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Kodama S.,Mito Kyodo General Hospital | Kodama S.,Niigata University | Horikawa C.,Niigata University | Fujihara K.,University of Tsukuba | And 9 more authors.
American Journal of Epidemiology | Year: 2012

The aim of this meta-analysis was to compare the association of waist-to-height ratio (WHtR) with risk of incident diabetes with the associations of 3 other conventional obesity indicators (body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)) with risk of incident diabetes. Literature searches in MEDLINE (January 1950 to April 27, 2011) and EMBASE (January 1974 to April 27, 2011) were conducted for prospective studies that made it possible to estimate the relative risk of diabetes per 1-standard deviation increase in WHtR, in addition to the RR of BMI, WC, or WHR. Strength of the estimated pooled relative risk for a 1-standard deviation increase of each indicator (expressed as RRWHtR, RRBMI, RR WC, and RRWHR) was compared with a bivariate random-effects model. Pooled relative risks of the 15 eligible studies with 6,472 diabetes cases were 1.62 (95 CI: 1.48, 1.78) for RRWHtR, 1.55 (95 CI: 1.43, 1.69) for RRBMI, 1.63 (95 CI: 1.49, 1.79) for RR WC, and 1.52 (95 CI: 1.40, 1.66) for RRWHR. WHtR had an association stronger than that of BMI (P<0.001) or WHR (P<0.001). The present meta-analysis showed that WHtR has a modestly but statistically greater importance than BMI and WHR in prediction of diabetes. Nevertheless, measuring height in addition to WC appeared to have no additional benefit. © 2012 The Author.


Nishiguchi S.,Shonan Kamakura General Hospital | Branch J.,Shonan Kamakura General Hospital | Suganami Y.,Shonan Kamakura General Hospital | Kitagawa I.,Shonan Kamakura General Hospital | Tokuda Y.,Mito Kyodo General Hospital
Internal Medicine | Year: 2014

Objective Patients with urosepsis associated with urinary tract calculi occasionally require drainage, primarily via ureteric stenting. Such patients require longer hospitalization. However, the indications for early ureteric stenting for this condition have not been clearly defined. To compare the length of stay (LOS) in the hospital between patients treated with earlier ureteric stenting versus those with delayed ureteric stenting.Methods Design: Retrospective cohort study. Setting: An acute care teaching hospital in Japan. Measurement: Length of hospital stay in days.Patients Patients with urosepsis associated with urinary tract calculi.Results Among a total of 30 patients (mean age, 72; 13 men), the mean number of days from emergency room admission to ureteric stenting was 3.5 days (range, 1-14 days), and the overall mean LOS was 36 days (range, 8-102 days). The early stenting group (mean LOS, 21 days) had a significantly shorter LOS than the delayed stenting group (mean LOS, 50 days), with an adjusted beta coefficient of -26 days [95% confidence interval (CI), -46, -6].Conclusion In patients with urosepsis associated with urinary tract calculi, performing early stenting within two days of admission may reduce the LOS in the hospital. © 2014 The Japanese Society of Internal Medicine.


Hamano J.,University of Tsukuba | Tokuda Y.,Mito Kyodo General Hospital
Journal of Primary Care and Community Health | Year: 2014

Background: Although several previous studies have examined the prevalence and risk factors associated with inappropriate prescribing (IP) among elderly patients, as identified by the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria, no research has been conducted among elderly home care patients. Objective: This study aimed to explore the prevalence of IP and its risk factors as identified by the STOPP/START criteria among elderly home care patients in Japan. Study Design: Crosssectional study. Setting: Home care settings in Japan. Participants: Eighty-nine patients aged 65 years or older who received regular home visiting services from Yamato Clinic between May 2013 and June 2013. Main Outcome Measure: The prevalence of IP and its risk factors as identified by the STOPP/START criteria. Results: Of the study population, 40.4% had at least one potentially inappropriate medication and 60.7% had at least one incidence of underprescribing. Risk factors for potentially inappropriate medications were hypertension, constipation, and polypharmacy, while those for underprescription were osteoporosis and polypharmacy. Conclusion: The prevalence of IP among elderly home care patients is high, with risk factors that include not only polypharmacy but also several specific underlying medical conditions. © The Author(s) 2014.


Kodama S.,Mito Kyodo General Hospital | Kodama S.,Niigata University | Tanaka S.,Kyoto University | Heianza Y.,Niigata University | And 7 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-The association between habitual physical activity (PA) and lowered risk of all-cause mortality (ACM) and cardiovascular disease (CVD) has been suggested in patients with diabetes. This meta-analysis summarizes the risk reduction in relation to PA, focusing on clarifying dose-response associations. RESEARCHDESIGNAND METHODS-Electronicliterature searcheswereconducted for cohort studies that examined relative risk (RR) of ACM or CVD in relation to PA in patients with diabetes. For the qualitative assessment, RR for the highest versus the lowest PA category in each study was pooled with a random-effects model. We added linear and spline regression analyses to assess the quantitative relationship between increases in PA and ACM and CVD risk. RESULTS-There were 17 eligible studies. Qualitatively, the highest PA category had a lower RR [95% CI] for ACM (0.61 [0.52-0.70]) and CVD (0.71 [0.60-0.84]) than the lowest PA category. The linear regression model indicated a high goodness of fit for the risk of ACM (adjusted R2 = 0.44, P = 0.001) and CVD (adjusted R 2 = 0.51, P = 0.001), with the result that a 1 MET-h/day incrementally higher PA was associated with 9.5% (5.0-13.8%) and 7.9% (4.3-11.4%) reductions in ACM and CVD risk, respectively. The spline regression model was not significantly different from the linear model in goodness of fit (P = 0.14 for ACM risk; P = 0.60 for CVD risk). CONCLUSIONS-More PA was associated with a larger reduction in future ACM and CVD risk in patients with diabetes. Nevertheless, any amount of habitual PA was better than inactivity.© 2013 by the American Diabetes Association.


Kodama S.,Mito Kyodo General Hospital | Kodama S.,Niigata University | Horikawa C.,Niigata University | Fujihara K.,Mito Kyodo General Hospital | And 10 more authors.
Obesity Reviews | Year: 2014

This meta-analysis quantified the risk of type 2 diabetes mellitus (T2DM) preceded by body weight (BW) gain in the general population. Systematic literature searches retrieved 15 eligible studies. The BW gain was divided into early weight-gain, which was defined as BW gain from early adulthood (18-24 years of age) to cohort entry (≥25 years of age), and late weight-gain, which was defined as BW gain from cohort entry. The pooled relative risk (RR; 95% confidence interval [CI]) of T2DM for an increment of BW gain standardized into a 5-kg m-2 increment in the body mass index (BMI) was 3.07 (2.49-2.79) for early weight-gain and 2.12 (1.74-2.58) for late weight-gain. When limiting analysis to studies that concurrently examined T2DM risk for current BMI (defined in both groups as BMI at cohort entry), a larger magnitude of T2DM risk was revealed for early weight-gain compared with current BMI (RR [95% CI], 3.38 [2.20-5.18] vs. 2.39 [1.58-3.62]), while there was little difference between late weight-gain (RR [95% CI], 2.21 [1.91-2.56]) and current BMI (RR [95% CI], 2.47 [1.97-3.30]). The meta-analysis suggested that BW gain was a quantifiable predictor of T2DM, as well as current obesity in adults. Particularly, BW gain in early rather than middle-to-late adulthood played an important role in developing T2DM. © 2013 International Association for the Study of Obesity.


Ishitsuka Y.,University of Tsukuba | Kawachi Y.,University of Tsukuba | Taguchi S.,Mito Kyodo General Hospital | Maruyama H.,University of Tsukuba | And 5 more authors.
Experimental Dermatology | Year: 2013

Non-melanoma skin cancer is the most frequently occurring type of cancer worldwide and is caused by epidermal carcinogenesis and malignant progression that involve dysregulated expression of proto-oncogenes and tumor suppressor genes. The proto-oncogene pituitary tumor-transforming gene 1 (PTTG1) is a ubiquitously expressed transcription factor that can promote enhanced proliferation of cultured epidermal keratinocytes. To investigate the potential roles of PTTG1 in epidermal carcinogenesis and malignant progression, the expression of PTTG1 was analysed by immunohistochemistry along with Ki67, keratin 10 (K10) and p53 in tissue samples of cutaneous squamous cell carcinomas (SCC), actinic keratoses (AK) and Bowen's disease (BD). Expression levels of PTTG1 were compared among these disease groups to test for correlations with proliferation, differentiation capacity or the existence of mutated tumor suppressor genes in each disease group. In each disease group, the expression levels of PTTG1 correlated positively with those of Ki67, although the differentiation status, measured by K10 expression, did not show any correlation. In contrast, the existence of mutated p53 proteins showed a positive correlation only in the SCC group. Moreover, the expression levels of PTTG1 in SCC did not correlate with known prognostic factors such as TNM staging or tumor thickness. These results suggest that PTTG1 may represent a proliferation marker associated with mutated p53 proteins but is not an informative predictor of poor clinical outcomes in SCC. © 2013 John Wiley & Sons A/S.


PubMed | Tsukuba Gakuen Hospital, Kensei General Hospital, University of Tsukuba, Mito Kyodo General Hospital and 2 more.
Type: Journal Article | Journal: Asian spine journal | Year: 2016

Retrospective, radiological study.To determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma.Little is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms.Twenty-two patients (9 men and 13 women; age, 19-79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptom-positive and -negative groups were analyzed for each variable.In the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%-10% (mean, 9%) in axial slices and 23%-31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%-86% (mean, 50%) in axial slices and 43%-88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Djrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign.PTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma.


PubMed | Tukuba University and Mito Kyodo General Hospital
Type: | Journal: BMJ case reports | Year: 2017

Minor damage to the scalp may lead to intracranial infection. Moreover, the postoperative state of the scalp, skull and meninges is especially noteworthy with respect to invasion of pathogens into the skull. Therefore, a detailed medical history should be obtained from patients with even minor scalp injuries to avoid intracranial infection. We herein report a case of intracranial infection caused by a minor scalp injury associated with previous craniotomy, which was missed at first.


PubMed | University of Tsukuba and Mito Kyodo General Hospital
Type: | Journal: BMJ case reports | Year: 2015

Deficiency of multiple vitamins can be identified in alcoholic and malnourished patients. We report a patient with Wernicke encephalopathy, a B1 deficiency and pellagra, a niacin deficiency. A 61-year-old Japanese man presented with generalised weakness. He had drunk alcohol heavily for more than a year without eating adequate meals. Physical examination showed disorientation, eye movement impairment, muscle wasting and a rash over the limbs. Multivitamin supplementations improved all the symptoms. Pellagra causes dementia, diarrhoea, or dermatitis, and can mimic non-specific erythaema in alcoholics. The differential diagnosis between pellagra and non-specific erythaema is important because of the treatability of pellagra by niacin supplementation.


PubMed | Mito Kyodo General Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

A 55-year-old woman was admitted to our hospital complaining of constipation and abdominal distention. She had a history of right breast surgery for cancer at the age of 48 years. An abdominalCT scan revealed tumors at the antrum of the stomach and the ascending colon, and the tumor at the ascending colon caused obstruction of the colon. She was diagnosed with breast cancer recurrence and was administered combination chemotherapy consisting of gemcitabine and paclitaxel. Ileus improved after this treatment, and she was discharged from the hospital and was able to receive outpatient chemotherapy. After 8 months, she experienced symptoms of ileus again, and conservative treatment was considered impossible. Therefore, she underwent distal gastrectomy and right hemicolectomy. Histological and immunohistological analyses confirmed that the tumors were breast cancer metastases. Chemotherapy with gemcitabine and paclitaxel helped our patient to return to daily life and improved her prognosis.

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