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Shimoyama I.,Chiba University | Kobayashi Y.,Kobayashi Hospital
International Medical Journal | Year: 2012

Objective: To study constructional apraxia, a quantitative method was proposed to evaluate the cube drawing test. Design: Six correlation coefficients were obtained between 1) a sample figure and a drawn figure, 2) a drawn figure and a figure rotated 180 degree of the drawn figure, 3) the left half of the drawn figure and a figure rotated 180 degree of the right half of the drawn figure, 4) the upper half of the drawn figure and a figure rotated 180 degree of the lower half of the drawn figure, 5) the left upper quadrant of the drawn figure and a figure rotated 180 degree of the right lower quadrant of the drawn figure, and 6) the right upper quadrant of the drawn figure and a figure rotated 180 degree of the left lower quadrant of the drawn figure. Materials and Methods: Three patients of clinical constructional apraxia and 3 healthy volunteers participated in this study after informed consent. Subjects were asked to draw copying a sample figure of the Necker's cube on a digitizer. And the correlation coefficients were obtained for 6 types of symmetry for the drawn figures. Results: The symmetry was deteriorated for the patients and the correlation coefficients were lower than those for the volunteers. Conclusion: The quantitative analysis should be useful to evaluate the higher brain function as for one of the neurological examinations. © 2012 Japan International Cultural Exchange Foundation & Japan Health Sciences University.


Takahashi M.,Jichi Medical University | Tanaka T.,Jichi Medical University | Takahashi H.,Jichi Medical University | Hoshino Y.,Jichi Medical University | And 10 more authors.
Journal of Clinical Microbiology | Year: 2010

We recently developed a cell culture system for hepatitis E virus (HEV) in PLC/PRF/5 and A549 cells, using fecal specimens from HEV-infected patients. Since transfusion-associated hepatitis E has been reported, we examined PLC/PRF/5 and A549 cells for the ability to support replication of HEV in various serum samples obtained from 23 patients with genotype 1, 3, or 4 HEV. HEV progenies emerged in culture media of PLC/PRF/5 cells, regardless of the coexistence of HEV antibodies in serum but dependent on the load of HEV inoculated (31% at 2.0 × 104 copies per well and 100% at ≥3.5 × 104 copies per well), and were successfully passaged in A549 cells. HEV particles in serum, with or without HEV antibodies, banded at a sucrose density of 1.15 to 1.16 g/ml, which was markedly lower than that for HEV particles in feces, at 1.27 to 1.28 g/ml, and were nonneutralizable by immune sera in this cell culture system. An immuno-capture PCR assay of HEV virions treated with or without detergent indicated that HEV particles in serum are associated with lipids and HEV ORF3 protein, similar to those in culture supernatant. By immunoprecipitation, it was found that >90% of HEV particles in the circulation exist as free virions not complexed with immunoglobulins, despite the coexistence of HEV antibodies. These results suggest that our in vitro cell culture system can be used for propagation of a wide variety of HEV strains in sera from various infected patients, allowing extended studies on viral replication specific to different HEV strains. Copyright © 2010, American Society for Microbiology. All Rights Reserved.


Aimoto T.,Nippon Medical School | Uchida E.,Nippon Medical School | Matsushita A.,Nippon Medical School | Kawano Y.,Nippon Medical School | And 2 more authors.
Journal of Nippon Medical School | Year: 2013

Background: Frey's procedure might be a good alternative to pylorus-preserving pancreaticoduodenectomy (PPPD) for patients with an inflammatory mass of the head of the pancreas, because it is technically easy and associated with low morbidity and good pain relief. Purpose: To analyze the short-term and long-term outcomes of Frey's procedure in comparison with PPPD and to evaluate the efficacy of Frey's procedure against preoperative locoregional complications. Patients and Methods: From August 1997 through December 2007, 6 patients underwent Frey's procedure (as described by Frey and Smith), and 10 patients underwent PPPD. The mean follow-up times were 70.8 months (Frey's procedure) and 119.8 months (PPPD). Preoperative biliary stricture and duodenal stenosis were observed in 4 and 3 patients, respectively, of patients undergoing Frey's procedure. Pain intensity was assessed with a pain scoring system. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of-Life Questionnaire-Core 30. Exocrine and endocrine pancreatic function was measured during follow-up. Results: Significant reductions in total pain scores and all QOL scale scores were observed immediately after surgery in all patients (P<0.05). Frey's procedure was superior to PPPD with regard to physical status 7 years after surgery (P<0.05). One patient in the Frey group had a grade B pancreatic fistula, and 2 patients in the PPPD group had intra-abdominal bleeding and delayed gastric emptying. There were no re-operations or surgery-related deaths in either group. Diabetes developed postoperatively in 2 patients in the PPPD group. No patients with preoperative duodenal or biliary stricture or both had a relapse. Three patients in the PPPD group died during follow-up of diseases unrelated to chronic pancreatitis. Conclusion: Frey's procedure is safe and effective with regard to pain relief, preservation of pancreatic function, and improvement of QOL over the long term. Moreover, this procedure can also be used to treat preoperative biliary stricture and duodenal stenosis associated with an inflammatory mass of the pancreatic head.


Takahashi H.,Jichi Medical University | Takahashi H.,Lymphotec Inc. | Tanaka T.,Jichi Medical University | Jirintai S.,Jichi Medical University | And 6 more authors.
Archives of Virology | Year: 2012

Recent evidence has indicated the cross-species transmission of hepatitis E virus (HEV) from pigs and wild boars to humans, causing zoonosis, mostly via consumption of uncooked or undercooked animal meat/viscera. However, no efficient cell culture system for swine and boar HEV strains has been established. We inoculated A549 cells with 12 swine and boar HEV strains of liver, feces, or serum origin at an HEV load of ≥2. 0 × 10 4 copies per well and found that the HEV progeny replicated as efficiently as human HEV strains, with a maximum load of ~10 8 copies/ml. However, the HEV load in the culture medium at 30 days post-inoculation differed markedly by inoculum, ranging from 1. 0 × 10 2 to 1. 1 × 10 7 copies/ml upon inoculation at a lower load of approximately 10 5 copies per well. All progeny were passaged successfully onto A549 and PLC/PRF/5 cells. In sharp contrast, no progeny viruses were detectable in the culture supernatant upon inoculation with 13 swine and boar HEV strains at an HEV load of <1. 8 × 10 4 copies per well. The present study also demonstrates that swine liver sold as food can be infectious, supporting the risk of zoonotic food-borne HEV infection. © 2011 Springer-Verlag.


Yazaki Y.,Kobayashi Hospital | Sugawara K.,Kitami Shokaki Clinic | Honda M.,Kobayashi Hospital | Ohnishi H.,Jichi Medical University | And 3 more authors.
Tohoku Journal of Experimental Medicine | Year: 2015

Autochthonous hepatitis E is increasingly being recognized in industrialized countries, including Japan. Although neurological abnormalities have been sporadically reported as an extrahepatic manifestation of hepatitis E virus (HEV) infection, it is rare and has not been reported in Japan. The present study aimed to characterize a total of 20 patients consecutively diagnosed with sporadic acute hepatitis E at a city hospital in Hokkaido, Japan, during 2001-2014, focusing on a patient complicated with neuropathy. Seventeen patients were infected with genotype 4 HEV, while the remaining three patients were with genotype 3 HEV. Although a 67-year-old male with severe hepatitis did not have predisposing factors associated with the development of neurological disorders, such as diabetes mellitus and the use of immunosuppressive agents, he developed bilateral peripheral facial palsy six days after admission. A neurological examination revealed the inability to smile, frown, close his eyes completely or puff out his cheeks. MRI brain scans were considered to be normal. Although it took 83 days after admission for the total bilirubin levels to normalize, his neurological symptoms resolved gradually within three weeks without any sequelae following conservative therapy. A full-length genomic analysis of the HEV strain (HE-JA30) isolated from the patient belonged to genotype 4 and was closest to that currently circulating in Hokkaido, Japan. This is the first report of HEV-associated neuropathy in Japan. While all of previous reports on HEV-related neuropathy involve genotype 3 HEV, the present report is unique in that genotype 4 HEV is responsible for the neuropathy. © 2015 Tohoku University Medical Press.


Kono T.,Asahikawa University | Mamiya N.,Asahikawa University | Mamiya N.,Higashiasahikawa Hospital | Chisato N.,Asahikawa University | And 7 more authors.
Evidence-based Complementary and Alternative Medicine | Year: 2011

Peripheral neurotoxicity is the major limiting factor for oxaliplatin therapy. Goshajinkigan (GJG), a traditional Japanese herbal medicine, was recently shown to be effective in protecting against the neurotoxicity of taxanes in Japan. We retrospectively investigated the effect of GJG on peripheral neurotoxicity associated with oxaliplatin therapy. Ninety patients with metastatic colorectal cancer that received FOLFOX4 or modified FOLFOX6 therapy were assigned to receive one of the following adjuncts: oral GJG at 7.5g day(1) (Group A, n = 11), intravenous supplementation of calcium gluconate and magnesium sulfate (1g each before and after FOLFOX) (Group B, n = 14), combined GJG and calcium gluconate and magnesium sulfate therapies (Group C, n = 21), or no concomitant therapy (Group D, n = 44). The incidence of peripheral neurotoxicity was investigated when the cumulative dose of oxaliplatin exceeded 500mgm(2). When the cumulative dose of oxaliplatin exceeded 500mgm(2), the incidence of neuropathy (all grades) in Groups AD was 50.0, 100, 78.9, and 91.7, respectively. It was lowest in the group that received GJG alone. Concomitant administration of GJG reduced the neurotoxicity of oxaliplatin in patients that received chemotherapy for colorectal cancer. © 2011 Toru Kono et al.


Kobayashi T.,Hiroshima International University | No Y.,Imamura Orthopaedic Clinic | Yoneta K.,Kobayashi Hospital | Sadakiyo M.,Sadamatsu Hospital | Gamada K.,Hiroshima International University
Foot and Ankle Specialist | Year: 2013

Functional ankle instability (FAI) may involve abnormal kinematics. However, reliable quantitative data for kinematics of FAI have not been reported. The objective of this study was to determine if the abnormal kinematics exist in the talocrural and subtalar joints in patients with FAI. Five male subjects with unilateral FAI (a mean age of 33.4 ± 13.2 years) were enrolled. All subjects were examined with stress radiography and found to have no mechanical ankle instability (MAI). Lateral radiography at weight-bearing ankle internal rotation of 0° and 20° was taken with the ankle at 30° dorsiflexion and 30° plantar flexion. Patients underwent computed tomography scan at 1.0 mm slice pitch spanning distal one third of the lower leg and the distal end of the calcaneus. Three-dimensional (3D) kinematics of the talocrural and subtalar joints as well as the ankle joint complex (AJC) were determined using a 3D-to-2D registration technique using a 3D-to-2D registration technique with 3D bone models and plain radiography. FAI joints in ankle dorsiflexion demonstrated significantly greater subtalar internal rotation from 0° to 20° internal rotation. No statistical differences in plantar flexion were detected in talocrural, subtalar or ankle joint complex kinematics between the FAI and contralateral healthy joints. During ankle internal rotation in dorsiflexion, FAI joints demonstrated greater subtalar internal rotation. The FAI joints without mechanical instability presented abnormal kinematics. This suggests that abnormal kinematics of the FAI joints may contribute to chronic instability. FAI joints may involve unrecognized abnormal subtalar kinematics during internal rotation in ankle dorsiflexion which may contribute to chronic instability and frequent feelings of instability.Level of Evidence: Diagnostic, Level IV, Cross-sectional © 2013 The Author(s).


Takahashi M.,Jichi Medical University | Tamura K.,Jichi Medical University | Hoshino Y.,Jichi Medical University | Nagashima S.,Jichi Medical University | And 7 more authors.
Journal of Medical Virology | Year: 2010

To investigate nationwide the prevalence of hepatitis E virus (HEV) infection in the general population of Japan, serum samples were collected from 22,027 individuals (9,686 males and 12,341 females; age, mean±standard deviation: 56.8±16.7 years; range: 20-108 years) who lived in 30 prefectures located in Hokkaido, mainland Honshu, Shikoku, and Kyushu of Japan and underwent health check-ups during 2002-2007, and were tested for the presence of IgG, IgM, and IgA classes of antibodies to HEV (anti-HEV) by in-house ELISA and HEV RNA by nested RT-PCR. Overall, 1,167 individuals (5.3%) were positive for anti-HEV IgG, including 753 males (7.8%) and 414 females (3.4%), the difference being statistically significant (P<0.0001). The prevalence of anti-HEV IgG generally increased with age and was significantly higher among individuals aged ≥50 years than among those aged <50 years (6.6% vs. 2.7%, P<0.0001). Although 13 individuals with anti-HEV IgG also had anti-HEV IgM and/or anti-HEV IgA, none of them had detectable HEV RNA. The presence of HEV RNA was further tested in 50 or 49-sample minipools of sera from the remaining 22,014 individuals, and three individuals without anti-HEV antibodies tested positive for HEV RNA. The HEV isolates obtained from the three viremic individuals segregated into genotype 3 and were closest to Japan-indigenous HEV strains. When stratified by geographic region, the prevalence of anti-HEV IgG as well as the prevalence of HEV RNA or anti-HEV IgM and/or anti-HEV IgA was significantly higher in northern Japan than in southern Japan (6.7% vs. 3.2%, P<0.0001; 0.11% vs. 0.01%, P=0.0056; respectively). © 2009 Wiley-Liss, Inc.


PubMed | Kobe Gakuin University, Shiga University of Medical Science, Kyoto University and Kobayashi Hospital
Type: Comparative Study | Journal: Ultrasound in medicine & biology | Year: 2015

The objective of the study described here was to compare lower extremity muscle quantity and quality between individuals with and those without knee osteoarthritis (OA). Twenty-one women with knee OA (mild, n = 8; severe, n = 13) and 23 healthy patients participated. Ultrasonography was used to measure muscle thickness (MT) and echo intensity (EI) of the rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, gluteus medius, gastrocnemius, soleus and tibialis anterior. MTs of the vastus medialis and vastus intermedius were smaller, and EIs of the vastus medialis, vastus intermedius, gluteus medius and tibialis anterior were larger, in the severe OA group compared than in the healthy group. Compared with the healthy group, the mild OA group had decreased MT and enhanced EI. Changes in quality and quantity occurring with knee OA progression differed among muscles. In the vastus medialis, change was observed from an earlier stage.


Autochthonous hepatitis E is increasingly being recognized in industrialized countries, including Japan. Although neurological abnormalities have been sporadically reported as an extrahepatic manifestation of hepatitis E virus (HEV) infection, it is rare and has not been reported in Japan. The present study aimed to characterize a total of 20 patients consecutively diagnosed with sporadic acute hepatitis E at a city hospital in Hokkaido, Japan, during 2001-2014, focusing on a patient complicated with neuropathy. Seventeen patients were infected with genotype 4 HEV, while the remaining three patients were with genotype 3 HEV. Although a 67-year-old male with severe hepatitis did not have predisposing factors associated with the development of neurological disorders, such as diabetes mellitus and the use of immunosuppressive agents, he developed bilateral peripheral facial palsy six days after admission. A neurological examination revealed the inability to smile, frown, close his eyes completely or puff out his cheeks. MRI brain scans were considered to be normal. Although it took 83 days after admission for the total bilirubin levels to normalize, his neurological symptoms resolved gradually within three weeks without any sequelae following conservative therapy. A full-length genomic analysis of the HEV strain (HE-JA30) isolated from the patient belonged to genotype 4 and was closest to that currently circulating in Hokkaido, Japan. This is the first report of HEV-associated neuropathy in Japan. While all of previous reports on HEV-related neuropathy involve genotype 3 HEV, the present report is unique in that genotype 4 HEV is responsible for the neuropathy.

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