1
|
Oku K, Yabuki M, Kishimoto T, Shinonaga A, Kimura D, Ito T, Sugioka T, Kobayashi Y, Satake H, Nagamoto H, Kawaguchi Y, Kumai T. Clinical reasoning of ultrasound imaging-guided manual passive manipulation for adhesion prevention in a patient with total knee arthroplasty: a case report. Physiother Theory Pract 2024; 40:1064-1071. [PMID: 36346357 DOI: 10.1080/09593985.2022.2143737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patients with total knee arthroplasty occasionally develop postoperative abnormalities such as posttraumatic knee stiffness and arthrofibrosis, which may affect activities of daily living. However, there are no clear assessment methods or interventions for knee stiffness. Musculoskeletal ultrasound imaging enables real-time evaluation of mobility and flexibility of tissues. The purpose of this case report was to describe the use of musculoskeletal ultrasound imaging for evaluating the optimal location and methods of passive manipulation. CASE DESCRIPTION The patient was an 82-year-old woman who had undergone total knee arthroplasty. She was unable to climb stairs due to limited knee flexion. Based on the results of musculoskeletal ultrasound imaging assessment, we hypothesized that the knee flexion limitation was caused by decreased sliding movement of the suprapatellar pouch. Hence, we performed passive manipulation on the tissue with decreased sliding under musculoskeletal ultrasound guidance. OUTCOMES The patient's knee flexion angle increased from 90° to 110° within 1 week of intervention, and her gait speed improved from 16.48 to 13.2 s per 10 m. Furthermore, after the intervention, she was able to climb 10 steps using a handrail. DISCUSSION Ultrasound imaging is important because it allows the examination of tissues with mobility changes such as in arthrofibrosis. Our work highlights the use of musculoskeletal ultrasound imaging for identifying the target region for therapy and for providing guidance during passive manipulation.
Collapse
Affiliation(s)
- Kosuke Oku
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Mayumi Yabuki
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tomoya Kishimoto
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Atsushi Shinonaga
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Daisuke Kimura
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tomotaka Ito
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tatsuya Sugioka
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Yusuke Kobayashi
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Hayato Satake
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Hideaki Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| |
Collapse
|
2
|
Nakano H, Matsugi A, Ito T, Oku K, Sakita M. Editorial: Pushing the limits of motor function recovery in rehabilitation: Basic to applied research based on neuroscience. Front Hum Neurosci 2023; 17:1160632. [PMID: 36908714 PMCID: PMC9996318 DOI: 10.3389/fnhum.2023.1160632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Hideki Nakano
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daito, Japan
| | - Tomotaka Ito
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Masahiro Sakita
- Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| |
Collapse
|
3
|
Ogata Y, Fujieda Y, Oku K, Tsutsumi A. A case of Hashimoto's thyroiditis presented with heliotrope-like skin rash. Scand J Rheumatol 2022; 51:525-526. [PMID: 35658785 DOI: 10.1080/03009742.2022.2070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Y Ogata
- Takikawa Municipal Hospital, Takikawa, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - K Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - A Tsutsumi
- Takikawa Municipal Hospital, Takikawa, Japan
| |
Collapse
|
4
|
Isojima S, Yajima N, Yanai R, Miura Y, Fukuma S, Kaneko K, Fujio K, Oku K, Matsushita M, Miyamae T, Wada T, Kaneko Y, Tanaka Y, Nakajima A, Murashima A. POS0734 THE CLINICAL JUDGMENT FOR THE ACCEPTABILITY OF PREGNANCY IN PATIENTS WITH SEROLOGICALLY ACTIVE SLE IN JAPAN: A NATIONWIDE ONLINE SURVEY FROM THE VIGNETTE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe risk of pregnancy complications, such as gestational hypertension is high in pregnancies with SLE. In addition, the risk of flare is elevated if pregnancy occurs during the high disease activity. The EULAR recommendation provides a checklist for preconception counseling, in which patients with SLE desiring pregnancy were required the condition that the disease activity prior to pregnancy should be stable for 6-12 months in terms of serological activity (1). However, it does not provide specific criteria for serological activity so that physicians should evaluate the risk of pregnancy in each case by their clinical intuitions.ObjectivesIn order to uncover the present clinical situation for the acceptability of pregnancy in patients with SLE, we performed questionnaire survey to physicians regarding to the degree of serological activity.MethodsThis cross-sectional study was performed to physicians registered with the Japanese College of Rheumatology from December 2020 to January 2021 using the online survey. The questionnaire asked about the characteristics of physicians, facilities and the permission of pregnancies with SLE using vignette scenarios. In this study, data from vignettes of women visiting a regular outpatient clinic were used. The vignettes varied in age (28 or 35 years), duration of stable disease and serological activity. Analysis methods were descriptive statistics, chi-square test. generalized estimating equations (GEE) was performed to investigate the relationship between the determining permission for pregnancy and the scenario patient’s characteristics (age, period of stable disease, titer of anti ds-DNA antibody)ResultsThe questionnaire was distributed to 4946 physicians, and 463 responded. Completion rate (ratio agreed to participate/finished survey) of survey was 91.1%. The median age of physicians was 46 (interquartile range (IQR) 2-10). The specialty was rheumatology (84.9%), other internal medicine (8%), and pediatrics (5.6%). There were no significant differences in patient’s age about the acceptability of pregnancy (coeffficianet -0.02, 95% CI -0.17 -0.01, p=0.42). Case who had been stable for 6 months were more tolerant of pregnancy than case who had been stable for 3 months (coeffficianet 0.12, 95% CI 0.09-0.15, P<0.001) Pregnancy was not allowed in case with mild or high serological activity (mild: coefficient -0.49, 95% CI -0.29- -0.22, p <0.001, high: -0.64, 95% CI -0.65 - -0.61, p <0.001). In contrast, as many as 92 (19.2%) physicians tolerated pregnancy even in the presence of residual high anti ds-DNA antibody titers. Female physicians are significantly more cautious about pregnancy than male when patients have a serologically high activity (12% vs 37.5%, p<0.001). There were no significant differences in specialty status or clinical experience.ConclusionWe found that even mild serological activity alone had a significant negative effect on the physician’s decision to allow pregnancy. We conclude that current physicians make cautious decisions about pregnancies of patients with SLE following the recommendation. On the other hand, an additional investigation should be performed about the results of pregnancies in patients with serological abnormalities, since there are some physicians who thought that pregnancy may be acceptable for patients with only serological abnormalities if the clinical symptoms are stable.References[1]Ann Rheum Dis.2017 Mar;76(3):476-485AcknowledgementsI would like to express my gratitude to the members of Japan College of Rheumatology who cooperated in filling out the questionnaire.Disclosure of InterestsSakiko Isojima: None declared, Nobuyuki Yajima: None declared, Ryo Yanai: None declared, Yoko Miura: None declared, Shingo Fukuma: None declared, Kayoko Kaneko: None declared, Keishi Fujio: None declared, Kenji Oku: None declared, Masakazu Matsushita: None declared, Takako Miyamae: None declared, Takashi Wada: None declared, Yuko Kaneko: None declared, Yoshiya Tanaka Speakers bureau: Y. Tanaka has received speaking fees and/or honoraria from Gilead, Abbvie, Behringer-Ingelheim, Eli Lilly, Mitsubishi-Tanabe, Chugai, Amgen, YL Biologics, Eisai, Astellas, Bristol-Myers, Astra-Zeneca, Grant/research support from: Y. Tanaka has received research grants from Asahi-Kasei, Abbvie, Chugai, Mitsubishi-Tanabe, Eisai, Takeda, Corrona, Daiichi-Sankyo, Kowa, Behringer-Ingelheim, and consultant fee from Eli Lilly, Daiichi-Sankyo, Taisho, Ayumi, Sanofi, GSK, Abbvie., Ayako Nakajima: None declared, ATSUKO MURASHIMA: None declared
Collapse
|
5
|
Ninagawa K, Kato M, Kono M, Fujieda Y, Oku K, Atsumi T. POS0863 DIFFERENTIATING THE DOMINANCE OF PULMONARY VASCULAR DISEASE OR INTERSTITIAL LUNG DISEASE ON HEMODYNAMIC ABNORMALITIES IN SYSTEMIC SCLEROSIS AND CLARIFYING EACH CHARACTERISTIC BY USING QUANTITATIVE EVALUATION OF CHEST CT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Group 1 and 3 pulmonary hypertension (PH) develop through different pathological mechanisms but have similar hemodynamic abnormalities. Systemic sclerosis (SSc) is associated with both pulmonary vascular disease (PVD) and interstitial lung disease (ILD), making it challenging to differentiate group 1 and 3 PH in those patients. A previous study using quantitative evaluation of chest computed tomography (CT) demonstrated that normal lung volume was inversely correlated with mean pulmonary arterial pressure (mPAP) in patients with group 3 PH (1).Objectives:In this study, we aimed to assess the dominance of PVD or ILD in SSc patients by quantitative evaluation of chest CT and to evaluate each characteristic.Methods:A total of 76 SSc patients who underwent right heart catheterization (RHC) were included. Chest CT was evaluated by using a software (Synapse Vincent Ver.3.0, Fujifilm) which quantified normal and total area of the lung. Then, we calculated abnormal area by drawing normal area from total area in the lung (%). Pulmonary function test (PFT) and serum biomarkers, such as KL-6 and LDH, were also evaluated. The dominance of PVD or ILD was defined as divergent or parallel change between the first and last assessments, respectively, in mPAP and abnormal area in the lung calculated using the software. Increase or decrease by over 10% in the last assessment compared to the first assessment was considered as a significant change in mPAP or abnormal area in the lung. P values were calculated by Mann-Whitney U test, and correlation coefficients were calculated by direct regression variance.Results:The median [range] values of mPAP and abnormal area in the lung at baseline were 23 [9-65] mmHg and 30.2 [0-100] %, respectively. Of 37 SSc and PH patients, 18 were defined as having PVD dominance while 19 as ILD dominance. Abnormal area in the lung at baseline was greater in patients with ILD dominance compared to those with PVD dominance (39.1 [16.3-98.3] v.s. 14.0 [0-99] %, p=0.002), whereas mPAP was higher in patients with PVD dominance than those with ILD dominance (42.5 [23.0-65.0] v.s. 26.0 [16.0-42.0] mmHg, p=0.002). PFT parameters including forced vital capacity were not different between the two groups. The ratio of mPAP/KL-6 showed a great difference between the two groups with its significant elevation in patients with PVD dominance (p=0.007).Conclusion:Quantitative evaluation of chest CT showed great efficiency in differentiating the dominance of PVD or ILD in patients with SSc and PH. In addition, the ratio of mPAP/KL-6 may easily be used as a parameter for dominance evaluation.References:[1]Iwasawa T, Kato S, Ogura T, Kusakawa Y, Iso S, Baba T, et al. Low-normal lung volume correlates with pulmonary hypertension in fibrotic idiopathic interstitial pneumonia: computer-aided 3D quantitative analysis of chest CT. AJR Am J Roentgenol. 2014;203(2):W166-73.Disclosure of Interests:None declared
Collapse
|
6
|
Matsugi A, Nagino K, Shiozaki T, Okada Y, Mori N, Nakamura J, Douchi S, Oku K, Nagano K, Tamaru Y. No Impact of Stochastic Galvanic Vestibular Stimulation on Arterial Pressure and Heart Rate Variability in the Elderly Population. Front Hum Neurosci 2021; 15:646127. [PMID: 33679355 PMCID: PMC7925407 DOI: 10.3389/fnhum.2021.646127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023] Open
Abstract
Objective Noisy galvanic vestibular stimulation (nGVS) is often used to improve postural stability in disorders, such as neurorehabilitation montage. For the safe use of nGVS, we investigated whether arterial pressure (AP) and heart rate vary during static supine and slow whole-body tilt with random nGVS (0.4 mA, 0.1–640 Hz, gaussian distribution) in a healthy elderly population. Methods This study was conducted with a double-blind, sham-controlled, cross-over design. Seventeen healthy older adults were recruited. They were asked to maintain a static supine position on a bed for 10 min, and the bed was tilted up (TU) to 70 degrees within 30 s. After maintaining this position for 3 min, the bed was passively tilted down (TD) within 30 s. Real-nGVS or sham-nGVS was applied from 4 to 15 min. The time course of mean arterial pressure (MAP) and RR interval variability (RRIV) were analyzed to estimate the autonomic nervous activity. Result nGVS and/or time, including pre-/post-event (nGVS-start, TU, and TD), had no impact on MAP and RRIV-related parameters. Further, there was no evidence supporting the argument that nGVS induces pain, vertigo/dizziness, and uncomfortable feeling. Conclusion nGVS may not affect the AP and RRIV during static position and whole-body tilting or cause pain, vertigo/dizziness, and discomfort in the elderly.
Collapse
Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka, Japan
| | - Koji Nagino
- Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Tomoyuki Shiozaki
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Yohei Okada
- Faculty of Health Science, Kio University, Nara, Japan.,Graduate School of Health Sciences, Kio University, Nara, Japan.,Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Nobuhiko Mori
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junji Nakamura
- Faculty of Health Science, Kio University, Nara, Japan.,Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shinya Douchi
- Department of Rehabilitation, National Hospital Organization Wakayama Hospital, Wakayama, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Kiyoshi Nagano
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka, Japan
| | - Yoshiki Tamaru
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka, Japan
| |
Collapse
|
7
|
Matsugi A, Oku K, Mori N. The Effects of Stochastic Galvanic Vestibular Stimulation on Body Sway and Muscle Activity. Front Hum Neurosci 2020; 14:591671. [PMID: 33381017 PMCID: PMC7767904 DOI: 10.3389/fnhum.2020.591671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
Objective: This study aimed to investigate whether galvanic vestibular stimulation with stochastic noise (nGVS) modulates the body sway and muscle activity of the lower limbs, depending on visual and somatosensory information from the foot using rubber-foam. Methods: Seventeen healthy young adults participated in the study. Each subject maintained an upright standing position on a force plate with/without rubber-foam, with their eyes open/closed, to measure the position of their foot center of pressure. Thirty minutes after baseline measurements under four possible conditions (eyes open/closed with/without rubber-foam) performed without nGVS (intensity: 1 mA, duration: 40 s), the stimulation trials (sham-nGVS/real-nGVS) were conducted under the same conditions in random order, which were then repeated a week or more later. The total center of pressure (COP) path length movement (COP-TL) and COP movement velocity in the mediolateral (Vel-ML) and anteroposterior (Vel-AP) directions were recorded for 30 s during nGVS. Furthermore, electromyography activity of the right tibial anterior muscle and soleus muscle was recorded for the same time and analyzed. Results: Three-way analysis of variance and post-hoc multiple comparison revealed a significant increment in COP-related parameters by nGVS, and a significant increment in soleus muscle activity on rubber. There was no significant effect of eye condition on any parameter. Conclusions: During nGVS (1 mA), body sway and muscle activity in the lower limb may be increased depending not on the visual condition, but on the foot somatosensory condition.
Collapse
Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Daitou, Japan
| | - Kosuke Oku
- Department of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Nobuhiko Mori
- Department of Neuromodulation and Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
8
|
Oku K, Kawahara I, Sugioka T, Tanaka Y, Hoshiba T, Hirose N, Kumai T. Immediate effects of plantar vibration stimuli during static upright posture following total hip arthroplasty in females. Somatosens Mot Res 2020; 37:238-244. [PMID: 32597287 DOI: 10.1080/08990220.2020.1784129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Proprioceptive function of the lower limbs deteriorates in patients following total hip arthroplasty. Patients show poor balance and rely more on visual information than proprioceptive information. Plantar vibration stimuli can mechanically enhance somatosensory input from the plantar cutaneous mechanoreceptors, thereby improving static balance. Plantar vibration stimuli may improve static balance in patients after total hip arthroplasty. This is the first study to investigate whether plantar vibration stimuli affects static balance during the early phase following total hip arthroplasty. MATERIALS AND METHODS In this cross-over design study, 16 female patients (aged 65.1 ± 11.0 years) received plantar vibration stimuli for 2 minutes or the sham interventions after total hip arthroplasty in a randomized order on different days. The foot centre of pressure was measured for the total path length, mediolateral path length, and anteroposterior path length directions before and immediately after the interventions in the static standing position both with eyes open and closed. Patients were instructed to minimize body sway when standing. RESULTS A significant increase was observed in the centre of pressure parameters in the eyes closed condition than in the eyes open condition. The centre of pressure parameters for the eyes closed condition was significantly decreased after vibration interventions than that before intervention. CONCLUSIONS This study supports the view that plantar vibration stimuli can change static balance in patients in the early phase after total hip arthroplasty temporarily by up-weighting sensory information. These stimuli may serve as a treatment option for influencing balance following total hip arthroplasty.
Collapse
Affiliation(s)
- Kosuke Oku
- Nara Medical University Graduate School, Kashihara, Nara, Japan.,Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Isao Kawahara
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Nara, Japan.,Department of Molecular Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Sugioka
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takuma Hoshiba
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.,Department of Sports Medicine, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
9
|
Sugawara M, Fujieda Y, Noguchi A, Tanimura S, Shimizu Y, Nakagawa I, Kono M, Kato M, Oku K, Atsumi T. SAT0057 PREDICTING INADEQUATE RESPONSE TO JAK INHIBITORS BY CLUSTER ANALYSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Oral Janus kinase inhibitors (JAKi) have dramatically altered outcomes in patients with rheumatoid arthritis (RA). However, there remains some proportion of patients who respond to inadequately JAKi treatment (JAKi-IR) [1,2]. The characteristics in RA patients associated with JAKi-IR have not been fully demonstrated.Objectives:To clarify the characteristics of JAKi-IR in patients with RA by cluster analysis.Methods:This retrospective study comprised 120 RA patients who were treated with JAKi (Tofacitinib or Baricitinib) between July 2013 and September 2019 in five facilities. The disease status at the baseline, at 12 weeks after JAKi treatment and at the time point of withdrawing JAKi was assessed using the Disease Activity Score (DAS28) and the American College of Rheumatology (ACR) response criteria. JAKi-IR was defined as follows, primary non-response at 12 weeks after JAKi treatment: withdrawal of JAKi with ACR20 non-response or non-improvement in DAS28-CRP (ΔDAS28-CRP<1.2 from baseline), secondary non-response: withdrawal of JAKi without clinical remission after 12 weeks. Hierarchical cluster analysis was performed with the following variables: gender, age, disease duration, bone erosion, ACR functional classification (Class ≥3), comcomitant rheumatoid arthritis related interstitial lung disease (RA-ILD) or other autoimmune disease (AID), anti-citrullinated protein antibody (ACPA) positivity, rheumatoid factor (RF) at baseline, use/dose of methotrexate (MTX) and prednisolone (PSL), serum ESR/CRP, tender/swollen joint counts (TJC/SJC), visual analog scale by patients (VAS-Pt), and prior of biologic DMARDs.Results:The 120 enrolled patients were classified into 4 groups by cluster analysis(Figure1), The characteristics of each group are as follows, Group A(n=21): female + bone erosion + RF/ACPA positive + AID + MTX non-user, Group B(n=36): male + older age + RA-ILD + RF/ACPA positive + MTX non-user, Group C(n=35): RF/ACPA positive + absence of RA-ILD + MTX user, Group D (n=28): seronegative + MTX user + absence of RA-ILD + history of biologic DMARDs failure. The rate of JAKi-IR was A:9%, B:8%, C:20%, D:32%, and the significant difference between Group B and D was identified (p=0.02). In multiple comparison of 4 groups, no significant difference was identified (p=0.06) (Figure2).Conclusion:JAKi-IR would be more likely to be seronegative, MTX use, absence of RA-ILD and history of biologic DMARDs failure. Cluster analysis is an exploratory tool that aids in the analysis of huge amount of data.References:[1] Takeuchi T, Yamanaka H, Yamaoka K, Arai S, Toyoizumi S, DeMasi R, et al. Efficacy and safety of tofacitinib in Japanese patients with rheumatoid arthritis by background methotrexate dose: A post hoc analysis of clinical trial data. Mod Rheumatol. 2019;29(5):756-66.[2] Tanaka Y, Atsumi T, Amano K, Harigai M, Ishii T, Kawaguchi O, et al. Efficacy and safety of baricitinib in Japanese patients with rheumatoid arthritis: Subgroup analyses of four multinational phase 3 randomized trials. Mod Rheumatol. 2018;28(4):583-91.Disclosure of Interests:Masanari Sugawara: None declared, Yuichiro Fujieda: None declared, Atsushi Noguchi: None declared, Shun Tanimura: None declared, Yuka Shimizu: None declared, Ikuma Nakagawa: None declared, Michihito Kono: None declared, Masaru Kato: None declared, Kenji Oku: None declared, Tatsuya Atsumi Grant/research support from: Eli Lily Japan K.K., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb Co., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc., Consultant of: Gilead Sciences, Inc., Eli Lilly Japan K.K., UCB Japan Co. Ltd., AbbVie Inc., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Speakers bureau: Eli Lilly Japan K.K., UCB Japan Co. Ltd., Bristol-Myers Squibb Co., AbbVie Inc., Eisai Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Pfizer Inc., Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc.
Collapse
|
10
|
Matsugi A, Douchi S, Suzuki K, Oku K, Mori N, Tanaka H, Nishishita S, Bando K, Kikuchi Y, Okada Y. Cerebellar Transcranial Magnetic Stimulation Reduces the Silent Period on Hand Muscle Electromyography During Force Control. Brain Sci 2020; 10:brainsci10020063. [PMID: 31991581 PMCID: PMC7071382 DOI: 10.3390/brainsci10020063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/29/2023] Open
Abstract
This study aimed to investigate whether cerebellar transcranial magnetic stimulation (C-TMS) affected the cortical silent period (cSP) induced by TMS over the primary motor cortex (M1) and the effect of interstimulus interval (ISI) on cerebellar conditioning and TMS to the left M1 (M1-TMS). Fourteen healthy adult participants were instructed to control the abduction force of the right index finger to 20% of the maximum voluntary contraction. M1-TMS was delivered during this to induce cSP on electromyograph of the right first dorsal interosseous muscle. TMS over the right cerebellum (C-TMS) was conducted prior to M1-TMS. In the first experiment, M1-TMS intensity was set to 1 or 1.3 × resting motor threshold (rMT) with 20-ms ISI. In the second experiment, the intensity was set to 1 × rMT with ISI of 0, 10, 20, 30, 40, 50, 60, 70, or 80 ms, and no-C-TMS trials were inserted. In results, cSP was significantly shorter in 1 × rMT condition than in 1.3 × rMT by C-TMS, and cSP was significantly shorter for ISI of 20–40 ms than for the no-C-TMS condition. Further, motor evoked potential for ISI40-60 ms were significantly reduced than that for ISI0. Thus, C-TMS may reduce cSP induced by M1-TMS with ISI of 20–40 ms.
Collapse
Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo 5-11-10, Daitou city, Osaka 574-0011, Japan
- Correspondence: ; Tel.: +81-72-863-5043; Fax: +81-72-863-5022
| | - Shinya Douchi
- Department of Rehabilitation, National Hospital Organization Kyoto Medical Center, Hukakusamukaihatacyo1-1, Husimi-ku Kyoto City, Kyoto 612-8555, Japan
| | - Kodai Suzuki
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Nara 630-0243, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo 5-11-10, Daitou city, Osaka 574-0011, Japan
| | - Nobuhiko Mori
- Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hiroaki Tanaka
- Graduate School of Health Sciences, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kitakatsuragi-gun, Nara 635-0832, Japan
- Department of Rehabilitation, Baba memorial Hospital, Nishiku Hamaderahunaotyohigashi 4-244, Sakai City, Osaka 592-8555, Japan
| | - Satoru Nishishita
- Institute of Rehabilitation Science, Tokuyukai medical corporation, 3-11-1 Sakuranocho, Toyonaka City, Osaka 560-0054, Japan
- Kansai Rehabilitation Hospital, 3-11-1 Sakuranocho, Toyonaka City, Osaka 560-0054, Japan
| | - Kyota Bando
- National Center Hospital, National Center of Neurology and Psychiatry, Kodaira 187-0031, Japan
| | - Yutaka Kikuchi
- Department of Rehabilitation for Intractable Neurological Disorders, Institute of Brain and Blood Vessels Mihara Memorial Hospital, Ohtamachi366, Isesaki City, Gunma 372-0006, Japan
| | - Yohei Okada
- Graduate School of Health Sciences, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kitakatsuragi-gun, Nara 635-0832, Japan
- Neurorehabilitation Research Center of Kio University, Koryo-cho, Kitakatsuragi-gun, Nara 635-0832, Japan
| |
Collapse
|
11
|
Matsugi A, Yoshida N, Nishishita S, Okada Y, Mori N, Oku K, Douchi S, Hosomi K, Saitoh Y. Cerebellum-mediated trainability of eye and head movements for dynamic gazing. PLoS One 2019; 14:e0224458. [PMID: 31682634 PMCID: PMC6827899 DOI: 10.1371/journal.pone.0224458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/14/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate whether gaze stabilization exercises (GSEs) improve eye and head movements and whether low-frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) inhibits GSE trainability. Methods 25 healthy adults (real rTMS, n = 12; sham rTMS, n = 13) were recruited. Real or sham rTMS was performed for 15 min (1 Hz, 900 stimulations). The center of the butterfly coil was set 1 cm below the inion in the real rTMS. Following stimulation, 10 trials of 1 min of a GSE were conducted at 1 min intervals. In the GSE, the subjects were instructed to stand upright and horizontally rotate their heads according to a beeping sound corresponding to 2 Hz and with a gaze point ahead of them. Electrooculograms were used to estimate the horizontal gaze direction of the right eye, and gyroscopic measurements were performed to estimate the horizontal head angular velocity during the GSE trials. The percentage change from the first trial of motion range of the eye and head was calculated for each measurement. The percent change of the eye/head range ratio was calculated to assess the synchronous changes of the eye and head movements as the exercise increased. Results Bayesian two-way analysis of variance showed that cerebellar rTMS affected the eye motion range and eye/head range ratio. A post hoc comparison (Bayesian t-test) showed evidence that the eye motion range and eye/head range ratio were reduced in the fifth, sixth, and seventh trials compared with the first trial sham stimulation condition. Conclusions GSEs can modulate eye movements with respect to head movements, and the cerebellum may be associated with eye–head coordination trainability for dynamic gazing during head movements.
Collapse
Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo, Daitou City, Osaka, Japan
- * E-mail:
| | - Naoki Yoshida
- Department of Research, Institute of Rehabilitation Science, Tokuyukai Medical Corporation, Sakuranocho, Toyonaka City, Osaka, Japan
- Department of Rehabilitation, Kansai Rehabilitation Hospital, Sakuranocho, Toyonaka City, Osaka, Japan
| | - Satoru Nishishita
- Department of Research, Institute of Rehabilitation Science, Tokuyukai Medical Corporation, Sakuranocho, Toyonaka City, Osaka, Japan
- Department of Rehabilitation, Kansai Rehabilitation Hospital, Sakuranocho, Toyonaka City, Osaka, Japan
| | - Yohei Okada
- Faculty of Health Science, Kio University, Umami-naka, Koryo-cho, Kitakatsuragi-gun, Nara, Japan
- Neurorehabilitation Research Center of Kio University, Koryo-cho, Kitakatsuragi-gun, Nara, Japan
| | - Nobuhiko Mori
- Department of Neuromodulation and Neurosurgery, Office for University-Industry Collaboration, Osaka University, Osaka, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Shijonawate Gakuen University, Hojo, Daitou City, Osaka, Japan
| | - Shinya Douchi
- Department of Rehabilitation, National Hospital Organization Kyoto Medical Center, Hukakusamukaihatacyo, Husimi-ku, Kyoto City, Kyoto, Japan
| | - Koichi Hosomi
- Department of Neuromodulation and Neurosurgery, Office for University-Industry Collaboration, Osaka University, Osaka, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Youichi Saitoh
- Department of Neuromodulation and Neurosurgery, Office for University-Industry Collaboration, Osaka University, Osaka, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
12
|
Sato T, Nakamura H, Fujieda Y, Ohnishi N, Abe N, Kono M, Kato M, Oku K, Bohgaki T, Amengual O, Yasuda S, Atsumi T. Factor Xa inhibitors for preventing recurrent thrombosis in patients with antiphospholipid syndrome: a longitudinal cohort study. Lupus 2019; 28:1577-1582. [PMID: 31635559 DOI: 10.1177/0961203319881200] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to clarify the efficacy and safety of factor Xa inhibitors for antiphospholipid syndrome patients in real world utilization. METHODS This is a retrospective cohort study comprised of all consecutive patients with antiphospholipid syndrome in our department over a period of 28 years. Patients treated with factor Xa inhibitors were extracted from the cohort. As a control group, patients treated with warfarin were selected from the same cohort with matched age, gender, coexistence of systemic lupus erythematosus, and the presence of antiplatelet therapy, after which we used a propensity score for each of the risk factors as an additional covariate in multivariate Cox proportional hazard regression. The primary endpoint was set as thrombotic and hemorrhagic event-free survival for five years. RESULTS Among 206 patients with antiphospholipid syndrome, 18 had a history of anti-Xa therapy (five rivaroxaban, 12 edoxaban, one apixaban). Fourteen out of 18 patients on anti-Xa therapy had switched to factor Xa inhibitors from warfarin. Event-free survival was significantly shorter during anti-Xa therapy than that during warfarin therapy (hazard ratio: 12.1, 95% confidence interval: 1.73-248, p = 0.01) ( Figure 1(a) ). Similarly, event-free survival in patients treated with factor Xa inhibitors was significantly shorter compared with controls (hazard ratio: 4.62, 95% confidence interval: 1.54-13.6, p = 0.0075). In the multivariate Cox proportional hazard model, event-free survival in patients with anti-Xa therapy remained significantly shorter (hazard ratio: 11.9, 95% confidence interval: 2.93-56.0, p = 0.0005). CONCLUSIONS Factor Xa inhibitors may not be recommended for antiphospholipid syndrome.
Collapse
Affiliation(s)
- T Sato
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - H Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - N Ohnishi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - N Abe
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - M Kono
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - M Kato
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - T Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - O Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - S Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, Sapporo, Japan
| |
Collapse
|
13
|
Sugawara E, Kato M, Fujieda Y, Oku K, Bohgaki T, Yasuda S, Umazume T, Morikawa M, Watari H, Atsumi T. Pregnancy outcomes in women with rheumatic diseases: a real-world observational study in Japan. Lupus 2019; 28:1407-1416. [PMID: 31551035 DOI: 10.1177/0961203319877258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We aimed to evaluate the obstetric complications and the risk factors for these events in pregnant women with rheumatic diseases (RDs). METHODS A single-center retrospective study of women with RDs at Hokkaido University Hospital between 2007 and 2016 was conducted. Clinical features and maternal and fetal outcomes were retrospectively collected. The rate of pregnancy complications was compared with the general obstetric population (GOP) in Japan. RESULTS Overall, 132 pregnancies in 95 women with RDs were recorded. Underlying RDs were systemic erythematosus (SLE) (n = 57), antiphospholipid syndrome (APS) (n = 35), rheumatoid arthritis (n = 9), and other RDs (n = 31). Antiphospholipid antibodies (aPL) were detected in 44 pregnancies (32%). Glucocorticoid was used in 82 pregnancies (62%), and tacrolimus in 20 pregnancies (15%). There were 24 disease flares (18%), but no RD-related death was documented. We recorded 112 live births, 6 abortions, 8 miscarriages, and 6 stillbirths. Pregnancies with RDs appeared to have frequent, emergency cesarean sections and preterm deliveries compared with GOP (30% vs 15% and 21% vs 14%, respectively). The median [interquartile range] birthweight in SLE and APS was lower than GOP (2591 [2231-2958] g and 2600 [2276-2920] g vs 2950 [2650-3250] g, respectively). In pregnancies with SLE, low complement levels presented the risk of maternal complications (odds ratio [95% CI]; 3.9 [1.0-14.9], p = 0.046) and anti-DNA antibody positivity was significantly correlated with the risk of fetal complications (3.5 [1.1-11.2], p = 0.036). In pregnancies with APS, maternal age over 35 years and duration of disease longer than 9 years (7.4 [1.3-40.8], p = 0.021, and 11.16 [1.1-118.8], p = 0.046, respectively) were significantly correlated with the risk of fetal complications. CONCLUSION Pregnancies with RDs were at increased risk of having both maternal complications and adverse neonatal outcomes, indicating these pregnancies should be closely monitored.
Collapse
Affiliation(s)
- E Sugawara
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - M Kato
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| | - T Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Faculty and Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
14
|
Ueta Y, Matsugi A, Oku K, Okuno K, Tamaru Y, Nomura S, Tanaka H, Douchi S, Mori N. Gaze stabilization exercises derive sensory reweighting of vestibular for postural control. J Phys Ther Sci 2017; 29:1494-1496. [PMID: 28931974 PMCID: PMC5599807 DOI: 10.1589/jpts.29.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate whether gaze stabilization exercise
derives sensory reweighting of vestibular for upright postural control. [Subjects and
Methods] Twenty-three healthy volunteers participated in this study. The center of
pressure of the total trajectory length was measured before (pre), immediately after
(post), and 10 min after (post10) gaze stabilization exercise, in the static standing
position, with the eyes open or closed, on the floor or on foam rubber. The sensory
contribution values of the visual, somatosensory, and vestibular systems were calculated
using center of pressure of the total trajectory length value in these measuring
conditions. [Results] The center of pressure of the total trajectory length on foam rubber
in post and post10 were significantly lower than that in the pre. The sensory contribution
values of vestibular in post10 stages were significantly higher than that in pre-stage.
[Conclusion] Gaze stabilization exercise can improve the static body balance in a
condition that particularly requires vestibular function. The possible mechanism involves
increasing sensory contribution of the vestibular system for postural control by the gaze
stabilization exercise, which may be useful to derive sensory reweighting of the
vestibular system for rehabilitation.
Collapse
Affiliation(s)
- Yusuke Ueta
- Department of Rehabilitation, National Hospital Organization Kyoto Medical Center, Japan
| | - Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University: 5-11-10 Hojo, Daitou city, Osaka 574-0011, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Shijonawate Gakuen University: 5-11-10 Hojo, Daitou city, Osaka 574-0011, Japan
| | - Kojiro Okuno
- Department of Rehabilitation, Wakakusa Tatsuma Rehabilitation Hospital, Japan
| | - Yoshiki Tamaru
- Faculty of Rehabilitation, Shijonawate Gakuen University: 5-11-10 Hojo, Daitou city, Osaka 574-0011, Japan
| | - Shohei Nomura
- Department of Rehabilitation, Baba Memorial Hospital, Japan
| | - Hiroaki Tanaka
- Department of Rehabilitation, Baba Memorial Hospital, Japan
| | - Shinya Douchi
- Department of Rehabilitation, National Hospital Organization Hyogo-chuo National Hospital, Japan
| | - Nobuhiko Mori
- Department of Rehabilitation, Wakayama Medical University, Kihoku Hospital, Japan
| |
Collapse
|
15
|
Hisada R, Kato M, Sugawara E, Fujieda Y, Oku K, Bohgaki T, Amengual O, Yasuda S, Atsumi T. Thrombotic risk stratification by platelet count in patients with antiphospholipid antibodies: a longitudinal study. J Thromb Haemost 2017; 15:1782-1787. [PMID: 28662299 DOI: 10.1111/jth.13763] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 08/30/2023]
Abstract
Essentials Thrombotic risk stratification is an unmet need in antiphospholipid antibody carriers. Platelet count and antiphospholipid score (aPL-S) were combined to predict thrombotic events. Patients with high aPL-S are at high thrombotic risk regardless of platelet count. If platelet count is low, patients with low aPL-S are also on high thrombotic risk. SUMMARY Background Thrombocytopenia is a non-criteria clinical manifestation of antiphospholipid syndrome. However, it remains to be elucidated whether thrombocytopenia increases thrombotic risk in antiphospholipid antibody (aPL) carriers. Objectives To investigate the impact of platelet count in terms of predicting thrombotic events in aPL carriers, and to stratify the thrombotic risk by combining platelet count and antiphospholipid score (aPL-S), which represents a quantification of aPL varieties and titers. Patients/methods A single-center, retrospective, longitudinal study comprising 953 consecutive patients who were suspected of having autoimmune disease between January 2002 and December 2006 was performed. Low platelet count was defined as a count of < 150 × 103 μL-1 at the time of aPL testing. Results A negative correlation was observed between aPL-S and platelet count (r = - 0.2477). Among aPL-positive patients, those with a low platelet count developed thrombosis more frequently than those without (hazard ratio [HR] 2.95, 95% confidence interval [CI] 1.11-7.88). Among aPL-negative patients, no difference was found in the predictive value of thrombosis regardless of platelet count. Patients with aPLs were further divided into two subgroups according to aPL-S. Among low-aPL-S patients, those with low platelet counts developed thrombosis more frequently than those without (HR 3.44, 95% CI 1.05-11.2). In contrast, high-aPL-S patients developed thrombosis frequently regardless of platelet count. Conclusions aPL carriers with low platelet counts are at high risk of developing thrombosis. In particular, 'low-aPL-S carriers' may be stratified by platelet count in terms of predicting future thrombotic events.
Collapse
Affiliation(s)
- R Hisada
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - M Kato
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - E Sugawara
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - T Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - O Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - S Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
16
|
Watanabe T, Oku K, Amengual O, Hisada R, Ohmura K, Nakagawa I, Shida H, Bohgaki T, Horita T, Yasuda S, Atsumi T. Effects of statins on thrombosis development in patients with systemic lupus erythematosus and antiphospholipid antibodies. Lupus 2017; 27:225-234. [DOI: 10.1177/0961203317716787] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T Watanabe
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - R Hisada
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Ohmura
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - I Nakagawa
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Shida
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
17
|
Nakamura H, Amengual O, Horita T, Kato M, Oku K, Bohgaki T, Yasuda S, Atsumi T. Acute aortic thrombosis related to antiphospholipid antibodies. Lupus 2016; 26:783-784. [PMID: 27852934 DOI: 10.1177/0961203316678672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H Nakamura
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Kato
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
18
|
Matsugi A, Tani K, Yoshioka N, Yamashita A, Mori N, Oku K, Murakami Y, Nomura S, Tamaru Y, Nagano K. Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score. J Phys Ther Sci 2016; 28:2737-2741. [PMID: 27821925 PMCID: PMC5088116 DOI: 10.1589/jpts.28.2737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/09/2016] [Indexed: 12/01/2022] Open
Abstract
[Purpose] This study investigated whether it is possible to predict return to home at
discharge from a rehabilitation hospital in Japan using the home care score of patients
with cerebrovascular or osteoarticular disease and low activities of daily living at
admission. [Subjects and Methods] The home care score and functional independent
measurement were determined for 226 patients at admission and at discharge from five
hospitals, and receiver operating characteristic analyses were conducted. [Results] The
home care score cutoff point for the prediction of return to home at admission and at
discharge was 11, and the area under the curve was more than 0.8. The area under the curve
of the home care score was 0.77 for patients with low activities of daily living and
within this group, the probability of return to home was approximately 50%, as predicted
by the functional independent measurement. The home care score increased after receiving
intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for
the prediction of return to home from a rehabilitation hospital, although prediction using
the functional independent measurement is difficult for patients with low activities of
daily living. Moreover, comprehensive interventions provided by the rehabilitation
hospitals improve the ability to provide home care of the patient’s family, which is
assessed by the home care score.
Collapse
Affiliation(s)
| | - Keisuke Tani
- Graduate School of Human and Environmental Studies, Kyoto University, Japan
| | - Nami Yoshioka
- Department of Rehabilitation, Bobath Memorial Hospital, Japan
| | - Akira Yamashita
- Department of Rehabilitation, Bobath Memorial Hospital, Japan
| | - Nobuhiko Mori
- Department of Rehabilitation, Wakayama Medical University, Japan
| | - Kosuke Oku
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | | | - Shohei Nomura
- Department of Rehabilitation, Pegasus Rehabilitation Hospital, Japan
| | - Yoshiki Tamaru
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | - Kiyoshi Nagano
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| |
Collapse
|
19
|
Amengual O, Forastiero R, Sugiura-Ogasawara M, Otomo K, Oku K, Favas C, Delgado Alves J, Žigon P, Ambrožič A, Tomšič M, Ruiz-Arruza I, Ruiz-Irastorza G, Bertolaccini ML, Norman GL, Shums Z, Arai J, Murashima A, Tebo AE, Gerosa M, Meroni PL, Rodriguez-Pintó I, Cervera R, Swadzba J, Musial J, Atsumi T. Evaluation of phosphatidylserine-dependent antiprothrombin antibody testing for the diagnosis of antiphospholipid syndrome: results of an international multicentre study. Lupus 2016; 26:266-276. [PMID: 27510605 DOI: 10.1177/0961203316660203] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A task force of scientists at the International Congress on Antiphospholipid Antibodies recognized that phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT) might contribute to a better identification of antiphospholipid syndrome (APS). Accordingly, initial and replication retrospective, cross-sectional multicentre studies were conducted to ascertain the value of aPS/PT for APS diagnosis. Methods In the initial study (eight centres, seven countries), clinical/laboratory data were retrospectively collected. Serum/plasma samples were tested for IgG aPS/PT at Inova Diagnostics (Inova) using two ELISA kits. A replication study (five centres, five countries) was carried out afterwards. Results In the initial study ( n = 247), a moderate agreement between the IgG aPS/PT Inova and MBL ELISA kits was observed ( k = 0.598). IgG aPS/PT were more prevalent in APS patients (51%) than in those without (9%), OR 10.8, 95% CI (4.0-29.3), p < 0.0001. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratio of IgG aPS/PT for APS diagnosis were 51%, 91%, 5.9 and 0.5, respectively. In the replication study ( n = 214), a moderate/substantial agreement between the IgG aPS/PT results obtained with both ELISA kits was observed ( k = 0.630). IgG aPS/PT were more prevalent in APS patients (47%) than in those without (12%), OR 6.4, 95% CI (2.6-16), p < 0.0001. Sensitivity, specificity, LR + and LR- for APS diagnosis were 47%, 88%, 3.9 and 0.6, respectively. Conclusions IgG aPS/PT detection is an easily performed laboratory parameter that might contribute to a better and more complete identification of patients with APS.
Collapse
Affiliation(s)
- O Amengual
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - R Forastiero
- 2 Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Departamento de Fisiologia, Hemostasia y Trombosis, Buenos Aires, Argentina
| | - M Sugiura-Ogasawara
- 3 Department of Obstetrics and Gynecology, Nagoya City University, Graduated School of Medical Sciences, Nagoya, Japan
| | - K Otomo
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - C Favas
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - J Delgado Alves
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - P Žigon
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Ambrožič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Tomšič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - I Ruiz-Arruza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - G Ruiz-Irastorza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - M L Bertolaccini
- 7 Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, UK
| | - G L Norman
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - Z Shums
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - J Arai
- 9 Medical and Biological Laboratories, Co. Ltd, Nagano, Japan
| | - A Murashima
- 10 Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - A E Tebo
- 11 Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - M Gerosa
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - P L Meroni
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - I Rodriguez-Pintó
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Cervera
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - J Swadzba
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - J Musial
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - T Atsumi
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
20
|
Hisada R, Kato M, Sugawara E, Ohmura K, Nakagawa I, Oku K, Bohgaki T, Amengual O, Horita T, Yasuda S, Atsumi T. THU0354 Thrombocytopenia in Patients with Antiphospholipid Antibodies: A Paradoxical Thrombotic Risk Factor. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
21
|
Otomo K, Amengual O, Fujieda Y, Nakagawa H, Kato M, Oku K, Horita T, Yasuda S, Matsumoto M, Nakayama KI, Hatakeyama S, Koike T, Atsumi T. Role of apolipoprotein B100 and oxidized low-density lipoprotein in the monocyte tissue factor induction mediated by anti-β2 glycoprotein I antibodies. Lupus 2016; 25:1288-98. [PMID: 26964561 DOI: 10.1177/0961203316638165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/12/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this paper is to elucidate the not yet known plasma molecule candidates involved in the induction of tissue factor (TF) expression mediated by β2GPI-dependent anticardiolipin antibody (aCL/β2GPI) on monocytes. METHODS Human serum incubated with FLAG-β2GPI was applied for affinity chromatography with anti- FLAG antibody. Immunopurified proteins were analyzed by a liquid chromatography coupled with mass spectrometry (LC-MS). TF mRNA induced by the identified molecules on monocytes was also analyzed. RESULTS Apolipoprotein B100 (APOB) was the only identified serum molecule in the MS search. Oxidized LDL, containing APOB as well as ox-Lig1 (a known ligand of β2GPI), was revealed as a β2GPI-binding molecule in the immunoprecipitation assay. TF mRNA was markedly induced by oxidized LDL/β2GPI complexes with either WBCAL-1 (monoclonal aCL/β2GPI) or purified IgG from APS patients. The activities of lipoprotein-associated phospholipase A2, one of the component molecules of oxidized LDL, were significantly higher in serum from APS patients than in those from controls. CONCLUSION APOB (or oxidized LDL) was detected as a major β2GPI binding serum molecule by LC-MS search. Oxidized LDL/aCL/β2GPI complexes significantly induced TF expressions on monocytes. These data suggest that complexes of oxidized LDL and aCL/β2GPI may have a crucial role in the pathophysiology of APS.
Collapse
Affiliation(s)
- K Otomo
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Y Fujieda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Nakagawa
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Kato
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Matsumoto
- Division of Proteomics, Multi-scale Research Center for Prevention of Medical Science, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - K I Nakayama
- Division of Proteomics, Multi-scale Research Center for Prevention of Medical Science, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - S Hatakeyama
- Department of Biochemistry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Koike
- Sapporo Medical Center NTT EC, Sapporo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
22
|
Noguchi A, Yasuda S, Kono M, Kato M, Oku K, Bohgaki T, Amengual O, Horita T, Sato T, Tsujino I, Nishimura M, Atsumi T. AB0677 Cardiac Magnetic Resonance Imaging Detects Disease-Specific Biventricular Involvement in Patients with Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
23
|
Amengual O, Fujita D, Ota E, Carmona L, Oku K, Sugiura-Ogasawara M, Murashima A, Atsumi T. Primary prophylaxis to prevent obstetric complications in asymptomatic women with antiphospholipid antibodies: a systematic review. Lupus 2015; 24:1135-42. [PMID: 25813871 DOI: 10.1177/0961203315578765] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/02/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Obstetric complications are common in patients with antiphospholipid syndrome. However, the impact of antiphosholipid antibodies (aPL) in the pregnancy outcomes of asymptomatic aPL carriers is uncertain. The aim of this systematic review is to assess whether primary prophylaxis is beneficial to prevent obstetric complications during pregnancy in asymptomatic women positive for aPL who have no history of recurrent pregnancy loss or intrauterine fetal death. METHODS Studies evaluating the effect of prophylactic treatment versus no treatment in asymptomatic pregnant aPL carriers were identified in an electronic database search. Design, population and outcome homogeneity of studies was assessed and meta-analysis was performed. The pooled Mantel-Haenszel relative risk of specific pregnancy outcomes was obtained using random effects models. Heterogeneity was measured with the I(2) statistic. All analyses were conducted using Review Manager 5.3. RESULTS Data from five studies involving 154 pregnancies were included and three studies were meta-analysed. The risk ratio and 95% confidence interval (CI) of live birth rates, preterm birth, low birth weight and overall pregnancy complications in treated and untreated pregnancies were 1.14 (0.18-7.31); 1.71 (0.32-8.98); 0.98 (0.07-13.54) and 2.15 (0.63-7.33),respectively. Results from the meta-analysis revealed that prophylactic treatment with aspirin is not superior to placebo to prevent pregnancy complications in asymptomatic aPL carriers. CONCLUSION This systematic review did not find evidence of the superiority of prophylactic treatment with aspirin compared to placebo or usual care to prevent unfavourable obstetric outcomes in otherwise healthy women with aPL during the first pregnancy.
Collapse
Affiliation(s)
- O Amengual
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - D Fujita
- Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki City, Osaka, Japan
| | - E Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - L Carmona
- Institute for Musculoskeletal Health, Madrid, Spain
| | - K Oku
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - A Murashima
- Department of Rheumatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - T Atsumi
- Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
24
|
Oku K, Amengual O, Bohgaki T, Horita T, Yasuda S, Atsumi T. An independent validation of the Global Anti-Phospholipid Syndrome Score in a Japanese cohort of patients with autoimmune diseases. Lupus 2014; 24:774-5. [DOI: 10.1177/0961203314561284] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Affiliation(s)
- K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
25
|
Matsugi A, Tani K, Mitani Y, Oku K, Tamaru Y, Nagano K. Revision of the predictive method improves precision in the prediction of stroke outcomes for patients admitted to rehabilitation hospitals. J Phys Ther Sci 2014; 26:1429-31. [PMID: 25276029 PMCID: PMC4175250 DOI: 10.1589/jpts.26.1429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/15/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to confirm the accuracy of a revised method for
predicting the Functional Independence Measure (FIM) at discharge when stroke patients are
first admitted to a rehabilitation hospital. [Subjects and Methods] The predictive
equation with logarithmic trend line was calculated based on the total score of the FIM at
admission and discharge in 93 patients with cerebral infarction (CI) and 60 patients with
intracerebral hemorrhage (ICH). In other patients with CI or ICH (validation group), the
differences between the actual FIM and the predicted FIM at discharge calculated by the CI
or ICH equation and the combined (CI + ICH) equation, as well as by the CI or ICH equation
and combined equation used in a previous study, were calculated. [Results] The multiple
correlation coefficients of the CI equation, ICH equation, and combined equation were
0.87, 0.71, and 0.8. The residual of the actual FIM and predicted FIM at discharge
calculated by the CI equation was the smallest in the CI validation group. In the ICH
validation group, the residual calculated for ICH patients alone was smaller than that
calculated by the previous ICH equation. [Conclusion] This easy-to-use method using a new
equation for prediction was more precise than the previous equation. Therefore, we should
revise the equation for predicting stroke patient outcome strata according to data from
within the governing medical administration system.
Collapse
Affiliation(s)
| | - Keisuke Tani
- Department of Rehabilitation, Baba Memorial Hospital, Japan
| | - Yasuhiro Mitani
- Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Kosuke Oku
- Department of Rehabilitation, Hanna Chuo Hospital, Japan
| | - Yoshiki Tamaru
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| | - Kiyoshi Nagano
- Faculty of Rehabilitation, Shijonawate Gakuen University, Japan
| |
Collapse
|
26
|
Abstract
Recently our group introduced the “antiphospholipid score” (aPL-S), a quantitative marker that represents aPL profile. We have validated its efficacy for the diagnosis of antiphospholipid syndrome (APS) and predictive value for thrombosis. The study comprised two independent sets of patients with autoimmune diseases. In the first set of patients ( n = 233), the aPL-S was established by analyzing aPL profiles. In the second set of patients ( n = 411), the predictive value of the aPL-S for thrombosis was evaluated. To define aPL-S, we calculated the relative risks (approximated by odds ratios (ORs)) of having APS manifestations (thrombosis and/or pregnancy morbidity) for each of the aPL tests and devised an original formula in which aPL-S was determined by OR: aPL-S = 5 × exp ([OR] −5)/4. The receiver operating characteristic (ROC) curve showed a hyperbolic pattern and the area under the ROC curve value was 0.752 (0.686 for revised Sapporo criteria), implying that aPL-S is a potential quantitative marker for APS diagnosis. The OR for thrombosis in patients with a high aPL-S (≥30) was 5.27 (95% confidence interval (95% CI) 2.32–11.95, p < 0.0001). By multivariate analysis, an aPL-S of ≥30 appeared to be an independent risk factor for thrombosis (hazard ratio 3.144 (95% CI 1.383–7.150), p = 0.006). The aPL-S is a useful quantitative index for diagnosing APS and may be a predictive marker for thrombosis in autoimmune diseases.
Collapse
Affiliation(s)
- K Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
27
|
Matsugi A, Uehara S, Kamata N, Mori N, Oku K, Mukai K, Nagano K. P694: Task dependency of long latency facilitatory effect on soleus H-reflex by cerebellar transcranial magnetic stimulation. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Amengual O, Forastiero R, Sugiura-Ogasawara M, Oku K, Otomo K, Alves J, Favas C, Žigon P, Ambrožič A, Tomšič M, Ruiz-Irastorza G, Ruiz-Arruza I, Bertolaccini M, Norman G, Shums Z, Arai J, Atsumi T. SAT0202 International Multi-Centre Study to Evaluate the Clinical Significance of Phosphatidylserine-Dependent Antiprothrombin Antibodies for the Diagnosis of Antiphospholipid Syndrome. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
29
|
Niwa H, Kato H, Hobo S, Kinoshita Y, Ueno T, Katayama Y, Hariu K, Oku K, Senoh M, Kuroda T, Nakai K. Postoperative Clostridium difficile infection with PCR ribotype 078 strain identified at necropsy in five Thoroughbred racehorses. Vet Rec 2013; 173:607. [PMID: 24336792 DOI: 10.1136/vr.101960] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Clostridium difficile is an important cause of acute enterocolitis in horses. We describe five cases of C difficile infection occurring postoperatively in Thoroughbred racehorses. Following diarrhoea or colic accompanied by a marked increase in packed cell volume (to ≥60 per cent) and leucopenia (≤4000 cells/μl) within two to four days after surgery in all five horses, four of them died or were euthanased because of colitis or severe diarrhoea. In these four horses, necrotising entero-typhlo-colitis was revealed by postmortem examination, and C difficile was recovered from the contents of the small and/or large intestine. The remaining horse was euthanased because of marked decline in general condition and the presence of a lung abscess, from which C difficile was isolated. The horse had had severe postoperative diarrhoea before the onset of respiratory disorder; laboratory tests for C difficile were not performed on the faeces. All C difficile isolates were toxin-A-positive, toxin-B-positive and actin-specific ADP-ribosyltransferase (CDT)-positive. The isolates were indistinguishable by pulsed field gel electrophoresis analysis, PCR ribotyping, and slpA sequence typing, and the slpA sequences and PCR ribotype patterns were identical to those of known PCR type 078. This case sequence might have been healthcare-associated infection, although there was about a four-month interval between each disease onset.
Collapse
Affiliation(s)
- H Niwa
- Microbiology Division, Epizootic Research Center, Equine Research Institute, Japan Racing Association, Shiba 1400-4, Shimotsuke, Tochigi 329-0412, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kato M, Atsumi T, Oku K, Amengual O, Nakagawa H, Fujieda Y, Otomo K, Horita T, Yasuda S, Koike T. The involvement of CD36 in monocyte activation by antiphospholipid antibodies. Lupus 2013; 22:761-71. [DOI: 10.1177/0961203313490242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background CD36, known as a scavenger receptor, is a transmembrane glycoprotein expressed on monocytes, platelets and endothelial cells, recognizes multiple ligands, including phosphatidylserine, and regulates atherogenesis and thrombosis. The objective of this study is to investigate the possible involvement of CD36 in the pathophysiology of thrombosis in patients with antiphospholipid syndrome (APS). Methods First, rs3765187, a missense mutation linked to CD36 deficiency, was investigated by TaqMan polymerase chain reaction (PCR) genotyping method in 819 Japanese, including 132 patients with APS, 265 with systemic lupus erythematosus (SLE) in the absence of APS, and 422 healthy subjects. Then, the involvement of CD36 in antiphospholipid antibody (aPL)-induced tissue factor (TF) expression was examined using CD36-null mice or anti-CD36. Purified IgG from patients with APS and a monoclonal phosphatidylserine-dependent antiprothrombin antibody were used in these experiments. TF expression was tested by real-time PCR and flow cytometry. Results Minor allele carrier of rs3765187 was less frequent in patients with APS (3.8% p = 0.032), but not in patients with SLE in the absence of APS (7.9% p = 0.32), compared with healthy subjects (10.2%). The aPL-induced TF expression was significantly suppressed on peritoneal macrophages from CD36-null mice compared to wild type and significantly inhibited by anti-CD36 on human monocytes. Conclusions The gene mutation linked to CD36 deficiency was less frequent in patients with APS. The deficient or suppressed CD36 function significantly reduced aPL-induced TF expression in vitro. Taken together, in a susceptible background CD36 scavenger receptor function may be involved in the thrombotic pathophysiology in patients with APS.
Collapse
Affiliation(s)
- M Kato
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Nakagawa
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Y Fujieda
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Otomo
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Koike
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
31
|
Watanabe T, Oku K, Amengual O, Shimamura S, Nakagawa I, Noguchi A, Kanetsuka Y, Kono M, Kurita T, Fujieda Y, Bohgaki T, Yasuda S, Horita T, Atsumi T. FRI0319 The analysis of risk and protective factors for thrombosis in systemic lupus erythematosus with or without antiphospholipid antibodies. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Niwa H, Hobo S, Kinoshita Y, Muranaka M, Katayama Y, Oku K, Hariu K. The possibility of aneurism of the anterior mesenteric artery with parasitic infection as a site of Salmonella Abortusequi carriage. J Equine Vet Sci 2012. [DOI: 10.1016/j.jevs.2012.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Fujieda Y, Atsumi T, Amengual O, Odani T, Otomo K, Kato M, Oku K, Kon Y, Horita T, Yasuda S, Koike T. Predominant prevalence of arterial thrombosis in Japanese patients with antiphospholipid syndrome. Lupus 2012; 21:1506-14. [DOI: 10.1177/0961203312458469] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To study the clinical and immunological manifestations of antiphospholipid syndrome (APS) in the Japanese population by a single-centre registration. Methods: In this retrospective cohort study, 141 consecutive patients with APS, fulfilling the Sydney revised Sapporo criteria for definite APS, who visited our autoimmune clinic from 1988 to 2010, were recruited and followed up. All the patients were interviewed and underwent a general physical examination by qualified rheumatologists on the day of blood sampling. Results: The population comprised 119 woman and 22 men with a mean age at diagnosis of 44 years (range 9–79 years). Seventy patients (49.6%) had primary APS, and 71 (50.4%) had systemic lupus erythematosus. The prevalence of thrombosis was 85.8 per cent, arterial thrombosis was found in 93 patients (66.0%) and venous thrombosis was found in 46 patients (32.6%). The most common thrombosis was cerebral infarction [86/141 (61.0%)] followed by deep vein thrombosis [33/141 (23.4%)]. Among 70 pregnant women, 45 (64.3%) had obstetric complications. Lupus anticoagulant was detected in 116 patients (82.3%), anticardiolipin antibodies in 83 (58.9%), anti-β2 glycoprotein I antibodies in 73 (51.8%) and phosphatidylserine-dependent antiprothrombin antibodies in 98 (69.5%). Conclusion: High prevalence of arterial thrombosis was noted in Japanese patients with APS. The profile of heterogeneous and complex clinical manifestations was substantiated in Japanese patients with APS.
Collapse
Affiliation(s)
- Y Fujieda
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Atsumi
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - O Amengual
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Odani
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Otomo
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Kato
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Y Kon
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Horita
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - S Yasuda
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Koike
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
34
|
Oku K, Ishida H, Okada Y, Hiraoka K. Facilitation of corticospinal excitability during motor imagery of wrist movement with visual or quantitative inspection of EMG activity. Percept Mot Skills 2012; 113:982-94. [PMID: 22403940 DOI: 10.2466/05.23.25.pms.113.6.982-994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study investigated facilitation of corticospinal excitability during motor imagery of wrist movement with visual or quantitative inspection of background electromyographic (EMG) activity. Ten healthy participants imagined wrist extension from a first-person perspective in response to a start cue. Transcranial magnetic stimulation was delivered to the motor cortex 2 sec. after the start cue. EMG signals were recorded from the extensor carpi radialis muscle. Trials with background EMG activity were discarded based on visual inspection. Both motor-evoked potential (MEP) and background EMG amplitudes increased during motor imagery. The amount of increase in MEP amplitude was positively correlated with the amount of increase in background EMG amplitude during motor imagery. The statistically significant increase in MEP amplitude during motor imagery disappeared when the effect of muscle activity was statistically eliminated or after trials with background EMG activity were discarded based on strict quantitative criteria. Facilitation of corticospinal excitability during motor imagery of wrist movement depends partially on muscle activity. Discarding background EMG activity during motor imagery based on visual inspection is not sufficient to equalize background EMG amplitude between resting and motor imagery. Discarding trials with background EMG activity through strict quantitative criteria is useful to equalize background EMG amplitude between at rest and during motor imagery.
Collapse
Affiliation(s)
- Kosuke Oku
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | | | | | | |
Collapse
|
35
|
Kato M, Kataoka H, Odani T, Fujieda Y, Otomo K, Oku K, Horita T, Yasuda S, Atsumi T, Ohira H, Tsujino I, Nishimura M, Koike T. The short-term role of corticosteroid therapy for pulmonary arterial hypertension associated with connective tissue diseases: report of five cases and a literature review. Lupus 2011; 20:1047-56. [PMID: 21676917 DOI: 10.1177/0961203311403347] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening complication in connective tissue diseases (CTD). It remains controversial whether immunosuppressive therapy is useful for PAH associated with CTD (PAH-CTD). The Dana Point algorithm does not refer such treatments in patients with PAH-CTD due to the lack of evidence. However, some case reports have shown the potential efficacy of immunosuppression for PAH-CTD. Here we report five cases of PAH-CTD treated with corticosteroids and discuss the current management of PAH-CTD with immunosuppressive agents. Our cases consisted of three active systemic lupus erythematosus (SLE), a quiescent SLE and an active polymyositis. WHO functional classes at baseline were class III in three cases and class II in two. Median follow-up period was 44 (28-92) weeks. PAH was diagnosed by right heart catheterization in all cases (median pulmonary arterial pressure was 45 (29-49) mmHg). All patients received 1 mg/kg of prednisolone (PSL) for 2-4 weeks, followed by appropriate dose reduction. Methylprednisolone pulse therapy was performed in patients resistant to the high dosage of PSL. Four patients received vasodilators in combination. The therapy as above improved WHO functional class 4 weeks after the initiation of PSL in all the patients. Two patients required dose increase or additional administration of vasodilators due to the dose reduction of PSL. Corticosteroid therapy may be effective for PAH-CTD at least in the short term, even in low general activity of CTD or moderate PAH. Our experience suggests that corticosteroid therapy, by itself or in conjunction with standard vasodilators, is effective for PAH-CTD patients.
Collapse
Affiliation(s)
- M Kato
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Fukaya S, Yasuda S, Hashimoto T, Oku K, Kataoka H, Horita T, Atsumi T, Koike T. Clinical features of haemophagocytic syndrome in patients with systemic autoimmune diseases: analysis of 30 cases. Rheumatology (Oxford) 2008; 47:1686-91. [PMID: 18782855 DOI: 10.1093/rheumatology/ken342] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Haemophagocytic syndrome (HPS) is known as a relatively rare complication in autoimmune diseases. Here we analysed the clinical features of HPS in patients with systemic autoimmune diseases. METHODS One thousand and fourteen patients with systemic autoimmune diseases admitted to Hokkaido University Hospital from 1997 to 2007 were recruited [350 SLE, 136 RA, 98 polymyositis/dermatomyositis (PM/DM), 88 SSc, 91 vasculitis syndrome, 37 primary SS, 26 adult onset Still's disease (AOSD) and 188 other diseases]. Clinical features and treatment outcomes were retrospectively analysed. RESULTS Thirty cases (3.0%) fulfilled HPS criteria (progressive cytopenia in two or more lineages and haemophagocytosis in reticuloendothelial systems). Underlying diseases were SLE (18), RA (2), PM/DM (2), SSc (2), vasculitis (1), SS (2) and AOSD (3). Nineteen patients were diagnosed as having autoimmune-associated HPS, eight infection-associated, one drug-induced and one developed HPS after haematopoietic stem cell transplantation. For the treatment of HPS, high-dose corticosteroid monotherapy was given in 26 cases, being effective in 12 (46%). Ten out of 15 patients with corticosteroid-resistant autoimmune-associated HPS were treated with CsA, cyclophosphamide or tacrolimus, leading to the remission in 80%. The overall mortality rate was 20%. Multivariate analysis showed that the presence of infections and CRP level >50 mg/l on HPS related with poor prognosis. CONCLUSIONS The prevalence of HPS among in-hospital patients with systemic autoimmunity is not ignorable. Administration of immunosuppressants was effective in cases with autoimmune-associated HPS, whereas prognosis was poor in infection-associated HPS.
Collapse
Affiliation(s)
- S Fukaya
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Oku K, Atsumi T, Bohgaki M, Amengual O, Kataoka H, Horita T, Yasuda S, Koike T. Complement activation in patients with primary antiphospholipid syndrome. Ann Rheum Dis 2008; 68:1030-5. [PMID: 18625630 DOI: 10.1136/ard.2008.090670] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the significance of complement activation in patients with primary antiphospholipid syndrome (APS). METHODS Thirty-six patients with primary APS, 42 control patients with non-systemic lupus erythematosus (SLE) connective tissue diseases, and 36 healthy volunteers were analysed retrospectively. Serum complement levels (C3, C4, CH(50)) and anaphylatoxins (C3a, C4a, C5a) were examined in all subjects, and serum complement regulatory factors (factor H and factor I) were measured in patients with primary APS. Plasma anticoagulant activity was determined in a mixing test using the activated partial thromboplastin time. RESULTS Serum complement levels were significantly lower in patients with primary APS than in patients with non-SLE connective tissue diseases (mean (SD) C3: 81.07 (17.86) vs 109.80 (22.76) mg/dl, p<0.001; C4: 13.04 (8.49) vs 21.70 (6.96) mg/dl, p<0.001; CH(50): 31.32 (8.76) vs 41.40 (7.70) U/ml, p<0.001) or healthy volunteers. Only two healthy subjects with low serum C4 levels showed hypocomplementaemia, whereas most patients with primary APS showed raised serum C3a and C4a. No subjects showed raised C5a. Patients with primary APS with low serum C3 or C4 had significantly higher levels of C3a or C4a than healthy controls. No patients had low serum complement regulatory factors. Among patients with primary APS, hypocomplementaemia was significantly more common in those with high anticoagulant activity than in those with low or normal activity. CONCLUSION Hypocomplementaemia is common in patients with primary APS, reflecting complement activation and consumption, and was correlated with anticoagulant activity, suggesting that antiphospholipid antibodies may activate monocytes and macrophages via anaphylatoxins produced in complement activation.
Collapse
Affiliation(s)
- K Oku
- Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Matsumoto T, Aoba T, Oku K, Asai T, Abe D, Takahashi Y, Sonoda M, Inoue D. The prevention of the cervical spinal cord injury by the start diving at the Masters swimming meet in Japan. J Sci Med Sport 2006. [DOI: 10.1016/j.jsams.2006.12.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Oku K, Atsumi T, Furukawa S, Horita T, Sakai Y, Jodo S, Amasaki Y, Ichikawa K, Amengual O, Koike T. Cerebral imaging by magnetic resonance imaging and single photon emission computed tomography in systemic lupus erythematosus with central nervous system involvement. Rheumatology (Oxford) 2003; 42:773-7. [PMID: 12730538 DOI: 10.1093/rheumatology/keg216] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the significance of magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) abnormalities in patients with systemic lupus erythematosus (SLE). METHODS Forty-four patients with SLE were retrospectively analysed. Patients were classified into three groups [1 and 2: patients with central nervous system (CNS) manifestations before and after starting high-dose steroid therapy, respectively; 3: patients without CNS manifestations. MRI was performed in all 44 patients and SPECT in 31. RESULTS Abnormal findings in MRI were found in 19 patients. MRI abnormalities were significantly more frequent in patients with CNS manifestations than in those without [71 vs 17%, odds ratio (OR) 11.9, confidence interval (CI) 2.8-49.9, P=0.0003]. After the initiation of steroid therapy, patients with CNS manifestations also had an increased frequency of abnormal MRI. No correlation was found between SPECT findings and CNS manifestations. However, patients with CNS manifestations after starting steroids showed a markedly increased frequency of abnormal MRI and SPECT compared with those without CNS manifestations (80 vs 7%; OR 56, CI 4.4-719, P=0.0003). The positive predictive value of abnormality in both techniques in developing CNS manifestations after starting steroids was 89%. CONCLUSION MRI findings correlated with CNS manifestations in SLE. Where there is a high suspicion of CNS involvement, the combination of MRI and SPECT may be useful in predicting CNS manifestations after starting steroid therapy.
Collapse
Affiliation(s)
- K Oku
- Department of Medicine II, Hokkaido University School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Izumi Y, Kaneko A, Oku K, Kimura M, Tanaka S, Tada H, Tatsumi K, Takano T, Hidaka Y, Amino N. Development of liver dysfunction after delivery is possibly due to postpartum autoimmune hepatitis. A report of three cases. J Intern Med 2002; 252:361-7. [PMID: 12366609 DOI: 10.1046/j.1365-2796.2002.01047.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Autoimmune diseases, especially autoimmune thyroid disease, frequently develop after delivery due to the immune rebound mechanism. Most cases involve transient dysfunction of affected organs. We examined three patients who developed liver dysfunction after delivery. They were all diagnosed with definite or probable autoimmune hepatitis using the scoring system of the International Autoimmune Hepatitis Group. Moreover, all of them had anti-CYP2D6 antibodies detected by a sensitive radioligand assay. Our findings strongly suggest that liver dysfunction is induced by postpartum autoimmune hepatitis, and clinicians should be aware of this disease.
Collapse
Affiliation(s)
- Y Izumi
- Department of Laboratory Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Yamanaka T, Oku K, Koyama H, Mizuno Y. Time-related changes of the cardiovascular system during maintenance anesthesia with sevoflurane and isoflurane in horses. J Vet Med Sci 2001; 63:527-32. [PMID: 11411498 DOI: 10.1292/jvms.63.527] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To clarify time-related changes in equine cardiovascular system during maintenance anesthesia (180 min, 1.2 minimum alveolar concentration) with sevoflurane (Sev-group) compared to isoflurane (Iso-group) as the basis for clinical use of Sev, horses were examined for the heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR) and pre-ejection period (PEP)/ejection time (ET) that is an index of the cardiac contractility. The HR was almost 30 beats/min in both groups without significant temporal change. MAP was significantly elevated with time but there was no significant difference between the groups. In the Sev-group, CI remained unchanged but the significant increase of CI with time was observed in the Iso-group. In the Sev-group SVR was significantly higher than that of the Iso-group and increased with time. No significant difference of PEP/ET was seen between the groups, but PEP/ET lowered with time in the Iso-group in association with prolonged ET. The results indicated that the time-dependent elevation of MAP in the Sev-group reflected increased SVR without increase of CI and that it reflected increased CI resulting from increased stroke volume in the Iso-group in association with lowered PEP/ET, that is, increased cardiac contractility.
Collapse
Affiliation(s)
- T Yamanaka
- Racehorse Clinic, Japan Racing Association Miho Training Center, Ibaraki
| | | | | | | |
Collapse
|
42
|
Abstract
Microscopic polyangiitis (MPA) is associated with renal dysfunction, in most cases, and occasionally with pulmonary hemorrhage. However, massive intestinal bleeding is a rare manifestation. We report a case of MPA in a man who developed arterial bleeding in the small intestine. A 74-year-old man was admitted after enduring a fever for 4 weeks. Laboratory examination revealed leucocytosis with neutrophil predominance, and renal dysfunction was noted. He did not respond to treatment with antibiotics, and the worsened renal function soon required hemodialysis. On the seventh hospital day, he suddenly developed massive melena. A colonoscopic examination suggested bleeding in the small intestine, and abdominal angiography demonstrated that the bleeding originated in a branch of the ileal artery. Hemostasis was achieved by transarterial embolization (TAE), but the patient suffered a massive pulmonary hemorrhage 2 days after the TAE. Although he responded well to a combination treatment with corticosteroid and cyclophosphamide, recurrence of pulmonary hemorrhage led to death, on the 87th hospital day. MPA in this patient was associated with three serious complications; deteriorating renal function, massive melena, and pulmonary hemorrhage. Of the various manifestations associated with MPA, arterial bleeding in the gastrointestinal tract, although rare, should be considered as one of the serious complications in MPA.
Collapse
Affiliation(s)
- S Ueda
- Department of Internal Medicine, Nara Prefectural Gojo Hospital, Japan
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Eighty-five thoroughbred racehorses with various types of fracture were subjected to arthroscopic surgery (44 horses) or internal fixation (41 horses) under sevoflurane anesthesia. The mean end-tidal sevoflurane concentration during anesthesia ranged from 2.5 to 2.8%. PaCO2 was maintained between 50 and 65 mmHg by controlled ventilation. The mean arterial blood pressure was maintained above 65 mmHg by infusion of dobutamine and fluids, however, heart rate significantly increased with time. Recovery from anesthesia was calm and smooth in almost all cases. No apparent complication was observed during and after anesthesia in all cases. Therefore, sevoflurane anesthesia is considered to be safe and useful for orthopedic surgery in racehorses.
Collapse
Affiliation(s)
- M Ohta
- Racehorse Clinic, Japan Racing Association Miho Training Center, Ibaraki-ken
| | | | | | | |
Collapse
|
44
|
Saito Y, Ito M, Ozawa Y, Obonai T, Kobayashi Y, Washizawa K, Ohsone Y, Takami T, Oku K, Takashima S. Changes of neurotransmitters in the brainstem of patients with respiratory-pattern disorders during childhood. Neuropediatrics 1999; 30:133-40. [PMID: 10480208 DOI: 10.1055/s-2007-973478] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined neuropathologically and immunohistochemically the respiratory centers in the brainstem of two patients with Joubert syndrome (JS), three patients with congenital central hypoventilation syndrome (CCHS) and a patient with apneustic breathing (prolonged inspiratory pause) due to unknown etiology. Immunoreactivity (IR) of tryptophan hydroxylase (TPH) was decreased in the dorsal raphe nuclei of two patients with JS compared with age-matched controls, as well as in two patients with Dandy-Walker malformation. The two JS patients showed vermian defect and elongated cerebellar peduncles, and peculiar vascularities in the midline of the whole brainstem were also noted in one of these patients. These findings, as a whole, confirm that the midline structures of brainstem are disordered both structurally and functionally in JS, conceivably resulting in respiratory patterns and psychomotor deficits. IR of serotonin 1A receptor showed no significant changes in the medulla oblongata of these patients, however. In the parabrachial complex, IR of substance P was increased in two patients with CCHS, and one with apneustic breathing. IR of tyrosine hydroxylase was also increased in the latter. The brainstem of these patients showed reactive astrogliosis. These findings suggest preceding hypoxic episodes as well as an increased activity in the parabrachial complex which plays an important role in conducting the driving force to the medullary respiratory neurons from ascending sensory pathways.
Collapse
Affiliation(s)
- Y Saito
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kawamura M, Kimura Y, Takahashi K, Satoh N, Oku K, Adachi T, Nakajima J, Murooka M, Fujiwara T, Hiramori K. Relation of urinary sodium excretion to blood pressure, glucose metabolism, and lipid metabolism in residents of an area of Japan with high sodium intake. Hypertens Res 1997; 20:287-93. [PMID: 9453264 DOI: 10.1291/hypres.20.287] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To evaluate the effects of prolonged intake of a high-sodium diet on glucose and lipid metabolism, we examined the relation of daily urinary sodium excretion to blood pressure, glucose metabolism, and lipid metabolism in 140 Japanese adults who lived in a region where the average daily consumption of sodium was high and stable during the past 15 yr; no subject had received any treatment for hypertension or metabolic disorders. Each subject was admitted to our health examination center for 2 d for measurement of blood pressure, sampling of blood, and glucose tolerance testing. A 24-h urine specimen was collected by each subject after discharge. Multiple regression analysis revealed that urinary sodium excretion was significantly independent of the mean blood pressure and was unrelated to the area under the serum glucose curve after glucose administration. The urinary sodium level was also unrelated to low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The prevalence of hypertension in the group with a daily sodium excretion below 140 mEq (low sodium group) was 0%, while that in the group with a daily sodium excretion above 280 mEq (high sodium group) was 44%; this difference was significant (p < 0.01). No significant difference was observed in the prevalence of metabolic disorders between the two groups. Our results suggest that sodium intake has little influence on glucose and lipid metabolism but has a significant influence on blood pressure in normotensive and untreated hypertensive subjects who reside in an area with a relatively high sodium intake.
Collapse
Affiliation(s)
- M Kawamura
- Second Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Oku K, Utsunomiya T, Mori H, Yamachika S, Yano K. Calculation of mitral valve area in mitral stenosis using the proximal isovelocity surface area method. Comparison with two-dimensional planimetry and Doppler pressure half time method. Jpn Heart J 1997; 38:811-9. [PMID: 9486934 DOI: 10.1536/ihj.38.811] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two-dimensional echocardiographic (2-D) planimetry and the Doppler pressure half-time (PHT) method have been used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS). Recently, the proximal isovelocity surface area (PISA) method has been shown to be accurate for calculating MVA. The purpose of this study was to compare the PISA method with previous methods. Thirty patients with MS were studied; 17 had pure MS, 4 combined mild MR, 6 combined mild AR, and 3 combined MR and AR. Color Doppler flow mapping was performed at an aliasing (blue-red interface) velocity of 14 cm/sec using the zero-baseline shift. MVA was calculated as 2 x 3.14 x R2 x 14 x (theta/180) / PFV, where R is the distance from aliasing to orifice, 14 is the aliasing velocity, theta is the internal angle of the mitral valve, and PFV is the peak flow velocity at the mitral orifice. MVA was also calculated using the 2-D and PHT methods, and compared with the PISA method. MVA calculated using the PISA method correlated well with the 2-D (r=0.90, p < 0.01, SEE = 0.18 cm2) and PHT methods (r=0.82, p < 0.01, SEE = 0.24 cm2). Compared with the 2-D method, the standard error of the estimate of the PISA method was - 0.14+/-0.18 cm2 and the percent error was -10.4+/-18.9%. Compared with the PHT method, the standard error of the estimate of the PISA method was + 0.01+/-0.24 cm2 and the percent error was +3.4+/-34.6%. MVA calculated using the PISA method correlated well with the 2-D and PHT methods in patients with pure MS or with MS combined mild regurgitation. The PISA method may be useful for calculating MVA as an alternative method.
Collapse
Affiliation(s)
- K Oku
- Third Department of Internal Medicine, Nagasaki University, Japan
| | | | | | | | | |
Collapse
|
47
|
Yoshikawa M, Matsui Y, Kawamoto H, Umemoto N, Oku K, Koizumi M, Yamao J, Kuriyama S, Nakano H, Hozumi N, Ishizaka S, Fukui H. Effects of glycyrrhizin on immune-mediated cytotoxicity. J Gastroenterol Hepatol 1997; 12:243-8. [PMID: 9142643 DOI: 10.1111/j.1440-1746.1997.tb00416.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intravenous administration of glycyrrhizin is known to decrease elevated plasma transaminase levels in patients with chronic viral hepatitis, in which immune-mediated cytotoxicity by cytotoxic T lymphocytes and tumour necrosis factor (TNF)-alpha is considered to play an important pathogenic role. However, the immunological interpretation of the transaminase-lowering action of glycyrrhizin is not known. Studies were performed to elucidate this action immunologically by assessing the effects of glycyrrhizin on immune-mediated cytotoxicity using an antigen-specific murine CD4+ T hybridoma line, which exhibits cytotoxicity against antigen-presenting cells after stimulation with specific antigen, and a murine TNF-alpha-sensitive fibroblast line. Glycyrrhizin inhibited the cytotoxic activity of the T cells against antigen-presenting cells and also suppressed TNF-alpha-induced cytotoxicity in the TNF-alpha-sensitive cell line in vitro. These results suggest that the decrease of elevated transaminase levels by glycyrrhizin in patients with chronic viral hepatitis is mediated in part by inhibition of immune-mediated cytotoxicity against hepatocytes.
Collapse
Affiliation(s)
- M Yoshikawa
- Third Department of Internal Medicine, Nara Medical University, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Ono J, Hasegawa T, Sugama S, Sagehashi N, Hase Y, Oku K, Endo Y, Ohdo S, Ishikiriyama S, Tsukamoto H, Okada S. Partial deletion of the long arm of chromosome 11: ten Japanese children. Clin Genet 1996; 50:474-8. [PMID: 9147876 DOI: 10.1111/j.1399-0004.1996.tb02715.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The clinical features of partial deletion 11q were correlated with the size of the deleted region. Ten Japanese children with partial deletion of 11q were investigated. They were divided into three groups. Three patients in the first group had interstitial deletions and preserved subband q24.1. Six patients in the second group demonstrated terminal deletion of 11q including subband q24.1, with typical features of 11q- syndrome (Jacobsen syndrome). The third group included only one patient, who had terminal deletion of 11q without characteristics of typical 11q- syndrome. Prominent features of patients in the first group included severe mental and motor developmental delay, seizures, cleft lip and palate, and ophthalmological findings. Patients in the second group showed mild to moderate developmental delays without deterioration. Abnormalities in neuroimages, high intensity in the cerebral white matter in T2-weighted magnetic resonance (MR) images, and recurrent infections were not observed after the age of 7 years. The subject in the third group, with the smallest amount of deleted chromosome, did not show developmental delays, suggesting that some unknown genes related to developmental delays may be located adjacent to subband q24.1. Variation in the deleted parts of 11q resulted in different clinical features in each group.
Collapse
Affiliation(s)
- J Ono
- Department of Pediatrics, Faculty of Medicine, Osaka University, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Handa K, Takao M, Nomoto J, Oku K, Shirai K, Saku K, Arakawa K. Evaluation of the coagulation and fibrinolytic systems in men with intermittent claudication. Angiology 1996; 47:543-8. [PMID: 8678328 DOI: 10.1177/000331979604700602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors evaluated elements of the coagulation and fibrinolytic systems in 18 male patients with intermittent claudication vs 19 men matched for risk factors who served as controls. Prothrombin time and activated partial thromboplastin time did not significantly differ in the patients and the controls. The plasminogen level in the two groups was not significantly different. The level of lipoprotein(a) was significantly higher in the patients than in the controls. The levels of antigen and the activity of protein C did not differ significantly between the two groups. The thrombomodulin level was significantly higher in the patients than in the controls. There were no significant differences between the two groups in the levels of alpha 2-macroglobulin, C1-inactivator, or antithrombin III. The levels of fibrinogen and alpha 1-antitrypsin were significantly higher in the patients vs the controls. Significantly lower levels of alpha 2-plasmin inhibitor and higher levels of alpha 2-plasmin inhibitor/plasmin complex and thrombin/antithrombin III complex were found in the patients vs the controls. These findings suggest that the levels of thrombin/antithrombin III complex, alpha 2-plasmin inhibitor/plasmin complex, and thrombomodulin may perhaps serve as indicators for injury to the peripheral endothelium and that the coagulation and fibrinolytic systems may be activated in patients with intermittent claudication.
Collapse
Affiliation(s)
- K Handa
- Department of Internal Medicine, School of Medicine, Fukuoka University, Japan
| | | | | | | | | | | | | |
Collapse
|
50
|
Teramoto F, Rokutan K, Kawakami Y, Fujimura Y, Uchida J, Oku K, Oka M, Yoneyama M. Effect of 4G-beta-D-galactosylsucrose (lactosucrose) on fecal microflora in patients with chronic inflammatory bowel disease. J Gastroenterol 1996; 31:33-9. [PMID: 8808426 DOI: 10.1007/bf01211184] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metabolic interaction between the intestinal microflora and the host has been suggested to play a role in the pathogenesis of chronic inflammatory bowel disease. Elemental or low-fat, low-residual diets in patients with Crohn's disease or ulcerative colitis are reported to decrease anaerobic bacteria and to change the composition of the intestinal microflora. We examined the effect of an indigestible agent, 4G-beta-D-galactosylsucrose (lactosucrose), which is selectively utilized by intestinal Bifidobacterium, on the composition of the intestinal microflora. After the administration of lactosucrose to two patients with Crohn's disease and five patients with ulcerative colitis for 2 weeks, significant induction of the growth of Bifidobacterium was observed, and significant reduction in the population level of Bacteroidaceae was seen. Bowel movements improved in four patients. The intestinal environment, estimated by measuring fecal pH, fecal levels of short-chain fatty acids and putrid products, and the urinary secretion of indican, also improved in these patients. These results suggest that lactosucrose may be useful for patients with chronic inflammatory bowel disease.
Collapse
Affiliation(s)
- F Teramoto
- Department of Clinical Nutrition, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | | | | | | | | | | | | | | |
Collapse
|