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Tsuji H, Kuramoto N, Sasai T, Shirakashi M, Onizawa H, Kitagori K, Akizuki S, Nakashima R, Watanabe R, Onishi A, Murakami K, Yoshifuji H, Tanaka M, Hashimoto M, Ohmura K, Morinobu A. AB0653 The association of autoantibodies with morbidity and mortality of scleroderma renal crisis in Japan. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe morbidity of scleroderma renal crisis (SRC) and autoantibodies in systemic sclerosis (SSc) vary by races and regions. Anti-RNA polymerase III is associated with SRC in America and European countries. However, the association of autoantibodies with SRC had not been elucidated in Japan.ObjectivesWe aimed to investigate the association of autoantibodies with morbidity and mortality of SRC in Japan.MethodsThe clinical characteristics and mortality of 330 patients with systemic sclerosis (SSc) at Kyoto University Hospital were retrospectively analyzed, focusing on anti-centromere, anti-RNA polymerase III, anti-topoisomerase I, and anti-U1-RNP. Logistic regression analyses were performed to examine the association of autoantibodies with the development and mortality of SRC. Kaplan-Meier survival analysis was performed comparing the groups classified by autoantibodies.ResultsAnti-centromere (n = 177/318, 56%), anti-topoisomerase I (n = 80/311, 26%), anti-RNA polymerase III (n = 27/204, 13%), and anti-U1-RNP (n = 24/305, 8%) were found in SSc patients (n = 330). SRC was observed in 24 out of 330 SSc patients, including anti-topoisomerase I (n = 12/24, 50%), anti-RNA polymerase III (n = 7/24, 29%), anti-U1-RNP (n = 5/24, 21%), and anti-centromere (n = 3/24, 13%). Anti-U1-RNP (odds ratio [95% confidence interval], 3.63 [1.11–10.2]), anti-RNA polymerase III (3.29 [1.16–8.70]), and anti-topoisomerase I (3.22 [1.37–7.57]) were associated with the development of SRC. All patients with SRC were treated with ACE inhibitors and the 1-year survival rate was 54%. Anti-topoisomerase I was associated with the 1-year mortality of SRC (6.00 [1.11–41.1]). When the survival rate was compared between the patients positive for anti-topoisomerase I (n=12) and negative for anti-topoisomerase I (n=12), the 1-year survival rate was 33% vs 75% (p=0.041), respectively (Figure 1A). Furthermore, the 1-year survival of anti-centromere (100%), anti-RNA polymerase III (83%), and others/not detected (50%) were shown in patients negative for anti-topoisomerase I (Figure 1B).Figure 1.Overall survival of patients with SRC according to the type of autoantibodies.(A) The survival rates in SRC patients who were positive for anti-topoisomerase I (solid line, n = 12) and those who were negative for anti-topoisomerase I (dotted line, n = 12).(B) SRC patients negative for anti-topoisomerase I were classified as patients with anti-RNA polymerase III (dotted line, n = 6), anti-centromere (broken line, n = 2), and others/not detected (chain line, n = 4).ConclusionSpecific SSc-related autoantibodies were associated with the morbidity and mortality in SRC.References[1]Nihtyanova SI, et al. Arthritis Rheumatol 2020;72(3):465-76.[2]Hamaguchi Y, et al. Arthritis Rheumatol 2015;67(4):1045-52.Table 1.Univariate logistic regression analysis for mortality in SRC (n = 24).VariablesOdds ratio (95% CI)P valueAge1.07 (0.99, 1.16)0.08Female sex3.00 (0.32, 66.6)0.38Diffuse/limited (diffuse %)0.25 (0.04, 1.36)0.12BMI0.67 (0.41, 0.93)0.049Modified Rodnan skin score0.95 (0.88, 1.02)0.15Digital ulcer0.52 (0.10, 2.63)0.43Reflux esophagitis0.60 (0.02, 17.1)0.73Pulmonary hypertension7.50 (1.17, 69.2)0.046Pleural effusion7.20 (1.23, 62.0)0.04Glucocorticoid use3.86 (0.65, 32.4)0.16Hemoglobin0.55 (0.25, 1.01)0.09Platelet1.00 (0.98, 1.01)0.44Total protein0.17 (0.02, 0.69)0.04Creatinine0.95 (0.67, 1.24)0.69CRP0.90 (0.67, 1.17)0.46Anti-topoisomerase I6.00 (1.11, 41.1)0.048Anti-centromere7.4x10-9 (--, 0.93)1.00Anti-RNA polymerase III0.36 (0.04, 2.18)0.29Anti-U1-RNP0.74 (0.08, 5.49)0.77Disclosure of InterestsNone declared
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Tsuji H, Kuramoto N, Sasai T, Shirakashi M, Onizawa H, Kitagori K, Akizuki S, Nakashima R, Watanabe R, Onishi A, Murakami K, Yoshifuji H, Tanaka M, Hashimoto M, Ohmura K, Morinobu A. Autoantibody profiles associated with morbidity and mortality in scleroderma renal crisis. Rheumatology (Oxford) 2022; 61:4130-4135. [PMID: 35078211 DOI: 10.1093/rheumatology/keac047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the association of autoantibodies with scleroderma renal crisis (SRC) among Japanese patients. METHODS The clinical characteristics and mortality of 330 patients with systemic sclerosis (SSc) at Kyoto University Hospital were retrospectively analyzed, focusing on anti-topoisomerase I, anti-centromere, anti-RNA polymerase III (RNAPIII), and anti-U1-RNP. Logistic regression analyses were performed to examine the association of autoantibodies with the development and mortality of SRC. RESULTS SRC was observed in 24 out of 330 SSc patients, including anti-topoisomerase I (n = 12/24, 50%), anti-RNAPIII (n = 7/24, 29%), anti-U1-RNP (n = 5/24, 21%), and anti-centromere (n = 3/24, 13%). Anti-U1-RNP (odds ratio [95% confidence interval], 3.63 [1.11-10.2]), anti-topoisomerase I (3.22 [1.37-7.57]), and anti-RNAPIII (3.29 [1.16-8.70]) were associated with the development of SRC. Furthermore, anti-topoisomerase I (6.00 [1.11-41.1]) was associated with the 1-year mortality of SRC. The 1-year survival rate after the onset of SRC among all patients and those positive for anti-topoisomerase I was 54% and 33%, respectively. In contrast, the survival rate in patients negative for anti-topoisomerase I was 75%, of which the survival rate of patients positive for anti-RNAPIII and anti-centromere was 83% and 100%, respectively. CONCLUSION Specific SSc-related autoantibodies were associated with the morbidity and mortality of SRC.
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Kuramoto N, Saito S, Fujii T, Kaneko Y, Saito R, Tanaka M, Takada H, Nakano K, Saito K, Sugimoto N, Sasaki S, Harigai M, Suzuki Y. Characteristics of rheumatoid arthritis with immunodeficiency-associated lymphoproliferative disorders to regress spontaneously by the withdrawal of methotrexate and their clinical course: A retrospective, multicenter, case-control study. Mod Rheumatol 2022; 32:24-31. [PMID: 33496194 DOI: 10.1080/14397595.2021.1879362] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate clinical characteristics and time course of lymphoproliferative disorders (LPDs) in rheumatoid arthritis (RA) patients after methotrexate (MTX) discontinuation, in those who achieved spontaneous regression (SR). METHODS We retrospectively reviewed clinical data from RA patients with LPDs obtained from eight institutions between 2000 and 2017 and compared clinical and pathological findings between SR and non-SR groups. RESULTS Among 232 RA patients with LPDs, 216 were treated with MTX at the onset of LPD and 144 (66.7%) achieved SR after MTX discontinuation. Higher MTX doses, high titers of anti-CCP antibodies (>13.5 U/mL), and lower LDH and soluble IL-2 receptor levels were associated with SR. Lymphocyte count was decreased at LPD onset and increased at 2 weeks after MTX discontinuation in the SR group. Epstein-Barr virus-positive mucocutaneous ulcer, reactive lymphoid hyperplasia and unclassifiable B-cell lymphoma, were more frequent in the SR than in the non-SR group. In multivariable analysis, diffuse large B-cell lymphomas was an independent predictive factor for non-SR. In the patients with SR, 73.9% achieved partial or complete regression as early as 2 weeks after MTX discontinuation. CONCLUSION SR and non-SR in RA patients with LPDs after MTX discontinuation were associated with certain clinical characteristics.
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Takada H, Kaneko Y, Nakano K, Tanaka M, Fujii T, Saito K, Sugimoto N, Sasaki S, Saito S, Saito R, Kuramoto N, Harigai M, Suzuki Y. Clinicopathological characteristics of lymphoproliferative disorders in 232 patients with rheumatoid arthritis in Japan: A retrospective, multicenter, descriptive study. Mod Rheumatol 2022; 32:32-40. [PMID: 33705243 DOI: 10.1080/14397595.2021.1899570] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the clinicopathological characteristics of lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA). METHODS In this multicenter case series, we retrospectively reviewed the medical records of RA patients who were newly diagnosed as having LPDs with or without biopsy confirmation between 2000 and 2017 in eight hospitals in Japan. RESULTS We included 232 patients with LPDs. The median age was 67 years (interquartile range [IQR], 60-73 years), and 77.1% were female. At the time of LPD diagnosis, 94.8% and 62.6% of the patients were methotrexate users and in remission or had low RA disease activity, respectively; lymphadenopathy and extranodal involvement were present in 77.1% and 51.9%, respectively. Major extranodal sites were the lungs and oral/oropharyngeal mucosa. The most common LPD pathological subtype was diffuse large B-cell lymphoma (40.5%), followed by classic Hodgkin lymphoma (10.8%), Epstein-Barr virus-positive mucocutaneous ulcer (7.7%), and reactive lymphoid hyperplasia (6.2%). The clinical and laboratory characteristics varied across the pathological subtypes. CONCLUSION LPD occurred mainly in methotrexate users, while RA disease activity did not seem to be associated with LPD development. Although the clinical manifestations vary among pathological subtypes, manifestations of LPD in patients with RA can include lymphadenopathy, extranodal mass, and mucocutaneous ulcer.
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Saito R, Tanaka M, Ito H, Kuramoto N, Fujii T, Saito S, Kaneko Y, Nakano K, Saito K, Takada H, Sugimoto N, Sasaki S, Harigai M, Suzuki Y. Overall survival and post-spontaneous regression relapse-free survival of patients with lymphoproliferative disorders associated with rheumatoid arthritis: a multi-center retrospective cohort study. Mod Rheumatol 2021; 32:50-58. [PMID: 33336615 DOI: 10.1080/14397595.2020.1866837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To clarify factors affecting 5-year survival rates and relapse rates after spontaneous regression (SR) of lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA). METHODS This retrospective longitudinal study comprised 232 patients with RA diagnosed with LPDs between January 2000 and March 2017 at eight hospitals in Japan. The Kaplan-Meier method was used to analyze survival and the Cox proportional hazard model was applied to identify predictive factors. RESULTS Among all patients, 1-, 2- and 5-year overall survival rates were 89.5%, 86.1%, and 78.2%, respectively. Multivariable analysis revealed four 5-year survival risk factors assessed at diagnosis: age above 70 years (p = .002), deep lymphadenopathy and/or more than one extranodal lesion (p = .008), Eastern Cooperative Oncology Group/Zubrod performance status of 2-4 (p = .004), and classic Hodgkin lymphoma (CHL) histology (p = .047). Among 143 patients who achieved SR, 2- and 5-year relapse rates were 14.2% and 24.9%, respectively. CHL histology (p = .003) and serum soluble interleukin-2 receptor levels exceeding 2000 IU/L (p = .014) were associated with post-SR relapse-free survival. Blood lymphocyte counts were significantly lower at relapse than at 3-6 months prior (p < .001). CONCLUSION Assessment of the above risk factors and routine inspection of blood lymphocyte counts could aid in the care management of LPDs in RA.
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Nakano K, Tanaka Y, Saito K, Kaneko Y, Saito S, Tanaka M, Saito R, Fujii T, Kuramoto N, Sugimoto N, Takada H, Harigai M, Sasaki S, Suzuki Y. Treatment of rheumatoid arthritis after regression of lymphoproliferative disorders in patients treated with methotrexate: a retrospective, multi-center descriptive study. Mod Rheumatol 2020; 32:41-49. [PMID: 33164614 DOI: 10.1080/14397595.2020.1847775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify the optimal treatment for rheumatoid arthritis (RA) after the regression of lymphoproliferative disorders (LPDs). METHODS The subjects were 232 patients with RA who developed LPD between 2000 and 2017 at seven hospitals participating in the LPD-WG study. Kaplan-Meier and Cox proportional regression analyses were performed to determine the factors associated with the rate of LPD relapse and the retention of biological disease-modifying antirheumatic drugs (bDMARDs). RESULTS Treatment for RA was resumed in 138 patients after spontaneous regression of LPD after the discontinuation of methotrexate and in 52 patients after chemotherapy for LPD (persistent-LPD). LPD relapses occurred in 23 patients. Not DMARDs use but Hodgkin's lymphoma was identified as a risk factor for LPD relapse. In 88 RA patients treated with bDMARDs [tocilizumab, 39 patients; abatacept 20 patients; tumor necrosis factor inhibitor, 29 patients], the one-year retention rate was 67.8%. The risk factors for discontinuation of bDMARDs were persistent-LPD, non-diffuse large B-cell lymphomas (non-DLBCL), and a high clinical disease activity index (CDAI). Tocilizumab showed the highest retention rate among bDMARDs, particularly in DLBCL. CONCLUSION Although any bDMARD could be used in patients after LPD regression, effectiveness and risk for relapse should be carefully assessed for each LPD subtype.
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Nakayama Y, Taura D, Shibue K, Kuramoto N, Mimori T, Inagaki N. A case of systemic lupus erythematosus complicated by subclinical Cushing's syndrome: case report. Mod Rheumatol Case Rep 2020; 4:16-20. [PMID: 33086965 DOI: 10.1080/24725625.2019.1638049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/24/2019] [Indexed: 06/11/2023]
Abstract
An 18-year-old female was diagnosed with subclinical Cushing's syndrome (CS) due to a left adrenal adenoma. When she was 20 years old, she developed lupus nephritis. She was treated with high-dose prednisolone (PSL) and soon developed the symptoms of CS. When she was 25 years old, we evaluated her serum glucocorticoid level while she continued to take oral PSL. The result suggested her CS was affected by both the oral PSL and the endogenous cortisol secreted by the adrenocortical adenoma, which was therefore resected. Seven months after the operation, the patient's body weight was decreasing, and her SLE remained in clinical remission. CS complicated by SLE is rare, and the decision to surgically remove an adrenal tumor in such a case is even more rare.
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Takeuchi Y, Hashimoto M, Nakashima R, Tanaka M, Kuramoto N, Murakami K, Yoshifuji H, Ohmura K, Mimori T. Anti-EJ, anti-MDA5 double-positive chronic clinically amyopathic dermatomyositis: a case report. Rheumatol Adv Pract 2018; 2:rky022. [PMID: 31431968 PMCID: PMC6649910 DOI: 10.1093/rap/rky022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/27/2018] [Indexed: 11/14/2022] Open
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Nakabo S, Hashimoto M, Ito S, Furu M, Ito H, Fujii T, Yoshifuji H, Imura Y, Nakashima R, Murakami K, Kuramoto N, Tanaka M, Satoh J, Ishigami A, Morita S, Mimori T, Ohmura K. Carbamylated albumin is one of the target antigens of anti-carbamylated protein antibodies. Rheumatology (Oxford) 2017; 56:1217-1226. [PMID: 28398552 PMCID: PMC5850724 DOI: 10.1093/rheumatology/kex088] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives. Anti-carbamylated protein (anti-CarP) antibodies are detected in RA patients. Fetal calf serum is used as an antigen source in anti-CarP ELISA, and the precise target antigens have not been found. We aimed to identify the target antigens of anti-CarP antibodies. Methods. Western blotting of anti-CarP antibodies was conducted. Anti-carbamylated human albumin (CarALB) antibody was detected by in-house ELISA for 493 RA patients and 144 healthy controls (HCs). An inhibition ELISA of anti-CarP antibodies by CarALB and citrullinated albumin (citALB) was performed using eight RA patients’ sera. Serum CarALB was detected by liquid chromatography–tandem mass spectroscopy (LC/MS/MS), and the serum MPO concentration was measured by ELISA. Results. We focused on carbamylated albumin because it corresponded to the size of the thickest band detected by western blotting of anti-CarP antibodies. Anti-CarALB antibody was detected in 31.4% of RA patients, and the correlation of the titres between anti-CarALB and anti-CarP was much closer than that between anti-citALB and anti-CCP antibodies (ρ = 0.59 and ρ = 0.16, respectively). The inhibition ELISA showed that anti-CarP antibodies were inhibited by CarALB, but not by citALB. CarALB was detected in sera from RA patients by LC/MS/MS. The serum MPO concentration was correlated with disease activity and was higher in RA patients with anti-CarALB antibody than in those without. Conclusion. We found that carbamylated albumin is a novel target antigen of anti-CarP antibodies, and it is the first reported target antigen that has not been reported as the target of ACPA.
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Takeuchi Y, Murakami K, Kuramoto N, Nakashima R, Hashimoto M, Imura Y, Yoshifuji H, Ohmura K, Mimori T. Clinical Images: Chronic Nonbacterial Osteomyelitis. Arthritis Rheumatol 2017; 69:1660. [DOI: 10.1002/art.40108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 11/08/2022]
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Nakabo S, Yoshifuji H, Hashimoto M, Imura Y, Nakashima R, Murakami K, Kuramoto N, Ito S, Satoh J, Tanaka M, Fujii T, Mimori T, Ohmura K. Anti-carbamylated Protein Antibodies Are Detectable in Various Connective Tissue Diseases. J Rheumatol 2017; 44:1384-1388. [DOI: 10.3899/jrheum.161432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
Abstract
Objective.Anti-carbamylated protein (anti-CarP) antibodies are possible diagnostic biomarkers of anticitrullinated protein antibody (ACPA)-negative rheumatoid arthritis (RA). We aimed to elucidate the prevalence of anti-CarP antibodies in non-RA connective tissue diseases (CTD) because CTD are important in the differential diagnosis of ACPA-negative RA.Methods.The sera from 266 patients with RA and 616 patients with CTD and 80 healthy controls were examined using an in-house anti-CarP ELISA.Results.The prevalence and the level of anti-CarP antibodies in several CTD were comparable to those in ACPA-negative RA.Conclusion.Anti-CarP antibodies are not useful for differentiating ACPA-negative RA from CTD.
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Nakajima T, Yoshifuji H, Murakami K, Kuramoto N, Nakashima R, Imura Y, Ohmura K, Terao C, Mimori T. WS3_1 The Synergistic Effects of HLA-B*52 and Risk Allele at a SNP in IL12B Region on Complication of Aortic Regurgitation in Patients with Takayasu Arteritis. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kuramoto N, Terao C, Ohmura K, Ikari K, Furu M, Yamakawa N, Yano K, Hashimoto M, Ito H, Fujii T, Murakami K, Sasai R, Imura Y, Yoshihuji H, Yukawa N, Taniguchi A, Momohara S, Yamanaka H, Matsuda F, Mimori T. AB0230 Centromere Pattern Exhibits A Specific Distribution of Titers among Anti-Nuclear Antibodies (ANAS) and Characterizes A Distinct Subset in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Morimoto T, Sakuma M, Matsui K, Kuramoto N, Toshiro J, Murakami J, Fukui T, Saito M, Hiraide A, Bates DW. Incidence of adverse drug events and medication errors in Japan: the JADE study. J Gen Intern Med 2011; 26:148-53. [PMID: 20872082 PMCID: PMC3019321 DOI: 10.1007/s11606-010-1518-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/30/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The epidemiology of adverse drug events (ADEs) and medication errors has received little evaluation outside the U.S. and Europe, and extrapolating from these data might not be valid, especially regarding selecting and prioritizing solutions. OBJECTIVE To assess the incidence and preventability of ADEs and medication errors in Japan. DESIGN The Japan Adverse Drug Events (JADE) study was a prospective cohort study. PATIENTS A cohort of 3,459 adults admitted to a stratified random sample of seven medical and eight surgical wards and three intensive care units in three tertiary care hospitals over 6 months. MAIN MEASURES We measured ADE and medication error rates from daily reviews of charts, laboratories, incident reports, and prescription queries by on-site reviewers; presence of a signal was considered an incident. Two independent physicians reviewed incidents to determine whether they were ADEs or medication errors and to assess severity and preventability. KEY RESULTS We identified 1,010 ADEs and 514 medication errors (incidence: 17.0 and 8.7 per 1,000 patient-days, respectively) during the study period. Among ADEs, 1.6%, 4.9% and 33% were fatal, life-threatening and serious, respectively. Among ADEs, 14% were preventable. The rate per admission was 29 per 100 admissions, higher than in U.S. studies because associated with of the long length of hospital stay in Japan (mean, 17 days). CONCLUSIONS The epidemiology and nature of ADEs and medication errors in Japan were similar to other countries, although more frequent per admission. Solutions that worked in these countries might thus improve medication safety in Japan, as could shortening hospital length of stay.
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Andreas B, Azuma Y, Bartl G, Becker P, Bettin H, Borys M, Busch I, Gray M, Fuchs P, Fujii K, Fujimoto H, Kessler E, Krumrey M, Kuetgens U, Kuramoto N, Mana G, Manson P, Massa E, Mizushima S, Nicolaus A, Picard A, Pramann A, Rienitz O, Schiel D, Valkiers S, Waseda A. Determination of the Avogadro constant by counting the atoms in a 28Si crystal. PHYSICAL REVIEW LETTERS 2011; 106:030801. [PMID: 21405263 DOI: 10.1103/physrevlett.106.030801] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/09/2010] [Indexed: 05/30/2023]
Abstract
The Avogadro constant links the atomic and the macroscopic properties of matter. Since the molar Planck constant is well known via the measurement of the Rydberg constant, it is also closely related to the Planck constant. In addition, its accurate determination is of paramount importance for a definition of the kilogram in terms of a fundamental constant. We describe a new approach for its determination by counting the atoms in 1 kg single-crystal spheres, which are highly enriched with the 28Si isotope. It enabled isotope dilution mass spectroscopy to determine the molar mass of the silicon crystal with unprecedented accuracy. The value obtained, NA = 6.022,140,78(18) × 10(23) mol(-1), is the most accurate input datum for a new definition of the kilogram.
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Sakuma M, Morimoto T, Matsui K, Seki S, Kuramoto N, Toshiro J, Murakami J, Fukui T, Saito M, Hiraide A, Bates DW. Epidemiology of potentially inappropriate medication use in elderly patients in Japanese acute care hospitals. Pharmacoepidemiol Drug Saf 2011; 20:386-92. [PMID: 21254304 DOI: 10.1002/pds.2110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 12/27/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The elderly receive many medications which may have adverse effects. Little evidence is available about the epidemiology of potentially inappropriate medications being prescribed to the elderly in Japan as defined by the Beers criteria, or whether or not these medications result in harm when used in this population. METHODS We conducted a prospective cohort study of patients aged ≥65 years who were admitted to three acute care hospitals in Japan. Trained research nurses followed up patients from randomly selected wards and collected data about their medications and all potential adverse drug events (ADEs). Two independent reviewers evaluated all the data. The use of potentially inappropriate medications and their effects on patients were identified using the updated Beers criteria. RESULTS A total of 2155 elderly patients were eligible; 56.1% received at least one drug listed in the Beers criteria (BL drug). The rates of BL drug prescriptions were 103.8 per 100 admissions and 53.6 [DOSAGE ERROR CORRECTED] per 1000 patient-days, and the incidence rate of ADEs related to BL drugs was 1.7 per 100 BL drug prescriptions. Among patients aged ≥65 years, relatively younger patients (p = 0.0002) and those with less complications (p = 0.04) were likely to be prescribed BL drugs. CONCLUSIONS Although BL drugs were frequently prescribed to elderly Japanese inpatients, the incidence of related ADEs appeared infrequent. These data suggest that re-evaluation of the appropriateness of the Beers criteria is needed before they are used in Japan and other nations to assess quality or for decision support.
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Kubota Y, Yano Y, Morimoto T, Seki S, Takada K, Kuramoto N, Maeda Y, Akaike A, Hiraide A. Reliability of evaluation for communication competency in pharmaceutical objective structured clinical examination (OSCE). YAKUGAKU ZASSHI 2009; 129:609-16. [PMID: 19420892 DOI: 10.1248/yakushi.129.609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the objective structured clinical examination (OSCE), which for pharmaceutical students training, adequate methods should be used for evaluating a student's skill and aptitude for good communication in a medical interview. However, the reliability of the evaluation methods used in the pharmaceutical OSCE has not been investigated sufficiently. In this study, we reviewed the evaluation scores and video recordings obtained in a pharmaceutical OSCE trial, and examined the reasons for disagreement in the scores between two raters. We had two experienced raters in medical communication re-evaluate the students using the vide images, and compared their scores with those on the examination day. The ratio of disagreement was 14.5% (87/600 items in 30 students), and the reason for disagreement could not be identified for 63 items that evaluated communication skills such as 'actively listen' and 'empathy'. A comparison of the scores on examination day and those on re-evaluation revealed a possible reason for the disagreement; the use of a checklist, i.e. binary scores, with criteria that differed between the raters. We suggest that the items used for a detailed performance evaluation be selected carefully and that rating scales be used in order to perform an adequate evaluation, especially regarding communication skill and aptitude.
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Kuramoto N, Morimoto T, Kubota Y, Maeda Y, Seki S, Takada K, Hiraide A. Public perception of and willingness to perform bystander CPR in Japan. Resuscitation 2008; 79:475-81. [PMID: 18805615 DOI: 10.1016/j.resuscitation.2008.07.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 07/09/2008] [Indexed: 11/25/2022]
Abstract
AIM Immediate bystander cardiopulmonary resuscitation (CPR) is the most essential factor for life saving in out-of-hospital cardiac arrest patients. We investigated the characteristics associated with willingness to attempt CPR among the Japanese general population. METHODS We randomly selected 2400 persons from all over Japan and conducted a questionnaire survey regarding their knowledge, experiences of and attitudes toward CPR. We performed descriptive statistics followed by multivariable logistic regression analyses. RESULTS A total of 1132 persons (47%) completed the questionnaire. Only 13% of the subjects were willing to attempt bystander CPR for their families and friends, and 7% were willing to attempt bystander CPR for strangers. Willingness to attempt CPR was independently associated with office workers or skilled workers [odds ratio (OR) 1.8; 95% confidence interval (CI): 1.1-2.7], having trained in CPR [OR: 3.1; 95% CI: 2.1-4.6], actual experience with CPR [OR: 3.8; 95% CI: 1.7-8.3], and having friends with heart diseases [OR: 1.8; 95% CI: 1.05-3.0]. Having trained in CPR was independently associated with younger age [OR: 1.6; 95% CI: 1.2-2.1], office workers or skilled workers [OR: 1.5; 95% CI: 1.1-2.0], having driver's license [OR: 1.7; 95% CI: 1.2-2.4] and awareness of AED placement in a public space [OR: 2.1; 95% CI: 1.4-3.1]. CONCLUSION Experience of CPR training closely associated with willingness to attempt CPR, and awareness of AED in a public space are significant factors in CPR training. AED placement might call attention to CPR training and develops willingness to attempt CPR.
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Taniura H, Sanada N, Kuramoto N, Yoneda Y. Evolutional Divergence of the Metabotropic Glutamate Receptor Genes: A New Receptor Belonging to the Metabotropic Glutamate Receptor Family in Dictyostelium discoideum. Curr Genomics 2006. [DOI: 10.2174/138920206778426979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goto Y, Kondo T, Ide T, Yasueda H, Kuramoto N, Yamamoto K. Cry j 1 isoforms derived from Cryptomeria japonica trees have different binding properties to monoclonal antibodies. Clin Exp Allergy 2004; 34:1754-61. [PMID: 15544601 DOI: 10.1111/j.1365-2222.2004.02108.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We identified five Cryptomeria japonica trees producing Cry j 1 isoforms that cannot be detected in a sandwich ELISA using two monoclonal antibodies, J1B01 and J1B07, suggesting that the binding affinity of these isoforms for both monoclonal antibodies is low. OBJECTIVES The binding properties of the Cry j 1 isoforms produced by five trees to J1B07 and J1B01 were examined. The complementary DNA (cDNA) sequences of the Cry j 1 isoforms were also determined. METHODS To clarify the binding properties of these Cry j 1 isoforms to J1B01 and J1B07, Cry j 1 was quantified in pollen samples collected from each of the five trees, by sandwich ELISAs using polyclonal antibodies and either J1B01 or J1B07. The cDNA sequences of isoforms with different binding properties were determined. To test the assumption that amino acid substitutions affect the binding affinities of Cry j 1 isoforms for monoclonal antibodies, cleaved amplified polymorphic sequences (CAPS) markers representing the putative polymorphisms were used to analyse additional trees. RESULTS Four of the five trees produced Cry j 1 isoforms with extremely low binding affinity for J1B07, whereas the other tree produced two different isoforms with low binding affinity for either J1B01 or J1B07. Cry j 1-encoding cDNA sequences for one of the four trees and for the exceptional fifth tree indicate that amino acid substitutions at positions 55 and 352 in mature Cry j 1 affect its binding to J1B01 and J1B07, respectively. This was supported by the results of CAPS analysis. CONCLUSION The existence of Cry j 1 isoforms with low binding affinity for either J1B01 or J1B07 was established. Furthermore, a single amino acid substitution is involved in this difference in binding affinity for each monoclonal antibody.
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Hayashi E, Kondo T, Terada K, Kuramoto N, Kawasaki S. Identification of AFLP markers linked to a resistance gene against pine needle gall midge in Japanese black pine. TAG. THEORETICAL AND APPLIED GENETICS. THEORETISCHE UND ANGEWANDTE GENETIK 2004; 108:1177-81. [PMID: 15067405 DOI: 10.1007/s00122-003-1537-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2003] [Accepted: 11/10/2003] [Indexed: 05/21/2023]
Abstract
Bulked segregant and AFLP analyses of two mapping populations (R17 x S6 and R17 x S1) were used to identify markers linked to Rpgm, the only known gene responsible for resistance to pine needle gall midge in Pinus thunbergii Parl. Rpgm was found to be bracketed by ACCC/CCTTT(190) on one side at a distance of 6.6 cM and ACGT/CCCGC(250) at 15.3 cM on the other side. The segregation of these markers was analyzed in two other families in order to determine their phase and transferability. One of the two additional resistant parents carried ACCC/CCTTT(190) in the homozygous state while the marker was in coupling (plus marker allele linked with an R allele) in a resistant parent, R17. The marker ACGT/CCCGC(250) was in a repulsion phase in R17 and was not detected in the other two resistant pine trees. Out of four AFLP markers identified, only ACGT/CCAAT(290) was transferable in all resistant trees tested, although its phase was opposite for different trees. These results indicate that in applying those markers to select resistant trees, the phase state of the markers in each resistant tree with respect to Rpgm needs to be considered.
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Hayashi E, Kondo T, Terada K, Kuramoto N, Kawasaki S. Identification of AFLP markers linked to a resistance gene against pine needle gall midge in Japanese black pine. TAG. THEORETICAL AND APPLIED GENETICS. THEORETISCHE UND ANGEWANDTE GENETIK 2004; 108:1177-1181. [PMID: 15067405 DOI: 10.1007/s001220050051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2003] [Accepted: 11/10/2003] [Indexed: 05/21/2023]
Abstract
Bulked segregant and AFLP analyses of two mapping populations (R17 x S6 and R17 x S1) were used to identify markers linked to Rpgm, the only known gene responsible for resistance to pine needle gall midge in Pinus thunbergii Parl. Rpgm was found to be bracketed by ACCC/CCTTT(190) on one side at a distance of 6.6 cM and ACGT/CCCGC(250) at 15.3 cM on the other side. The segregation of these markers was analyzed in two other families in order to determine their phase and transferability. One of the two additional resistant parents carried ACCC/CCTTT(190) in the homozygous state while the marker was in coupling (plus marker allele linked with an R allele) in a resistant parent, R17. The marker ACGT/CCCGC(250) was in a repulsion phase in R17 and was not detected in the other two resistant pine trees. Out of four AFLP markers identified, only ACGT/CCAAT(290) was transferable in all resistant trees tested, although its phase was opposite for different trees. These results indicate that in applying those markers to select resistant trees, the phase state of the markers in each resistant tree with respect to Rpgm needs to be considered.
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Kuramoto N, Nakamichi H, Kishimoto S. Ulcerated giant juvenile xanthogranuloma accompanied by hyperlipidaemia. Acta Derm Venereol 2003; 82:210-1. [PMID: 12353716 DOI: 10.1080/00015550260132541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Miyamoto N, Kuramoto N, Yamada H. Differences in spatial autocorrelation between four sub-populations of Alnus trabeculosa Hand.-Mazz. (Betulaceae). Heredity (Edinb) 2002; 89:273-9. [PMID: 12242643 DOI: 10.1038/sj.hdy.6800132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2001] [Accepted: 05/14/2002] [Indexed: 11/09/2022] Open
Abstract
To investigate the spatial structure of Alnus trabeculosa Hand.-Mazz, we compared three sub-populations at Imaichi in Tochigi Prefecture and one sub-population at Juo in Ibaraki Prefecture, Japan. A total of 269 trees, covering 0.71 ha in total, were mapped and genetically analyzed using nine enzyme systems encoding 13 isozyme loci. There were no significant differences between the four sub-populations in terms of Na,Ne, H(o), H(e )and F(IS). However, according to spatial autocorrelation analysis, the Juo sub-population, which is younger than the others, showed an aggregation of multilocus genotypes, especially within 25 m radii. In contrast with the Juo sub-population, those in Imaichi showed no clear spatial structuring. In the three Imaichi sub-populations, gametic phase disequilibrium is attributable to heterogeneity of genotype frequencies, but in the Juo sub-population it seems to be due to other factors, connected with the composition of the trees in the sub-population and/or its founder population, gene flow and asexual propagation. To conserve as much as possible of the genes or genotypes in restricted areas, conservation of populations that do not show clear family structures, such as those in Imaichi, would be most effective.
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