Respiratory Disease Center

Kumagaya, Japan

Respiratory Disease Center

Kumagaya, Japan
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Enomoto Y.,Respiratory Disease Center | Enomoto Y.,Hamamatsu University School of Medicine | Yokomura K.,Respiratory Disease Center | Hasegawa H.,Respiratory Disease Center | And 3 more authors.
Geriatrics and Gerontology International | Year: 2017

Aim: Although methicillin-resistant Staphylococcus aureus (MRSA) is commonly isolated from respiratory specimens in healthcare-associated pneumonia (HCAP), it is difficult to determine the causative pathogen because of the possibilities of contamination/colonization. The present study aimed to identify clinical predictors of the true pathogenicity of MRSA in HCAP. Methods: Patients with HCAP with positive MRSA cultures in the sputum or endotracheal aspirates who were admitted to Seirei Mikatahara General Hospital, Hamamatsu, Japan, from 2009 to 2014 were enrolled. According to the administered drugs and the treatment outcomes, patients with true MRSA pneumonia (MP) and those with contamination/colonization of MRSA (false MP) were identified. Baseline characteristics were compared between groups, and clinical predictors of true MP were evaluated by logistic regression analyses. Results: A total of 93 patients (mean age 78.7 ± 12.6 years) were identified and classified into the true MP (n = 16) or false MP (n = 77) groups. Although baseline characteristics were broadly similar between groups, the true MP group had significantly more patients with PaO2 ≤ 60 Torr/pulse oximetry saturation ≤90% and those with MRSA single cultivation. Both variables were significant predictors of true MP in multivariate analysis (odds ratio of PaO2 ≤ 60 Torr/pulse oximetry saturation ≤90%: 5.64, 95% confidence interval 1.17–27.32; odds ratio of MRSA single cultivation: 4.76, 95% confidence interval 1.22–18.60). Conclusions: Poor oxygenation and MRSA single cultivation imply the true pathogenicity of MRSA in HCAP with positive respiratory MRSA cultures. The present results might be helpful for the proper use of anti-MRSA drugs in this population. Geriatr Gerontol Int 2017; 17: 456–462. © 2016 Japan Geriatrics Society


Yeung M.W.,Public Health Ontario Toronto | Khoo E.,Public Health Ontario Toronto | Brode S.K.,University of Toronto | Jamieson F.B.,University of Toronto | And 6 more authors.
Respirology | Year: 2016

Nontuberculous mycobacterial (NTM) infections are increasing in disease frequency worldwide. This systematic review examines health-related quality of life (HRQOL), comorbidities and mortality associated with pulmonary NTM disease. We searched MEDLINE, EMBASE, CINAHL, Scopus Life Sciences, conference proceedings and Google (earliest date available to February 2015) for primary studies. Eligible studies compared populations with and without pulmonary NTM disease in high-income jurisdictions. We excluded studies on HIV/AIDS. All languages were accepted. Two reviewers followed MOOSE and PRISMA reporting guidelines and independently appraised quality using STROBE. All studies were summarized qualitatively regardless of quality. Of 3193 citations screened, we included 17 studies mostly from Taiwan (n=5) and the USA (n=4). Two studies assessed HRQOL; one assessed comorbidities, 11 assessed mortality, and three assessed multiple outcomes. Populations with pulmonary NTM reported significantly worse or similar HRQOL than the general population, depending on the instruments used. Some suggested greater prevalence of having bronchiectasis (n=2) and greater risk of developing pulmonary tuberculosis (n=1). Most (n=7) suggested no difference in mortality, although only one was age-matched and gender-matched to the general population. Four suggested NTM populations had higher mortality-two of which compared with the general population and were deemed of high quality, while two compared with non-NTM patients from hospital. High clinical heterogeneity in study design may explain discordant results. Bias assessments and controlling for confounding were carried out poorly. No consistent trends were observed although there is suggestion of an increased health burden from respiratory diseases and increased mortality associated with pulmonary NTM disease. © 2016 Her Majesty the Queen in Right of Canada.


Ozawa Y.,Respiratory Disease Center | Omae M.,Respiratory Disease Center | Fujii M.,Shizuoka General Hospital | Matsui T.,Respiratory Disease Center | And 11 more authors.
BMC Cancer | Year: 2015

Background: Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. However, none of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. This study aimed to determine the effects of MRI and SRI on the benefits of PCI in patients with LS-SCLC. Methods: The clinical records of pathologically proven SCLC from January 2006 to June 2013 in facilities equipped with or had access to SRI in Japan were retrospectively reviewed. Patients with LS-SCLC and complete or good partial responses after initial treatment were included in the study and analyzed by the Kaplan-Meier method. Results: Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n = 29) and those without PCI (non-PCI groups; n = 95). At baseline, ratios of patients with stage III were significantly advantageous for the non-PCI group, although younger age and high ratios of complete response and MRI confirmed absence of brain metastasis were advantageous for the PCI group. Neither median survival times (25 vs. 34 months; p = 0.256) nor cumulative incidence of brain metastasis during 2 years (45.5 vs. 30.8 %; p = 0.313) significantly differed between the two groups. Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p = 0.680, 42.3 vs. 52.3 %; p = 0.458, respectively). Conclusion: PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available. © 2015 Ozawa et al.


PubMed | Hamamatsu University School of Medicine, Shizuoka General Hospital, 1 20 1 Handayama, Respiratory Disease Center and 2 more.
Type: | Journal: BMC cancer | Year: 2015

Magnetic resonance imaging (MRI) enables a more sensitive detection of brain metastasis and stereotactic irradiation (SRI) efficiently controls brain metastasis. In limited-stage small cell lung cancer (LS-SCLC), prophylactic cranial irradiation (PCI) in patients with good responses to initial treatment is recommended based on the survival benefit shown in previous clinical trials. However, none of these trials evaluated PCI effects using the management of brain metastasis with MRI or SRI. This study aimed to determine the effects of MRI and SRI on the benefits of PCI in patients with LS-SCLC.The clinical records of pathologically proven SCLC from January 2006 to June 2013 in facilities equipped with or had access to SRI in Japan were retrospectively reviewed. Patients with LS-SCLC and complete or good partial responses after initial treatment were included in the study and analyzed by the Kaplan-Meier method.Of 418 patients with SCLC, 124 met criteria and were divided into patients receiving PCI (PCI group; n=29) and those without PCI (non-PCI groups; n=95). At baseline, ratios of patients with stage III were significantly advantageous for the non-PCI group, although younger age and high ratios of complete response and MRI confirmed absence of brain metastasis were advantageous for the PCI group. Neither median survival times (25 vs. 34 months; p=0.256) nor cumulative incidence of brain metastasis during 2 years (45.5 vs. 30.8%; p=0.313) significantly differed between the two groups. Moreover, these factors did not significantly differ among patients with stage III disease (25 vs. 26 months; p=0.680, 42.3 vs. 52.3%; p=0.458, respectively).PCI may be less beneficial in patients with LS-SCLC if the management with MRI and SRI is available.


Mita N.,Respiratory Disease Center | Narahara H.,Gunma University | Okawa M.,Gunma University | Hinohara H.,Gunma University | And 4 more authors.
Journal of Infection and Chemotherapy | Year: 2012

A 59-year-old Japanese diabetic woman was admitted to a small private hospital with general malaise, fever, and a1-month history of low back pain. A computed tomography scan of the abdomen revealed left abdominal necrotizing fasciitiswith suspected left psoas muscle abscess. She was transferred to Gunma University Hospital, received antibiotic therapy, andunderwent debridement of the infected subcutaneous tissue, fascia, and necrotic left psoas muscle. She was transferred to theintensive care unit to receive mechanical ventilation and inotropic support. Blood culture showed growth of Klebsiellapneumoniae, from which hypermucoviscosity was detected by the string test. She was extubated on day 5 of hospitalization andtransferred to a general ward on day 14. Free skin grafting was performed on day 76, and she was discharged on day 134without any complications. © 2011 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.


PubMed | Hamamatsu University School of Medicine and Respiratory Disease Center
Type: | Journal: Geriatrics & gerontology international | Year: 2016

Although methicillin-resistant Staphylococcus aureus (MRSA) is commonly isolated from respiratory specimens in healthcare-associated pneumonia (HCAP), it is difficult to determine the causative pathogen because of the possibilities of contamination/colonization. The present study aimed to identify clinical predictors of the true pathogenicity of MRSA in HCAP.Patients with HCAP with positive MRSA cultures in the sputum or endotracheal aspirates who were admitted to Seirei Mikatahara General Hospital, Hamamatsu, Japan, from 2009 to 2014 were enrolled. According to the administered drugs and the treatment outcomes, patients with true MRSA pneumonia (MP) and those with contamination/colonization of MRSA (false MP) were identified. Baseline characteristics were compared between groups, and clinical predictors of true MP were evaluated by logistic regression analyses.A total of 93 patients (mean age 78.712.6 years) were identified and classified into the true MP (n=16) or false MP (n=77) groups. Although baseline characteristics were broadly similar between groups, the true MP group had significantly more patients with PaOPoor oxygenation and MRSA single cultivation imply the true pathogenicity of MRSA in HCAP with positive respiratory MRSA cultures. The present results might be helpful for the proper use of anti-MRSA drugs in this population. Geriatr Gerontol Int 2016; : -.

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