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Matsudo, Japan

Uemura K.,Matsudo City Hospital
Neurologia Medico-Chirurgica | Year: 2010

For clinical assessment of motor disturbances, the motor system is better classified into the voluntary versus automatic motor systems than into the pyramidal versus extrapyramidal motor systems. The voluntary motor system is related to externally guided movements initiated by the premotor area while the automatic motor system is related to memory guided automatic movements initiated by the supplementary motor area and supported by an appropriate posture and associated movements. Among the pyramidal tract signs, muscle weakness alone is related to involvement of the corticospinal fibers of Betz cell origin while hyperreflexia and spasticity is related to involvement of the reticulospinal fibers running medial to the corticospinal fibers in the spinal cord. The earliest clinical manifestation of cervical myelopathy due to cervical spondylosis is always hyperreflexia and spasticity without any muscle weakness. The memory depends upon the 3 processes of encoding, retention, and recall, and must be classified into the immediate memory or recall lasting for only several seconds tested by the digit span test, the intermediate memory lasting for up to 2 years at maximum at the hippocampus whose disturbance can best be tested by the digit learning test, and the long-term memory which can last as long as one lives which can be tested by asking one's experience before more than 2 years. The classical dichotic concept of recent (short-term) versus remote (long-term) memories must be abandoned. Source


Nakamura J.,Chiba University | Saisu T.,Chiba Childrens Hospital | Yamashita K.,Funabashi Central Hospital | Suzuki C.,Matsudo City Hospital | And 2 more authors.
Arthritis and Rheumatism | Year: 2010

Objective. To clarify whether age at the time of the initial administration of corticosteroids is a risk factor for corticosteroid-associated osteonecrosis in children with systemic lupus erythematosus (SLE), using magnetic resonance imaging (MRI). Methods. From 1986 to 2007, MRI was used to prospectively study 676 joints, including 72 joints (36 hips and 36 knees) in 18 pediatric patients with SLE (<15 years old), 100 joints (50 hips and 50 knees) in 25 adolescent patients with SLE (15-20 years old), and 504 joints (252 hips and 252 knees) in 126 adult patients with SLE (>20 years old), beginning just after corticosteroid administration, for at least 1 year. The followup rate was 100%. Results. In pediatric patients, osteonecrosis developed in 4 joints (6%; all hips). In adolescent patients, osteonecrosis developed in 49 joints (49%; 18 hips and 31 knees). In adult patients, osteonecrosis developed in 207 joints (41%; 95 hips and 112 knees). The rate of osteonecrosis was significantly lower in pediatric patients than in adolescent or adult patients (P = 0.0001). Logistic regression analysis revealed that adolescent and adult patients had a significantly higher risk for osteonecrosis compared with pediatric patients, with an odds ratio of 10.3 (P < 0.0001). The youngest patients with osteonecrosis in the hip and knee were 14.9 years old and 15.5 years old, respectively. Osteonecrosis did not develop in patients younger than age 14 years. Conclusion. Our results suggest that age at the time of the initial administration of corticosteroids is associated with osteonecrosis in pediatric patients with SLE. © 2010, American College of Rheumatology. Source


Kashimura M.,Matsudo City Hospital | Murayama K.,Gunma Cancer Center | Kojima M.,Dokkyo Medical University
International Journal of Surgical Pathology | Year: 2013

Primary hepatic and hepatosplenic diffuse large B-cell lymphomas (DLBCLs) are rare cancers and form nodules in most instances. However, very rare cases can diffusely infiltrate the whole liver without nodules. The general clinicopathological features of these lymphomas have not been reported to date. In our current study, we attempted to elucidate the features of these lesions through our direct observations and by reviewing the current literature. We describe the characteristics of 2 patients with hepatic and hepatosplenic DLBCL by autopsy. The lymphoma cells showed diffuse infiltration of the liver, red pulp of the spleen, and bone marrow with intrasinusoidal and interstitial lymphomatous infiltration of the organs. We discuss our observations in relation to previously reported DLBCLs with a similar pathology. © The Author(s) 2013. Source


Sanayama Y.,Chiba University | Ikeda K.,Chiba University | Saito Y.,Chiba University | Kagami S.-I.,Asahi General Hospital | And 13 more authors.
Arthritis and Rheumatology | Year: 2014

Objective The aim of this prospective multicenter study was to identify biomarkers that can be used to predict therapeutic responses to tocilizumab in patients with rheumatoid arthritis (RA). Methods We recruited patients with RA who were treated with tocilizumab for the first time, and determined therapeutic responses at 6 months. In the training cohort (n = 40), gene expression in peripheral blood mononuclear cells (PBMCs) at baseline was analyzed using genome-wide DNA microarray, with 41,000 probes derived from 19,416 genes. In the validation cohort (n = 20), expression levels of the candidate genes in PBMCs at baseline were determined using real-time quantitative polymerase chain reaction (qPCR) analysis. Results We identified 68 DNA microarray probes that showed significant differences in signal intensity between nonresponders and responders in the training cohort. Nineteen putative genes were selected, and a significant correlation between the DNA microarray signal intensity and the qPCR relative expression was confirmed in 15 genes. In the validation cohort, a significant difference in relative expression between nonresponders and responders was reproduced for 3 type I interferon response genes (IFI6, MX2, and OASL) and MT1G. Receiver operating characteristic curve analysis of models incorporating these genes showed that the maximum area under the curve was 0.947 in predicting a moderate or good response to tocilizumab in the validation cohort. Conclusion Using genome-wide DNA microarray analyses, we identified candidate biomarkers that can be used to predict therapeutic responses to tocilizumab in patients with RA. These findings suggest that type I interferon signaling and metallothioneins are involved in the pathophysiology of RA. Copyright © 2014 by the American College of Rheumatology. Source


Nakamura J.,Chiba University | Harada Y.,Chiba University | Oinuma K.,Funabashi Orthopaedic Hospital | Iida S.,Matsudo City Hospital | And 2 more authors.
Lupus | Year: 2010

Systemic lupus erythematosus (SLE) patients are at high risk of developing osteonecrosis. This study utilized MRI to document the long-term natural history of asymptomatic osteonecrosis associated with corticosteroid therapy in SLE patients. Two hundred and one SLE patients treated with high-dose corticosteroids were prospectively observed from 1986 to 1997. The inclusion criterion was that patients had received periodic MRI examinations of all their hip and knee joints for ≥10 years. Joints that were already collapsed and symptomatic at the first examination were excluded. Five hundred and thirty-seven joints (251 hips and 286 knees) were identified in 144 patients, with a mean follow-up period of 13.6 years (range, 10-20 years) and a follow-up rate of 73%. Mean age of SLE onset was 26 years, and the mean highest oral corticosteroid dosage was 57 mg/day. Osteonecrosis developed in 238 (44%) of 537 joints. At final follow-up, 117 (49%) of these 238 joints demonstrated spontaneous repair in the necrotic area. Osteonecrosis completely disappeared in 21 joints. Enlargement of osteonecrosis was noted in 35 joints (15%) following increased steroid dosage because of SLE recurrence. Finally, 52 joints (22%) were collapsed. Spontaneous repair of asymptomatic osteonecrosis was observed, whereas enlargement occurred only after corticosteroid dosage increases. © The Author(s), 2010. Source

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