Long-term lamivudine treatment for chronic hepatitis B in Japanese patients： A project of Kyushu University Liver Disease Study

AIM:To determine the efficacy of long-term lamivudinetreatment of a large number of Japanese patients withchronic hepatitis B.METHODS:In this retrospective,multi-center trial,318 Japanese patients with chronic hepatitis B received100 mg of lamivudine daily for up to 36(median 21)mo.Virological response was a decline to a serumHBV DNA level less than 3.7 log copies/mL.Virological breakthrough was defined as the reappearance of aserum HBV DNA level to more than 10-fold the minimumduring treatment.RESULTS:Lamivudine produced virological responsein 86.8% of the 318 patients at 6 mo,in 80.2% of252 patients at 12 mo,in 69.2% of 133 patients at 24mo,and in 53.6% of 28 patients at 36 mo.Forwardstepwise logistic regression analysis showed an HBV DNAlevel less than 6.8 log copies/mL(P<0.0001),HBeAgnegativity(P<0.0001),a platelet count of 100×10~9/L ormore(P=0.0162)at baseline,and a decline of the HBVDNA level of more than 3.2 log copies/mL as comparedwith the baseline level at 3 mo after the start oftreatment(P=0.0003)to be significantly associated withvirological response.Among patients with a virologicalresponse,virological breakthrough was seen in 5.3%of 19 patients who responded virologically at 1 mo,in20.7% of 203 patients at 3 mo,in 27.5% of 51 patientsat 6 mo,in 33.3% of 12 patients at 9 mo,and in 100%of 3 patients at≥15 mo.A virological breakthrough wasfound significantly more often in patients with delayedvirological response.CONCLUSION:Lamivudine treatment could suppressserum HBV DNA in most of the tested Japanese patients.Long-term efficacy might be seen in patients withoutHBeAg at baseline,in the absence of cirrhosis,and inpatients with a decline in HBV DNA level soon after thestart of treatment.     

Subtemporal hippocampectomy preserving the basal temporal language area for intractable mesial temporal lobe epilepsy: preliminary results

PURPOSE: Decline in verbal memory as a surgical complication remains an unresolved problem in mesial temporal lobe epilepsy. Some areas in the temporal lobe associated with the language function, often including the basal temporal language area, have been removed or transected by conventional surgical procedures. The authors defined the basal temporal language area and removed only the epileptogenic zone with a subtemporal approach. METHODS: The basal temporal language area was evaluated by using long-term subdural electrodes in five patients with language-dominant-side mesial temporal lobe epilepsy. While preserving this area, the hippocampus and the parahippocampal gyrus were removed by using a combined subtemporal, transventricular, transchoroidal fissure approach. Verbal memory performance was assessed with the Wechsler Memory Scale-Revised (WMS-R) before and after the operation. RESULTS: The basal temporal language area, defined as a part of the inferior temporal gyrus, the fusiform gyrus, and the parahippocampal gyrus, was spared by entering the temporal horn via collateral sulcus. Verbal memory was significantly improved by 3 months and 1 year after the operation. CONCLUSIONS: In language-dominant-side mesial temporal lobe epilepsy, preserving the basal temporal language area would have potential to improve verbal memory outcomes after removal of the epileptogenic zone.     

Long-term follow-up study of borderline patients in Japan: a preliminary study

To date, only few reports are available regarding the long-term outcome of borderline personality disorder (BPD) in Japan. We conducted a retrospective follow-up study on the long-term outcome and predictive factors of BPD in Japan. Of 72 patients who received treatment at Fukuoka University Hospital between 1973 and 1989 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for BPD retrospectively, 19 patients (26.4%) were followed up. We evaluated global outcome at follow-up using the Global Assessment of Functioning Scale scored from a completed self-reported questionnaire. The mean Global Assessment of Functioning score was 60.7, which meant fair to good functioning. The suicide rate was 6.9% (5/72). Using a logistic regression model, overinvolvement in family relationships and the number of medical facilities where patient was previously treated predicted poor outcome. These results are similar to those reported in the United States and Canada, except for the result that Japanese patients with BPD are more likely to live with their original family at follow-up than American patients.     

Estrogen alters c-Fos response to immobilization stress in the brain of ovariectomized rats

Estrogen receptors are widely expressed in the brain, where estrogen modulates central nervous function. In this study, we investigated the effect of estrogen on the emotional stress response in the brain by comparing the CNS patterns of c-Fos expression in response to immobilization stress (IMO) in ovariectomized rats with placebo treatment (OVX + Pla) vs. ovariectomized rats supplemented with 17beta-estradiol (OVX + E2). Increased c-Fos immunoreactive neurons in response to IMO were observed in cerebral cortex, septum, thalamus, hypothalamus, midbrain, pons and medulla oblongata in accordance with previous findings. When OVX + E2/Stress were compared with OVX + Pla/Stress, the numbers of c-Fos immunoreactive cells were significantly lower in the lateral septum, paraventricular hypothalamic nucleus, dorsomedial hypothalamic nucleus, medial amygdaloid nucleus, lateral periaqueductal gray, laterodorsal tegmental nucleus and locus coeruleus, while they were significantly higher in paraventricular thalamic nucleus and nucleus of the solitary tract. These data suggest that neuronal activities in these areas are influenced bidirectionally by systemic estrogen level.     

Exploring the possibility of risk assessment of Japanese sexual offenders using Static-99

Background The number of sexual offences reported in Japan doubled between 1992 and 2002. This has prompted attention to assessment of risk of recidivism. Aims To explore whether an actuarial assessment of risk widely used in the West can be meaningfully applied to Japanese men serving a prison sentence for sexual offences. Method All sex offenders incarcerated in Kitakyushu Medical Prison in Fukuoka at any time in a period of one year (1 July 2002‐30 June 2003) were identified. Demographic data, characteristics of offences and the Static‐99 were rated from records. Results Following a slightly modified application of coding rules, all items of the Static‐99 were rateable. Nine offenders of 45 whose Static‐99 score was over 6 were thus identified as high‐risk offenders. The items distinguishing apparently high‐risk men were history of institutionalization as a delinquent and mental retardation. Conclusions and implications for practice The Static‐99 may be a useful tool in assessing sex offenders in Japan. With apparently increasing recognition of sex crimes here, it seems timely to be developing a systematic approach to assessment. Further work is required to test its value in practice as a predictor of recidivism. Copyright © 2006 John Wiley & Sons, Ltd.     

Effect of changing femoral head diameter on bony and prosthetic jumping angles

European Journal of Orthopaedic Surgery & Traumatology - In THA, using a larger femoral head can increase the oscillation angle and jumping distance. However, there have been no reports which...     

Management of the late effects of disconnected pancreatic duct syndrome: A case report

BACKGROUND There have been few reports about the late effects of disconnected pancreatic duct syndrome(DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later.Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis(WON) with pancreatic transection 7 years ago.CASE SUMMARY An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm(AAA),hypertension, dyslipidemia, and chronic kidney disease. Computed tomography(CT) scan showed that the pancreatic fluid collection(PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure.CONCLUSION This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.     

The Accuracy of the Computed Tomography-Based Navigation System in Total Hip Arthroplasty Is Comparable With Crowe Type IV and Crowe Type I Dysplasia: A Case-Control Study

BackgroundClinical outcomes of total hip arthroplasty (THA) for Crowe type IV are poorer than for Crowe type I, because it is more difficult to accurately position the acetabular components. This study aimed to examine the accuracy of the computed tomography (CT)-based navigation system for acetabular component positioning in primary THA for Crowe type IV.MethodsFrom 2006 to 2018, 29 patients who underwent 34 primary THAs for Crowe type IV were enrolled in the “Type IV” group and 32 patients who underwent 34 THAs for Crowe type I were enrolled in the “Type I” group, formed by matching patients in the Type IV group on age, gender, body mass index, and surgical approach. We investigated (1) the accuracy of the cup size between that at preoperative planning and that actually implanted and (2) the mean deviation of the cup angle and 3-dimensional position of acetabular components between preoperative plan and postoperative records.ResultsThe accuracy of the cup size was 79.4% and 94.1% in the Type IV and Type I groups, respectively, without a statistically significant change detected (P = .075). The mean deviations of the cup angle and 3-dimensional position were comparable in both groups.ConclusionUsing the CT-based navigation system, it was possible to accurately implant the acetabular component for Crowe type IV, and the accuracy was comparable to that for Crowe type I. The CT-based navigation system is a useful intraoperative tool to accurately implant the acetabular component, especially with severe pelvic deformities such as Crowe type IV.