Search

Objective To evaluate the gustatory function before and after vestibular schwannoma (VS) surgery. Methods In this retrospective study, we evaluated the gustatory function of 12 patients who underwent VS surgery at Tsukuba University Hospital between 2012 and 2018. Gustatory function was examined using electrogustometry before VS surgery and 3 months, 6 months and 1 year after surgery. Electrogustometry was tested at the area mapped to the chorda tympani nerve, glossopharyngeal nerve and greater superficial petrosal nerve (GSPN). Intergroup mean comparisons of the threshold were performed using a one-way analysis of variance (ANOVA) followed by the Bonferroni post-hoc test. Results The gustatory function mapped to the chorda tympani nerve was significantly disturbed 6 months after the surgery as compared with the preoperative function (p = 0.033) and that the dysfunction recovered at 1 year. However, gustatory function mapped to the glossopharyngeal nerve and greater superficial petrosal nerve (GSPN) was not impaired. Conclusion The gustatory function mapped to the chorda tympani nerve is impaired after surgery for VS. The dysfunction peaked at 6 months after surgery, and recovered within 1 year.

The prognostic role of pretreatment C-reactive protein (CRP) has been reported for head and neck cancer. However, little is known about the relationship between the changes in CRP levels during treatment and prognosis. This study aimed to investigate the correlation between CRP elevation during concurrent chemoradiotherapy (CCRT) and survival outcomes.The medical records of patients with oropharyngeal, hypopharyngeal, and laryngeal cancer treated with CCRT at the University of Tsukuba Hospital and National Hospital Organization Mito Medical Center from April 2014 to December 2019 were retrospectively reviewed. Patients were divided into normal (0.3 mg/dl) and elevated (≥0.3 mg/dl) CRP groups according to the CRP level after the first cycle of cisplatin. The primary endpoint was progression-free survival (PFS).A total of 74 patients were enrolled, of whom 36 (49%) showed elevated CRP levels after the first cycle of cisplatin. The 3-year PFS was 83.3% and 61.0% in the normal and elevated CRP groups, respectively, showing significant differences between the two groups.Elevated CRP levels after the first cycle of cisplatin is an objective predictive marker for survival in patient with head and neck squamous cell carcinoma treated with CCRT.

Purpose To clarify the utility of the area of residual tumor for patients with esophageal squamous cell cancer treated with neoadjuvant chemotherapy. Methods We enrolled 186 patients with esophageal squamous cell cancer who underwent surgical resection following neoadjuvant chemotherapy at our hospital. Using digital images, we measured the area of residual tumor at the maximum plane of the specimen and divided the patient into three groups as follows: 0 (area = 0 mm2), low (area = 0 mm2 to 40 mm2), and high (area ≥ 40 mm2). The clinicopathological factors and prognosis were compared among these groups. Results The median area of residual tumor was 15.0 mm2 (range 0–1,448.8 mm2). Compared with the 0 and low group, the high group was significantly associated with poorer recurrence-free survival (all P

This study examined the effectiveness of a new health promotion program, which is a collective intervention program aimed at improving lifestyle habits. It was designed as a one-year prospective cohort study. This program targeted non-obese persons at risk of developing lifestyle-related diseases and participants with hypertension, dyslipidemia, or hyperglycemia who were not included in the specific health guidance system in Japan. The Wadaiko rhythm exercise, which is a traditional performing art, is incorporated into this intervention as an enjoyable routine that can help participants continue the program, preventing them from dropping out. After a one-year follow-up, the effectiveness of the health promotion program was evaluated in 18 participants (2 males, 16 females; mean age 65.2 ± 3.4 years) and 92 controls. The results showed that triglyceride in the intervention group significantly decreased (−24.5 mg/dL; p = 0.02; 95% confidence interval [CI], −44.73 to −4.27) and high-density lipoprotein cholesterol significantly increased (+6.1 mg/dL; p < 0.01; 95% CI, 2.46 to 9.65), although levels in the control group did not change. These results suggest that the health promotion program could contribute to lifestyle habit improvements in those who are excluded from receiving specific health guidance.

The most common preventative measure against mumps is vaccination with mumps vaccine. Over 122 countries have implemented mumps vaccine routine immunization programs, mostly via Measles-Mumps-Rubella (MMR) vaccine. In Japan, the unexpectedly high incidence of aseptic meningitis caused by mumps vaccine led to the discontinuation of the MMR national vaccination program in 1993, inadvertently resulting in the re-emergence of mumps. Plans of introducing monovalent mumps vaccine into routine vaccination schedule have become one of the emerging topics in health policy that has warranted the need in evaluating its value for money.We conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios (ICERs) of two different vaccination programs (a single-dose program at one-year-old, a two-dose program with second dose uptakes at five) compared to status quo from both payers' and societal perspectives. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. Costs per vaccination were assumed at ¥6140 (US$58;1US$ = ¥106).Both programs reduce disease treatment costs compared to status quo, while the reduction cannot offset vaccination cost. ICER of either program is found to be under ¥5,000,000 (US$47,170)/QALY willingness-to-pay (WTP) threshold from either perspective. Results of probabilistic sensitivity analyses expressed by net monetary benefit indicated that at the WTP threshold, the acceptability is at 92.6% for two-dose vaccination program, 0% for single-dose vaccination program, and 7.4% for current no vaccination program. Two-dose program was optimal among the alternatives. One-way sensitivity analyses revealed that proportion of mumps-related hearing loss among mumps cases and vaccine effectiveness (VE) were key variables in changing the ICERs.Routine vaccination program of single- and two-dose programs were cost-effective from both payers' and societal perspectives. Between the two, the two-dose vaccination program was observed to be more favorable.

Postoperative complications may depend on the systemic inflammatory response. We evaluated the predictive potential of the combination of platelet count and neutrophil-to-lymphocyte ratio (COP-NLR) for the incidence of pharyngocutaneous fistula (PCF) in patients who have undergone total laryngectomy.Retrospective cohort study.Patients who underwent total laryngectomy between 2000 and 2020 were recruited from four hospitals. The correlations between the incidence of PCF and several risk factors, including the COP-NLR, were examined. Patients with both elevated platelet count and elevated neutrophil-to-lymphocyte ratio (NLR) were categorized as COP-NLR 2, and patients with either one or no abnormal values of both parameters were assigned as COP-NLR 1 and COP-NLR 0, respectively.A total of 235 patients were identified. The overall incidence of PCF was 12.3%. The cut-off value for NLR before surgery was set at 3.95 (sensitivity = 58.6%, specificity = 69.4%, area under the curve [AUC] = 0.635), and the platelet count was set at 320 × 10COP-NLR is a novel predictive factor for the development of PCF in patients undergoing total laryngectomy.4 Laryngoscope, 132:1582-1587, 2022.

Objective The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool. Although concurrent chemoradiotherapy (CCRT), particularly cisplatin-based CCRT, is a standard treatment for locoregional advanced head and neck squamous cell carcinoma (HNSCC), the predictive factors of adverse events related to CCRT remain to be elucidated. The present study aimed to determine the association between GNRI and CCRT-related adverse events in patients of all ages with head and neck cancer (HNC) who underwent CCRT. Methods We retrospectively analyzed and compared the clinical characteristics and adverse events of 82 patients with HNC treated with CCRT according to their GNRI at the Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba Hospital, between May 2014 and November 2019. The GNRI was calculated according to the equation: 1.489 × serum albumin (g/L) + 41.7 × (body weight/ideal body weight). We compared two groups: low GNRI (GNRI Results Eighty-two patients were enrolled in this study. There were 61 (76%) and 21 (26%) patients in the normal GNRI group and low GNRI group, respectively. There were significant differences in the incidence of grade ≥ 3 radiation mucositis, radiation dermatitis, and leukopenia between the low GNRI group and the normal GNRI groups. Conclusions Patients with low GNRI scores were more likely to have severe adverse events. Pretreatment GNRI predicted severe CCRT-related adverse events in patients of all ages with HNC undergoing CCRT.

This study was aimed at understanding diabetes knowledge, health beliefs, and behaviors among type 2 diabetes patients in Balinese rural areas. The study used the Health Belief Model (HBM) in applied thematic analysis. It involved semi-structured focus groups with 20 patients (M = 49.95 years old, SD 6.7). Three themes formulated: poor diabetes knowledge, diabetes perceived as a life burden, and the factors affecting self-efficacy in practicing healthy lifestyle. The poor diabetes knowledge was due to traditional indigenous beliefs and low health literacy. The perception that diabetes is a life burden was related with physical and psychological condition. The factors affecting the self-efficacy were the perceived barriers and external influence. It is need to understand the traditional indigenous beliefs, burdens, and lacking internal intention as the modifying factors of health beliefs. This study suggests that the development of integrated health promotion of diabetes should consider the HBM’s modifying factors in rural areas.

Vestibular schwannomas usually originate in the internal acoustic meatus, and gradually extends into the cerebellopontine cistern. Invasive growth into the petrous bone is extremely rare. We describe a case of a vestibular schwannoma that aggressively extended into the petrous bone and extracranial space. This may have arisen because of an unusually peripheral site of origin on the vestibular nerve.

BACKGROUND We evaluated the prognostic potential of the combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) in patients with advanced head and neck cancer. METHODS We proposed a modified COP-NLR scoring system defined as follows: score 0 (platelet count level

Aim To identify attributes of nurses' workplace social capital in Japan. Background Much attention has been paid to nurses' workplace social capital to improve the quality of the work environment; however, few studies are available on the attributes of nurses' workplace social capital. Methods Semi-structured interviews were conducted with 32 nurses at seven hospitals. Nurses reported on the attributes of workplace social capital, such as characteristics facilitating individual positive action in an organisation, which were qualitatively analysed using the Kawakita Jiro method. Results The attributes of nurses' workplace social capital were organised into six groups: affirmation; exchange of appreciation; unrestricted information sharing; ability to trust; access to the strength; and altruistic reciprocity. Conclusion The attributes of nurses' workplace social capital included a social structure that allowed nurses to make full use of their abilities both vertically and horizontally and were supported by a sense of security. In particular, newly emerged exchange of appreciation and altruistic reciprocity were important for nurses in Japan in building cooperative relationships with others. Implications for Nursing Management Managing human relationships, such as exchange of appreciation and altruistic reciprocity, in clinical settings based on nurses' workplace social capital may promote positive emotions in the organisation, positive ideas among staff and cooperative teamwork, which may lead to high-quality patient care.

Objective The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC. Study design Retrospective cohort study. Methods Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI 98). The primary endpoint was overall survival. Results A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]). Conclusions The GNRI could be considered a useful prognostic factor in patients with AHNC. Level of evidence 4 Laryngoscope, 131:E151-E156, 2021.

To determine the prognostic factors for hearing recovery in patients with sudden sensorineural hearing loss (SSHL) refractory to systemic corticosteroids following salvage treatment.This is a retrospective observational study at nine tertiary referral hospitals. A total of 120 patients with sudden deafness refractory to systemic corticosteroids were enrolled. The patients were randomly assigned to receive topical application of recombinant human IGF-1 or intratympanic injection of dexamethasone as salvage treatment. Multiple regression analysis was performed to identify determinants of hearing recovery using pure tone audiometry results at 8 weeks after treatment. Clinical predictors that were evaluated included age, sex, pretreatment hearing level, presence of vertiginous symptoms, days to study entry from symptom onset and salvage treatment assignment (IGF-1 vs. dexamethasone).The linear regression model identified age (P=0.001), pretreatment hearing level (P0.001), days to study entry from symptom onset (P=0.011) and treatment assignment (P=0.033) at 8 weeks after treatment as significant variables influencing the recovery of pure tone audiometry average thresholds. Younger age (60 years), early initiation of salvage treatment and treatment with topical IGF-1 therapy had significant effects on hearing recovery.The results indicate that early initiation and choice of treatment modalities for salvage treatment may be important for the prognosis of patients with refractory SSHL. The positive effect of topical IGF-1 therapy on hearing recovery indicates its utility as salvage treatment.

The intraoral stent (IOS) is an individualized mouth opening device that can be used during radiotherapy (RT) for head and neck cancer to prevent unnecessary irradiation to normal tissues. The purpose of the present study was to compare the severity of oral mucositis (OM) between patients using and not using an IOS during RT for maxillary and nasal cavity cancer.We designed and implemented a retrospective cohort study. The study sample included patients with maxillary and nasal cavity cancer who had undergone RT. The primary predictor variable was IOS application, and the outcome variable was the grade of OM.The IOS group included 18 patients with an IOS and the control group, 16 patients without an IOS. The parameters of the dose-volume histogram included the median dosage covering 1 mL (D1mL) for the tongue and the mean dosage. The D1mL (36.2 vs 65.4 Gy) and mean dosage (4.9 Gy vs 25.9 Gy) were both significantly lower in the IOS group than in the control group (P .005). The incidence of OM using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were significantly different between the oral stomatitis grade and the use of an IOS (P = .028). A significant difference was found in opioid use between the IOS and control groups (P = .009).The use of an IOS decreased the radiation dosage to the tongue, the grade of OM, and opioid usage during RT.

Sphingolipid metabolites including ceramide, sphingosine (Sph), and sphingosine-1-phosphate (S1P) play important roles in the regulation of cell survival and death. Sphingosine kinase (Sk) phosphorylates Sph to S1P. Sk is reportedly overexpressed in various cancer cells, and Sk inhibitors are therefore a target of anti-tumor therapy. However, the effects of Sph and Sk inhibitors on cochlear hair cells were unknown. In the present study, expression of Sk isotypes in the cochlea was examined. In addition, the changes in Sk activity induced by cisplatin (CDDP) and the effects of an Sk inhibitor, Sph, and S1P on CDDP ototoxicity were investigated using tissue culture techniques. Cochleae were dissected from Sprague–Dawley rats on postnatal days 3–5. Organ of Corti explants were exposed to 5 lM CDDP for 48 h with or without the Sk inhibitor, Sph, or S1P. Both Sk1 and Sk2 were expressed in the normal cochlea. CDDP activated Sk. The Sk inhibitor itself caused hair cell loss at a high concentration, and at lower concentrations, it increased CDDP-induced hair cell loss. Sph itself also induced hair cell death and increased hair cell loss induced by CDDP. However, S1P decreased hair cell loss induced by CDDP. Sk inhibitor has the function by increasing ototoxic Sph and decreasing otoprotective S1P and therefore potentially causes ototoxicity. Consideration of the possibility of ototoxicity is required in the usage of Sk inhibitors.

Ceramide, a sphingolipid metabolite, regulates diverse cellular processes including apoptosis, cell senescence, the cell cycle, and cellular differentiation. Exogenously administered ceramide reportedly increased cochlear hair cell death due to gentamicin-induced ototoxicity. Ceramide is mainly generated via a ceramide/sphingomyelin cycle by sphingomyelinase and sphingomyelin synthase or via de novo synthesis by serine palmitoyltransferase and ceramide synthase. This study was designed to investigate the possible involvement of neutral sphingomyelinase, sphingomyelin synthase, or serine palmitoyltransferase in hair cell death due to gentamicin. The basal turns of the organ of Corti of Sprague–Dawley rats were dissected on postnatal days 3–5. Cochlear cultures were exposed to media containing 35 μM gentamicin for 48 h to assess the effects of GW4869 (a neutral sphingomyelinase inhibitor), 2-hydroxyoleic acid (a sphingomyelin synthase activator), and myriocin (a serine palmitoyltransferase inhibitor). Hair cell loss was significantly decreased in the presence of GW4869 or 2-hydroxyoleic acid. Myriocin had no significant effects against gentamicin-induced hair cell loss. In addition, neutral sphingomyelinase was activated by gentamicin exposure. The present findings strongly suggest that the ceramide/sphingomyelin cycle plays an important role in the protection of hair cells against gentamicin-induced ototoxicity.

Background and objective Sphingolipid metabolites, including ceramide, sphingosine, and their phosphorylates (ceramide-1-phosphonate [C1P] and sphingosine-1-phosphate [S1P]), regulate diverse cellular processes including apoptosis, the cell cycle, and cellular differentiation. Recent studies have shown that these sphingolipid metabolites are generated in response to ototoxic agents and play important roles in determining the fate of cochlear hair cells in ototoxic injury. Methods This review summarizes the current knowledge on the roles of sphingolipid mediators in cochlear ototoxicity. Results During ototoxicity, ceramide is mainly generated via sphingomyelinase in the cochlea through a ceramide/sphingomyelin cycle from sphingomyelin. The generated ceramide is converted to other sphingolipid mediators. Ceramide and sphingosine accelerate cochlear hair cell death induced by ototoxic agents, while, C1P and S1P, on the other hand, protect cochlear hair cells. Hair cell protection of S1P is mediated by S1P receptor subtype 2 (S1PR2). Conclusion Sphingolipid mediators play important roles in cochlear hair cell survival or death in ototoxic injury.

Sphingosine-1-phosphate (S1P) is a sphingolipid metabolite that regulates various critical biological processes, such as cell proliferation, survival, migration, and angiogenesis. The action of S1P is exerted by its binding to 5 specific G protein-coupled S1P receptors (S1PR), S1PR1-S1PR5. Aminoglycoside antibiotics including gentamicin induce cochlear hair cell loss and sensorineural hearing loss. Apoptotic cell death is considered to play a key role in this type of cochlear injury. S1P acts as a cochlear protectant against gentamicin ototoxicity. In the present study, expression of S1PRs in the cochlea was examined. In addition, the effects of S1PR antagonists on gentamicin ototoxicity were investigated using tissue culture techniques. Cochleas were dissected from Sprague-Dawley rats on postnatal days 3-5. Basal turn organ of Corti explants were exposed to 35 μM gentamicin for 48 h with or without S1PR antagonists. S1PR(1-3) were expressed in the organ of Corti and spiral ganglion. The S1PR2 antagonist increased gentamicin-induced hair cell loss, while the S1PR1 and S1PR3 antagonists did not affect gentamicin ototoxicity. These results indicate the possibility that S1P act as a cochlear protectant against gentamicin ototoxicity via activation of S1PR2.

Facial palsy, salivary leakage and postoperative bleeding are the main complications in parotid gland surgery. To find ways to reduce the occurrence of these complications, we compare traditional methods using the hand-tie ligation technique with a bipolar electrode knife against LigaSure TM Small Jaw, a newly developed vessel sealing device, in parotid gland operations.

Authors reported a case of cholesteatoma that mimicked facial neurinoma. To avoid confusion in such cases, diffusion-weighted MRI may be useful in preoper-ative differential diagnosis.

Objective Peroxiredoxin (Prx) is a new family of antioxidative proteins. Prx I is ubiquitously expressed in various tissues and is important in the defense of tissues from increases in reactive oxygen species (ROS). The present study was designed to examine the expression of Prx subtypes in the mouse cochlea and to show the possible involvement of Prx I in protecting the cochlea against cisplatin ototoxicity. Methods Postnatal-day-3-to-5 wildtype mice and Prx I-deficient mice were used. Prx expression in the cochlea was assessed by real-time PCR assay. Prx I protein expression was examined by immunofluorescence staining. Cochlear explants were exposed to 2, 5, and 10-μM cisplatin for 48 h, and the cochlear hair cell losses of the wildtype and Prx I-deficient mice were compared. In addition, the histologic features of the cochlear lateral wall were examined after cisplatin incubation. Results mRNAs of all Prx subtypes were expressed in the mouse cochlea. Prx I was one of the abundant subtypes and was upregulated after 48-h exposure to 5-μM cisplatin. Immunofluorescence staining showed the ubiquitous expression of Prx I in the cochlea. No difference in cochlear hair cell loss induced by cisplatin was found between the wildtype mice and the Prx I-deficient mice. However, spiral ligament fibrocytes of Prx I-deficient mice were significantly sensitive to cisplatin at 20-μM or lower. Conclusion Prx I is important for protection of at least the spiral ligament fibrocytes of the cochlear lateral wall in cisplatin ototoxicity.

Purpose To investigate the clinical features, prognostic factors, and toxicity of treatment for unresectable carcinomas of the nasal cavity and paranasal sinus (NCPS) treated with proton beam therapy (PBT). Methods and Materials Seventeen patients (13 men, 4 women) with unresectable carcinomas of the NCPS who underwent PBT at the University of Tsukuba between 2001 and 2007 were analyzed. The patients' median age was 62 years (range, 30–83 years). The tumors were located in the nasal cavity in 3 patients, the frontal sinus in 1, the ethmoid sinus in 9, and the maxillary sinus in 4. The clinical stage was Stage IVA in 5 cases, IVB in 10, and recurrent in 2. The tumors were deemed unresectable for medical reasons in 16 patients and because of refusal at a previous hospital 4 months earlier in 1 patient. All the patients received PBT irradiation dose of 22–82.5 GyE and a total of 72.4–89.6 GyE over 30–64 fractions (median 78 GyE over 36 fractions) with X-ray, with attention not exceeding the delivery of 50 GyE to the optic chiasm and brainstem. Results The overall survival rate was 47.1% at 2 years and 15.7% at 5 years, and the local control rate was 35.0% at 2 years and 17.5% at 5 years. Invasion of the frontal or sphenoid sinus was a prognostic factor for overall survival or local control. Late toxicity of more than Grade 3 was found in 2 patients (brain necrosis in 1 and ipsilateral blindness in 1); however, no mortal adverse effects were observed. Conclusion Proton beam therapy enabled a reduced irradiation dose to the optic chiasm and brainstem, enabling the safe treatment of unresectable carcinomas in the NCPS. Superior or posterior extension of the tumor influenced patient outcome.

平成13年の医師法の一部改正により聴覚障害者が医師になることが可能となった。しかし, 医学教育で求められる極めて多くの情報を, どのように聴覚障害医学生に伝えるかという方法論は確立されておらず, 公的な支援制度もない。我々は, 上記の医師法改正後, 全国で3人目となる聴覚障害医学生を受け入れた。様々な関係団体と協力し, 本人の日常コミュニケーション手段である手話あるいはパソコン要約筆記を用いて情報保障に努めた。講義にはパソコン要約筆記が, 臨床実習では手話通訳が有効であった。しかし, 専門用語など特殊な内容が多いため, 対応可能な手話通訳者の養成と確保などの課題も明らかとなった。スムーズな支援のためには, 1) リーダーシップ, 2) きめ細かな連絡, 3) 信頼関係が鍵になると考えられた。個々の障害学生の希望と教育環境によって対応は変わってくると考えられるが, このような経験が蓄積, 共有され, 今後の聴覚障害学生教育の一助となることを希望し報告する。