Ventriculoperitoneal Shunt Outcomes among Infants

Ventriculoperitoneal shunts (VPSs) are used for the treatment of hydrocephalus. Here we analyzed the outcomes of VPS placements in 24 infants to determine the risk factors for shunt failure. The infants had undergone the initial VPS operation in our hospital between March 2005 and December 2013. They were observed until the end of January 2014. We obtained Kaplan-Meier curves and performed a multivariate Cox regression analysis of shunt failure. Of the 24 cases, the median (range) values for gestational age, birth weight, and birth head circumference (HC) were 37 (27-39) wks, 2,736 (686-3,788) g, and 35.3 (23.0-45.3) cm, respectively. The total number of shunt procedures was 45. Shunt failure rates were 0.51/shunt and 0.0053/shunt/year. Shunt infection rates were 0.13/shunt and 0.0014/shunt/year. The Kaplan-Meier analysis revealed an increased risk for shunt failure in infants ＜1 month old or in the HC ＞90ｵtile. The Cox regression analysis yielded hazard ratios (HRs) of 2.93 (95ｵ confidence interval (CI), 0.96-10.95, p＝0.059) for age ＜1 month, and 4.46 (95ｵCI:1.20-28.91,p＝0.023) for the HC ＞90ｵtile. The multivariate Cox regression analysis showed adjusted HRs of 17.56 (95ｵCI:2.69-202.8, p＝0.001) for age ＜1 month, and 2.95 (95ｵCI:0.52-24.84, p＝0.228) for the HC ＞90ｵtile. Our findings thus revealed that the risk factors for shunt failure in infants include age ＜1 month at the initial VPS placement

Changes in the Features of Invasive Pneumococcal Disease after Introduction of the Seven-valent Pneumococcal Conjugate Vaccine in a Regional Core Hospital of Kochi, Japan

Since the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in 2007, invasive pneumococcal disease has declined, but the incidence of Streptococcus pneumoniae serotype 19A has risen worldwide. The present study examined changes in the features of invasive pneumococcal disease since the introduction of the PCV7 in Kochi, Japan. Pediatric cases of invasive pneumococcal disease were investigated before and after vaccine introduction (January 2008 to December 2013). Cases of invasive pneumococcal disease tended to decrease after PCV7 introduction. In addition, before introduction of the vaccine, most serotypes causing invasive pneumococcal disease were those included in the vaccine. However, after the introduction, we found cases infected by serotypes not covered by vaccine. Penicillin-resistant S. pneumoniae was the predominant serotype causing invasive pneumococcal disease before introduction of the PCV7, and the susceptibility of this serotype to antibiotics improved after vaccine introduction. Serotype isolates identified after vaccine introduction were also relatively susceptible to antibiotic therapy, but decreased susceptibility is expected

Translation and validation of a Japanese version of the irritable bowel syndrome-quality of life measure (IBS-QOL-J)

AIMS: To compare quality of life (QOL) for patients with irritable bowel syndrome (IBS) between the U.S. and Japan, it is indispensable to develop common instruments. The IBS-QOL, which is widely used in Western countries, was translated into Japanese as there has been a lack of Japanese disease-specific QOL measures for IBS. METHODS: The original 34 items of the IBS-QOL were translated from English into Japanese through two independent forward translations, resolution, back translation, and resolution of differences. Forty nine patients who had GI symptoms but did not have any organic diseases (including 30 IBS patients diagnosed by Rome II criteria) were recruited from Tohoku University Hospital in Sendai, Japan and completed a Japanese version of the IBS-QOL (IBS-QOL-J) concomitant with a Japanese version of the IBS severity index (IBSSI-J) twice within 7–14 days. RESULTS: The IBS-QOL-J demonstrated high internal consistency (Cronbach's alpha; 0.96) and high reproducibility (intraclass correlation coefficient; 0.92, p < 0.001). Convergent analyses confirmed that the overall score of IBS-QOL-J was significantly correlated with overall severity of IBS symptoms on the IBSSI-J (r = -0.36, p = 0.01) and with the individual items on the IBSSI-J that assess interference with life in general (r = -0.47, p = 0.001) and dissatisfaction with bowel habits (r = -0.32, p < 0.05). Eight patients who reported continuous abdominal pain in the past 6 months had significantly lower scores in the IBS-QOL-J than those who did not (53.7 +- 12.7 vs. 73.6 +- 19.5, p < 0.01). Age, sex, education or marital status did not affect scores on the measure. CONCLUSION: The IBS-QOL-J is a reliable instrument to assess the disease-specific QOL for IBS. Considering cross-cultural comparison, this measure is likely to be a valuable tool to investigate the QOL in Japanese patients with IBS

Two Relapsed Stage III Childhood Anaplastic Large Cell Lymphoma Patients with NPM-ALK Fusion in Bone Marrow from Initial Diagnosis

Childhood anaplastic large cell lymphoma (ALCL) accounts for approx. 10–30 of cases of non-Hodgkin lymphoma, and the ALCL99 study reported 60–75 disease-free survival; however, a relatively high relapse rate was observed (25–30 ). We report 2 patients with Stage III ALCL who relapsed 6–18 months after the end of ALCL99 chemotherapy. A retrospective molecular analysis identified the nucleophosmin (NPM)-anaplastic lymphoma kinase (ALK) fusion gene in the first diagnostic bone marrow samples taken from both patients. However, antibodies against the ALK protein appeared to be relatively low in the serum of both patients (×100 and ×750). An increase in chemotherapy intensity may be beneficial if Stage III ALCL patients are shown to be NPM-ALK chimera-positive in the first diagnostic bone marrow sample

Two Relapsed Stage III Childhood Anaplastic Large Cell Lymphoma Patients with NPM-ALK Fusion in Bone Marrow from Initial Diagnosis

Childhood anaplastic large cell lymphoma (ALCL) accounts for approx. 10–30 of cases of non-Hodgkin lymphoma, and the ALCL99 study reported 60–75 disease-free survival; however, a relatively high relapse rate was observed (25–30 ). We report 2 patients with Stage III ALCL who relapsed 6–18 months after the end of ALCL99 chemotherapy. A retrospective molecular analysis identified the nucleophosmin (NPM)-anaplastic lymphoma kinase (ALK) fusion gene in the first diagnostic bone marrow samples taken from both patients. However, antibodies against the ALK protein appeared to be relatively low in the serum of both patients (×100 and ×750). An increase in chemotherapy intensity may be beneficial if Stage III ALCL patients are shown to be NPM-ALK chimera-positive in the first diagnostic bone marrow sample

Quantitative and Qualitative Urinary Cellular Patterns Correlate with Progression of Murine Glomerulonephritis

The kidney is a nonregenerative organ composed of numerous functional nephrons and collecting ducts (CDs). Glomerular and tubulointerstitial damages decrease the number of functional nephrons and cause anatomical and physiological alterations resulting in renal dysfunction. It has recently been reported that nephron constituent cells are dropped into the urine in several pathological conditions associated with renal functional deterioration. We investigated the quantitative and qualitative urinary cellular patterns in a murine glomerulonephritis model and elucidated the correlation between cellular patterns and renal pathology

建学の精神の徹底を図る初年次教育の実践と課題 ―ホスピタリティ概論の分析から―

本研究は、2017年度から始まった本学の初年次教育を定着させるとともに、新入生が大学での教育を理解し、建学の精神に代表される理念やディプロマポリシーを自分のものとして捉え、その実現に向けた主体的な学修の基盤を構築するという初年次教育の目標の達成を図ることにある。このためには、彼らの特性をとらえるとともに、彼らが初年次教育をどのように捉え、理解したかを把握しなければならない。そこで初年次教育の科目の一つとして開設された「ホスピタリティ概論」を活用して、全受講生を対象とした2つの調査を3年間実施した。1つ目の調査は入学当初の学生像をとらえ授業展開に生かすために学生の特徴を把握するものであり、第1回目の授業で実施された。2つ目の調査は授業内容の理解度を評価するものであり、第10回目に実施された。これらの回答を年度と学科毎に集計、分析した。その結果、次のことが明らかになった。①オープンキャンパスへの参加や進学希望状況などの本学入学に至る経緯が学科によって異なること、そして、入学当初には心身に不安を抱いている学生が、どの学科にも相当数存在すること。3年間の調査によって各学科の学生の特色が明らかになり、学科毎の適切な学修支援方策の作成に向けた示唆が得られたこと。②この講義を受けて、建学の精神であるホスピタリティの獲得に大学が力を入れており、その実現が求められていると多くの学生が認識していること、及び、本科目の重点目標である多様性の理解力の育成につながる他学科の学生とのコミュニケーションの機会に意義を見出していること等から、授業の目標達成に向けた順調な歩みが見られること。これらの結果及び他の科目の報告から、初年次教育が定着しつつあること、そして、その目標達成に向けた歩みが順調であると判断した。ただ、更なる充実のための課題も浮かび上がっている

Missing western half of the Pacific Plate: Geochemical nature of the Izanagi-Pacific Ridge interaction with a stationary boundary between the Indian and Pacific mantles

The source mantle of the basaltic ocean crust on the western half of the Pacific Plate was examined using Pb–Nd–Hf isotopes. The results showed that the subducted Izanagi–Pacific Ridge (IPR) formed from both Pacific (180–∼80 Ma) and Indian (∼80–70 Ma) mantles. The western Pacific Plate becomes younger westward and is thought to have formed from the IPR. The ridge was subducted along the Kurile–Japan–Nankai–Ryukyu (KJNR) Trench at 60–55 Ma and leading edge of the Pacific Plate is currently stagnated in the mantle transition zone. Conversely, the entire eastern half of the Pacific Plate, formed from isotopically distinct Pacific mantle along the East Pacific Rise and the Juan de Fuca Ridge, largely remains on the seafloor. The subducted IPR is inaccessible; therefore, questions regarding which mantle might be responsible for the formation of the western half of the Pacific Plate remain controversial. Knowing the source of the IPR basalts provides insight into the Indian–Pacific mantle boundary before the Cenozoic. Isotopic compositions of the basalts from borehole cores (165–130 Ma) in the western Pacific show that the surface oceanic crust is of Pacific mantle origin. However, the accreted ocean floor basalts (∼80–70 Ma) in the accretionary prism along the KJNR Trench have Indian mantle signatures. This indicates the younger western Pacific Plate of IPR origin formed partly from Indian mantle and that the Indian–Pacific mantle boundary has been stationary in the western Pacific at least since the Cretaceous