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Ohno T.,Seirei Mikatahara General Hospital | Ohno T.,Japanese National Center for Geriatrics and Gerontology | Morita T.,Seirei Mikatahara General Hospital | Tamura F.,The Nippon Dental University | And 3 more authors.
Supportive Care in Cancer | Year: 2016

Objective: Considering the high incidence of oral complications in terminally ill cancer patients, dental services are necessary for high-quality palliative care. However, to our knowledge, there have been no nationwide studies examining the need and availability of dental services in palliative care. In this study, a nationwide survey was conducted to clarify the need and availability of dental services for physicians and nurses engaged in palliative care in Japan. Materials and methods: A questionnaire was distributed to 436 certified palliative care units and palliative care teams registered with Hospice Palliative Care Japan. The questionnaire consisted of questions related to (1) background, (2) need of dental services, and (3) availability of dental services. Results: The response rate was 48.2 % (n = 210). As a whole, 93 % of all respondents indicated that dental services were absolutely necessary, highly necessary, or necessary. In addition, 94 % of respondents thought dental treatment by dentists was often or sometimes necessary; 96 % of respondents thought oral care provided by specialists was often or sometimes necessary. As a whole, 71 % of the respondents reported that dental services were always available, but 28 % reported that dental services were available only sometimes. In actuality, in 31 % of the institutions, dental services were available 1 day/week or less, and in 39 %, dental services were dispatched from outside the institution. Conclusion: The results of this study revealed that Japanese palliative care units and teams have a markedly high need of dental services, but there is insufficient availability. To improve oral complications of terminally ill cancer patients, dentistry professionals should be more available in palliative care. © 2015, Springer-Verlag Berlin Heidelberg.


PubMed | Japanese National Center for Geriatrics and Gerontology, The Nippon Dental University, Seirei Mikatahara General Hospital and Tokyo Metropolitan Geriatric Medical Center
Type: Journal Article | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2015

Considering the high incidence of oral complications in terminally ill cancer patients, dental services are necessary for high-quality palliative care. However, to our knowledge, there have been no nationwide studies examining the need and availability of dental services in palliative care. In this study, a nationwide survey was conducted to clarify the need and availability of dental services for physicians and nurses engaged in palliative care in Japan.A questionnaire was distributed to 436 certified palliative care units and palliative care teams registered with Hospice Palliative Care Japan. The questionnaire consisted of questions related to (1) background, (2) need of dental services, and (3) availability of dental services.The response rate was 48.2% (n=210). As a whole, 93% of all respondents indicated that dental services were absolutely necessary, highly necessary, or necessary. In addition, 94% of respondents thought dental treatment by dentists was often or sometimes necessary; 96% of respondents thought oral care provided by specialists was often or sometimes necessary. As a whole, 71% of the respondents reported that dental services were always available, but 28% reported that dental services were available only sometimes. In actuality, in 31% of the institutions, dental services were available 1 day/week or less, and in 39%, dental services were dispatched from outside the institution.The results of this study revealed that Japanese palliative care units and teams have a markedly high need of dental services, but there is insufficient availability. To improve oral complications of terminally ill cancer patients, dentistry professionals should be more available in palliative care.


Aida J.,Metropolitan Institute of Gerontology | Vieth M.,Institute of Pathology | Ell C.,Dr Horst Schmidt Clinic | May A.,Dr Horst Schmidt Clinic | And 10 more authors.
American Journal of Surgical Pathology | Year: 2011

It is difficult for surgical pathologists to determine the origin of tissues in samples taken from the columnar-lined esophagus (CLE) or stomach by biopsy or endoscopic resection (ER) on the basis of histologic examination alone. We examined histopathologically a single section (5 to 22 mm in size; mean, 12 mm) from each of 66 cases of CLE (36 short segments, 30 long segments) from German patients with reference to 3 histologic markers of esophageal origin: esophageal glands proper and/or ducts, squamous islands, and double muscularis mucosae, all of which had been reported previously, and palisade vessels as a new histologic parameter as well. Palisade vessels were defined histologically as veins >100 μm in size in and above the original muscularis mucosae. Esophageal glands proper and/or ducts, squamous islands, and double muscularis mucosae were seen in 33%, 18%, and 71% of the specimens, respectively. Palisade longitudinal vessels were observed in 78% and 63% of specimens of short-segment and long-segment CLE, respectively. Palisade vessels were never seen in ER specimens from the stomach or in the middle esophagus and stomach among control autopsy specimens. At least 1 of these 4 markers was seen in 88% of the sections. Therefore, ER specimens were confirmed to originate from CLE in 88% of single histologic sections of CLE on the basis of histologic examination alone. Copyright © 2011 by Lippincott Williams & Wilkins.


Aida J.,Tokyo Metropolitan University | Aida J.,Tokyo Metropolitan Geriatric Medical Center | Kobayashi T.,Niigata University | Saku T.,Niigata University | And 11 more authors.
Journal of Oral Pathology and Medicine | Year: 2012

Objectives: A precancerous condition is a lesion that, if left untreated, leads to cancer or can be induced to become malignant. In the oral region, leukoplakia is a lesion that has been regarded as precancerous. In cases of oral carcinoma, we have frequently noticed that a type of leukoplakia histologically demonstrating hyper-orthokeratosis and mild atypia (ortho-keratotic dysplasia; OKD) is often associated with carcinoma, either synchronously or metachronously. Therefore, we consider OKD-type leukoplakia to be a true precancerous lesion. Materials and Methods: In an attempt to clarify the relationship between OKD as a precancerous condition in the oral mucosa and telomere length, we estimated telomere lengths in this type of leukoplakia using quantitative fluorescence in situ hybridization, and also quantified the frequency of anaphase-telophase bridges (ATBs) in comparison with squamous cell carcinoma in situ (CIS) and the background tissues of CIS and OKD. Results: Ortho-keratotic dysplasia was frequently associated with squamous cell carcinoma (45.0%) and showed significantly shorter telomeres than normal control epithelium, CIS, or the background of CIS or OKD. The frequency of ATBs was much higher in OKD than in control epithelium or CIS. Conclusion: Ortho-keratotic dysplasia appears to be frequently associated with carcinoma, chromosomal instability, and excessively shortened telomeres, not only in the lesion itself but also in the surrounding background. Therefore, when this type of leukoplakia is recognized in the oral region, strict follow-up for oral squamous cell carcinoma is necessary, focusing not only on the areas of leukoplakia, but also the surrounding background. © 2011 John Wiley & Sons A/S.


Ishii T.,Nippon Medical School | Hagiwara K.,Saitama University | Ikeda S.,Tokyo Medical and Dental University | Arai T.,Tokyo Metropolitan Geriatric Medical Center | And 6 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2012

Surfactant protein D (SFTPD) is a lung-specific anti-inflammatory factor that antagonizes inflammation by inhibiting oxidative stress and stimulating innate immunity. Variations in SFTPA2 and SFTPB, genes for other surfactant proteins, have been associated with lung cancer. We therefore investigated associations between SFTPD variations and lung cancer as well as emphysema and interstitial pneumonia, which are characterized by chronic inflammation from which lung cancer often arises. DNA from 1342 autopsy samples, including those from 140 subjects with lung cancer, was investigated. The single nucleotide polymorphism (SNP) rs721917, which results in methionine being exchanged for threonine at amino acid 11 (the Met11Thr variation), tended to be associated with emphysema and was associated with interstitial pneumonia and lung cancer. A haplotype analysis revealed that the haplotypes associated with emphysema and lung cancer differed from that associated with interstitial pneumonia, suggesting a differential role for SFTPD in the development of these diseases. A mediating analysis did not reveal a mediating effect exerted by emphysema or interstitial pneumonia on lung cancer. Our results suggested that SFTPD plays a role in the development of lung cancer and that the role for lung cancer may differ from that for interstitial pneumonia. © 2012 Informa Healthcare USA, Inc.


Kaburaki T.,University of Tokyo | Takamoto M.,University of Tokyo | Araki F.,University of Tokyo | Fujino Y.,University of Tokyo | And 3 more authors.
International Ophthalmology | Year: 2010

Purpose We report a case of Candida albicans endophthalmitis with subretinal abscess formation in a patient who underwent liver transplantation. Methods Case report. Results A 51-year-old Japanese woman complained of deep pain and ciliary injection in her right eye. Three months prior, the patient had undergone liver transplantation for cirrhosis caused by hepatitis C. A slit-lamp examination revealed intense anterior chamber inflammation with hypopyon and fundoscopy showed a yellowish-white subretinal mass lesion in the inferior peripheral fundus. Systemic and topical antibiotics did not prevent further progression of the infection. The patient underwent pars plana vitrectomy treatment three times and a histopathological study of a vitreous specimen revealed C. albicans to be the causative organism. Conclusion A subretinal abscess, previously reported in Nocardia, Pseudomonas, Staphylococcus, and Aspergillus infection cases, can also occur in patients infected with Candida. Therefore, Candida infection should be considered as a potential cause of subretinal abscess in organ transplant recipients. © 2009 Springer Science+Business Media B.V.


Muraki S.,University of Tokyo | Akune T.,University of Tokyo | Oka H.,University of Tokyo | Ishimoto Y.,Wakayama Medical University | And 6 more authors.
Arthritis and Rheumatism | Year: 2012

Objective To examine the incidence and progression of radiographic knee osteoarthritis (OA) and the incidence of knee pain, and their risk factors in Japan, using the large-scale population of the nationwide cohort study ROAD (Research on Osteoarthritis/osteoporosis Against Disability). Methods Subjects from the ROAD study who had been recruited in 2005-2007 were followed up with knee radiography 3 years later. A total of 2,262 paired radiographs (74.4% of the original sample) were scored using the Kellgren/Lawrence (K/L) grading system, and the incidence and progression rate of knee OA was examined. The incidence rate of knee pain was also examined. In addition, risk factors were tested for their association with incident and progressive radiographic knee OA and incident knee pain. Results Given the ≥3.3-year followup, the rate of incident K/L grade ≥2 radiographic knee OA was 6.9% and 11.9% in men and women, respectively, while that of K/L grade ≥3 knee OA was 8.4% and 13.9% in men and women, respectively. The rate of progressive knee OA was 17.8% and 22.3% in men and women, respectively. The incident rate of knee pain was 21.2% and 27.3% in men and women, respectively. Female sex was a risk factor for incident K/L grade ≥2 knee OA, but was not associated with incident K/L grade ≥3 knee OA or progressive knee OA. Knee pain was a risk factor for incident and progressive knee OA. Previous knee injury was a risk factor for knee pain but not for radiographic knee OA. Conclusion The present longitudinal study revealed a high incidence of radiographic knee OA in Japan. Copyright © 2012 by the American College of Rheumatology.


Sakurai T.,Kobe University | Iimuro S.,University of Tokyo | Araki A.,Tokyo Metropolitan Geriatric Medical Center | Umegaki H.,Nagoya University | And 3 more authors.
Gerontology | Year: 2010

Background: Management of metabolic syndrome (MetS) seems to constitute an efficient strategy to attain successful ageing. Although the clinical entity of MetS in patients with diabetes mellitus has been discussed, there is very little information on MetS-type cardiometabolic risk factor clustering in diabetic elderly. Objective: To determine the relationship among age-associated changes in obesity, insulin resistance, and clustering of MetS-type risk factors, in association with vascular complications, in Japanese elderly with type 2 diabetes. Methods: A cross-sectional study was conducted of 812 diabetic elderly enrolled in the Japanese Elderly Diabetes Intervention Trial. Information on diabetes, blood examinations and complications was obtained. Abdominal obesity, insulin resistance and prevalence of MetS risk factor clustering, defined by three sets of criteria from the International Diabetes Federation (IDF), the Japanese Society of Internal Medicine (JSIM), and the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI), were analyzed. Results: Waist circumference and insulin resistance estimated by homeostasis model assessment insulin resistance (HOMA-IR) increased with age, followed by a partial decrease at age 80 and over. Prevalence of IDF-MetS and JSIM-MetS also increased with age at least until the age of 80, whereas the incidence of AHA/NHLBI-MetS did not show any apparent age changes. There was a significant crude linear association between waist circumference and HOMA-IR, which was highly elevated in IDF and AHA/NHLBI overlapping with MetS, and also elevated in AHA/NHLBI without abdominal obesity. Although IDF-MetS and JSIM-MetS, which specify abdominal obesity, did not always appear to be associated with cardiovascular diseases, AHA/NHLBI-MetS, comprising both abdominal obesity and non-abdominal obesity, independently correlated with coronary heart disease and stroke after adjustment for other risk factors of atherosclerotic diseases. Conclusion: There was an age-associated increase in the prevalence of abdominal obesity and insulin resistance in elderly diabetic Japanese subjects, with a clear relationship between waist circumference and insulin resistance. However, insulin resistance was elevated not only in cases with but also in those without abdominal obesity if accompanied by clustering of metabolic disorders. The AHA/NHLBI definition of MetS proved to be the most useful to predict cardiovascular disease in the diabetic elderly. Copyright © 2009 S. Karger AG.


Muraki S.,Tokyo Medical University | Akune T.,Tokyo Medical University | Nagata K.,Wakayama Medical University | Ishimoto Y.,Wakayama Medical University | And 7 more authors.
Clinical Rheumatology | Year: 2015

The objective of the present longitudinal study was to clarify whether osteophytosis and joint space narrowing predict quality of life (QOL) decline using a longitudinal population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. The present study analyzed 1,525 participants who completed the radiographic examination at baseline and questionnaires regarding QOL at a 3-year follow-up (546 men and 979 women; mean age, 67.0 ± 11.0 years). This study examined the associations of osteophyte area (OPA) and minimum joint space width (mJSW) in the medial compartment of the knee at baseline with pain and physical functional disability measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). OPA and mJSW in the medial compartment of the knee were measured using a knee osteoarthritis (OA) computer-aided diagnosis system. Overall, OPA independently predicted physical functional disability after 3 years of follow-up. When analyzed in men and women separately, OPA, rather than mJSW, was an independent predictor for pain and physical functional disability after 3 years of follow-up in men. OPA, rather than mJSW, also predicted worsening of pain in men during the 3-year follow-up, whereas in women, mJSW, rather than OPA, predicted worsening of pain. In conclusion, the present longitudinal study using a large-scale population from the ROAD study found gender differences in the association of osteophytosis and joint space narrowing with pain and physical functional disability. © 2014, Clinical Rheumatology.


Sonoo M.,Teikyo University | Higashihara M.,Tokyo Metropolitan Geriatric Medical Center
Clinical Neurology | Year: 2014

Fasciculations and fasciculation potentials (FPs) have been long known as a characteristic feature of amyotrophic lateral sclerosis (ALS). In this article, the history of the researches on fasciculation and FPs is first reviewed. The word and concept of fasciculation was first properly defined by Denny-Brown and Pennybacker (1938). It is noteworthy that they already stressed the necessity of strict discrimination of FPs from the "contraction fasciculation", a remnant of large voluntary motor unit potentials (MUPs), in this early milestone paper. FPs are rarely observed in neurogenic diseases other than ALS or disorders presenting with conduction block, i. e. they retain a high specificity in ALS diagnosis. Despite such usefulness, FPs were devaluated in the revised El-Escorial criteria. It is welcome that their value has been restored in the newer Awaji criteria. In the actual practice, correct identification of FPs would be a critical point. Remnant of voluntary MUPs is the greatest FP mimic to be differentiated. The key point for differentiation is the firing rhythm. FPs are characterized by a low-frequency and quite irregular firing, showing clustering of discharges. In contrast, voluntary MUPs are characterized by a semiregular firing.

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