8
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Hwangbo Y, Kang D, Kang M, Kim S, Lee EK, Kim YA, Chang YJ, Choi KS, Jung SY, Woo SM, Ahn JS, Sim SH, Hong YS, Pastor-Barriuso R, Guallar E, Lee ES, Kong SY, Cho J. Incidence of Diabetes After Cancer Development: A Korean National Cohort Study. JAMA Oncol 2019; 4:1099-1105. [PMID: 29879271 DOI: 10.1001/jamaoncol.2018.1684] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Diabetes is an established risk factor for developing cancer. A limited body of evidence also suggests that cancer can increase the risk of developing new cases of diabetes, but the evidence is inconclusive. Objective To evaluate whether the development of cancer is associated with increasing risk of subsequent diabetes. Design, Setting, and Participants This cohort study included a nationally representative sample of the Korean general population observed for up to 10 years (January 1, 2003, to December 31, 2013). A total of 524 089 men and women 20 to 70 years of age without diabetes and with no history of cancer at baseline were included. Exposures Incident cancer (time-varying exposure). Main Outcomes and Measures Incident type 2 diabetes using insurance claim codes. Results During 3 492 935.6 person-years of follow-up (median follow-up, 7.0 years) in 494 189 individuals (50.0% female; mean [SD] age, 41.8 [12.5] years), 15 130 participants developed cancer and 26 610 participants developed diabetes. After adjustment for age, sex, precancer diabetes risk factors, metabolic factors, and comorbidities, the hazard ratio (HR) for diabetes associated with cancer development was 1.35 (95% CI, 1.26-1.45; P < .001). The excess risk for diabetes was highest in the first 2 years after cancer diagnosis, but it remained elevated throughout follow-up. By cancer type, development of pancreatic (HR, 5.15; 95% CI, 3.32-7.99), kidney (HR, 2.06; 95% CI, 1.34-3.16), liver (HR, 1.95; 95% CI, 1.50-2.54), gallbladder (HR, 1.79; 95% CI, 1.08-2.98), lung (HR, 1.74; 95% CI, 1.34-2.24), blood (HR, 1.61; 95% CI, 1.07-2.43), breast (HR, 1.60; 95% CI, 1.27-2.01), stomach (HR, 1.35; 95% CI, 1.16-1.58), and thyroid cancer (HR, 1.33; 95% CI, 1.12-1.59) was associated with a significantly increased risk of diabetes. Conclusions and Relevance In this large Korean cohort, cancer development increased the risk of subsequent diabetes. These data provide evidence that cancer is associated with an increased risk of diabetes in cancer survivors independent of traditional diabetes risk factors. Physicians should remember that patients with cancer develop other clinical problems, such as diabetes, with higher frequency than individuals without cancer, and should consider routine diabetes screening in these patients.
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Affiliation(s)
- Yul Hwangbo
- Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Minwoong Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Saemina Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Kyung Lee
- Division of Endocrinology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Young Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Yoon Jung Chang
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea.,Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Kui Son Choi
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Translational Epidemiology Research Branch, Research Institute, National Cancer Center, Goyang, South Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, National Cancer Center, Goyang, South Korea
| | - Jin Seok Ahn
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Hoon Sim
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yun Soo Hong
- Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roberto Pastor-Barriuso
- National Center for Epidemiology, Instituto de Salud Carlos III, and Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Eliseo Guallar
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eun Sook Lee
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Translational Epidemiology Research Branch, Research Institute, National Cancer Center, Goyang, South Korea.,Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.,Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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10
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Sakamoto K, Imamura T, Kihira K, Suzuki K, Ishida H, Morita H, Kanno M, Mori T, Hiramatsu H, Matsubara K, Terui K, Takahashi Y, Suenobu SI, Hasegawa D, Kosaka Y, Kato K, Moriya-Saito A, Sato A, Kawasaki H, Yumura-Yagi K, Hara J, Hori H, Horibe K. Low Incidence of Osteonecrosis in Childhood Acute Lymphoblastic Leukemia Treated With ALL-97 and ALL-02 Study of Japan Association of Childhood Leukemia Study Group. J Clin Oncol 2018; 36:900-907. [PMID: 29360413 DOI: 10.1200/jco.2017.75.5066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Osteonecrosis (ON) is a serious complication of the treatment of childhood acute lymphoblastic leukemia (ALL); however, data relating to ON in Asian pediatric patients with ALL are scarce. Therefore, we performed a retrospective analysis of cohorts of Japanese patients with ALL to clarify the incidence, clinical characteristics, and risk factors of ON. Patients and Methods The incidence and characteristics of ON were determined in patients with ALL (n = 1,662) enrolled in two studies from the Japan Association of Childhood Leukemia Study (JACLS) group (n = 635 and n = 1,027 patients treated with the ALL-97 and ALL-02 protocols, respectively). Results In total, 24 of 1,662 patients suffered from ON, of which 12 of 635 and 12 of 1,027 patients were treated with the ALL-97 and the ALL-02 protocol, respectively. Of the 24 patients, 23 were older than 10 years. In multivariate analysis, age (≥ 10 years) was the sole significant risk factor for ON ( P < .001). Separate evaluation of patients ≥ 10 years of age indicated a 5-year cumulative incidence of ON of 7.2% (95% CI, 4.0% to 12.6%) and 5.9% (95% CI, 3.3% to 10.4%) in the ALL-97 and the ALL-02 protocol, respectively, which was lower than reported previously, despite an administration of dexamethasone (DEX) similar to that in comparable studies; however, concomitant administration of DEX and l-asparaginase was reduced in the JACLS protocols. Conclusion We identified a low frequency of ON in the JACLS ALL-97 and ALL-02 studies. Although the sole risk factor for ON was age (≥ 10 years), even among high-risk patients, ON incidence was significantly lower than that reported in previous studies. These results suggest that, not only the total amount of DEX, but also how DEX and l-asparaginase are administered, which affects the clearance of DEX, may be associated with ON incidence in patients with ALL.
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Affiliation(s)
- Kenichi Sakamoto
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Imamura
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Kentaro Kihira
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Koji Suzuki
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Hisashi Ishida
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Hiromi Morita
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Miyako Kanno
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Mori
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Hidefumi Hiramatsu
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Kousaku Matsubara
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Kiminori Terui
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Takahashi
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - So-Ichi Suenobu
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Daiichiro Hasegawa
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Yoshiyuki Kosaka
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Koji Kato
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Akiko Moriya-Saito
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Atsushi Sato
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Hirohide Kawasaki
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Keiko Yumura-Yagi
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Junichi Hara
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Hiroki Hori
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
| | - Keizo Horibe
- Kenichi Sakamoto and Toshihiko Imamura, Kyoto Prefectural University of Medicine; Hidefumi Hiramatsu, Kyoto University, Kyoto; Kenichi Sakamoto, Toshihiko Imamura, Akiko Moriya-Saito, and Keizo Horibe, National Hospital Organization Nagoya Medical Center; Koji Kato, Japanese Red Cross Nagoya First Hospital, Nagoya; Kentaro Kihira and Hiroki Hori, Mie University, Mie; Koji Suzuki, University of Fukui Faculty of Medical Sciences, Fukui; Hisashi Ishida, Okayama University, Okayama; Hiromi Morita, University of Occupational and Environmental Health, Iseigaoka; Miyako Kanno, Yamagata University, Yamagata; Takeshi Mori, Kobe University; Kousaku Matsubara, Kobe City Nishi-Kobe Medical Center; Daiichiro Hasegawa and Yoshiyuki Kosaka, Hyogo Prefectural Children's Hospital, Kobe; Kiminori Terui, Hirosaki University, Hirosaki; Yoshihiro Takahashi, Aomori Prefectural Central Hospital, Aomori; So-ichi Suenobu, Oita University, Oita; Atsushi Sato, Miyagi Children's Hospital, Sendai; Hirohide Kawasaki, Kansai Medical University; Keiko Yumura-Yagi, Yumura Clinic; and Junichi Hara, Osaka City General Hospital, Osaka, Japan
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