Publications by authors named "Morihito Takita"

96 Publications

Disaster response among hospital nurses dispatched to evacuation centers after the Great East Japan Earthquake: a thematic analysis.

BMC Health Serv Res 2022 Jul 1;22(1):848. Epub 2022 Jul 1.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan.

Background: Disaster relief operations involve a variety of components of healthcare efforts. The post-disaster recovery is a key component of hospital preparedness. This study aimed to investigate the role of hospital nurses in the disaster area and their challenges during the relief efforts after the Great East Japan Earthquake in 2011.

Methods: Semi-structured interviews were conducted with ten nurses who worked in a general public hospital before the Great East Japan Earthquake and were dispatched to the evacuation centers after the disaster. A qualitative approach with the thematic analysis method was employed. Three research queries (RQs) were prepared before the interview.

Results: The study participants played administrative roles as city employees in addition to performing nursing services as healthcare providers in evacuation centers. The first RQ on their challenges in evacuation centers gave us four themes: criticism by the evacuees, conflicts between multiple roles, difficulties in performing the first experience, and anxiety in working. The second RQ asking about motivation to accomplish disaster relief efforts raised three themes of carrying out the nursing role, acceptance by evacuees, and strengths of human connections. Two themes of awareness of disaster medicine and professional growth were raised from the third RQ of gains from the experiences in the evacuation centers.

Conclusions: The hospital nurses in the disaster area performed multiple roles in the relief efforts in the evacuation centers, which developed a psychological burden on them. A sense of competence supported the motivation to accomplish the disaster relief activities and professional growth as a specialist in disaster medicine. A study limitation is missing hospital nurses who resigned during the relief efforts. Further study is warranted to refine the disaster preparedness of hospital operations.
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http://dx.doi.org/10.1186/s12913-022-08231-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247954PMC
July 2022

Changes in the proportion of anemia among young women after the Great East Japan Earthquake: the Fukushima health management survey.

Sci Rep 2022 Jun 25;12(1):10805. Epub 2022 Jun 25.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan.

This study aimed to evaluate the sequential changes in the proportion of anemia among young women over eight years after the Great East Japan Earthquake in 2011 using a prospective study of the Fukushima Health Management Survey. This study focused on the women aged between 20 and 44 who lived in the evacuation area of the nuclear power plant accident. The yearly age-adjusted proportion of anemia was accessed with data between July 2011 and March 2019. A total of 9,198 women participated in the health checkup in 2011, albeit the participation was decreased to 1,241 in 2018. The age-adjusted proportion of anemia was 16.7% in 2012 and then declined after 2013 (p with Cochran-Armitage trend test = 0.03). The multivariate regression analysis identified < 23 kg/m of body mass index (BMI), no history of smoking, and no habitual alcohol use as independent baseline characteristics predictive of temporality anemic condition after the disaster (Adjusted odds ratios [95% confidence interval]; 1.98 [1.43-2.74], 1.85 [1.21-2.83], and 1.42 [1.07-1.90], respectively). Thus, women with low BMI and healthier habits might risk temporarily anemic status after the disaster. Our findings signal the importance of preventing anemia in young women after the disaster.
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http://dx.doi.org/10.1038/s41598-022-14992-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233683PMC
June 2022

Time-Dependent Changes in Death Reports and the Sex Ratio in the Safety Surveillance of SARS-CoV-2 Vaccination in Japan, the United States, and European Countries.

Cureus 2022 Mar 22;14(3):e23380. Epub 2022 Mar 22.

Research Division, Medical Governance Research Institute, Minato-ku, Tokyo, JPN.

The national safety surveillance of vaccines is a fundamental measure to ensure vaccination safety and maintain transparency and public trust. Our previous study revealed an early increase in death reports after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in Japanese surveillance despite our hypothesis that no time-dependent variations in the number of death reports would be seen if the vaccination is not related to serious adverse events. This study is an extensive investigation to determine whether the number of death reports varied consistently over time after vaccination in the older population in Japan, the US, and European countries. We collected the death reports after BNT162b2 mRNA vaccination in individuals aged 65 years or older using the open databases in Japan, the US (Vaccine Adverse Event Reporting System, VAERS), and European countries (EudraVigilance). We observed an early increase of death reports on Day 2 after the vaccination in all three databases. The female-to-male ratio was also assessed and showed a certain degree of time-dependence ( of linear regression 0.54, =0.01) in Japan but not in the US and European countries. The findings suggest the existence of unknown predictors of the adverse events of the SARS-CoV-2 vaccination, especially for the older Japanese population. The continuous and careful monitoring safety aspects of the vaccines are warranted.
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http://dx.doi.org/10.7759/cureus.23380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022046PMC
March 2022

Factors Associated with COVID-19 Vaccine Booster Hesitancy: A Retrospective Cohort Study, Fukushima Vaccination Community Survey.

Vaccines (Basel) 2022 Mar 26;10(4). Epub 2022 Mar 26.

Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan.

This was a retrospective cohort study, which aimed to investigate the factors associated with hesitancy to receive a third dose of a coronavirus disease 2019 (COVID-19) vaccine. A paper-based questionnaire survey was administered to all participants. This study included participants who provided answers in the questionnaire about whether they had an intent to receive a third dose of a vaccine. Data on sex, age, area of residence, adverse reactions after the second vaccination, whether the third vaccination was desired, and reasons to accept or hesitate over the booster vaccination were retrieved. Among the 2439 participants, with a mean (±SD) age of 52.6 ± 18.9 years, and a median IgG-S antibody titer of 324.9 (AU/mL), 97.9% of participants indicated their intent to accept a third vaccination dose. The logistic regression revealed that participants of a younger age (OR = 0.98; 95% CI: 0.96-1.00) and with a higher antibody level (OR = 2.52; 95% CI: 1.27-4.99) were positively associated with hesitancy over the third vaccine. The efficacy of the COVID-19 vaccine and concerns about adverse reactions had a significant impact on behavior regarding the third vaccination. A rapid increase in the booster dose rate is needed to control the pandemic, and specific approaches should be taken with these groups that are likely to hesitate over the third vaccine, subsequently increasing booster contact rate.
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http://dx.doi.org/10.3390/vaccines10040515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032295PMC
March 2022

Closed-Loop Control in Very Young Children with Type 1 Diabetes.

N Engl J Med 2022 04;386(15):1482

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1056/NEJMc2202163DOI Listing
April 2022

Profiles of anemia in adolescent students with sports club membership in an outpatient clinic setting: a retrospective study.

PeerJ 2022 25;10:e13004. Epub 2022 Feb 25.

Department of Internal Medicine, Yoshinobu Clinic, Kagoshima, Japan.

Background: Anemia is a common health issue among adolescents. Anemic conditions could affect physical performance; however, the actual profiles of anemia in adolescent students in sports clubs have not been well documented.

Methods: We conducted a retrospective chart review of individuals aged 13-22 years who belonged to sports clubs in schools and visited an outpatient clinic between August 1, 2016, and August 31, 2020. The medical and laboratory records, including serum levels of ferritin, folate, vitamin B12, and creatinine kinase at their first visit were assessed.

Results: A total of 485 individuals (231 male (48%) and 254 female (52%) patients) were eligible for the study. The most common club activity was track and field ( = 171 (35%)). The overall prevalence of the World Health Organization-defined anemia was 16.5% (95% CI [13.1-20.4]; 9.0% [5.4-13.8] and 23.1% [17.8-29.2] in males and females, respectively) after excluding pre-treated individuals. Hypoferritinemia and elevation of serum creatinine kinase levels were identified as independent contributors to anemia in both sexes (odds ratios: 13.2 (95% CI [4.2-41.1]), < 0.001 and 14.7 (95% CI [1.8-118.4]), = 0.012, respectively for males; odds ratios: 6.6 (95% CI [1.3-13.9]), < 0.001 and 2.7 (95% CI [1.4-5.5]), = 0.004, respectively for females).

Discussion: Anemia is prevalent in both male and female adolescent students in sports clubs. Iron deficiency and excessive training indicated by elevated creatinine kinase levels may contribute to the risk of anemia. Physicians should assess the amount of exercise, and not merely iron storage, in clinical practice.
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http://dx.doi.org/10.7717/peerj.13004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884060PMC
February 2022

A Case of Exacerbation of Subclinical Hyperthyroidism after First Administration of BNT162b2 mRNA COVID-19 Vaccine.

Vaccines (Basel) 2021 Sep 29;9(10). Epub 2021 Sep 29.

Department of Internal Medicine, Navitas Clinic Shinjuku, 4-1-6 Shinjuku 7th Floor of Newoman Bldg, Shinjuku, Tokyo 160-0022, Japan.

COVID-19 vaccines are the most critical measure for controlling the COVID-19 pandemic; however, we have little information on their complications. We experienced a case of a patient who developed hyperthyroidism complicated with atrial fibrillation and heart failure on the sixth day after the first dose of COVID-19 vaccination. This case report shows the importance of considering hyperthyroidism as a possible complication after COVID-19 vaccination.
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http://dx.doi.org/10.3390/vaccines9101108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538620PMC
September 2021

Prevalence of iron deficiency among university kendo practitioners in Japan: an observational cohort study.

J Int Soc Sports Nutr 2020 Dec 7;17(1):62. Epub 2020 Dec 7.

Medical Governance Research Institute, Minato-ku, Tokyo, Japan.

Background: Iron deficiency is widely recognized as being the cause of anemia in athletes, although iron status in athletes of Kendo, a traditional Japanese martial art based on swordsmanship and practiced as an educational sport, has not been widely investigated.

Methods: We performed a health assessment on anemia and serum ferritin levels, along with nutrient intake evaluation, for Kendo practitioners in a university in Japan.

Results: A total of 56 Kendo practitioners (39 male and 17 female) aged between 18 and 23 years participated in the study. No individuals exhibited WHO-defined anemia (less than 13 or 12 g/dL of hemoglobin levels in male or female), while hypoferritinemia (less than 30 ng/mL) was found in seven (41%) females but not in males. Significantly higher body mass index was found in the female athletes with hypoferritinemia compared to females with normo-ferritinemia in sub-analysis (median [interquartile range]; 25.6 [24.2, 26.9] versus 22.6 [21.7, 24.1], respectively. p < 0.05). No significant differences in the intake of iron were registered between males and females (with and without hypoferritinemia) using data from a food-frequency questionnaire survey.

Conclusion: No apparent anemia was found in adolescent Kendo practitioners, although this study confirmed the presence of hypoferritinemia in several female athletes. Careful follow-up, involving both clinical and nutritional assessment, will be necessary for them to prevent progression into anemia. A future study with larger cohorts in multiple sites is warranted to assess the prevalence of iron deficiency for validation and, if necessary, to devise a strategy for improving the iron status in Kendo athletes.
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http://dx.doi.org/10.1186/s12970-020-00393-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720520PMC
December 2020

FOLFIRINOX for Recurrent Pancreatic Cancer After Pancreatic Resection: A Secondary Analysis of the Nationwide Multicenter Observational Study Conducted by the Japan Adjuvant Study Group of Pancreatic Cancer 06.

Pancreas 2020 Nov/Dec;49(10):1372-1377

Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.

Objectives: The multidrug regimen with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is widely used for recurrent pancreatic cancer after pancreatic resection. However, there are concerns about severe toxicities and poor tolerability of FOLFIRINOX in these patients because some suffer from surgery-associated malnutrition, weight loss, and diabetes mellitus. We evaluated the toxicity and tolerability of FOLFIRINOX in these patients.

Methods: This study was conducted as a secondary analysis of the Japan Adjuvant Study Group of Pancreatic Cancer 06 study, which was a multicenter observational study of FOLFIRINOX for pancreatic cancer in Japan. The toxicity and tolerability of FOLFIRINOX in recurrent disease correlated with those of both the locally advanced and the metastatic disease group.

Results: The major grades 3 and 4 toxicities observed in the recurrent and locally advanced or metastatic disease groups were neutropenia (68% vs 63%), febrile neutropenia (4% vs 15%, P = 0.007), thrombocytopenia (4% vs 3%), diarrhea (4% vs 8%), and sensory neuropathy (0% vs 2%). The dose modification and relative dose intensity did not differ markedly between the groups.

Conclusions: The toxicity and tolerability of FOLFIRINOX for recurrence after pancreatic resection were similar to those for locally advanced or metastatic disease with appropriate patient selection and dose modifications.
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http://dx.doi.org/10.1097/MPA.0000000000001692DOI Listing
September 2021

Outcomes of Islet Autotransplantation in Chronic Pancreatitis Patients with Complete Acinar Atrophy.

Cell Transplant 2020 Jan-Dec;29:963689720949242

Annette C. and Harold C. Simmons Transplant Institute, 22683Baylor University Medical Center, Dallas, TX, USA.

Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment for refractory chronic pancreatitis (CP). Pathological features of CP include progressive fibrosis in pancreas parenchyma, atrophy, and/or ductal occlusion. Complete acinar atrophy (CAA) caused by chronic fibrosis and necroinflammation results in exocrine sufficiency and may influence islet isolation characteristics during TPIAT. In this analysis of patients who underwent TPIAT at our center, we compared transplant outcomes among those with CAA ( = 5) vs non-acinar atrophy (NAA; matching controls, = 36). Data were analyzed using one-way analysis of variance with Bonferroni post hoc test or Student's test. Pancreas digestion was longer in CAA than in NAA cases (18.6 vs 14.6 min) despite a lower pancreas weight (55.2 vs 91.2 g). Obtained tissue volume was 1.0 ml in the CAA group and 12.1 ml in the NAA group. Both groups had similar islet viability (96%) and islet dose (CAA, 3,391 IEQ/kg; NAA, 4141.1 IEQ/kg). During islet infusion, serum cytokine (IL-6, IL-8, and MCP-1) levels and plasma hsa-miR-375 levels were lower in the CAA group than in the NAA group, but not significantly. Serum tumor necrosis factor α levels at 3 h after infusion were significantly higher in CAA group than in NAA group. After TPIAT, the metabolic outcomes of the CAA group were comparable with that of the NAA group. Narcotics usage decreased significantly over 24 months in both groups, with the CAA group reporting being pain free at 12 months. Complete atrophy of acinar cells of pancreas did not significantly impact islet yield or endocrine function after TPIAT.
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http://dx.doi.org/10.1177/0963689720949242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784518PMC
June 2021

Iron Deficiency Anaemia: Its Prevalence Among Women of Reproductive Age in Shanghai and Tokyo and Links to Body Mass Index.

Cureus 2020 Jul 28;12(7):e9436. Epub 2020 Jul 28.

Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, CHN.

In this study, we examined the prevalence of iron deficiency anaemia (IDA) among young women between the ages of 20-44 living in Shanghai, China, and Tokyo, Japan with a particular emphasis on investigating its possible links with body mass index (BMI). Shanghai data were obtained from annual health check-up records conducted between May and September 2016 (n=2,006). Tokyo data were from health examinations of employees working in dispensing pharmacies between July and February 2017 (n=877). Anaemia prevalence was found to be 14.8% and 11.4% in Shanghai and Tokyo, respectively. The proportion of women with a BMI of <18.5 was 9.9% in Shanghai and 25.7% in Tokyo. Anaemia prevalence tends to be high in women with a low BMI. Women with a BMI of <18.5 had the highest prevalence of anaemia (18.2%) in Shanghai. Yet, the prevalence of anaemia was low (9.3%) among Tokyo women with a BMI of <18.5, significantly lower than those with a BMI between 18.5-25.0 (12.5%). IDA is a significant problem among women in both Shanghai and Tokyo, where the 'desire for thinness" is commonplace among young women. The Tokyo participants with a low BMI, however, appear to have managed to avoid developing IDA.
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http://dx.doi.org/10.7759/cureus.9436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450885PMC
July 2020

Geographical Profiles of COVID-19 Outbreak in Tokyo: An Analysis of the Primary Care Clinic-Based Point-of-Care Antibody Testing.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720942695

Navitas Clinic Tachikawa, Tachikawa, Tokyo, Japan.

The primary care clinic plays a major role in triage for coronavirus disease 2019 (COVID-19), where seroprevalence in the setting of primary care clinic remains less clear. As a point-of-care immunodiagnostic test for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the serosurvey represents an alternative to the polymerase chain reaction (PCR) test to measure the magnitude of COVID-19 outbreak in the communities lacking sufficient diagnostic capability for PCR testing. We assessed seropositivity for the SARS-CoV-2 IgG between April 21 and May 20, 2020, at 2 primary care clinics in Tokyo, Japan. The overall positive percentage of SARS-CoV-2 IgG was 3.83% (95% confidence interval [CI]: 2.76-5.16) for the entire cohort (n = 1071). The 23 special wards of central Tokyo exhibited a significantly higher prevalence compared with the other areas of Tokyo after classification by residence ( = .02, 4.68% [3.08-6.79] vs 1.83 [0.68-3.95] in central and suburban Tokyo, respectively). In central Tokyo, the southern area showed the highest seroprevalence compared with the other areas (7.92% [3.48-15.01]), corresponding to the cumulative number of confirmed COVID-19 patients by PCR test reported by the Tokyo Metropolitan Government. The seroprevalence surveyed in this study was too low for herd immunity, suggesting the need for robust disease control and prevention. A regional-level approach, rather than state- or prefectural-level, could be of importance in ascertaining detailed profiles of the COVID-19 outbreak.
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http://dx.doi.org/10.1177/2150132720942695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370565PMC
July 2020

The Proportion of Female Physician Links With Advanced Educational Opportunity for Female and by Female.

Int J Health Policy Manag 2020 09 1;9(9):411-412. Epub 2020 Sep 1.

Medical Governance Research Institute, Tokyo, Japan.

Background: The overall proportion of female physician is increasing worldwide. However, its ratio exhibits a substantial diversity among each member country of Organisation for Economic Co-operation and Development (OECD). This study aimed to reveal the social factors of countries associated with the percentage of female physicians.

Methods: We retrieved the percentage of female physicians and social characteristic which may affect the ratio of female physicians of 36 OECD countries in 2016 or nearest year from the World Bank Open Data. Multivariate regression analysis was performed after univariate evaluations with Spearman's coefficient to explore correlation of social variables with the proportion of female physicians.

Results: The percentages of female adolescents who dropped out of school before lower secondary school, female population that attained or completed Master's or equivalent degree, female labour force, and female academic staff in tertiary education showed statistically significant correlation with proportion of female physicians (Spearman coefficient = -0.527, 0.585, 0.501, and 0.499; =.01, .001, .002, and .008). Female's educational attainment at least Master's or equivalent and that of female academic staff at tertiary education were selected after multivariate analysis.

Conclusion: Our study revealed the relationships between advanced education opportunity and female participation in academic positions with the percentage of female physicians. Our research is limited in the difficulty to evaluate physicians' working hours in spite of its possible effect. Further studies with qualitative assessment are warranted to explore the detail reasons to cause gender gap in physician.
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http://dx.doi.org/10.15171/ijhpm.2019.147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557424PMC
September 2020

Nurses' perceptions of medical procedures and nursing practices for older patients with non-cancer long-term illness and do-not-attempt-resuscitation orders: A vignette study.

Nurs Open 2020 07 13;7(4):1179-1186. Epub 2020 Apr 13.

Department of nursing Minamisoma Municipal General Hospital Minamisoma Japan.

Aim: To elucidate influence of a do-not-attempt-resuscitation (DNAR) order on nurses' perceptions of the medical procedures and nursing practices for non-cancer older patients.

Design: A vignette-based questionnaire study.

Methods: A questionnaire survey asking nurses their perceptions of clinical practices for the following three vignettes was performed in a community hospital in Japan (120): the control vignettes with an older patient with repeated heart failure who was living alone and the other two with either an absence of relatives or a diagnosis of dementia. We also prepared additions to each vignette describing a DNAR order.

Results: Nurses' perception on cardiopulmonary resuscitation, defibrillation, blood tests and intravenous nutrition showed statistically significant and minimally important declines after the DNAR order compared with before for all three vignettes ( < .001). DNAR orders can influence nurses' perceptions of clinical practices for non-cancer older patients with chronic heart failure.
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http://dx.doi.org/10.1002/nop2.495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308706PMC
July 2020

Anti-inflammatory Approach With Early Double Cytokine Blockade (IL-1β and TNF-α) Is Safe and Facilitates Engraftment in Islet Allotransplantation.

Transplant Direct 2020 Mar 10;6(3):e530. Epub 2020 Feb 10.

Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.

Background: The approach to reducing nonspecific inflammation after islet allotransplantation has been designed to improve engraftment, typically using 1 agent. We report results with the use of combination inflammatory blockade consisting of anti-interleukin (IL)-1β and tumor necrosis factor (TNF)-α.

Methods: Nine patients underwent islet allotransplantation under a prospective research protocol using double cytokine blockade with anti-TNF-α (etanercept, d 0, 3, 7, 10) and IL-1β (anakinra, d 0-7) at the time of each islet infusion. The primary endpoint, assessed 2 years after the last islet transplant, was the elimination of severe hypoglycemic events and hypoglycemia unawareness, with proper glycemic control, and detectable serum C-peptide.

Results: No thrombotic events or infectious complications were associated with combined IL-1β and TNF-α blockade. Six patients became insulin independent, 2 had partial function, and 1 had primary nonfunction. After 24-month follow-up, 6 of 9 patients had excellent glycemic control, hemoglobin A1c ≤6.5%, and no episodes of hypoglycemia unawareness. Eight patients developed HLA alloantibodies at various time points (class 1, 5; class 2, 6), with enhanced T-cell alloreactivity. One patient retained good graft function despite having anti-glutamic acid decarboxylase 65 antibodies.

Conclusions: The use of double cytokine blockade is safe, with reduction of inflammation at transplantation and presumably with better engraftment. However, it does not influence later islet loss from T-cell-mediated autoimmunity and alloimmunity, which require other strategies to maintain long-term islet function.
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http://dx.doi.org/10.1097/TXD.0000000000000977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056279PMC
March 2020

Multicenter Trial of Closed-Loop Control in Type 1 Diabetes.

Authors:
Morihito Takita

N Engl J Med 2020 02;382(6):577

Navitas Clinic, Tokyo, Japan

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http://dx.doi.org/10.1056/NEJMc1915995DOI Listing
February 2020

Absence of Relatives Impairs the Approach of Nurses to Cardiopulmonary Resuscitation in Non-Cancer Elderly Patients without a Do-Not-Attempt-Resuscitation Order: A Vignette-Based Questionnaire Study.

Tohoku J Exp Med 2020 01;250(1):71-78

Department of Nursing, Minamisoma Municipal General Hospital.

A Do-Not-Attempt-Resuscitation (DNAR) order solely precludes performing cardiopulmonary resuscitation (CPR) following cardiopulmonary arrest. A patient's personal status is known to influence a range of clinical practices, not only CPR, when a DNAR order is given. We assessed whether the absence of supporting relatives or a diagnosis of dementia can influence nurses' perceptions of clinical practices for elderly patients with non-malignant and chronic diseases. A vignette-based questionnaire was used to evaluate nurses' beliefs both before and after issuance of a DNAR order. Three vignettes were developed: the control vignette described an 85-year-old woman with repeated heart failure, the second and third incorporated a lack of relatives and a dementia diagnosis, respectively. The survey assessed the approach of nurses to 10 routine medical procedures, including CPR, clinical laboratory testing and nursing care, using a 5-base Likert-scale, for six vignette scenarios. A questionnaire was completed by 186 nurses (64% response). The pre-DNAR non-relative vignette showed significantly lower scores for CPR, indicating a deterioration in willingness to perform CPR, compared to the pre-DNAR control (median [interquartile]; 3 [2-4] and 4 [3-4] in the non-relative and control vignettes, respectively, p < 0.001). No significant differences were observed between the dementia and control vignettes. Absence of contactable relatives and resultant lack of communication can diminish the perception of nurses regarding the provision of CPR, even when a DNAR does not exist. This result suggests a necessity for comprehensive training all medical staff about issuance of DNAR orders and what care should be provided thereafter.
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http://dx.doi.org/10.1620/tjem.250.71DOI Listing
January 2020

Impact of microbial contamination of the islet product during total pancreatectomy with islet autotransplantation.

J Hepatobiliary Pancreat Sci 2020 Apr 12;27(4):211-218. Epub 2020 Feb 12.

Baylor Simmons Transplant Institute, Dallas, TX, USA.

Background: The combined use of interleukin-1β and tumor necrosis factor-α blockers in the peritransplant period has improved outcomes of total pancreatectomy with islet autotransplantation (TPIAT). However, these drugs may suppress the immune system, resulting in severe infection.

Methods: We retrospectively investigated the impact of microbial-contaminated islet product on posttransplant complications and metabolic outcomes of TPIAT patients receiving the IL-1β and TNF-blockade treatment at our center.

Results: Among 108 TPIAT patients, 37 patients (34%) received contaminated products. Preoperative stent treatment and fibrosis score were independent risk factors for the contamination. There were no significant differences between the contaminated and noncontaminated product groups in posttransplant infectious complication rate, length of hospitalization, or readmission rate. However, islet equivalents (P < .0001) and insulin independence rate (P = .036) at 6 months were significantly lower for patients receiving contaminated product.

Conclusions: These results suggest that combined anti-inflammatory drug use is safe and well tolerated in TPIAT patients who receive contaminated islet product and does not increase the rate of infectious complications; however, contaminated islet product is associated with poor metabolic outcomes.
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http://dx.doi.org/10.1002/jhbp.709DOI Listing
April 2020

Lower trust in national government links to no history of vaccination.

Lancet 2020 01;395(10217):31-32

Medical Governance Research Institute, Tokyo 108-0074, Japan; Department of Internal Medicine, Navitas Clinic, Tokyo, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/S0140-6736(19)32686-8DOI Listing
January 2020

The responsibility of the Japanese Media, The Fukushima accident & the use of personal data for research.

QJM 2019 Jul 27. Epub 2019 Jul 27.

Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan.

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http://dx.doi.org/10.1093/qjmed/hcz193DOI Listing
July 2019

Internal exposure risk due to radiocesium and the consuming behaviour of local foodstuffs among pregnant women in Minamisoma City near the Fukushima nuclear power plant: a retrospective observational study.

BMJ Open 2019 07 9;9(7):e023654. Epub 2019 Jul 9.

Department of Obstetrics and Gynecology, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan.

Objectives: This study aimed to evaluate the internal cesium (Cs) level among pregnant women in Minamisoma City (the area straddling the evacuation zones) over a 5-year period after Japan's 2011 Fukushima nuclear accident and assess the status and transition of their food-acquiring preferences during this period.

Design: A retrospective observational study of a screening along with a questionnaire survey.

Setting: This study was conducted in an obstetrics and gynaecology service in Minamisoma City in Fukushima, Japan.

Participants: Participants included pregnant women who applied for the voluntary internal radiation exposure screening programme.

Primary And Secondary Outcome Measures: Internal radiation exposure was evaluated using the whole-body counter (WBC) in the screening programme. Data from a food acquisition preference questionnaire administered to the participants were analysed and compared across the 5-year period after adjusting for covariates.

Results: Overall, 804 screening programmes were conducted with 579 participants during the study period. All participants had internal contamination levels below the detection limit of the WBC unit (220 and 250 Bq/body for Cs-134 and Cs-137, respectively). Based on the most conservative assumption, their maximum annual effective doses by Cs-134 and Cs-137 together were estimated at 16 µSv/year. Contrary to limited internal contamination risks and counter-dose initiatives by the government, a considerable number of pregnant women were still concerned about consuming potentially contaminated local food products when purchasing them at supermarkets between 2012 (78.4%) and 2015 (75.0%).

Conclusions: Health effects from post-accident internal radiation exposure were likely to be insignificant in pregnant women. National/local action is urgently needed to promote scientific understanding in pregnant women regarding limited internal exposure risks from local food products in the market. However, few mothers chose to participate in the internal radiation exposure screening programme, and thus, caution is required in interpreting the results of analyses.
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http://dx.doi.org/10.1136/bmjopen-2018-023654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615778PMC
July 2019

Entrance examination misogyny in Japanese medical schools.

Lancet 2019 Apr 4;393(10179):1416. Epub 2019 Apr 4.

Department of Internal Medicine, Jyoban Hospital, Tokiwa Foundation, Fukushima 972-8322, Japan.

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http://dx.doi.org/10.1016/S0140-6736(18)33180-5DOI Listing
April 2019

Delayed Diagnosis of Herpes Zoster Infection due toLong-Term Pregabalin Treatment for Lumbar Spinal Canal Stenosis: A Case Report.

J Orthop Case Rep 2018 Nov-Dec;8(6):85-87

Department of Internal Medicine, Navitas Clinic Shinjuku, Tokyo, Japan.

Introduction: Lumbar spinal stenosis is a common disease among elderly adults, and pregabalin is increasingly used for pain relief in this disease. However, little is known about whether pregabalin may cause any undesirable outcomes when used conjointly with other medications in elderly people. We report a case of herpes zoster infection, the initial symptom of which was obscured due to the use of a combination of pregabalin, tramadol, and acetaminophen for lumbar spinal canal stenosis.

Case Report: In February 2018, a 72-year-old Japanese man presented with eruption without pain on his right shoulder. As an itching sensation and pain gradually emerged, he visited the clinic10days after the initial appearance of the eruption. He was diagnosed with lumbar spinal canal stenosis, in 2014, and had been prescribed a combination of tramadol, acetaminophen, and pregabalin for pain relief. He was diagnosed with herpes zoster infection, and valacyclovir was prescribed for 7 days. His symptoms were relieved on the 10thdayafter the initial presentation.

Conclusion: The use of multiple analgesic agents, including pregabalin, may conceal pain associated with herpes zoster infection and delay its early diagnosis, possibly leading to a worse outcome of the disorder.
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http://dx.doi.org/10.13107/jocr.2250-0685.1272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424327PMC
March 2019

Negative Aspects of the Regional Quota System in Japan.

JMA J 2019 Mar 22;2(1):85-86. Epub 2019 Feb 22.

Medical Governance Research Institute, Tokyo, Japan.

is a measure to improve the maldistribution and shortage of physicians in rural areas in Japan. Although quota seats have been on the rise, a considerable number of young physicians and medical students return their loans and do not fulfill their duty periods for several important reasons, including an obligation term lasting for 9 years. The number of medical students who do not apply for admission to the quota has increased, and vacancies have developed in some medical schools. Urgent modification of this program is therefore required to make it suitable for actual situations of both rural medical care and the education of young physicians.
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http://dx.doi.org/10.31662/jmaj.2018-0055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930711PMC
March 2019

Negative peritoneal washing cytology during interval debulking surgery predicts overall survival after neoadjuvant chemotherapy for ovarian cancer.

J Gynecol Oncol 2018 Sep 4;29(5):e70. Epub 2018 May 4.

Department of Gynecologic Oncology, Kanagawa Cancer Center, Kanagawa, Japan.

Objective: Optimal debulking in interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) has been reported as a prognostic factor for patients with ovarian cancer. However, the identification of microscopic residual disease (MRD) using visualization and palpation is subjective. Peritoneal washing cytology (PWC) during IDS is an easy-to-implement, objective approach for assessing disease status, although its clinical relevance and association with MRD is not known. The aim of this study was to evaluate the efficacy of PWC during IDS.

Methods: In total, 164 patients diagnosed with ovarian cancer at our institution were retrospectively evaluated, including 64 who had received NAC. Seventeen patients had undergone an exploratory laparotomy followed by NAC, while the remaining patients were diagnosed based on imaging, peritoneal cytology, and tumor markers. The PWC was performed before intraperitoneal observation at laparotomy during IDS.

Results: NAC-treated patients had stage III-IV disease. IDS was performed in 78.1% of NAC-treated patients. Seventeen patients (26.6%) were PWC-negative and 33 patients (51.6%) were PWC-positive. Fourteen patients (21.9%) had progressive disease and were ineligible for IDS. The median overall survival of the PWC-negative, PWC-positive, and non-IDS groups was 47, 18, and 5 months, respectively. The differences were significant (p<0.01). PWC was an independent prognostic factor in the multivariate Cox regression analysis (p<0.001).

Conclusion: PWC during IDS may be a prognostic factor for NAC-treated patients with ovarian cancer. PWC may be more useful than visualization and palpation in IDS for determining the presence of MRD.
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http://dx.doi.org/10.3802/jgo.2018.29.e70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078894PMC
September 2018

Predictive gene-expression score for follicular lymphoma.

Lancet Oncol 2018 06 1;19(6):e281. Epub 2018 Jun 1.

Jyoban Hospital of Tokiwa Foundation, 972-8322 Fukushima, Japan.

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http://dx.doi.org/10.1016/S1470-2045(18)30324-3DOI Listing
June 2018

A call for improved transparency in financial aspects of clinical trials: a case study of the CREATE-X trial in the New England Journal of Medicine.

Invest New Drugs 2018 06 8;36(3):517-522. Epub 2018 Mar 8.

Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, 972-8322, Japan.

Introduction Globally, laws and guidelines for managing conflict of interest are increasingly implemented to achieve transparency in financial ties between physicians and pharmaceutical and medical device industries, yet little information is available regarding the limitations of the current frameworks for disclosing these financial ties. Case In June 2017, the Capecitabine for Residual Cancer as Adjuvant Therapy (CREATE-X) trial was published in the New England Journal of Medicine. In this study, which suggested the post-surgery addition of capecitabine would improve survival of high-risk breast cancer patients, the cost of capecitabine for off-label use was illegally claimed to the Japanese public health insurance system, rather than being covered by the research budget. This illegal claim led to the profit of more than 100,000,000 JPY (approximately 0.91 million USD) for Chugai Pharmaceutical Company (CPC), which manufactures capecitabine. Additional evidence suggests that the CPC made donations of at least 100,000,000 JPY (approximately 0.91 million USD) and 236,000,000 JPY (approximately 2.1 million USD) to the Japan Breast Cancer Research Group (JBCRG), the study's sponsor and funder where the majority of the Japanese authors served high-level positions, and the Advanced Clinical Research Organization, the other study funder, respectively, during the study period, though the total amount has not been clarified. Neither the CPC's involvement nor its undue profit was mentioned in the published article. Conclusion This case report highlights the lack of financial transparency in the CREATE-X trial, and discusses the potential limitations that may exist in the current frameworks for disclosing financial ties between physicians and relevant industries in clinical trials. Achieving improved transparency is essential to heighten credibility in the findings of clinical trials.
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http://dx.doi.org/10.1007/s10637-018-0577-xDOI Listing
June 2018

A study of the clinical utility of a 20-minute secretin-stimulated endoscopic pancreas function test and performance according to clinical variables.

Gastrointest Endosc 2017 Dec 3;86(6):1048-1055.e2. Epub 2017 Apr 3.

Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Background And Aims: Direct pancreas juice testing of bicarbonate, lipase, or trypsin after stimulation by secretin or cholecystokinin is used to determine exocrine function, a surrogate for diagnosing chronic pancreatitis (CP). Endoscopic pancreas function tests (ePFTs), where a peak bicarbonate concentration (PBC) ≥80 mEq/L in pancreas juice is considered normal, are now used more frequently. In this ePFT, aspirates start 35 minutes after secretin administration because pancreas output peaks 30 minutes after secretagogue administration. The performance of ePFT in a cohort of patients with a presumptive diagnosis of CP referred to a pancreas clinic for consideration of an intervention including total pancreatectomy and islet autotransplantation was studied, compared with EUS, ERCP, histology, and consensus diagnosis. The effect of sedation, narcotic use, aspirate volume, body mass index, age, and proton pump inhibitors (PPIs) on test performance is reported.

Methods: After a test dose, synthetic human secretin was administered intravenously, and 30 minutes later sedation was achieved with midazolam and fentanyl or propofol. A gastroscope was advanced to the major papilla where 4 continuous aspiration samples were performed at 5-minute intervals in sealed bottles. PBC ≥80 mEq/L was normal.

Results: Eighty-one patients had ePFTs from August 2010 through October 2015. Twenty-seven patients (33%) were diagnosed with CP. Eighteen of the 27 patients with CP and 1 of the 54 patients without CP had an abnormal ePFT, producing a sensitivity of 66% (95% CI, 46.0-83.5), specificity 98% (95% CI, 90.1-99.9), positive predictive value 94.7% (95% CI, 74-99.9), and negative predictive value 85.5% (95% CI, 74.2-93.1). ERCP and PBC concordance was generally poor, but none of the patients without CP had major EUS changes, and only 3 patients with a PBC <80 mEq/L had a normal EUS. The PBC was affected by narcotics and PPI use.

Conclusion: A 20-minute ePFT after secretin administration had a marginal sensitivity for diagnosis of CP. The diagnosis of CP should not rely on a single study and certainly not a PFT. The duodenal aspirate volume did not correlate with the PBC, which contrasts with current secretin-enhanced MRCP knowledge; therefore, further studies on this subject are warranted. Neither type of sedation, BMI, nor age affected test performance. Narcotics and PPIs may affect the PBC, so borderline results should be interpreted with caution in these groups.
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http://dx.doi.org/10.1016/j.gie.2017.03.1532DOI Listing
December 2017

Predictive Significance of Tumor Depth and Budding for Late Lymph Node Metastases in Patients with Clinical N0 Early Oral Tongue Carcinoma.

Head Neck Pathol 2017 Dec 3;11(4):477-486. Epub 2017 Apr 3.

Department of Otolaryngology Head and Neck Surgery, Yokohama City University, Yokohama, Kanagawa, Japan.

In clinical N0 early oral tongue carcinoma, treatment of occult lymph node metastasis is controversial. The purpose of this study was to assess the histopathological risk factors for predicting late lymph node metastasis in early oral tongue carcinoma. We retrospectively reviewed 48 patients with early oral tongue squamous cell carcinoma. Associations between the histopathological factors (depth of tumor, differentiation, blood vessel invasion, lymphatic invasion, and tumor budding) and late lymph metastasis were analyzed. Although the univariate analysis identified blood vessel invasion, lymphatic invasion, and high-grade tumor budding as predictive factors for neck recurrence (p < 0.001), the Cox proportional hazards model identified high-grade tumor budding as an independent predictive factor (p < 0.01). The combination of a tumor depth ≥ 3 mm and high-grade tumor budding yielded high diagnostic accuracy. Tumor depth and budding grade were identified as histopathological risk factors for late neck recurrence in clinical N0 early oral tongue carcinoma.
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http://dx.doi.org/10.1007/s12105-017-0814-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677061PMC
December 2017

MiR-375 and miR-200c as predictive biomarkers of islet isolation and transplantation in total pancreatectomy with islet autotransplantation.

J Hepatobiliary Pancreat Sci 2016 Sep 19;23(9):585-94. Epub 2016 Aug 19.

Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA.

Background: Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment for refractory chronic pancreatitis. Predictable biomarkers for the endocrine function after transplantation would be helpful in selecting patients for TPIAT. This study aims to identify novel biomarkers for predicting the outcome of islet isolation and transplantation in TPIAT patients.

Methods: This paper studied microRNA of 31 TPIAT patients and 11 deceased donors from plasma samples before TPIAT. MiR-7, miR-200a, miR-200c, miR-320, and miR-375 were analyzed along with patient characteristics and the outcomes of islet isolation and transplantation via univariate and multivariate regression analysis.

Results: MiR-375 before TPIAT showed a significant correlation with ∆C-peptide (r = -0.396, P = 0.03) and post-digestion islet count (r = -0.372, P = 0.04). And also miR-200c was significantly correlated with insulin requirement, C-peptide, and SUITO index at 1 year after transplantation. Moreover it was confirmed that miR-200c was a predictable factor of endocrine outcome in multi regression analysis (coefficient = -7.081, P = 0.001).

Conclusions: We concluded that miR-375 and miR-200c could potentially serve as novel biomarkers in predicting the islet yield in islet isolation and the metabolic function after transplantation for chronic pancreatitis patients.
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http://dx.doi.org/10.1002/jhbp.377DOI Listing
September 2016
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