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Otoshi K.,Fukushima Medical University | Takegami M.,Japan National Cardiovascular Center Research Institute | Sekiguchi M.,Fukushima Medical University | Onishi Y.,Institute for Health Outcomes and Process Evaluation Research IHope International | And 5 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2014

Background: Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). Methods: The study enrolled 2144 participants who were older than 40years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. Results: Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P<.05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE. Conclusion: RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.

Nishi H.,University of Tokyo | Shibagaki Y.,University of Tokyo | Shibagaki Y.,Kanagawa University | Kido R.,University of Tokyo | And 5 more authors.
Clinical Transplantation | Year: 2013

Chronic kidney disease (CKD) is one of the common complications after deceased donor liver transplantation. Although the worldwide pressing shortage in deceased donors has directed attention to living donor liver transplantation (LDLT), LDLT cohort data focusing on chronic renal dysfunction is limited. A total of 280 adult LDLT recipients (median 49 yr, 156 men) at the University of Tokyo hospital between 1996 and 2006 were reviewed. A total of 224 pre-transplant liver failure patients (80.0%) showed an estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m2. However, during follow-up at a mean of 1222 d after transplantation, eGFR declined to 60 mL/min/1.73 m2 and 30 mL/min/1.73 m2 in 150 (53.2%) and 21 (7.5%), respectively, and four patients (1.4%) required maintenance renal replacement therapy. Multivariate Cox proportional hazard model regression analysis revealed that recipient age (HR, 3.42 per 10-yr increment; p < 0.001) and pre-transplant eGFR (HR, 0.85 per 10-mL/min/1.73 m2 increment; p = 0.04) were associated independently with a post-transplant decrease in eGFR to less than 30 mL/min/1.73 m2. We conclude that higher age and lower pre-transplant eGFR of an LDLT recipient indicate a high likelihood of subsequent development of advanced CKD. Preventive or therapeutic intervention should be optimized for these high-risk patients. © 2012 John Wiley & Sons A/S.

Sekiguchi M.,Fukushima Medical University | Wakita T.,Kansai University | Wakita T.,Institute for Health Outcomes and Process Evaluation Research IHope International | Otani K.,Fukushima Medical University | And 4 more authors.
Spine | Year: 2012

Study Design.: A cross-sectional study. Objective.: We developed a reliable and valid instrument to measure symptom severity in patients with lumbar spinal stenosis (LSS). Summary of Background Data.: Studies on LSS have investigated the efficacy of drug therapy compared with conservative therapy and surgery, examined predictive factors for therapeutic effects, and ascertained postoperative quality of life. However, patient background factors have varied among studies, making it difficult to compare findings across studies. Methods.: First, focus group interviews were conducted, and data were analyzed using qualitative Methods. Then, 189 patients with a diagnosis of LSS from 9 hospitals completed the LSS questionnaire. Exploratory factor analysis was conducted to examine the construct validity, and Cronbach α coefficient was calculated to test internal consistency. The criterion-related validity used pain, numbness, and walking capacity as external criteria. The test-retest reliability with an interval of 1 to 5 weeks was analyzed in 163 patients. Results.: Qualitative study extracted 10 domains and created a pool of 36 items. With factor analysis, items with factor loading less than 0.35 were excluded, and 25 items in 8 domains were selected. The Cronbach α of these items was 0.929. The coefficient of the test-retest reliability was 0.807. Pain, numbness, and walking capacity were significantly correlated with the scores of the LSS symptom scale. Conclusion.: A 25-item LSS symptom scale was developed, and its reliability and validity were confirmed. © 2012, Lippincott Williams & Wilkins.

Fukuma S.,Kyoto University | Fukuma S.,Institute for Health Outcomes and Process Evaluation Research IHope International | Kurita N.,Kyoto University | Kurita N.,Institute for Health Outcomes and Process Evaluation Research IHope International | And 4 more authors.
Kidney International Supplements | Year: 2013

Chronic kidney disease-mineral and bone disorder (CKD-MBD) has recently attracted attention in light of its association with clinical outcomes, such as fracture, cardiovascular disease, and mortality. Management of CKD-MBD has therefore come to have a central role in dialysis practice. Cinacalcet, a newly developed drug, has changed prescription patterns in many centers based on different changes in MBD markers than those observed with active vitamin D derivatives. As physicians require real-world evidence to guide their treatment decisions with respect to MBD management, we conducted the Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D), a 3-year observational study involving prevalent hemodialysis patients with secondary hyperparathyroidism (SHPT). Here, we review the results from the MBD-5D and discuss issues of MBD management in the cinacalcet era. Three years since the introduction of cinacalcet, 40% of hemodialysis patients with SHPT have come to use cinacalcet, enjoying marked improvement in management of circulating MBD markers, such as intact parathyroid hormone (PTH), phosphorus, and calcium. Combination therapy with cinacalcet and a vitamin D receptor activator (VDRA) may allow physicians to choose more suitable prescription patterns based on patient characteristics and therapeutic purposes. We observed an additive association between 'starting cinacalcet' and 'increased VDRA dose,' with marked improvement in the control of intact PTH levels. Further, the combination pattern of 'starting cinacalcet' and 'decreased VDRA dose' was associated with better achievement of target serum phosphorus and calcium levels. Future studies should examine the effect of different prescription patterns for SHPT treatment on clinical outcomes. © 2013 International Society of Nephrology.

Kato A.,Hamamatsu University | Kido R.,Institute for Health Outcomes and Process Evaluation Research IHope International | Kido R.,Medical Checkup Center | Onishi Y.,Institute for Health Outcomes and Process Evaluation Research IHope International | And 4 more authors.
Nephron - Clinical Practice | Year: 2014

Background/Aims: Bone fracture is often complicated in hemodialysis (HD) patients. Metabolic acidosis is related to bone disease and muscle wasting, but it is not known whether acid-base disturbance is associated with the risk of bone fractures. The aim of this study was to clarify the association of serum bicarbonate level with bone fracture in HD patients. Methods: Using a subcohort of the Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D), 890 prevalent HD patients (age: 62 years old, male: 62.8%, duration of dialysis: 8.3 years) with secondary hyperparathyroidism were studied. After measuring predialysis serum bicarbonate at a 2-day interdialytic interval, we prospectively followed them every 3 months, and examined the occurrence of any type of bone fracture or hospitalization due to fracture over a 3-year observation period. Results: Seventy-four bone fractures and 47 hospitalizations due to fracture were observed during the follow-up period. HD patients with serum bicarbonate <20 mmol/l had a 1.93 (95% CI 1.01-3.71)-fold higher risk for all-cause fractures than those with serum bicarbonate of 20.0-21.9 mmol/l. A higher bicarbonate level (≥22 mmol/l) was also related to an increased risk of bone fracture. A restricted cubic regression spline disclosed that the higher or the lower than 21.0 mmol/l of serum bicarbonate, the greater the risk for bone fracture. Conclusion: Both a lower level and a higher level of predialysis bicarbonate concentration were associated with risk of bone fracture in HD patients with secondary hyperparathyroidism. © 2014 S. Karger AG, Basel.

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