Yamagata-shi, Japan
Yamagata-shi, Japan

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Ohno-Matsui K.,Tokyo Medical and Dental University | Kawasaki R.,Yamagata University | Jonas J.B.,University of Heidelberg | Cheung C.M.G.,National University of Singapore | And 15 more authors.
American Journal of Ophthalmology | Year: 2015

Purpose To develop a classification and grading system for myopic maculopathy. Design Development and evaluation of a classification system for myopic maculopathy based on observational case series. Methods A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan. Results We defined 5 categories of myopic maculopathy including "no myopic retinal degenerative lesion" (Category 0), "tessellated fundus" (Category 1), "diffuse chorioretinal atrophy" (Category 2), "patchy chorioretinal atrophy" (Category 3), and "macular atrophy" (Category 4). Three additional features to supplement these categories were defined as "plus" lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement. Conclusions We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies. © 2015 by Elsevier Inc. All rights reserved.


Aizawa T.,Tohoku University | Tanaka Y.,Tohoku Central Hospital | Yokoyama T.,Odate Municipal General Hospital | Shimada Y.,Akita University | And 6 more authors.
Journal of Orthopaedic Science | Year: 2016

Background There are no diagnostic support tools composed of a simple, single-sheet, self-administered, self-reported history questionnaire (SSHQ) for patients with leg symptoms caused by either lumbar spinal stenosis (LSS) or lumbar disc herniation (LDH), at the same time, can discriminate the two diseases. Methods We conducted retrospective and prospective derivation studies and a prospective validation study. Based on data from 137 patients with LSS and 206 with LDH, we identified key prediction factors to establish the diagnosis of LSS and LDH, which became the basis of a temporary SSHQ. Next, we performed a prospective derivation study in which 296 patients with LSS or LDH completed preoperatively this temporary SSHQ. After univariate and multivariate analyses of each question, questions on both diseases in addition to age factor were selected, providing the final version of the SSHQ. A validation study was subsequently performed with 342 consecutive patients with leg symptoms. The sensitivity, specificity and likelihood ratio of this SSHQ were calculated to determine the cut-off points for LSS and LDH. Results A SSHQ with 15 questions was developed from retrospective and prospective derivation studies. The score of each question was weighted based on the multivariate analysis and then, it was approximated to integer value. According to assessment of the discriminatory performance of the clinical prediction rule of the SSHQ, the cut-off point for LSS was ≥13 and that for LDH was ≥11. The sensitivity, specificity, and positive and negative likelihood ratios of this SSHQ at those cut-off points were, respectively, 92.7%, 84.7%, 6.07, and 0.09 for LSS, and 91.0%, 85.2%, 6.15, and 0.11 for LDH. Conclusions This is the first report of a diagnostic support tool for patients with LSS- or LDH-induced leg symptoms combined in a single SSHQ that could help establish diagnosis of the two diseases in the daily clinical practice. © 2016 The Japanese Orthopaedic Association


Ijima H.,Jinnochi Hospital | Jinnouchi H.,Jinnochi Hospital | Hamaguchi K.,Oita University | Ohguni S.,Matsue Municipal Hospital | And 4 more authors.
Diabetology International | Year: 2011

Aims: Hb Toranomon [β112 (G14) Cys → Try] was the variant hemoglobin first reported by Harano et al. (Hemoglobin 20:361-369, 1996). Since 2004 there have been successive reports of Hb Toranomon based on abnormal HbA1c levels measured by high-performance liquid chromatography (HPLC). HbA1c levels are known to vary depending on the HPLC model used. We compared the HbA1c measured by new and old HPLC models in patients with Hb Toranomon. Method: Eight patients with Hb Toranomon (5 men, 3 women; 4 with diabetes and 4 without diabetes; 7 heterozygotes, 1 homozygote) were studied. HbA1c levels measured using the old HPLC models (Arkray HA-8150 and Tosoh GHb III) and the new HPLC models (Arkray HA-8160 or later, Tosoh GHbV or later) were compared with the results of immunoassay, enzymatic assay, affinity assay of HbA1c, and glycated albumin (GA). Results: HbA1c levels measured by the old and new Arkray models were 10 and 30% lower, respectively, and those measured by the new Tosoh models were 30% higher than the results of immunoassay. The same trends were found in comparisons with the HbA1c results of enzymatic and affinity assays or GA. Conclusion: Glycated variant hemoglobins, such as Hb Toranomon, may have previously been measured as HbA1c and are difficult to identify because of the low divergence from other glycemic control indicators in the old HPLC models. The recent detection of successive Hb Toranomon patients is likely due to the abnormally low or high HbA1c levels by the upgraded measuring models. © 2011 The Japan Diabetes Society.


Ngo L.M.,Tohoku University | Aizawa T.,Tohoku University | Hoshikawa T.,Tohoku Central Hospital | Tanaka Y.,Tohoku Central Hospital | And 3 more authors.
European Spine Journal | Year: 2012

Purpose The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss its pathomechanism. Methods Among 251 patients with lower cervical spine fractures and/or dislocations surgically treated, 11 (9 males and 2 females, averaged age, 52 years) had this kind of injury. Medical charts and medical images were reviewed retrospectively. Results Injury levels were C4-5, C5-6 and C6-7 in 1, 4 and 6 patients, respectively. A fracture was found at the superior facet in 6, and at the inferior facet in 5. The anterior displacement of the vertebral body ranged from 7 to 19 mm. The unilateral horizontal facet appearance on an anteroposterior radiograph and the triple image on a CT composed of a separated fracture fragment, the base of the fractured facet, and the neighboring non-fractured facet were characteristic. All patients had neurological deficits from Frankel A to D, and were surgically treated by posterior fusion using wire or cable, or combined anterior and posterior spinal fusion. Conclusions The fracture and contralateral dislocation of the twin facet joints can cause severe neurological deficits because of its gross anterior displacement. Its plausible pathomechanism is extension force exerted to the cervical spine when it is maximally bent laterally. © 2011 Springer-Verlag.


Kokubun S.,Tohoku University | Ozawa H.,Tohoku University | Aizawa T.,Tohoku University | Ly N.M.,Tohoku University | Tanaka Y.,Tohoku Central Hospital
Journal of Neurosurgery: Spine | Year: 2011

Object. Tethered cord syndrome (TCS) is a disorder involving an abnormal stretching of the tethered spinal cord caused by several pathological conditions and presents with a variety of neurological symptoms. Untethering (tethered cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal cord injury and postoperative retethering. To avoid these potential risks, the authors applied spine-shortening osteotomy to adult patients with TCS, and report on the surgical procedure and treatment outcomes. Methods. Eight patients with TCS caused by a lipomyelomeningocele were surgically treated by the authors' original procedure of spine-shortening osteotomy. Six patients were male and 2 were females; average age at the time of surgery was 31 years old. Spine-shortening osteotomy was performed at the level of L-1 in all but 2 patients, in whom it was performed at T-12, with spinal fusion between T-12 and L-2 or T-11 and L-1 using a pedicle screw-rod system. The average follow-up period was 6.2 years and the patients' pre- and postoperative conditions were evaluated clinically and radiologically. Results. Preoperatively, all patients displayed severe neurological deficits such as motor disturbance, muscle atrophy, and bladder dysfunction. Several months before surgery, all showed progressive symptoms. Those symptoms showed initial improvement in 6 patients and stabilized in 2 postoperatively, but the improved symptoms worsened again in 4 of the 6 patients. The osteotomized vertebrae were shortened by 21 mm on average, and all spines showed complete bone union without loss of correction. At the final follow-up evaluations, 6 patients showed stabilization as per the modified Japanese Orthopaedic Association score for thoracic myelopathy. Conclusions. Spine-shortening osteotomy successfully helps reduce the spinal cord tension without causing direct neural damage. At minimum, it stabilized the patients' symptoms and/or helped delay neurological deterioration for a period of time. Spine-shortening osteotomy might be a feasible mode of treatment for adult TCS caused by a spinal lipoma.


PubMed | Tohoku Central Hospital, Fukushima Medical University, Tohoku University, Yamagata Institute of Spine and Spinal Disorders and 4 more.
Type: Journal Article | Journal: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association | Year: 2016

There are no diagnostic support tools composed of a simple, single-sheet, self-administered, self-reported history questionnaire (SSHQ) for patients with leg symptoms caused by either lumbar spinal stenosis (LSS) or lumbar disc herniation (LDH), at the same time, can discriminate the two diseases.We conducted retrospective and prospective derivation studies and a prospective validation study. Based on data from 137 patients with LSS and 206 with LDH, we identified key prediction factors to establish the diagnosis of LSS and LDH, which became the basis of a temporary SSHQ. Next, we performed a prospective derivation study in which 296 patients with LSS or LDH completed preoperatively this temporary SSHQ. After univariate and multivariate analyses of each question, questions on both diseases in addition to age factor were selected, providing the final version of the SSHQ. A validation study was subsequently performed with 342 consecutive patients with leg symptoms. The sensitivity, specificity and likelihood ratio of this SSHQ were calculated to determine the cut-off points for LSS and LDH.A SSHQ with 15 questions was developed from retrospective and prospective derivation studies. The score of each question was weighted based on the multivariate analysis and then, it was approximated to integer value. According to assessment of the discriminatory performance of the clinical prediction rule of the SSHQ, the cut-off point for LSS was 13 and that for LDH was 11. The sensitivity, specificity, and positive and negative likelihood ratios of this SSHQ at those cut-off points were, respectively, 92.7%, 84.7%, 6.07, and 0.09 for LSS, and 91.0%, 85.2%, 6.15, and 0.11 for LDH.This is the first report of a diagnostic support tool for patients with LSS- or LDH-induced leg symptoms combined in a single SSHQ that could help establish diagnosis of the two diseases in the daily clinical practice.


Sasaki Y.,Yamagata University | Takeda H.,Yamagata University | Sato T.,Yamagata University | Orii T.,Yamagata University | And 6 more authors.
Metabolism: Clinical and Experimental | Year: 2011

Obesity and insulin resistance are thought to be risk factors for colorectal adenoma. Glucose-dependent insulinotropic polypeptide (GIP) stimulates insulin secretion from the pancreas and promotes fat accumulation in adipocytes. The association between serum GIP and the risk of colorectal adenoma has not been examined previously. We investigated this association in 370 subjects who underwent total colonoscopy during thorough physical checkups between January and December 2008. We used a cross-sectional design and classified the subjects into a colorectal adenoma group and a control group without adenoma according to their endoscopic findings. Serum GIP concentrations in samples of venous blood obtained after an overnight fast were measured using a sandwich enzyme-linked immunosorbent assay kit. The mean levels of fasting GIP (34.9 ± 49.5 vs 25.0 ± 20.1 pg/mL, P =.04), triglyceride, glucose, and insulin and the values of the homeostasis model assessment of insulin resistance in the colorectal adenoma group were significantly higher than those in the control group. Multiple logistic regression analysis showed that the highest quartile of fasting GIP levels was associated with a significantly high risk of colorectal adenoma (odds ratio, 2.1; 95% confidence interval, 1.08-3.96; P =.01) in comparison with the lowest quartile. Quartile analysis demonstrated that increased levels of GIP were related to increased levels of fasting insulin and values of homeostasis model assessment β-cell. These results suggest that an increased level of fasting GIP is associated with an increased risk of colorectal adenoma. © 2011 Elsevier Inc. All rights reserved.


Sasaki Y.,Yamagata University | Takeda H.,Yamagata University | Sato T.,Yamagata University | Orii T.,Yamagata University | And 8 more authors.
Clinical Cancer Research | Year: 2012

Purpose: It is widely acknowledged that chronic low-grade inflammation plays a key role in the development of obesity-related insulin resistance and type 2 diabetes. The level of circulating interleukin- 6 (IL-6), one of the major proinflammatory adipokines, is correlated with obesity and insulin resistance, which are known to be risk factors for colorectal adenoma. We examined the association between the circulating level of IL-6 and the presence of colorectal adenoma. Experimental Design: In a total colonoscopy-based cross-sectional study conducted between January and December 2008, serum levels of IL-6 were measured in samples of venous blood obtained from 336 male participants attending health checkups (118 individuals with colorectal adenoma and 218 agematched controls) after an overnight fast. Results: In the colorectal adenoma group, the median levels of serum IL-6 (1.24 vs. 1.04 pg/mL; P=0.01), triglyceride, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were to be significantly higher than those in the control group. When restricted to individuals with adenoma, levels of IL-6 were positively correlated with body mass index, insulin, and HOMA-IR. Multiple logistic analyses adjusted to include insulin or HOMA-IR showed that high levels of IL-6 were associated with the presence of colorectal adenoma. There was no significant interaction of IL-6 with HOMA-IR to modify this association. Conclusions: Our findings suggest that increased serum levels of IL-6 are positively associated with the presence of colorectal adenoma in men, independently of insulin and HOMA-IR. ©2011 AACR.


Iwashita Y.,Tohoku Central Hospital | Sakurai K.,Tohoku Central Hospital | Kanaya T.,Tohoku Central Hospital
Japanese Journal of Anesthesiology | Year: 2012

Background : In patients with spinal cord diseases, it is difficult to obtain stress electrocardiogram and to evaluate preoperative cardiac risk. We evaluate these patients by chest CT and if the patients have calcified coronary artery, we recommend further testing by coronary arteriogram. Methods : We evaluated the patients who had undergone coronary arteriogram from January 2008 through December 2009. Results : In 27 out of 158 cases (17.1%) operations were postponed or cancelled. In 12 out of 112 patients with no subjective symptom but with coronary calcification operations were also postponed or cancelled. Conclusions : Preoperative chest CT and coronary arteriogram are useful for evaluation of preoperative cardiac function.

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