Minematsu K.,Japan National Cardiovascular Center Research Institute |
Toyoda K.,Japan National Cardiovascular Center Research Institute |
Hirano T.,Oita University |
Kimura K.,Kawasaki Medical School |
And 13 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2013
In Japan, intravenous alteplase, a recombinant tissue-type plasminogen activator (rt-PA), was approved for an indication of ischemic stroke in 2005 on the basis of the results of a clinical trial with a unique dose of the drug (0.6 mg/kg). The Japan Stroke Society published the guidelines for intravenous application of rt-PA and organized training sessions for proper use all over Japan in an effort to promote the safe, widespread use of intravenous alteplase. Seven years following its approval, clinical experience with intravenous alteplase has accumulated, additional evidence of intravenous alteplase has been found in Japan and overseas, and the medical environment has substantially changed, including approvals for new drugs and medical devices. Notably, the use of alteplase in the extended therapeutic time window (within 4.5 hours of symptom onset) became covered by insurance in Japan in August 2012. To address these changing situations, we have decided to prepare the revised guidelines. In preparing the second edition, we took care to make its contents more practical by emphasizing information needed in clinical practice. While the first edition was developed with emphasis on safety in light of limited clinical experience with intravenous alteplase in Japan in 2005, this second edition is a substantial revision of the first edition mainly in terms of eligibility criteria, on the basis of accumulated evidence and the clinical experience. © 2013 by National Stroke Association.
PubMed | Red Cross, Osaki Citizen Hospital, National Hospital Organization, Fukushima Medical University and 10 more.
Type: Clinical Trial, Phase II | Journal: European journal of haematology | Year: 2016
We conducted a phase II study to evaluate the efficacy and safety of dasatinib in Japanese patients with imatinib-resistant or imatinib-intolerant chronic myeloid leukemia (CML).From 2009 to 2011, 54 CML-chronic phase (CP) patients with resistance (n=40) or intolerance (n=25) to imatinib were registered to undergo dasatinib treatment. Eleven patients showed both resistance and intolerance to imatinib. Coincidentally, the resistance criteria in this study were the same as a non-optimal response to tyrosine kinase inhibitors (TKIs) as defined in the European LeukemiaNet (ELN) 2013 recommendations.The overall incidence rate of major molecular response (MMR) at 12months was 62.3% (n=47). Forty patients with resistance to imatinib who were warning and failure patients based on the ELN 2013 recommendations were assessed; cumulative MMR and MR(4.5) rates were 62.5% (n=39) and 21.0% (n=40), respectively, at 12months. Twelve patients who showed a BCR-ABL transcript level >1% on the international scale did not achieve a MMR or discontinued dasatinib treatment because of insufficient effects. With regard to safety issues, grade 3/4 non-hematologic adverse events (AEs) were infrequent.Patients with non-optimal responses (who meet ELN 2013 warning and failure criteria) to imatinib should be switched quickly to dasatinib, which is less toxic in CML-CP patients, to improve their prognoses. A BCR-ABL1 IS of <1% at 3months of dasatinib administration is a landmark for good therapeutic outcome.
Ichikawa S.,Yamagata City Hospital Saiseikan |
Ichikawa S.,Tohoku University |
Suzuki T.,Yamagata City Hospital Saiseikan |
Kimura J.,Yamagata City Hospital Saiseikan |
Harigae H.,Tohoku University
Internal Medicine | Year: 2012
We present a 56-year-old woman with acute promyelocytic leukemia (APL) complicated with serious chronic subdural hematoma at presentation. She was treated with urgent hematoma evacuation and subsequent prompt chemotherapy, with administration of platelets and fresh frozen plasma. After six weeks, she achieved hematological complete remission. Thereafter she received three courses of conventional consolidation chemotherapy and achieved molecular remission. Even under conditions of severe coagulatory disturbance, aggressive therapeutic intervention including surgical procedures can save the life of a patient suffering from simultaneous APL and fatal subdural hematoma at presentation. © 2012 The Japanese Society of Internal Medicine.
Kawai M.,Kawai ENT Clinic |
Ohta N.,Yamagata City Hospital SAISEIKAN
Practica Oto-Rhino-Laryngologica | Year: 2015
Beclometasone (product name: Salcoat®) for oral spray is a powder formulation containing a large amount of a mucosal-adhesive base material (hydroxypropyl cellulose: HPC), which allows the drug to be retained longer at the local site. When the product is sprayed on the affected site with a dedicated small sprayer (pubriser®), the HPC gelates by absorbing moisture on the mucosal surface and adheres to the mucosa. As a result, it remains at the affected site for a prolonged period of time and thereby also releases the active ingredient (steroid) locally for a prolonged period of time. Treatment with Salcoat® nasal spray (one puff in each nostril, twice daily) was given to 10 patients with nasal polyps associated with allergic rhinitis who showed no improvement with conservative treatment for one year or longer. Subjective improvement in the feeling of nasal congestion was observed in 7 cases and the nasal polyps shrank in 5 cases. Treatment with Salcoat® was prematurely discontinued in one patient because nasal congestion occurred immediately after the formulation was sprayed, due to gelation of the drug. None of the patients showed any signs of mycosis.
Okano S.,Research Laboratory for Molecular Genetics |
Hayasaka K.,Yamagata University |
Igarashi M.,Yamagata City Hospital Saiseikan |
Togashi Y.,Research Laboratory for Molecular Genetics |
Nakajima O.,Research Laboratory for Molecular Genetics
Journal of Diabetes Investigation | Year: 2013
Aims/Introduction: In earlier reports, we described that transgenic (Tg) mice ubiquitously expressing cryptochrome1 (CRY1) with a mutation in cysteine414 (CRY1-AP Tg mice) show an early-onset insulin-secretory defect of diabetes mellitus resembling human maturity-onset diabetes of the young (MODY). To clarify the yet undiscovered molecular pathogenesis of diabetes mellitus in which the mutant of CRY1 is involved, we examined age-dependent characteristics of islets of CRY1-AP Tg mice. Materials and Methods: Immunohistochemical analyses of islets were carried out for 2-, 4- and 19-week-old mice. Insulin contents in the pancreas and glucose-stimulated insulin secretion of isolated islets of mice were measured at 4 weeks. Real-time polymerase chain reaction analyses using pancreases of mice at 4 and 21 weeks-of-age were carried out. Results: Already at a young stage, the proliferation of β-cells was reduced in CRY1-AP Tg mice. Insulin contents and the levels of glucose-stimulated insulin secretion were lower than those of wild-type controls in CRY1-AP Tg mice at the young stage. The expression of insulin and glucose-sensing genes was reduced at the young stage. At the mature stage, altered distribution and hyperplasia of α-cells were observed in the islets of CRY1-AP Tg mice. Conclusions: Architectural abnormality in islets progressed with age in CRY1-AP Tg mice. The reduced expression of insulin and glucose-sensing genes, along with the lowered proliferation of β-cells from an early stage, is a possible primary cause of early-onset insulin-secretory defect in CRY1-AP Tg mice. Our results suggest that CRY1 is crucial for the maintenance of β-cell function. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd.
Ichikawa S.,Yamagata City Hospital Saiseikan
Journal of clinical and experimental hematopathology : JCEH | Year: 2012
A 71-year-old woman presented with massive splenomegaly. Open splenectomy was performed, and the diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), was made, with a characteristic immunophenotype of CD3(+), CD4(-), CD8(-), T-cell receptor (TCR)αβ(+), and TCRγδ(-). After splenectomy, she suffered abrupt exacerbation of the lymphoma with disseminated intravascular coagulation and enteropathy. Although chemotherapy was started, her medical condition did not improve and she died a week later. Postmortem reevaluation of the pathological specimen confirmed her diagnosis as CD20(+) PTCL-NOS. Although it is a rare disease entity, CD20(+) T-cell lymphoma can demonstrate aggressive clinical behavior.
Kudo K.,Yamagata City Hospital Saiseikan |
Konta T.,Yamagata University |
Degawa N.,Yamagata City Hospital Saiseikan |
Saito S.,Yamagata City Hospital Saiseikan |
And 3 more authors.
Clinical and Experimental Nephrology | Year: 2012
Background: Kidney disease is a known risk factor for stroke. This study investigated the relationship between kidney damage and stroke types. Methods: A total of 525 incident stroke patients were registered and followed for 1 year. The prevalence of kidney damage [proteinuria and/or renal insufficiency (estimated glomerular filtration rate <60 ml/min/1.73 m2)] in incident stroke and its effects on 1-year prognosis were examined. Results: Among all stroke patients, kidney damage and its component (proteinuria and renal insufficiency) were commonly observed (48.2, 25.5, and 33.9%, respectively). The prevalence of ischemic stroke was significantly higher in patients with kidney damage (75.9%) than in those without (58.9%). The most frequent type of stroke among all patients with kidney damage and renal insufficiency only was cardioembolic infarction. In contrast, in patients with proteinuria only and patients without kidney damage, the most frequent type was subcortical and subarachnoid hemorrhage, respectively. Multiple logistic regression analysis showed that kidney damage or the combination of its components were independently associated with 1-year death [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.40-6.59, P = 0.005 for kidney damage, OR 2.82, 95% CI 1.05-7.58, P = 0.040 for proteinuria only, and OR 5.77, 95% CI 2.23-15.0, P < 0.001 for both proteinuria and renal insufficiency]. In addition, for 1-year outcomes, there were selective associations between ischemic stroke and proteinuria and between hemorrhagic stroke and renal insufficiency. Conclusions: This study shows that kidney damage is common in Japanese stroke patients, and proteinuria and renal insufficiency are differentially related to development and prognosis, depending stroke types. © 2012 Japanese Society of Nephrology.
PubMed | Okitama Public General Hospital, Matsumoto University, Shiseido General Hospital, Yamagata City Hospital Saiseikan and 2 more.
Type: | Journal: Neuroscience research | Year: 2016
Spinal reflex arcs mediated by low-threshold (group I) afferents from muscle spindles and Golgi tendon organs modulate motoneuron excitabilities to coordinate smooth movements. In this study, the reflex arcs between the brachioradialis (BR) and extensor carpi radialis muscles (ECR) were examined in nine healthy human subjects using a post-stimulus time-histogram method. Electrical conditioning stimuli (ES) to the radial nerve branches innervating BR (BR nerve) and ECR (ECR nerve) with the intensity just below the motor threshold were delivered and firings of the ECR and BR motor units were recorded in 6 and 7 of the nine subjects, respectively. ES to the BR and ECR nerves induced a peak (facilitation) in 27/59 ECR and 22/68 BR motor units, respectively, in every subject. Such facilitation was never provoked by pure cutaneous stimulation. The remaining motor units received no effects by ES. The central synaptic delay of the facilitation was almost equal to that of the homonymous facilitation. These findings suggest that facilitation between BR and ECR exists in humans. Group I afferents should mediate the facilitation through a monosynaptic path in the spinal cord.
PubMed | Yamagata City Hospital Saiseikan, Teikyo University, Matsumoto University and Yamagata University
Type: | Journal: Neuroscience research | Year: 2016
Spinal reflex arcs mediated by low threshold afferents between the brachioradialis (BR) and flexor carpi radialis (FCR) were studied in eleven healthy human subjects using a post-stimulus time-histogram method. Electrical conditioning stimuli (ES) to the radial nerve branch innervating BR with the intensity below the motor threshold (MT) induced an early and significant trough (inhibition) in 32/85 FCR motor units (MUs) in 9/9 subjects. Such inhibition was never provoked by cutaneous stimulation. The central synaptic delay (CSD) of the inhibition was approximately 1.1ms longer than that of the homonymous FCR facilitation. ES to the median nerve branch innervating FCR with the intensity below MT induced an inhibition in 27/71 BR-MUs in 10/10 subjects. CSD of the inhibition was about 1.1ms longer than that of the homonymous BR facilitation. These findings suggest that inhibition between BR and FCR exists in humans. Group I afferents seem to mediate the inhibition through an oligo(di or tri)-synaptic path.
Wall Enhancement of the Intracranial Aneurysms Revealed by Magnetic Resonance Vessel Wall Imaging Using Three-Dimensional Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium: A Sign of Ruptured Aneurysm?
PubMed | Yamagata City Hospital Saiseikan, Philips and Yamagata University
Type: Journal Article | Journal: Clinical neuroradiology | Year: 2016
Wall enhancement of saccular cerebral aneurysms has not been researched sufficiently. Our purpose of this study was to investigate the incidence of aneurysmal wall enhancement by the three-dimensional turbo spin-echo sequence with motion-sensitized driven equilibrium (MSDE-3D-TSE) imaging after gadolinium injection.We retrospectively reviewed the pre- and postcontrast MSDE-3D-TSE images of 117 consecutive patients with intracranial aneurysms from September 2011 to July 2013. A total of 61 ruptured and 83 unruptured aneurysms of 61 patients with subarachnoid hemorrhage (SAH) and 56 non-SAH patients were enrolled in this study. We evaluated the wall enhancement of each aneurysm on postcontrast MSDE-3D-TSE images compared with precontrast images. We classified the aneurysmal wall enhancement into three groups as Strong enhancement, Faint enhancement, and No enhancement.Strong/Faint enhancement of the aneurysm was detected in 73.8/24.6% of the ruptured aneurysms and 4.8/13.3% of the unruptured aneurysms. No enhancement was found in 1.6% of the ruptured aneurysms and 81.9% of the unruptured aneurysms.By magnetic resonance vessel wall imaging using the MSDE-3D-TSE sequence, wall enhancement was frequently observed on ruptured aneurysms. Therefore, aneurysmal wall enhancement may be an indicator of the ruptured condition, which is useful information for managing patients with SAH.