Factors involved in body weight loss and its maintenance in morbidly obese inpatients.

BACKGROUND: Body weight loss in patients with obesity improves abnormal glucose tolerance, dyslipidemia and hypertension; however, it is difficult to maintain this loss of body weight. The objective of this study was to examine factors involved in body weight loss and its maintenance in morbidly obese inpatients. METHOD: The subjects were 31 patients (11 males and 20 females) who were admitted to hospital for obesity management. Factors involved in body weight changes during hospitalization and after discharge were examined retrospectively. The mean age was 58.1 ± 13.6 years and body mass index (BMI) was 40.2 ± 10.2 kg/m2. Twenty-four patients were complicated with type 2 diabetes mellitus. Diet therapy was 23.8 ± 3.9 kcal/kg ideal body weight/day. RESULTS: Excess weight loss (EWL) during hospitalization varied from 4.2 to 61.7%. Since EWL was affected by duration of hospital stay, the subjects were divided by the median of EWL per day. The subjects with greater EWL per day had lower body weight, BMI and fat mass on admission in the entire (n = 31), diabetic (n = 24), and non-diabetic subjects (n = 7), respectively. EWL per day was not different between diabetic and non-diabetic subjects. Follow-up data revealed that BMI remained unchanged 3 months after discharge but modestly increased 1 year after discharge, irrespective of EWL per day during hospitalization. In diabetic subjects followed up 1 year after discharge (n = 15), the increase in body weight was smaller than that in non-diabetic subjects (n = 3). CONCLUSION: These results suggest that EWL in morbidly obese inpatients is greater than those with lower baseline BMI and fat mass. The presence of diabetes had no effects on EWL during hospitalization. EWL during hospitalization was not correlated with its maintenance after discharge. Diabetic patients displayed lesser degree of body weight gain after discharge, possibly due to the effects of anti-diabetic medications.

Fibroblast growth factor-23 induces cellular senescence in human mesenchymal stem cells from skeletal muscle.

Although muscle wasting and/or degeneration are prevalent in patients with chronic kidney disease, it remains unknown whether FGF-23 influences muscle homeostasis and regeneration. Mesenchymal stem cells (MSCs) in skeletal muscle are distinct from satellite cells and have a known association with muscle degeneration. In this study we sought to investigate the effects of FGF-23 on MSCs isolated from human skeletal muscle in vitro. The MSCs expressed FGF receptors (1 through 4) and angiotensin-II type 1 receptor, but no traces of the Klotho gene were detected. MSCs and satellite cells were treated with FGF-23 and angiotensin-II for 48 h. Treatment with FGF-23 significantly decreased the number of MSCs compared to controls, while treatment with angiotensin-II did not. FGF-23 and angiotensin-II both left the cell counts of the satellite cells unchanged. The FGF-23-treated MSCs exhibited the senescent phenotype, as judged by senescence-associated ß-galactosidase assay, cell morphology, and increased expression of p53 and p21 in western blot analysis. FGF-23 also significantly altered the gene expression of oxidative stress regulators in the cells. In conclusion, FGF-23 induced premature senescence in MSCs from skeletal muscle via the p53/p21/oxidative-stress pathway. The interaction between the MSCs and FGF-23 may play a key role in the impaired muscle reparative mechanisms of chronic kidney disease.

[Effect of Kiken-Yochi training (KYT) induction on patient safety at the department of radiological technology].

PURPOSE: In this report, we evaluated whether radiological technologists' (RTs') awareness of patient safety would improve and what kind of effects would be seen at the department of radiological technology by introducing KYT [K: kiken (hazard), Y: yochi (prediction), T: (training)]. METHODS: KYT was carried out by ten RTs based on a KYT sheet for the department of radiological technology. To evaluate the effects of KYT, we asked nine questions each to ten participants before and after KYT enforcement with regard to their attitude to patient safety and to operating procedures for working safely. RESULTS: Significant improvements after KYT enforcement were obtained in two items concerning medical safety: It is important for any risk to be considered by more than one person; The interest in preventive measures against medical accident degree conducted now) and one concerning operating procedures (It is necessary to have a nurse assist during testing with the mobile X-ray apparatus) (p<0.05). CONCLUSIONS: Performing KYT resulted in improved awareness of the importance of patient safety. KYT also enabled medical staffers to evaluate objectively whether the medical safety measures currently performed would be effective for patients.

Palatoplasty and growth of the temporal bone mastoid air cells.

OBJECTIVES: The present study was undertaken to analyze the relationship between the method used for manipulation of the levator veli palatini muscle and the area of the mastoid air cells in patients with cleft palate. DESIGN: Retrospective study. PATIENTS: The subjects were 50 patients seen for surgical treatment of cleft palate. INTERVENTIONS: Palatoplasty was carried out using the mucosal flap method in 25 patients and the mucoperiosteal flap method in 25 patients. In the mucosal flap method, the levator veli palatini muscle was overlapped and sutured, followed by posterior movement of the muscle bundle (the posterior relocation group). In the mucoperiosteal flap method (the control group), the mucoperiosteal flap was pushed back, followed by end-to-end suturing of the muscle. The area of the mastoid air cells was measured on X-rays when patients were 5 years old. RESULTS: The mastoid air cell area did not differ significantly between the posterior relocation group (mean, 5.00 cm(2); range, 1.66 to 19.7 cm(2)) and the control group (mean, 5.3 cm(2); range, 2.29 to 15.9 cm(2)). CONCLUSION: No significant growth of mastoid air cells was noted following posterior relocation of the levator veli palatini muscle. Thus, in cases of cleft palate in which significant growth of mastoid air cells is not expected following reconstruction of the levator veli palatini muscle, the results confirm the view that tympanic ventilation tube insertion is the most suitable method for the treatment of otitis media.

[T2 laryngeal cancer study in our department].

Laryngeal cancer is the most common malignant tumor in the head and neck region.Because early detection and treatment are possible, outcomes are relatively good.Many studies have reported on the treatment of laryngeal cancer.Different hospitals have used generally similar treatment regimens.However, factors such as laryngeal preservation and the treatment of choice for patients with T2 laryngeal cancer still differ among hospitals.Survival rates can be increased depending on treatment, sometimes at the cost of losing voice functions that could have been preserved.In our department, we have emphasized curative treatment and the preservation of organs and functions.We have mainly used chemoradiotherapy concurrently with S-1 and nedaplatin for the treatment of T2 laryngeal cancer.We studied 27 patients(23 men and 4 women)with T2 laryngeal cancer, who received first-line therapy in our department from April 2005 through March 2010. Their mean age was 64.1 years(range, 42 to 80).The mean follow-up period was 30.6 months(range, 2 to 60 months).The tumor-nodemetastasis classification was T2N0M0 in 24 patients, T2N1M0 in 1, and T2N2bM0 in 2.In our department, the disease-specific survival rate was 96.3%. The complete response rate was 88.9%, and the laryngeal preservation rate was 92.6%.

[Laryngeal cancer treatment outcomes in our department].

Laryngeal cancer is one of the most common types of head and neck cancer. Numerous studies have reported treatment outcomes, and therapeutic approaches and results are generally well established. However, the widespread use of concurrent chemoradiation therapy(CCRT)has led to differences among hospitals in laryngeal preservation rates in patients with T2 and T3 tumors. CCRT is the mainstay of treatment for laryngeal cancer in our department, given our goals of achieving organ and functional preservation, as well as radical cure. Our regimen for CCRT is comprised of chemotherapy with S-1 plus nedaplatin, concurrently with radiation therapy(SN therapy). We report outcomes obtained from 60 patients with laryngeal cancer who received first-line treatment in our department from April 2005 through March 2010. Cumulative survival rates according to disease stage were as follows: Stage I, 100%; Stage II, 96. 2%; Stage III, 83. 3%; and Stage IV, 48. 8%. The complete response rate after SN therapy was 84. 3%. After excluding patients with T4 tumors, the laryngeal preservation rate was 85. 7%.

[Effects of concurrent chemoradiation therapy in three cases of nasopharyngeal cancer].

Nasopharyngeal cancer has an abundance of lymphatic tissues, and is therefore frequently associated with cervical and distant metastases. Most cases with nasopharyngeal cancer have poorly-differentiated squamous cell carcinomas or undifferentiated carcinomas, for which radiotherapy alone or a combination of radiotherapy and chemotherapy has been reported to be effective. However, under the present circumstances, even if the primary focus is controlled, distant metastases appear early and worsen the treatment outcomes. In this report, we present the results of concurrent chemoradiation therapy(CCRT) administered to three cases of nasopharyngeal cancer at our department. In terms of treatment outcomes, two of the three patients who had undergone CCRT showed no relapse of the primary focus, but distant metastases appeared in early stages and worsened their survival outcomes. Currently in our department, S-1 and nedaplatin have been used as chemotherapy agents at rather high dosages. It may be difficult to control the distant metastases just by strengthening the impact of our regimen. A new treatment modality with novel drugs would be required in the future. Further studies on novel prophylactics and treatment methods for distant metastases are expected.

[Efficacy of concurrent chemoradiotherapy in cases with cervical lymph node metastasis from oropharyngeal or hypopharyngeal cancer].

We reported the efficacy of concurrent chemoradiotherapy(CCRT)for cervical lymph node metastasis in patients with oropharyngeal or hypopharyngeal squamous cell carcinoma. The subjects were 17 patients with oropharyngeal or hypopharyngeal cancer with cervical lymph node metastasis, who underwent CCRT treatment between January 2005 and December 2009. The proportion of patients showing a complete response(CR)was 64. 7%; however, if patients without any residual viable cancer cells in the specimens obtained by neck dissection were also defined as CR, then, 82. 4% achieved CR. Thus, CCRT showed good efficacy without the need for planned neck dissection(PND). The limited recurrence cases and absence of serious complications associated with neck dissection after CCRT suggested that PND is not necessarily required. However, since assessment of cervical lymph nodes after CCRT is difficult, it would be desirable to develop a reliable examination and to study the most suitable examination for detecting the presence/absence of cervical lymph node metastasis.

[A case of hypopharyngeal cancer successfully treated with concurrent S-1, nedaplatin and radiotherapy].

A 68-year-old man was admitted with hoarseness. Laryngofiberscopy showed a tumor that obstructed the posterior hypopharyngeal wall and the larynx, and biopsy revealed well-differentiated squamous cell carcinoma. CT demonstrated bilateral cervical lymph node metastases. The patient was diagnosed as having hypopharyngeal cancer(T4N2cM0)and was treated with concurrent S-1, nedaplatin and radiotherapy(hereafter referred to as SN therapy). CT and endoscopy after primary treatment showed disappearance of the tumor, and the treatment outcome was assessed as complete response(CR). Currently, the patient is being treated with S-1 as adjuvant chemotherapy in the outpatient setting, and no recurrence or metastasis has been observed. These results suggest that SN therapy was effective for advanced hypopharyngeal cancer from the viewpoint of both curative treatment and organ and function preservation.

[Efficacy of concurrent chemoradiotherapy with S-1 plus nedaplatin for hypopharyngeal cancer].

Many reports have been published on the treatment for hypopharyngeal cancer, and the treatment modalities and results have become uniform to some extent. More specifically, reconstruction by means of free jejunal grafts has become widespread, and the results of surgical treatments have stabilized. On the other hand concurrent chemoradiotherapy has been widely performed, and the results from the standpoint of organ and function preservation have revealed the various differences between institutions. In our department, we have been using concurrent chemoradiotherapy for advanced cancer with a view to organ and function preservation. In this article, we report 6 cases with hypopharyngeal cancer treated by concurrent chemoradiotherapy with S-1 plus nedaplatin(SN therapy)in our department between January 2005 and December 2008. The complete response rate after SN therapy was 83. 3%, and the laryngeal preservation rate was 100%.

[Three cases of adenocarcinoma of the head and neck maintaining QOL by administration of docetaxel].

A primary head and neck adenocarcinoma is a comparatively rare disease, and surgical resection has been the first choice for its treatment. In the present study, we performed chemotherapy with weekly administration of docetaxel in 3 cases with unresectable or recurrent adenocarcinoma of the head and neck on an outpatient basis, resulting in long-term maintenance of the patients' QOL. Each case had submandibular gland carcinoma, parotid gland carcinoma, or parathyroid gland carcinoma. Their observation period was 42, 76, or 87 months, respectively. Docetaxel was administered for 18, 19, or 28 courses, respectively. No adverse events of grade 3 or higher were observed. The present results might suggest that it is possible to treat patients with adenocarcinoma in the head and neck without decreasing patients' QOL.

[Efficacy of concomitant therapy with S-1, CDGP, and radiation for laryngeal cancer].

OBJECTIVE: Several clinical trials examining treatment strategies for advanced laryngeal cancer have demonstrated that concurrent chemoradiotherapy is the most effective treatment for improving the patient response to radiotherapy and laryngeal preservation. We evaluated a new regimen of S-1/CDGP(Nedaplatin) with radiotherapy (RT), and established that it represented an effective new treatment option that allowed for the preservation of the larynx. METHODS: A total of 16 patients with stage II to IV laryngeal cancer(excluding T4 stage)who had been treated at our institution from 2001 to 2007 were recruited for the present study. All patients had histologically-confirmed squamous cell carcinomas. RESULTS: The administration of S-1/CDGP/RT led to a complete response (CCR) in all patients with stage II or IV disease, with preservation of the larynx in all of these cases. For patients with stage III disease, 6 (85%) experienced CR, and 1 patient (15%) had a partial response. The laryngeal preservation rate for these patients was 85%. Severe toxicities, i. e., neutropenia, thrombocytopenia, and dermatitis of grade 3, were observed. The overall five-year survival rate was 72%, and the disease specific survival rate was 92%.

[Effectiveness of simultaneous combination therapy using S-1, nedaplatin and radiotherapy for 7 cases of oropharynx cancer].

Various treatments for oropharynx cancer included radiotherapy, arterial injection chemotherapy (as well as combined chemoradiotherapy), combined concurrent chemoradiotherapy, and surgical resection and reconstruction. There are also treatment differences among facilities. Our department has been providing a treatment modality for head and neck malignancies with the aims of functional and morphological preservation with a high cure rate. We herein report the treatment efficacy in 7 cases of oropharynx cancer (6 cases on lateral wall and 1 case on superior wall)treated with S-1, nedaplatin and radiotherapy (SN therapy) at our department between April 2006 and December 2006. The total of 7 cases included 1 case of T1N1M0, 1 of T2N0M0, 2 of T2N2bM0, 1 of T2N2cM0, 1 of T3N2cM0, and 1 case of T4N2cM0. The patients were all male and their ages ranged from 57 to 76 years old, with the average age of 68.4 years. Six of the 7 cases are surviving without cancer through treatment and their functions and morphologies have been preserved. In the 1 case of T4N2cM0, the tumor did not disappear and the patient expired due to the original lesion. Although SN therapy supposedly enables functional and morphological preservation, it is necessary to increase the number of cases and examine the efficacy of SN therapy for oropharynx cancer for functional and morphological preservation and the survival rate.

[Effects of concurrent S-1, nedaplatin/radiation therapy for 5 cases of head and neck cancer with esophageal carcinoma].

It is not rare to observe multiple cancers in cases of head and neck carcinoma. Such cancers are important factors for deciding the therapeutic strategy. Complications of esophageal cancer are particularly frequent in cases of hypopharyngeal cancer in comparison to other head and neck tumors. At our department, for organ and functional preservation, and radical cure, we have used simultaneous therapy instead of separate therapy for head and neck tumors and esophageal cancer. We have been implementing concurrent S-1, nedaplatin/radiation therapy (hereinafter called SN therapy) for cases of advanced cancer of the head and neck, and we applied the same therapy for cases of head and neck carcinoma with esophageal cancer. The subjects comprised 5 cases of head and neck tumors complicated by esophageal cancer for which therapy was conducted at our department between April 2005 and March 2009. The histologic type was squamous cell carcinoma in all of the cases. There were 2 cases of laryngeal cancer (T3N2cM0, T3N0M0) and 3 cases of hypopharyngeal cancer (T3N2cM0, T4N2cM0, T3N2bM0). As a result, 3 out of the 5 cases have remained cancer-free, and the average observation period was 29. 3 months. One case expired due to an unrelated cause as a result of cardiac disease, while in the remaining case, the tumor did not disappear and the patient died due to the disease. It is necessary to continue examining the survival rate by increasing the number of cases.

[Effectiveness of simultaneous combination therapy using S-1 and nedaplatin/radiation (SN therapy) for 4 cases of maxillary cancer].

There are a variety of reports on radiotherapy, combined chemotherapy with radiation (including arterial injection), block resection via surgery, and fractional resection for maxillary cancer, and currently various differences among facilities. In our department, we provide treatment with the aim of preserving the organs and functions in cases of head and neck malignant tumors. We herein report the effectiveness of treatment in 4 cases of maxillary cancer, using S-1, nedaplatin/radiation (SN) therapy at our department from January 2005 to December 2008. The cases comprised 4 patients, including 3 cases of T4N0M0 and 1 case of T2N0M0. All patients were males between 29 to 67 years old, wherein the mean was 52.3 years old. All cases resulted in survival without cancer after the application of the treatment policy of our department, wherein all functions were preserved. It is believed that the performance of SN therapy made it possible to minimize the scope of surgery and preserve the organs and functions. It will be necessary to increase the number of cases in order to examine the effectiveness of the organ and function preservation as well as the survival rate for maxillary cancer after SN therapy.

[Effectiveness of concomitant therapy with S-1, nedaplatin, and radiation for laryngeal cancer].

Laryngeal cancer occurs more frequently in head and neck cancers, so there are a number of reports regarding the treatment results,wherein the therapeutic strategy and results are stable to some extent. However, due to the spread of chemoradiotherapy, there are differences in the larynx preservation rates for T2 and T3 cases, depending on the facility. Our department has been administering chemoradiotherapy for advanced cancer based on the perspective of conserving the organ and the function. We herein report our examination of 20 laryngeal cancer cases receiving concomitant therapy with S-1, Nedaplatin, and radiation (hereinafter, referred to as SN therapy) in our department from April 2005 to December 2008. The resulting complete response (CR) rate for the SN therapy was 82.4%, excluding T4 cases. Due to their refusal of surgery, 2 of 3 cases in which the SN therapy had been administered for T4 cases receiving SN therapy showed CR, wherein the CR rate in all cases after the SN therapy was 80. 0%. The larynx preservation rate after the SN therapy was 94.1%.

[The effectiveness of concomitant radiotherapy with S-1 and nedaplatin for tongue cancer].

The development of reconstructive surgery and the use of free flaps have allowed for a larger dissection range even for advanced tongue cancer, resulting in an improvement of the prognosis. However, both the postoperative swallowing and masticatory function are still considered to have not yet reached a satisfactory level. Accordingly, our department has been administering concurrent chemoradiotherapy (CCRT) for advanced cancer to preserve the organ and the function; there are cases in which even comparatively small tumors are difficult to dissect due to the occurrence site. We have been treating these cases using CCRT as well. We herein report our results of 10 tongue cancer cases in which CCRT with S-1 and Nedaplatin (hereinafter, referred to as SN therapy) was administered in our department from April 2002 to October 2008. The complete response rate of the SN therapy was 60. 0% (6 of 10 examples). The 5-year disease-specific survival rates were 50. 0% for Stage II, 75. 0% for Stage III, and 75. 0% for Stage IV, respectively.

[Two cases of head and neck squamous cell carcinoma in which S-1 administration resulted in long-term sustained QOL].

Palliative treatments are applied for older adult cases that are not indicated for either surgery or potential chemotherapy, as well as in cases with unresectable primary lesions, distant metastases, and serious complications among head and neck cancer cases. There is no established treatment for such cases, and therefore treatment has to be selected on a case-by-case basis. Two cases showing sustained QOL after long administration of S-1 are presented in this paper. The first is an 84-year-old male patient with cancer of the hypopharynx (T3N2aM1, stage IVc). The second is a 70- year-old male patient who had recurrent cancer of the larynx (T1N0M0, stage I) after primary treatment. However, we were unable to perform surgery due to possible complications of severe emphysema. Regulating the dosage and intervals of S-1 enabled the patients in both cases to survive with cancer as outpatients for 2 years and 2 months after the initial visit (1 year and 10 months from the start of the administration of S-1) in the former case and 3 years from the initial visit (2 years and 1 month from the start of the administration of S-1) in the latter case.

[Clinical phase trial of concurrent chemoradiotherapy combined TS-1 and nedaplatin].

We have treated head and neck carcinoma by concurrent chemoradiotherapy combined with 5-fluorouracil (5-FU) and cisplatin (CDDP). However,this chemoradiotherapy could not show an enormous effect in the advanced carcinoma of Stage III and IV. Therefore,we changed the contents of the chemotherapy, i.e., we replaced 5-FU, one of the agents with time dependency, to continuous administration of TS-1 for 2 weeks,also replacing CDDP, one of the agents with dose dependency, to nedaplatin (CDGP) in order to reduce kidney dysfunction. In this concurrent chemoradiotherapy, oral TS-1 was continued for 2 weeks and CDGP was administered on the 4 th day from the start of TS-1. In addition, radiotherapy was performed concurrently. In this way,we performed a phase I clinical trial of concurrent chemoradiotherapy combining TS-1 and nedaplatin (CDGP). As for the incidence of adverse events,grade 3 mucositis due to radiation was observed in two patients. As a result of the phase I clinical trial,we decided the maximum-tolerated dose (MTD) of TS-1 to be 80 mg/m2 (maximum 120 mg/body) and 100 mg/m2 for CDGP, and then determined the recommended dose(RD) of TS-1 as 80 mg/m2 (maximum 120 mg/ body) TS-1 and of CDGP as 9 0 mg/m2 CDGP.