Long-term geometric quality assurance of radiation focal point and cone-beam computed tomography for Gamma Knife radiosurgery system

To investigate the geometric accuracy of the radiation focal point (RFP) and cone-beam computed tomography (CBCT) over long-term periods for the ICON Leksell Gamma Knife radiosurgery system. This phantom study utilized the ICON quality assurance tool plus, and the phantom was manually set on the patient position system before the implementation of treatment for patients. The deviation of the RFP position from the unit center point (UCP) and the positions of the four ball bearings (BBs) in the CBCT from the reference position were automatically analyzed. During 544 days, a total of 269 analyses were performed on different days. The mean ± standard deviation (SD) of the deviation between measured RFP and UCP was 0.01 ± 0.03, 0.01 ± 0.03, and -0.01 ± 0.01 mm in the X, Y, and Z directions, respectively. The deviations with offset values after the cobalt-60 source replacement (0.00 ± 0.03, -0.01 ± 0.01, and -0.01 ± 0.01 mm in the X, Y, and Z directions, respectively) were significantly (p = 0.001) smaller than those before the replacement (0.02 ± 0.03, 0.02 ± 0.01, and -0.02 ± 0.01 mm in the X, Y, and Z directions, respectively). The overall mean ± SD of four BBs was -0.03 ± 0.03, -0.01 ± 0.05, and 0.01 ± 0.03 mm in the X, Y, and Z directions, respectively. Geometric positional accuracy was ensured to be within 0.1 mm on most days over a long-term period of more than 500 days.

Curative Radiotherapy for Oropharyngeal Squamous Cell Carcinoma Stratified by p16 Status, According to the Eighth Edition American Joint Committee on Cancer Staging Manual: A Retrospective Study

Background/Aim

The prevalence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing worldwide. This retrospective study aimed to investigate the clinical outcomes of patients with OPSCC undergoing definitive radiotherapy, stratified according to their p16 status.

Patients and Methods

A retrospective analysis was conducted on consecutive patients with OPSCC treated with curative external beam radiotherapy between May 2015 and September 2023. Clinical staging was determined by the eighth edition AJCC staging manual for p16 positive and negative OPSCC. All patients were treated with radiotherapy using a simultaneous integrated boost (SIB) with helical tomotherapy. The fractionation scheme, with or without chemotherapy, for the primary site and nodal lesions consisted of 2 Gy per fraction for a total dose of 70 Gy in 35 fractions over seven weeks.

Results

This study included 76 patients with a median age of 66 years. With a median follow-up time of 32.6 months, the 3-year progression-free survival rate was significantly higher in p16 positive patients compared to p16 negative patients (79.6% vs. 42.5%, p<0.001). Concerning 54 patients with p16-positive tumors, the overall survival rates indicated excellent clinical outcomes for stage I, II, and III with results of 100%, 100%, and 88.1%, respectively.

Conclusion

This retrospective study revealed the clinical outcomes of patients with OPSCC treated with radical radiotherapy, emphasizing the significance of p16 status. While acknowledging the limitations of the retrospective nature of this study, future prospective studies with larger cohorts and extended follow-up periods are needed to enhance evidence quality.

Relationship between hydrogel spacer distribution and dosimetric parameters in linear-accelerator-based stereotactic body radiotherapy for prostate cancer

PURPOSE

To explore the potential of quantitative parameters of the hydrogel spacer distribution as predictors for separating the rectum from the planning target volume (PTV) in linear-accelerator-based stereotactic body radiotherapy (SBRT) for prostate cancer.

METHODS

Fifty-five patients underwent insertion of a hydrogel spacer and were divided into groups 1 and 2 of the PTV separated from and overlapping with the rectum, respectively. Prescribed doses of 36.25-45 Gy in five fractions were delivered to the PTV. The spacer cover ratio (SCR) and hydrogel-implant quality score (HIQS) were calculated.

RESULTS

Dosimetric and quantitative parameters of the hydrogel spacer distribution were compared between the two groups. For PTV, D99% in group 1 (n = 29) was significantly higher than that in group 2 (n = 26), and Dmax , D0.03cc , D1cc , and D10% for the rectum were significantly lower in group 1 than in group 2. The SCR for prostate (89.5 ± 12.2%) in group 1 was significantly higher (p < 0.05) than that in group 2 (74.7 ± 10.3%). In contrast, the HIQS values did not show a significant difference between the groups. An area under the curve of 0.822 (95% confidence interval, 0.708-0.936) for the SCR was obtained with a cutoff of 93.6%, sensitivity of 62.1%, and specificity of 100%.

CONCLUSIONS

The SCR seems promising to predict the separation of the rectum from the PTV in linear-accelerator-based SBRT for prostate cancer.

Hypofractionated Radiotherapy as a Standalone Treatment Modality for Locally Advanced Type B2 Thymoma in an Octogenarian Patient: 45 Gy in 15 Fractions

Thymic epithelial tumors (TETs), particularly type B2 thymomas, are rare neoplasms primarily found in the anterior mediastinum. The current therapeutic approach includes surgery, chemotherapy, and radiotherapy, but there is limited research on radiotherapy as a standalone treatment. This case report aims to elucidate the clinical outcomes of hypofractionated radiotherapy as a standalone treatment for locally advanced type B2 thymoma, offering insights into its potential efficacy and role in clinical practice.

Risk factors for local recurrence of keloids and hypertrophic scars after postoperative electron beam radiotherapy

OBJECTIVE

Keloids and hypertrophic scars are benign fibroproliferative lesions that occur as a result of skin injury. Postoperative radiation therapy is used to reduce the recurrence rate because of the high recurrence rate with surgical treatment alone. This study aimed to identify the risk factors for recurrence after postoperative electron beam radiotherapy.

MATERIALS AND METHODS

Patients with keloid or hypertrophic scars with at least one lesion and who underwent postoperative electron beam radiotherapy at our institution from June 2013 to March 2022 were included in the study, while patients with a follow-up period of fewer than three months were excluded.

RESULTS

A retrospective analysis was performed on 94 lesions in 81 patients. Exactly two years after the treatment, the actuarial local control rate was 86.4%. The chest wall, shoulder, and suprapubic area were identified as high-risk recurrence sites. Compared to other body sites, these sites had significantly lower local control rates (two-year local control rates: 75.5% vs. 95.2%, P = 0.005). After multivariate analysis, treatment site (P = 0.014), male gender (P = 0.019), and younger age (P = 0.029) were revealed to be statistically significant risk factors for local recurrence. Risk factors for keloid recurrence after postoperative electron beam radiotherapy were therefore identified.

CONCLUSION

This result could be used for follow-up and as a determinant for the optimal dose/fractionation of postoperative radiotherapy.

Survival Following Palliative Radiotherapy for Head and Neck Squamous Cell Carcinoma: Examining Treatment Indications in Elderly Patients

Background/Aim

This study investigated the survival outcomes of patients with head and neck squamous cell carcinoma (HNSCC) undergoing palliative radiotherapy, particularly focusing on challenges and factors associated with older age, providing insights into appropriate palliative radiotherapy use in this demographic.

Patients and Methods

A retrospective study was conducted using electronic medical records of 73 patients with HNSCC who were deemed unsuitable for curative therapy. Palliative radiotherapy involved a uniform dose of 30 Gy in 10 fractions. Survival analysis was performed using Kaplan-Meier method, and multivariate analysis identified significant prognostic factors.

Results

The median overall survival was 7.5 months, with no significant difference between age groups. Karnofsky performance status (KPS) >70 correlated with favorable survival. Multivariate analysis confirmed KPS as an independent prognostic factor (hazard ratio=1.949, p=0.031).

Conclusion

The results of this study align with those of previous studies, emphasizing the importance of palliative radiotherapy for HNSCC treatment. Optimal dose fractionation regimens remain undetermined, and tailored approaches that consider factors, such as age and performance status are crucial. Individualized, comprehensive assessments and supportive care measures enhance patient well-being, reflecting palliative care principles.

Dual-energy computed tomography-based iodine concentration as a predictor of histopathological response to preoperative chemoradiotherapy for pancreatic cancer

To explore predictors of the histopathological response to preoperative chemoradiotherapy (CRT) in patients with pancreatic cancer (PC) using dual-energy computed tomography-reconstructed images. This retrospective study divided 40 patients who had undergone preoperative CRT (50-60 Gy in 25 fractions) followed by surgical resection into two groups: the response group (Grades II, III and IV, evaluated from surgical specimens) and the nonresponse group (Grades Ia and Ib). The computed tomography number [in Hounsfield units (HUs)] and iodine concentration (IC) were measured at the locations of the aorta, PC and pancreatic parenchyma (PP) in the contrast-enhanced 4D dual-energy computed tomography images. Logistic regression analysis was performed to identify predictors of histopathological response. Univariate analysis did not reveal a significant relation between any parameter and patient characteristics or dosimetric parameters of the treatment plan. The HU and IC values in PP and the differences in HU and IC between the PP and PC (ΔHU and ΔIC, respectively) were significant predictors for distinguishing the response (n = 24) and nonresponse (n = 16) groups (P < 0.05). The IC in PP and ΔIC had a higher area under curve values [0.797 (95% confidence interval, 0.659-0.935) and 0.789 (0.650-0.928), respectively] than HU in PP and ΔHU [0.734 (0.580-0.889) and 0.721 (0.562-0.881), respectively]. The IC value could potentially be used for predicting the histopathological response in patients who have undergone preoperative CRT.

Intrafractional Diaphragm Variations During Breath-Hold Stereotactic Body Radiotherapy for a Liver Tumor Based on Real-Time Registration Between Kilovoltage Projection Streaming and Digitally Reconstructed Radiograph Images: A Case Report

In liver stereotactic body radiotherapy (SBRT), precise image guidance is paramount, serving as the foundation of this treatment approach. The accuracy of SBRT in liver cancer treatment heavily relies on meticulous imaging techniques. The diaphragm, situated adjacent to the liver, is a crucial anatomical structure susceptible to positional and motion variations, which can potentially impact the accuracy of liver tumor targeting. This study explores the application of real-time kilovoltage projection streaming images (KVPSI) in comparison to digitally reconstructed radiography (DRR) for assessing diaphragm position deviations during breath-hold liver tumor SBRT. A 76-year-old male diagnosed with cholangiocarcinoma underwent breath-hold SBRT using split arc volumetric modulated arc therapy (VMAT), where a full arc was split into six sub-arcs, each spanning 60 degrees. The diaphragm dome positions were continuously monitored through KVPSI during treatment. The intrafractional position deviations of the diaphragm were calculated and analyzed for each split arc. The case report revealed a mean diaphragm dome deviation of 0.47 mm (standard deviation: 4.47 mm) in the entire arc. This pioneering study showcases the feasibility of intrafractional diaphragm position variation assessment using real-time KVPSI during the breath-hold liver tumor VMAT-SBRT. Integrating real-time imaging techniques enhances our comprehension of the intra-breath-hold variations, thereby guiding adaptive treatment strategies and potentially improving treatment outcomes. Clinical validation through further research is essential.

Thirty-day Mortality in Palliative Radiotherapy: A Retrospective Cohort Analysis in a Single Center

Background/Aim

Palliative radiotherapy is a critical component of cancer care aimed at symptom management and enhancing the quality of life of patients with advanced cancer. Balancing symptom relief and potential risks is pivotal in clinical decision-making. This study explored the 30-day mortality (30-DM) rate after palliative radiotherapy in a single-center setting to shed light on potential prognostic factors and safety considerations.

Patients and Methods

This retrospective cohort study included patients who underwent palliative radiotherapy for various indications between March 2020 and February 2023. Data were retrieved from electronic medical records and analyzed according to ethical guidelines. The primary outcome measure was 30-DM rate, and multivariate logistic regression analysis was conducted to identify the independent predictors of 30-DM.

Results

A total of 931 palliative radiotherapy sessions were administered to 601 patients, with a median of one session per patient. The cohort had a median age of 70 years, predominantly men (58%), and featured diverse primary cancer types, with lung cancer being the most prevalent (15.8%). The 30-DM rate was 12.9%. Multivariate analysis identified Karnofsky Performance Status (KPS) as the sole independent prognostic factor significantly associated with 30-DM.

Conclusion

This study provides valuable insights into 30-DM rates following palliative radiotherapy. Future research should focus on prospective multicenter investigations with larger cohorts and comprehensive data collection, ultimately leading to improved risk prediction models for personalized treatment decisions in palliative radiotherapy.

Failure Patterns of Recurrence in Patients With Localized Esthesioneuroblastoma Following Surgery and Adjuvant Radiotherapy Without Elective Nodal Irradiation

BACKGROUND

Esthesioneuroblastoma (ENB), a rare malignancy arising from the olfactory epithelium, poses clinical challenges owing to its propensity for local invasion and recurrence. Its management typically involves surgical resection and adjuvant radiotherapy. However, debate persists regarding the optimal treatment strategy, particularly the use of elective nodal irradiation (ENI). This study aimed to investigate recurrence patterns in patients with localized ENB treated with surgery and adjuvant radiotherapy without ENI.

METHODS

Our retrospective analysis included patients who underwent surgery followed by adjuvant radiotherapy for treatment of ENB between January 2011 and November 2022. Patients with incomplete data or who had received neoadjuvant radiotherapy were excluded. Patient characteristics, radiotherapy data (type, dose, and duration), and follow-up data were collected. Recurrence patterns were evaluated, and overall survival (OS), disease-free survival (DFS), and local control rates were determined using the Kaplan-Meier method.

RESULTS

Twelve patients with ENB (median age, 56 years) were included. Most had stage C disease. The median radiation dose was 60 Gy, and the median treatment duration was six weeks. Only one death was confirmed during the observation period, and the five-year DFS rates were 64.3%. Local control was achieved in 11 patients, with only one experiencing local recurrence. Regional lymph node recurrence occurred in three patients and was successfully managed via neck dissection. The timing of recurrence varied, emphasizing the importance of long-term surveillance.

CONCLUSION

Adjuvant radiotherapy without ENI is a viable treatment option for ENB, resulting in favorable local control and OS outcomes. Regional lymph node metastases were observed but effectively managed via salvage therapy. Prospective studies with larger cohorts are warranted to confirm the effectiveness of this treatment strategy and to define optimal radiotherapy fields.

[A report of five cancer screening rates and the related measures for cancer control in the workplace, surveyed by the Corporate Action to Promote Cancer Control]

OBJECTIVES

Most cancer control measures in the workplace have limited supporting evidence. This study aimed to identify highly effective cancer control measures, based on a survey by the Corporate Action to Promote Cancer Control.

METHODS

The firms and organizations that responded to the web survey were included. The questionnaire comprised five cancer (stomach, lung, colorectal, breast, and cervical) screening rates and their countermeasures to promote cancer control. We conducted a non-hierarchical cluster analysis according to the degree of the measures and compared the screening rates among each group using an analysis of variance. Then, we performed two multiple regression analyses with the mean screening rates for stomach/lung/colorectal cancer and breast/cervical cancer as dependent variables, the implementation of each countermeasure as an independent variable, and the size and industry as control variables.

RESULTS

We obtained responses from 704 firms and organizations. The three groups classified by cluster analysis were defined as active, moderate, and negative. For all cancer screenings, the main effects were significant, and multiple comparisons revealed that the difference between the active and negative groups (ts > 3.30, ps < .01, Hedges' ds > 0.73) and the moderate and negative groups (ts > 3.70, ps < .01, Hedges' ds > 0.88) were significant. For the four cancers other than lung, the difference between the active and moderate groups was not significant (ts < 0.21, ps < .84, Hedges' ds < 0.02), and for lung, the difference was significant, but the effect size was small. The multiple regression analyses revealed that "distribution of colorectal cancer test kits to all subjects" (β = 0.14) was significant for stomach, lung, and colorectal cancer, while "financial supports for cancer screening" (β = 0.24), "screening as part of employment" (β = 0.18), and "careful screening of female subjects" (β = 0.17) were significant for breast and cervical cancer, respectively.

CONCLUSIONS

We identified effective countermeasures for cancer control in the workplace, and these measures will help increase cancer screening rates.

Novel breath-hold liver target stereotactic ablative radiotherapy using the intrafraction diaphragm registration of kilovoltage projection streaming image with digitally reconstructed radiography of the planning computed tomography

Stereotactic ablative radiotherapy (SABR) is an emerging treatment option for patients with primary or metastatic liver tumors, particularly for those who are not eligible for surgery or transplantation. SABR is a high-precision radiation therapy that delivers a high dose of radiation to the tumor while minimizing the dose to the surrounding healthy tissues. However, the accurate targeting of the tumor is a crucial aspect of liver SABR, which requires real-time imaging and tracking of the liver and tumor motion during treatment. One of the motion management strategies for liver SABR is the repeated breath-hold technique, which involves the patient holding their breath multiple times during treatment delivery to reduce the movement of the liver and other organs due to breathing. This technique helps to improve the accuracy of the treatment and reduce the radiation dose to the healthy liver. The current study proposes a novel approach for multiple breath-hold volumetric modulated arc therapy (VMAT) stereotactic ablative radiotherapy for liver tumors, which uses the intrafraction diaphragm registration in real time to improve the accuracy and precision of the treatment. The proposed approach is based on real-time comparison of the diaphragmatic surface location between the digitally reconstructed radiography (DRR) and intrafraction kilovoltage projection streaming images (kV-PSI) having the same beam angles. The image cross-correlation between the DRR and the intrafraction kV-PSI provides a measure of the similarity between the two images and can be used to identify and track the diaphragm position during VMAT delivery. The proposed methodology consists of several steps, including planning CT and treatment planning, reference image reconstruction, and patient positioning and immobilization. The proposed approach has the potential to improve the accuracy and precision of liver cancer VMAT SABR, thereby increasing the efficacy of the treatment and reducing the risk of radiation exposure to surrounding healthy tissues.

Retrospective comparison between definitive stereotactic body radiotherapy and radical surgery for 538 patients with early-stage non-small cell lung cancer in a single institution

Introduction

Survival information for stereotactic body radiotherapy (SBRT) and surgery for stage I non-small cell lung cancer (NSCLC) was examined.

Methods

Stage I NSCLC patients who underwent surgery or SBRT between 2012 and 2016 were retrospectively enrolled in this single-institution study. Using the Kaplan--Meier method and Cox regression model, overall survival (OS) was estimated and compared.

Results

Among 538 enrolled patients, compared to the surgery group (443), the SBRT group (95) had more complications (P = 0.01), worse performance status (P = 0.001), and were older (P < 0.001). Three-year OS was 70.5% post SBRT and 90.1% postsurgery. The 3-year cancer-specific survival (CSS) and disease-free survival (DFS) post SBRT and postsurgery were 92.7% vs. 92.3% and 61.1% vs 79.3%, respectively. Three-year locoregional and distant control rates post SBRT and postsurgery were 85.6% vs. 90.1% and 82.5% vs. 86.4%, respectively. Multivariate analysis using the Cox model, including age, T-stage, CCI, and C/T ratio and treatment, showed the surgery group's OS to be significantly superior to that of the SBRT group (HR of SBRT per surgery: 1.90, 95%CI: 1.12-3.21, P = 0.017). No significant differences were observed in rates of adverse events.

Conclusion

Although OS was better in the surgery group, no differences in CSS existed. This analysis suggests the need for future studies that compare specific radical surgeries and SBRT in a prospective and randomized setting.

Intractable Pleural Effusion After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

Stereotactic ablative radiotherapy (SABR) is an effective and attractive treatment option for patients who are poor surgical candidates. This case report describes a rare but serious complication of intractable pleural effusion after SABR for early-stage lung cancer. The patient was an 89-year-old woman with a medical history of early-stage breast cancer who was treated with partial resection and postoperative radiotherapy of 50 gray (Gy) in 25 fractions. SABR using 55 Gy in four fractions was conducted for lung lesions. The patient developed a pleural effusion that was refractory to conservative management and required multiple interventions, including repeated thoracentesis. This case report emphasizes the importance of monitoring and managing pleural effusion in patients with lung cancer receiving radiotherapy.

Development of Japanese Cancer Intelligence Quotient to Measure Cancer Literacy and Knowledge among Japanese Laypersons

INTRODUCTION

Health literacy has been identified an essential factor in leading a healthy lifestyle. Because some cancer prevention and screening methods have been established, we believe that identifying disadvantaged populations with low literacy regarding cancer is crucial. Thus, in this study, we aim to create a self-administered cancer-specific health literacy scale to be administered to Japanese laypersons.

METHODS

Using definitions from previous studies, we constructed a scale named the Japanese Cancer Intelligence Quotient (JCIQ) for both literacy (JCIQ-L) and knowledge (JCIQ-K) aspects. We generated potential items for both aspects, extracted appropriate ones using two-step online surveys, and compared the JCIQ and cancer-preventive behaviors and cancer-screening intentions, both of which we set as alternative indicators of the right attitude and practice toward cancer by performing a multiple regression analysis from another web survey.

RESULTS

Between April and May 2020, we conducted three-step surveys online. After conducting the two-step surveys for thousands of people, we extracted 12 literacy questions and 22 knowledge questions using factor analysis and the correct answer ratio of every item. In the final investigation of 3,094 people, a multiple regression analysis found that the JCIQ-L and JCIQ-K were significant factors in terms of predicting both behaviors (JCIQ-L:β = 0.07, p < 0.001, JCIQ-K:β = 0.05, p < 0.01) and willingness (JCIQ-L:β = 0.04, p < 0.05, JCIQ-K:β = 0.17, p < 0.001) after adjusting for participant characteristics (e.g., gender, age, income level, employment status).

CONCLUSIONS

We developed the first reliable scale for measuring cancer literacy and knowledge of Japanese laypersons.

Stereotactic radiosurgery ensures an effective and safe long-term control of Koos grade IV vestibular schwannomas: a single-center, retrospective, cohort study

PURPOSE

Stereotactic radiosurgery (SRS) is a standard treatment modality for vestibular schwannomas (VSs). However, there is a paucity of data on tumor control and neurological preservation for larger VSs. We aimed to investigate the long-term effectiveness of SRS for Koos grade IV compared with I-III VSs.

METHODS

We included 452 patients with VSs (50 Koos grade IV and 402 Koos grade I‒III) who were treated with SRS at our institution from 1990 to 2021. Tumor control and functional preservation were calculated using the Kaplan-Meier method and compared between groups with the log-rank test.

RESULTS

The median post-SRS follow-up period was 68 months. Progression-free survival rates were 91% at 5 and 10 years for Koos grade IV VSs, and 95% and 92%, respectively, for Koos grade I‒III VSs (p = 0.278). In Koos grade IV VSs, functional preservation rates of the facial and trigeminal nerves were both 96% at 5 years (both 98% for Koos grade I‒III VSs; facial, p = 0.410; trigeminal, p = 0.107). Hearing preservation rates were 61% at 5 years for Koos grade IV VSs and 78% for Koos grade I-III VSs (p = 0.645). Symptomatic transient tumor expansion was more common with Koos grade IV VSs (8.0% vs. 2.5%, p = 0.034), although all related symptoms diminished in accordance with tumor shrinkage.

CONCLUSION

SRS may contribute to long-term tumor control and adequate neurological preservation in the treatment of Koos grade IV VSs, comparable to those in the treatment of Koos grade I‒III VSs.

The Spontaneous Remission of Recurrent Lymph Node Metastatic Prostate Cancer With Lowering Serum Prostate-Specific Antigen Level

The incidence rate of spontaneous remission of malignant cancer is very low. Reports on spontaneous remission in advanced prostate cancer are extremely limited. Our patient was treated with androgen deprivation therapy, local radiotherapy, and surgical castration at the initial diagnosis. Approximately nine years after treatment, he experienced a rise in serum prostate-specific antigen level and relapse of obturator lymph node adenopathy. Initially, androgen deprivation therapy was reinitiated, which resulted in castration-resistant prostate cancer. Although androgen deprivation therapy was discontinued, spontaneous remission of recurrent lymph node and spontaneous reduction in serum prostate-specific antigen level was seen. There was no sign of radiological recurrence for over eight years without prostate cancer treatment.

Effect of employers' concerns about cancer countermeasures on the implementation of cancer screening and support for balancing cancer treatment and work in small and medium-sized Japanese enterprises

OBJECTIVE

Japan has recently implemented screening and support to balance cancer treatment and work. The present study evaluated whether the interest of employers in small and medium-sized enterprises (SMEs) affects cancer control in the workplace.

METHODS

Cancer preparedness at work was examined by a Japanese life insurance company contracting 370 000 SMEs. The analysis targeted SMEs hiring ≤50 employees whose employer was aged ≥40 years. The endpoints were performing one or more screening for stomach, colon, or lung cancer recommended for both sexes in Japan and implementing three or more supportive measures from the nine systems listed in a questionnaire. Logistic regression analysis was performed to predict these endpoints using other factors.

RESULTS

The survey was completed from January 5 to 28, 2022 and included 5268 eligible companies. Around half were small enterprises with up to five employees. Screenings were performed for stomach (32%), colorectal (27%), and lung (26%) cancers. Sick leave (36%) was the most common support for balancing cancer treatment and work. Logistic regression analysis revealed that employer's concern was a significant predictor of screening (odds ratio [OR] = 3.59, P < .001) and support (OR = 2.55, P < .01) compared with "not concerned at all," along with industry type, annual sales, experience of employees with cancer, and employer's participation in screening.

CONCLUSION

Our findings suggested that employers' interest was a powerful predictor of implementing cancer control in SMEs. Educational intervention targeted toward the employer could play a critical role in improving SMEs.

Effects on annual income changes after radical radiotherapy versus after prostatectomy in patients with localized prostate cancer with a specific employment status: A web-based pilot study

Men with localized prostate cancers are insured for undergoing radical radiotherapy or prostatectomy. However, limited information is available on the influence of cancer treatments on patients’ employment status in Japan. Therefore, in this web-based survey, we aimed to compare the effects of post-treatment changes on the annual income of patients with prostate cancer after undergoing radical radiotherapy and prostatectomy and to identify the risk factors associated with the decrease in annual income. We investigated the clinical characteristics and demographics including pre-treatment working status, self-employment, non-regular employment, working for wage or salary, and joblessness of patients with localized prostate cancer. Multivariable logistic regression was performed to analyze the effects of various factors on the change in the annual income of self-employed and non-regularly employed workers. Seventy-eight eligible patients with localized prostate cancer had undergone radiotherapy, and 128 patients had undergone prostatectomy. Among self-employed and non-regularly employed workers, post-treatment income decline rates in those who underwent radiotherapy were smaller but not significant (12% vs. 42%, P = 0.074). Multivariable logistic regression analysis revealed that initial treatment for prostate cancer was the only significant risk factor for the post-treatment income decline among self-employed and non-regularly employed workers. Radiotherapy was associated with a smaller decrease in income (odds ratio, 0.22; 95% confidence interval, 0.052–0.95; P = 0.042). Our novel results implied the effectiveness of radiotherapy in preventing post-treatment income decline among patients with prostate cancer based on specific employment status: self-employed or non-regularly employed.

Relationship between Consulting for Second Medical Opinions, Radiotherapy, and Satisfaction with Therapy, Analyzed by Structural Equation Modeling: A Web-Based Survey

OBJECTIVE

The radiotherapy utilization rate in Japan is lower than that in other developed countries. This study identified factors associated with the low rate, by conducting an online survey of Japanese cancer survivors.

METHODS

We reviewed the web survey results of Japanese cancer patients. The survey examined the process of choosing treatments and the actual treatment received. We included respondents whose most engaged-in treatment was either radiotherapy or surgery, dividing them into two groups. We used the chi-square test to compare the patients in the both groups for their impression of the therapy, decision-making approach, and decision to seek second medical opinions (SMOs). To assess the relationship between seeking SMOs, being most engaged in radiotherapy, and feeling satisfied, we used the structural equation modeling (SEM) approach.

RESULTS

We included 139 patients in the radiotherapy group and 681 patients in the surgery group. Compared with patients in the surgery group, more patients in the radiotherapy group sought SMOs (19% vs. 28%), shared opinions with their doctor (27% vs. 42%), and were satisfied with their treatment (69% vs. 78%). SEM analysis showed that seeking SMOs contributed to radiotherapy being the most-engaged-in therapy (β = 0.23; P < 0.01), and the treatment contributed to the satisfaction (β = 0.15; P < 0.01).

CONCLUSION

Patients who underwent radiotherapy felt more satisfied with the treatment than patients who underwent surgery. Perceptions about radiotherapy and SMOs may be a reason for the low utilization of radiotherapy in Japan.

Hyponatremia and hypokalemia as risk factors for falls

BACKGROUND/OBJECTIVES

Fall accidents may reduce an individual's quality of life and ability to perform the activities of daily life, and may delay recovery from illness. Consequently, medical institutions need to take measures to prevent falls. There are various risk factors for falls, including advanced age, illness and medication effects. Although hyponatremia and hypokalemia have been reported to increase the rate of falls, how they affect falls is not fully understood.

SUBJECTS/METHODS

We retrospectively examined 2948 patients, ⩾18 years old who had been hospitalized for ⩾3 days at Gifu (Japan) Municipal Hospital between May 2012 and April 2013 to determine the effects of hyponatremia and hypokalemia on the risk of falls. After the patients had been divided into fall and non-fall groups, their data were subjected to univariate and multiple regression analysis to identify significant differences.

RESULTS

The univariate analysis results revealed significant differences between the groups in terms of age (⩾65 years); the presence of hyponatremia, hypokalemia, central nervous system disease, cardiovascular disease and/or peripheral nerve/muscular disease; intake of medications that increase the risk of falls; and increased sedative dosage. The multivariate analysis results revealed significant differences between the groups in terms of the presence of hyponatremia (odds ratio (OR), 1.751; 95% confidence interval (CI), 1.020-3.005), hypokalemia (OR, 2.209; 95% CI, 1.280-3.813), central nervous system disease (OR, 2.492; 95% CI, 1.629-3.814) and/or age ⩾65 years (OR, 2.180; 95% CI, 1.242-3.826).

CONCLUSIONS

The results indicated that the presence of hyponatremia or hypokalemia increases the risk of falls.

Presence of multiple HIV type 1 subtypes among mothers and children in Japan

We collected blood samples from 70 HIV-1-infected pregnant women and 76 babies born to HIV-1-infected women in Japan, from 1989 to 1999. To analyze the genetic diversity of HIV-1 among mothers and children, we sequenced the C2-V3 regions of HIV-1 gp120. Phylogenetic tree analysis of these regions revealed that multiple HIV-1 subtypes, A, B, D, E, and G, were circulating among mothers and children in Japan. Thus, the genetic heterogeneity of HIV-1 among mothers and children in Japan is steadily increasing, although the number of cases remains small. Perhaps the longest term survivor, an 11-year-old child with a vertical HIV-1 subtype G infection in Japan, is one of our subjects.

Bax-induced apoptosis not demonstrated in the congenital toxoplasmosis in mice

A prominent neuropathological change observed in a murine model of congenital toxoplasmosis is cerebral cortical hypoplasia. In the early embryonic life of toxoplasmosis mice, the number of apoptotic cell observed in cerebral cortex is increased, indicating that increased number of apoptotic cells might relate to the pathogenetic mechanism of the cortical hypoplasia. Immunohistochemical expression of apoptosis-related factors, Bcl-2 and Bax has been studied in fetal murine brains infected with toxoplasma and in controls. Paraffin sections of the fetal brains on embryonic day (ED) 10, 12, 14, 16 and 18 were applied for the immunostains of Bcl-2 and Bax. Totally, 47 experimental animals (ED10: n=8, ED12: n=6, ED14: n=12, ED16: n=6, ED18: n=15) and 48 control animals (ED10: n=6, ED12: n=8, ED14: n=9, ED16: n=9, ED18: n=16) were examined. Bcl-2 positive cells were detected on ED10, whereas Bax positive cells appeared on ED14. No difference of Bcl-2 and Bax expression between toxoplasmosis and control groups was detected, suggesting that there is no clear relation between Bax-induced apoptosis and cortical dysplasia in congenital toxoplasmosis.

Herpes zoster in immunocompetent and immunocompromised Japanese children

BACKGROUND

To confirm epidemiological features of herpes zoster among children with or without immunosuppression, herpes zoster patients who had presented to this hospital were retrospectively investigated.

METHODS

Medical records were reviewed for the 92 cases of pediatric herpes zoster patients diagnosed during the period from 1981 to 1998. The age at onset of herpes zoster and of varicella, the interval between varicella and zoster, the dermatomal distribution of herpes zoster and complications were compared between immunocompetent and immunocompromised children.

RESULTS

The mean age at onset of zoster in immunocompetent children was 8.5 +/- 4.0 years and in immunosuppressed children was 9.7 +/- 3.8 years. The age at onset of varicella was significantly lower (1.6 +/- 1.8 years) in immunocompetent than in immunosuppressed children (4.6 +/- 2.7 years). The interval between varicella and zoster was 6.2 +/- 3.2 years in immunocompetent children. More than 80% of patients with acute leukemia or malignant lymphoma had herpes zoster within 2 years after diagnosis of malignancy. Lesions of herpes zoster were most frequently found in the thoracic nerve regions. Five of 11 zoster patients with cutaneous dissemination, three of five zoster patients having aseptic meningitis and three of four patients complicated facial palsy were children without underlying disease.

CONCLUSIONS

The present study confirmed that varicella in the first year of life was a risk factor in immunocompetent children, as reported previously. Herpes zoster in children without immunosuppression was found not to be as mild as generally accepted.

Neuronal intranuclear hyaline inclusion disease with polyglutamine-immunoreactive inclusions

Neuronal intranuclear hyaline inclusion disease (NIHID) is a group of neurodegenerative disorders characterized by the presence of intranuclear inclusions in neurons (NIs). We report here clinicopathological findings of a 25-year-old female patient who died after 13 years of a clinical course characterized by progressive gait disturbance and movement disorders. Histological examination revealed widespread NIs with neuronal loss in restricted regions; neuronal loss was severe in the subthalamic nucleus, internal pallidum, substantia nigra, Edinger-Westphal nucleus and Purkinje cell layer. Quantification of the NIs combined with a graded evaluation of neuronal loss revealed an overall tendency for more severe neuronal loss to be accompanied by a lower frequency of NIs. A morphological similarity to the nuclear inclusions recently identified in several CAG repeat diseases prompted us to examine the immunolocalization of ubiquitin and expanded polyglutamine stretches, which demonstrated the presence of ubiquitin at the periphery of most NIs. An expanded polyglutamine stretch was seen in the center of limited number of NIs. These findings indicate that abnormal fragments such as expanded polyglutamine regions are incorporated into the inclusion, aggregated in its center, and thereby metabolized by a ubiquitin-dependent proteolytic pathway. Although it remains to be elucidated how the formation of NIs is related to neuronal degeneration, our findings suggest that NIs are formed in the process of sequestering or degrading abnormal protein fragments and formation of NIs may not be immediately toxic to neurons.

Vertical infection of human immunodeficiency virus as an imported infectious disease

BACKGROUND AND METHODS

In Japan, 26 children who vertically acquired human immunodeficiency virus (HIV) infection had been reported as at February 1997. Little information was published about their epidemiological backgrounds and the rate of perinatal HIV transmission in Japan remains unknown. To learn the epidemiological features of perinatal HIV infection in Japan, we examined the medical records of five perinatally infected children.

RESULTS

Three of five mothers were Japanese and two others were South East Asian. Four of them acquired HIV infection abroad and one became infected through her spouse who had acquired infection abroad. Therefore, HIV infection in these five cases can be regarded as an imported infectious disease. None of the five mothers noticed their HIV infection before their pregnancy. One mother was found to be HIV seropositive during her pregnancy, but the others did not notice their HIV infection until their delivery.

CONCLUSIONS

To reduce the incidence of perinatally HIV-infected children it is necessary to lower the incidence of mother-to-infant HIV transmission. In Western countries they have succeeded in reducing the risk for perinatal HIV transmission with perinatal zidovudine therapy. To prescribe the preventive therapy against perinatal HIV transmission, it is essential to know if pregnant women are infected with HIV or not. Therefore, women of childbearing age should accept voluntary prenatal HIV testing. At the same time, they should be offered such programs that can enable them to receive timely counseling, besides medical treatment, if they are found to be HIV infected.

High incidence of breakthrough varicella observed in healthy Japanese children immunized with live attenuated varicella vaccine (Oka strain)

In order to know the rate of occurrence of varicella among vaccinees (breakthrough varicella: BV), questionnaire postcards were sent to 593 healthy children who had received varicella vaccine (Oka strain) from March 1987 to December 1989. The questionnaire survey was repeated once a year until January 1996. The annual attack rate from the 1st to 3rd questionnaire was approximately 12%: however, from the 5th to 8th one it was 1-4%. To February 1996, the cumulative attack rate was 157/459 (34.2%). This rate was comparable to that among vaccinees who had confirmed seroconversion; namely, 51/132 (38.6%). These rates are much higher than those reported by other authors. All BV cases were clinically mild; even subjects who had received the vaccine 7 years prior to the disease showed mild symptoms. The high incidence may be partly explained by the regional epidemiology of varicella. The decrease in annual incidence with time after vaccination may be due to the following reasons: some vaccinees remained free from BV owing to reinforcement of their immunity from subclinical infection of varicella-zoster virus (VZV) and others from diminution of opportunity for exposure to VZV with increasing age. Varicella vaccine seems to be effective in modifying the symptoms of varicella, but not potent enough in protecting from VZV infection.

[Varicella in adulthood: clinical features, severity scores, source of infection and complications]

Varicella has been thought to be one of the representative infectious disease in childhood, but recently we are under the impression that adults contracting varicella are increasing in number. On the other hand, they say that varicella generally causes a serious illness in adult patients. So we investigated signs and symptoms of varicella, source of infection, occupations of adult patients, except those who were immunologically compromised, by means of medical records, to know the characteristics of varicella in adulthood. According to the varicella severity score proposed by Nagai et al., varicella in the hospitalized adult patient was found to be much severer than that in children. The most remarkable symptoms, were high fever and sore throat, and these were the main reason of hospitalization in most of our patients. Although severity scores were very high in admitted adult patients with varicella, their clinical courses were not serious, and most of them recovered with only supportive therapy. These patients rarely suffered from complications, like pneumonia. If adult patients with varicella hospitalized in the early stage and received supportive care, they could recover without any complications. In most cases of adult varicella the source of infection was unknown. In the case of married persons, however, many of them were infected through their child. When adults contract varicella, not only the patients themselves suffer from high fever and sore throat, but also they act as the source of infection, if they are medical care workers. Furthermore, in public, the contraction of varicella results a socioeconomic loss from suspension of business caused by the illness. Prophylaxis with varicella vaccine, therefore, should be considered, when there are people who have never contracted varicella, whether or not they are medical staff.

Use of recombinant tissue-type plasminogen activator to treat massive pulmonary embolism after cesarean section: a case report

A 30-year-old primigravida, delivering by cesarean section, went into shock with cardiac arrest due to pulmonary thromboembolism. Thrombolytic therapy with recombinant-tissue-type plasminogen activator (rt-PA) induced a rapid improvement in both the hemodynamic and respiratory conditions. This case shows the marked efficacy of rt-PA in treating massive pulmonary thromboembolism. Close attention must be given to the patient in such a case, however, because the risk of hemorrhagic complication exists.

Pathomechanism of cerebral hypoplasia in experimental toxoplasmosis in murine fetuses

In order to elucidate the pathological mechanism of cerebral hypoplasia in congenital toxoplasmosis, fetal toxoplasmosis was induced by intraperitoneal injection of Toxoplasma gondii into five pregnant mice on embryonal Day 5 (E5). The maternal and fetal brains were examined histologically and immunohistochemically; six fetuses were examined on E16 and 21 on E18. T. gondii organisms were immunohistochemically detected in the maternal brains, placentas and the ventricular zone of the fetal cerebrum. In none of the fetal brains was any gross deformity observed, except for cerebral hypoplasia. On E16 and E18, the cerebral cortices were seen to consist of immature laminations, and the cells had less cytoplasm and rounder hyperchromatic nuclei than those in the control mice. The cerebral walls and the cortical layers, except in the ventricular zone, were thinner than in the controls (P < 0.01 in each case). On E18, the proliferating cell nuclear antigen immunolabeling index was higher, and the cytoplasm of more cells in the cortical plate was immunoreactive with anti-beta-tubulin antibody compared with control mice. Using an in situ end-labeling technique, apoptotic cells were not observed in the cortices in mice of both groups. It is suggested that the cerebral hypoplasia following Toxoplasma infection is related to delayed maturation.

Immunohistochemical distribution of surfactant apoproteins in hypoplastic lungs of nonimmunologic hydrops fetalis

Forty-three patients with nonimmunologic hydrops fetalis (NIHF), including 32 patients (74%) with hypoplastic lung, were immunohistochemically examined for the expression of surfactant apolipoproteins (SPs), using anti-gamma G immunoglobulins against human SP-A with a molecular weight (MW) of 35 K and SP-B with a MW of 5 K compared with that in 59 patients in a control group and 45 patients with hypoplastic lung induced by causes other than NIHF. In the control group, SP-A was expressed in the lungs from 23 gestational weeks and became more numerous and intense in alveolar type II cells after 31 gestational weeks, whereas SP-B began to be expressed from 20 gestational weeks, and almost all patients showed a diffuse positivity after 26 gestational weeks. In the NIHF group, SP-A expression was generally weak, even after 31 gestation weeks. Moreover, most of the patients showing a weak expression of SP-A were also associated with hypoplastic lung and had a clinical history of persistent intrauterine pleural effusion of more than 2 weeks. Conversely, the immunoreactivity of SP-B was well preserved in NIHF cases either with or without hypoplastic lung. These results suggest that in the NIHF lung, there is a possible delay in the functional maturation or development of SP-A synthesis by alveolar type II cells, and this retardation of the functional maturation in type II cells also participates in the postnatal respiratory insufficiency in NIHF.

[Medical care of AIDS patients by hospitals in Tokyo]

An anonymous questionnaire survey was performed in 1991 in all 749 hospitals in Tokyo, by the Tokyo Metropolitan Government's Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Infection Research Team, to collect information relating to hospital services for persons with AIDS or HIV infection. The response rate was 61%. The following results were obtained: 1) Sixty-five hospitals (14%) had seen persons with AIDS or HIV infection. Hospitals with a greater number of beds had more experience in seeing persons with AIDS or HIV infection. Thirty-four hospitals (7%) provided outpatient services for patients with AIDS or HIV infection, and 30 hospitals (7%) had the facilities for inpatients. Three hundred forty-seven hospitals (78%) were capable of HIV antibody tests. Ninety-one hospitals (20%) had organized training courses for hospital workers to prevent HIV infection. Two hundred eight hospitals (46%) expressed preference that persons with AIDS or HIV infection be treated at public (non-private) hospitals. 2) The results of multivariate logistic regression analysis indicated that a hospital's acceptance of persons with AIDS or HIV infection for diagnosis or treatment was significantly related to past experience in seeing persons with AIDS or HIV infection, availability of an examination room that protects privacy of patients, presence of a department of internal medicine, and awareness of the availability of special AIDS counselor dispatch services by the Tokyo metropolitan government.

Peculiar eosinophilic inclusions within astrocytes in a patient with malformed brain

At autopsy, we observed eosinophilic inclusions within the astrocytic cytoplasm in areas of polymicrogyria and heterotopic gray matter in a 17-year-old female with severe mental retardation and physical handicaps who had died of respiratory failure. The inclusions stained with acid fuchsin, azocarmine, Holzer's stain and phosphotungstic acid hematoxylin (PTAH). They reacted with anti-S-100 protein antibody. The cytoplasm of the astrocytes containing the inclusions reacted with antibody to GFAP. The inclusions were amorphous masses that consisted of aggregated clusters of osmiophilic coarse granules about 30 nm in diameter. Some rough endoplasmic reticulum was observed on the inside and outside of the inclusions and in the cytoplasm of the astrocytes lacking such inclusions. We suggest that these inclusions resulted from an abnormality at or near the rough endoplasmic reticulum.

Immunohistochemistry of neuronal inclusions in the cerebral cortex and brain-stem in Lewy body disease

Three cases of Lewy body disease were investigated in order to compare the morphological and immunohistochemical characteristics of the neuronal inclusions in the cerebral cortex (CC) and brain-stem (BS). Ultrastructurally, the CC contained intermediate-sized filaments with variable amounts of granular material and other organelles, whereas the BS consisted of an electron-dense core and an outer area with radially oriented filaments. The cerebral cortex was immuno-reactive with antibodies against tyrosine hydroxylase (TH) and tau protein, and differed from BS. In addition, although the CC were antigenically similar to BS in their neurofilament (70, 160 and 200 kDa) and ubiquitin contents, the localization of neurofilament immunoreactivity differed between them, being confined positively to the core of CC, but to the periphery of the BS. Although Lewy bodies (LB) in idiopathic Parkinson's disease are morphologically similar to BS, they have been reported to differ in their immunoreactivity with antibodies against tau. It has been reported that CC differ from LB with regard to immunoreactivity with antibodies against TH and tropomyosin. It is inferred that these inclusions (CC, BS and LB) differ in morphogenesis.

[Cerebral malformations associated with probable intrauterine infection]

An autopsy case with various cerebral malformations was studied and discussed on the pathogenesis. The patient was a 17-year-old female who developed tonic seizures around the age of 1 month and was treated under a diagnosis of infantile spasms. A CT scanning revealed agenesis of corpus callosum, subtentorial arachnoid cyst and brain atrophy. Neuropathologically multiple malformations were observed in the brain, polymicrogyria, pachygyria, cerebral gray matter heterotopia, partial agenesis of corpus callosum, hypoplasia of cerebellar vermis and arachnoid cyst. The most remarkable finding was chronic inflammation represented by infiltration of lymphocytes and foamy macrophages, fibrosis and vascular hyalinization in the arachnoid membrane as well as in the choroid plexus of the third ventricle. Proliferation of astrocytes with intracytoplasmic eosinophilic inclusions was also found in the areas of polymicrogyria and heterotopia. The infratentorial cyst was walled by scarring cerebellar tissue with a focal inflammation which was probably caused by an encephaloclastic process. The diversity in these cerebral malformations suggests that etiology might be polyphasic in time and infectious in nature during the intrauterine period of cerebral development.

[A case of perinatal transmission of human immunodeficiency virus--diagnosis of HIV infection by culture and PCR]

A child born from a mother with HIV infection was reported. We have followed the patient from 3 month old of age. Her HIV antibody disappeared at 7 month by EIA, and at 10 month by WR. But we confirmed her HIV infection by PCR and HIV culture, repeatedly at those times, PCR and HIV culture are thought to be necessary for sero-negative infants born from mothers positive for HIV antibody.

Efficacy of recombinant human granulocyte colony-stimulating factor on neutropenia in patients with AIDS

The efficacy of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on neutropenia was evaluated in 14 patients with AIDS and AIDS-related complex (ARC). In all patients, including 11 neutropenic patients, 100 or 200 micrograms/m2 of rhG-CSF significantly increased the neutrophil counts. The response was greater in patients with higher neutrophil counts before the treatment, and was also dose-dependent. Although the effect seemed to be less potent, the agent also increased the neutrophil counts even when zidovudine (azidothymidine, AZT) and other myelosuppressive antiviral agents were administered simultaneously. These observations indicate that rhG-CSF may be beneficial in preventing and treating some secondary infections, and will make it easier to continue therapy with antiviral agents in patients with AIDS or ARC.

[Clinical study on norfloxacin in pediatrics]

Pediatric infections were treated with norfloxacin (NFLX), a pyridonecarboxylic acid antibiotic developed by Kyorin Co., Ltd., to investigate its clinical efficacy. 1. Thirteen patients were treated with NFLX. These patients included of 5 with Campylobacter enteritis, 4 with Salmonella enteritis, 3 with dysentery and 1 with acute enteritis. 2. Of 14 pathogens identified, complete eradications were observed with 13 strains and partial eradication was seen in 1 case. Thus, overall eradication rate was 92.9%. 3. These were no symptoms nor abnormal laboratory findings which indicated an occurrence of side effect due to the NFLX treatment.

[Mild varicella observed in children vaccinated with varicella vaccine between 1984 and 1987]

We investigated varicella cases developed in children who received varicella vaccine in the period from October 1984 to March 1987. In this period 463 children were vaccinated and 334 of the vaccines were seronegative before injection. Seroconversion was observed in 276 seronegative vaccinees producing a seroconversion rate of 83.1%. Thirty-five children developed exanthem more than 4 weeks after the vaccination and were diagnosed as varicella. Among them one child was found to be antibody-positive in his preserum and five were seronegative in both their pre- and post-sera. Thus, among the children who were seroconverted by the vaccination only 30 had varicella (the attack rate = 10.9%). No varicella cases were reported, however, among 27 children who first became seropositive after revaccination. When these children were added to the seroconverted ones, the case rate amounted to 9.9% (30/303). The general symptoms of varicella observed in the vaccinated children were mild or extremely mild, so varicella vaccine is reasonably indicated to be efficient and useful although it could no completely protect the vaccinees from natural varicella.

Seroepidemiology of pertussis in the Japanese population

To ascertain just how widely Bordetella pertussis infection occurs in Japan, we assessed the immune level against pertussis in various age-groups in the Japanese population. Using sera mainly obtained from 6- to 75-year old subjects who visited the Tokyo Metropolitan Komagome Hospital, we determined the levels of bacterial agglutinins to Bordetella pertussis, of anti-filamentous hemagglutinin and of anti-pertussis toxin. The bacterial agglutinin titers in the older age-groups seemed to be slightly lower than those in the younger age-groups, but no obvious differences between the older and the younger age-groups were found in the levels of anti-filamentous hemagglutinin and anti-pertussis toxin. The older subjects were assumed to acquire these antibodies through clinical or subclinical natural pertussis infections because, prior to 1951, mass vaccination against pertussis was not practice in Japan. Our results reasonably indicate that Bordetella pertussis widely infests Japan, so that vaccination is inevitably warranted to prevent pertussis epidemics and to lower the pertussis case rates.

[A clinical study on cefteram pivoxil in the field of pediatrics]

Cefteram pivoxil (CFTM-PI, T-2588), a new oral cephem antibiotic of ester type, was evaluated for its safety, efficacy and pharmacokinetics. 1. One child, 4 years of age (18 kg body weight), was administered orally 3 mg/kg after meal. The peak serum level of CFTM was 0.78 microgram/ml after 2 hours, and cumulative urinary excretion rate during the first 6 hours was 15.0%. 2. Clinical studies on CFTM-PI were carried out in 17 pediatric patients; 1 with acute pharyngitis, 2 with acute tonsillitis, 1 each with pertussis, acute bronchitis, 2 with broncho-pneumonia, 4 with scarlatina, 3 with acute otitis media, and 1 each with lymphadenitis, acrobystitis and urinary tract infection. Clinical responses were excellent in 9, good in 6, fair in 1, poor in 1, and the overall clinical efficacy rate was 88.2%. 3. Bacteriological efficacy was investigated with 10 strains of 5 species (Streptococcus pyogenes 4, Streptococcus pneumoniae 2, Haemophilus influenzae 2, Enterococcus and Bacteroides 1) isolated from 9 patients. All strains were eradicated. 4. As to adverse reactions, mild diarrhea was observed in 1 patient. But therapy had to be continued without procedure and the diarrhea disappeared after 6 days. No adverse hematological, renal or hepatic effects were noted.

[A clinical evaluation of cefpodoxime proxetil in pediatrics]

Children with acute infections were treated with cefpodoxime proxetil (CPDX-PR, CS-807), a new oral cephalosporin. 1. A girl of 4 years old, weighing 17 kg, and another girl of 12 years old, weighing 33 kg, were administered orally each 3 mg/kg of CPDX-PR. Blood levels of CPDX reached peaks of 1.39 and 2.26 micrograms/ml at 4 hours-post-dose, and T1/2's were 2.09 and 2.63 hours, respectively. Cumulative urinary recovery rates for 8 hours were 57.3 and 80.9%, respectively. 2. A total of 30 patients was treated with CPDX-PR. These patients included 10 with acute tonsillitis, 6 with acute bronchitis, 5 with bronchopneumonia, 2 with scarlet fever and 2 with urinary tract infections, and one each with acute pneumonia, acute otitis media, acute otitis media plus sweat gland abscess, staphylococcal scalded skin syndrome and acute lymphadenitis. The treatment was effective in 27 cases out of 29 (except one with an unknown response) with a clinical efficacy rate of 93.1%. 3. Bacteriological responses to CPDX-PR were as follows; eradication of pathogen in 7, and unknown in 2 out of 9 cases from whom pathogens had been isolated prior to the treatment. 4. As a side effect, diarrhea was observed in 1 patient, but it was possible to continue the treatment. With regard to laboratory tests, a slight elevation of GOT and slight elevations of GOT and GPT were found in 1 case each.

Comparative restriction endonuclease analysis of varicella-zoster virus clinical isolates

The DNAs of 67 isolates of varicella-zoster virus (VZV) obtained from 31 individuals were compared by restriction endonuclease analysis using BamHI, EcoRI, PstI and SmaI. All of the epidemiologically unrelated 26 isolates could be differentiated using SmaI and another one or two enzymes. However, the DNA cleavage profiles of multiple VZV isolates from the same patient and the isolates from a group of patients who were infected with VZV from the same source were found to be identical to each other, as reported previously. No patients were found who were simultaneously infected with different VZV strains. Moreover, VZV showed no change in DNA fragment profiles after serial passages not only through human embryonic lung cells but also through patients.