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Hang N.T.L.,Tokyo Womens Medical University | Hang N.T.L.,National Center for Global Health | Maeda S.,Research Institute of Tuberculosis | Keicho N.,Research Institute of Tuberculosis | And 3 more authors.
Tuberculosis | Year: 2015

The influence of Mycobacterium tuberculosis (MTB) lineages/sublineages on unfavorable tuberculosis (TB) treatment outcomes is poorly understood. We investigated the effects of Beijing genotype sublineages and other factors contributing to treatment outcome. Patients newly diagnosed with sputum smear-positive and culture-positive TB in Hanoi, Vietnam, participated in the study. After receiving anti-TB treatment, they were intensively followed up for the next 16 months. MTB isolates collected before treatment were subjected to drug susceptibility testing, and further analyzed to determine MTB (sub) lineages and their clonal similarities. Of 430 patients, 17 had treatment failure and 30 had TB recurrence. Rifampicin resistance was associated with treatment failure {adjusted odds ratio = 6.64 [95% confidence interval (CI), 1.48-29.73]}. The modern Beijing genotype was significantly associated with recurrent TB within 16 months [adjusted hazard ratio = 3.29 (95% CI, 1.17-9.27)], particularly after adjustment for the relevant antibiotic resistance. Human immunodeficiency virus coinfection and severity on chest radiographs were not significantly associated with unfavorable outcomes. Our findings provide further understanding of the influence of MTB strains on unfavorable treatment outcomes. Multiple risk factors should be considered for the optimal management of TB. © 2015 Elsevier Ltd.


Tajima M.,University of Tokyo | Hiroi Y.,University of Tokyo | Hiroi Y.,National Center for Global Health | Takazawa Y.,University of Tokyo | And 6 more authors.
Human Pathology | Year: 2014

Summary Immunoglobulin G4 (IgG4)-related disorders in various organs have recently been described, but multiple systemic aneurysms have not yet been reported. Here, we present a 68-year-old Japanese man with multiple systemic aneurysms and tumor-forming pericoronary arteritis who was undergoing low-dose corticosteroid therapy. Elevated serum IgG4 (2390 mg/dL) and IgG4-positive plasmacyte infiltration in the salivary glands led to a diagnosis of IgG4-related disease. High-dose corticosteroid therapy was initiated, whereupon the inflammatory lesions shrank. However, the large, well-developed common hepatic aneurysm and splenic aneurysm did not change. Our patient died of splenic aneurysm rupture in the sixth month of treatment. The autopsy revealed IgG4-positive plasmacyte infiltration in the coronary wall and a thinned splenic aneurysm wall. This case suggests that early high-dose corticosteroid therapy may be necessary for the treatment of IgG4-related cardiovascular disorders. A minor salivary gland biopsy might facilitate the early diagnosis of IgG4-related disease even if 18F-fluorodeoxyglucose positron emission tomography provides no inflammatory findings. © 2014 Elsevier Inc.


Minamimoto R.,National Center for Global Health | Minamimoto R.,Yokohama City University | Senda M.,Institute of Biomedical Research and Innovation | Jinnouchi S.,Atsuchi Memorial Institute of Radiology | And 3 more authors.
Clinical Breast Cancer | Year: 2015

Background The [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program is defined as cancer screening for asymptomatic subjects using FDG-PET/computed tomography with or without combination of other screening tests. The aim of this study was to analyze the detection rate and effectiveness of the FDG-PET cancer screening program for breast cancer between 2006 and 2009 in Japan. Patients and Methods A total of 62,054 asymptomatic female subjects underwent FDG-PET cancer screening. We analyzed 473 cases with findings of possible breast cancer in any screening tests. Results Among 473 possible cases, 161 were verified as breast cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET for breast cancer were 83.9% and 41.7%, respectively. The relative sensitivity and PPV of mammography (MMG) for breast cancer was less than for FDG-PET; results for breast ultrasonography (US) were close to FDG-PET. The combination of FDG-PET with MMG and US might contribute to increased sensitivity but does not improve PPV. Most breast cancer cases (83.0%) detected using the FDG-PET cancer screening program were stage 0 or I based on the Union for International Cancer Control criteria. Conclusion The FDG-PET screening program in Japan detected breast cancer at an early stage. A combination of FDG-PET and MMG and/or breast US yields the best results for detecting breast cancer. The FDG-PET cancer-screening program alone cannot detect all breast cancers. © 2015 Elsevier Inc.


Hamada Y.,Clinical Center | Nagata N.,National Center for Global Health and Medicine | Shimbo T.,Japan National Institute of Information and Communications Technology | Igari T.,National Center for Global Health | And 13 more authors.
AIDS Patient Care and STDs | Year: 2013

We conducted a single-center prospective study to evaluate the utility of cytomegalovirus (CMV) antigenemia assay for the diagnosis of CMV-gastrointestinal disease (GID). The study subjects were HIV-infected patients with CD4 count ≤200 μL/cells who had undergone endoscopy. A definite diagnosis of CMV-GID was made by histological examination of endoscopic biopsied specimen. CMV antigenemia assay (C10/C11 monoclonal antibodies), CD4 count, HIV viral load, history of HAART, and gastrointestinal symptoms as measured by 7-point Likert scale, were assessed on the same day of endoscopy. One hundred cases were selected for analysis, which were derived from 110 cases assessed as at high-risk for CMV-GID after endoscopy screening of 423 patients. Twelve patients were diagnosed with CMV-GID. Among the gastrointestinal symptoms, mean bloody stool score was significantly higher in patients with CMV-GID than in those without (2.5 vs. 1.7, p=0.02). The area under the receiver-operating characteristic curve of antigenemia was 0.80 (95%CI 0.64-0.96). The sensitivity, specificity, positive likelihood ratio (LR), and negative LR of antigenemia were 75.0%, 79.5%, 3.7, and 0.31, respectively, when the cutoff value for antigenemia was ≥1 positive cell per 300,000 granulocytes, and 50%, 92.0%, 5.5, and 0.55, respectively, for ≥5 positive cells per 300,000 granulocytes. In conclusion, CMV antigenemia seems a useful diagnostic test for CMV-GID in patients with HIV infection. The use of ≥5 positive cells per 300,000 granulocytes as a cutoff value was associated with high specificity and high positive LR. Thus, a positive antigenemia assay with positive endoscopic findings should allow the diagnosis of CMV-GID without biopsy. © Copyright 2013, Mary Ann Liebert, Inc.


Satake N.,National Center for Global Health
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica | Year: 2011

Polypharmacy and high-dose treatment of antipsychotics have been major problems in Japanese mental health. Although importance of simplifying prescription has been recognized, polypharmacy and high-dose medication especially for Schizophrenia remains prevalent. It's considered that psycho-social approach; for example, improvement of coping skills and social support such as care management can make reform of treatment efficiently and also improve patient's QOL. In ACT service, Medication, rehabilitation and social support work closely together and it could make prescription change even for SMI patients. Low-dose medication leads improvement of cognitive function and furthermore social activity. Considering the higher dose of antipsychotics prescribed concurrency in Japan, it's important to evaluate the change in medication for patients of ACT in Japan. We did one year follow up study about prescription change for 52 patients who have used ACT program at ACT-J team for more than one year at the end of December 2009. It was found that the dosage antipsychotics significantly decreased from 1131.3 mg converted to the relative potency equivalent of 100 mg of Chlorpromazine (CPZ eq), to 731.3 mg (CPZ eq) over the course of the 12 months. But there was no significant change about polyphamacy. Also it could be possible to reduce rehospitalization under the ACT program. Because recovery model could make improve not only drop out from psychiatric service, but user's dependency for hospitalization.

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