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Miki M, Miki K, Akiba E, Kagawa H, Oshitani Y, Matsuki T, Tsujino K, Kitada S, Maekura R, Kida H. The diagnostic impact of fractional exhaled nitric oxide for asthmatic cough in nontuberculous mycobacterial pulmonary disease. BMC Pulm Med 2024; 24:210. [PMID: 38684989 PMCID: PMC11059766 DOI: 10.1186/s12890-024-03028-3] [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: 12/20/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Measurement of exhaled nitric oxide (FeNO) is a potentially useful diagnostic test for asthma. However, no study has explored the relationship between FeNO and respiratory symptoms of nontuberculous mycobacterial pulmonary disease (NTM-PD) complicated with asthma. The objective of this study was to assess the utility of measuring FeNO levels in patients with NTM-PD complicated by asthma. METHODS In this single-center retrospective cohort study, 140 NTM-PD patients with FeNO measured were enrolled. We selected NTM-PD patients who complicated with asthma as the NTM+BA group, defined using the following criteria: NTM patients with symptoms consistent with asthma, and NTM patients with symptomatic improvement after diagnostic therapy with ICS ± a long-acting beta 2-agonist (LABA). We then calculated a diagnostic cutoff point to distinguish between the NTM+BA groups and the NTM groups (all others). High-resolution computed tomography (HRCT) images were evaluated using the CT scoring system and their association with FeNO was examined. RESULTS A total of 89 patients were included in the study. (31 in the NTM+BA group and 58 in the NTM group). Compared with the NTM group, the NTM+BA group had higher rates of allergic disease (51.6% vs. 22.4%; p=0.0085) and higher FeNO values (median, 23 [interquartile range {IQR}, 15.0-43.0] ppb vs. median, 17 [IQR, 11.8-23.0] ppb; p=0.015). With diagnostic asthma care using mainly ICS/LABA with reference to the FeNO, most patients (91.0%, 20/22) in the NTM-preceding subgroup in the NTM+BA group demonstrated a prompt improvement of their symptoms and AFB culture findings did not worsen (Culture positive rate (%): Pre-treatment: 59.1% vs. Post-treatment: 40.9%, p=0.3660) at 6 months after starting diagnostic therapy. The optimal diagnostic cutoff point of FeNO to distinguish between the two groups was calculated as 21.5 ppb by the ROC curve (sensitivity 75%, specificity 71.93%, p<0.0001; area under the curve: 0.7989). No significant correlation was observed between FeNO and the severity of CT images in the patients. CONCLUSIONS A certain number of patients with NTM-PD showed exacerbated respiratory symptoms due to asthmatic complications. Elevated FeNO levels suggest asthma complications, even in patients with NTM.
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Affiliation(s)
- Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan.
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, 32 Kotani, Kurosaki, Muya-cho, Naruto-shi, Tokushima, 772-8503, Japan.
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Eri Akiba
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | | | | | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | | | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
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Tateishi Y, Ozeki Y, Nishiyama A, Miki M, Maekura R, Kida H, Matsumoto S. Virulence of Mycobacterium intracellulare clinical strains in a mouse model of lung infection - role of neutrophilic inflammation in disease severity. BMC Microbiol 2023; 23:94. [PMID: 37009882 PMCID: PMC10069106 DOI: 10.1186/s12866-023-02831-y] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Mycobacterium intracellulare is a major etiological agent of Mycobacterium avium-intracellulare pulmonary disease (MAC-PD). However, the characteristics of the virulence of M. intracellulare and the in vivo chemotherapeutic efficacy remain unclear. In this study, we examined the virulence of nine M. intracellulare strains with different clinical phenotypes and genotypes in C57BL/6 mice. RESULTS We classified three types of virulence phenotypes (high, intermediate, and low) based on the kinetics of the bacterial load, histological lung inflammation, and neutrophilic infiltration. High virulence strains showed more severe neutrophilic infiltration in the lungs than intermediate and low virulence strains, with 6.27-fold and 11.0-fold differences of the average percentage of neutrophils in bronchoalveolar lavage fluid, respectively. In particular, the high virulence strain M.i.198 showed the highest mortality in mice, which corresponded to the rapid progression of clinical disease. In mice infected with the drug-sensitive high virulence strain M019, clarithromycin-containing chemotherapy showed the highest efficacy. Monotherapy with rifampicin exacerbated lung inflammation with increased lymphocytic and neutrophilic infiltration into the lungs. CONCLUSIONS The virulence phenotypes of clinical strains of M. intracellulare were diverse, with high virulence strains being associated with neutrophilic infiltration and disease progression in infected mice. These high virulence strains were proposed as a useful subject for in vivo chemotherapeutic experiments.
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Affiliation(s)
- Yoshitaka Tateishi
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Yuriko Ozeki
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Akihito Nishiyama
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Mari Miki
- Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata, 951-8510, Japan
- Laboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga, Surabaya, East Java, Indonesia
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Maekura R, Miki K, Tateishi Y, Matsumoto S, Kitada S, Miki M, Kida H. Long-Term Prognosis and Antimycobacterial Glycolipid Antibody as Biomarker in Mycobacterium avium-intracellulare Complex Pulmonary Disease. Microbiol Spectr 2022; 10:e0053022. [PMID: 35467367 PMCID: PMC9241601 DOI: 10.1128/spectrum.00530-22] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Clinical characteristics and outcomes of multidrug chemotherapy have been used as the main prognostic factors for Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD) over the last decade; however, no useful prognostic biomarkers have been reported. The aim is to ascertain whether the serum antibody titers could include useful prognostic predictors of MAC-PD. Ninety-four patients with MAC-PD were enrolled and regularly followed up with for more than 5 years or until death. Cox proportional hazard regression and receiver operating characteristic (ROC) curve analyses were used to identify predictors of mortality in this prospective observational study. According to treatment outcomes, 85 patients completed follow-up and were classified into four groups. Seventeen patients (20%) died during follow-up (median, 10.1 years; interquartile range, 8.1 to 12.4 years). All 11 patients with MAC-PD-specific death were included in the 14 patients of the group nonresponsive to the multidrug chemotherapy. They had significantly higher anti-Mycobacterium glycolipid (MBGL) antibody titers than those in the other groups and a significantly (P < 0.0001) poorer survival prognosis. The anti-MBGL antibody titers also served as a negative prognostic factor. A cutoff score of 7, which was calculated by clinical poor prognostic characteristics and anti-MBGL antibody titers, differentiated the nonresponse group and the other groups at baseline (sensitivity, specificity, and area under the curve: 92.9%, 81.7%, and 0.95, respectively). In conclusion, anti-MBGL antibody titers were useful to assess the refractory MAC-PD. The predictions of treatment outcome and mortality become more accurate by using anti-MBGL antibody and clinical poor prognostic characteristics together. IMPORTANCE The natural history of MAC-PD is challenging to predict in immunocompetent patients at diagnosis, and the current multidrug chemotherapy options are not strong enough to eliminate mycobacteria from the lungs. Therefore, the diagnosis of MAC-PD does not necessarily lead to the decision to start chemotherapy. We have also observed refractory patients in clinical practice, who were resistant to multiple-drug chemotherapy and showed persistent excretion of MAC bacilli and progressive worsening of chest radiographic findings until death. We have reported that the measurements of anti-MBGL antibody titers helped assess refractory MAC-PD in this study. Furthermore, the predictions of treatment outcome and mortality become more accurate by using the anti-MBGL antibody in addition to clinical poor prognostic characteristics, which were older age, lower body mass index, the positive results of a smear test for acid-fast bacteria (AFB), and presence of cavitary disease.
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Affiliation(s)
- Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
- Graduate School of Medical Safety Management, Jikei University of Health Care Sciences, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Yoshitaka Tateishi
- Department of Bacteriology, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Niigata University Graduate School of Medicine, Niigata, Japan
| | | | - Mari Miki
- Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
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Miyazaki A, Miki K, Maekura R, Tsujino K, Hashimoto H, Miki M, Yanagi H, Koba T, Nii T, Matsuki T, Kida H. Increased Oxygen Extraction by Pulmonary Rehabilitation Improves Exercise Tolerance and Ventilatory Efficiency in Advanced Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11040963. [PMID: 35207235 PMCID: PMC8878603 DOI: 10.3390/jcm11040963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’O2) is calculated using the product of minute ventilation (V’E) and the difference between inspiratory and expiratory O2 concentrations (ΔFO2). However, little is known about the response of ΔFO2 to pulmonary rehabilitation (PR). The aim of the present study was (1) to investigate whether PR increases peak V’O2, based on whether ΔFO2 or V’E at peak exercise increase after PR, and (2) to investigate whether an improvement in ΔFO2 correlates with an improvement in ventilatory efficiency. Methods: A total of 38 patients with severe and very severe COPD, whose PR responses were evaluated by CPET, were retrospectively analyzed. Results: After PR, peak V’O2 was increased in 14 patients. The difference in ΔFO2 at peak exercise following PR correlated with the difference in peak V’O2 (r = 0.4884, p = 0.0019), the difference in V’E/V’CO2-nadir (r = −0.7057, p < 0.0001), and the difference in V’E–V’CO2 slope (r = −0.4578, p = 0.0039), but it did not correlate with the difference in peak V’E. Conclusions: The increased O2 extraction following PR correlated with improved exercise tolerance and ventilatory efficiency. In advanced COPD patients, a new strategy for improving O2 extraction ability might be effective in those in whom ventilatory ability can be only minimally increased.
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Affiliation(s)
- Akito Miyazaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
- Correspondence: ; Tel.: +81-6-6853-2001
| | - Ryoji Maekura
- Graduate School of Health Care Sciences, Jikei Institute, Osaka 532-0003, Japan;
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Mari Miki
- Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Naruto 772-8503, Japan;
| | - Hiromi Yanagi
- Department of Clinical Examination, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan;
| | - Taro Koba
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takuro Nii
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan; (A.M.); (K.T.); (H.H.); (T.K.); (T.N.); (T.M.); (H.K.)
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Miki K, Tsujino K, Maekura R, Matsuki T, Miki M, Hashimoto H, Kagawa H, Kawasaki T, Kuge T, Kida H. Corrigendum: Oxygen Extraction Based on Inspiratory and Expiratory Gas Analysis Identifies Ventilatory Inefficiency in Chronic Obstructive Pulmonary Disease. Front Physiol 2021; 12:770151. [PMID: 34658937 PMCID: PMC8516151 DOI: 10.3389/fphys.2021.770151] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Ryoji Maekura
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hisako Hashimoto
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Takahiro Kawasaki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Tomoki Kuge
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
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Ohara Y, Ozeki Y, Tateishi Y, Mashima T, Arisaka F, Tsunaka Y, Fujiwara Y, Nishiyama A, Yoshida Y, Kitadokoro K, Kobayashi H, Kaneko Y, Nakagawa I, Maekura R, Yamamoto S, Katahira M, Matsumoto S. Correction: Significance of a histone-like protein with its native structure for the diagnosis of asymptomatic tuberculosis. PLoS One 2021; 16:e0256946. [PMID: 34449816 PMCID: PMC8396761 DOI: 10.1371/journal.pone.0256946] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0204160.].
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Tateishi Y, Ozeki Y, Nishiyama A, Miki M, Maekura R, Fukushima Y, Nakajima C, Suzuki Y, Matsumoto S. Comparative genomic analysis of Mycobacterium intracellulare: implications for clinical taxonomic classification in pulmonary Mycobacterium avium-intracellulare complex disease. BMC Microbiol 2021; 21:103. [PMID: 33823816 PMCID: PMC8025370 DOI: 10.1186/s12866-021-02163-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mycobacterium intracellulare is a representative etiological agent of emerging pulmonary M. avium-intracellulare complex disease in the industrialized countries worldwide. The recent genome sequencing of clinical strains isolated from pulmonary M. avium-intracellulare complex disease has provided insight into the genomic characteristics of pathogenic mycobacteria, especially for M. avium; however, the genomic characteristics of M. intracellulare remain to be elucidated. RESULTS In this study, we performed comparative genomic analysis of 55 M. intracellulare and related strains such as M. paraintracellulare (MP), M. indicus pranii (MIP) and M. yonogonense. Based on the average nucleotide identity, the clinical M. intracellulare strains were phylogenetically grouped in two clusters: (1) the typical M. intracellulare (TMI) group, including ATCC13950 and virulent M.i.27 and M.i.198 that we previously reported, and (2) the MP-MIP group. The alignment of the genomic regions was mostly preserved between groups. Plasmids were identified between groups and subgroups, including a plasmid common among some strains of the M.i.27 subgroup. Several genomic regions including those encoding factors involved in lipid metabolism (e.g., fadE3, fadE33), transporters (e.g., mce3), and type VII secretion system (genes of ESX-2 system) were shown to be hypermutated in the clinical strains. M. intracellulare was shown to be pan-genomic at the species and subspecies levels. The mce genes were specific to particular subspecies, suggesting that these genes may be helpful in discriminating virulence phenotypes between subspecies. CONCLUSIONS Our data suggest that genomic diversity among M. intracellulare, M. paraintracellulare, M. indicus pranii and M. yonogonense remains at the subspecies or genovar levels and does not reach the species level. Genetic components such as mce genes revealed by the comparative genomic analysis could be the novel focus for further insight into the mechanism of human pathogenesis for M. intracellulare and related strains.
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Affiliation(s)
- Yoshitaka Tateishi
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
| | - Yuriko Ozeki
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Akihito Nishiyama
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Yukari Fukushima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
- International Collaboration Unit, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
- International Collaboration Unit, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Laboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga, Kampus C Jl. Mulyorejo, Surabaya, Indonesia
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Maekura T, Miki K, Miki M, Kitada S, Maekura R. Clinical Effects Of Acupuncture On The Pathophysiological Mechanism Of Chronic Obstructive Pulmonary Disease During Exercise. Int J Chron Obstruct Pulmon Dis 2019; 14:2787-2798. [PMID: 31827322 PMCID: PMC6902284 DOI: 10.2147/copd.s225694] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Pharmacological therapy and pulmonary rehabilitation are useful for exertional dyspnoea in patients with chronic obstructive pulmonary disease (COPD); however, several patients have no meaningful improvements. Although acupuncture significantly improves exercise intolerance and dyspnoea, the pathophysiological mechanism of these effects is unknown; therefore, we evaluated this mechanism using cardiopulmonary exercise testing in a single-arm, open experimental study. Patients and methods Sixteen patients with COPD underwent acupuncture once a week for 12 weeks. Primary outcomes were exercise performance parameters, including peak oxygen uptake in the incremental exercise tests (IETs) and the time to the limit of tolerance measured in constant work rate exercise tests (CWRETs) at 70% peak work-rate of the IET. IETs and CWRETs were performed at baseline and at weeks 12, 16, and 24. Results During the time course, there were significant increases in peak oxygen uptake (p = 0.018) and minute ventilation (V̇E, p = 0.04) in the IETs. At 12 weeks, the endurance time significantly increased (810 ± 470 vs 1125 ± 657 s, p < 0.001) and oxygen uptakes at terminated exercise were significantly lower (771 ± 149 mL/min, p < 0.05) than those at baseline (822 ± 176 mL/min) in CWRETs. The significant decreases in oxygen uptake and minute ventilation and improvements in Borg scale scores were also observed during CWRETs after acupuncture. The decreases at isotime in the Borg scale (r = −0.789, p = 0.0007) and V̇E (r = −0.6736, p = 0.0042) were significantly correlated with the improvement of endurance time. Conclusion The positive effects of acupuncture on exertional dyspnoea were associated with increased endurance time influenced by improved oxygen utilisation and reduced ventilation during exercise. Acupuncture may be a new intervention for COPD in addition to conventional maintenance therapies.
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Affiliation(s)
- Tomonori Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan.,Course of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan.,Course of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
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Miki K, Kitada S, Miki M, Hui SP, Shrestha R, Yoshimura K, Tsujino K, Kagawa H, Oshitani Y, Kida H, Maekura R, Kangawa K. A phase II, open-label clinical trial on the combination therapy with medium-chain triglycerides and ghrelin in patients with chronic obstructive pulmonary disease. J Physiol Sci 2019; 69:969-979. [PMID: 31595463 PMCID: PMC10716959 DOI: 10.1007/s12576-019-00716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/19/2019] [Indexed: 12/20/2022]
Abstract
The aim of this study was to investigate the effect of activated ghrelin with dietary octanoic acids or medium-chain triglyceride (MCT) administration to underweight patient with chronic obstructive pulmonary disease (COPD). Eleven severe and very severe COPD patients received a 5-day treatment with edible MCT. Sequentially, 10 patients received a 3-week combination treatment with MCT and intravenous acyl ghrelin. Five-day MCT treatment increased endogenous acyl ghrelin (p = 0.0049), but the total ghrelin level was unchanged. MCT-ghrelin combination treatment improved the peak oxygen uptake (p = 0.0120) during whole treatment course. This effect was attributed to the resultant improvements in cardiac function by O2 pulse, and to the difference between inspired and expired oxygen concentration rather than minute ventilation. Addition of dietary MCT to ghrelin treatment improved the aerobic capacity of underweight COPD patients, likely by mechanisms of increased O2 delivery through improvements in primary cardiocirculatory and muscular crosstalk.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan.
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Shu-Ping Hui
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi-5, Sapporo, Japan
| | - Rojeet Shrestha
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi-5, Sapporo, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Hiroshi Kida
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
- Graduate School of Health Care Sciences, Jikei Institute, Miyahara 1-2-8, Yodogawa-ku, Osaka, Japan
| | - Kenji Kangawa
- National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibeshinmachi, Suita, Japan
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10
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Maekura R, Kitada S, Osada-Oka M, Tateishi Y, Ozeki Y, Fujicawa T, Miki M, Jyunnko O, Mori M, Matsumoto S. Serum antibody profiles in individuals with latent Mycobacterium tuberculosis infection. Microbiol Immunol 2019; 63:130-138. [PMID: 30851131 PMCID: PMC6767593 DOI: 10.1111/1348-0421.12674] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/28/2018] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 11/26/2022]
Abstract
One-third of the world's humans has latent tuberculosis infection (LTBI), representing a large pool of potentially active TB. Recent LTBI carries a higher risk of disease progression than remote LTBI. Recent studies suggest important roles of antibodies in TB pathology, prompting us to investigate serum antibody profiles in a cohort with LTBI. In this single-center prospective observational study, we analyzed IgG-antibody concentrations against five major Mycobacterium tuberculosis (Mtb) antigens (including 6 kDa early secretory antigenic target (ESAT6), CFP10, and antigen 85A, which are expressed mainly in the growth phase; and mycobacterial DNA-binding protein 1 (MDP1) and alpha-crystallin like protein (Acr), which are expressed in the dormant phases) in individuals with recent (n=13) or remote (n=12) LTBI, no Mtb infection (n=19), or active TB (n=15). Antibody titers against ESAT6 and MDP1 were significantly higher in individuals with recent LTBI than in those with no Mtb infection or remote LTBI. All pairwise antibody titers against these five major antigens were significantly correlated throughout the stages of Mtb infection. Five individuals with recent LTBI had significantly higher antibody titers against ESAT6 (P = 0.03), Ag85A (P = 0.048), Acr (P = 0.057), and MDP1 (P = 0.0001) than in individuals with remote LTBI; they were also outside the normal range (+2 SDs). One of these individuals was diagnosed with active pulmonary TB at 18-month follow-up examination. These findings indicated that concentrations of antibodies against both multiplying and dormant Mtb are higher in recent LTBI and that individuals with markedly higher antibody titers may be appropriate candidates for prophylactic therapy.
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Affiliation(s)
- Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.,Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Mayuko Osada-Oka
- Food Hygiene and Environmental Health, Division of Applied Life Science, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Yoshitaka Tateishi
- Department of Bacteriology, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Yuriko Ozeki
- Department of Bacteriology, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Takeya Fujicawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Ogawa Jyunnko
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Niigata University Graduate School of Medicine, Niigata, Japan
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11
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Miki M, Yasuoka S, Tsutsumi R, Nakamura Y, Hajime M, Takeuchi Y, Miki K, Kitada S, Maekura R. Human airway trypsin-like protease enhances interleukin-8 synthesis in bronchial epithelial cells by activating protease-activated receptor 2. Arch Biochem Biophys 2019; 664:167-173. [PMID: 30677406 DOI: 10.1016/j.abb.2019.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/31/2018] [Revised: 12/31/2018] [Accepted: 01/16/2019] [Indexed: 11/16/2022]
Abstract
Human airway trypsin-like protease (HAT) localizes at human bronchial epithelial cells (HBECs). HAT enhanced release of interleukin-8 (IL-8) from HBECs at 10-100 mU/mL and the enhanced release was almost completely abolished by 50 μM leupeptin, a serine protease inhibitor. Previous reports suggested that HAT displays its physiological functions via protease-activated receptor 2 (PAR2). In the present study, we examined the mechanism whereby HAT upregulates IL-8 synthesis in HBECs with a focus on PAR2. Northern blot analysis revealed that HAT enhanced IL-8 mRNA expression at concentrations of 10-100 mU/mL. PAR2 activating peptide (PAR2 AP) also enhanced IL-8 release and IL-8 mRNA expression in HBECs at 50-1,000 μM at similar levels as HAT. Knockdown of PAR2 mRNA by siRNA methods showed that PAR2 mRNA expression was significantly depressed in primary HBECs, and both HAT- and PAR2 AP-induced IL-8 mRNA elevation was significantly depressed in PAR2 siRNA-transfected HBECs. Additionally, HAT cleaved the PAR2 activating site (R36-S37 bond) of synthetic PAR2 N-terminal peptide. These results indicate that HAT stimulates IL-8 synthesis in airway epithelial cells via PAR2 and could help to amplify inflammation in chronic respiratory tract disease.
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Affiliation(s)
- Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Osaka, Japan.
| | - Susumu Yasuoka
- Department of Nutrition and Metabolism, University of Tokushima School of Medicine, Tokushima, Japan
| | - Rie Tsutsumi
- Department of Nutrition and Metabolism, University of Tokushima School of Medicine, Tokushima, Japan
| | - Yoichi Nakamura
- Medical Center for Allergic and Immune Diseases, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Maeda Hajime
- Department of Thoracic Surgery, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Yukiyasu Takeuchi
- Department of Thoracic Surgery, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Ryoji Maekura
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
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12
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Ohara Y, Ozeki Y, Tateishi Y, Mashima T, Arisaka F, Tsunaka Y, Fujiwara Y, Nishiyama A, Yoshida Y, Kitadokoro K, Kobayashi H, Kaneko Y, Nakagawa I, Maekura R, Yamamoto S, Katahira M, Matsumoto S. Significance of a histone-like protein with its native structure for the diagnosis of asymptomatic tuberculosis. PLoS One 2018; 13:e0204160. [PMID: 30359374 PMCID: PMC6201868 DOI: 10.1371/journal.pone.0204160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/25/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis causes the highest mortality among all single infections. Asymptomatic tuberculosis, afflicting one third of the global human population, is the major source as 5–10% of asymptomatic cases develop active tuberculosis during their lifetime. Thus it is one of important issues to develop diagnostic tools for accurately detecting asymptomatic infection. Mycobacterial DNA-binding protein 1 (MDP1) is a major protein in persistent Mycobacterium tuberculosis and has potential for diagnostic use in detecting asymptomatic infection. However, a previous ELISA-based study revealed a specificity problem; IgGs against MDP1 were detected in both M. tuberculosis-infected and uninfected individuals. Although the tertiary structures of an antigen are known to influence antibody recognition, the MDP1 structural details have not yet been investigated. The N-terminal half of MDP1, homologous to bacterial histone-like protein HU, is predicted to be responsible for DNA-binding, while the C-terminal half is assumed as totally intrinsically disordered regions. To clarify the relationship between the MDP1 tertiary structure and IgG recognition, we refined the purification method, which allow us to obtain a recombinant protein with the predicted structure. Furthermore, we showed that an IgG-ELISA using MDP1 purified by our refined method is indeed useful in the detection of asymptomatic tuberculosis.
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Affiliation(s)
- Yukiko Ohara
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
- Department of Microbiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
- * E-mail: (YOh); (YOz); (SM)
| | - Yuriko Ozeki
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
- * E-mail: (YOh); (YOz); (SM)
| | - Yoshitaka Tateishi
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
| | - Tsukasa Mashima
- Graduate School of Energy Science, Kyoto University, Gokasho, Uji, Kyoto, Japan
| | - Fumio Arisaka
- College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, Japan
| | - Yasuo Tsunaka
- Graduate School of Medical Life Science, Yokohama City University, 1-7-29 Suehiro-cho, Tsurumi-ku, Yokohama, Japan
| | - Yoshie Fujiwara
- Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto, Japan
| | - Akihito Nishiyama
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
| | - Yutaka Yoshida
- Department of Structural Pathology, Institute of Nephrology, Graduate School of Medicine, Niigata University, Niigata, Japan
| | - Kengo Kitadokoro
- Graduate School of Science and Technology, Department of Biomolecular Engineering, Kyoto Institute of Technology, Matsugasakigosyokaido-cho, Sakyo-ku, Kyoto, Japan
| | - Haruka Kobayashi
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
| | - Yukihiro Kaneko
- Department of Bacteriology and Virology, Osaka-City University Graduate School of Medicine, Osaka, Japan
| | - Ichiro Nakagawa
- Department of Microbiology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, Japan
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Saburo Yamamoto
- Central Laboratory, Japan BCG Laboratory, Kiyose-shi, Tokyo, Japan
| | - Masato Katahira
- Graduate School of Energy Science, Kyoto University, Gokasho, Uji, Kyoto, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Niigata University School of Medicine, Niigata, Japan
- * E-mail: (YOh); (YOz); (SM)
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13
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Kagawa H, Miki K, Kitada S, Miki M, Yoshimura K, Oshitani Y, Nishida K, Sawa N, Tsujino K, Maekura R. Dyspnea and the Varying Pathophysiologic Manifestations of Chronic Obstructive Pulmonary Disease Evaluated by Cardiopulmonary Exercise Testing With Arterial Blood Analysis. Front Physiol 2018; 9:1293. [PMID: 30333757 PMCID: PMC6176099 DOI: 10.3389/fphys.2018.01293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/24/2018] [Accepted: 08/27/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) show varying mechanisms of exertional dyspnea with different exercise capacities. Methods: To investigate the pathophysiologic conditions related to exertional dyspnea, 294 COPD patients were evaluated using cardiopulmonary exercise testing (CPET) with arterial blood analyses, with the patients classified into two groups according to their exercise limitation: the leg fatigue group (n = 58) and the dyspnea group (n = 215). The dyspnea group was further subdivided into four groups based on peak oxygen uptake ( V ° O 2 in mL/min/kg): group A (< 11), group B (11 to < 15), group C (15 to < 21), and group D (≥21). Results: In the dyspnea group, group A (n = 28) showed the following findings: (i) the forced expiratory volume in 1 s was not correlated with the peak V ° O 2 (p = 0.288), (ii) the arterial oxygen tension (PaO2) slope (peak minus resting PaO2/Δ V ° O 2 ) was the steepest (p < 0.0001) among all subgroups, (iii) reduced tidal volume (VT) was negatively correlated with respiratory frequency at peak exercise (p < 0.0001), and (iv) a break point in exertional VT curve was determined in 17 (61%) patients in group A. In these patients, there was a significant negative correlation between bicarbonate ion ( HCO 3 - ) levels at peak exercise and VT level when the VT-break point occurred (p = 0.032). In group D (n = 46), HCO 3 - levels were negatively correlated with plasma lactate levels (p < 0.0001). In all subgroups, the HCO 3 - level was negatively correlated with minute ventilation. The dyspnea subgroups showed no significant differences in the overall mean pH [7.363 (SD 0.039)] and Borg scale scores [7.4 (SD, 2.3)] at peak exercise. Conclusions: During exercise, ventilation is stimulated to avoid arterial blood acidosis and hypoxemia, but ventilatory stimulation is restricted in the setting of reduced respiratory system ability. These conditions provoke the exertional dyspnea in COPD. Although symptom levels were similar, the exertional pathophysiologic conditions differed according to residual exercise performance; moreover, COPD patients showed great inter-individual variability. An adequate understanding of individual pathophysiologic conditions using CPET is essential for proper management of COPD patients.
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Affiliation(s)
- Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kohei Nishida
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Nobuhiko Sawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka,Japan.,Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
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14
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Miki K, Tsujino K, Edahiro R, Kitada S, Miki M, Yoshimura K, Kagawa H, Oshitani Y, Ohara Y, Hosono Y, Kurebe H, Maekura R. Exercise tolerance and balance of inspiratory-to-expiratory muscle strength in relation to breathing timing in patients with chronic obstructive pulmonary disease. J Breath Res 2018; 12:036008. [PMID: 29321341 DOI: 10.1088/1752-7163/aaa6db] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
RATIONALE Little is known about the applicability of respiratory muscle training based on exertional pathophysiological conditions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between breathing timing and exertional responses, as well as whether exertional changes in the inspiratory duty cycle (Ti/Ttot) affect pathophysiological conditions, including respiratory muscles. METHODS Forty-five stable COPD patients (mean age: 71.2 years, severe and very severe COPD: 80%) were evaluated based on exertional cardiopulmonary function and respiratory muscle strength. To compare exertional responses and the balance of inspiratory-to-expiratory muscle strength, the patients were divided into two groups according to whether the Ti/Ttot increased (Ti/Ttot-increased group: resting Ti/Ttot ≤ peak Ti/Ttot, n = 21) or decreased during exercise (Ti/Ttot-decreased group: resting Ti/Ttot > peak Ti/Ttot, n = 24). RESULTS At peak exercise, the Ti/Ttot was positively correlated with minute ventilation ([Formula: see text] E), and oxygen uptake ([Formula: see text]) in all patients. No significant differences were seen in breathing frequency, tidal volume, or [Formula: see text] E at peak exercise between the two groups. Compared with the Ti/Ttot-increased group, the Ti/Ttot-decreased group had significantly lower mean values of [Formula: see text] and ΔFO2 (the inspired minus expired oxygen concentration) at peak exercise, and significantly higher mean values of the absolute ratio of maximal inspiratory pressure/maximal expiratory pressure. CONCLUSIONS The exertional change of breathing timing affected exercise tolerance and the balance of inspiratory-to-expiratory muscle strength; this finding might be helpful in making the contradictory choice of managing COPD patients with inspiratory or expiratory muscle training.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan
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15
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Ose N, Maeda H, Takeuchi Y, Susaki Y, Kobori Y, Taniguchi S, Maekura R. Solitary pulmonary nodules due to non-tuberculous mycobacteriosis among 28 resected cases. Int J Tuberc Lung Dis 2018; 20:1125-9. [PMID: 27393550 DOI: 10.5588/ijtld.15.0819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In some patients, non-tuberculous mycobacteria (NTM) infections manifest in solitary nodules (solitary nodular [SN] type) generally caused by Mycobacterium avium complex (MAC). In patients treated using surgical resection, the American Thoracic Society guidelines state that postoperative chemotherapy is not necessary in the absence of lesions, although there have been a few reports of such cases. METHODS Twenty-eight patients diagnosed with NTM who underwent solitary pulmonary nodule resection at Toneyama Hospital, Osaka, Japan, between January 2000 and October 2012 were enrolled. We evaluated the influence of the surgical procedure and chemotherapy on outcomes in this retrospective study. RESULTS Of the 28 patients, 12 were males and 16 were females; the mean age was 58.6 ± 13.2 years. Twenty-five patients were asymptomatic and bronchoscopy was performed in 18; only 2 had a definitive diagnosis of NTM. The pathogen responsible was MAC in 27 patients and M. kansasii in 1. The surgical procedure used was wedge resection in 22 patients, segmentectomy in 1 and lobectomy in 5. Postoperative chemotherapy was administered to 9 patients. Twenty-six patients had no recurrence. CONCLUSION We believe that wedge resection is a valid surgical intervention for SN type NTM; additional postoperative chemotherapy is unnecessary in cases with no residual lesions in the operated lung lobe.
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Affiliation(s)
- N Ose
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - H Maeda
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - Y Takeuchi
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - Y Susaki
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - Y Kobori
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - S Taniguchi
- Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan
| | - R Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital, Osaka, Japan
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16
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Miki K, Maekura R, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Kagawa H, Oshitani Y, Satomi A, Nishida K, Sawa N, Inoue K. Pulmonary rehabilitation for COPD improves exercise time rather than exercise tolerance: effects and mechanisms. Int J Chron Obstruct Pulmon Dis 2017; 12:1061-1070. [PMID: 28435239 PMCID: PMC5388245 DOI: 10.2147/copd.s131061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND COPD patients undergoing pulmonary rehabilitation (PR) show various responses. The purpose of this study was to investigate the possible mechanisms and predictors of the response to PR in COPD patients. METHODS Thirty-six stable COPD patients underwent PR including a 4-week high-intensity exercise training program, and they were evaluated by cardiopulmonary exercise testing. All patients (mean age 69 years, severe and very severe COPD 94%) were classified into four groups by whether the exercise time (Tex) or the peak oxygen uptake [Formula: see text] increased after PR: two factors increased (both the Tex and the peak [Formula: see text] increased); two factors decreased; time only increased (the Tex increased, but the peak [Formula: see text] economized); and [Formula: see text] only increased (the Tex decreased, but the peak [Formula: see text] increased). Within all patients, the relationships between baseline variables and the post-to-pre-change ratio of the time-slope, Tex/(peak minus resting [Formula: see text]), were investigated. RESULTS Compared with the two factors increased group (n=11), in the time only increased group (n=18), the mean differences from pre-PR at peak exercise in 1) minute ventilation [Formula: see text] (P=0.004), [Formula: see text] (P<0.0001), and carbon dioxide output [Formula: see text] (P<0.0001) were lower, 2) [Formula: see text]/ [Formula: see text] (P=0.034) and [Formula: see text]/ [Formula: see text] (P=0.006) were higher, and 3) the dead space/tidal volume ratio (VD/VT) and the dyspnea level were similar. After PR, there was no significant difference in the ratio of the observed peak heart rate (HR) to the predicted peak HR (220 - age [years]) between the two groups. A significant negative correlation with the baseline time-slope (r=-0.496, P=0.002) and a positive correlation with the baseline body mass index (BMI) (r=0.496, P=0.002) were obtained. CONCLUSIONS PR in COPD patients improves Tex rather than exercise tolerance, economizing oxygen requirements, resulting in reduced ventilatory requirements without cardiac loads followed by reduced exertional dyspnea. In addition, the time-slope and BMI could be used to predict PR responses beforehand.
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Affiliation(s)
| | | | | | | | | | - Hiroshi Yamamoto
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | - Toshiko Kawabe
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
| | | | | | | | | | | | - Kimiko Inoue
- Department of Rehabilitation Medicine, National Hospital Organization, Toneyama National Hospital, Toyonaka, Japan
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17
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Miki K, Maekura R. [Nutrition management for COPD]. Nihon Rinsho 2016; 74:801-806. [PMID: 27254950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory reaction of the lung and of the whole body, and pulmonary cachexia often occurs during the advanced stage. The effects of nutritional support upon the management of under-nutrition in COPD remain controversial. However, a study of the effects of nutritional supplement therapy upon such patients with COPD has recently been published. The present report comprises a review of recent articles about the nutritional support of patients with COPD, especially those with cachexia, and a discussion about the roles of nutritional supplement therapy, focusing on exercise and treatment with ghrelin and vitamin D in the management of COPD.
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18
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Oga T, Taniguchi H, Kita H, Tsuboi T, Tomii K, Ando M, Kojima E, Tomioka H, Taguchi Y, Kaji Y, Maekura R, Hiraga T, Sakai N, Kimura T, Mishima M, Chin K. Analysis of the relationship between health status and mortality in hypercapnic patients with noninvasive ventilation. Clin Respir J 2015; 11:772-780. [PMID: 26605994 DOI: 10.1111/crj.12415] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 09/13/2015] [Accepted: 11/13/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Toru Oga
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Hideo Kita
- Department of Respiratory Medicine; Takatsuki Red Cross Hospital; Osaka Japan
| | - Tomomasa Tsuboi
- Department of Respiratory Medicine; National Hospital Organization Minami-Kyoto Hospital; Kyoto Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine; Kobe City Medical Center General Hospital; Hyogo Japan
| | - Morihide Ando
- Department of Pulmonary Medicine; Ogaki Municipal Hospital; Gifu Japan
| | - Eiji Kojima
- Department of Respiratory Medicine; Komaki City Hospital; Aichi Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine; Kobe City Medical Center West Hospital; Hyogo Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine; Tenri Hospital; Nara Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Toru Hiraga
- Department of Respiratory Medicine; National Hospital Organization Toneyama Hospital; Osaka Japan
| | - Naoki Sakai
- Department of Respiratory Medicine; Otsu Red Cross Hospital; Shiga Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy; Tosei General Hospital; Aichi Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine, Kyoto University; Kyoto Japan
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19
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Kuroyama M, Kagawa H, Kitada S, Maekura R, Mori M, Hirano H. Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases. BMC Pulm Med 2015; 15:135. [PMID: 26518258 PMCID: PMC4628246 DOI: 10.1186/s12890-015-0134-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exogenous lipoid pneumonia is a rare disease caused by aspiration or inhalation of oily substances. CASE PRESENTATION A 66-year-old male with dry cough (Case 1) and a 38-year-old female with shortness of breath (Case 2) demonstrated ground-glass opacities on chest computed tomography and were diagnosed with lipoid pneumonia based on the confirmation of lipid-laden alveolar macrophages. Both patients habitually performed sesame oil pulling via nasal or mouth washing for several months prior to the diagnosis. CONCLUSION Steroid therapy and bronchoalveolar lavage resulted in improvement in Case 1, and no intensive therapy was required for Case 2. Sesame oil pulling has been rarely been reported to cause lipoid pneumonia.
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Affiliation(s)
- Muneyoshi Kuroyama
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toneyama, 5-1-1, Toyonaka, Osaka, 560-8552, Japan. .,Department of Respiratory Medicine, Allergy, and Rheumatic Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toneyama, 5-1-1, Toyonaka, Osaka, 560-8552, Japan.
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toneyama, 5-1-1, Toyonaka, Osaka, 560-8552, Japan.
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toneyama, 5-1-1, Toyonaka, Osaka, 560-8552, Japan.
| | - Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toneyama, 5-1-1, Toyonaka, Osaka, 560-8552, Japan.
| | - Hiroshi Hirano
- Department of Pathology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.
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Kitada S, Yoshimura K, Miki K, Miki M, Hashimoto H, Matsui H, Kuroyama M, Ageshio F, Kagawa H, Mori M, Maekura R, Kobayashi K. Validation of a commercial serodiagnostic kit for diagnosing pulmonary Mycobacterium avium complex disease. Int J Tuberc Lung Dis 2015; 19:97-103. [PMID: 25519798 DOI: 10.5588/ijtld.14.0564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A commercial serodiagnostic kit for diagnosing pulmonary disease due to Mycobacterium avium complex (MAC-PD) was developed and launched in Japan in 2011. OBJECTIVE To evaluate the performance of this kit in routine clinical settings. METHODS In this retrospective single-centre study, data on serum levels of anti-glycopeptidolipid (GPL) core IgA antibody (U/ml) measured using the kit were analysed in patients diagnosed with MAC-PD according to American Thoracic Society criteria, in those with pulmonary tuberculosis (PTB) or pulmonary M. kansasii disease and in healthy volunteers. RESULTS The anti-GPL-core IgA antibody levels of serum were significantly higher (P < 0.0001) in patients with MAC-PD (n = 485) than in those with PTB (n = 133) or pulmonary M. kansasii disease (n = 23) or in healthy subjects (n = 265). When the cut-off level was set at 0.7 U/ml, the sensitivity and specificity were respectively 78.6% and 96.9%. Higher antibody levels were observed in patients with greater extent of disease on chest computed tomography (P < 0.0001). CONCLUSIONS The serodiagnostic kit revealed good sensitivity and specificity. The antibody levels may reflect disease activity. Additional work is needed to determine whether the diagnostic assay could be used in conjunction with current diagnostic criteria to improve the diagnosis of MAC-PD.
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Affiliation(s)
- S Kitada
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - K Yoshimura
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - K Miki
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - M Miki
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - H Hashimoto
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - H Matsui
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - M Kuroyama
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - F Ageshio
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - H Kagawa
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - M Mori
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - R Maekura
- Department of Respiratory Medicine, National Hospital Organization, National Toneyama Hospital, Osaka, Japan
| | - K Kobayashi
- Sakai City Institute of Public Health, Osaka, Japan
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Miki K, Maekura R, Nakazato M, Matsumoto N, Kitada S, Miki M, Yoshimura K, Mori M, Kangawa K. Randomized, dose-finding trial of ghrelin treatment for chronic respiratory failure. Clin Respir J 2015; 11:496-505. [PMID: 26260705 DOI: 10.1111/crj.12364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/07/2015] [Accepted: 08/03/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Ghrelin, a growth hormone-releasing peptide, has shown efficacy in chronic obstructive pulmonary disease (COPD) patients in previous trials. This study was designed to evaluate the effective dose of ghrelin in chronic respiratory failure patients. METHODS In this randomized, double-blind, dose-finding, single-center study, 18 patients, including 16 with COPD, were randomly assigned to receive pulmonary rehabilitation (PR) with intravenous ghrelin at 1 μg/kg or 2 μg/kg, twice daily for 3 weeks. The primary outcome was the change in peak oxygen uptake ( V˙o2). Secondary outcomes included changes in plasma vascular endothelial growth factor (VEGF)-A levels, and exertional cardio-respiratory functions with blood gas analysis. RESULTS With incremental exercise, there was no significant differences in the mean difference (high-dose ghrelin minus low-dose ghrelin) of peak V˙o2 (1.0 mL/kg/min, 95% CI: -0.6 to 2.6 mL/kg/min, between-group, P = 0.193). However, there were significant differences in the mean difference of (i) O2 -pulse (0.6 mL/beats, 95% CI: 0.0 to 1.1 mL/beats, between-group, P = 0.035) at iso-time; and ii) PaO2 (4.2 mmHg, 95% CI: 0.2 to 8.2 mmHg, between-group, P = 0.041) and PaCO2 (-3.1 mmHg, 95% CI: -6.0 to -0.3 mmHg, between-group, P = 0.034) at peak exercise. The mean difference in the plasma VEGF-A level was significantly inhibited by high dose-ghrelin with PR (-125.4 pg/mL, 95% CI: -235.2 to -15.5 pg/mL, between-group, P = 0.028). CONCLUSION Although the primary outcome of the study was not met, high-dose ghrelin with PR improved exertional cardiac function and blood gas values, and inhibited circulating VEGF-A levels.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Masamitsu Nakazato
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuhiro Matsumoto
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Kenji Kangawa
- Department of Biochemistry, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
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Maekura R, Hiraga T, Miki K, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Mori M. Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1787-800. [PMID: 26366071 PMCID: PMC4562755 DOI: 10.2147/copd.s86455] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Indexed: 11/23/2022] Open
Abstract
Take-home summary Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD. Purpose We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities. Patients and methods The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan–Meier analyses. Results In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172–0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296–0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved. Conclusion The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.
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Affiliation(s)
- Ryoji Maekura
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Toru Hiraga
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Mari Miki
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Hiroshi Yamamoto
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Toshiko Kawabe
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
| | - Masahide Mori
- Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
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Mori M, Ageshio F, Kagawa H, Oshitani Y, Fujikawa T, Saito H, Sako H, Yano Y, Kitada S, Maekura R. [THE GENETIC EXAMINATION OF BRONCHIAL LAVAGE ENABLES THE PROMPT DIAGNOSIS OF PULMONARY MYCOBACTERIUM KANSASII--A CASE REPORT]. Kekkaku 2015; 90:619-623. [PMID: 26665518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 59-year-old man with chronic obstructive pulmonary disease and bronchial asthma presented at our hospital with an abnormal shadow on the chest radiograph, which was obtained as part of a routine medical examination. Computed tomography of the chest revealed two nodules in the right upper lung with the longest diameter measuring 29 mm and 10 mm, respectively. A granulomatous disease was strongly suspected based on the histological features of the transbronchial lung biopsy specimen. Results of smear examination for mycobacteria and genetic examination of the bronchial lavage aspirate by the transcription reverse transcription concerted (TRC) reaction method for Mycobacterium tuberculosis and M. avium complex (MAC), were both negative. However, three days after the bronchoscopic examination, an additional genetic examination by the TRC method confirmed the diagnosis of M. kansasii infection. About two weeks later, the culture results were positive and M. kansasii infection was re-confirmed with the DNA probe method. The patient responded well to treatment with a combination of isoniazid, rifampicin, and ethambutol. In Japan, among the nontuberculous mycobacterial infections, the prevalence of pulmonary M.kansasii disease is second only to infection with MAC. However, it is often difficult to distinguish this disease from pulmonary tuberculosis. In this patient, a genetic examination with the TRC method enabled a prompt diagnosis of M. kansasii infection. The TRC method appears to be a useful tool for diagnosing nontubercular mycobacterial infections.
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Miki K, Maekura R, Nagaya N, Miki M, Kitada S, Yoshimura K, Mori M, Kangawa K. Effects of ghrelin treatment on exertional dyspnea in COPD: an exploratory analysis. J Physiol Sci 2015; 65:277-84. [PMID: 25724656 PMCID: PMC10717273 DOI: 10.1007/s12576-015-0366-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/05/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
A substudy of ghrelin treatment in a multicenter trial previously revealed that administration of ghrelin improves the exercise capacity of underweight COPD patients. To clarify exertional dyspnea more precisely, exploratory analysis was conducted on data from the substudy. Of 20 underweight COPD patients who were randomized to pulmonary rehabilitation with intravenous ghrelin (2 μg/kg, n = 10) or placebo (n = 10) twice daily for 3 weeks in the substudy, 16 (ghrelin = 9, placebo = 7) could be investigated for dyspnea break-point on the dyspnea-ratio (%) of Δoxygen uptake ([Formula: see text]) (= peak minus resting [Formula: see text]) curve. A significant treatment effect of ghrelin on percentage [Formula: see text] at the dyspnea break-point to Δ[Formula: see text] (p = 0.049) was achieved. In conclusion, underweight COPD patients benefitted from ghrelin treatment in terms of shifts to the early exercise phase of the dyspnea break-point during a standardized exercise program.
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Affiliation(s)
- Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, 560-8552, Japan,
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Matsumoto N, Miki K, Tsubouchi H, Sakamoto A, Arimura Y, Yanagi S, Iiboshi H, Yoshida M, Souma R, Ishimoto H, Yamamoto Y, Yatera K, Yoshikawa M, Sagara H, Iwanaga T, Mukae H, Maekura R, Kimura H, Nakazato M, Kangawa K. Ghrelin administration for chronic respiratory failure: a randomized dose-comparison trial. Lung 2015; 193:239-47. [PMID: 25634352 DOI: 10.1007/s00408-015-9685-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Repeated ghrelin administration leads to improvements in symptoms, muscle wasting and exercise tolerance in cachectic patients with pulmonary disease. We investigated the optimal ghrelin dose for underweight patients with chronic respiratory failure. METHODS In this multicenter, randomized, dose-comparison exploratory study, 44 cachectic patients with chronic respiratory failure were randomly assigned pulmonary rehabilitation with intravenous twice-daily administration of 1 or 2 μg/kg ghrelin for 3 weeks. The primary endpoint was improvement in 6-min walking distance (6 MWD). The secondary endpoint was change in peak VO2. RESULTS Twenty-one patients were assigned to the 1 μg/kg ghrelin group and 23 to the 2 μg/kg ghrelin group. Change from baseline 6 MWD after treatment was similar between groups(1 μg/kg: 53.9 m, 2 μg/kg: 53.9 m, p = 0.99). Mean change in peak VO2 was significantly greater in the 2 μg/kg group (63.1 ml/min) than in the 1 μg/kg group (-63.8 ml/min, p = 0.048). Food intake and lean body mass significantly increased in both groups, and the St. George Respiratory Questionnaire score, body weight, and body mass index were remarkably improved in only the 2 μg/kg group, although there was no significant difference between groups. No treatment-related serious events were reported for either group. CONCLUSION Improvements in the oxygen uptake capacity were greater in patients receiving 2 μg/kg ghrelin twice daily for 3 weeks than in those receiving 1 μg/kg, although exercise tolerance was similar between groups at the end of the 3-week treatment period. Thus, a twice daily dose of 2 μg/kg ghrelin is recommended over 1 μg/kg ghrelin for patients with chronic respiratory failure and weight loss.
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Affiliation(s)
- Nobuhiro Matsumoto
- Neurology, Respirology, Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan,
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Yoshimura K, Maekura R, Hiraga T, Miki K, Kitada S, Miki M, Tateishi Y, Mori M. Identification of three exercise-induced mortality risk factors in patients with COPD. COPD 2014; 11:615-26. [PMID: 24914923 DOI: 10.3109/15412555.2014.898038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/13/2022]
Abstract
The survival rate of chronic obstructive pulmonary disease (COPD) patients with severely reduced exercise capacity is extremely low. We recently identified three life-threatening pathophysiological conditions during cardiopulmonary exercise testing (CPET): (1) exercise-induced hypoxemia, (2) sympathetic overactivity, and (3) progressive respiratory acidosis at low-intensity exercise. The present prospective observation study aimed to determine whether these parameters constitute risk factors of mortality in moderate-to-very severe COPD. Ninety-six COPD patients were followed-up, monthly, for >3 years. Subsequently, spirometry and CPET were performed to examine parameters of exercise-induced hypoxemia ([PaO2 slope, mmHg/L · min(-1)] = Decrease in PaO2/ΔV˙ O2 (Difference in ΔV˙ O2 between at rest and at peak exercise)), progression of acidosis ([ΔpH/ΔV˙ O2,/L · min(-1)] = Decrease in pH/ΔV˙ O2), and sympathetic overactivity ([Δnorepinephrine (NE)/ΔV˙ O2, ng/mL/L · min(-1)] = Increase in NE/ΔV˙ O2). Univariate analysis revealed a significant association between the three conditions with increased mortality. Kaplan-Meier analysis showed that the quartile combining the steepest PaO2 slope (≤-55 mmHg/ΔV˙ O2 [L/min]), steepest decrease in arterial blood pH (≤ -1.72/ΔV˙ O2 [L/min]), and most rapid increase in plasma NE level (≥ 5.2 ng/VO2 [L/min]) during incremental exercise was associated with higher all-cause mortality. These conditions showed cumulative effects on COPD patients' survival. Multivariate analyses revealed that these three life-threatening factors are also independent predictors of mortality based on age, heart rate and PaO2 at rest, body mass index, and forced expiratory volume in 1 s. Thus, these new exercise-induced mortality risk factors may lead to more efficient pulmonary rehabilitation programs for COPD patients based on patient-specific exercise-induced pathophysiological profiles.
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Affiliation(s)
- Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital , Toyonaka-city, Osaka , Japan
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Nishiuchi Y, Tamaru A, Suzuki Y, Kitada S, Maekura R, Tateishi Y, Niki M, Ogura H, Matsumoto S. Direct detection of Mycobacterium avium in environmental water and scale samples by loop-mediated isothermal amplification. J Water Health 2014; 12:211-219. [PMID: 24937215 DOI: 10.2166/wh.2013.007] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We previously demonstrated the colonization of Mycobacterium avium complex in bathrooms by the conventional culture method. In the present study, we aimed to directly detect M. avium organisms in the environment using loop-mediated isothermal amplification (LAMP), and to demonstrate the efficacy of LAMP by comparing the results with those obtained by culture. Our data showed that LAMP analysis has detection limits of 100 fg DNA/reaction for M. avium. Using an FTA(®) elute card, DNA templates were extracted from environmental samples from bathrooms in the residences of 29 patients with pulmonary M. avium disease. Of the 162 environmental samples examined, 143 (88%) showed identical results by both methods; 20 (12%) and 123 (76%) samples were positive and negative, respectively, for M. avium. Of the remaining 19 samples (12%), seven (5%) and 12 (7%) samples were positive by the LAMP and culture methods, respectively. All samples that contained over 20 colony forming units/primary isolation plate, as measured by the culture method, were also positive by the LAMP method. Our data demonstrate that the combination of the FTA elute card and LAMP can facilitate prompt detection of M. avium in the environment.
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Affiliation(s)
- Yukiko Nishiuchi
- Toneyama Institute for Tuberculosis Research, Osaka City University Medical School, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan E-mail:
| | - Aki Tamaru
- Department of Infectious Diseases, The Osaka Prefectural Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka 537-0025, Japan
| | - Yasuhiko Suzuki
- Research Center for Zoonosis Control, Hokkaido University, North 20, West 10 Kita-ku, Sapporo, Hokkaido 001-0020, Japan
| | - Seigo Kitada
- National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan
| | - Ryoji Maekura
- National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan
| | - Yoshitaka Tateishi
- National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan; Department of Bacteriology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Mamiko Niki
- Department of Bacteriology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Hisashi Ogura
- Department of Virology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Yano Y, Kitada S, Mori M, Yokota S, Maekura R. Monotherapy With Erythromycin for Mycobacterium avium Complex Pulmonary Disease. Chest 2014. [DOI: 10.1378/chest.1787848] [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: 11/01/2022] Open
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Osada-Oka M, Tateishi Y, Hirayama Y, Ozeki Y, Niki M, Kitada S, Maekura R, Tsujimura K, Koide Y, Ohara N, Yamamoto T, Kobayashi K, Matsumoto S. Antigen 85A and mycobacterial DNA-binding protein 1 are targets of immunoglobulin G in individuals with past tuberculosis. Microbiol Immunol 2013; 57:30-7. [PMID: 23157580 DOI: 10.1111/j.1348-0421.2012.12005.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/19/2012] [Accepted: 11/02/2012] [Indexed: 12/01/2022]
Abstract
Development of accurate methods for predicting progression of tuberculosis (TB) from the latent state is recognized as vitally important in controlling TB, because a majority of cases develop from latent infections. Past TB that has never been treated has a higher risk of progressing than does latent Mycobacterium tuberculosis infection in patients who have previously received treatment. Antibody responses against 23 kinds of M. tuberculosis proteins in individuals with past TB who had not been medicated were evaluated. These individuals had significantly higher concentrations of antibodies against Antigen 85A and mycobacterial DNA-binding protein 1 (MDP1) than did those with active TB and uninfected controls. In addition, immunohistochemistry revealed colocalization of tubercle bacilli, antigen 85 and MDP1 inside tuberculous granuloma lesions in an asymptomatic subject, showing that M. tuberculosis in lesions expresses both antigen 85 and MDP1. Our study suggests the potential usefulness of measuring antibody responses to antigen 85A and MDP1 for assessing the risk of TB progression.
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Affiliation(s)
- Mayuko Osada-Oka
- Department of Bacteriology, Osaka City University Graduate School of Medicine, 1-4-3 Abeno-ku, Osaka 545-8585, Japan
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Maekura R, Hiraga T, Miki K, Kitada S, Yoshimura K, Miki M, Tateishi Y. Differences in physiological response to exercise in patients with different COPD severity. Respir Care 2013; 59:252-62. [PMID: 23821762 DOI: 10.4187/respcare.02201] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with COPD have reduced exercise tolerance associated with dyspnea. This exercise intolerance is primarily due to impaired ventilatory mechanics, but it is also associated with a combination of factors, including inefficient gas exchange, lactic acidosis at a low work rate, and exercise-induced hypoxemia. The survival prognosis of COPD patients with severely reduced exercise capacity is extremely poor, but the pathophysiology of these patients during exercise remains to be accurately established. The present study aimed to characterize life-threatening factors such as hypoxemia, acidosis, and sympathetic activation during exercise in these patients. METHODS We monitored changes in life-threatening factors and compared these factors among quartile groups, defined according to their peak oxygen uptake status. Ninety-one COPD subjects (82 males, 9 females, average age 69.7 ± 6.8 y) consecutively underwent incremental cardiopulmonary exercise testing using a cycle ergometer. Arterial blood gases, lactate, and catecholamines were measured during cardiopulmonary exercise testing. RESULTS The pathophysiology of the COPD differed among the 4 subject groups. Subjects with the most severely reduced exercise capacity (peak oxygen uptake ≤ 623 mL/min) were characterized by exercise-induced steep decrease in PaO2 slope (-78 ± 70 mm Hg/L/min), rapid progression of respiratory acidosis, little change in lactic acidosis, and sympathetic activation at low-intensity work load (plasma norepinephrine 1.41 ± 0.94 ng/mL at 20 watts work load), in addition to the limitation of increase in ventilation and impaired gas exchange. CONCLUSIONS The mechanisms of exercise intolerance in COPD patients significantly differed among subjects with different exercise capacities. Subjects with the most severely reduced exercise capacity had the characteristics of exercise-induced hypoxemia, sympathetic overactivity, and progressive respiratory acidosis at low-intensity exercise. These life-threatening pathophysiological conditions could be improved by medication and/or pulmonary rehabilitation.
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Affiliation(s)
- Ryoji Maekura
- Department of Respiratory Medicine, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan
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Miki K, Maekura R, Nagaya N, Kitada S, Miki M, Yoshimura K, Tateishi Y, Motone M, Hiraga T, Mori M, Kangawa K. Effects of ghrelin treatment on exercise capacity in underweight COPD patients: a substudy of a multicenter, randomized, double-blind, placebo-controlled trial of ghrelin treatment. BMC Pulm Med 2013; 13:37. [PMID: 23758800 PMCID: PMC3683541 DOI: 10.1186/1471-2466-13-37] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/29/2013] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this substudy of the ghrelin treatment, multicenter, randomized, double-blind, placebo-controlled trial was to investigate the effects of ghrelin administration on exercise capacity and the underlying mechanisms in underweight patients with chronic obstructive pulmonary disease (COPD) using cardiopulmonary exercise testing. Methods Twenty underweight COPD patients were randomized to pulmonary rehabilitation with intravenous ghrelin (2 μg/kg, n = 10) or placebo (n = 10) twice daily for 3 weeks in a double-blind fashion. The primary outcome was changes in peak oxygen uptake V•o2. Secondary outcomes included changes in exertional cardio-respiratory functions: O2-pulse, physiologic dead space/tidal volume-ratio (VD/VT), ventilatory equivalent for oxygen V•E/V•o2, and ventilatory equivalent for carbon dioxide V•E/V•co2. Results With incremental exercise, at peak exercise, there was a significant difference in the mean difference (ghrelin minus placebo), i.e., treatment effect in: i) peak V•o2 (1.2 mL/kg/min, 95% CI: 0.2-2.3 mL/kg/min, between-group p = 0.025); ii) V•E/V•o2 (-4.2, 95% CI: -7.9 to -0.5, between-group p = 0.030); iii) V•E/V•co2 (-4.1, 95% CI: -8.2 to -0.1, between-group p = 0.045); iv) VD/VT (-0.04, 95% CI: -0.08 to -0.00, between-group p = 0.041); and v) O2-pulse (0.7 mL/beat, 95% CI: 0.3 to 1.2 mL/beat, between-group p = 0.003). Additionally, repeated-measures analysis of variance (ANOVA) indicated a significant time-course effect of ghrelin versus placebo in the peak V•o2 (p = 0.025). Conclusion Ghrelin administration was associated with improved exertional capacity and improvements in ventilatory-cardiac parameters. Trial registration UMIN (University Hospital Medical Information Network in Japan) C000000061
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Affiliation(s)
- Keisuke Miki
- Department of Internal medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, Japan.
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Tamaru A, Nakajima C, Wada T, Wang Y, Inoue M, Kawahara R, Maekura R, Ozeki Y, Ogura H, Kobayashi K, Suzuki Y, Matsumoto S. Dominant incidence of multidrug and extensively drug-resistant specific Mycobacterium tuberculosis clones in Osaka Prefecture, Japan. PLoS One 2012; 7:e42505. [PMID: 22952596 PMCID: PMC3432034 DOI: 10.1371/journal.pone.0042505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022] Open
Abstract
Infection and transmission of multidrug-resistant Mycobacterium tuberculosis (MDR-Mtb) and extensively drug-resistant M. tuberculosis (XDR-Mtb) is a serious health problem. We analyzed a total of 1,110 Mtb isolates in Osaka Prefecture and neighboring areas from April 2000 to March 2009. A total of 89 MDR-Mtb were identified, 36 (48.5%) of which were determined to be XDR-Mtb. Among the 89 MDR-Mtb isolates, 24 (27.0%) phylogenetically distributed into six clusters based on mycobacterial interspersed repetitive units-various number of tandem repeats (MIRU-VNTR) typing. Among these six clusters, the MIRU-VNTR patterns of four (OM-V02, OM-V03, OM-V04, and OM-V06) were only found for MDR-Mtb. Further analysis revealed that all isolates belonging to OM-V02 and OM-V03, and two isolates from OM-V04 were clonal. Importantly such genotypes were not observed for drug-sensitive isolates. These suggest that few but transmissible clones can transmit after acquiring multidrug resistance and colonize even in a country with a developed, well-organized healthcare system.
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Affiliation(s)
- Aki Tamaru
- Department of Infectious Diseases, Osaka Prefectural Institute of Public Health, Osaka, Osaka, Japan.
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Yano Y, Kitada S, Mori M, Kagami S, Taguri T, Uenami T, Namba Y, Yoneda T, Yokota S, Maekura R. Pulmonary disease caused by rapidly growing mycobacteria: a retrospective study of 44 cases in Japan. ACTA ACUST UNITED AC 2012; 85:305-11. [PMID: 22890130 DOI: 10.1159/000339631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 05/21/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The features of pulmonary disease caused by rapidly growing mycobacteria (RGM) have not been sufficiently documented. OBJECTIVES To establish these features, we retrospectively evaluated 44 patients. METHODS We screened respiratory isolates at the National Toneyama Hospital (Osaka, Japan) between 2003 and 2007. Diagnosis was based on the latest guidelines of the American Thoracic Society. The patients were classified into 3 types according to their radiographic findings: fibrocavitary, nodular bronchiectatic and unclassified variant. RESULTS We obtained 1,348 nontuberculous mycobacteria respiratory isolates from 1,187 patients, including 119 RGM isolates from 100 patients. Forty-four of these 100 patients were definitively diagnosed with respiratory disease due to RGM. The most common pathogen was Mycobacterium abscessus, which accounted for 65.9% of cases, followed by Mycobacterium fortuitum at 20.5%. There was a statistically significant difference in smoking history between patients infected with these 4 RGM species (excluding those with an unknown smoking history; p = 0.039). The overall evaluation of radiographic findings revealed 18.2% as fibrocavitary, 43.2% as nodular bronchiectatic and 38.6% as unclassified variants in these 44 patients. There was a significant difference in radiographic findings between the 4 RGM species (p = 0.002). There was also a significant difference in radiographic findings between M. abscessus and M. fortuitum infected patients (p = 0.022). CONCLUSIONS Patients with M. abscessus seem to have less of a smoking history and more frequent nodular bronchiectatic radiographic patterns than patients with M. fortuitum. In contrast, fibrocavitary patterns might be more frequent with M. fortuitum infection.
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Affiliation(s)
- Yukihiro Yano
- Department of Respiratory Medicine, National Hospital Organization National Toneyama Hospital, Toyonaka, Japan. yanoy @ toneyama.go.jp
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Yoshimura K, Maekura R, Hiraga T, Kitada S, Miki K, Miki M, Tateishi Y. Effects of tiotropium on sympathetic activation during exercise in stable chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis 2012; 7:109-17. [PMID: 22615527 PMCID: PMC3355834 DOI: 10.2147/copd.s28677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tiotropium partially relieves exertional dyspnea and reduces the risk of congestive heart failure in chronic obstructive pulmonary disease (COPD) patients. However, its effect on the sympathetic activation response to exercise is unknown. AIMS This study aimed to determine whether tiotropium use results in a sustained reduction in sympathetic activation during exercise. METHODS We conducted a 12-week, open-label (treatments: tiotropium 18 μg or oxitropium 0.2 mg × 3 mg), crossover study in 17 COPD patients. Treatment order was randomized across subjects. The subjects underwent a pulmonary function test and two modes of cardiopulmonary exercise (constant work rate and incremental exercise) testing using a cycle ergometer, with measurement of arterial catecholamines after each treatment period. RESULTS Forced expiratory volume in 1 second and forced vital capacity were significantly larger in the tiotropium treatment group. In constant exercise testing, exercise endurance time was longer, with improvement in dyspnea during exercise and reduction in dynamic hyperinflation in the tiotropium treatment group. Similarly, in incremental exercise testing, exercise time, carbon dioxide production, and minute ventilation at peak exercise were significantly higher in the tiotropium treatment group. Plasma norepinephrine concentrations and dyspnea intensity were also lower during submaximal isotime exercise and throughout the incremental workload exercise in the tiotropium treatment group. CONCLUSION Tiotropium suppressed the increase of sympathetic activation during exercise at the end of the 6-week treatment, as compared with the effect of oxipropium. This effect might be attributed to improvement in lung function and exercise capacity and reduction in exertional dyspnea, which were associated with decreases in respiratory frequency and heart rate and reduced progression of arterial acidosis.
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Affiliation(s)
- Kenji Yoshimura
- Department of Respiratory Medicine, Toneyama National Hospital, Osaka, Japan
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Miki K, Maekura R, Hiraga T, Kitada S, Miki M, Yoshimura K, Tateishi Y. Effects of oxygen on exertional dyspnoea and exercise performance in patients with chronic obstructive pulmonary disease. Respirology 2012; 17:149-54. [PMID: 22008208 DOI: 10.1111/j.1440-1843.2011.02086.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The results of studies on the oxygen response in patients with COPD should provide important clues to the pathophysiology of exertional dyspnoea. We investigated the exercise responses to hyperoxia in relation to dyspnoea profile, as well as cardiopulmonary, acidotic and sympathetic parameters in 35 patients with stable COPD (mean FEV(1) 46% predicted). METHODS This was a single-blind trial, in which patients breathed 24% O(2) or compressed air (CA) in random order during two incremental cycle exercise tests. RESULTS PaO(2) and PaCO(2) were higher (P < 0.0001 and P < 0.05, respectively) at each exercise point while patients were breathing 24% O(2) compared with CA. At a standardized time point near peak exercise, use of O(2) resulted in reduced plasma lactate and plasma noradrenaline concentrations (P < 0.01). Peak minute ventilation/indirect maximum voluntary ventilation was similar while breathing 24% O(2) and CA. At peak exercise, the dyspnoea score, pH and plasma noradrenaline concentrations were similar while breathing 24% O(2) and CA. The dyspnoea-ratio (%) of Δoxygen uptake (peak minus resting oxygen uptake) curve reached a break point that occurred at a similar exercise point while breathing 24% O(2) or CA. CONCLUSIONS Regardless of whether they breathed CA or 24% O(2) , patients with COPD did not develop ventilatory compensation for exertional acidosis, and the pH values measured were similar. Hyperoxia during a standardized exercise protocol did not alter the pattern of exertional dyspnoea in these patients, compared with breathing CA, although hyperoxia resulted in miscellaneous effects.
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Affiliation(s)
- Keisuke Miki
- Department of Internal medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.
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Kitada S, Uenami T, Yoshimura K, Tateishi Y, Miki K, Miki M, Hashimoto H, Fujikawa T, Mori M, Matsuura K, Kuroyama M, Maekura R. Long-term radiographic outcome of nodular bronchiectatic Mycobacterium avium complex pulmonary disease. Int J Tuberc Lung Dis 2012; 16:660-4. [PMID: 22410245 DOI: 10.5588/ijtld.11.0534] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Mycobacterium avium complex pulmonary disease (MAC-PD) is a growing health problem, little is known about long-term radiographic outcome and factors for deterioration in patients with MAC-PD. METHODS Data on patients with nodular bronchiectatic (NBE) MAC-PD who underwent regular follow-up for >5 years were retrospectively reviewed. Changes in plain chest radiograph (CXR) and baseline characteristics were compared between the stable and deteriorated groups. RESULTS Seventy-two patients were investigated, including 30 patients who were examined 10 years after the initial visit. One patient (1.4%) showed progressive or remarkably progressive disease on CXR at 1 year; this rate increased to 22.2% at 5 years and to 53.3% at 10 years. Body mass index (BMI) at the initial visit was lower in the deteriorated group than in the stable group. Cavitary disease and resistance to a macrolide were seen more frequently at the initial visit in the deteriorated group than in the stable group. CONCLUSIONS NBE MAC-PD is a slowly but substantially progressive long-term infection (5-10 years). Our data suggest that patients with lower BMI, cavitary disease and resistance to a macrolide at initial visit are more likely to progress to deteriorating disease.
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Affiliation(s)
- S Kitada
- Department of Respiratory Medicine, National Hospital Organisation National Toneyama Hospital, Toyonaka-shi, Osaka, Japan.
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Nojiri T, Yamamoto K, Maeda H, Takeuchi Y, Funakoshi Y, Maekura R, Okumura M. Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection. Ann Thorac Cardiovasc Surg 2012; 18:206-11. [DOI: 10.5761/atcs.oa.11.01787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mori M, Maekura R. [Smoking cessation]. Nihon Rinsho 2011; 69:1831-1835. [PMID: 22073582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Smoking has been determined as a cause of chronic obstructive pulmonary disease (COPD) in most patients. Smoking cessation should be stressed above everything else for COPD patients under all conditions. A smoking habit is determined not as a preference but as a dependency on tobacco; therefore, smoking cessation is difficult solely based on one's motivation. Smoking cessation therapy is employed with cessation aids. Now, we can use nicotine-containing gum, patches, and the nicotine-receptor partial agonist varenicline. First, nicotine from tobacco is replaced with a nicotin patch, or a nicotine-free condition is induced by varenicline. Subsequently, the drugs are gradually reduced. In Japan, smoking cessation therapy is covered by public health insurance as definite requirements.
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Affiliation(s)
- Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital
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Tateishi Y, Motone M, Yoshimura K, Miki M, Miki K, Kitada S, Hashimoto H, Hiraga T, Maekura R. [Susceptibility to rifabutin and novel fluoroquinolones in Mycobacterium avium complex isolates from patients with sputum culture-positive pulmonary disease who are undergoing standard chemotherapy]. Nihon Kokyuki Gakkai Zasshi 2010; 48:797-802. [PMID: 21141056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We investigated the susceptibility to conventional and newer antimycobacterial agents including rifabutin (RBT) and novel fluoroquinolones (NFQs) among 48 clinical Mycobacterium avium complex (MAC) isolates from patients with sputum culture-positive MAC disease who were undergoing standard chemotherapy. RBT and NFQs were superior to conventional agents because of higher rates of susceptibility and lower minimum inhibitory concentration. NFQs showed cross-resistance among quinolones. In contrast, RBT did not show cross-resistance to RFP. Most clarithromycin-resistant or rifampicin-resistant cases were susceptible to RBT and NFQs. In conclusion, RBT and NFQs possess good in vitro antimicrobial activity among clinical isolates of culture-positive pulmonary MAC disease, which suggests that a combination of such microbiologically active agents may improve clinical effectiveness more than standard chemotherapy regimens.
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Affiliation(s)
- Yoshitaka Tateishi
- Department of Internal Medicine, National Hospital Organization, Toneyama Hospital
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40
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Nojiri T, Maeda H, Takeuchi Y, Funakoshi Y, Maekura R, Yamamoto K, Okumura M. Predictive value of preoperative tissue Doppler echocardiographic analysis for postoperative atrial fibrillation after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg 2010; 140:764-8. [DOI: 10.1016/j.jtcvs.2009.11.073] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/04/2009] [Accepted: 11/18/2009] [Indexed: 12/01/2022]
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41
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Kitada S, Kobayashi K, Nishiuchi Y, Fushitani K, Yoshimura K, Tateishi Y, Miki K, Miki M, Hashimoto H, Motone M, Fujikawa T, Hiraga T, Maekura R. Serodiagnosis of pulmonary disease due to Mycobacterium avium complex proven by bronchial wash culture. Chest 2010; 138:236-7. [PMID: 20605832 DOI: 10.1378/chest.10-0248] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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42
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Miki K, Maekura R, Hiraga T, Hashimoto H, Kitada S, Miki M, Yoshimura K, Tateishi Y, Sugano T, Motone M. Exertional dyspnea-related acidotic and sympathetic responses in patients with sequelae of pulmonary tuberculosis. J Physiol Sci 2010; 60:187-93. [PMID: 20087706 PMCID: PMC10716986 DOI: 10.1007/s12576-009-0083-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 08/12/2009] [Accepted: 12/25/2009] [Indexed: 10/20/2022]
Abstract
The objective of this study was to investigate whether exertional dyspnea correlates with exercise responses, especially arterial blood pH and plasma norepinephrine (NE) changes, in patients with sequelae of tuberculosis (TBsq). Cardiopulmonary exercise testings were performed in 49 TBsq patients and 9 controls. Each group had a break point in the dyspnea, plasma lactate, and plasma NE changes during exercise, all of which occurred at a similar exercise point. In TBsq patients in both exercise phases before and after the dyspnea break point, the dyspnea-slope (DeltaBorg scale/Deltaminute ventilation) correlated with the pH-slope (DeltapH/Deltaoxygen uptake) (r = -0.616, p < 0.0001; r = -0.629, p < 0.0001, respectively, before and after the break point) and with the NE-slope (DeltaNE/Deltaoxygen uptake) (r = 0.443, p = 0.0012; r = 0.643, p < 0.0001, respectively, before and after the break point). In TBsq patients during exercise, increases in circulating NE levels and exertional acidosis were correlated with exertional dyspnea.
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Affiliation(s)
- Keisuke Miki
- Department of Internal Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka, Japan.
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Nojiri T, Maeda H, Takeuchi Y, Funakoshi Y, Kimura T, Maekura R, Yamamoto K, Okumura M. Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer. Eur J Cardiothorac Surg 2010; 37:787-91. [DOI: 10.1016/j.ejcts.2009.09.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/27/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022] Open
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Miki K, Maekura R, Hiraga T, Hashimoto H, Kitada S, Miki M, Yoshimura K, Tateishi Y, Fushitani K, Motone M. Acidosis and raised norepinephrine levels are associated with exercise dyspnoea in idiopathic pulmonary fibrosis. Respirology 2009; 14:1020-6. [PMID: 19740262 DOI: 10.1111/j.1440-1843.2009.01607.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Exertional dyspnoea limits patients with IPF in their activities of daily living. The mechanism, however, has not been elucidated. This study tested the hypothesis in IPF that exertional dyspnoea correlates with cardiopulmonary exercise responses, specifically changes in arterial blood pH and plasma norepinephrine (NE). METHODS Cardiopulmonary exercise testing with measurements of dyspnoea (Borg scale), plasma NE, plasma lactate and arterial blood gases were performed in 29 patients with IPF and in nine controls. RESULTS Both groups showed obvious break points in dyspnoea changes during exercise. In IPF, an abrupt change in the Borg scale, pH, PaCO(2) and plasma NE occurred in the late exercise phase after the 'break point'. Compared with controls, patients with IPF had significantly higher HCO(3)(-) levels and physiologic dead space/tidal volume during exercise. In IPF, during both exercise phases, the dyspnoea slope (DeltaBorg scale/Deltaminute ventilation) correlated with the pH slope (DeltapH/Deltaoxygen uptake) (before the break point: r = -0.537, P = 0.0022; r = -0.886, P < 0.0001, after the break point) and the NE slope (DeltaNE/Deltaoxygen uptake) (before the break point: r = 0.481, P = 0.0075; R = 0.784, P < 0.0001, after the break point). CONCLUSIONS In patients with IPF, exercise-induced acidosis and increases in circulating NE levels were associated with intensity of exertional dyspnoea.
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Affiliation(s)
- Keisuke Miki
- Department of Internal Medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.
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Nishiuchi Y, Tamaru A, Kitada S, Taguri T, Matsumoto S, Tateishi Y, Yoshimura M, Ozeki Y, Matsumura N, Ogura H, Maekura R. <i>Mycobacterium avium</i> Complex Organisms Predominantly Colonize in the Bathtub Inlets of Patients’ Bathrooms. Jpn J Infect Dis 2009. [DOI: 10.7883/yoken.jjid.2009.182] [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: 03/02/2023]
Affiliation(s)
- Yukiko Nishiuchi
- Toneyama Institute for Tuberculosis Research Osaka City University Medical School, Japan
| | - Aki Tamaru
- Department of Infectious Diseases, Osaka Prefectural Institute of Public Health, Japan
| | - Seigo Kitada
- National Hospital Organization Toneyama National Hospital, Japan
| | - Takahiro Taguri
- National Hospital Organization Toneyama National Hospital, Japan
| | - Sohkichi Matsumoto
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
| | | | - Mamiko Yoshimura
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
| | - Yuriko Ozeki
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
| | - Narumi Matsumura
- National Hospital Organization Toneyama National Hospital, Japan
| | - Hisashi Ogura
- Department of Virology, Osaka City University Graduate School of Medicine, Japan
| | - Ryoji Maekura
- National Hospital Organization Toneyama National Hospital, Japan
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Nishiuchi Y, Tamura A, Kitada S, Taguri T, Matsumoto S, Tateishi Y, Yoshimura M, Ozeki Y, Matsumura N, Ogura H, Maekura R. Mycobacterium avium complex organisms predominantly colonize in the bathtub inlets of patients' bathrooms. Jpn J Infect Dis 2009; 62:182-186. [PMID: 19468176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Medical treatment of pulmonary Mycobacterium avium complex (MAC) disease does not always provide curative effects and is frequently hampered by recurrence. This suggests the presence of a reservoir for MAC in the environment surrounding patients. We previously reported the recovery of MAC isolates from the residential bathrooms of outpatients. In the present study, to ascertain the colonizing sites and the possibility of an MAC reservoir in the bathrooms of patients, we tested the recovery and the genetic diversity of MAC isolates from 6 sites of specimens, including 2 additional sampling sites, inside the showerhead and the bathtub inlet, in the residential bathrooms of patients with pulmonary MAC disease. MAC isolates were recovered from 15 out of the 29 bathrooms (52%), including specimens from 14 bathtub inlets and 3 showerheads. Nearly half of these bathrooms (7/15) contained MAC strains that were identical or similar to their respective clinical isolates Additionally, in 5 out of 15 bathrooms, polyclonal colonization was revealed by pulsed-field gel electrophoresis. The results imply that colonization of MAC organisms in the bathrooms of MAC patients occurs predominantly in the bathtub inlets, and there is thus a risk of infection and/or reinfection for patients via use of the bathtub and other sites in the bathroom.
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Affiliation(s)
- Yukiko Nishiuchi
- Toneyama Institute for Tuberculosis Research Osaka City University Medical School, Osaka 560-8552, Japan.
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Tateishi Y, Hirayama Y, Ozeki Y, Nishiuchi Y, Yoshimura M, Kang J, Shibata A, Hirata K, Kitada S, Maekura R, Ogura H, Kobayashi K, Matsumoto S. Virulence of Mycobacterium avium complex strains isolated from immunocompetent patients. Microb Pathog 2008; 46:6-12. [PMID: 19013228 DOI: 10.1016/j.micpath.2008.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 09/29/2008] [Accepted: 10/02/2008] [Indexed: 01/15/2023]
Abstract
Mycobacterium avium complex (MAC) disease has been increasing worldwide not only in immunocompromised but also in immunocompetent humans. However, the relationship between mycobacterial strain virulence and disease progression in immunocompetent humans is unclear. In this study, we isolated 6 strains from patients with pulmonary MAC disease. To explore the virulence, we examined the growth in human THP-1 macrophages and pathogenicity in C57BL/6 mice. We found that one strain, designated 198, which was isolated from a patient showing the most progressive disease, persisted in THP-1 cells. In addition, strain 198 grew to a high bacterial load with strong inflammation in mouse lungs and spleens 16 weeks after infection. To our knowledge, strain 198 is the first isolated MAC strain that exhibits hypervirulence consistently for the human patient, human macrophages in vitro, and even for immunocompetent mice. Other strains showed limited survival and weak virulence both in macrophages and in mice, uncorrelated to disease progression in human patients. We demonstrated that there is a hypervirulent clinical MAC strain whose experimental virulence corresponds to the serious disease progression in the patients. The existence of such strain suggests the involvement of bacterial virulence in the pathogenesis of pulmonary MAC disease in immunocompetent status.
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Affiliation(s)
- Yoshitaka Tateishi
- Department of Bacteriology, Osaka City University Graduate School of Medicine, and Department of Internal Medicine, National Hospital Organization Toneyama National Hospital, 5-1-1 Toneyama, Toyonaka, Osaka 560-8552, Japan.
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Kitada S, Kobayashi K, Ichiyama S, Takakura S, Sakatani M, Suzuki K, Takashima T, Nagai T, Sakurabayashi I, Ito M, Maekura R. Serodiagnosis ofMycobacterium avium–Complex Pulmonary Disease Using an Enzyme Immunoassay Kit. Am J Respir Crit Care Med 2008; 177:793-7. [DOI: 10.1164/rccm.200705-771oc] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Mori M, Iwasaki T, Nakazawa Y, Namba Y, Niinaka M, Yano Y, Kitada S, Kimura H, Naka N, Okada T, Nakagawa M, Maekura R, Yokota S. [A case of lung adenocarcinoma effectively treated with sivelestat and corcicosteroid for drug-induced lung disease due to gefitinib]. Nihon Kokyuki Gakkai Zasshi 2008; 46:232-236. [PMID: 18409572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 70-year-old Japanese man was re-admitted because of relapse of adenocarcinoma of the lung. He received daily administration of gefitinib as second-line chemotherapy. He was given a diagnosis of drug-induced lung disease due to gefitinib on day 6 because of hypoxemia and ground glass opacities in the bilateral lung fields. There was no response to corticosteroid pulse therapy. Continuous administration of sivelestat was intravenously added from day 9. Although mechanical ventilation was required for 10 days, lung infiltrates and hypoxia gradually improved. Sivelestat and corcicosteroid was apparently effective in this case and may be useful treatment for drug-induced lung disease due to gefitinib.
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Affiliation(s)
- Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital
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Miki K, Maekura R, Hiraga T, Hirotani A, Hashimoto H, Kitada S, Miki M, Yoshimura K, Naka N, Motone M. The degree of exercise hypoxemia reflects pulmonary artery pressure during early exercise in chronic obstructive pulmonary disease patients. Clin Physiol Funct Imaging 2007; 28:64-9. [PMID: 18005165 DOI: 10.1111/j.1475-097x.2007.00778.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The causes of both exertional pulmonary hypertension and pulmonary hypertension in general in chronic obstructive pulmonary disease (COPD) remain to be elucidated. To further understand the pathophysiology in COPD patients, it may be important to recognize the existence of exertional pulmonary hypertension and to determine the severity of exertional hypoxemia. However, little is known about their relationship. To investigate whether the severity of exertional hypoxemia, as evaluated by the Deltaartery oxygen tension/Deltaoxygen consumption (PaO(2)-slope) correlates with the mean pulmonary artery pressure (Ppa), cardiopulmonary exercise testing with haemodynamics was done in 10 patients with moderate to very severe COPD. The PaO(2)-slope was significantly correlated with the mean Ppa from 25% to 40% of the maximum Watts (Wmax), and was most significant at 30% Wmax (r = -0.904, P<0.0001). In this phase, all parameters, except for the mean Ppa and the mixed venous oxygen tension, were not markedly changed from resting levels. At 30% Wmax, the mean Ppa (mean, 27 mmHg) with no or mild hypoxemia was also significantly correlated with the Deltaartery oxygen saturation/Deltaoxygen consumption (SpO(2)-slope) (r = -0.789, P = 0.004). On stepwise multiple regression analysis, the PaO(2)-slope was the most significant predictor of mean Ppa at 30% Wmax. In conclusion, the PaO(2)-slope and the SpO(2)-slope reflect Ppa during the early exercise phase. Thus, assessment of these parameters could be useful to evaluate the cardiopulmonary haemodynamic pathophysiology of COPD patients.
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Affiliation(s)
- Keisuke Miki
- Department of Internal medicine, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.
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