Objective Adherence to rehabilitation exercise is much lower in patients with hematologic malignancies (22.5-45.8%) than in patients with solid tumors (60-85%) due to the administration of more intensive chemotherapeutic regimens in the former. Virtual reality exercise can be performed even in a biological clean room and it may improve the adherence rates in elderly patients with hematologic malignancies. Thus, in this pilot study, we aimed to investigate the feasibility and safety of virtual reality exercise intervention using Nintendo Wii Fit in patients with hematologic malignancies receiving chemotherapy. Methods In this feasibility study, 16 hospitalized patients with hematologic malignancies aged ! 60 years performed virtual reality exercise for 20 minutes using the Nintendo Wii Fit once a day, five times a week, from the start of chemotherapy until hospital discharge. The adherence rate, safety, and physical and psychological performances were assessed. Results The adherence rate for all 16 patients was 66.5%. Nine patients completed the virtual reality exercise intervention with 88 sessions, and the adherence rate was 62.0%. No intervention-related adverse effects >Grade 2, according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, were observed. We noted maintenance of the physical performance (e.g., Barthel index, handgrip strength, knee extension strength, one-leg standing time, and the scores of timed up and go test and Instrumental Activities of Daily Living) and psychosocial performance (e.g., score of hospital anxiety and depression scale). Conclusion Virtual reality exercise using the Wii Fit may be feasible, safe and efficacious, as demonstrated in our preliminary results, for patients with hematologic malignancies receiving chemotherapy.
A sensational newspaper article concerning a possible adverse reaction to the human papillomavirus (HPV) vaccine was published in March 2013 in Japan. In June 2013, the Japanese government suspended their proactive recommendation for vaccination, despite the lack of proof for a causal relationship. We searched Nikkei Telecom 21, the largest newspaper database in Japan, for articles published from January 2011 to December 2015 to evaluate the characteristics of newspaper publications about human papillomavirus vaccination. We identified 1138 HPV vaccine-related articles. Compared with those published before March 2013, articles concerning human papillomavirus vaccination after March 2013 were more likely to include adverse reaction-related and authority-related keywords; articles that included efficacy-related keywords decreased significantly. Negative-negative and negative-neutral articles became more frequent, and positive-positive and positive-neutral articles were less frequent. A sensational case report shaped the tone of negative media coverage as a catalyst, regardless of scientific statements from health authorities.
Cancer cells often develop drug resistance. In cisplatin-resistant HeLa cisR cells, fibroblast growth factor 13 (FGF13/FHF2) gene and protein expression was strongly upregulated, and intracellular platinum concentrations were kept low. When the FGF13 expression was suppressed, both the cells' resistance to platinum drugs and their ability to keep intracellular platinum low were abolished. Overexpression of FGF13 in parent cells led to greater resistance to cisplatin and reductions in the intracellular platinum concentration. These cisplatin-resistant cells also showed increased resistance to copper. In preoperative cervical cancer biopsy samples from poor prognoses patients after cisplatin chemoradiotherapy, FGF13-positive cells were detected more abundantly than in the biopsy samples from patients with good prognoses. These results suggest that FGF13 plays a pivotal role in mediating resistance to platinum drugs, possibly via a mechanism shared by platinum and copper. Our results point to FGF13 as a novel target and useful prognostic guide for cancer therapy.
We have little information on chronic graftversus-host disease (GVHD) after cord blood transplantation (CBT). We investigated its clinical features in 1072 Japanese patients with hematologic malignancies who received a transplant through the Japan Cord Blood Bank Network. The primary end point was to investigate the incidence of any chronic GVHD. Median age of the patients was 33 years (range, 0-79 years). The cumulative incidence of chronic GVHD 2 years after transplantation was 28%. Chronic GVHD was fatal in 29 patients. Multivariate analysis demonstrated that development of chronic GVHD was favorably associated with both overall survival and event-free survival. Multivariate analysis identified risk factors of chronic GVHD: higher patient body weight, higher number of mismatched antigens for GVHD direction, myeloablative preparative regimen, use of mycophenolate mofetil in GVHD prophylaxis, and development of grades II to IV acute GVHD. Although chronic GVHD is a significant problem after CBT, it is associated with improved survival, perhaps due to graft-versus-malignancy effects. IntroductionChronic graft-versus-host disease (GVHD) is a significant concern in allogeneic hematopoietic stem cell transplantation (HSCT). Many studies have been published on clinical features of chronic GVHD following bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT). In contrast, we have limited information on chronic GVHD following cord blood transplantation (CBT). MethodsInformed consent was obtained in accordance with the Declaration of Helsinki. According to local policy, the study was approved by Japan Cord Blood Bank Network. We had no direct contact with human subjects during our study; data on patients who underwent CBT were obtained from the Japan Cord Blood Bank Network. The primary end point of this study was to investigate the incidence of any chronic GVHD after CBT. Cord blood units are provided with written informed consent. Between June 1997 and August 2006, 2713 cord blood transplant recipients were registered with the Japan Cord Blood Bank Network. All recipients received a single cord blood unit. We included those with hematologic malignancies who underwent CBT without T-cell depletion. We excluded patients with a history of any type of allogeneic HSCT prior to CBT. A total of 2015 patients met the criteria. Of those, we excluded 943 with disease progression, death without progression, and graft failure within 100 days after transplantation. In this study, we retrospectively investigated clinical features of chronic GVHD in the remaining 1072 patients. Cytomegalovirus-seropositive cord blood unit was not provided to transplantation centers. Acute and chronic GVHD were diagnosed and graded according to standard criteria. 1,2 GVHD that developed after day 100 was defined as chronic GVHD. If the mode of presentation for chronic GVHD was progressive, the date of onset was defined as day 100. SAS version 9.1.3 (SAS Institute, Cary, NC) was used for all statistical analyses. Res...
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