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Through a questionnaire survey of teachers of special classes for children with low vision in Japan’s primary and lower secondary schools, this study aims to clarify the basic data of children in these classes, the realities of their learning situations, and the realities of the instruction they receive from their teachers. A special class for children with low vision is a class specially organised in primary and lower secondary schools to deliver an education that is appropriate to children with low vision. Basic data items for children covered grade, sex, and visual acuity and also the written characters, low-vision devices, and textbooks that they use in their studies. The survey also elicited responses about the information and communication technology (ICT) devices that teachers use in their teaching, their number of years’ teaching experience, their number of years’ experience teaching children who are visually impaired, and the content or topic of training that they desire to improve their specialisation in the education of children who are visually impaired. In addition to obtaining statistics on basic items related to children’s sex and visual acuity, the results revealed change in children’s actual situations over the years through comparison with the results of previous studies. Specifically, the percentage of children with visual acuity under 20/66 increased, and the usage rate of braille decreased. We also learned that while usage rates of enlarged textbooks and ICT devices are increasing, the rate of using low-vision devices is decreasing. In addition, it was revealed that a majority of teachers had less than 3 years’ experience in education for children who are visually impaired, regardless of general teaching experience, and that there is a considerable need for training in basic knowledge.

Highlights • Incidence of endometrial cancer has shown a remarkable increase globally. • Case of an obese patient who underwent panniculectomy combined surgical staging. • Combination of panniculectomy was effective for surgery in obese patients., Introduction Panniculectomy is regarded as an effective approach in highly obese patients with endometrial cancer to improve surgical access or space of the surgical field. Presentation of case A 66-year-old nulliparous woman was brought in from another hospital to our institute for newly diagnosed endometrial carcinoma. The patient was 158 cm in height and weighed 135.8 kg during the first visit to our hospital. Her body mass Index (BMI) was 54.4 kg/m2. Unfortunately, the patient developed an umbilical hernia and strangulation before the surgery. Emergency partial ileal resection and simple closure of the umbilical hernia were performed. We were finally able to perform simple hysterectomy, and bilateral salpingo-oophorectomy with panniculectomy. Her weight at the time of surgery was 115.5 kg which had been reduced by 20 kg from the time she was first brought in, and the BMI decreased from 54.4 to 45.3 kg/m2. The patient underwent follow-up without adjuvant therapy since she was in the low-risk group, and showed no signs of recurrence 12 months after surgery. Discussion There are various risks associated with surgery in highly obese patients. Diabetes mellitus, hypertension and smoking are reported to be risk factors of wound complication in panniculectomy, and it was reported that diabetes mellitus was an independent risk factor. Conclusion The combination of panniculectomy was considered as an effective approach to perform safe surgery for obese patients.

Bevacizumab (Bev) is an antiangiogenic drug used to treat various malignances, including ovarian cancer (OC). Bev is generally well-tolerated; however, it has a characteristic toxicity profile. In particular, gastrointestinal perforation (GIP) is a rare but serious side effect that can be lethal. A 55-year-old woman with recurrent OC had an episode of GIP during third-line chemotherapy comprising Bev and topotecan (TPT). Bev was discontinued while TPT was continued as monotherapy. Three months after discontinuation of Bev, the patient presented with left lower abdominal pain and was diagnosed with a second GIP. She had emergent surgery. One year later, she is still alive and healthy, and is continuing TPT. This is the first report of recurrent GIP after discontinuation of Bev. Our case suggests that physicians should be aware of GIP even after the discontinuation of Bev., Highlights • Recurrent perforation after discontinuation of Bevacizumab in ovarian cancer • Early diagnosis of intestinal perforation is crucial for preventing sepsis peritonitis. • CT scan can lead to an earlier diagnosis of gastro-intestinal perforation.

Background/aim Treatments for controlling delayed nausea after chemotherapy are inadequate, potentially inciting malnutrition. We sought to determine the incidence of nausea, anorexia, and food intake after chemotherapy. Patients and methods Subjects were females with gynecological cancers who underwent chemotherapy between 2008 and 2013. Nausea, anorexia, and food intake in the acute (day 1) and delayed phases (days 2 and 3) were retrospectively evaluated. Results Subjects included 156 females. Chemotherapies were highly (HEC; n=24) and moderately emetogenic (MEC; n=132). There were no significant between-group differences for anorexia control during either the acute or the delayed phase and both groups demonstrated significantly worse control of nausea during the delayed phase. In the HEC group, food intake was significantly reduced on days 2 and 3 compared with day 1. Conclusion Rates of nausea, anorexia, and food intake significantly worsened over time, particularly in the MEC group. Current supportive therapies appear inadequate and should be improved.

There are few studies on serum vascular endothelial growth factors and receptors (VEGF/VEGFRs) in patients with uterine cervical cancer (CC). The aim of this study was to determine whether VEGF/VEGFRs could be used as prognostic biomarkers in patients with CC. A total of 107 patients with stage IB to IIB CC, who underwent radical hysterectomy at Tottori University Hospital between 2006 and 2015, were included in this study. Serum samples were collected prior to radical hysterectomy, and levels of VEGF-A, VEGF-C, VEGFR-1, and VEGFR-2 were analyzed by enzyme-linked immunosorbent assays. We evaluated the association between the levels of these angiogenic factors and clinicopathologic variables. Survival analysis of 93 patients treated between 2006 and 2013 was performed. The levels of VEGF-A in patients with bulky tumor, pelvic lymph-node involvement (PLNI), and parametrial infiltration (PI) were significantly higher than those in patients without these factors (P = 0.022, P = 0.020, and P = 0.0013, respectively). The overall survival (OS) of patients with high VEGF-A and VEGFR-2 defined by median levels was significantly lower than the OS of patients with low levels of VEGF-A and VEGFR-2 (P = 0.014, P = 0.012, respectively). Multivariate analysis revealed that PLNI, serum VEGF-A levels, and serum VEGFR-2 levels were independent prognostic factors for OS (hazard ratio for VEGF-A 3.42, 95% CI 1.07–13.2; hazard ratio for VEGFR-2 6.37, 95% CI 1.59–43.5). Our results suggest that serum VEGF-A and VEGFR-2 may be promising prognostic biomarkers for CC.

Objective: National health insurance coverage for the laparoscopic staging surgery for patients with stage IA endometrial cancer started from April 2014 in Japan. We conducted this retrospective study to evaluate the surgical outcomes of the laparoscopic surgery for patients with low-risk endometrial cancer compared with those of the laparotomy. Materials and methods: A total of 120 patients with presumed low-risk endometrial cancer, who were treated at Tottori University Hospital between 2005 and 2016, were eligible for this study. The laparoscopic staging surgery included only the pelvic lymphadenectomy and not the para-aortic lymphadenectomy. We evaluated the discrepancy between preoperative presumption and postoperative diagnosis of recurrent risk factors. Results: Forty patients underwent the laparoscopic surgery and 80 patients received the laparotomy. The laparoscopic surgery resulted in less intraoperative blood loss and shorter hospital stay. The operative time was significantly longer for the laparoscopic surgery compared with the laparotomy, but this difference was not seen in obese patients with a body mass index ≥30 kg/m2. The type of the surgical procedure did not affect the incidence of perioperative complications. Among 120 patients, 104 (86.6%) were diagnosed as FIGO stage IA, 118 (98.3%) with endometrioid adenocarcinoma grade 1 or 2, and 107 (89.1%) with myometrial invasion depth

Objectives: The aim of this study was to evaluate the diagnostic significance of high-risk human papillomavirus (hrHPV) testing for managing women with atypical glandular cells (AGC) and to explore the distribution of hrHPV genotypes. Methods: We analyzed cytologic and histopathologic diagnoses in patients referred to our institution due to AGC or atypical squamous cells of undetermined significance (ASC-US). All patients underwent hrHPV testing and genotyping, and positive (PPV) and negative predictive values (NPV) for cervical intraepithelial neoplasia (CIN) 2 or worse [CIN2+/adenocarcinoma in situ (AIS)+] were calculated. Results: Among 41 cases previously diagnosed with AGC, 22 (53%) were classified as CIN2+ (2 squamous cell carcinomas), whereas only 2 were AIS or adenocarcinoma. Twenty-seven (65.8%) cases in the AGC group were hrHPV positive. The most frequent genotypes in both the ASC-US and AGC groups were HPV16 and HPV52. The PPV of hrHPV testing for CIN2+/AIS+ was significantly higher in the AGC than in the ASC-US group (74.1 vs. 35.0%; p = 0.0005). The NPV for CIN2+/AIS+ was significantly lower in the AGC than in the ASC-US group (74.4 vs. 100%; p = 0.0441). Conclusion: In patients with AGC, both glandular and squamous lesions must be monitored. hrHPV testing is useful for detecting CIN2+/AIS+ in AGC.

BackgroundBevacizumab, which targets vascular endothelial growth factor (VEGF)-A, has recently been proven to be effective for the treatment of epithelial ovarian cancer (EOC). Thus, interest in VEGF-A has increased. There are few reports on concomitant detection of both ligands and its soluble receptors in serum samples, and the significance of serum VEGF-A in EOC is unclear, unlike the situation with tissue samples. We conducted the present study to explore the levels of serum VEGF family and its receptors and to evaluate their utility as prognostic biomarkers.MethodsA total of 128 patients with EOC, who were consecutively treated at Tottori University Hospital between 2006 and 2012, were included. Blood samples were collected before initial surgery. Serum concentrations of VEGF-A, VEGF-C, VEGFR-1, and VEGFR-2 were analyzed by enzyme-linked immunosorbent assay. We also examined the mRNA and protein expression of VEGF-A in tumor tissue from 30 cases by real-time reverse transcription polymerase chain reaction and immunohistochemistry.ResultsThe levels of VEGF-A in patients with stage III/IV disease were significantly higher than those with stage I/II disease (P = 0.0036). On the other hand, the level of VEGFR-2 in stage III/IV was significantly lower than that in stage I/II (P = 0.0026). With the cutoff value of VEGF/VEGFRs at the median level, the overall survival (OS) for patients with high VEGF-A levels was significantly lower than those with low levels (P = 0.015). Patients with high VEGFR-2 levels showed better prognosis than those with low VEGFR-2 levels (P = 0.023). Multivariate analysis revealed that International Federation of Gynecology and Obstetrics stage and serum VEGF-A were independent prognostic factors for OS [hazard ratio 2.01, 95% confidence interval (1.13–3.63), P = 0.017]. There was no significant correlation between mRNA or protein expression and serum levels of VEGF-A.ConclusionsSerum VEGF-A is an independent prognostic factor for OS in patients with EOC, implying that serum VEGF-A is a prognostic biomarker for EOC. Further study to validate the data is needed.

To design a method for predicting outbreaks of paralytic shellfish poisoning (PSP) in scallop fishing grounds, the relationship between the distribution of the toxic dinoflagellate Alexandrium tamarense and the dynamics of the Soya Warm Current (SWC) was examined in the Okhotsk Sea off Hokkaido. Surveys were conducted from May to June to clarify the transportation mechanism of A. tamarense from the oceanic area to the coastal area. The sea-level difference (SLD) between Wakkanai and Abashiri was monitored as an index of the strength of the SWC southeastward flow in an alongshore belt to examine the possible occurrence of A. tamarense in the coastal area during temporal weakening of the SWC. A bottom-mounted acoustic Doppler current profiler (ADCP) was used for direct observations of the SWC. The results indicated that PSP occurred when low-salinity water contaminated with A. tamarense extended to the coast during temporal weakening of the SWC due to a decrease of the SLD. Our results strongly indicate that predictions can be realized by monitoring the decrease of SLD as an index of temporal weakening of the SWC after surveys of the distribution of A. tamarense in the oceanic area before the period of PSP occurrence.

To investigate the mechanisms influencing the spatial distribution of the toxic dinoflagellate Alexandrium tamarense in the Okhotsk Sea off Hokkaido, Japan, intensive field surveys were conducted at 34–37 stations in late July every year from in 2002–2007. Alexandrium tamarense occurred every year. However, the abundance of A. tamarense fluctuated year by year, with extremely low cell densities of A. tamarense in 2005. High abundances of A. tamarense were found frequently in the oceanic area of the surface low-salinity water (LSW, salinity≤32.5) and the mixed water (MW). Low abundances were found along the coastal area of the Soya Warm Current (SWC, salinity≥33.6) and in the dichothermal water (DTW, temperature≤2°C) in the layer of oceanic areas deeper than 30 m. The PO4-P concentration in each water mass was in the order DTW>MW>LSW>SWC and the lowest PO4-P concentration that occurred in the SWC is considered to be a potential limiting factor for the growth of A. tamarense. The reason for the low A. tamarense abundance in the DTW is considered to be the low water temperature and low light intensity. It is concluded that the water mass of LSW has favorable conditions for the growth of A. tamarense. The relative frequency of each water mass fluctuated every year and the results suggest that the frequency of occurrence of the LSW and MW is one of the most significant factors controlling the abundance of A. tamarense in the area.

Objective: Angiogenesis is one of the processes that is critical for the growth, invasion and metastasis of solid tumors, including uterine cervical cancer (CC). The vascular endothelial growth factor (VEGF) family is one of the major pathways involved in tumor angiogenesis. The aim of this study was to determine whether serum levels of these angiogenic factors could be used as biomarkers in patients with CC.Methods: A total of 107 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB to IIB CC who were treated at Tottori University Hospital between 2006 and 2015 were enrolled in this study. The study was approved by the Institutional Review Board of the School of Medicine of Tottori University. All patients gave written informed consent before the collection of specimens according to institutional guidelines. Serum samples were collected before initial surgery and levels of VEGF-A, -C, VEGFR-1, and VEGFR-2 were analyzed by enzyme-linked immunosorbent assay (ELISA). We evaluated the association between the levels of these angiogenic factors and clinicopathologic variables. With a median follow-up duration of 1743 days, survival analysis of 93 patients treated between 2006 and 2013 was performed. We also determined the mRNA expression of VEGF-A by real-time RT-PCR in fresh frozen tumors and the protein expression by immunohistochemical staining in paraffin-embedded tumors from CC patients. The mRNA levels of VEGF-A relative to GAPDH were used for the analysis.Results: Median levels of serum VEGF-A, -C, VEGFR-1, and VEGFR-2 were 313, 8122, 68, and 6210 pg/ml, respectively. We found a significant positive correlation between VEGF-A levels and the maximum tumor diameter (P=0.010). Patients with pelvic lymph node involvement (PLNI) showed significantly higher levels of VEGF-A and VEGFR-2 than those without PLNI. Patients with bulky tumor or parametrial infiltration (PI) also showed significantly higher levels of VEGF-A. In contrast, patients with a bulky tumor or PLNI showed significantly lower levels of VEGFR-1. Both histological types and FIGO stage were not related to levels of these angiogenic factors. We set the cutoff values of these factors at the median levels of the angiogenic factors. The 5-year overall survival rate (OS) for patients with high VEGF-A levels was significantly lower than those with low levels (92.9% vs. 72.8%, P = 0.014). The 5-year OS for patients with high VEGFR-2 levels was significantly lower than those with low levels (94.7% vs. 73.8%, P = 0.012). PLNI and PI were prognostic factors for overall survival. Multivariate analysis revealed that PLNI, VEGF-A, and VEGFR-2 levels were independent prognostic factors. The mRNA and protein expressions of VEGF-A were strongly observed in the cancer cells. There was no correlation between mRNA levels and serum levels of VEGF-A.Conclusion: These results suggest that serum VEGF-A may be a promising prognostic biomarker for CC. Citation Format: Daiken Osaku, Tetsuro Oishi, Mayumi Sawada, Hiroaki Komatsu, Jun Chikumi, Akiko Kudoh, Michiko Nonaka, Shinya Sato, Muneaki Shimada, Hiroaki Itamochi, Tasuku Harada. Comprehensive analysis of serum levels of VEGF and its receptors in patients with uterine cervical cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5735. doi:10.1158/1538-7445.AM2017-5735

The present study aimed to investigate the influence of the weight of white canes on upper limb load. Concretely, we conducted quantitative evaluations of the load on upper limb muscles during swinging action of the cane. The white canes used were a new type of white cane newly fabricated using aramid fibers, as well as a conventional type of white cane fabricated using carbon fibers. The results indicated that the newly developed cane reduced the load on the muscles by about 50% in comparison with the conventional type of cane. It became clear that it was possible to sustain the same posture even when used continuously over a long period of time.

Objective: Angiogenesis is one of the processes that is critical for the growth, invasion and metastasis of solid tumors, including uterine cervical cancer (CC). The vascular endothelial growth factor (VEGF) family is one of the major pathways involved in tumor angiogenesis. The aim of this study was to determine whether serum levels of these angiogenic factors could be used as biomarkers in patients with CC. Methods: A total of 115 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB to IIB CC who were treated at Tottori University Hospital between 2006 and 2015 were enrolled in this study. The study was approved by the Institutional Review Board of the School of Medicine of Tottori University. All patients gave written informed consent before the collection of specimens according to institutional guidelines. Serum samples were collected before initial surgery and levels of VEGF-A, -C and VEGFR1 were analyzed by enzyme-linked immunosorbent assay (ELISA). We evaluated the association between the levels of VEGF-A, -C, and VEGFR1 and clinicopathologic variables. Survival analysis was performed with 86 patients treated between 2006 and 2013. We also determined the mRNA expression VEGF-A, -C, and VEGFR1 by real-time RT-PCR in fresh frozen tumors and the protein expression by immunohistochemical staining in paraffin-embedded tumors from CC patients. Results: The mRNA and protein expressions of VEGF-A, -C, and VEGFR1 were strongly observed in the cancer cells. Median levels of serum VEGF-A, -C and VEGFR1 were 313, 8404 and 67.2 pg/ml, respectively. The levels of VEGF-A in patients with lymph node involvement were significantly higher than those in patients without it. On the contrary, the levels of VEGFR1 in patients with lymph node involvement were significantly lower than those in patients without it. Both histological types and FIGO stage were not related to levels of these angiogenic factors. We found a significant positive correlation between VEGF-A levels and the maximum tumor diameter. There was a significant negative correlation between VEGFR1 levels and the maximum tumor diameter. The overall survival rate was significantly lower in FIGO stage IIB than stage IB- IIA patients. We set the cutoff value of these factors at the median levels of each angiogenic factors. The 5-year survival rate for patients with high VEGF-A levels was significantly lower than those with low levels (92.9% vs. 72.8%, P = 0.014). Both VEGFR1 and VEGF-C levels were not related to outcome of patients. Multivariate analysis revealed that serum VEGF-A level and FIGO stage were independent prognostic factors. Conclusion: These results suggest that serum VEGF-A may be a promising prognostic biomarker for CC. Citation Format: Mayumi Sawada, Tetsuro Oishi, Hiroaki Komatsu, Hiroaki Itamochi, Michiko Nonaka, Seitya Sato, Jun Chikumi, Sinya Sato, Sinya Sato, Muneaki Shimada, Tasuku Harada. Serum VEGF-A may predict prognosis in patients with uterine cervical cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3386.

Objective: Angiogenesis is one of the processes that is critical for the growth, invasion and metastasis of solid tumors, including epithelial ovarian cancer (EOC). The vascular endothelial growth factor (VEGF) family is one of the major pathways involved in tumor angiogenesis. The aim of this study was to determine whether serum levels of these angiogenic factors could be used as biomarkers in patients with EOC. Methods: A total of 133 patients with EOC who were treated at Tottori University Hospital between 2006 and 2014 were enrolled in this study. The study was approved by the Institutional Review Board of the School of Medicine of Tottori University. All patients gave written informed consent before the collection of specimens according to institutional guidelines. Serum samples were collected before initial surgery and levels of VEGF-A, -C and VEGFR1 were analyzed by enzyme-linked immunosorbent assay (ELISA). We evaluated the association between the levels of VEGF-A, -C, and VEGFR1 and clinicopathologic variables. We also determined the mRNA expression VEGF-A, -C, and VEGFR1 by real-time RT-PCR in fresh frozen tumors and the protein expression by immunohistochemical staining in paraffin-embedded tumors from EOC patients. Additionally, serum samples were collected before and after bevacizumab treatment, and levels of angiogenic factors were examined. Results: The mRNA and protein expressions of VEGF-A, -C, and VEGFR1 were strongly observed in the cancer cells. Median levels of serum VEGF-A, -C and VEGFR1 were 284, 4861 and 417 pg/ml, respectively. The levels of VEGF-A ans VEGFR1 in patients at stage III-IV were significantly higher than those in patients at stage I-II. Both histologic subtypes and lymph node involvement were not related to levels of these angiogenic factors. We found a significant positive correlation between VEGF-A levels and the ascitic volume. The overall survival rate was significantly lower in FIGO stage III or IV patients with EOC. We set the cutoff value of these factors at the median levels of each angiogenic factors. The 5-year survival rate for patients with high VEGF-A levels was significantly lower than those with low levels (60.7% vs. 45.5%, P = 0.029). Both VEGFR1 and VEGF-C levels were not related to outcome of patients. Multivariate analysis revealed that serum VEGF-A level and FIGO stage were independent prognostic factors. VEGF-A levels dramatically decreased after treatment with bevacizumab. Conclusion: These results suggest that serum VEGF-A may be a promising prognostic biomarker for EOC. Further study is needed to determine if could be predictive biomarker. Citation Format: Hiroaki Komatsu, Tetsuro Oishi, Hiroaki Itamochi, Mayumi Sawada, Michiko Nonaka, Seiya Sato, Jun Chikumi, Shinya Sato, Muneaki Shimada, Tasuku Harada. Serum VEGF-A may predict prognosis in patients with epithelial ovarian cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3387.