Saitama, Japan
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Nishinaga M.,Saitama Memorial Hospital | Takata J.,The Center to Promote Creativity in Medical Education | Shimizu Y.,Kochi Medical School | Okumiya K.,Humanity | And 4 more authors.
Geriatrics and Gerontology International | Year: 2015

Aim: The purpose of the present study was to clarify the longitudinal association between brachial-ankle pulse wave velocity (baPWV) and the onset of impairment in activities of daily living (ADL) among community-dwelling individuals. Methods: Deaths and the onsets of ADL impairment during 3 years were followed for 450 individuals without ADL impairment at entry who were aged 65 years or older (men:women 181:269; mean age 77 years). They were dichotomized on the median baPWV value at entry. Results: Within 3 years, 28 died and 60 had an onset of ADL impairment. The high baPWV group had a higher incidence of deaths (high baPWV group vs low baPWV group, 9.3% vs 3.1%) and ADL impairment (high baPWV group vs low baPWV group, 20.7% vs 9.3%). After adjustment for age, sex and systolic blood pressure, as compared with the low baPWV group, the high baPWV group had increased risk for mortality (adjusted odds ratio 3.22; 95% confidence interval 1.26-8.22) and the onset of ADL impairment (adjusted odds ratio 1.94; 95% confidence interval 1.03-3.63). When the onset of ADL impairment was grouped according to medical conditions that preceded/accompanied the onset of ADL impairment, elevated baPWV was associated with increased risk for the onset of ADL impairment after/accompanying fall/fracture. Conclusions: The assessment of arterial stiffness by baPWV contributes to identifying functionally independent community-dwelling older individuals at risk for ADL impairment, in particular ADL impairment associated with fall/fracture, as well as for mortality. © 2014 Japan Geriatrics Society.


PubMed | Saitama Memorial Hospital, Kyoto University, Humanity, The Center to Promote Creativity in Medical Education and Kochi Medical School
Type: Journal Article | Journal: Geriatrics & gerontology international | Year: 2015

The purpose of the present study was to clarify the longitudinal association between brachial-ankle pulse wave velocity (baPWV) and the onset of impairment in activities of daily living (ADL) among community-dwelling individuals.Deaths and the onsets of ADL impairment during 3 years were followed for 450 individuals without ADL impairment at entry who were aged 65 years or older (men:women 181:269; mean age 77 years). They were dichotomized on the median baPWV value at entry.Within 3 years, 28 died and 60 had an onset of ADL impairment. The high baPWV group had a higher incidence of deaths (high baPWV group vs low baPWV group, 9.3% vs 3.1%) and ADL impairment (high baPWV group vs low baPWV group, 20.7% vs 9.3%). After adjustment for age, sex and systolic blood pressure, as compared with the low baPWV group, the high baPWV group had increased risk for mortality (adjusted odds ratio 3.22; 95% confidence interval 1.26-8.22) and the onset of ADL impairment (adjusted odds ratio 1.94; 95% confidence interval 1.03-3.63). When the onset of ADL impairment was grouped according to medical conditions that preceded/accompanied the onset of ADL impairment, elevated baPWV was associated with increased risk for the onset of ADL impairment after/accompanying fall/fracture.The assessment of arterial stiffness by baPWV contributes to identifying functionally independent community-dwelling older individuals at risk for ADL impairment, in particular ADL impairment associated with fall/fracture, as well as for mortality. Geriatr Gerontol Int 2015; 15: 840-847.


Otani T.,Saitama Memorial Hospital | Otani T.,Tokyo Women's Medical University | Kasahara T.,Josai Hospital | Uchigata Y.,Tokyo Women's Medical University
Journal of the Japan Diabetes Society | Year: 2014

As of 2013, a total of 66 patients have won the Lilly Insulin 50-year Award, which has been granted annually in Japan since 2003. Of these 66 patients, 16 (24 %) (13 with type 1 diabetes, two with type 2 diabetes and one with another type of diabetes) are visiting or have visited the Diabetes Center at the Tokyo Women's Medical University School of Medicine on an outpatient basis. The average Hb A l c value in patients with type 1 diabetes from 1983 to 2013 was 8.4 %. A total of 10 patients (77 %) had hypertension and five patients (38 %) had dyslipidemia. Meanwhile, two patients (15 %) had no retinopathy and nine patients (69 %) underwent photocoagulation, whereas no patients had proliferative retinopathy. In addition, six patients (46 %) showed abnormal urine albumin levels; however, no patients progressed to Stage 4 (renal failure) diabetic nephropathy. In terms of medical history, four patients (31 %) had a cerebrovascular disorder and one patient (8 %) had coronary artery disease. The subjects suffered from various diseases, including diabetes, and have overcome an extremely poor environment to lead a normal daily life with insulin treatment.


Otani T.,Saitama Memorial Hospital | Otani T.,Tokyo Women's Medical University | Yokoyama H.,Jiyugaoka Medical Clinic | Uchigata Y.,Tokyo Women's Medical University
Diabetes Research and Clinical Practice | Year: 2015

Aims: We investigated changes in vital prognosis according to the year at diagnosis of type 1 diabetes mellitus (T1DM) in a hospital-based survey. Methods: Of 1054 Japanese subjects diagnosed as T1DM between 1952 and 1999 before the age of 30 and consulted the diabetes center between 1962 and 1999, the survival status up to 2010 or 20 years of follow-up was investigated. Subjects were divided by the year at diagnosis of T1DM: before 1979 (Group A: n=. 359), 1980 to 1989 (Group B: n=. 400), and 1990 to 1999 (Group C: n=. 295). The mortality (/100,000 person years) and standardized mortality ratio (SMR) were calculated, and the effect of year at diagnosis of T1DM was explored by the Cox proportional hazard model. Results: The survival status was confirmed in 90.0%. The mortality rate (95%CI) and age and sex adjusted SMR (95%CI) were 457 (288-627) and 3.0 (1.9-4.2) in Group A, 265 (143-387) and 2.2 (1.2-3.2) in Group B, and 144 (29-259) and 1.6 (0.3-2.9) in Group C, respectively. The cumulative survival rate was significantly different according to the year at diagnosis of T1DM (. p=. 0.0239). Cox's proportional hazard model revealed that Groups B and C had significantly lower risks of death than Group A after adjustment for gender and age at diagnosis of T1DM (HR 0.48 [95%CI 0.26-0.87] for Group B and HR 0.25 [95%CI 0.09-0.60] for Group C). Conclusion: This study indicated that vital prognosis is improving according to the year at diagnosis of T1DM and suggested the need of a nationwide survey. © 2015 Elsevier Ireland Ltd.


Kasahara T.,Josai Hospital | Otani T.,Saitama Memorial Hospital | Otani T.,Tokyo Women's Medical University | Maruyama H.,Matsudo Clinic | And 2 more authors.
Diabetology International | Year: 2011

We report the case of a female patient with type 1 diabetes mellitus who developed diabetes at 1 year and 7 months and is now over 60 years old (duration of type 1 diabetes, 59 years) and has experienced only mild diabetic complications. The patient developed diabetic coma in May 1952, at 1 year and 7 months. In April 1994, at 43 years old, she achieved favorable glycemic control after being switched to intensive insulin therapy. Mean HbA1c level over the past 14 years was 6. 4% (JDS). Retinopathy was noted in 1968, at 18 years old. From 1973 to 1985, at 23-35 years old, she underwent a total of six photocoagulation procedures. Her retinopathy is currently stable. Urine albumin level was 5. 6 mg/g Cr, indicating no nephropathy. In January 2007, at 56 years old, the right and left ankle brachial indices were 0. 95 and 0. 86, respectively. Magnetic resonance angiography of the lower extremities revealed vascular insufficiency in both lower legs, but examination of the intima-media complex thickness, head computed tomography, and nuclear cardiology revealed no abnormalities. Treatment with eicosapentaenoic acid and regular ambulation improved vascular insufficiency in both lower legs. © 2011 The Japan Diabetes Society.


Kotani K.,Jichi Medical University | Yamada S.,Shino Test Corporation | Uurtuya S.,Jichi Medical University | Yamada T.,Jichi Medical University | And 2 more authors.
Lipids in Health and Disease | Year: 2010

Background. Oxidized lipoproteins play important roles in the atherosclerotic processes. Oxidized lipoprotein(a) (oxLp(a)) may be more potent in atherosclerotic pathophysiology than native Lp(a), a cardiovascular disease-relevant lipoprotein. Increased blood glucose concentrations can induce oxidative modification of lipoproteins. The aim of this study was to investigate the association between circulating oxLp(a) and cardiometabolic variables including blood glucose in healthy volunteers within the normal range of blood glucose. Methods. Several cardiometabolic variables and serum oxLp(a) (using an ELISA system) were measured among 70 healthy females (mean age, 22 years). Results. Lp(a) and glucose were significantly and positively correlated with oxLp(a) in simple correlation test. Furthermore, a multiple linear regression analysis showed oxLp(a) to have a weakly, but significantly positive and independent correlation with only blood glucose ( = 0.269, P < 0.05). Conclusions. These results suggest that increased glucose may enhance the oxidization of Lp(a) even at normal glucose levels. © 2010 Kotani et al; licensee BioMed Central Ltd.


Asami M.,Saitama Memorial Hospital | Hashiba Y.,Saitama Memorial Hospital | Otani T.,Saitama Memorial Hospital
Journal of the Japan Diabetes Society | Year: 2014

A 39-year-old female was emergently admitted to the hospital with thirst, vomiting and weakness in the extremities. She had a 10-year history of consumption of 3-4.5 Z/day of cola. Her blood glucose level was 638 mg/dZ, her HbAlc level was 14.3 % and her urine tested positive for ketone bodies; therefore, she was diagnosed with diabetic ketoacidosis. The results of an arterial blood gas analysis were within the normal range, at a pH of 7.42. The serum anion gap was 16, indicating metabolic acidosis. The serum HCCV level was 30 mmol/Z, which suggested concomitant metabolic alkalosis. Marked hypokalemia (1.9 mEq/Z) was also noted. Nevertheless, no hypertension was observed, and the results of hormone assays excluded the possibility of endocrine disease. Therefore, the caffeine in the cola was a suspected cause of the patient's hypokalemia, and a caffeine tolerance test was performed. Since a reduction in the blood potassium level (from 4.0 mEq/Z to 2.4 mEq/l) was observed with a slight decrease in the urinary potassium level, an intracellular potassium shift was considered to have caused the hypokalemia. When soft drink ketosis complicated by marked hypokalemia is observed in patients with diabetes, the excessive intake of caffeine-containing beverages should be suspected as a possible etiology.


Hashiba Y.,Saitama Memorial Hospital | Ishikawa M.,Jichi Medical University | Otani T.,Saitama Memorial Hospital
Journal of the Japan Diabetes Society | Year: 2013

A 36-year-old woman had been aware of changes in her facial features since approximately 2006 (at 33 years of age). A sense of excessive thirst manifested in 2008 (at 35 years of age); however, it was left untreated. The patient developed a fever of 37.3 t, nausea and epigastric pain in January 2009 (at 36 years of age) and presented to our hospital the following day. Her blood glucose level was 645 mg/d/. Metabolic acidosis (pH: 7.144, HCCV: 3.8 mmol//, PC02:11.4 mmHg) with a high anion gap (31.2 mEq//) was detected and the urinary ketone body concentration was 3 +. Diabetic ketoacidosis was diagnosed. The patient had acromegalic facial features and high levels of growth hormone (260 ng/m/) and insulin-like growth factor-1 (1,047 ng/m/). A head computed tomography scan revealed a well-defined mass with a maximum diameter of 4 cm and a high density in the sella turcica. These findings led to a diagnosis of acromegaly. The patient experienced sudden onset of visual disturbance and headaches on hospital day 6 and underwent emergency surgery under a diagnosis of pituitary apoplexy. There are few reports of patients with diabetic ketoacidosis that are diagnosed with acromegaly. We herein describe this rare case of acromegaly complicated by pituitary apoplexy.


Otani T.,Tokyo Medical University | Otani T.,Saitama Memorial Hospital | Yokoyama H.,Jiyugaoka Medical Clinic | Ohashi Y.,Chuo University | Uchigata Y.,Tokyo Medical University
BMJ Open Diabetes Research and Care | Year: 2016

Objective: To explore whether the incidence of endstage renal disease (ESRD) in type 1 diabetes (T1DM) was lowered over time, and how the baseline characteristics and risk factor management during follow-up were associated with the incident ESRD. Research design and methods: An observational cohort study was performed in 1014 patients with T1DM diagnosed from 1961 to 1999, who were admitted to the diabetes center. The incidence of ESRD up to 2010 and the effect of risk factors, including annual mean glycated haemoglobin (HbA1c) and blood pressure, were investigated. Results: During a mean follow-up of 19.3 years, with 88.3% follow-up rate, the incidence of ESRD was significantly lower in T1DM diagnosed in 1985–1999 than in 1961–1984 (0.8 vs 5.0 per 1000 person-years, p<0.0001), which was not precluded by preceding death. Multivariate Cox regression analysis indicated that the former group (vs the latter) was associated with a significantly reduced risk of ESRD independent of baseline variables of age, duration and gender (p<0.01). The continuous variable of year of T1DM diagnosis remained significant after adjustment for the above variables plus baseline proteinuria and retinopathy (p=0.02). Time-dependent Cox regression analysis indicated that ESRD was associated with annual mean HbA1c (p<0.01), systolic blood pressure (p<0.001) and baseline proteinuria (p<0.001), followed by continuous variable of year of T1DM diagnosis (p=0.09). Conclusions: Our data indicate that incidence of ESRD is decreasing over time, coinciding with enhanced glycemic and blood pressure controls. The incidence of ESRD in recently diagnosed T1DM appears to be much lower than previously reported ESRD incidence. © 2016, BMJ Publishing Group. All rights reserved.


Kotani K.,Jichi Medical University | Yamada S.,Shino Test Corporation | Yamada T.,Jichi Medical University | Taniguchi N.,Jichi Medical University | Sakurabayashi I.,Saitama Memorial Hospital
Lipids in Health and Disease | Year: 2011

Background: Oxidized lipoprotein(a) (oxLp(a)) can be a more potent marker of atherogenesis than native Lp(a), although Lp(a) is considered to be a risk factor for atherosclerotic diseases. Limited clinical data are available regarding the significance of oxLp(a) in atherosclerotic manifestations. This study aimed to investigate the association between the serum oxLp(a) and carotid artery intima-media thickness (CIMT), in comparison to the serum Lp(a) levels, among asymptomatic subjects. Methods. The atheroscrerosis-related variables including Lp(a) and oxLp(a) were measured in 136 cardiovascular disease-free subjects (61 males and 75 females, mean age of 64 years). The serum oxLp(a) level was quantified using a sandwich ELISA system. The CIMT level was ultrasonographically measured on bilateral carotid arteries. Results: The median level of Lp(a) was 120 mol/L, oxLp(a) was 0.06 nmol/L, and CIMT was 0.7 mm, respectively. A simple correlation test showed that the CIMT was significantly and positively correlated with age, systolic blood pressure and oxLp(a) (r = 0.208, P < 0.05). A multiple linear regression analysis revealed that oxLp(a) continued to show a significant and positive correlation with the CIMT ( = 0.202, P = 0.01). Although the similar analyses were conducted for Lp(a), it showed only a weak correlation with the CIMT (r = 0.011, = 0.041, both P < 0.05). Conclusions: These results suggest that oxLp(a) may be more closely associated with accelerated carotid atherosclerosis, in comparison to Lp(a), in this population. This finding can be important for obtaining a better understanding of the different atherogenic roles played by oxLp(a) in comparison to Lp(a). © 2011 Kotani et al; licensee BioMed Central Ltd.

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