Successful Treatment with S-1 for Recurrent Breast Cancer with Multiple Bone Metastases and Markedly Improved Quality of Life / 日本農村医学会雑誌

A 69-year-old woman was referred on suspicion of multiple bone metastases. She had undergone modified radical mastectomy for right breast cancer at age 40 years. Positron emission tomography revealed multiple bone metastases, and serum levels of CEA, CA15-3, and NCCST439 were elevated. The diagnosis was metastatic breast cancer. Pathological re-examination confirmed that the tumor cells were positive for estrogen receptor and progesterone receptor, and negative for HER2. Endocrine therapy with letrozole was initiated, followed by toremifene citrate as second-line therapy and exemestane as third-line therapy. Seventeen months later, she developed trouble walking because of lower-extremity edema, which was caused by a synovial cyst of the left hip joint. Although no other metastases were detected, S-1 was introduced (2 weeks followed by 1 week of rest) due to severe decline in quality of life. Six months after initiation of S-1, the synovial cyst disappeared and lower-extremity edema was improved. At 11 months after initiation of S-1, serum CA15-3 level had fallen to approximately within normal limits. As of now, although the tumor marker level has been rising gradually, no other metastases except for bone metastases have been detected and treatment is continuing.

Tacrolimus for ulcerative colitis in children: a multicenter survey in Japan

BACKGROUND/AIMS: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.METHODS: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.RESULTS: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.CONCLUSIONS: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.

Factors contribute to efficiency of specimen concentration of Mycobacterium tuberculosis by centrifugation and magnetic beads

A concentration of specimen is recommended for the effective recovery of Mycobacterium tuberculosis [MTB], but the bacteriological efficiency is not well evaluated. The present study evaluated the factors contributing to concentration efficiency of centrifugation and bead-based technique [TB-Beads; Microsens, UK] to recover MTB by using simple in vitro specimens. Four specimens were prepared [6.5 × 103; 8.1 × 104; 7.9 × 105; and 6.4 × 106 cfu/mL] of different concentrations with or without 5 × 104 of THP-1 cells [RIKEN BRC, Japan]. Specimens were subjected to centrifugation at 2000, 3000, and 4000g for 15 min, and to TB-Beads. The concentration and recovery rate were calculated to evaluate the efficiency of each method. The specimens containing a higher number of bacteria and THP-1 cells had a tendency to yield a higher concentration and recovery rate [p = 0.001-0.083]. MTB was recovered more efficiently with THP-1 cells from the 6.5 × 103 cfu/mL specimen by centrifugation [p= 0.001] than without them; 24.7-54.4% of MTB were recovered with THP-1 cells by centrifugation at 3000g for 15 min, while the recovery using TB-Beads was a maximum of 12.7%. The efficiency of centrifugation depends on the bacterial density and the co-existence of THP-1 cells. The efficiency of TB-Beads was not as high as centrifugation

Public Health Insurance in Vietnam towards Universal Coverage: Identifying the challenges, issues, and problems in its design and organisational practices / 国際保健医療

  In recent years, many low- and middle-income countries are experiencing public health reforms, and Vietnam is one of those leading countries moving towards universal health coverage. Nevertheless, the government is currently facing challenges in sustaining health finance and reaching the entire population due to issues surrounding the design of the scheme and organisational practice. <BR><b>Objectives</b><BR>  This paper has two objectives. The first objective is to summarise the history of the health insurance scheme and its design by collecting information from official documents in order to provide up-to-date information for a better understanding of the Vietnamese health system. The second objective is to review existing reports and related literature to identify the challenges and problems arising from the design of the health insurance system including premiums, benefit packages and payment rules, and organisational practices such as health service delivery.<BR><b>Method</b><BR>  To collect information, decrees and laws as well as existing documents and reports by Vietnamese government agencies and related literature are thoroughly reviewed.<BR><b>Results</b><BR>  We found that the government needs major revision of premiums and subsidies in terms of complexity of the design such as subdivided premiums for different statuses and large subsidies that could lead to unsustainable health finance. Also, hidden distorted incentives of health service providers such as unnecessary expensive technologically advanced medical treatment and inappropriate prescription of drugs are challenges. These embezzlements have increased both OOP payment and the financial burden on the health insurance budget.

Upregulation of epidermal growth factor receptor 4 in oral leukoplakia / 国际口腔科学杂志·英文版

In the present study, we investigate the expression profile of the epidermal growth factor receptor family, which comprises EGFR/ErbB1, HER2/ErbB2, HER3/ErbB3 and HER4/ErbB4 in oral leukoplakia (LP). The expression of four epidermal growth factor receptor (EGFR) family genes and their ligands were measured in LP tissues from 14 patients and compared with levels in 10 patients with oral lichen planus (OLP) and normal oral mucosa (NOM) from 14 healthy donors by real-time polymerase chain reaction (PCR) and immunohistochemistry. Synchronous mRNA coexpression of ErbB1, ErbB2, ErbB3 and ErbB4 was detected in LP lesions. Out of the receptors, only ErbB4 mRNA and protein was more highly expressed in LP compared with NOM tissues. These were strongly expressed by epithelial keratinocytes in LP lesions, as shown by immunohistochemistry. Regarding the ligands, the mRNA of Neuregulin2 and 4 were more highly expressed in OLP compared with NOM tissues. Therefore, enhanced ErbB4 on the keratinocytes and synchronous modulation of EGFR family genes may contribute to the pathogenesis and carcinogenesis of LP.

Somatoform Disorders among Patients Who Visit Kampo Clinic / 日本東洋医学雑誌

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.<br>One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.<br>Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).<br>Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.