68-positive cells, and some cells were positive for AGE and beta2m. These findings suggest that beta2m accumulation and inflammatory reaction finally promote destruction of connective tissues. MRI, CT and/or myelography are necessary for diagnosing spinal canal stenosis accompanied by DRA. In conclusion, we propose a more comprehensive concept of dialysis-related spinal canal stenosis, which includes both DSA and myeloradiculopathy induced by extradural thickness.

Effects of thyroid hormone deficiency on electrocardiogram findings of congenitally hypothyroid neonates.

Hypothyroid status is believed to cause various metabolic changes in infants. However, it is interesting that even severely hypothyroid neonates, detected during mass neonatal screening, rarely show bradycardia, hypothermia, or inactivity. To study cardiac functions of screen-detected neonates with congenital hypothyroidism (CH), we recorded the electrocardiograms (ECG) of 53 screen-detected CH neonates before levothyroxine (LT4) replacement therapy, and 15 age-matched normal neonates for controls. The 53 CH neonates were divided into two groups according to initial serum thyroid hormone levels: a mildly hypothyroid group (n = 37), serum thyroid-stimulating hormone (TSH) less than 100 microIU/mL and free thyroxine (FT4) 0.6 ng/dl or more; and a severely hypothyroid group (n = 16), TSH 100 microIU/mL or more and FT4 less than 0.6 ng/dL. TSH, FT4, and other blood chemicals were measured on an autoanalyzer (Hitachi 7170). After blood sampling, the ECG was recorded during induced sleep by oral administration of triclofos sodium syrup. ECG parameters, including HR, PR, QRS, QT time and corrected QT time (QTc) were automatically obtained, using an auto-ECG analyzing system. The following results were obtained. No CH patients showed abnormal ECG findings. There was no significant difference of the mean heart rates (HRs) between the mildly hypothyroid (147.5 +/- 16.3 beats per minute) and the control group (148.3 +/- 12.1 beats per minute). The mean HR in the severely hypothyroid group (134.0 +/- 17.9 beats per minute, p = 0.007) was significantly low compared with the normal control group. However, all values were within normal ranges. QTc in the severely hypothyroid group (0.414 +/- 0.015, p = 0.033) was significantly shorter than in the control group (0.440 +/- 0.052). No statistical differences of PR, QRS, and QT time were noted among the three groups. All ECG parameters were within normal ranges. HR positively correlated with FT4 and log (FT4), and negatively with TSH and log (TSH). From these results we conclude that the deficiency of thyroid hormones does not affect ECG findings of congenitally hypothyroid neonates. This may be consistent with the unexpectedly mild signs and symptoms of screen-detected hypothyroid neonates.

[A case of Becker type congenital myotonia with myalgia].

We reported a case of Becker type congenital myotonia with myalgia. A 28 year-old woman admitted to our hospital because of right anterior chest pain and back pain. She was diagnosed as myotonic dystrophy by other university hospital when she was 16 years old. Physical examination revealed only myotonia and could not find muscle atrophy or cataracta which were usually found in myotonic dystrophy. The quadriceps muscle biopsy revealed complete absence of type IIB muscle fiber. We diagnosed her Becker type congenital myotonia by the clinical course and family history and the histopathological findings of quadriceps muscle. Myalgia which she complained seemed to have some connection with this disease. But we could not prove the pathogenesis of this myalgia.

[Efficacy of paromomycin sulfate in the elimination of Diphyllobothrium species and Taenia saginata in clinical cases].

Recently it has been known that paromomycin sulfate had marked anthelmintic activity against some species of tapeworms. In this investigation, paromomycin sulfate was used for treating 6 cases of diphyllobothriasis and 1 case of Taenia saginata infection. Paromomycin sulfate was administered orally in a single dose or 2 divided doses of 40--60 mg/kg, being followed by a purge about 1.5 hours later. Strobila or fragments of proglottids were expelled from 5 cases, of which only 1 scolex was found in a case of infection with marine species of Diphyllobothrium. In 1 case of diphyllobothriasis no worm or worm-fragment was found in the stool even after the second challenge of treatment. Nevertheless follow-up examination for more than 1 month showed no evidence of remaining infection in all cases. Transient dizziness was observed in only 1 case, disappearing within about 30 minutes. Serum- and urine-examinations detected no abnormal signs in all cases excepting 1 case of diphyllobothriasis with suspected hepatitis. It was concluded that paromomycin sulfate is effective therapeutic agent for the treatment of taeniasis and diphyllobothriasis including marine species.

[An experimental study on the appropriate proportion of dopamine and dobutamine for mixed infusion to treat cardiopulmonary dysfunction].

This study was aimed to investigate appropriate proportion for combined use of dopamine (DA) and dobutamine (DB) to treat cardiopulmonary dysfunction. The total dose of 10 micrograms.kg-1.min-1 with several different proportions in steps of 2 micrograms.kg-1.min-1 of DA and DB was administered to mongrel dogs with intact lung and with cardiopulmonary dysfunction caused by lung edema induced by oleic acid instillation. The hemodynamic variables during and after the infusion with the combined dosages of both agents were compared with that of baseline values. In dogs with intact lung, cardiac index (CI) increased significantly in all proportions of both agents. The levels of CI tend to increase prominently when the proportion of DB in the mixture was increased. Heart rates showed a tendency to increase with higher proportion of DB. Increasing proportions of DA caused a more increase of arterial pressure than by increasing that of DB. In dogs with pulmonary edema, these hemodynamic characteristics with the proportional changes of both drugs were demonstrated more significantly than in normal dogs. From these results, it was concluded that the appropriate combined preparation of both agents to increase CI without extreme tachycardia in dogs with cardiopulmonary dysfunction was the mixed solution of DA 2-4 micrograms.kg-1.min-1 and DB 6-8 micrograms.kg-1.min-1.

[Neurological sequelae caused by surgical procedures during adenoidectomy under anesthesia].

A five-year old boy with good risk was anesthetized with nitrous-oxide and halothane under orotracheal intubation for adenoidectomy and tubing of bilateral middle-ear cavities. Patient was on supine position with extension of neck. A mouth-gag was applied and the pharynx was packed with gauze. After long unskilled surgical procedures, severe neurological complications which were initiated with severe arrhythmias and followed by signs of paralysis of bilateral IX, X, XI, XII cranial nerves at their nuclei in medulla oblongata, were observed during the post-anesthetic period. The patient was saved with neurological sequelae of the cranial nerves and is alive after 6 years from the incident. The causes of this complications were discussed.

Porcine androgenetic embryos develop to fetal stage in recipient mothers.

In livestock, parthenogenic embryos are simple to produce, but androgenetic embryos have been successfully produced only in sheep and cows. In the present study, matured porcine oocytes were enucleated by micromanipulation and then fertilized with sperm in vitro, thereby producing porcine androgenetic embryos. Porcine androgenetic embryos, which had only sperm genomes, were assessed for cleavage and for blastocyst formation 2 and 6 d after IVF, respectively. There was no difference in cleavage rate between androgenetic embryos and biparental IVF embryos (mean ± SD androgenetic: 65.5 ± 5.4%; biparental IVF: 63.2 ± 3.6%), but there was a difference in the rate of blastocyst formation (androgenetic: 4.5 ± 0.7%; biparental IVF: 30.2 ± 2.6%, P < 0.05). The average number of cells in Day 6 androgenetic blastocysts (34.3 ± 18.2) was lower (P < 0.05) than that in biparental IVF blastocysts (44.1 ± 19.5), but did not differ from that in parthenogenetic embryos (35.7 ± 16.7). The androgenetic embryos were transferred into recipient mothers to examine the competence of post-implantation development. Androgenetic fetuses were present on Days 21 and 25, but not on Days 28, 31, or 35. Of the six androgenetic fetuses recovered on Day 21, five had normal, translucent bodies, and two of these five had beating hearts. The four fetuses recovered on Day 25 were all non-viable. In conclusion, porcine androgenetic embryos initiated embryogenesis and had reached a viable fetal stage 21 days after IVF.