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Kuninaka N.,National Center Hospital of Neurology and Psychiatry | Kuninaka N.,National Hospital Organization Yokohama Medical Center | Kawaguchi M.,National Center Hospital of Neurology and Psychiatry | Kawaguchi M.,National Center for Global Health and Medicine | And 5 more authors.
Neuropathology | Year: 2015

The Gallyas method is a silver impregnation technique that is essential in the field of neuropathology because of its high sensitivity for the detection of argentophilic inclusion bodies in the central nervous system. In Japan, the Gallyas method has improved and is widely used as the "modified Gallyas method". However, this method is not popularly used in general pathology laboratories because of the need for special reagents, several staining processes, and skilled techniques. The objective of the current study was to provide a simplified Gallyas method. We omitted the lanthanum nitrate step from the staining process and verified the adequacy in comparison with the original method as well as immunohistochemistry, using specimens from patients of Alzheimer's disease, argyrophilic grain disease, multiple system atrophy, Pick's disease, and Lewy body disease. The simplified method provided good staining to all the structures in archival tissues, compared with the modified Gallyas method in a significantly shorter staining time. The lanthanum nitrate step can be omitted from the modified Gallyas method, resulting in reduction in the number of reagents required and shortening of the staining time. © 2014 Japanese Society of Neuropathology. Source

Toyoda K.,Japan National Cardiovascular Center Research Institute | Yasaka M.,National Hospital Organization Kyushu Medical Center | Uchiyama S.,Tokyo Womens Medical University | Nagao T.,Tokyo Metropolitan HMTC Ebara Hospital | And 8 more authors.
Stroke | Year: 2010

Background and purpose: A prospective, multicenter, observational cohort study was conducted to clarify the association between major bleeding events and blood pressure (BP) levels during follow-up before development of bleeding events in antithrombotic users. Methods: A total of 4009 patients taking oral antithrombotic agents for cardiovascular or cerebrovascular diseases (2728 men, 69±10 years old) were followed. Changes in systolic and diastolic BPs between entry and the last clinic visit before intracranial hemorrhage (ICH) or extracranial hemorrhage were assessed. Results: Over a median follow-up of 19 months, ICH developed in 31 patients and extracranial hemorrhage developed in 77. Entry BP levels were similar among patients with ICH, those with extracranial hemorrhage, and those without hemorrhagic events. Both systolic BP and diastolic BP were relatively high during follow-up as compared with the levels at entry in patients with ICH, whereas they showed plateaus in patients with extracranial hemorrhage and patients without hemorrhagic events. Average systolic BP levels between 1 and 6 months (hazard ratio, 1.45; 95% CI, 1.08 to 1.92 per 10-mm Hg increase) and between 7 and 12 months (hazard ratio, 1.47; 95% CI, 1.05 to 2.01) as well as average diastolic BP levels between 7 and 12 months (hazard ratio, 2.05; 95% CI, 1.15 to 3.62) were independently associated with development of ICH after adjustment for established ICH predictors. The optimal cutoff BP level to predict impending risk of ICH was ≥130/81 mm Hg using receiver operating characteristic curve analysis. Conclusions: An increase in BP levels during antithrombotic medication was positively associated with development of ICH, suggesting the importance of adequate BP control for avoiding ICH. BP levels did not appear to be associated with extracranial hemorrhage. Copyright © 2010 American Heart Association. All rights reserved. Source

Toyoda K.,Japan National Cardiovascular Center Research Institute | Yasaka M.,National Hospital Organization Kyushu Medical Center | Uchiyama S.,Tokyo Womens Medical University | Iwade K.,National Hospital Organization Yokohama Medical Center | And 8 more authors.
Hypertension Research | Year: 2014

The CHADS 2 and CHA 2 DS 2 -VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS 2 and CHA 2 DS 2 -VASc scores were assessed based on information at entry. Scores of 0, 1 and ≥2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS 2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA 2 DS 2 -VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS 2, and 1.44, 1.69 and 2.24% by CHA 2 DS 2 -VASc. After multivariate adjustment, the CHADS 2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03-3.38 per 1-category increase) and the CHA 2 DS 2 -VASc tended to be associated with ischemia (2.18, 0.89-8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS 2 and CHA 2 DS 2 -VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke. © 2014 The Japanese Society of Hypertension. All rights reserved. Source

Tokinaga A.,Yokohama City University | Furuya M.,Yokohama City University | Udaka N.,Yokohama City University | Asai-Sato M.,Yokohama City University | And 2 more authors.
Pathology International | Year: 2014

Endometrial stromal tumors (ESTs) are composed of cells resembling endometrial stroma, and are divided into benign and malignant types based on morphology. Endometrial stromal nodule (ESN) is a benign localized tumor, and endometrial stromal sarcoma (ESS) is an infiltrative and potentially metastatic neoplasm. A series of genetic aberrations contribute to pathological diagnosis of ESTs. At present, subsets of ESN and ESS-low grade (ESS-LG) are characterized as JAZF1-SUZ12/JJAZ1 gene fusion. The ESTs that show higher grade atypia but lack nuclear pleomorphism include YWHAE-FAM22ESS. Here we report an unusual case of ESTs. Sudden colonic perforation occurred to the patient, and emergency surgery was performed. Pathological findings suggested metastatic ESS. Thorough medical examination of the genital organs detected a 1cm-sized well-demarcated uterine tumor. Microscopically, the tumor lacked infiltrative features, conforming to the definition of ESN. Both lesions demonstrated identical cytology and shared JAZF1-SUZ12 gene fusion. Endometriosis was not found in any areas of the resected organs, strongly suggesting that the uterine orthotopic tumor metastasized. The current case uncovered the problems of differential diagnosis between ESN and ESS-LG. We demonstrate detailed pathological features of the two lesions, and discuss the possibility of orthotopic EST with limited infiltration to develop into ESS-LG. © 2014 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd. Source

Inagaki M.,Okayama University | Kawashima Y.,National Institute of Mental Health | Kawanishi C.,Yokohama City University | Yonemoto N.,National Institute of Mental Health | And 7 more authors.
Journal of Affective Disorders | Year: 2015

Background: A huge number of patients with self-harm and suicide attempt visit emergency departments (EDs). We systematically reviewed studies and examined the effect of interventions to prevent repeat suicidal behavior in patients admitted to EDs for a suicidal attempt. Method: We searched the databases of MEDLINE, PsychoINFO, CINAHL, and EMBASE through August 2013. Eligible studies were randomized controlled trials assessing the effects on repeat suicidal behavior of interventions initiated in suicidal patients admitted to EDs. Interventions in each trial were classified into groups by consensus. Meta-analyses were performed to determine pooled relative risks (RRs) and 95% confidence intervals (CIs) of repetition of suicide attempt for interventions in each group. Results: Out of 5390 retrieved articles, 24 trials were included and classified into four groups (11 trials in the Active contact and follow-up, nine in the Psychotherapy, one in the Pharmacotherapy, and three in the Miscellaneous). Active contact and follow-up type interventions were effective in preventing a repeat suicide within 12 months (n = 5319; pooled RR = 0.83; 95% CI: 0.71 to 0.97). However, the effect at 24 months was not confirmed (n = 925; pooled RR = 0.98; 95% CI: 0.76-1.22). The effects of the other interventions on preventing a repetition of suicidal behavior remain unclear. Limitation: Caution is needed regarding the heterogeneity of the effects. Conclusion: Interventions of active contact and follow-up are recommended to reduce the risk of a repeat suicide attempt at 12 months in patients admitted to EDs with a suicide attempt. However, the long-term effect was not confirmed. © 2014 Elsevier B.V. All rights reserved. Source

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