Gentaro Tsumatori

Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients: A preliminary experience

Stereotactic radiation therapy is highly effective in the treatment of small brain metastases, regardless of the histology. This suggests that small extracranial malignancies may be curable with similar radiation therapy. The authors developed a novel treatment unit for administering such therapy.

Relation between the Serum E-Selectin Level and the Survival Rate of Patients with Resected Non-small Cell Lung Cancers

E‐Selectin is an inducible adhesion molecule, which is expressed on cytokine‐activated endothelial cells and is thought to interact with cancer cells to initiate metastases. The relationship between serum E‐selectin levels and prognoses in 101 patients with resected non‐small cell lung cancers (NSCLCs) was studied, and survival curves were compared in relation to E‐selectin levels and expression of two carbohydrate antigens, Sialyl Lewisx (SLX) and Sialyl Lewisa (CA19‐9), which were immunohistochemically detected in resected specimens in 65 of the 101 cases. The serum Eselectin level on admission was 48.9±25.7 ng/ml (mean±SD, n=101), and the E‐selectin‐positive rate was 22.7%, being correlated with the progression of T‐factor. The high E‐selectin group showed a significantly worse survival rate than the normal E‐selectin group. Multivariate analysis confirmed the significant prognostic value of E‐selectin. The mean postoperative E‐selectin level in 52 cases (36.93 ng/ml) was significantly lower than the preoperative E‐selectin level (43.57 ng/ml), indicating that certain NSCLCs might induce the expression of E‐selectin. In cases expressing carbohydrate antigens (SLX, CA19‐9), the high E‐selectin group showed a significantly worse survival curve than the normal E‐selectin group. On the other hand, there was no significant difference in the survival curve between the high and normal E‐selectin groups when carbohydrate antigens were negative. These results suggest that patients who have high serum E‐selectin levels, especially with carbohydrate antigen‐positive NSCLC, might be expected to have poor prognoses.

Real-time optical diagnosis of the rat brain exposed to a laser-induced shock wave: observation of spreading depolarization, vasoconstriction and hypoxemia-oligemia.

Despite many efforts, the pathophysiology and mechanism of blast-induced traumatic brain injury (bTBI) have not yet been elucidated, partially due to the difficulty of real-time diagnosis and extremely complex factors determining the outcome. In this study, we topically applied a laser-induced shock wave (LISW) to the rat brain through the skull, for which real-time measurements of optical diffuse reflectance and electroencephalogram (EEG) were performed. Even under conditions showing no clear changes in systemic physiological parameters, the brain showed a drastic light scattering change accompanied by EEG suppression, which indicated the occurrence of spreading depression, long-lasting hypoxemia and signal change indicating mitochondrial energy impairment. Under the standard LISW conditions examined, hemorrhage and contusion were not apparent in the cortex. To investigate events associated with spreading depression, measurement of direct current (DC) potential, light scattering imaging and stereomicroscopic observation of blood vessels were also conducted for the brain. After LISW application, we observed a distinct negative shift in the DC potential, which temporally coincided with the transit of a light scattering wave, showing the occurrence of spreading depolarization and concomitant change in light scattering. Blood vessels in the brain surface initially showed vasodilatation for 3–4 min, which was followed by long-lasting vasoconstriction, corresponding to hypoxemia. Computer simulation based on the inverse Monte Carlo method showed that hemoglobin oxygen saturation declined to as low as ∼35% in the long-term hypoxemic phase. Overall, we found that topical application of a shock wave to the brain caused spreading depolarization/depression and prolonged severe hypoxemia-oligemia, which might lead to pathological conditions in the brain. Although further study is needed, our findings suggest that spreading depolarization/depression is one of the key events determining the outcome in bTBI. Furthermore, a rat exposed to an LISW(s) can be a reliable laboratory animal model for blast injury research.

Usage of emotion recognition in military health care

Post Traumatic Stress Disorder (PTSD), depression and suicide are major psychiatric problem in both military and civilian situation. These mental diseases combine with emotion change. Recently, the technology of emotion recognition has been developed rapidly and highly. Therefore, we investigate if the emotion recognition by natural speaking voice could detect the emotion change which would occur when exposing mental stress. We used “Sensibility technology ST Emotion” (AGI Japan Inc.) for emotion voice analysis system. This system determines emotional elements as including anger, joy, sorrow, and calmness. It also measures feeling of excitement. Voice data were collected from the personnel of military medical corps participating in a special stressful mission. The voice data were divided into two groups depending on participating period. Some subjects feelings during experimental period were changed. There is a tendency that “joy” of long stay group (Group L) is lower than short stay group (Group S) and “sorrow” of Group L is higher than Group S. The result suggested that the techniques of emotion recognition may be used for screening of mental status in military situation. However, further development is necessary for practical use.

Decreased Plasma Brain-Derived Neurotrophic Factor and Vascular Endothelial Growth Factor Concentrations during Military Training

Decreased concentrations of plasma brain-derived neurotrophic factor (BDNF) and serum BDNF have been proposed to be a state marker of depression and a biological indicator of loaded psychosocial stress. Stress evaluations of participants in military mission are critically important and appropriate objective biological parameters that evaluate stress are needed. In military circumstances, there are several problems to adopt plasma BDNF concentration as a stress biomarker. First, in addition to psychosocial stress, military missions inevitably involve physical exercise that increases plasma BDNF concentrations. Second, most participants in the mission do not have adequate quality or quantity of sleep, and sleep deprivation has also been reported to increase plasma BDNF concentration. We evaluated plasma BDNF concentrations in 52 participants on a 9-week military mission. The present study revealed that plasma BDNF concentration significantly decreased despite elevated serum enzymes that escaped from muscle and decreased quantity and quality of sleep, as detected by a wearable watch-type sensor. In addition, we observed a significant decrease in plasma vascular endothelial growth factor (VEGF) during the mission. VEGF is also neurotrophic and its expression in the brain has been reported to be up-regulated by antidepressive treatments and down-regulated by stress. This is the first report of decreased plasma VEGF concentrations by stress. We conclude that decreased plasma concentrations of neurotrophins can be candidates for mental stress indicators in actual stressful environments that include physical exercise and limited sleep.

Rumor-Related and Exclusive Behavior Coverage in Internet News Reports Following the 2009 H1N1 Influenza Outbreak in Japan.

OBJECTIVE We sought to elucidate news article reporting of adverse public psychosocial behaviors, in particular, rumor-related coverage (eg, panic, demagoguery) and exclusive behavior coverage (negative behaviors, eg, discrimination, bullying) during the 2009 influenza A (H1N1) influenza pandemic in Japan. METHODS We examined 154 Internet news-site articles reporting adverse public psychosocial responses in the first 60 days of the outbreak. Rumor-related coverage and exclusive behavior coverage were dichotomously coded as included or not. Moreover, we assessed whether or not health information (eg, coping methods, virus toxicity information) or emphasis on information quality (eg, importance of information, cautions about overreactions) were simultaneously reported. RESULTS Rumor-related coverage (n=120, 77.9%) was less likely to simultaneously report public health information (eg, toxicity information, health support information, and cautions about overreactions; P<.05). Conversely, exclusive behavior coverage (n=41, 26.6%) was more likely to report public health information (P<.05). CONCLUSIONS Rumor-related coverage was less likely to have accompanying public health information, whereas exclusive behavior coverage was more likely to include it. During public health crises, it is essential to understand that rumors and exclusive behaviors have adverse effects on the public and that accompanying public health information may help people take proactive coping actions.

Trial application of oxygen and carbon isotope analysis in tooth enamel for identification of past-war victims for discriminating between Japanese and US soldiers

Stable isotope analysis has undergone rapid development in recent years and yielded significant results in the field of forensic sciences. In particular, carbon and oxygen isotopic ratios in tooth enamel obtained from human remains can provide useful information for the crosschecking of morphological and DNA analyses and facilitate rapid on-site prescreening for the identification of remains. This study analyzes carbon and oxygen isotopic ratios in the tooth enamel of Japanese people born between 1878 and 1930, in order to obtain data for methodological differentiation of Japanese and American remains from the Second World War. The carbon and oxygen isotopic ratios in the tooth enamel of the examined Japanese individuals are compared to previously reported data for American individuals (born post WWII), and statistical analysis is conducted using a discrimination method based on a logistic regression analysis. The discrimination between the Japanese and US populations, including Alaska and Hawaii, is found to be highly accurate. Thus, the present method has potential as a discrimination technique for both populations for use in the examination of mixed remains comprising Japanese and American fallen soldiers.

Validity of a Voice-Based Evaluation Method for Effectiveness of Behavioural Therapy

In this study, we used General Health Questionnaire 30 (GHQ30) and voice to evaluate the stress reduction effect of a stress resilience program, and examined the validity of stress evaluation by voice. We divided the subjects who participated in the program into two groups by the number of training sessions. The results showed a stress-reduction effect only in the group with more training sessions (more than 13 sessions) for both GHQ30 and voice-based indexes. Moreover, both indexes showed a highly negative correlation between the pre-training value and the difference between the post-training and pre-training values. This implies that the effect of the training is more evident for subjects with higher stress levels. The voice-based evaluation showed trends similar to those displayed by GHQ30.

Disaster Victim Identification: Psychological Distress and Posttraumatic Stress in Dentists After the 2011 Fukushima Disaster

Objective: To evaluate the correlates of psychological responses in dentists who conducted disaster victim identification (DVI) in Fukushima following the 2011 earthquake/tsunami/nuclear disaster. Method: Self-report questionnaires were administered to 49 male dentists six to nine months after the disaster. Psychological distress and posttraumatic stress were measured using the General Health Questionnaire–30 (GHQ-30) and Impact of Event Scale–Revised (IES-R), respectively. Independent variables included sociodemographic characteristics, participant disaster exposures, DVI-related exposures, and fear of radiation exposure during DVI. Hierarchical multiple regression analysis was performed to examine independent-dependent variable relations. Results: Thirty-eight participants (77.6%) had examined ≥ 40 corpses, 20 (40.8%) reported ≥ 4 corpse-related exposures, and six (12.2%) reported ≥ 5 gruesome corpse exposures. Mean (SD) GHQ-30 and IES-R scores were 5.08 (5.31) and 9.90 (10.1), respectively. Higher levels of psychological distress were associated with younger age (adjusted β = −0.29), extensive property loss (β = 0.34), and anxiety for the future (β = 0.33). Higher levels of posttraumatic stress were associated with extensive property loss (adjusted R2 = 17.7%, β = 0.30). Neither outcome was associated with DVI-related exposures or fear of radiation exposure during DVI (p < 0.05). Conclusions: Dentists’ psychological burden was associated with disaster, but not DVI, exposures.

Molecular Hydrogen Prevents Social Deficits and Depression-Like Behaviors Induced by Low-Intensity Blast in Mice

Detonation of explosive devices creates blast waves, which can injure brains even in the absence of external injuries. Among these, blast-induced mild traumatic brain injury (bmTBI) is increasing in military populations, such as in the wars in Afghanistan, Iraq, and Syria. Although the clinical presentation of bmTBI is not precisely defined, it is frequently associated with psycho-neurological deficits and usually manifests in the form of poly-trauma including psychiatric morbidity and cognitive disruption. Although the underlying mechanisms of bmTBI are largely unknown, some studies suggested that bmTBI is associated with blood-brain barrier disruption, oxidative stress, and edema in the brain. The present study investigated the effects of novel antioxidant, molecular hydrogen gas, on bmTBI using a laboratory-scale shock tube model in mice. Hydrogen gas has a strong prospect for clinical use due to easy preparation, low-cost, and no side effects. The administration of hydrogen gas significantly attenuated the behavioral deficits observed in our bmTBI model, suggesting that hydrogen application might be a strong therapeutic method for treatment of bmTBI.