Critical review of 'Public domain application': a flexible drug approval system in Japan

BACKGROUND

'Public domain application' is a flexible drug approval system in Japan, similar to the fast track designation in the United States.

METHODS

From 1999 to 2009, four drugs and three regimens received approval from `Public domain application'. The data from the review reports were extracted, and the reviewing process was critically re-evaluated.

RESULTS

The study drugs were categorized into three groups according to the sizes of the studies and evidence levels in the original articles that were submitted. Carboplatin was categorized into the first group with a large number of study patients and a high evidence level; the review report had studies with more than 15 000 total patients and 8 phase III studies. The ifosfamide and vinblastine regimen was categorized into the second group, with a low number of study patients and a low evidence level; the review report had studies with less than 1000 total patients and 1 phase III study. Dacarbazine; cytarabine; methotrexate, vinblastine, doxorubicin, and cisplatin; bleomycin, etoposide, and cisplatin; and fludarabine were categorized into the remaining third group, with a moderate number of study patients and evidence level.

CONCLUSIONS

Drugs with various backgrounds, including evidence levels and physicians' experiences, were approved via `Public domain application'. The approvals of most drugs were evaluated to be appropriate.

Optimal prostate-specific antigen screening interval for prostate cancer

BACKGROUND

To identify the optimal interval for repeat prostate-specific antigen (PSA) testing to screen for prostate cancer in healthy adults.

PATIENTS AND METHODS

A retrospective cohort study was conducted on 7332 healthy males without prostate cancer at baseline from 2005 to 2008. Participants underwent annual health checkups including PSA testing at the Center for Preventive Medicine in Japan. Participants with high PSA (≥ 4.0 ng/ml) underwent further examination for prostate cancer. A subgroup analysis was conducted age group (<50 years, ≥ 50 years).

RESULTS

Mean age was 50 years. Mean PSA at baseline was 1.2 ng/ml. In over 50-year group, for those with initial PSA of <1.0, 1.0-1.9, 2.0-2.9, and 3.0-3.9 ng/ml at baseline, the 3-year cumulative incidence of prostate cancer was 0%, 0.1%, 0.3%, and 5.7%, respectively. No prostate cancer was identified in those <50 years, regardless of PSA level.

CONCLUSIONS

If PSA screening is recommended, males >50 years with PSA of 3.0-3.9 ng/ml at baseline should undergo rescreening at 2 years. For men with PSA <3.0 ng/ml, PSA rescreening at intervals of ≥ 3 years is appropriate. PSA screening may not be indicated in males of <50 years of age.

The function of platelet-derived growth factor in the differentiation of mouse tongue striated muscle

OBJECTIVE

To determine the function of platelet-derived growth factor (PDGF) in the final differentiation phase of tongue striated muscle cells.

MATERIALS AND METHODS

We analyzed the expressions of PDGF-A, -B, platelet-derived growth factor receptor (PDGFR)-α, and PDGFR-β in mouse tongues between embryonic days (E) 11 and 15. Furthermore, we examined the effects of human recombinant PDGF-AB and the peptide antagonist for PDGFRs using an organ culture system of mouse embryonic tongue. Mouse tongues at E12 were cultured in BGJb medium containing human recombinant PDGF-AB for 4 days or the peptide antagonist for PDGF receptors for 8 days.

RESULTS

PDGF-A, -B, PDGFR-α, and -β were expressed in the differentiating muscle cells between E11 and 15. The human recombinant PDGF-AB induced increases in the mRNA expressions of myogenin and muscle creatine kinase (MCK) and the number of fast myosin heavy chain (fMHC)-positive cells, markers for the differentiation of muscle cells. On the other hand, the peptide antagonist for PDGFRs induced suppressions in the mRNA expressions of myogenin and MCK, and the number of fMHC-positive cells. Both the PDGF-AB and the antagonist failed to affect the expressions of cell proliferation markers.

CONCLUSION

These results suggest that PDGF functions as a positive regulator in the final differentiation phase of tongue muscle cells in mouse embryos.

P4-20-05: Inflammatory Breast Cancer: Comparison of Epidemiology, Biology, and Prognosis between Japan and the United States, a Hospital-Based Study

Background: Inflammatory breast cancer (IBC) is a challenging disease characterized by low incidence, rapid progression, and poor survival. The epidemiology of IBC has been slow to emerge, given that the rarity of IBC makes large prospective clinical trials difficult. Compared to non-IBC, well-established features of IBC include a younger age of onset and lower frequency of hormone receptor positivity. Higher body mass index (BMI) is a purported risk factor. Previous reports also suggest that IBC is associated with more racial disparities, including incidence and age at diagnosis. The epidemiology of IBC in East Asia, however, has not been investigated. We performed a comparative study of IBC in Japan versus the United States to determine its epidemiologic and clinical features and to evaluate the differences in epidemiological factors between the two countries.

Patients and Method: Patients who visited St. Luke's International hospital (SLIH) in Tokyo, Japan and The University of Texas MD Anderson Cancer Center (MDA) in Texas, USA between 2003 and 2009 were identified. Epidemiological and biological data were collected from electronic medical records. Patient and tumor characteristics were tabulated and stratified by hospital. Kaplan-Meier curves were created for survival estimates and log-rank test was used for cross-group comparisons. Cox proportional-hazard analysis was used to identify a subset of significant prognostic variables that related to overall survival.

Result: 34 patients at SLIH and 531 patients at MDA were identified. Mean age at diagnosis was 52 years old (range, 32–81, SD, 10.8) and 50 years old (range, 22–87, SD, 11.6), respectively (P=0.476). Mean BMI was 22.9 kg/m2 (range, 17.3−30.5, SD 3.3 ) and 31.0 kg/m2 (range, 13.6−88.9, SD, 7.8) respectively (P&lt;0.01). Clinical Staging was not significantly different; Stage IIIB 38.2%, Stage IIIC 26.5%, and Stage IV 32.4% at SLIH versus 48.6%, 23.7%, and 27.3% at MDA (P= 0.167). Estrogen receptor (ER) and progesterone receptor (PR) negative cases were, respectively, 50.0% and 64.7% at SLIH and 50.5% and 64.2% at MDA (ER, P= 0.935; PR, P=0.908). Her-2 over-expression cases were 38.2% at SLIH and 28.6% at MDA (P=0.174). A significant difference in nuclear grade was seen between SLIH and MDA: 20.6% at SLIH were Grade 3 versus 68.7% at MDA (P&lt;0.01). Median overall survival at SLIH was 3.6 years versus 2.3 years at MDA (P=0.570). No prognostic factors were associated with overall survival.

Conclusion: Though IBC at SLIH differed significantly from IBC at MDA by several epidemiologic and biologic factors, there was no significant difference in survival. To define the epidemiological, prognostic, and risk factors of IBC in Japan, as well as in the world, further studies are needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-20-05.

Can the 'head-turning sign' be a clinical marker of Alzheimer's disease?

Aims

To investigate the incidence and severity of the ‘head-turning sign’ (HTS), i.e. turning the head back to the caregiver(s) for help, in patients with various dementias and discuss its clinical specificity in Alzheimer's disease (AD).

Methods

We investigated the incidence and severity of HTS while administering a short cognitive test (the revised Hasegawa Dementia Rating Scale: HDSR) in outpatients with AD [125 patients, including 4 with AD + vascular dementia (VaD)], 8 with amnestic mild cognitive impairment (aMCI), 34 with dementia with Lewy bodies (DLB), 8 with progressive supranuclear palsy (PSP) and 6 with VaD.

Results

Significant differences were found among the 5 disease groups in the incidence and severity of HTS, and HDSR scores. Given the significant differences between AD and DLB in post hoc analyses, patients were dichotomized into AD-related (AD and aMCI) and AD-nonrelated (PSP, DLB and VaD) groups. Both incidence (41 vs. 17%, p = 0.002) and severity of HTS (0.80 ± 1.13 vs. 0.21 ± 0.60, p = 0.001) were significantly higher in the AD-related group, while average age and HDSR scores were comparable between both groups. AD-related disease, female gender and low HDSR score contributed significantly to the occurrence and severity of HTS.

Conclusions

HTS can be a clinical marker of AD and aMCI, and may represent a type of excuse behavior as well as a sign of dependency on and trust in the caregivers.

Onset Patterns and Initial Symptoms of Dementia with Lewy Bodies: Possible Pathophysiological Diversities Deduced from a SPECT Study

Background/Aims

The aim of this study was to investigate onset patterns and initial symptoms in patients with dementia with Lewy bodies (DLB) and their association with SPECT findings.

Methods

We studied 29 probable and 12 possible DLB patients. Onset was defined as ‘acute’ when symptoms (in various combinations) present within a few weeks or ‘chronic’ when a few symptoms present and progress during a longer period of time. Initial symptoms were dichotomized into ‘cognitive’ and ‘non-cognitive’. We conducted voxel-to-voxel statistical analyses of SPECT, and uptake deviations from age-matched controls were depicted with Z-scores.

Results

In acute patients, decreases were more apparent in the bilateral frontal and temporal lobes, whereas chronic patients showed decreases in the bilateral occipital, posterior cingulate and precuneal regions. Differences in the left frontal and left posterior cingulate were significant and those in the left temporal region showed a tendency toward significance. Patients with cognitive symptoms demonstrated more marked decreases in the bilateral temporal, parietal, occipital, cingulate and precuneal regions. Differences in the left parietal area reached significance and the total decreases were larger in patients with cognitive than non-cognitive symptoms, with a trend toward significance.

Conclusions

The multiplicity of onset patterns and initial symptoms may possibly be based on pathophysiological diversities in DLB.

Obsessive-compulsive behavior as a symptom of dementia in progressive supranuclear palsy

AIMS

To describe obsessive-compulsive symptoms (OCS) as under-recognized behavioral and psychological symptoms of dementia of progressive supranuclear palsy (PSP) and to discuss possible mechanisms based on MRI and SPECT findings.

METHODS

We studied 74 PSP patients. OCS are defined as persistent and unreasonable, but non-delusional/hallucinatory, ideas and behaviors. Demography, cognition, the widths of middle cerebellar peduncles (MCP) and the inter-caudate distances (ICD), both corrected by the intracranial size (MCP and ICD ratios), and changes on voxel-based SPECT were compared between the subgroups with and without OCS. Finally, the predicative power of various factors to OCS was investigated.

RESULTS

We observed OCS in 18 patients (24%). They were obsessed with daily trifles and physical symptoms among other things. OCS was not associated with demography or cognitive levels. OCS-positive patients had significantly smaller MCP and ICD ratios and showed marked uptake decreases in the orbitofrontal cortex, caudate and thalamus. Relative uptake increases in the cerebellum, specifically the tonsils, were milder in OCS-positive than -negative patients. A smaller right MCP, a smaller ICD ratio and lower uptake increases in the right cerebellar were the significant predictors of OCS.

CONCLUSIONS

OCS are frequent but under-recognized behavioral and psychological symptoms of dementia in PSP. Dysfunction of the fronto-caudate-thalamus-cerebellum circuit may be involved.

Cytodifferentiation activity of synthetic human enamel sheath protein peptides

BACKGROUND AND OBJECTIVE

Enamel sheath protein (ESP) is involved in the construction of the enamel sheath during tooth development. The 17 kDa ESP is a one-step cleavage product processed by proteolysis from the N-terminal side of sheathlin (ameloblastin/amelin), one of the porcine enamel matrix proteins. Enamel sheath protein exhibits periodontal ligament and cementum regeneration activity in a buccal dehiscence model in dogs, and promotes the cytodifferentiation of cultured human periodontal ligament (HPDL) cells. The aim of this study was to determine the peptide segment on the C-terminal side sequence of the human ESP that possesses a cytodifferentiation activity on cultured HPDL cells.

MATERIAL AND METHODS

The peptides synthesized on the basis of human ESP C-terminal side sequence were tested for their ability to increase the alkaline phosphatase (ALP) and mineralization activity of cultured HPDL cells. The expressions of osteocalcin, osteopontin and bone sialoprotein were measured by semi-quantitative PCR and therefore were determined to be specific indicators of mineralized tissue differentiation.

RESULTS

Multiple synthetic peptides from the human ESP increased the ALP activity and stimulated matrix mineralization in long-term cultures of HPDL cells. Semi-quantitative PCR demonstrated the osteocalcin, osteopontin and bone sialoprotein expressions to increase relative to the control values. The peptide SDKPPKPELPGVDF had the strongest cytodifferentiation activity among all the synthetic peptides tested.

CONCLUSION

A specific peptide sequence derived from the C-terminal side of the human ESP promotes the cytodifferentiation and mineralization activity of HPDL cells in a cell culture system.

Biochemical alterations in the palatal processes in fetuses of biotin-deficient mice

To clarify the role of biotin in palatal formation, we investigated the effects of biotin deficiency on the development of palatal processes in mouse fetuses at midgestation. We also investigated protein expressions in the palatal processes. Pregnant mice were given either a biotin-deficient diet or a biotin-supplemented (control) diet from day 0 of gestation (dg 0). Some dams in the biotin-deficient group were changed to a biotin-supplemented diet on dg 12, 13 or 14. On dg 15, the palatal processes were dissected from these fetuses and their peptides were characterized using two-dimensional electrophoresis and liquid chromatography/tandem mass spectrometry (LC-MS/MS) system. Regarding Trasler's stage for the growth of the palatal processes in mouse fetuses on dg 15, the average stage of palatal development was 5.83 +/- 0.39 in the biotin-supplemented group, 5.39 +/- 0.66 in the dg 13-supplemented group, and 4.64 +/- 0.90 in the biotin-deficient group. The development of the palatal processes significantly increased in relation to the earlier day of biotin supplementation. In a protein analysis of palatal processes by isoelectro focusing (IEF) and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), a 19-kDa spot was confirmed around position at pI 6-7 in the biotin-supplemented group, but this protein was not present in either the biotin-deficient group or the dg 13-supplemented group. From the MS/MS database of peptides, adenosine diphosphate (ADP)-ribosylation factor 2 (arf2) and alpha-crystallin were detected in the mesenchyme of the palatal processes. It is suggested that the expression of these proteins may be downregulated by biotin deficiency, inducing the inhibited development of palatal processes.

Changes in the expression of myosins during postnatal development of masseter muscle in the microphthalmic mouse

In the present study, to elucidate the influences of the deficiency of teeth on the masseter muscle, we analyzed changes in the expression of MyHC isoform mRNAs during postnatal development in mi/mi mice using real-time PCR. By 8 weeks of age, MyHC I had nearly disappeared in the +/+ mice, while it was still present in the mi/mi, and the level of MyHC I mRNA in the mi/mi was 5.1-fold higher than that in the +/+ (p<0.01). The levels of MyHC IIx mRNAs in the mi/mi mice were 41 ~ 55% lower than those in the +/+ at both 3 weeks and 4 weeks of age (p<0.05). No significant difference in the expression of MyHC IIa and IIb mRNAs in the masseter muscle was found between the mi/mi and +/+. From these results, we speculate that the deficiency of teeth affects the masseter muscles during the postnatal development.

Visuospatial dysfunction may be a key in the differentiation between Alzheimer's disease and subcortical cognitive impairment in moderate to severe stages

AIMS

Recent studies have suggested that subcortical cognitive impairment (SubCI) and Alzheimer's disease (AD) can be differentiated by visuospatial tasks. We addressed at what severity stage these differences become apparent and what components in visuospatial processes are subject to impairment.

METHODS

Sixty patients with AD, 22 with vascular cognitive impairment and 63 with extrapyramidal diseases with cognitive impairment were assessed using the revised Hasegawa Dementia Scale (HDSR), clock drawing/reading/matching tests (CDT, CRT, CMT), figure copying (FIG) and Frontal Assessment Battery (FAB). Patients were categorized according to the HDSR scores in order to control for the severity of global cognitive impairment. Raw scores were converted to Z-scores for comparisons.

RESULTS

In the mild stage, results of all measures were comparable between AD and SubCI. In the moderate-severe stage, scores of CDT, CRT, CMT, FIG and FAB were significantly lower in SubCI. The results suggest that (given that global cognition is controlled for) visuo-perception, visuo-construction and semantic-numerical analyses of visual information may be more impaired in SubCI than AD.

CONCLUSIONS

AD and SubCI may be difficult to be differentiated in the mild stages, and the visuospatial cognitive system may be extensively defective in SubCI.

Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series

BACKGROUND AND STUDY AIMS

Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a "short" DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique.

PATIENTS AND METHODS

In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a "short" DBE.

RESULTS

Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso-pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction.

CONCLUSIONS

Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a "short" DBE is effective in patients who have undergone bowel reconstruction.

Effects of basicity and FeO concentration on the retention of 137Cs and 60Co in slag made from non-metallic radioactive wastes

Simulated non-metallic wastes containing 60Co, 137Cs and 152Eu were melted to examine the effects of basicity and FeO concentration on the retention of the radioactive nuclides in a resulting solidified product (Al2O3-CaO-FeO-SiO2 quaternary slag). The retention of 60Co was almost independent of chemical composition of slag. On the other hand, the retention of 137Cs decreased with an increase of the basicity of slag, defined as a ratio of CaO to SiO2 in wt. independent of FeO concentration. Energy dispersive X-ray fluorescence spectroscopic analysis and Mössbauer spectroscopic measurement were also conducted for the solidified product. Mössbauer spectra indicated that Fe2+ ions as well as Ca2+ ions existed as network modifying cations in a silicate network structure of slag. Referring to a structure model of silicate glasses, it is inferred that the retention of 137Cs reflects differences in chemical properties between Ca2+ and Fe2+ in the internetwork region formed by modifying cations and anionic non-bridging oxygen.

PDA usage by Japanese resident physicians is low: a cross-sectional survey

OBJECTIVES

Personal digital assistants (PDAs) are in widespread use by resident physicians in many countries, reaching as high as 95% in some reports. Uses are varied and include clinical decision support and support of evidence-based practice. Utilization by resident doctors in Japan has not been characterized. This study was conducted to determine practice patterns of PDA use by Japanese resident physicians.

METHODS

A nationwide cohort survey study was distributed to all 1070 residency teaching programs in Japan. The survey included questions pertaining to use of PDAs in clinical practice.

RESULTS

1124 surveys were returned (response rate of approximately 75%). 297 (30.7%) respondents reported currently using PDAs, while 971 (86.4%) reported having used a PDA in the past. PDA users were more likely to be male (p <0.05), but no other significant differences were found when examining the following variables: age, training site (university hospital versus community teaching hospital), satisfaction with existing information technology access.

CONCLUSIONS

Use of PDAs among Japanese resident physicians is much lower than their counterparts in other countries. In light of this, further research on patient outcomes in Japan and the impact of PDA usage on patient outcomes is urgently needed. If demonstrated to improve outcomes, barriers to adoption need to be identified and overcome.

The effects of cigarette exposure on rat salivary proteins and salivary glands

OBJECTIVE

Passive smoking is the involuntary inhalation of cigarette smoke (CS) and has an adverse impact on oral health. We examined the effect of CS exposure on saliva and salivary glands (SGs).

METHODS

Cigarette smoke-exposed rats were intermittently housed in an animal chamber with whole-body exposure to CS until killed. Whole saliva was collected before CS exposure (0 day), and 15 and 30 days after the start of CS exposure. Saliva secretion was stimulated by administration of isoproterenol and pilocarpine after anesthesia. SGs were collected on 31 days.

RESULTS

The increase in body weight of the CS-exposed rats was less than that of the control rats. Salivary flow rates did not differ at 0, 15 or 30 days after the start of CS exposure. However, the amylase and peroxidase activities and total protein content in the saliva were significantly lower in 15-day CS-exposed rats than in 15-day control rats. Histological examination of the SGs of CS-exposed rats showed vacuolar degeneration, vasodilation and hyperemia.

CONCLUSION

These results suggest that CS exposure has adverse impacts on salivary composition and SGs, which could aggravate the oral environment.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for T3 and T4 head and neck cancer: Possibility of organ preservation in advanced head and neck cancer

e17020

Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL.

No significant financial relationships to disclose.

[Assessment of rate of infection with agents of bacterial infections in ticks captured on one of the Moscow park terrains]

AIM

To study the rate of infection of ticks captured one of the Moscow park terrains with bacteria (agents of tick borreliosis and anaplasmosis).

MATERIALS AND METHODS

Rates of infection of dried ticks with agents of main tick-borne bacterial infections (tick borreliosis and anaplasmosis) were determined by nested PCR.

RESULTS

In May-June 2006, 76 ticks (40 adult females, 36 adult, males) belonged to Ixodes ricinus species were captured by the method "on flag". Number of ticks on the chosen terrain was 1.77 ticks per km2. 22.4% of ticks (12 females and 5 males) were positive for the agent of tick borreliosis--spirochete Borrelia burgdorferi sensu lato which is pathogenic for humans. The main detected pathogen was Euro-Asian genovariant of B. garinii--7 female and 5 male ticks (70.6% from total number of infected ticks) were infected with it. Five female ticks were infected with genovariant of B. afzelii. One female tick (1.2%) was infected with B. valaisiana.

CONCLUSION

Anaplasma A. phagocytophilum causing human granulocytic anaplasmosis was not detected in captured adult ticks.