Discontinuation of etanercept after achievement of sustained remission in patients with rheumatoid arthritis who initially had moderate disease activity-results from the ENCOURAGE study, a prospective, international, multicenter randomized study
PubMed | Chibaken Saiseikai Narashino Hospital, Tokyo Women's Medical University, Juntendo University, University of Occupational and Environmental Health Japan and 14 more.
Type: Journal Article | Journal: Modern rheumatology | Year: 2016
To investigate the efficacy and safety of etanercept (ETN) in patients with rheumatoid arthritis (RA) with moderate disease activity and the possibility to discontinue ETN after achieving remission.Multicenter, randomized, and open-label study was conducted in Japan and Korea. RA patients (disease duration<5 years) with moderate disease activity despite methotrexate (MTX) treatment were allocated to either MTX or ETN+MTX (Period 1) for 12 months. Patients who achieved sustained remission defined as DAS28<2.6 at both 6 and 12 months in the ETN+MTX group, were randomized to either continue or discontinue ETN for 12 months (Period 2).A total of 222 patients were enrolled in Period 1 and clinical remission was achieved in 106/157 (67.5%) and 5/28 (17.9%) patients in the ETN+MTX and MTX groups, respectively. In Period 2, sixty-seven patients were randomized and finally 28/32 (87.5%) and 15/28 (53.6%) patients who continued or discontinued ETN maintained clinical remission. Baseline disease activity and the presence of comorbid diseases influenced the maintenance of remission after ETN discontinuation.ETN+MTX was efficient for RA patients with moderate disease activity into remission. After achieving sustained remission, a half of the patients who discontinued ETN could maintain remission for 1 year.
PubMed | Chibaken Saiseikai Narashino Hospital, Tokyo Women's Medical University, Kanagawa Childrens Medical Center, Saitama Childrens Medical Center and 7 more.
Type: Journal Article | Journal: Journal of the neurological sciences | Year: 2015
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) at onset manifests an early seizure (ES) usually lasting more than 30 min. Following ES, some patients exhibit almost clear consciousness with no neurological symptoms, and no MRI abnormality for a few days, which may lead to an initial misdiagnosis of prolonged febrile seizures (PFS). To allow an early diagnosis of AESD, we retrospectively analyzed clinical manifestations, laboratory data, and radiologic and EEG findings in patients with AESD (n=62) having ES of over 30 min, and ones with PFS (n=54), using logistic regression analyses. Multivariate logistic regression analysis revealed that an age below 1.5 years and a Glasgow Coma Scale score of 14 or less than 14 (Japan Coma Scale score of 1 or higher) were high risk factors of developing AESD. We proposed an AESD prediction score system consisting of consciousness level, age, duration of convulsions, enforcement of mechanical intubation, and aspartate aminotransferase, blood glucose and creatinine levels (full score: 9), the mean scores in AESD and PFS being 5.9 and 1.8, which were significantly different (p<0.001). We herein propose a scoring system for differentiating patients with AESD and PFS around the time of ES (score of 4 or more than 4 suggesting AESD), which may contribute to early therapeutic intervention and an improved neurologic outcome.
Shigemura T.,Chiba University |
Nakamura J.,Chiba University |
Kishida S.,Chiba University |
Harada Y.,Chibaken Saiseikai Narashino Hospital |
And 3 more authors.
Rheumatology | Year: 2012
Objective: The purpose of the study was to clarify the incidence of alcohol-associated osteonecrosis of the knee using MRI. Methods: A total of 131 patients (56 women and 75 men) with osteonecrosis of the femoral head were enrolled; 60 patients had a history of alcohol abuse and 71 had previously received steroids. All patients underwent MRI of the knee. The incidence of alcohol-associated osteonecrosis of the knee was compared with that of steroid-associated osteonecrosis of the knee. Predictive factors of alcohol- and steroid-associated osteonecrosis of the knee were also evaluated. Results: The incidence of alcohol-associated osteonecrosis of the knee was lower than that of steroid-associated osteonecrosis of the knee (18.3 vs 54.9%; P < 0.001, Fisher's exact probability test). No significant difference in weekly alcohol consumption was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee. No significant difference in daily maximum steroid doses was observed between patients with osteonecrosis of the knee and those without osteonecrosis of the knee. Conclusion: The present study revealed that the incidence of alcohol-associated osteonecrosis of the knee is lower than that of steroid-associated osteonecrosis of the knee. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Yamamoto S.,Chiba University |
Watanabe A.,Teikyo University |
Nakamura J.,Chiba University |
Ohtori S.,Chiba University |
And 4 more authors.
Journal of Magnetic Resonance Imaging | Year: 2011
Purpose: To evaluate articular cartilage degeneration with transverse relaxation time (T2) mapping in systemic lupus erythematosus (SLE) patients with noncollapsed and asymptomatic osteonecrosis of the femoral head associated with corticosteroids. Materials and Methods: T2 mapping with a 1.5-T magnetic resonance imaging system was prospectively performed for 28 normal hips from 14 healthy volunteers (control group) and 15 hips from 10 SLE patients that met the inclusion criteria of noncollapsed and asymptomatic osteonecrosis of the femoral head (osteonecrosis group). Exclusion criteria were past experience of pain, trauma, infection, or prior hip joint surgery. Distribution of T2 values of the femoral head cartilage were compared between the control group and the osteonecrosis group with respect to acetabular dysplasia by center-edge angle (CEA). Results: T2 values of the femoral head cartilage were significantly higher in the osteonecrosis group than in the control group (34.4 msec vs. 30.8 msec, P = 0.001). Multiple regression analysis revealed that the osteonecrosis group and decreased CEA was significantly associated with high T2 values (T2 value = 34.6 + 3.6 × [osteonecrosis] - 0.14 × CEA, R 2 = 0.52, P = 0.003). Conclusion: Degeneration of articular cartilage was associated with osteonecrosis of the femoral head in SLE patients and acetabular dysplasia. Copyright © 2011 Wiley Periodicals, Inc.
Tada H.,Chibaken Saiseikai Narashino Hospital |
Takanashi J.-I.,Kameda Medical Center |
Takanashi J.-I.,Toho University
Brain and Development | Year: 2014
We reported a 5-year-old boy with 18q- syndrome who showed typical magnetic resonance imaging (MRI) findings of high signal intensity on T2-weighted imaging, and a slightly high but lower than normal signal on T1-weighted imaging of the white matter. MR spectroscopy (MRS) revealed increased concentrations of creatine, myoinositol and choline with a normal N-acetylaspartate one. The cerebral white matter lesions observed on MRI in patients with 18q- syndrome have been considered to reflect hypomyelination due to a decrease in myelin basic protein so far, however, MRS suggested reactive astrocytic gliosis and accelerated myelin turnover, which are compatible with recent pathological reports of 18q- syndrome. © 2012 The Japanese Society of Child Neurology.
External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study
PubMed | Chibaken Saiseikai Narashino Hospital and Toho University
Type: Comparative Study | Journal: Japanese journal of clinical oncology | Year: 2015
The aim of this study is to validate and compare the predictive accuracy of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology among representative patients with prostate cancer. We previously developed a nomogram, as did Chun et al. In this validation study, patients originated from two centers: Toho University Sakura Medical Center (n = 214) and Chibaken Saiseikai Narashino Hospital (n = 216). We assessed predictive accuracy using area under the curve values and constructed calibration plots to grasp the tendency for each institution. Both nomograms showed a high predictive accuracy in each institution, although the constructed calibration plots of the two nomograms underestimated the actual probability in Toho University Sakura Medical Center. Clinicians need to use calibration plots for each institution to correctly understand the tendency of each nomogram for their patients, even if each nomogram has a good predictive accuracy.
PubMed | Chibaken Saiseikai Narashino Hospital, Chiba University and Chibaken Saiseikai Narashino Hospial.
Type: Comparative Study | Journal: Hinyokika kiyo. Acta urologica Japonica | Year: 2016
The urine cytology test is one of the most important tools for the diagnosis of malignant urinary tract tumors. This test is also of great value for predicting malignancy. However, the sensitivity of this test is not high enough to screen for malignant cells. In our laboratory, we were able to attain a high sensitivity of urine cytology tests after changing the preparation method of urine samples. The differences in the cytodiagnosis between the two methods are discussed here. From January 2012 to June 2013, 2,031 urine samples were prepared using the conventional centrifuge method (C method) ; and from September 2013 to March 2015, 2,453 urine samples were prepared using the filtration method (F method) for the cytology test. When the samples included in category 4 or 5, were defined as cytological positive, the sensitivities of this test with samples prepared using the F method were significantly high compared with samples prepared using the C method (72% vs 28%, p0.001). The number of cells on the glass slides prepared by the F method was significantly higher than that of the samples prepared by the C method (p0.001). After introduction of the F method, the number of f alse negative cases was decreased in the urine cytology test because a larger number of cells was seen and easily detected as atypical or malignant epithelial cells. Therefore, this method has a higher sensitivity than the conventional C method as the sensitivity of urine cytology tests relies partially on the number of cells visualized in the prepared samples.
PubMed | Chibaken Saiseikai Narashino Hospital, Toho University and Chiba University
Type: Journal Article | Journal: Urology case reports | Year: 2016
We present an extremely rare case of acute renal failure following radical hysterectomy although we inserted ureteral catheter bilaterally. A 76-year old female received bilateral ureteral catheterization prior to operation. Just after operation oliguria was admitted and serum creatinine level increased to 3.6mg/dL. An abdominal computed tomography (CT) revealed bilateral hydronephrosis. From soon after exchange to double J catheter large amount of urine was collected and the level of creatinine normalized 2days later. The shape of J catheter may be more effective than open-end catheter because it has multiple side hole and can ensure urinary drainage.
PubMed | Chibaken Saiseikai Narashino Hospital, Teikyo University, Toho University, Chiba University and Chiba Cancer Center
Type: | Journal: International journal of clinical oncology | Year: 2016
A retrospective, multi-institutional collaborative study was conducted to evaluate the impact of second transurethral resection (TUR) on the clinical outcome of non-muscle invasive high-grade bladder cancer and to identify predictors of invasion to the lamina propria (pT1) or deeper and residual tumor at the second TUR.The clinical and pathological features of 198 patients with non-muscle invasive high-grade bladder cancer treated in five medical institutions from April 1990 to March 2013 were reviewed retrospectively. All patients underwent a second TUR within a mean of 1.5months after the first resection. Clinicopathological findings of the first and second TURs were compared. Cancer-specific survival and recurrence-free survival were evaluated. Univariate and multivariate analyses for predictors of residual cancer at the second TUR were performed using a logistic regression model.At the second TUR, no tumor was found in 111 (56%) patients, and 87 (44%) had residual cancer. At the first TUR, five pT1 patients (3%) were upstaged to pT2, one pTa patient (1%) was upstaged to pT1, and 12 G2 patients (6%) had their tumor upgraded to G3. Patients the group with less than stage pT1 cancer at the second TUR had significantly better survival than those in the group with stage pT1 or deeper cancer. Tumor multiplicity at the first resection was an independent risk factor for pT1 or deeper tumor at the second TUR.A second TUR is a valuable diagnostic procedure for accurate staging of non-muscle invasive high-grade bladder cancer. Tumor multiplicity at the first TUR was a significant independent predictor of pT1 or deeper tumor at the second TUR.
Nakao M.,Chibaken Saiseikai Narashino Hospital |
Kobayashi S.,Chibaken Saiseikai Narashino Hospital
Journal of Arrhythmia | Year: 2013
A 27-year-old man presented to our hospital with a 1-year-hisory of repeated syncope, which particularly occurred while bathing or on a hot day. The head-up tilt test did not induce arrhythmia; however, blood pressure decreased by 39 mm Hg without any symptoms. Given that no bradycardia/tachycardia was induced on electrophysiological study and carotid sinus massage, an implantable loop recorder (ILR) was implanted. After 2 months, syncope again occurred during bathing at midnight. Sinus arrest and a maximum ventricular pause of 10.2 s were documented using the ILR. After pacemaker implantation, the patient had not experienced syncope for 14 months. © 2012 Japanese Heart Rhythm Society.