Nagai Clinic

Misato, Japan

Nagai Clinic

Misato, Japan
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Nagai K.,Nagai Clinic | Matsumaru K.,Nagai Clinic | Nakamura N.,Saiseikai Yokohama shi Nanbu Hospital
Case Reports in Gastroenterology | Year: 2011

A 56-year-old Japanese female with a 10-year history of thyroiditis presented to our institution. The laboratory data and clinical findings suggested that the patient had complicated nonalcoholic fatty liver disease or nonalcoholic steatohepatitis (NASH) with autoimmune hepatitis according to the criteria by the application of the International Autoimmune Hepatitis score. The patient could not manage by herself so dietary- and exercise-based treatment was difficult. Accordingly, ursodeoxycholic acid and ezetimibe therapy was started and continued until the performance of a liver needle biopsy to define the diagnosis. However, no improvement in liver function was observed. In addition, pathological findings indicated that the patient had NASH. The patient was finally diagnosed as having NASH. Therefore, voglibose was added to the ursodeoxycholic acid and ezetimibe therapy, and this addition of voglibose actually took effect. The patient's serum aspartate transaminase and alanine aminotransferase levels decreased dramatically. This report is the first to document other treatment possibilities of NASH in a case when dietary therapy is difficult. Copyright © 2011 S. Karger AG, Basel.

PubMed | Hikari Clinic, Teraoka Clinic, Nagai Clinic, Tsunoda Iin and 5 more.
Type: | Journal: Journal of gastroenterology | Year: 2016

Some patients with irritable bowel syndrome (IBS) show poor response to treatment. However, risk factors associated with poor therapeutic response have not been determined.This multicenter trial evaluated consecutive outpatients with IBS undergoing treatment for more than 1month. Mental health status and physical function were evaluated using the Japanese version of the SF-8. Therapeutic response was evaluated using the IBS severity index-Japanese version (IBS-SIJ). Patients with IBS-SIJ scores 175 were defined as poor responders to treatment, whereas those with IBS-SIJ scores <175 were defined as good responders. The demographic and clinical characteristics of these two groups, along with medications, were compared.The study enrolled 131 participants, 75 with IBS-SIJ scores 175-56 with IBS-SIJ scores <175. Multiple logistic regression analysis showed that female sex [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.19-5.97, p=0.0167] and mental component summary (MCS) of the SF-8 <40 (OR 2.58, 95% CI 1.12-5.97, p=0.0263) were independent risk factors for poor therapeutic response in patients with IBS.Lower MCS and female sex were risk factors for poor therapeutic response in patients with IBS. Ascertaining the mechanisms by which lower MCS and female sex are associated with poor therapeutic response in IBS may help design better treatments (Trial registration number: UMIN000016804).

Otsuki J.,Nagai Clinic | Nagai Y.,Nagai Clinic | Matsuyama Y.,Gifu University | Terada T.,Gifu University | Era S.,Gifu University
Systems Biology in Reproductive Medicine | Year: 2012

A number of reports have suggested that the oxidative state of human albumin in serum and in some body fluids is associated with cell damage. However there are no reports on the redox state of human follicular fluid (FF) and its influence on oocyte viability. The aim of this study was to examine the relationship between the redox state of FF and serum on oocyte viability. The cytoplasmic condition of oocytes was evaluated microscopically at collection in 117 women. Deteriorating oocytes were recognized by degenerative changes in their cytoplasm. The redox state of FFs that yielded degenerated oocytes was evaluated and compared with fluids containing normal oocytes. The redox state of the corresponding FF and serum, at the time of oocyte retrieval, was analyzed by high performance liquid chromatography. The redox state of FF that contained degenerated oocytes was found to have a significantly elevated oxidized state compared with the FFs that yielded normal oocytes. Also the albumin in the FF of patients was found to be predominantly in the reduced state compared with that in their serum at the time of oocyte retrieval. In addition, increasing age and endometriosis were found to shift the redox of serum to the oxidative state. We propose that the reduced state of albumin in FF may play an important role in protecting oocytes from oxidative damage. © Copyright ©2012 Informa Healthcare USA, Inc.

Otsuki J.,Nagai Clinic | Nagai Y.,Nagai Clinic | Matsuyama Y.,Gifu University | Terada T.,Gifu University | Era S.,Gifu University
Systems Biology in Reproductive Medicine | Year: 2013

Albumin has multiple physiological functions in embryo culture, such as a chelator of heavy metals, free radical scavenger, pH and osmotic regulator, a stabilizer, growth factor carrier, a surfactant, and a nutrient. However, the commercially available human serum albumin (HSA) products may not be completely safe since they could be contaminated with viruses and prions. Recombinant human serum albumin (rHSA) has been reported to be as efficient as commercial HSA for fertilization and embryo development. Despite the possible benefits of rHSA, it has not been widely used for embryo culture due to its high cost of production. Our objective was to analyze the redox state of different types of HSA products and rHSA to define oxidative status batch variations of HSA and rHSA and to evaluate the optimal concentration of rHSA for mouse embryo culture. The redox state of the HSA and rHSA used in embryo culture media was found to vary widely. Redox variations were found among different HSA batches as well as among rHSA batches. The highest blastocyst development and hatching rates were obtained with rHSA used at a concentration of 0.05mg/mL. We showed that very low concentrations of rHSA were most favorable for advanced mouse embryo development in culture. © 2013 Informa Healthcare USA, Inc.

PubMed | Nagai Clinic and Saiseikai Yokohama shi Nanbu Hospital
Type: Journal Article | Journal: Iranian Red Crescent medical journal | Year: 2015

In daily practice, it is common to experience difficulty in treating decubitus ulcers (pressure ulcers, also known as decubitus ulcers) and stasis dermatitis of the lower limbs. We hereby report that omega-3-acid ethyl esters were remarkably effective when administered to cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving the blood flow and promoting blood circulation.Case 1: A 21-year-old Japanese female with lower-body paralysis. Pressure ulcers appeared on the heel and first toe of her left lower extremity. Although the patient had been treated with various ointments such as dimethyl isopropylazulene and 0.9% iodine-containing ointment, the course showed no improvement, so omega-3-acid ethyl esters was administered orally, completely healing the ulcer of the first toe in 10 weeks. Case 2: A 76-year-old Japanese male. The patient had been treated on an outpatient basis for 15 years due to hypertension, heart failure, type 2 diabetes mellitus, and hyperlipidemia. Two years prior to this presentation, stasis dermatitis occurred in the lower limbs and at the end of last year, erosive ulcers appeared on the front part of the lower-right thigh and shin. Although treatment with various topical ointment and dressings was performed, the course showed no improvement. Oral administration of omega-3-acid ethyl esters was initiated. At 12 weeks, his condition entered the white phase and healed almost completely.This report is the first to document other treatment possibilities for pressure ulcer and/or stasis dermatitis in cases where the use of topical applied ointments and medications is difficult. This new therapy may therefore help physicians to treat pressure ulcers and stasis dermatitis.

Watanabe H.,Shiga University of Medical Science | Inoue K.,University of Tokyo | Doi M.,Former Aiiku Hospital | Matsumoto M.,Waseda University | And 3 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2010

Aim: The purpose of our study was to investigate the association between low maternal prepregnancy body mass index (BMI) less than 18.5 kg/m2 and the incidence of small for gestational age (SGA) infants. Material & Methods: This was a cross-sectional study. The women with BMI of less than 25.0 kg/m2 who gave birth to single term infants (37-42 weeks) at clinics and hospitals in the Tokyo metropolitan area between 2003 and 2004 were analyzed for risk factors for SGA. Results: Five hundred and seventy-two women were underweight (BMI < 18.5 kg/m2) and 2708 (75.1%) were normal (18.5 ≤ BMI < 25.0 kg/m2). Birthweight, analyzed by multiple regression analysis, was highly related (P < 0.05) to gestational age, maternal age, parity, prepregnancy BMI, maternal weight gain and maternal smoking status. Women with a less than 9 kg weight during pregnancy were 1.8 times (confidence interval [CI], 1.6-2.2) more likely to give birth to an SGA infant compared with women who gained 9-12 kg. Maternal smoking more than 10 cigarettes per day was associated with an increased risk of having an SGA infant (odds ratio [OR], 2.5; CI, 1.8-3.5). Women with prepregnancy BMI less than 21.0 kg/m2 were associated with an increased risk of having an SGA infant (OR, 1.6; CI, 1.3-2.2 for BMI < 18.5 kg/m2, and OR, 1.4; CI, 1.2-1.7 for 18.5 ≤ BMI ≤ 21.0 kg/m2). Conclusion: We conclude that the detrimental effect of low prepregnancy BMI in Japanese women on birthweight and incidence of SGA infants. Our findings suggest that appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the SGA infants and increasing the birthweight. © 2010 Japan Society of Obstetrics and Gynecology.

Otsuki J.,Nagai Clinic | Nagai Y.,Nagai Clinic | Lopata A.,University of Melbourne | Chiba K.,Ochanomizu University | And 2 more authors.
Human Reproduction | Year: 2012

BACKGROUND: Gentle compression of mouse oocytes during meiosis-1 prevented the usual extrusion of a small polar body and resulted in the symmetrical division of the ooplasm into two cells of similar size within the zona pellucida. The purpose of our study was to determine whether such cells, equivalent to two small oocytes, were capable of embryonic development and would result in birth following transfer to the uterus. METHODS: IVF of the 2-celled oocytes was performed and the twin intra-zonal embryos were observed. In each case, the two embryos that originated from fertilized cells with two pronuclei were observed to amalgamate and form a single morula and subsequent blastocyst that was transferred to the uterus of a recipient of a different mouse strain. FISH analysis was performed on sectioned paraffin-embedded tissue of the offspring. RESULTS: In symmetrically divided oocytes each cell contained a metaphase II spindle. Both cells were fertilizable and cleaved to form twin embryos within the same zona pellucida. Most twin embryos amalgamated to form a single compacted morula, which progressed to hatched blastocysts that contained a single inner cell mass. In total, 104 of these blastocysts were transferred to 19 mice, two of which became pregnant, resulting in the birth of three offspring. FISH analysis showed that one newborn contained both XX and XY cells. CONCLUSIONS: We found that two small oocytes fertilized within the same zona pellucida to form twin embryos that amalgamate to establish a single chimeric embryo. This may be one mechanism that leads to the formation of a chimeric hermaphrodite when an embryo containing XX cells mixes with its intra-zonal twin containing XY cells. © The Author 2011. Published by Oxford University Press. All rights reserved.

Otsuki J.,Nagai Clinic | Nagai Y.,Nagai Clinic | Sankai T.,Japan National Institute of Biomedical Innovation
Reproductive BioMedicine Online | Year: 2014

Germinal-vesicle (GV) transfer, spindle-chromosome complex transfer in metaphase-II oocytes and two pronuclei transfer have been evaluated as possible treatments for patients who have mitochondrial diseases. However, GV transfers often lead to heteroplasmy while the other two methods are frequently associated with aneuploidy. The present study used a new method based on the transfer of aggregated chromosomes, which occurs in human oocytes, before the metaphase spindle is established. © 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Yasmin L.,Japan National Institute of Biomedical Innovation | Takano J.-I.,Japan National Institute of Biomedical Innovation | Nagai Y.,Nagai Clinic | Otsuki J.,Japan National Institute of Biomedical Innovation | Sankai T.,Japan National Institute of Biomedical Innovation
Comparative Medicine | Year: 2015

Because of their developmental similarities to humans, nonhuman primates are often used as a model to study fetal development for potential clinical applications in humans. The detection of fetal DNA in maternal plasma or serum offers a source of fetal genetic material for prenatal diagnosis. However, no such data have been reported for cynomolgus monkeys (Macaca fascicularis), an important model in biomedical research. We have developed a specific, highly sensitive PCR system for detecting and quantifying male-specific fetal DNA in pregnant cynomolgus monkeys. We used multiplex quantitative real-time PCR to analyze cell-free DNA in maternal blood serum obtained from 46 pregnant monkeys at gestational weeks 5, 12, and 22. The presence of SRY gene and DYS14 Y chromosomal sequences was determined in 28 monkeys with male-bearing pregnancies. According to confirmation of fetal sex at birth, the probe and primers for detecting the Y chromosomal regions at each time point revealed 100% specificity of the PCR test and no false-positive or false-negative results. Increased levels of the SRY-specific sequences (mean, 4706 copies/mL serum DNA; range, 1731 to 12,625) and DYS14-specific sequences (mean, 54,814 copies/mL serum DNA; range, 4175-131,250 copies) were detected at week 22. The SRY- and DYS14-specific probes appear to be an effective combination of markers in a multiplex PCR system. To our knowledge, this report is the first to describe the detection of cell-free DNA in cynomolgus monkeys. Copyright 2015 by the American Association for Laboratory Animal Science.

Matsumaru K.,Nagai Clinic
BMJ case reports | Year: 2010

The authors describe a case of SAPHO syndrome with bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer. The patient had undergone transurethral resection (TUR) and was treated with BCG immunotherapy following TUR. Two years after treatment for bladder cancer, the patient had palmoplantar pustulosis, and in the past 1 month suffered from pain localised to the anterior chest wall. The bone scintigraphy showed a strong focal enrichment in the right chest wall, suggesting spondyloarthropathy rather than malignant disease. On the basis of clinical and scintigraphy findings, SAPHO syndrome was diagnosed. The patient was treated with topical therapy and non-steroidal anti-inflammatory drugs and symptoms improved. The authors suggest that SAPHO syndrome might be caused by an association with BCG immunotherapy.

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