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Conclusion. When excessive height loss occurs in the elderly, which may be indicated by a cervical-bent posture, examination of the head and neck should be performed to detect common carotid artery (CCA) and internal carotid artery (ICA) aberration. In such cases brain magnetic resonance imaging (MRI) examination should be conducted to determine whether infarction is present. Objectives. To examine the relationships among bent posture, height loss, aberration of carotid arteries, and ischemic stroke risk with a case-control study. Methods: Controls (n = 163) were selected from among patients who had undergone MRI of the brain because of otolaryngologic symptoms. Case patients (n = 72) were selected from among those whose primary diagnosis was cerebral infarction in the area served by the ICA. Both groups were age-matched between 65 and 84 years old. The neck and pharyngeal cavity in each of the 235 patients were examined to determine whether the carotid arteries exhibited aberration. Patients' current height and greatest lifetime height were recorded, along with presence or absence of bent posture and other stroke risk factors. Results: Height loss alone could predict stroke risk in 79.1% of patients: 90.2% based on carotid artery aberration and 91.4% when all risk factors (aberration of carotid artery, height loss, bent posture) were analyzed. © 2011 Informa Healthcare.

Izumi K.,Keio University | Izumi K.,National Tokyo Medical Center | Kaneko Y.,Keio University | Hashizume M.,Chugai Pharmaceutical Co. | And 2 more authors.
PLoS ONE | Year: 2015

Objective: To explore the baseline predictors of clinical effectiveness after tocilizumab or infliximab treatment in biologic-naïve rheumatoid arthritis patients. Methods: Consecutive biologic-naïve patients with rheumatoid arthritis initiating infliximab (n = 57) or tocilizumab (n = 70) treatment were included in our prospective cohort study. Our cohort started in February 2010, and the patients observed for at least 1 year as of April 2013 were analysed. We assessed baseline variables including patients' characteristics (age, sex, disease duration, prednisolone dose, methotrexate dose, other disease-modifying antirheumatic drug use, Clinical Disease Activity Index [CDAI]) and serum biomarker levels (C-reactive protein, immunoglobulin M-rheumatoid factor, anti-cyclic citrullinated protein/pep-tide antibodies, interferon-y, interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-17, tumor necrosis factor-a, soluble intercellular adhesion molecule-1, bone alkaline phosphatase, osteonectin, osteopontin) to extract factors associated with clinical remission (CDAK2.8) at 1 year using univariate analyses, and the extracted factors were entered into a multivariate logistic regression model. Similar analyses were also performed for Simplified Disease Activity Index (SDAI) remission (<3.3) and Disease Activity Score with 28 joint counts, erythrocyte sedimentation rate (DAS28-ESR) remission (<2.6). © 2015 Izumi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Suzuki H.,Keio University | Nishizawa T.,National Tokyo Medical Center | Hibi T.,Keio University
Future Microbiology | Year: 2010

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcers and gastric cancer. H. pylori eradication has been shown to have a prophylactic effect against gastric cancer. According to several international guidelines, the first-line therapy for treating H. pylori infection consists of a proton pump inhibitor (PPI) or ranitidine bismuth citrate, with any two antibiotics among amoxicillin, clarithromycin and metronidazole, given for 7-14 days. However, even with these recommended regimens, H. pylori eradication failure is still seen in more than 20% of patients. The failure rate for first-line therapy may be higher in actual clinical practice, owing to the indiscriminate use of antibiotics. The recommended second-line therapy is a quadruple regimen composed of tetracycline, metronidazole, a bismuth salt and a PPI. The combination of PPI-amoxicillin-levofloxacin is a good option as second-line therapy. In the case of failure of second-line therapy, the patients should be evaluated using a case-by-case approach. European guidelines recommend culture before the selection of a third-line treatment based on the microbial antibiotic sensitivity. H. pylori isolates after two eradication failures are often resistant to both metronidazole and clarithromycin. The alternative candidates for third-line therapy are quinolones, tetracycline, rifabutin and furazolidone; high-dose PPI/amoxicillin therapy might also be promising. © 2010 Future Medicine Ltd.

Yamazaki K.,Shizuoka Cancer Center | Kuwano H.,Gunma University | Ojima H.,Gunma Prefectural Cancer Center Ota | Otsuji T.,Dongo Hospital | And 10 more authors.
Cancer Chemotherapy and Pharmacology | Year: 2015

Purpose: Biochemical modulation of 5-fluorouracil (5-FU) by leucovorin (LV) enhances antitumor activity. LV is thus often added to 5-FU-based regimens for the treatment of metastatic colorectal cancer (mCRC). A combination of S-1, oxaliplatin, and LV (SOL) was shown to be feasible, effective, and safe in a previous phase I trial. We therefore conducted a randomized phase II trial to evaluate efficacy and safety of SOL compared with mFOLFOX6. Methods: Patients with mCRC and no prior chemotherapy were randomly assigned to receive either SOL or mFOLFOX6. SOL consisted of S-1 (40-60 mg bid) plus oral LV (25 mg bid) for 1 week and oxaliplatin (85 mg/m2) on day 1, repeated every 2 weeks. Results: Among 107 patients enrolled from July 2008 through July 2009, 105 (56 in the SOL group and 49 in the mFOLFOX6 group) were eligible and evaluated. The median progression-free survival was 9.6 months in the SOL group and 6.9 months in the mFOLFOX6 group [hazard ratio (HR) 0.83, 95 % confidence interval (CI) 0.49-1.40]. The median overall survival was 29.9 and 25.9 months, respectively (HR 0.91, 95 % CI 0.55-1.49). The response rate was 55 % in both groups. Grade 3 or 4 adverse drug reactions were neutropenia (20 % with SOL vs 41 % with mFOLFOX6), sensory neuropathy (20 vs 2.0 %), anorexia (13 vs 7.8 %), fatigue (11 vs 5.9 %), and diarrhea (11 vs 3.9 %). Conclusions: SOL demonstrated promising efficacy and acceptable toxicity as first-line chemotherapy for mCRC. Further studies of SOL combined with molecular target agents are warranted. © 2015 Springer-Verlag Berlin Heidelberg.

Okano S.,National Cancer Center Hospital East | Okano S.,Jikei University School of Medicine | Yoshino T.,National Cancer Center Hospital East | Fujii M.,National Tokyo Medical Center | And 10 more authors.
Japanese Journal of Clinical Oncology | Year: 2013

Background: We investigated the tolerability of cetuximab plus radiotherapy in Japanese patients with untreated locally advanced squamous cell carcinoma of the head and neck. Methods: Patients with epidermal growth factor receptor-expressing locally advanced squamous cell carcinoma of the head and neck received cetuximab (400 mg/m2 initial dose then 250 mg/m2 weekly) for 7 weeks plus concomitant boost radiotherapy (weeks 2-7: once daily [1.8 Gy] for 3.6 weeks, then twice daily [1.8 Gy morning and 1.5 Gy afternoon] for 2.4 weeks). The primary endpoint was treatment completion rate (the rate of treated patients completing ≥70% of the planned cetuximab dose and the full dose of radiotherapy within 2 weeks over the planned schedule). Results: Twenty-two patients were evaluable. The treatment completion rate was 100% (95% confidence interval 85-100). The response rate 8 weeks post-radiotherapy was 82% (95% confidence interval 60-95). The most common grade 3/4 treatment-emergent adverse events were mucosal inflammation (73%); dermatitis (27%); and infection, radiation skin injury and stomatitis (23% each). Conclusions: Cetuximab plus concomitant boost radiotherapy can be safely administered to Japanese patients with locally advanced squamous cell carcinoma of the head and neck. Tolerability and efficacy were in line with those reported in the Phase III Bonner trial in a Western population of patients with locally advanced squamous cell carcinoma of the head and neck. © The Author 2013. Published by Oxford University Press.

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