Ohta A.,Saitama Medical UniversitySaitama |
Hashimoto S.,Aichi University |
Murakami Y.,Shiga University of Medical Science |
Kawado M.,Aichi University |
And 4 more authors.
Japanese Journal of Infectious Diseases | Year: 2014
This study aimed to describe the geographical spread and temporal accumulation of cases during the 2009 influenza A (H1N1) epidemic in Japan. Using a method adopted by the National Epidemiological Surveillance of Infectious Diseases (NESID) to identify epidemics, we described the frequency and temporal change of the 2009 influenza A (H1N1) epidemic among designated public health center areas in Japan. We calculated the proportion of public health center areas with an epidemic by week from 1999 to 2010. The 2009 influenza A (H1N1) epidemic had several distinguishing features compared with previous seasonal influenza epidemics. For example, the 2009 epidemic started in autumn and peaked at week 49, almost 10 weeks earlier than that of previous seasonal influenza epidemics. Additionally, the 2009 epidemic had the highest total number of public health center areas reporting an epidemic within a season, but only the second highest proportion of areas with an epidemic in the peak week (78.5%). The duration of the epidemic was 17 weeks, which was longer than that of previous epidemics. The present study results shed light on the epidemiology of the 2009 influenza A (H1N1) pandemic and provide useful information to create strategies to prevent future pandemics. © 2014 National Institute of Health. All rights reserved.
Okamoto K.,Saitama Medical UniversitySaitama |
Koyama I.,Saitama Medical UniversitySaitama |
Hara K.,Saitama Medical UniversitySaitama |
Aikawa M.,Saitama Medical UniversitySaitama |
And 3 more authors.
Journal of the Pancreas | Year: 2015
Context: Treatment of pancreatic fistulae after pancreaticoduodenectomy is extremely important because it determines the patient's postoperative course. In particular, treatment of Grade B cases should be conducted in a timely manner to avoid deterioration to grade C. Objective We report the successful treatment of six cases of postoperative intractable, Grade B pancreatic fistulae, in which fistula closure was achieved through the use of tissue adhesive. Methods Six subjects presented at our hospital with Grade B pancreatic fistulae after pancreaticoduodenectomy. In all cases, the drain amylase values were high immediately after the operation, and the replacement of the drain was enforced. Closure of the fistula was performed by pouring tissue adhesive into the fistula from the drain, after the fistula had been straightened. Results Closure of the fistula was achieved in all six cases at the first attempt. The average fistula length was 13.2 cm, the average volume of pancreatic fluid discharge just before treatment was 63.3 ml, the average amylase value in the drainage was 40338.5 IU/L, and the subjects were discharged from hospital an average of 8.8 days after treatment. There were no recurrences after treatment. Conclusion Intractable pancreatic fistulae can be effectively treated using the tissue adhesive method. © 2015, E.S. Burioni Ricerche Bibliografiche. All rights reserved.
Masutani S.,Saitama Medical UniversitySaitama |
Kuwata S.,Saitama Medical UniversitySaitama |
Kurishima C.,Saitama Medical UniversitySaitama |
Iwamoto Y.,Saitama Medical UniversitySaitama |
And 4 more authors.
International Journal of Cardiology | Year: 2016
Objective The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired reserve function associated with coronary supply/demand imbalance. Methods We studied the ventricular pressure-area relationship in 22 pediatric HFpEF patients and 22 control subjects before and after dobutamine infusion and during abdominal compression. Coronary supply/demand balance was assessed by subendocardial viability ratio (SEVR) calculated from the aortic pressure waveform. Results Compared with controls, the HFpEF patients had significantly higher end-systolic (Ees) and arterial (Ea) elastance. Increased ventricular diastolic stiffness also occurred in the HFpEF patients, resulting in modest elevation of end-diastolic pressure (EDP) at rest (13.6 ± 4.3 vs. 7.3 ± 2.3 mm Hg, P < 0.0001). The difference in EDP became more evident with a preload increase through abdominal compression, indicating a limited diastolic reserve in HFpEF patients (EDP changes; 11.3 ± 6.2 for HFpEF vs. 3.4 ± 0.6 mm Hg for controls, P = 0.016). The HFpEF patients exhibited impaired beta-adrenergic reserve in ventricular contractility and ventricular-arterial coupling in response to dobutamine infusion. SEVR was significantly lower in the HFpEF (0.64 ± 0.11) than in the control (0.79 ± 0.07, P < 0.0001) and was significantly correlated with LV diastolic stiffness and dobutamine-induced changes in ventricular contractility. Conclusions HFpEF in children involves higher ventricular-arterial stiffness at rest as well as impaired systolic and diastolic reserve, which closely correlate with impaired coronary supply/demand balance. © 2016 Elsevier Ireland Ltd
Koga T.,Saitama University |
Koga T.,Saitama Medical UniversitySaitama |
Tokuyama K.,Saitama University |
Tokuyama K.,Saitama Medical UniversitySaitama |
And 7 more authors.
Allergology International | Year: 2015
Abstract Background Acute exacerbation of asthma is divided qualitatively into mild, moderate, and severe attacks and respiratory failure. This system is, however, not suitable for estimating small changes in respiratory condition with time and for determining the efficacy of treatments, because it has a qualitative, but not quantitative nature. Methods To evaluate the usefulness of quantitative estimation of asthma exacerbation, modified Pulmonary Index Score (mPIS) values were measured in 87 asthmatic children (mean age, 5.0 ± 0.4 years) during hospitalization. mPIS was calculated by adding the sum of scores for 6 items (scores of 0-3 were given for each item). These consisted of heart rate, respiratory rate, accessory muscle use, inspiratory-to-expiratory flow ratio, degree of wheezing, and oxygen saturation in room air. Measurements were made at visits and at hospitalization and were then made twice a day until discharge. Results mPIS values were highly correlated among raters. mPIS values at visits were 9.1 ± 0.1 and 12.6 ± 0.4 in subjects with moderate and severe attacks, respectively (p < 0.001). mPIS values of subjects requiring continuous inhalation therapy (CIT) with isoproterenol in addition to systemic steroids were significantly higher than the values of those without CIT (12.0 ± 0.5 and 9.3 ± 0.2, respectively, p < 0.001). A score of 10 was suggested to be the optimal cutoff for distinguishing between subjects requiring and not requiring CIT, from the perspectives of both sensitivity and specificity. mPIS at hospitalization correlated well with the period until discharge, suggesting that this score was a useful predictor for the clinical course after hospitalization. Conclusions mPIS could be a useful tool for several aspects during acute asthma attacks, including the determination of a treatment plan, and prediction of the period of hospitalization in admitted patients, although prospective studies would be required to establish our hypothesis. © 2014 Japanese Society of Allergology.
Urano T.,University of Tokyo |
Inoue S.,University of Tokyo |
Inoue S.,Saitama Medical UniversitySaitama
Biochemical and Biophysical Research Communications | Year: 2014
Osteoporosis is a skeletal disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of bone tissue, which increases susceptibility to fractures. BMD is a complex quantitative trait with normal distribution and seems to be genetically controlled (in 50-90% of the cases), according to studies on twins and families. Over the last 20 years, candidate gene approach and genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNPs) that are associated with low BMD, osteoporosis, and osteoporotic fractures. These SNPs have been mapped close to or within genes including those encoding nuclear receptors and WNT-β-catenin signaling proteins. Understanding the genetics of osteoporosis will help identify novel candidates for diagnostic and therapeutic targets. © 2014 Elsevier Inc. All rights reserved.
Matsuzawa T.,Saitama Medical UniversitySaitama |
Ishida H.,Saitama Medical UniversitySaitama |
Yoshida S.,University of Tokyo |
Isayama H.,University of Tokyo |
And 11 more authors.
Gastrointestinal Endoscopy | Year: 2015
Background Endoscopic self-expandable metal stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear. Objective To clarify the short-term safety and efficacy of endoscopic self-expandable metal stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure. Design Prospective clinical cohort study. Setting Fourteen academic centers and 32 community hospitals. Patients A total of 513 consecutive patients with malignant colorectal obstruction. Intervention Endoscopic self-expandable metal stent placement, sharing of stent placement methods among participating facilities. Main Outcome Measurements The primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days. Results The clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), stent migration (1.0%), and stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P =.02). Stricture marking trended toward a negative association with technical failure (P =.09). Limitations Noncomparative study. Conclusion Strict inclusion criteria and stricture marking may improve the technical and clinical success of stent placement. © 2015 American Society for Gastrointestinal Endoscopy.