Yusuke Okubo

Comparison of percutaneous radiofrequency ablation and CyberKnife® for initial solitary hepatocellular carcinoma: A pilot study

AIM To compare therapeutic outcomes and adverse events in initial solitary hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and CyberKnife(®). METHODS Seventy three consecutive patients with initial solitary HCC treated with RFA (38 patients; RFA group) and CyberKnife(®) (35 patients; CK group) were enrolled in this study. Background factors were compared between the two groups. Local and intrahepatic distant recurrence control, and cumulative survival rates were compared between the two groups. These were determined using the Kaplan-Meier method, and the significance of differences was analyzed by log-rank test. The presence of more grade 3 on CTCAE ver. 4.0 early and late adverse events was investigated. RESULTS In background factors, age was significantly higher (P = 0.005) and the tumor diameter was significantly larger (P = 0.001) in the CK group. The 1-year local recurrence control rates were 97.4% and 97.1% in the RFA and CK groups, respectively (P = 0.71); the 1-year intrahepatic distant recurrence control rates were 85.6% and 86.1%, respectively (P = 0.91); and the 1-year cumulative survival rates were 100% and 95.2%, respectively (P = 0.075), showing no significant difference in any rate between the two groups. There were no late adverse event in the RFA group, but 11.4% in the CK group had late adverse events. In the CK group, the Child-Pugh score at 12 mo after treatment was significantly higher than that in the RFA group (P = 0.003) and significantly higher than the score before treatment (P = 0.034). CONCLUSION The occurrence of adverse events is a concern, but CyberKnife(®) treatment is likely to become an important option for local treatment of early HCC.

Impact of pediatric obesity on acute asthma exacerbation in Japan

Asthma and obesity are common health problems in children. This study investigated the impact of obesity on children hospitalized with acute asthma exacerbation.

The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States

Obesity is the most common public health problem and is a clinically complicating risk factor among hospitalized children. The impact of pediatric obesity on the severity and morbidity of lower respiratory tract infections remains unclear.

Pediatric hypervirulent Klebsiella pneumoniae septic arthritis

Cases of infection with hypervirulent Klebsiella pneumoniae are gradually increasing in number, and cause life‐threatening community‐acquired infection even in immunocompetent patients. A 14‐year‐old boy developed septic hip arthritis due to hypervirulent K. pneumoniae (sequence type 23, serotype K1, magA positive). The patient initially seemed to have been successfully treated with antibiotics and surgical intervention, but septic arthritis developed into osteomyelitis of the femoral head and myositis, which required long‐term antibiotic therapy and additional surgical intervention. This is the first pediatric case of hypervirulent K. pneumoniae septic hip arthritis. Treatment plans should mainly consist of antibiotic therapy and surgical intervention. Clinicians, even pediatricians, in developed countries should be aware of the increasing incidence of hypervirulent Klebsiella pneumoniae infection.

Anaphylactic shock after the ingestion of jellyfish without a history of jellyfish contact or sting

We read with interest the article entitled “Anaphylaxis caused by ingestion of jellyfish” by Imamura et al. in this journal [1]. They stated that their case subject was sensitized through the skin by jellyfish stings and that subsequent jellyfish intake induced anaphylaxis. However, we experienced a case of anaphylaxis after jellyfish ingestion without any history of jellyfish contact or sting.A 14-year-old boy developed a cough, urticaria and dyspnea 30 minutes after he ate a breakfast that [...]

National trend survey of hospitalized patients with febrile seizure in the United States

PURPOSE Several studies have reported the prevalence and incidence of febrile seizure (FS) among children in the USA and other countries. However, recent trends in FS among hospitalized children, hospital course, and risk factors for its severity remain unknown at a national level in the USA. METHOD Hospital discharge records of patients with FS aged <6years were obtained for the years 2003, 2006, 2009, and 2012 from the Kids Inpatient Database. Data were weighted to estimate the annual hospitalization rates with respect to gender and race/ethnicity in the United States. Multivariable logistic regression was conducted to ascertain factors associated with FS severity. RESULTS A decreasing trend in total annual hospitalization rates due to FS was observed, ranging from 59.0 per 100,000 children in 2003 to 40.8 per 100,000 children in 2012 (p < 0.001). Winter predominance of hospitalizations was observed (p = 0.001). Hispanic children and children admitted to hospitals in northeast region were less likely to be severely affected. Age, gender, health insurance status, and household income level were not associated with FS severity. CONCLUSIONS Total hospitalization rates due FS is decreasing, and race/ethnicity and geographic locations of the patients were associated with FS severity.

Nationwide survey of pediatric septic arthritis in the United States

BACKGROUND The epidemiology of pediatric septic arthritis, such as annual hospitalization rates and disparities by age, gender, race/ethnicity, and socioeconomic status, remains unclear. METHODS We obtained hospital discharge records of patients under the age of 20 years with septic arthritis from the kids inpatient database for 2006, 2009 and 2012. We weighted the records to estimate the number of hospitalizations in the US and calculated the annual rates of hospitalization due to septic arthritis. We used multivariable logistic regression to assess risk factors associated with comorbidities of osteomyelitis and bacteremia/septicemia. RESULTS Overall annual hospitalization rates showed a decreasing trend (4.23, 3.64, and 3.28 per 100,000 children in 2006, 2009, and 2012, respectively). Children who were male, white or black, and between the ages of 0-4 years were more likely to have higher hospitalization rates than others. The proportions of hospitalizations were high among children living in lower-income areas. Large joints at the lower limbs were the most frequently affected sites of infection. Infections of large joints and age category of 10-14 years were the factors that were significantly associated with comorbidities of osteomyelitis and bacteremia/septicemia. CONCLUSIONS We demonstrated a change in the epidemiological patterns of pediatric septic arthritis and identified risk factors associated with comorbidities of osteomyelitis and bacteremia/septicemia.

Evaluation of contrast-enhanced ultrasonography for hepatocellular carcinoma prior to and following stereotactic body radiation therapy using the CyberKnife® system: A preliminary report

The CyberKnife® is expected to be a novel local treatment for hepatocellular carcinoma (HCC), however, a long-term follow-up using dynamic computed tomography and magnetic resonance imaging is required to determine the effect of treatment in a number of the affected patients. Therefore, there is a requirement to evaluate procedures for early determination of the effect of CyberKnife treatment. The present study aimed to evaluate the changes in the hemodynamics of the tumors and the hepatic parenchyma surrounding the tumor prior to and following CyberKnife treatment for HCC. A total of 4 HCC patients were enrolled in this study. These patients underwent CyberKnife treatment and were evaluated by image analysis prior to and following treatment using contrast-enhanced ultrasonography (CEUS) with Sonazoid. CEUS was performed prior to treatment, at 2 and 4 weeks post-treatment, and every 4 weeks thereafter for as long as possible. The dynamics of the enhancement of the tumor and the hepatic parenchyma surrounding the tumor in the vascular phase, and the presence or absence of a hypoechoic area in the hepatic parenchyma surrounding the tumor in the post-vascular phase were assessed. Results showed that: i) In the patient with earlier changes, hemodynamic changes were evident in the tumor at 4 weeks and in the hepatic parenchyma surrounding the tumor at 2 weeks post-treatment, respectively; ii) the tumor showed hypoenhancement in all patients; and iii) with regard to findings in the hepatic parenchyma surrounding the tumor, strong hyperenhancement appeared in the vascular phase initially, followed by a hypoechoic area in the post-vascular phase. Evaluation of the hemodynamics of tumors and hepatic parenchyma surrounding the tumor using CEUS with Sonazoid may be therapeutically applicable, as it is less invasive than dynamic computed tomography (CT) and provides an early evaluation of the effectiveness of CyberKnife treatment.

Nationwide Survey of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Children in the United States

Although Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious, life‐threatening reactions to drug therapies, no efforts have been made to investigate the comprehensive change in epidemiology with respect to age, sex, and race and ethnicity in children. The risk of death was 0.3% to 1.5%, and the highest hospitalization rates were in children 15 to 19 years of age, boys, and black children. The highest proportions of hospitalizations were children with very low household income, those with private insurance, and those treated at large urban teaching hospitals in the West. A significant winter–autumn predominance was observed.

Nationwide survey of pediatric acute osteomyelitis in the USA

The epidemiology of pediatric acute osteomyelitis in the USA, such as annual hospitalization rates and disparities with respect to age, sex, race/ethnicity, and socioeconomic status, remains unknown. We obtained discharge records of hospitalized patients with acute osteomyelitis younger than 20 years of age from the Kids Inpatient Database for 2006, 2009, and 2012. We weighted the records to estimate the number of hospitalizations in the USA and calculated the annual rates of hospitalization because of acute osteomyelitis. We used a multivariable logistic regression analysis to assess the risk factors associated with the development of septic arthritis and bacteremia/septicemia. Overall annual hospitalization rates ranged from 1.34 to 1.66/100 000 children. Male-to-female ratios were 1.6−1.8. Black children, children aged 2, 7, and 12 years, and those living in very low median household income regions were more likely to have higher hospitalization rates. The lower limbs were the most frequent infection sites. Osteomyelitis at the pelvis/thigh, upper arm, hand, and forearm was significantly associated with the development of septic arthritis and bacteremia/septicemia. We determined the epidemiological patterns of pediatric acute osteomyelitis in the USA and identified the risk factors associated with the development of septic arthritis and bacteremia/septicemia. Level of Evidence: Level II.