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Quality indicators for cervical cancer care in Japan
Tomone Watanabe,Mikio Mikami,Hidetaka Katabuchi,Shingo Kato,Masanori Kaneuchi,Masahiro Takahashi,Hidekatsu Nakai,Satoru Nagase,Hitoshi Niikura,Masaki Mandai,Yasuyuki Hirashima,Hiroyuki Yanai,Wataru Ya 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6
Objective: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. Methods: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. Results: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p<0.001), recurrent urinary tract infections (p=0.013), and leg lymphedema (p=0.038). Age over 50-year (HR=9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR=7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR=5.13; 95% CI, 1.38–19.1) and DSS (HR=5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p=0.046), but no impact on survival. Conclusion: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC. Objective: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. Methods: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. Results: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. Conclusion: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
Kazuki Tagawa,Mikio Watanabe,Tetsukazu Yahara 한국응용곤충학회 2018 Journal of Asia-Pacific Entomology Vol.21 No.3
Carnivorous plants are major predators of small insects in some habitats. Because traps of carnivorous plants are serious threats for small insects, it is probable to evolve a mechanism to sense a cue of carnivorous plants and avoid being trapped. However, such a sensing behavior of small insects has never been described. Here we report that a hoverfly species Sphaerophoria menthastri, a major pollinator species of carnivorous sundew Drosera toyoakensis, exhibits a behavior to sense a cue of trap leaves and avoids landing there. In a quadrat (5m×5 m) where D. toyoakensis and other non-carnivorous plant species co-occur, we observed behaviors of hoverflies approaching D. toyoakensis and other plants. The numbers of approaches to trap leaves, flowers of D. toyoakensis, flowers of non-carnivorous Lysimachia fortunei and leaves of Poaceae and Cyperaceae were 9, 60, 52 and 54, respectively, and the numbers of landings to those four organs were 2, 55, 49 and 49, respectively. When S. menthastri approached trap leaves, almost all individuals successfully avoided landing there by 1 or 2 hesitation behaviors. These findings suggest that S. menthastri can sense the cue of trap leaves during an approach.
Accuracy and applicable range of a reconstruction technique for hybrid rockets
Nagata, Harunori,Nakayama, Hisahiro,Watanabe, Mikio,Wakita, Masashi,Totani, Tsuyoshi Techno-Press 2014 Advances in aircraft and spacecraft science Vol.1 No.3
Accuracy of a reconstruction technique assuming a constant characteristic exhaust velocity ($c^*$) efficiency for reducing hybrid rocket firing test data was examined experimentally. To avoid the difficulty arising from a number of complex chemical equilibrium calculations, a simple approximate expression of theoretical $c^*$ as a function of the oxidizer to fuel ratio (${\xi}$) and the chamber pressure was developed. A series of static firing tests with the same test conditions except burning duration revealed that the error in the calculated fuel consumption decreases with increasing firing duration, showing that the error mainly comes from the ignition and shutdown transients. The present reconstruction technique obtains ${\xi}$ by solving an equation between theoretical and experimental $c^*$ values. A difficulty arises when multiple solutions of ${\xi}$ exists. In the PMMA-LOX combination, a ${\xi}$ range of 0.6 to 1.0 corresponds to this case. The definition of $c^*$ efficiency necessary to be used in this reconstruction technique is different from a $c^*$ efficiency obtained by a general method. Because the $c^*$ efficiency obtained by average chamber pressure and ${\xi}$ includes the $c^*$ loss due to the ${\xi}$ shift, it can be below unity even when the combustion gas keeps complete mixing and chemical equilibrium during the entire period of a firing. Therefore, the $c^*$ efficiency obtained in the present reconstruction technique is superior to the $c^*$ efficiency obtained by the general method to evaluate the degree of completion of the mixing and chemical reaction in the combustion chamber.
( Takashi Hoshino ),( Toshifumi Watanabe ),( Yusuke Nakagawa ),( Hiroki Katagiri ),( Nobutake Ozeki ),( Toshiyuki Ohara ),( Mikio Shioda ),( Yuji Kono ),( Ichiro Sekiya ),( Hideyuki Koga ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-
Purpose: This study assessed the clinical outcomes of periprosthetic joint infection patients who underwent twostage revision total knee arthroplasty with antibiotic-loaded cement spacers fabricated using a handmade silicone mold. Materials and methods: This study included seven patients (average age 77 years, average follow-up time 54 months) who underwent surgery at our hospital between 2009 and 2013. Clinical outcomes including knee scores, function scores, knee range of motion, and walking ability at the final observation, period from the primary total knee arthroplasty to implant removal, period from implant removal to revision total knee arthroplasty, and followup period after revision total knee arthroplasty were investigated. Results: At the final follow-up, the average knee range of motion was 99°, with no significant differences at each stage; average knee and function scores were 84 and 77, respectively. With cement spacers, five patients were able to walk with a t-cane. No recurrence of infection was observed. Conclusions: The clinical outcomes of the current case series demonstrated good knee function with preserved walking ability, without any recurrence of periprosthetic joint infection. This study suggests that using a handmade silicone mold could be an effective option for periprosthetic joint infection after a total knee arthroplasty.
Koji Matsuo,Muneaki Shimada,Tsuyoshi Saito,Kazuhiro Takehara,Hideki Tokunaga,Yoh Watanabe,Yukiharu Todo,Kenichirou Morishige,Mikio Mikami,Toru Sugiyama 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.1
Objective: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. Methods: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. Results: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. Conclusion: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
Yusuke Kobayashi,Kenta Masuda,Akira Hiraswa,Kazuhiro Takehara,Hitoshi Tsuda,Yoh Watanabe,Katsutoshi Oda,Satoru Nagase,Masaki Mandai,Aikou Okamoto,Nobuo Yaegashi,Mikio Mikami,Takayuki Enomoto,Daisuke A 대한부인종양학회 2022 Journal of Gynecologic Oncology Vol.33 No.5
Objective: The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. Methods: A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. Results: A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. Conclusion: Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.
A marine deep-towed DC resistivity survey in a methane hydrate area, Japan Sea
후등충덕,립곡귀사,정산영장,고목량,송본량,오전의구,좌등간부,도변준수,도신화,진전가전,목하정고,Goto, Tada-Nori,Kasaya, Takafumi,Machiyama, Hideaki,Takagi, Ryo,Matsumoto, Ryo,Okuda, Yoshihisa,Satoh, Mikio,Watanabe, Toshiki,Seama, Nobukazu,Mikad Korean Society of Earth and Exploration Geophysici 2008 지구물리와 물리탐사 Vol.11 No.1
해양 심부 견인 전기비저항 탐사 방법이 새로이 개발되었다. 이 방법은 탄성파 반사법 탐사에서 잘 영상화 되지 않던 메탄 하이드레이트의 상부 경계를 찾아내기 위해 고안되었다. 이 장비는 하나의 송신기와 8개의 송신 전극들 및 한 개의 수신쌍극자를 갖는 160 m 연장의 긴 꼬리가 연구용 탐사선에 연결 되어 해저면 근처에서 끌리도록 만들어져 있다. 수치모형실험은 고안된 해양 전기비저항 탐사 방법이 메탄 하이드레이트 층의 상부를 효과적으로 잘 영상화함을 보여주었다. 실제 탐사는 메탄 하이드레이트가 노두로 관찰된 동해에 속해 있는 Joetsu의 먼바다에서 수행되었다. 대략 3.5 km에 달하는 탐사측선에 대하여 전기비저항 자료가 성공적으로 얻어 졌으며 상대적으로 높은 겉보기비저항 값들이 감지되었다. 특별히 메탄 하이드레이트가 들어나 있는 지역에서는 이상적으로 높은 겉보기비저항 값이 관측되었으며, 우리는 이 고겉보기비저항 값이 해저면 밑의 메탄 하이드레이트 지역에 의한 것으로 해석 하였다. 해양 전기비저항 탐사는 메탄 하이드레이트가 매장되어 있는 지역에서 해저면 하부를 잘 영상화 할 수 있는 새로운 도구가 될 것이다.