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Inaba M, Naito H, Yorifuji T, Nakamichi C, Maeyama H, Ishikawa H, Shime N, Uemori S, Ishihara S, Takaoka M, Ohtsuka T, Harada M, Nozaki S, Kohama K, Sakurai R, Sato S, Muramatsu S, Yamashita K, Mayumi T, Aita K, Nakao A. Impact of frailty on long-term mortality in older patients receiving intensive care via the emergency department. Sci Rep 2023; 13:5433. [PMID: 37012346 PMCID: PMC10070345 DOI: 10.1038/s41598-023-32519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
The aim of this study was to evaluate whether frailty was associated with 6-month mortality in older adults who were admitted to the intensive care unit (ICU) with an illness requiring emergency care. The investigation was a prospective, multi-center, observational study conducted among the ICUs of 17 participating hospitals. Patients ≥ 65 years of age who were admitted to the ICU directly from an emergency department visit were assessed to determine their baseline Clinical Frailty Scale (CFS) scores before the illness and were surveyed 6 months after admission. Among 650 patients included in the study, the median age was 79 years old, and overall mortality at 6 months was as low as 21%, ranging from 6.2% in patients with CFS 1 to 42.9% in patients with CFS ≥ 7. When adjusted for potential confounders, CFS score was an independent prognostic factor for mortality (one-point increase in CFS, adjusted risk ratio with 95% confidence interval 1.19 [1.09-1.30]). Quality of life 6 months after admission worsened as baseline CFS score increased. However, there was no association between total hospitalization cost and baseline CFS. CFS is an important predictor of long-term outcomes among critically ill older patients requiring emergent admission.
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Affiliation(s)
- Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan.
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan.
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Chikaaki Nakamichi
- Advanced Emergency and Critical Care Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - Hiroki Maeyama
- Emergency and Critical Care Center, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Hideki Ishikawa
- Trauma and Resuscitation Center, Teikyo University Hospital, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sadayori Uemori
- Department of Emergency, Yodogawa Christian Hospital, Osaka, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care, Hyogo Emergency Medical Center, Kobe, Japan
| | - Makoto Takaoka
- Acute Care Division, Harima-Himeji General Medical Center, Himeji, Japan
| | - Tsuyoshi Ohtsuka
- Emergency Department, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Masahiro Harada
- Department of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Satoshi Nozaki
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Keisuke Kohama
- Department of Emergency, Disaster, and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryota Sakurai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shuho Sato
- Emergency Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Shun Muramatsu
- Emergency Department, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazunori Yamashita
- Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | - Kaoruko Aita
- Uehiro Division, Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, University of Tokyo, Tokyo, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan
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Abstract
Advance care planning (ACP) for people with dementia, as with other diseases, is a necessary process to realize medical treatment and care in the final stage of a person's life. On the other hand, dementia, a disease that is expected to make it difficult for people to make decisions on their own in the future, has a long course, and is characterized by uncertainty regarding the course of the disease, which may also be a limiting factor in the implementation of ACP for people with dementia. On the other hand, the uncertainties may also be a reason for implementing ACP. This paper reviews reports on ACP initiatives for people with dementia from many countries and presents their characteristics, cultural and customary influences, effects, facilitating and inhibiting factors, and recommendations for implementation, with the aim of promoting future ACP initiatives for people with dementia. The aim of the study was to promote future ACP initiatives for people with dementia.
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Affiliation(s)
| | - Yoshihisa Hirakawa
- Department of Health Development and Innovation, Aichi Comprehensive Health Science Center
| | - Kaoruko Aita
- Uehiro Division, Center for Death & Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology
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3
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Miyashita J, Shimizu S, Shiraishi R, Mori M, Okawa K, Aita K, Mitsuoka S, Nishikawa M, Kizawa Y, Morita T, Fukuhara S, Ishibashi Y, Shimada C, Norisue Y, Ogino M, Higuchi N, Yamagishi A, Miura Y, Yamamoto Y. Culturally Adapted Consensus Definition and Action Guideline: Japan's Advance Care Planning. J Pain Symptom Manage 2022; 64:602-613. [PMID: 36115500 DOI: 10.1016/j.jpainsymman.2022.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A conceptual framework for advance care planning is lacking in societies like Japan's valuing family-centered decision-making. OBJECTIVES A consensus definition of advance care planning with action guideline adapted to Japanese society. METHODS We conducted a multidisciplinary modified Delphi study 2020-2022. Thirty physicians, 10 healthcare and bioethics researchers, six nurses, three patient care managers, three medical social workers, three law experts, and a chaplain evaluated, in 7 rounds (including two web-based surveys where the consensus level was defined as ratings by ≥70% of panelists of 7-9 on a nine-point Likert scale), brief sentences delineating the definition, scope, subjects, and action guideline for advance care planning in Japan. RESULTS The resulting 29-item set attained the target consensus level, with 72%-96% of item ratings 7-9. Advance care planning was defined as "an individual's thinking about and discussing with their family and other people close to them, with the support as necessary of healthcare providers who have established a trusting relationship with them, preparations for the future, including the way of life and medical treatment and care that they wish to have in the future." This definition/action guideline specifically included support for individuals hesitant to express opinions to develop and express preparations for the future. CONCLUSION Adaptation of advance care planning to Japanese culture by consciously enhancing and supporting individuals' autonomous decision-making may facilitate its spread and establishment in Japan and other societies with family-centered decision-making cultures.
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Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University.
| | - Sayaka Shimizu
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University
| | - Ryuto Shiraishi
- Department of Palliative Medicine, Kobe University School of Medicine
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | | | - Kaoruko Aita
- Uehiro Division for Death & Life Studies and Practical Ethics, The University of Tokyo
| | | | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology
| | | | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | | | - Chiho Shimada
- Faculty of Humanities and Social Science, Saku University
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Mieko Ogino
- Department of Neurology, Ichikawa Hospital, International University of Health and Welfare
| | | | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University
| | - Yasuhiko Miura
- Department of General Medicine, The Jikei University School of Medicine
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University
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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Contemporary Issues and Practicalities in Completing Advance Care Planning for Patients With Severe COPD Living Alone: A Qualitative Study. J Soc Work End Life Palliat Care 2022; 18:80-95. [PMID: 34605374 DOI: 10.1080/15524256.2021.1976353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Health care professionals working with older people living alone with chronic obstructive pulmonary disease (COPD) to complete advance care planning (ACP) often encounter the double burden of social isolation and acute exacerbations in this planning. The study explored clinicians' perceptions regarding factors influencing the completion of ACP for older people with COPD living alone. Individual interviews were conducted with 18 health care professionals using the video meeting platform in 2020. A semi-structured interview guide included: (a) behavior and lifestyle related to decision-making, (b) desired place to die, and (c) facilitators and barriers to autonomy in patients with severe COPD who live alone. Five main themes were identified: information sharing among team members, patient readiness, desired place of death, economic constraints, and care at the time of and after death. Partly due to the heterogeneity and complexity of clinical courses and treatment responses of COPD, a wide range of social issues of a person's life were related to practicality in the completion of ACP for older people with COPD living alone. Social work knowledge and skills such as in-depth interviewing, outreach finance and welfare support, and holistic perspective play an essential role in completing ACP for COPD patients living alone.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Kaoruko Aita
- Graduate School of Humanities and Sociology, University of Tokyo, Tokyo, Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- National Center for Geriatrics and Gerontology, Obu, Japan
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Okada K, Tsuchiya K, Sakai K, Kuragano T, Uchida A, Tsuruya K, Tomo T, Hamada C, Fukagawa M, Kawaguchi Y, Watanabe Y, Aita K, Ogawa Y, Uchino J, Okada H, Koda Y, Komatsu Y, Sato H, Hattori M, Baba T, Matsumura M, Miura H, Minakuchi J, Nakamoto H, Okada K, Tsuchiya K, Sakai K, Kuragano T, Uchida A, Tsuruya K, Tomo T, Hamada C, Fukagawa M, Kawaguchi Y, Watanabe Y, Aita K, Ogawa Y, Uchino J, Okada H, Koda Y, Komatsu Y, Sato H, Hattori M, Baba T, Matsumura M, Miura H, Minakuchi J, Nakamoto H. Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00365-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014.
Methods and results
In response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management.
Conclusions
The proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.
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Kinugawa K, Sakata Y, Ono M, Nunoda S, Toda K, Fukushima N, Shiose A, Oishi S, Yumino D, Imamura T, Endo M, Hori Y, Kashiwa K, Aita K, Kojin H, Tejima Y, Sawa Y. Consensus Report on Destination Therapy in Japan - From the DT Committee of the Council for Clinical Use of Ventricular Assist Device Related Academic Societies. Circ J 2021; 85:1906-1917. [PMID: 34433758 DOI: 10.1253/circj.cj-21-0462] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Destination therapy (DT) is the indication to implant a left ventricular assist device (LVAD) in a patient with stage D heart failure who is not a candidate for heart transplantation. The implantable LVAD has been utilized in Japan since 2011 under the indication of bridge to transplant (BTT). After almost 10 year lag, DT has finally been approved and reimbursed in May 2021 in Japan. To initiate the DT program in Japan, revision of the LVAD indication from BTT is necessary. Also, in-depth discussion of caregiver issues as well as end-of-life care is indispensable. For that purpose, we assembled a DT committee of multidisciplinary members in August 2020, and started monthly discussions via web-based communication during the COVID-19 pandemic. This is a summary of the consensus reached after 6 months' discussion, and we have included as many relevant topics as possible. Clinical application of DT has just started, and we are willing to revise this consensus to meet the forthcoming issues raised during real-world clinical experience.
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Affiliation(s)
- Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Shinichi Nunoda
- Department of Therapeutic Strategy for Severe Heart Failure, Graduate School of Medicine, Tokyo Women's Medical University
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Akira Shiose
- Department of Cardiovascular Surgery, Faculty of Medical Sciences, Kyushu University
| | - Shogo Oishi
- Department of Cardiology, Himeji Brain and Heart Center
| | | | - Teruhiko Imamura
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Miyoko Endo
- Department of Nursing, The University of Tokyo Hospital
| | - Yumiko Hori
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Kashiwa
- Department of Medical Engineering, The University of Tokyo Hospital
| | - Kaoruko Aita
- Graduate School of Humanities and Sociology, The University of Tokyo
| | - Hiroyuki Kojin
- Department of Quality and Patient Safety, Graduate Faculty of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi
| | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Hirakawa Y, Saif-Ur-Rahman KM, Aita K, Nishikawa M, Arai H, Miura H. Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis. Geriatr Gerontol Int 2021; 21:779-787. [PMID: 34318579 PMCID: PMC8444945 DOI: 10.1111/ggi.14237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 12/02/2022]
Abstract
Advance care planning is considered an important issue in end‐of‐life care for older adults. The ongoing COVID‐19 pandemic has interrupted the healthcare system and end‐of‐life care tremendously. This review aimed to explore available articles on advance care planning amid the pandemic and analyze qualitatively. PubMed and Google Scholar were searched on February 2021 using the relevant keywords. Retrieved articles were screened applying inclusion criteria. Any article describing advance care planning during the COVID‐19 era was included. A qualitative content analysis was conducted. In total, 20 articles incorporating 5542 participants from five countries were included. Among the articles, eight were primary studies and the rest were perspective papers or secondary analysis. From the qualitative content analysis six major themes emerged namely palliative care, lack of coordination among acute care, hospital palliative care, and long‐term care, community‐based advance care planning, real‐time dissemination of scientific information on the regional pandemic situation, online system and legislation. The COVID‐19 pandemic had decreased the uptake of advance care planning. Findings of the review suggested simplification of the procedure regarding advance care planning, implementation of community‐based advance care planning and utilization of online resources to enhance the process. Geriatr Gerontol Int 2021; 21: 779–787.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan.,Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
| | - Kaoruko Aita
- University of Tokyo Graduate School of Humanities and Sociology, Tokyo, Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- National Center for Geriatrics and Gerontology, Obu, Japan
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Hirakawa Y, Aita K, Nishikawa M, Arai H, Miura H. Facilitating Advance Care Planning for Patients With Severe COPD: A Qualitative Study of Experiences and Perceptions of Community Physicians, Nurses, and Allied Health Professionals. Home Healthc Now 2021; 39:81-90. [PMID: 33662966 PMCID: PMC7934328 DOI: 10.1097/nhh.0000000000000945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Patients with severe COPD often fail to receive adequate palliative care and are subject to undesired hospital transfers and cardiopulmonary resuscitation. Although promoting advance care planning (ACP) in the community can help ensure the optimal delivery of palliative care for patients with COPD, the key challenges to routinely implementing ACP are not known. The aim of this study was to identify the perception of healthcare professionals with regard to ACP for adults living with severe COPD and the challenges to facilitating ACP. A multicenter qualitative study design was used. In-depth semistructured interviews were held involving 38 healthcare professionals from 19 institutions in Japan. Text data were analyzed by content analysis. Five main themes capturing the challenges to routine implementation of ACP were identified: daily decision-making; sense of ethical decision-making; in-depth interviewing skills; collaborative information sharing among team members; and knowledge dissemination regarding ACP. The model demonstrates the complexity inherent in ACP facilitation for community-dwelling adults with severe COPD, with all the elements required for successful ACP implementation. We recommend an approach that recognizes the importance of stakeholder education, particularly educating professionals to develop the knowledge, attitudes, and skills required for ACP facilitation: in-depth interviewing, collaborative information sharing, and ethical analysis, focusing on decision-making concerning everyday life support.
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Kuzuya M, Aita K, Katayama Y, Katsuya T, Nishikawa M, Hirahara S, Miura H, Yanagawa M, Arai H, Iijima K, Okochi J, Kozaki K, Yamaguchi Y, Rakugi H, Akishita M. The Japan Geriatrics Society consensus statement “recommendations for older persons to receive the best medical and long‐term care during the
COVID
‐19 outbreak—considering the timing of advance care planning implementation”. Geriatr Gerontol Int 2020; 20:1112-1119. [DOI: 10.1111/ggi.14075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics Nagoya University Graduate School of Medicine Nagoya Japan
- Institutes of Innovation for Future Society Nagoya University Nagoya Japan
| | - Kaoruko Aita
- Uehiro Division, Center for Death & Life Studies and Practical Ethics, Graduate School of Humanities and Sociology The University of Tokyo Tokyo Japan
| | - Yoko Katayama
- Department of Nursing Kagawa Prefectural University of Health Sciences Takamatsu Japan
| | - Tomohiro Katsuya
- Katsuya Clinic, Amagasaki, Japan/Department of Clinical Gene Therapy Osaka University Graduate School of Medicine Suita Japan
| | - Mitsunori Nishikawa
- Department of Palliative Care National Center for Geriatrics and Gerontology Obu Japan
| | - Satoshi Hirahara
- Training/Research Center Tokyo Fureai Medical & Cooperative Society Tokyo Japan
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion National Center for Geriatrics and Gerontology Obu Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology Obu Japan
| | - Katsuya Iijima
- Institute of Gerontology The University of Tokyo Tokyo Japan
| | - Jiro Okochi
- Tatsumanosato Geriatric Health Services Facility Daito Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine Kyorin University, School of Medicine Mitaka Japan
| | - Yasuhiro Yamaguchi
- Department of Respiratory Medicine Jichi Medical University Saitama Medical Center Saitama Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine Graduate School of Medicine, The University of Tokyo Tokyo Japan
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10
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Kuzuya M, Aita K, Katayama Y, Katsuya T, Nishikawa M, Hirahara S, Miura H, Rakugi H, Akishita M. Japan Geriatrics Society "Recommendations for the Promotion of Advance Care Planning": End-of-Life Issues Subcommittee consensus statement. Geriatr Gerontol Int 2020; 20:1024-1028. [PMID: 32964534 DOI: 10.1111/ggi.14042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/27/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
The Japan Geriatrics Society has so far announced "The Japan Geriatrics Society Position Statement 2012" and "Guidelines for the Decision-Making Processes in Medical and Long-Term Care for the Elderly - Focusing on the Use of Artificial Hydration and Nutrition" related to end-of-life care for older adults. In 2018, the Ministry of Health, Labor and Welfare revised the "Guidelines for the Decision-Making Processes in Medical and Long-Term Care in the End of Life," recommending the practice of advance care planning (ACP). This was the first time when the Japanese government publicized its stance on ACP. Immediately after the government's announcement, the Japan Medical Association announced its committee report, "The Super-aged Society and the End-of-life Care," which also recommended the practice of ACP. The guidelines were published when the society was experiencing substantial changes related to geriatric care in Japan, and required timely and ethically appropriate decision-making processes. However, because ACP is a concept imported from English-speaking countries, some Japanese people could find it difficult to understand the role and methodology of ACP because of differences in culture and the medical/long-term care system. Therefore, the Japan Geriatrics Society has decided to publish the "Recommendations for the Promotion of Advance Care Planning" for medical and long-term care professionals nationwide with the aim of using the recommendations on a daily basis. The society recognizes ACP as indispensable to improve end-of-life care for individuals, particularly for older adults. We anticipate that the recommendations will provide practical guidance for those strenuously working toward this goal. Geriatr Gerontol Int 2020; 20: 1024-1028..
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Affiliation(s)
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
| | - Kaoruko Aita
- Uehiro Division, Center for Death & Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo, Tokyo, Japan
| | - Yoko Katayama
- Department of Nursing, Kagawa Prefectural University of Health Sciences, Takamatsu, Japan
| | - Tomohiro Katsuya
- Katsuya Clinic, Amagasaki, Japan.,Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Satoshi Hirahara
- Training/Research Center, Tokyo Fureai Medical & Cooperative Society, Tokyo, Japan
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Imai K, Morita T, Akechi T, Baba M, Yamaguchi T, Sumi H, Tashiro S, Aita K, Shimizu T, Hamano J, Sekimoto G, Maeda I, Shinjo T, Nagayama J, Hayashi E, Hisayama Y, Inaba K, Abo H, Suga A, Ikenaga M. The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine. J Palliat Med 2020; 23:1184-1190. [PMID: 32283043 DOI: 10.1089/jpm.2019.0626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] Open
Abstract
Background: When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. Objective: To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Design: Consensus methods using the Delphi technique were used. Results: The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). Conclusions: We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.
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Affiliation(s)
- Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Japan
| | | | - Hiroko Sumi
- Nursing Department, Kyoto University Hospital, Kyoto, Japan
| | - Shimon Tashiro
- Department of Sociology, Graduate School of Arts and Letters, Tohoku University, Sendai, Japan
| | - Kaoruko Aita
- Uehiro Division, The Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo, Tokyo, Japan
| | - Tetsuro Shimizu
- Iwate University of Health and Medical Sciences, Morioka, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Go Sekimoto
- Home Palliative Care, Sekimoto Home Care Clinic, Kobe, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | | | - Jun Nagayama
- Division of Palliative Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Eriko Hayashi
- Department of Nursing, Fujisawa Shounandai Hospital, Kanagawa, Japan
| | - Yukie Hisayama
- Patient Family Support Center, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Hirofumi Abo
- Department of Palliative Medicine, Rokko Hospital, Kobe, Japan
| | | | - Masayuki Ikenaga
- Department of Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan
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Ouchi Y, Toba K, Ohta K, Kai I, Shimizu T, Higuchi N, Shimazono S, Iijima S, Suwa S, Nishimura M, Ninomiya H, Aita K. Guidelines from the Japan Geriatrics Society for the decision-making processes in medical and long-term care for the elderly: Focusing on the use of artificial hydration and nutrition. Geriatr Gerontol Int 2018; 18:823-827. [DOI: 10.1111/ggi.13441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kenji Toba
- National Center for Geriatrics and Gerontology; Obu Japan
| | - Kikuko Ohta
- Faculty of Nursing and Medical Care; Keio University; Tokyo Japan
| | - Ichiro Kai
- Graduate School of Humanities and Sociology; The University of Tokyo; Tokyo Japan
| | - Tetsuro Shimizu
- Iwate University of Health and Medical Sciences; Morioka Japan
| | | | | | - Setsu Iijima
- Faculty of Human Sciences; University of Tsukuba; Tsukuba Japan
| | - Sayuri Suwa
- School of Nursing; Chiba University; Chiba Japan
| | | | | | - Kaoruko Aita
- Graduate School of Humanities and Sociology; The University of Tokyo; Tokyo Japan
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Shimada C, Nakazato K, Arai K, Aita K, Shimizu T, Tsuruwaka M, Ishizaki T, Takahashi R. [Communication with important others regarding their preferences for end-of-life care]. Nihon Ronen Igakkai Zasshi 2016; 52:79-85. [PMID: 25786632 DOI: 10.3143/geriatrics.52.79] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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
AIM Our aim in this study was to explore individual factors that make it likely for Japanese older adults to engage in communication with important other persons regarding their preferences for end-of-life care. METHODS We conducted a questionnaire survey of outpatients at Tokyo Metropolitan Geriatric Hospital in the last six days of March 2012. Nine-hundred and sixty-eight outpatients consented in writing to participate in this survey. Two items on the questionnaire concerned the participants' attempts to communicate their preferences regarding end-of-life care; that is, whether they had discussed this issue with their significant others and whether they had written notes indicating how they want to be cared for in the final days of their lives. RESULTS The participants who had designated a surrogate decision-maker were more likely to report answers of both than only discussion (OR=2.52) and less likely to reports answers of no communication than only discussion (OR=0.37). In addition, (a) those who did not wish to rely on artificial nutrition or hydration (OR=0.68) and (b) those who often thought about their death were more likely to be in the only discussion group than in the no communication group, although these factors were not significantly associated with whether the participants were likely to be in the both or only discussion groups. CONCLUSIONS Our findings indicate that individuals often attempt to clarify their preferences in order to make it easier for their significant others to make end-of-life care decision on their behalf, so that they may receive their desired care.
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Akamatsu G, Ikari Y, Ohnishi A, Nishida H, Aita K, Sasaki M, Yamamoto Y, Sasaki M, Senda M. Automated PET-only quantification of amyloid deposition with adaptive template and empirically pre-defined ROI. Phys Med Biol 2016; 61:5768-80. [DOI: 10.1088/0031-9155/61/15/5768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Shimada C, Hirayama R, Nakazato K, Arai K, Ishizaki T, Aita K, Shimizu T, Inamatsu T, Takahashi R. What has become more acceptable? Continuity and changes in older adults' attitudes toward end-of-life care in Japan. Geriatr Gerontol Int 2015; 15:927-8. [DOI: 10.1111/ggi.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chiho Shimada
- Tokyo Metropolitan Institute of Gerontology; Tokyo Japan
| | - Ryo Hirayama
- Tokyo Metropolitan Institute of Gerontology; Tokyo Japan
| | | | - Kazuko Arai
- Tokyo Metropolitan Institute of Gerontology; Tokyo Japan
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Aita K. [End-of-life care in emergency settings in the super-aged society: withholding CPR from frail elderly with severe ADL impairment]. Nihon Rinsho 2013; 71:1089-1094. [PMID: 23855219] [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: 06/02/2023]
Abstract
Emergency and intensive care unit demographics have changed with the advent of the super-aged society in Japan. Japan has the highest population aging rate in the world. It is now predicted that an increasing number of people will die at higher age. The oldest old individuals show increasing frailty, with an excess vulnerability to stressors. It is believed that frail elderly would receive limited benefit from highly invasive emergency treatment and advanced intensive care which, on the contrary, could bring about harmful effects on frail elderly. So far a number of frail oldest-old nursing home residents with cardiopulmonary arrest have been taken by ambulance to emergency medical centers to receive cardio-pulmonary resuscitation in vain in Japan. Now is the time to stop the harmful ritual. Withholding CPR from frail elderly with severe ADL impairment would not constitute an act of ageism but the act of humanity based on medical evidence.
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Affiliation(s)
- Kaoruko Aita
- The Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo
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Aita K. [How to provide medical and nursing care that respects the wishes of older patients with diminished competence]. Nihon Ronen Igakkai Zasshi 2013; 50:487-490. [PMID: 24047660 DOI: 10.3143/geriatrics.50.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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18
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Aita K. [Survey of Japanese geriatricians on their practices and attitude towards artificial nutrition and hydration for patients with end-stage dementia]. Nihon Ronen Igakkai Zasshi 2012; 49:71-4. [PMID: 22466774 DOI: 10.3143/geriatrics.49.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Aita K, Kai I. Physicians' psychosocial barriers to different modes of withdrawal of life support in critical care: A qualitative study in Japan. Soc Sci Med 2009; 70:616-22. [PMID: 19932548 DOI: 10.1016/j.socscimed.2009.10.036] [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] [Received: 02/12/2009] [Indexed: 11/28/2022]
Abstract
Despite a number of guidelines issued in Anglo-American countries over the past few decades for forgoing treatment stating that there is no ethically relevant difference between withholding and withdrawing life-sustaining treatments (LST), it is recognized that many healthcare professionals in Japan as well as some of their western counterparts do not agree with this statement. This research was conducted to investigate the barriers that prevent physicians from withdrawing specific LST in critical care settings, focusing mainly on the modes of withdrawal of LST, in what the authors believe was the first study of its kind anywhere in the world. In 2006-2007, in-depth, face-to-face, semistructured interviews were conducted with 35 physicians working at emergency and critical care facilities across Japan. We elicited their experiences, attitudes, and perceptions regarding withdrawal of mechanical ventilation and other LST. The process of data analysis followed the grounded theory approach. We found that the psychosocial resistance of physicians to withdrawal of artificial devices varied according to the modes of withdrawal, showing a strong resistance to withdrawal of mechanical ventilation that requires physicians to halt the treatment when continuation of its mechanical operation is possible. However, there was little resistance to the withdrawal of percutaneous cardiopulmonary support and artificial liver support when their continuation was mechanically or physiologically impossible. The physicians shared a desire for a "soft landing" of the patient, that is, a slow and gradual death without drastic and immediate changes, which serves the psychosocial needs of the people surrounding the patient. For that purpose, vasopressors were often withheld and withdrawn. The findings suggest what the Japanese physicians avoid is not what they call a life-shortening act but an act that would not lead to a soft landing, or a slow death that looks 'natural' in the eyes of those surrounding the patient. The purpose of constructing such a final scene is believed to fulfill the psychosocial needs of the patient's family and the physicians, who emphasize on how death feels to those surrounding the patient. Unless withdrawing LST would lead to a soft landing, Japanese clinicians, who recognize that the results of withdrawing LST affect not only the patient but those around the patient, are likely to feel that there is an ethically relevant difference between withholding and withdrawing LST.
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Affiliation(s)
- Kaoruko Aita
- The University of Tokyo, Graduate School of Humanities and Sociology, Global COE Programme Death and Life Studies, 7-3-1 Hongo, Bunkyo-ku, Tokyo113-0033, Japan.
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Affiliation(s)
- Kaoruko Aita
- Global Centre of Excellence Program Death and Life Studies, Graduate School of Humanities and Sociology, University of Tokyo, Tokyo 113-0033, Japan.
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21
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Aita K, Kai I. Withdrawal of mechanical ventilation from dying patients at emergency and critical care facilities in Japan: a qualitative study with physicians. ACTA ACUST UNITED AC 2009. [DOI: 10.3893/jjaam.20.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Yamamoto I, Horita S, Takahashi T, Kobayashi A, Toki D, Tanabe K, Hattori M, Teraoka S, Aita K, Nagata M, Yamaguchi Y. Caveolin-1 expression is a distinct feature of chronic rejection-induced transplant capillaropathy. Am J Transplant 2008; 8:2627-35. [PMID: 19032226 DOI: 10.1111/j.1600-6143.2008.02421.x] [Citation(s) in RCA: 21] [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: 01/25/2023]
Abstract
Peritubular capillary basement membrane multilayering (PTCBMML) is a pathological landmark of chronic rejection-induced transplant capillaropathy (TC), but its cellular mechanisms are not fully understood. We observed de novo caveolae formation in endothelial cells in TC under electron microscopy. To examine the role of caveolae and their structural components in TC, biopsy samples from cases of chronic rejection were double-immunostained for Caveolin-1 (Cav-1) and Pathologische Anatomie Leiden-endothelium (PAL-E; a marker of peritubular capillary [PC]). Thirty-two cases of chronic rejection (group I) were compared with 18 cases of interstitial fibrosis and tubular atrophy with no evidence of any specific etiology (IF/TA; group II) and eight cases of peritubular capillaritis (group III). The Cav-1/PAL-E immunoreactivities in groups I-III (%Cav-1/PAL-E) were 41.8+/-23.1%, 8.1+/-7.3% (p < 0.01 vs. group I) and 12.7+/-7.4% (p < 0.01 vs. group I), respectively. Furthermore, multiple linear regression models demonstrated that %Cav-1/PAL-E was independently associated with the PTCBMML grade and reduced PC number. No correlation was observed between %Cav-1/PAL-E and PC C4d deposition in group I. We conclude that de novo caveolae formation in PC endothelia is involved in TC in chronic rejection.
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Affiliation(s)
- I Yamamoto
- Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
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Aita K, Takahashi M, Miyata H, Kai I, Finucane TE. Physicians' attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study. BMC Geriatr 2007; 7:22. [PMID: 17705852 PMCID: PMC1997114 DOI: 10.1186/1471-2318-7-22] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 08/17/2007] [Indexed: 11/25/2022] Open
Abstract
Background The question of whether to withhold artificial nutrition and hydration (ANH) from severely cognitively impaired older adults has remained nearly unexplored in Japan, where provision of ANH is considered standard care. The objective of this study was to identify and analyze factors related to the decision to provide ANH through percutaneous endoscopic gastrostomy (PEG) in older Japanese adults with severe cognitive impairment. Methods Retrospective, in-depth interviews with thirty physicians experienced in the care of older, bed-ridden, non-communicative patients with severe cognitive impairment. Interview content included questions about factors influencing the decision to provide or withhold ANH, concerns and dilemmas concerning ANH and the choice of PEG feeding as an ANH method. The process of data collection and analysis followed the Grounded Theory approach. Results Data analysis identified five factors that influence Japanese physicians' decision to provide ANH through PEG tubes: (1) the national health insurance system that allows elderly patients to become long-term hospital in-patients; (2) legal barriers with regard to limiting treatment, including the risk of prosecution; (3) emotional barriers, especially abhorrence of death by 'starvation'; (4) cultural values that promote family-oriented end-of-life decision making; and (5) reimbursement-related factors involved in the choice of PEG. However, a small number of physicians did offer patients' families the option of withholding ANH. These physicians shared certain characteristics, such as a different perception of ANH and repeated communication with families concerning end-of-life care. These qualities were found to reduce some of the effects of the factors that favor provision of ANH. Conclusion The framework of Japan's medical-legal system unintentionally provides many physicians an incentive to routinely offer ANH for this patient group through PEG tubes. It seems apparent that end-of-life education should be provided to medical providers in Japan to change the automatic assumption that ANH must be provided.
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Affiliation(s)
- Kaoruko Aita
- Department of Social Gerontology, School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Miyako Takahashi
- Department of Social Gerontology, School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, School of Medicine, The University of Tokyo, Japan
| | - Ichiro Kai
- Department of Social Gerontology, School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Thomas E Finucane
- Division of Gerontology and Geriatric Medicine, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
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Aita K, Miyata H, Takahashi M, Kai I. Japanese physicians' practice of withholding and withdrawing mechanical ventilation and artificial nutrition and hydration from older adults with very severe stroke. Arch Gerontol Geriatr 2007; 46:263-72. [PMID: 17561284 DOI: 10.1016/j.archger.2007.04.006] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 04/08/2007] [Accepted: 04/17/2007] [Indexed: 11/16/2022]
Abstract
Amid the lack of legislation or guidelines regarding withholding and withdrawing care in Japan, some physicians who have withdrawn mechanical ventilation from dying patients have recently been subjected to police investigations on suspicion of murder. Under the circumstances, we examined Japanese physicians' attitudes towards mechanical ventilation and artificial nutrition and hydration (ANH) as life-sustaining treatments (LST) to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. Face-to-face, in-depth interviews were conducted with 27 physicians ranging in age from 26 to 70 in 2004 mainly in the Tokyo metropolitan area. The study findings show that the informants held different views towards the two LST because most doctors considered ANH to be indispensable, while they did not think so for mechanical ventilation. Regarding the reasons that lead physicians to consider ANH is indispensable while mechanical ventilation is not, the following factors were identified: ANH's special status as food and water, ordinary/extraordinary, the level of technology, and sense of unnaturalness. Because of its indispensability, ANH is automatically provided, while mechanical ventilation could be withheld in some patients that the physicians have diagnosed to have no hope for recovery. The current legal framework in Japan, which poses legal risks for physicians when withdrawing care, have led some of the physicians to withdraw care in a secret manner, thus causing an unnecessary psychological burden on the physicians. This study indicated that the legal framework has possibly caused troubles in two ways: routinely providing patients with possibly unwanted mechanical ventilation and ANH, and conversely, prompting some doctors to withhold mechanical ventilation in some cases, thereby potentially depriving some patients of a chance to recover. The introduction of the practice of a trial treatment period may be more cogent, considering the inherent uncertainty of diagnoses. The findings of the study also indicated that the physician informants tended to view the value of maintaining the lives of non-communicative patients in terms of the relationships of such patients with others. The vulnerability of patients without strong relationships with others needs to be taken into consideration when compiling guidelines regarding withholding and withdrawing care in Japan.
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Affiliation(s)
- Kaoruko Aita
- Department of Social Gerontology, School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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25
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Aita K, Yamaguchi Y, Horita S, Ohno M, Tanabe K, Fuchinoue S, Teraoka S, Toma H, Nagata M. Thickening of the peritubular capillary basement membrane is a useful diagnostic marker of chronic rejection in renal allografts. Am J Transplant 2007; 7:923-9. [PMID: 17391134 DOI: 10.1111/j.1600-6143.2006.01708.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In kidney transplantation, the multilayering of the peritubular capillary basement membrane (MLPTC) in electron microscopy (EM) has been recognized as a feature of chronic rejection (CR). In this study, thickening of the peritubular capillary (PTC) basement membrane was evaluated by light microscopy (LM) to determine whether it corresponds to the MLPTC in EM and whether it can be used as a diagnostic marker of CR. Forty-eight patients with late renal allograft were divided into chronic allograft nephropathy (CAN) with CR (Group 1, n = 23), CAN without CR (Group 2, n = 19) and CAN-free (Group 3, n = 6). The thickening of the PTC basement membrane (ptcbm) was scored from grades 0 to 2 (ptcbm score), and the MLPTC thickness was measured in EM. Interobserver agreement on ptcbm scores was statistically significant (Kappa coefficient = 0.63). LM and EM lesions corresponded very well. The ptcbm score was highest in Group 1, and ptcbm2 corresponded closely with CR. Group 1 showed significantly thicker MLPTC than Groups 2 and 3. The results validated the usefulness of the ptcbm score and suggested that the thickening of the PTC basement membrane can be a novel diagnostic marker of CR.
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Affiliation(s)
- K Aita
- Department of Molecular Pathology, Institute of Basic Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
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Miyata H, Aita K, Shiraishi H, Kai I. Understanding treatment attitudes toward dementia: differences among community residents and health care professionals. Nihon Koshu Eisei Zasshi 2007; 54:254-61. [PMID: 17533961] [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: 05/15/2023]
Abstract
To examine how the severity of dementia affects attitudes to treatment preferences in a lay group of community residents and a group of medical care professionals who provide direct care to dementia affected patients. The participants were 259 community residents aged between 40 and 65, and 217 care professionals working at nursing homes or group homes. Respondents were randomly assigned to one of two scenarios involving moderate or severe dementia and each was asked questions about their preferences and attitudes to the employment of eight types of active treatments (ATs) to deal with a newly acquired illness as well as eight types of life-sustaining treatment (LST). Among the community residents, there were no significant differences in preferences toward any treatment items between the moderate dementia and severe dementia scenarios. Similarly, care professionals showed no significant differences in attitudes toward 15 of the 16 treatment items. The community residents had more negative attitudes than care professionals in attitudes to all types of LST, including four variations of AT that have a good chance of success. After dementia deprives an individual of decision-making capacity, progress of the disease has little effect on both community residents and care professionals' preferences. When discussing about end-of-life decision-making, care professionals need to be careful about the gaps in perception of good chance treatments with patients.
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Affiliation(s)
- Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Japan
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27
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Nonaka M, Hataya K, Hatakeyama T, Ooga J, Aita K, Maezawa K, Soda H, Koike Y, Sakurai O, Ishida Y, Morohoshi K, Yamano K. [Surgical fixation for flail chest]. Kyobu Geka 2006; 59:966-71; discussion 972-3. [PMID: 17058656] [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: 05/12/2023]
Abstract
Flail chest occurs by blunt chest trauma and is associated with pulmonary contusion, atelectasis, pneumothorax, hemothorax, and respiratory failure. Because of its severity, it may need internal pneumatic stabilization or surgical fixation. Some patients do not need the internal stabilization and are observed conservatively. Some of these patients, however, increase the flail after palliating the pain and getting up. These patients show inefficient ventilation and surgical fixation is needed. The operation should be performed after the improvement of pulmonary contusion. In this paper, we presented 2 patients who showed such course and clarified the surgical methodology.
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Affiliation(s)
- Makoto Nonaka
- Department of Surgery, Yokohama Asahi Central and General Hospital, Yokohama, Japan
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28
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Affiliation(s)
- Kaoruko Aita
- Department of Social Gerontology, School of Health Sciences and Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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29
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Aita K, Shiga J. Herpes simplex virus types 1 and 2 infect the mouse pituitary gland and induce apoptotic cell death. Arch Virol 2004; 149:2443-51. [PMID: 15338324 DOI: 10.1007/s00705-004-0391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 07/02/2004] [Indexed: 10/26/2022]
Abstract
Herpes simplex virus (HSV) infected the anterior lobe of the pituitary gland resulting in cytopathic changes following intravenous (i.v.) inoculation of male mice. Both HSV type 1 (HSV-1) and type 2 (HSV-2) were isolated from pituitary gland following i.v. infection, but not after intraperitoneal inoculation. HSV-infected pituitary cells were microscopically visible beginning at 24 h or 48 h following i.v. inoculation and were localized in the anterior pituitary. In both HSV-1 and -2 infections the pituitary lesions were apoptotic, as determined by light and electron microscopy, TUNEL, and DNA gel electrophoresis. However, the pituitary infection does not appear to be life-threatening since pituitary lesions were also observed following i.v. infection with HSV-1 strain -GC which possesses low virulence. These results suggest that the pituitary gland is one of the target organs of HSV infection.
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Affiliation(s)
- K Aita
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
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Aita K, Yamaguchi Y, Shimizu T, Horita S, Furusawa M, Tanabe K, Fuchinoue S, Toma H. Histological analysis of late renal allografts of antidonor antibody positive patients with C4d deposits in peritubular capillaries. Clin Transplant 2004; 18 Suppl 11:7-12. [PMID: 15191366 DOI: 10.1111/j.1399-0012.2004.00240] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The association of humoral immunity with late renal allograft dysfunction has recently been recognized, and many reports have revealed C4d deposits in peritubular capillaries (C4d in PTC), and the presence of serum antidonor HLA antibody in patients suffering from graft dysfunction, long time after transplantation. In this study, morphological changes in renal allograft biopsies more than 1 year after transplantation in 14 patients with C4d in PTC and serum antidonor antibody were investigated for the presence of chronic rejection (CR). In addition to the light microscope study, an electron microscope study was done to evaluate the multilayering of the peritubular capillary basement membrane (MLPTC). Histologically, only seven of 14 patients met the criteria of CR, and 71.4% (5/7) of CR patients had episodes of acute humoral rejection (AHR), coexisting with acute tubulointerstitial rejection. Peritubular capillaritis was observed in all patients, although it differed in severity. Transplant glomerulitis and interstitial inflammation were also observed in many patients: 71.4% (10/14) and 92.9% (13/14) respectively. MLPTC was observed in 12 patients (85.7%), but the severity of the MLPTC did not reflect the severity of peritubular capillaritis or any other histological features. The long-term outcomes of the patients CR, especially those with episodes of AHR, were poor, and two of them lost their graft functions. On the other hand, patients without CR had relatively favourable outcomes. In conclusion, we confirmed the diverse morphological changes of late renal allografts, which cannot be categorized as chronic humoral rejection (CHR), and such patients who do not have typical morphological changes such as CHR, should be followed-up on a long-term basis in order to clarify the significance of C4d on PTC in late renal allografts.
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Affiliation(s)
- K Aita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.
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31
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Abstract
Replication of herpes simplex virus type 1 (HSV-1) in the adrenal gland of mice was observed 12 h after intravenous inoculation, peaked at 48 h (7 x 10(7) PFU/tissue), and was maintained until death. Virus spread to the bilateral intermediolateral column of the thoracic spinal cord. Infected cells appeared in the fascicular zone of the adrenal cortex 12 h after infection, and cell death was evident in lesions found in the adrenal cortex. Lesions involved the medulla 48 h after inoculation. In cortical lesions, cell nuclei were fragmented or shrunken with little damage to the cytoplasm. DNA fragmentation appeared 12 h after inoculation and increased mainly in cortical lesions, which were characterized by apoptosis induced by HSV-1 infection. In the adrenal medulla, cells were fused and formed multinucleated giant cells but rarely displayed cell death. Macrophages, which serve as a frontal barrier to viral infection in the adrenal gland, especially the cortex, were fewer in number than those found in the liver or spleen. It is likely that HSV-1 easily infects the adrenal gland, resulting in suppression of local immunity, and that adrenal cell apoptosis serves as a primitive type of immunity to limit viral replication.
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Affiliation(s)
- K Aita
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
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32
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Aita K, Jin Y, Irie H, Takahashi I, Kobori K, Nakasato Y, Kodama H, Yanagawa Y, Yoshikawa T, Shiga J. Are there histopathologic characteristics particular to fulminant hepatic failure caused by human herpesvirus-6 infection? A case report and discussion. Hum Pathol 2001; 32:887-9. [PMID: 11521236 DOI: 10.1053/hupa.2001.26477] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 8-month-old boy was admitted to a neighboring hospital for severe liver dysfunction and drowsiness 4 days after a diagnosis of exanthem subitum. A diagnosis of fulminant hepatic failure was made, and liver biopsy was performed during the acute stage. The presence of human herpesvirus-6 variant B (HHV-6B) DNA was shown in liver tissue by polymerase chain reaction (PCR) and in the endothelium of the portal vein by in situ hybridization (ISH). Histologic examination showed microvesicular steatosis resembling that of Reye's syndrome, even though aspirin had not been prescribed. We considered HHV-6 to be the causative agent in this case and report what is perhaps the first precise histologic description of fulminant hepatic failure caused by HHV-6.
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Affiliation(s)
- K Aita
- Department of Pathology, Central Laboratory for Electron Microscopy, Teikyo University School of Medicine, Tokyo, Japan
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33
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Abstract
The density of pulmonary neuroendocrine cells (PNECs) in 21 sudden infant death syndrome (SIDS) cases, 19 controls, and 25 fetuses was studied morphometrically. Formalin-fixed, paraffin-embedded lung samples were immunostained with antibody against chromogranin A (CGA). The percentage of PNEC-positive airways and the density of PNECs in each airway were calculated in all cases. The density of PNECs was expressed as the number of cells per millimeter of basement membrane. The percentage of PNEC-positive airways reached nearly 100% by term and did not change significantly until 12 months of age in both the SIDS cases and the controls. The density of PNECs also showed a rapid increase in the saccular stage fetus and had its peak of about 4 cells/mm around birth. The density of PNECs, including the standard deviation, was higher in SIDS cases than in controls. The uneven distribution of PNECs may affect respiratory control in SIDS victims.
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Affiliation(s)
- K Aita
- Department of Legal Medicine, Institute of Community Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
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34
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Aita K, Doi M, Tanno K, Oikawa H, Ohashi N, Misawa S. Quantitative analysis of pulmonary neuroendocrine cell distribution of the fetal small airways using double-labeled immunohistochemistry. Forensic Sci Int 2000; 113:183-7. [PMID: 10978622 DOI: 10.1016/s0379-0738(00)00260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pulmonary neuroendocrine cells (PNECs) are supposed to play an essential role in development of fetal lung and neonatal respiratory adaptation. Some previous studies have suggested the close relation between PNECs and sudden infant death syndrome (SIDS). To investigate how PNECs distribute to the thermal bronchioli of fetal lung may be a clue to clarify this relation. Since it is difficult to distinguish bronchiole from alveolus in fetal lung, we performed double immunostaining with antibody against chromogranin A (CGA) and alpha-smooth muscle actin (SMA) which can make clear distinction between them. In this study, formalin-fixed, paraffin-embedded lung tissues from 18 autopsy cases from 16 to 28 weeks of gestation were assessed. CGA immunopositive cells were counted and the length of basement membranes of terminal bronchioli was measured with computed image analyzer. Density of PNECs was expressed as the number of immunopositive cells per millimeter of basement membrane. Terminal bronchiole stained with SMA was clearly distinguished from alveolus at 16 weeks. With gestational age, CGA immunopositive PNECs were gradually increased in 2 folds by the 25th week. After that, their density wasn't changed significantly until termination. It is suggested that PNECs in terminal bronchiole was playing an important role in morphogenesis of alveolar ducts and alveolar sacks.
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Affiliation(s)
- K Aita
- Department of Legal Medicine, Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan.
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35
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Tanno K, Kohno M, Ohashi N, Ono K, Aita K, Oikawa H, Honda K, Misawa S. Patterns and mechanisms of pedestrian injuries induced by vehicles with flat-front shape. Leg Med (Tokyo) 2000; 2:68-74. [PMID: 12935445 DOI: 10.1016/s1344-6223(00)80026-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To clarify the difference between flat-front vehicles and bonnet-front vehicles with regard to the patterns and mechanisms of vehicle-induced pedestrian injuries, we investigated 101 cases of pedestrians who were struck by the front of a vehicle. There were 33 flat-front vehicle collision cases and 68 bonnet-front vehicle collision cases. The frequency of chest injuries in flat-front vehicle collisions (30.3%) was significantly higher than that in bonnet-front vehicle collisions (11.8%). Lower leg fractures were more common in bonnet-front vehicle collisions than in flat-front vehicle collisions. Although head injuries were common in both cases, the mechanisms of these injuries differed. The pedestrians who were struck by flat-front vehicles tended to sustain more severe injuries at lower impact speeds. All of these results stem from the difference in the front shape of the two types of vehicle. Pedestrians who are struck by the front of flat-front vehicles receive the impact force to the trunk, particularly the chest, at the initial impact and are thrown out forward after the impact, because the front of these vehicles is perpendicular to the road.
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Affiliation(s)
- K Tanno
- Tsukuba Medical Examiner's Office, Ibaraki 305-8558, Japan
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36
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Irie H, Aita K. [Role of apoptosis induced by acute herpes simplex virus]. Nihon Rinsho 2000; 58:794-800. [PMID: 10774197] [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: 02/16/2023]
Abstract
Apoptosis is induced by acute herpes simplex viral infection in the adrenal cortex, myenteric plexus of the gut, ovary, and liver of mice. Viral replication is closely related to apoptosis. This apoptosis is increased in immunosuppressive regions like the adrenal cortex and liver of macrophag-depleted mice. However, the herpes simplex virus is known to possess US3 gene, which interferes with cell apoptosis. In the liver of macrophage-depleted mice infected with US3 gene-deficient mutant herpes, the apoptosis is confined to within the narrow limits of inflammatory cell infiltration, mainly of neutrophils, and it plays a part in the restriction of virus multiplication. Thus, a possibility exists that apoptosis works as a primitive immunity in herpes simplex virus infection.
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Affiliation(s)
- H Irie
- Department of Pathology, Teikyo University School of Medicine
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37
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Irie H, Koyama H, Kubo H, Fukuda A, Aita K, Koike T, Yoshimura A, Yoshida T, Shiga J, Hill T. Herpes simplex virus hepatitis in macrophage-depleted mice: the role of massive, apoptotic cell death in pathogenesis. J Gen Virol 1998; 79 ( Pt 5):1225-31. [PMID: 9603338 DOI: 10.1099/0022-1317-79-5-1225] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Infection with herpes simplex virus or hepatitis viruses can lead to fulminant hepatitis, but there is controversy about the underlying conditions needed for such disease. To investigate how the impairment of host defences might be involved, macrophages were depleted by administration of silica to mice before intravenous injection with herpes simplex virus type 1 (HSV-1). Such mice died rapidly and their livers were yellowish and shrunken (acute yellow atrophy), and occasionally grossly haemorrhagic. Small foci of apoptotic cells developed in the liver lobules; these rapidly became confluent and zonal over time. The overall lesion pattern was similar to massive hepatic necrosis, and there was extensive HSV replication in the liver lesions. In the liver, DNA fragmentation characteristic of apoptosis followed the time course of HSV-1 propagation. These findings suggest that one of the underlying conditions for fulminant viral hepatitis may be inadequate macrophage response, and that the massive hepatic damage, often defined as cell necrosis, may actually be apoptosis of liver cells subsequent to virus infection.
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MESH Headings
- Alanine Transaminase/blood
- Animals
- Apoptosis
- Aspartate Aminotransferases/blood
- DNA Fragmentation
- Disease Models, Animal
- Hepatitis, Viral, Animal/immunology
- Hepatitis, Viral, Animal/pathology
- Hepatitis, Viral, Animal/physiopathology
- Hepatitis, Viral, Animal/virology
- Herpesvirus 1, Human/immunology
- Herpesvirus 1, Human/physiology
- Humans
- Liver/pathology
- Liver/virology
- Macrophages/immunology
- Male
- Mice
- Mice, Inbred C3H
- Virus Replication
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Affiliation(s)
- H Irie
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.
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Abe Y, Nakano S, Aita K, Sagishima M. Streptococcal and staphylococcal superantigen-induced lymphocytic arteritis in a local type experimental model: comparison with acute vasculitis in the Arthus reaction. J Lab Clin Med 1998; 131:93-102. [PMID: 9452132 DOI: 10.1016/s0022-2143(98)90082-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many pathogenic bacteria produce superantigenic exotoxins. To study their pathogenetic role, in particular to test whether these toxins are able to induce vasculitis, we developed a local-type experimental model in rabbits. Toxins were injected along the intermediate auricular artery of the ear. The histology of ear skin, including the artery, was examined after single or repeated injections. Repeated injections of streptococcal erythrogenic toxins produced chronic-type arteritis characteristic of lymphocytic infiltration, whereas single injection induced no acute-type vasculitis. Staphylococcal enterotoxin B and toxic shock syndrome toxin-1 also induced the same type of arteritis, although weaker in degree. In human patients these lesions are similar to those of Kawasaki disease, a systemic vasculitis with unknown etiology. The Arthus reaction to human serum albumin in immunized rabbits included acute-type vasculitis similar to polyarteritis nodosa when examined in this model. Microvasculitis lesions similar to leukoclastic vasculitis were combined in the Arthus reaction but not in the superantigen-induced lesions. Our experimental model described here is widely applicable to the study of the etiology and pathogenesis of human diseases involving vasculitis lesions.
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Affiliation(s)
- Y Abe
- Department of Pathology, Teikyo University School of Medicine, Tokyo, Itabashi, Japan
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39
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Abe Y, Nakano S, Aita K, Sagishima M. Erythrogenic toxin-induced arteritis in a rabbit ear model. Comparison with Arthus reaction angiitis. Adv Exp Med Biol 1997; 418:805-7. [PMID: 9331774 DOI: 10.1007/978-1-4899-1825-3_190] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We have developed a local type experimental model of angiitisin rabbits. Repeated intracutaneous injections of erythrogenic toxins types A and C (ETA, ETC) along the intermediate auricular artery of the rabbit ear produced subacute type arteritis, characteristic of lymphocyticinfiltration, simulating Kawasaki disease angiitis. Staphylococcal enterotoxin B (SEB) and toxic shock syndrome toxin 1 (TSST) also induced similar lesions, indicating superantigens as inflammogens in vivo. Conversely, the Arthus reaction included acute type angiitis when tested similarly in rabbits immunized to human serum albumin. The ear artery was infiltrated by heterophil leukocytes, often together with venules and capillaries affected, resembling periarteritis nodosa and leukoclastic vasculitis in human disease.
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Affiliation(s)
- Y Abe
- Department of Pathology, School of Medicine, Teikyo University, Tokyo, Japan
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40
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Higashi S, Nishimura H, Aita K, Iwanaga S. Identification of regions of bovine factor VII essential for binding to tissue factor. J Biol Chem 1994; 269:18891-8. [PMID: 8034645] [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: 01/28/2023] Open
Abstract
Initiation of the extrinsic blood coagulation pathway is mediated by a complex formed between plasma-derived factor VII/VIIa and cell-derived tissue factor (TF). To identify the site(s) of interaction, zymogen VII and VIIa were enzymatically and chemically modified, and their affinities for TF were estimated by measuring their inhibitory effects on the amidolytic activity enhanced after formation of the VIIa-TF complex. We found that the VIIa-light chain (Ki = 3.5 x 10(-7) M) and its fragment consisting of the gamma-carboxyglutamic acid (Gla)-domain and the first epidermal growth factor (EGF)-like domain (Gla-EGF1 peptide; Ki = 1.0 x 10(-6) M) have an affinity for TF. Therefore, one of the binding sites of VII with TF is probably located in the Gla-EGF1 region. On the other hand, a dansyl-Glu-Gly-Arg chloromethyl ketone-treated Gla-domainless VIIa (Ki = 0.7 x 10(-7) M) showed a high affinity for TF, whereas the corresponding Gla-domainless VII similarly treated showed no binding potential, thereby indicating that binding site(s) other than in the Gla-EGF1 region are present in VIIa but not in VII. Acetylation or carbamylation of the alpha-amino group of the NH2-terminal Ile-153 of VIIa resulted in the loss of binding affinity for TF; such modifications convert VIIa into a zymogen-like inactive form by destroying the salt bridge between Ile-153 and Asp-343 in VIIa. The rate of carbamylation of VIIa was reduced in the presence of TF. Protection of the alpha-amino group of Ile-153 from carbamylation after complex formation was consistent with salt bridge formation between Ile-153 and Asp-343 in the VIIa-TF complex. Therefore, binding of TF with the heavy chain of VIIa may induce a conformational change that brings the alpha-amino group of Ile-153 close to the beta-carboxyl group of Asp-343 to make a stable salt bridge.
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Affiliation(s)
- S Higashi
- Department of Molecular Biology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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Aoba H, Aita K, Nakagawa K, Takahashi K, Hirano M. The effect of circulatory disturbance on placental alkaline phosphatase in rats. TOHOKU J EXP MED 1972; 108:19-23. [PMID: 4648389 DOI: 10.1620/tjem.108.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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43
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Okano T, Aita K, Ikeda K. Electronic properties of N-heteroaromatics. XII. On the mode of interaction between theophylline and ethylenediamine in aqueous solution. Chem Pharm Bull (Tokyo) 1967; 15:1621-5. [PMID: 5583816 DOI: 10.1248/cpb.15.1621] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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44
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Okano T, Aita K. [Electronic properties of N-heteroaromatics. XI. Interaction of p-benzoquinone with caffeine and theophylline]. YAKUGAKU ZASSHI 1967; 87:1243-7. [PMID: 5626995 DOI: 10.1248/yakushi1947.87.10_1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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