Steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia.

PURPOSE: To report the characteristics of the steroid-induced ocular hypertensive response in pediatric patients with acute lymphoblastic leukemia (ALL) treated with prednisolone (PSL) during induction therapy and with dexamethasone (DEX) during reinduction therapy. STUDY DESIGN: Retrospective. PATIENTS AND METHODS: This study included pediatric patients diagnosed with B-cell precursor ALL and treated with systemic corticosteroids sometime during the period from 2016 to 2018 at Shizuoka Children's Hospital. Data were extracted from the hematology/oncology records related to the type, dose, and duration of systemic corticosteroids as well as to the ophthalmologic examination findings, intraocular pressure (IOP) data, symptoms of high IOP, and antiglaucoma medications obtained during corticosteroid administration. The maximal IOPs of the PSL and DEX groups were compared. RESULTS: Twenty-eight patients (18 boys and 10 girls; mean age 5.5 years) were treated with systemic corticosteroids. Twelve of the 22 courses of PSL and 33 of the 44 courses of DEX were found to be associated with high IOP. The maximal IOP was higher with the use of DEX than with the use of PSL, including in those who received prophylactic therapy (PSL 25.2 mmHg, DEX 33.6 mmHg; P = 0.02). Antiglaucoma medication was given to 21 patients; 6 patients had symptoms of ocular hypertension. The maximal IOPs were 52.8 mmHg and 70.8 mmHg in the PSL and DEX groups, respectively. Both groups of patients reported severe headache. CONCLUSION: Increased IOP was frequently observed during systemic corticosteroid therapy in pediatric patients with ALL. Although most patients were asymptomatic, they occasionally presented with severe systemic symptoms. Regular ophthalmologic examinations should be included in the treatment guidelines for ALL.

Diabetes care providers' manual for disaster diabetes care.

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the "Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake" under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current "Manual for Disaster Diabetes Care" has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

Diabetes Care Providers' Manual for Disaster Diabetes Care.

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the "Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake" under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current "Manual for Disaster Diabetes Care" has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

Healthy Aging and Concerns Among Elderly Japanese: A Text Analysis Approach.

Japan is facing an unprecedented aging society. In 2013, 25.1% of the total population in Japan was 65 years old and over. One third of the population in Japan will be at least 65 years old in 2035; healthy aging is crucial for public health and society in Japan. Under the budget limitations of social security, policies and frequent policy changes have created great uncertainty and concern for the elderly population. Given these circumstances, we conducted questionnaire surveys in 2010 to examine concerns in this age-group. In 2010, we sent questionnaires to university graduates 65 years old and older, randomly selected from a list of an alumni association of 11 universities. The questionnaires were open-ended and asked them to write any concerns that they had about health care, health policy, health systems, and their future. We received 344 responses. Among those who responded, 271 (78.8%) respondents said that they had concerns. We conducted a text analysis (Trend Search-Keyword Associator 2008) and extracted the keywords from their responses. The keywords that were extracted frequently included hospitals, doctors, health-care system, health care, Japanese government policies, government, medical insurance system for the elderly, support, increase, copayment, health (their own), scarcities, and burdens. In this study, many elderly people in Japan are concerned about health-care expenditures, health-care systems, and health policies. This may be caused by frequent health policy changes and uncertainty due to frequent administration changes such as the lack of clarity concerning raising the out of pocket payment rate from 10% to 20% for elderly people under budget constraints in Japan. Correct policy making and determination to eliminate the concerns from this vulnerable population in Japan are necessary for healthy aging.

Reevaluation of a lectin antibody ELISA kit for measuring fucosylated haptoglobin in various conditions.

BACKGROUND: Fucosylated haptoglobin (Fuc-Hpt) is a novel cancer biomarker in a variety of pathological conditions. We previously found that the level of Fuc-Hpt is increased in the sera of patients with pancreatic cancer, and established a lectin antibody ELISA using Aleuria aurantia lectin, which specifically binds to fucosylated residues on oligosaccharides. METHODS: To apply this assay system to the clinical detection of several diseases, several assay conditions such as serum dilutions and inhibitory factors were investigated. The Fuc-Hpt kit was available for 25-625 fold serum dilution. RESULTS: While the values of Fuc-Hpt assay using sera and plasma were different, they showed positive correlation. The addition of bilirubin and formagine did not influence on Fuc-Hpt assay, but hemoglobin inhibited this assay in a dose-dependent manner. CONCLUSIONS: We reevaluated this lectin antibody ELISA kit for measuring fucosylated haptoglobin in various conditions in this study.

[Three cases of uveitis induced by mycobacteriosis therapy using rifabutin].

BACKGROUND: Rifabutin has been used clinically to combat tuberculosis as well as nontuberculosis Mycobacterium since 2008 in Japan. Uveitis associated with rifabutin is described in many reports, but none of these are of Japanese. We report three Japanese cases of nontuberculosis Mycobacterium with rifabutin-associated uveitis. CASE 1: A 91-year-old woman developed bilateral uveitis with hypopyon and vitreous opacity at 2 months after the initiation of rifabutin administration. The uveitis persisted regardless of topical administration of corticosteroids and the discontinuance of rifabutin. Her right eye required goniosynechiolysis in order to cure a secondary glaucoma, and the left eye required vitrectomy in order to cure vitreous inflammation. CASE 2: A 72-year-old woman developed uveitis in her right eye at 7 months after the initiation of rifabutin administration. Rifabutin was stopped two days after she presented, and the uveitis resolved quickly with topical administration of corticosteroids. CASE 3: An 83-year-old woman developed bilateral uveitis at 6 months after the initiation of rifabutin administration. The rifabutin was stopped two months after the initiation and the uveitis resolved with topical corticosteroids. CONCLUSION: Rifabutin rarely causes uveitis as an ocular side effect. Early diagnosis and is important and reduction or discontinuance of the rifabutin as well as anti-inflammatory therapy need to be implemented when a patient develops this condition.

Magnetic resonance imaging of the medial rectus muscle of patients with consecutive exotropia after medial rectus muscle recession.

PURPOSE: To investigate the morphologic characteristics of the medial rectus muscle in patients with consecutive exotropia. DESIGN: Retrospective, nonrandomized, interventional study. PARTICIPANTS AND CONTROLS: Eleven eyes of 10 patients with consecutive exotropia were studied. Thirteen eyes of 13 age-matched normal subjects were studied as controls. METHODS: All of the patients underwent an advancement of a previously operated medial rectus muscle. Patients were divided into 3 groups based on the insertion of the medial rectus muscle: Normally recessed stretched scar, and slipped muscle. MAIN OUTCOME MEASURES: A comparison was made of the clinical findings, intraoperative findings, and distance from the limbus to the medial rectus muscle measured on magnetic resonance images among the groups. RESULTS: The medial rectus of 4 eyes of 3 patients had normally recessed insertions and 7 eyes had abnormal insertions (3 stretched scars, 4 slipped muscles). The clinical findings were not different among the 3 groups. The magnetic resonance images showed that the medial rectus muscle was located closest to the limbus in the control subjects and most distant in the patients with a slipped muscle (P<0.005). The clinical findings in the patients with a stretched scar and with normally recessed were indistinguishable. CONCLUSIONS: Magnetic resonance images of the medial rectus muscles of the control subjects and operated groups are significantly different morphologically. A slipped medial rectus muscle has characteristic magnetic resonance findings that are distinguishable from the muscle with normally recessed and stretched scar.

Vascular endothelial growth factor is an autocrine growth factor for cardiac myxoma cells.

BACKGROUND: Cardiac myxomas are generally considered benign, but malignant tumors have been reported. Vascular endothelial growth factor (VEGF), an angiogenic factor, plays a role in the growth, progression, and metastasis of solid tumors and it has been reported that VEGF expression is upregulated in cardiac myxomas that have a high microvessel density. The purpose of this study was to determine whether cardiac myxoma cells possess a VEGF-autocrine system that regulates tumor growth. METHODS AND RESULTS: Immunohistochemical analyses revealed the presence of VEGF and its receptors, VEGFR-1 (flt-1) and VEGFR-2 (KDR/flk-1), in the cytoplasm of tumor cells from 18 of 18 myxoma tissue specimens examined. Two different myxoma cell lines were established and constitutively secreted large amounts of VEGF as determined by enzyme-linked immunosorbent assay. The expression of VEGF, VEGFR-1, and VEGFR-2 mRNA was detected in both cell lines by reverse-transcriptase polymerase chain reaction. Myxoma cell proliferation, as determined by thymidine incorporation, was enhanced by the addition of VEGF in a dose-dependent manner, and cell proliferation was inhibited in a dose-dependent manner by the addition of a neutralizing VEGF antibody. CONCLUSIONS: These results indicate that cardiac myxoma cells possess a VEGF-autocrine system, which could contribute to the malignant potential of histologically benign myxomas through direct stimulation of tumor cell growth as well as through induction of angiogenesis.

Osteopontin deficiency protects joints against destruction in anti-type II collagen antibody-induced arthritis in mice.

Rheumatoid arthritis is one of the most critical diseases that impair the quality of life of patients, but its pathogenesis has not yet been fully understood. Osteopontin (OPN) is an extracellular matrix protein containing Arg-Gly-Asp (RGD) sequence, which interacts with alpha(v)beta3 integrins, promotes cell attachment, and cell migration and is expressed in both synovial cells and chondrocytes in rheumatoid arthritis; however, its functional relationship to arthritis has not been known. Therefore, we investigated the roles of OPN in the pathogenesis of inflammatory process in a rheumatoid arthritis model induced by a mixture of anti-type II collagen mAbs and lipopolysaccharide (mAbs/LPS). mAbs/LPS injection induced OPN expression in synovia as well as cartilage, and this expression was associated with joint swelling, destruction of the surface structures of the joint based on scanning electron microscopy, and loss of toluidine blue-positive proteoglycan content in the articular cartilage in wild-type mice. In contrast, OPN deficiency prevented the mice from such surface destruction, loss of proteoglycan in the articular joint cartilage, and swelling of the joints even when the mice were subjected to mAbs/LPS injection. Furthermore, mAbs/LPS injection in wild-type mice enhanced the levels of CD31-positive vessels in synovia and terminal deoxynucleotidyltransferase-mediated UTP end labeling-positive chondrocytes in the articular cartilage, whereas such angiogenesis as well as chondrocyte apoptosis was suppressed significantly in OPN-deficient mice. These results indicated that OPN plays a critical role in the destruction of joint cartilage in the rheumatoid arthritis model in mice via promotion of angiogenesis and induction of chondrocyte apoptosis.