Final report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology, on a fact-finding questionnaire on the status of treatment of hereditary breast and ovarian cancer syndrome in Japan

Hereditary breast and ovarian cancer syndrome (HBOC) is a hereditary tumor that can be definitively diagnosed by detection of germline mutation of the BRCA1 or BRCA2 gene. The HBOC Public Awareness and Management Sub-committee of the Tumor Committee, Japan Society of Obstetrics and Gynecology carried out a fact-finding survey on the status of treatment of HBOC in Japan. The directors of medical specialty teaching facilities were notified of the questionnaire by post, with the request for one respondent per facility. The response period was from 8 July 2014 to 31 March 2015. Of the 678 facilities that were asked to compete the questionnaire, 341 (50.3%) responded. The responses are shown in the respective tables. For questions with free responses, similar answers have been grouped together, and the written answers have been freely translated. Based on these results, the Japan Society of Obstetrics and Gynecology considers that the 14 conditions, including consultations by specialist staff, must be met before risk-reducing salpingo-oophorectomy is carried out

Fabrication of Planar Power Inductor for Embedded Passives in LSI Package for Hundreds Megahertz Switching DC–DC Buck Converter

Recently, research and development of integrated low-voltage dc-dc converter to LSIs has been active. In order to realize such integrated dc power supply, power magnetic devices must be integrated in it. The authors have fabricated planar power inductor embedded in LSI package for hundreds megahertz switching dc-dc buck converter. In this study, two types of planar power inductors have been fabricated: one was spin-sprayed Zn-ferrite thick film magnetic core inductor, and the other was composite magnetic core (Fe-based amorphous/polyimide) inductor. Footprint of the fabricated inductors was 850 x 850 mu m(2), their inductance was about 10 nH, and the quality factor Q was about 20 at 100 MHz. The rating current which depends on the superimposed dc characteristic was at least up to 2 A.ArticleIEEE TRANSACTIONS ON MAGNETICS. 47(10):3204-3207 (2011)journal articl

Fabrication of Planar Power Inductor for Embedded Passives in LSI Package for Hundreds Megahertz Switching DC-DC Buck Converter

Recently, research and development of integrated low-voltage dc-dc converter to LSIs has been active. In order to realize such integrated dc power supply, power magnetic devices must be integrated in it. The authors have fabricated planar power inductor embedded in LSI package for hundreds megahertz switching dc-dc buck converter. In this study, two types of planar power inductors have been fabricated: one was spin-sprayed Zn-ferrite thick film magnetic core inductor, and the other was composite magnetic core (Fe-based amorphous/polyimide) inductor. Footprint of the fabricated inductors was 850 x 850 mu m(2), their inductance was about 10 nH, and the quality factor Q was about 20 at 100 MHz. The rating current which depends on the superimposed dc characteristic was at least up to 2 A.ArticleIEEE TRANSACTIONS ON MAGNETICS. 47(10):3204-3207 (2011)journal articl

Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy

Background: We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. Methods: Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. Results: The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. Conclusions: Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care

Nivolumab Versus Gemcitabine or Pegylated Liposomal Doxorubicin for Patients With Platinum-Resistant Ovarian Cancer: Open-Label, Randomized Trial in Japan (NINJA)

PURPOSE: This phase III, multicenter, randomized, open-label study investigated the efficacy and safety of nivolumab versus chemotherapy (gemcitabine [GEM] or pegylated liposomal doxorubicin [PLD]) in patients with platinum-resistant ovarian cancer. MATERIALS AND METHODS: Eligible patients had platinum-resistant epithelial ovarian cancer, received ≤ 1 regimen after diagnosis of resistance, and had an Eastern Cooperative Oncology Group performance score of ≤ 1. Patients were randomly assigned 1:1 to nivolumab (240 mg once every 2 weeks [as one cycle]) or chemotherapy (GEM 1000 mg/m2 for 30 minutes [once on days 1, 8, and 15] followed by a week's rest [as one cycle], or PLD 50 mg/m2 once every 4 weeks [as one cycle]). The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), overall response rate, duration of response, and safety. RESULTS: Patients (n = 316) were randomly assigned to nivolumab (n = 157) or GEM or PLD (n = 159) between October 2015 and December 2017. Median OS was 10.1 (95% CI, 8.3 to 14.1) and 12.1 (95% CI, 9.3 to 15.3) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.0; 95% CI, 0.8 to 1.3; P = .808). Median PFS was 2.0 (95% CI, 1.9 to 2.2) and 3.8 (95% CI, 3.6 to 4.2) months with nivolumab and GEM or PLD, respectively (hazard ratio, 1.5; 95% CI, 1.2 to 1.9; P = .002). There was no statistical difference in overall response rate between groups (7.6% v 13.2%; odds ratio, 0.6; 95% CI, 0.2 to 1.3; P = .191). Median duration of response was numerically longer with nivolumab than GEM or PLD (18.7 v 7.4 months). Fewer treatment-related adverse events were observed with nivolumab versus GEM or PLD (61.5% v 98.1%), with no additional or new safety risks. CONCLUSION: Although well-tolerated, nivolumab did not improve OS and showed worse PFS compared with GEM or PLD in patients with platinum-resistant ovarian cancer

EGUIDE project and treatment guidelines

Background Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. Aims The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. Method A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. Results All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. Conclusions All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists

Cytologic Assessment of Tumor Grade in Endometrial Cancer : A Comparison of the Cytgologic Scoring System with Fractional Endometrial Curettage

To establish a cytological scoring system for the assessment of tumor grade in endometrial cancer, 11 cytological items were examined in 45 patients with this cancer. Four items (the cluster rate, cluster edges, anisokaryosis, and macronucleoli or irregular nucleoli) were shown to have value for determining the tumor grade, and a scoring system was created using these four items. Tumor grading was then performed in 109 patients with endometrial curettage, and the results were compared with the pathological tumor grade. The diagnostic accuracy of cytological tumor grading was 88% for grade 1, 63% for grade 2, and 82% for grade 3 tumors, with an overall accuracy of 78%. The dianostic accuracy of fractional endometrial curettage was 92% for grade 1, 35% for grade 2, and 59% for grade 3 tumors, with an overall accuracy of 66%. Preoperative investigation of the grade of endometrial cancer by endometrial aspuration cytology provides additional information about tumor differentiation and has potential to replace fractional endmetrial curettage

Identification of a high-risk subgroup in cytology-positive stage iiaA endometrial cancer

OBJECTIVE: To identify a high-risk subgroup among patients with cytology-positive stage IIIA endometrial cancer. STUDY DESIGN: Fifty-four stage IIIA endometrial cancer patients who were positive only on peritoneal cytology were divided into two groups based on the cytologic pattern of their peritoneal smears. In group A, malignant cell clusters had well-defined edges, while the tumor cell clusters had scalloped edges in group B. The prognostic significance of these findings was investigated. RESULTS: The five-year disease-free survival rate was 97.5% in group A (n=3D40) versus 50% in group B (n=3D14). Multivariate analysis confirmed that the cytologic pattern had an independent influence on survival. CONCLUSION: Positive peritoneal cytology composed of malignant cell clusters with well-defined edges has no impact on survival. Only endometrial cancer patients who show tumor cell clusters with scalloped edges in peritoneal smears are worth considering for upstaging