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Ikeda K, Kaneko T, Uchida J, Nakamura T, Takeda T, Nagayama H. Identifying profiles of stroke patients benefitting from additional training: a latent class analysis approach. J Rehabil Med 2024; 56:jrm22141. [PMID: 38380814 DOI: 10.2340/jrm.v56.22141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To identify profiles of stroke patient benefitting from additional training, using latent class analysis. DESIGN Retrospective observational study. PATIENTS Patients with stroke (n = 6,875) admitted to 42 recovery rehabilitation units in Japan between January 2005 and March 2016 who were registered in the Japan Association of Rehabilitation Database. METHODS The main outcome measure was the difference in Functional Independence Measure (FIM) scores between admission and discharge (referred to as "gain"). The effect of additional training, categorized as usual care (no additional training), self-exercise, training with hospital staff, or both exercise (combining self-exercise and training with hospital staff), was assessed through multiple regression analyses of latent classes. RESULTS Applying inclusion and exclusion criteria, 1185 patients were classified into 7 latent classes based on their admission characteristics (class size n = 82 (7%) to n = 226 (19%)). Patients with class 2 characteristics (right hemiparesis and modified dependence in the motor-FIM and cognitive-FIM) had positive FIM gain with additional training (95% confidence interval (95% CI) 0.49-3.29; p < 0.01). One-way analysis of variance revealed that training with hospital staff (95% CI 0.07-16.94; p < 0.05) and both exercises (95% CI 5.38-15.13; p < 0.01) led to a significantly higher mean FIM gain than after usual care. CONCLUSION Additional training in patients with stroke with right hemiparesis and modified dependence in activities of daily living was shown to improve activities of daily living. Training with hospital staff combined with self-exercise is a promising rehabilitation strategy for these patients.
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Affiliation(s)
- Kohei Ikeda
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan.
| | - Takao Kaneko
- Department of Rehabilitation, Yamagata prefectural central hospital, Yamagata, Japan
| | - Junya Uchida
- Department of Rehabilitation Therapy, Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
| | - Takuto Nakamura
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan
| | - Taisei Takeda
- Department of Rehabilitation Therapy, Saiseikai Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
| | - Hirofumi Nagayama
- Kanagawa University of human Services, Faculty of Health and Social Service, School of Rehabilitation, Division of Occupational Therapy Program, Yokosuka, Kanagawa, Japan
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Kaneko T, Nagayama H, Ikeda K, Nakamura T, Niimi A, Inoue N, Takeda T, Uchida J. Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review. BMJ Open 2023; 13:e079318. [PMID: 38128942 DOI: 10.1136/bmjopen-2023-079318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher healthcare costs. Healthcare expenditure worldwide has been on the rise, especially among older adults, emphasising the importance of enabling independent living while reducing healthcare costs. Occupational therapy holds promising outcomes in promoting functional independence and enhancing the quality of life for older adults, but research on its cost-effectiveness remains limited. This systematic review aims to evaluate the recent evidence on the cost-effectiveness of occupational therapy interventions for older adults from a pragmatic perspective. METHODS AND ANALYSIS This systematic review will cover full economic evaluations, including cost-effectiveness, cost-utility and cost-benefit analyses, by reviewing randomised and cluster randomised controlled trials. The participants will be aged over 65 years without disease or disability restrictions. Primary outcomes will be assessed using functional status and quality-of-life assessments. Studies published before July 2023 will be searched in PubMed, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with no language restrictions. ETHICS AND DISSEMINATION Ethical approval is not required for this literature-based systematic review. The study's findings will update the evaluation of occupational therapy's cost-effectiveness in older adults and will be made public by publishing them in scholarly journals. PROSPERO REGISTRATION NUMBER CRD42023453558.
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Affiliation(s)
- Takao Kaneko
- Department of Rehabilitation, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Takuto Nakamura
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Ayaka Niimi
- Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Natsuki Inoue
- Higashi Kanagawa Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Taisei Takeda
- Higashi Kanagawa Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Junya Uchida
- Higashi Kanagawa Rehabilitation Hospital, Yokohama, Kanagawa, Japan
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Kudo M, Ito H, Sato K, Nagayama H, Fujisawa S, Yoshioka T. Comment on: Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation. J Am Geriatr Soc 2023; 71:1336-1337. [PMID: 36632669 DOI: 10.1111/jgs.18231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Masataka Kudo
- Departments of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan.,Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hideyuki Ito
- Department of Rehabilitation, Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan
| | - Kotaro Sato
- The Academic and Research Centre, Hokkaido Centre for Family Medicine, Sapporo, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Satoshi Fujisawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Yoshioka
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
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Yamakawa S, Nagayama H, Tomori K, Ikeda K, Niimi A. Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study. Front Rehabil Sci 2023; 3:1045231. [PMID: 36684684 PMCID: PMC9849931 DOI: 10.3389/fresc.2022.1045231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
Background and purpose The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. Methods We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. Results We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. Conclusions AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.
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Affiliation(s)
- Shiori Yamakawa
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan,Correspondence: Hirofumi Nagayama
| | - Kounosuke Tomori
- Department of Occupational Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kinugasa Hospital, Yokosuka, Japan
| | - Ayaka Niimi
- Department of Occupational Therapy, Yokohama Brain and Spine Center, Yokohama, Japan
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Yamamoto M, Kubo S, Hirama N, Teranishi S, Tashiro K, Seki K, Maeda C, Hiro S, Kajita Y, Sugimoto C, Segawa W, Nagayama H, Nagaoka S, Kudo M, Kaneko T. 1089P Hepcidin expression as a predictive biomarker for anti-PD1/PDL1 antibody monotherapy for advanced non-small cell lung cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ishikawa T, Tomori K, Nagayama H, Okita Y. The Occupational Experience Helps to Express the Clients' Occupational Needs in Goal Setting: A Retrospective Study in Subacute Care Setting. Occup Ther Health Care 2021; 36:408-421. [PMID: 34802382 DOI: 10.1080/07380577.2021.2003498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigates whether reflection on occupational experience during assessment and intervention would help clients express their occupational needs in goal setting. Sixty-two participants who were not able to express their occupational needs in the initial assessment process were either allocated to the occupational experience group who undertook occupation-based assessment and intervention, or the physical training group who engaged in physical training only. The ratio of participants who expressed their occupational needs in each group was 67% (30/45) and 12% (2/17) respectively. Reflection on occupational experience during assessment and intervention to help clients express their occupational needs would have significant implications for practice, as it may encourage clients to reflect on their performance more easily.
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Affiliation(s)
- Tetsuya Ishikawa
- Department of Rehabilitation, Saiseikai Kanagawaken Hospital, Kanagawa, Japan
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Hirofumi Nagayama
- Department of Rehabilitation, Faculty of Health and Social Services, Kanagawa University of Human Services, Kanagawa, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia.,Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Nagayama H, Tomori K, Ikeda K, Yamauchi K. Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data. J Am Med Dir Assoc 2021; 22:1762-1766.e1. [PMID: 33476570 DOI: 10.1016/j.jamda.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study examined the association between intensive rehabilitation for subacute stroke patients and medical costs and readmission ratio during the year after discharge. DESIGN This was a natural experiment study. SETTING AND PARTICIPANTS We identified individuals with a diagnosis of cerebrovascular disorder (ICD-10: I60-I69 cerebrovascular disease) in an insurance claims database in Japan from January 2005 to December 2017. From the database, 980 patients who were admitted to a convalescent rehabilitation unit with stroke were identified. After excluding 575 patients, 405 were eligible for the study. METHODS In Japan, from April 2011, a new policy was established that allows special costs to be added as rehabilitation time increases. This policy provides an additional medical fee for inpatients in a convalescent rehabilitation unit who receive more than 120 minutes of rehabilitation therapy. We defined high-intensity rehabilitation as transfer from hospitalization to a convalescent rehabilitation unit after April 2011. Outcomes were total direct medical costs and readmission ratio during the year after discharge from the convalescent rehabilitation unit. RESULTS Daily rehabilitation time, total rehabilitation time, and total medical costs of the high-intensity rehabilitation group were significantly higher than those of the low-intensity rehabilitation group (P < .001, P < .001, P = .011, respectively). However, there was no significant difference in the medical costs during the year after discharge (P = .653) or in the readmission ratio (hazard ratio: 1.09, 95% confidence interval: 0.55-2.18, P = .804). CONCLUSIONS AND IMPLICATIONS Intensive rehabilitation did not reduce medical costs or the readmission ratio during the first year after discharge. Future studies should consider the necessary rehabilitation intensity given the severity of the patient's condition, using large sample sizes.
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Affiliation(s)
- Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.
| | - Kounosuke Tomori
- Department of Occupational Therapy, School of Health Science, Tokyo University of Technology, Tokyo, Japan
| | - Kohei Ikeda
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Kanagawa, Japan
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Yamaguchi S, Okutsu M, Tomori K, Nagayama H, Okita Y. Effects of collaborative consultation using iPad application in school-based occupational therapy: A single-arm pre-post pilot study. Aust Occup Ther J 2020; 68:135-143. [PMID: 32996147 DOI: 10.1111/1440-1630.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This pilot study examined the effect of collaborative consultation with teachers in school-based occupational therapy (SBOT) using iPad application for goal-setting-Aid for Decision-Making in Occupation Choice for School (ADOC-S). METHOD A single arm pre-post intervention design was conducted at four preschools in Japan. The participants were 10 preschool teachers (10.5 ± 0.4 years of teaching), and 10 children (3.8 ± 0.4 years old; five boys). The teachers received three collaborative consultations (1 hr for each) from one occupational therapist. Firstly, the occupational therapist conducted an observational assessment of the child's school life, then the teacher and occupational therapist identified occupation-based goals for each child using the ADOC-S. Secondly, the teacher and the occupational therapist developed the graded goals using the Goal Attainment Scale (GAS) and discussed the daily intervention plan for the teachers to conduct. Thirdly, the occupational therapist followed up on the intervention process using GAS. The subjective outcome was measured at 10 point-satisfaction and performance score in each goal using Canadian Occupational Performance Measure (COPM). The observed outcome was measured using GAS and Strengths and Difficulties Questionnaire (SDQ). RESULTS All the participants including teachers and children successfully underwent the intervention process. Significant improvement was found pre-post and effect size (ES) was large on the COPM (ES; r = .85-.94), GAS (ES; r = .98-.99) and SDQ (ES; r = .64). All goals (30/30) exceeded expectations of GAS from zero to +2. CONCLUSION Although there are some limitations and considerations which need to be resolved for future studies, our results suggest that ADOC-S would help build a rapport with a teacher in SBOT settings, and this collaborative consultation would facilitate a positive outcome.
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Affiliation(s)
| | | | - Kounosuke Tomori
- Department of Occupational Therapy, School of Health Science, Tokyo University of Technology, Tokyo, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre,, Melbourne, Vic, Australia
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Saito Y, Tomori K, Nagayama H, Sawadai T, Kikuchi E. Differences in the occupational therapy goals of clients and therapists affect the outcomes of patients in subacute rehabilitation wards: a case-control study. J Phys Ther Sci 2019; 31:521-525. [PMID: 31417214 PMCID: PMC6642888 DOI: 10.1589/jpts.31.521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of differences in the goals recognized
by the client and the occupational therapist on patient outcome. [Participants and
Methods] A retrospective case-control study was conducted to compare rehabilitation
outcomes of cases wherein the occupational therapy goals were matched/unmatched (control)
with those of the patients in seven subacute rehabilitation wards in Japan. The outcomes
were Functional Independence Measure, number of days of hospitalization, occupational
therapy, and total medical cost. [Results] The motor Functional Independence Measure
scores in the matched-goal group were significantly higher than those of the
unmatched-goal group, and the home discharge rate showed a tendency to increase. It was
speculated whether the client had received an explanation about the goal. [Conclusion]
Rehabilitation outcome may vary depending on whether occupational therapy goals are
matched.
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Affiliation(s)
- Yuki Saito
- Department of Rehabilitation Science, Division of Occupational Therapy, Sendai Seiyo Gakuin College: 4-3-55 Nagamachi, Taihakuku, Sendai 982-0011 Japan
| | - Kounosuke Tomori
- Department of Occupational Therapy, School of Health Science, Tokyo University of Technology, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Japan
| | - Tatsunori Sawadai
- Department of Occupational Therapy, School of Health Science, Tokyo University of Technology, Japan
| | - Emiko Kikuchi
- Department of Occupational Therapy, Graduate School of Medical Science, Teikyo Heisei University, Japan
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Nagayama H, Kobayashi N, Ishibashi Y, Kobayashi R, Murai C, Yamauchi K. Cost and outcome of occupation-based practice for community dwelling frail elderly: a pilot study. Clin Interv Aging 2018; 13:1177-1182. [PMID: 29983552 PMCID: PMC6027685 DOI: 10.2147/cia.s163381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this pilot study was to determine the effectiveness and costs of the occupation-based practice for community dwelling frail elderly. Design Pilot pre-post design without a control group. Setting A care management center involving 37 local elderly. Subject The final analysis included 26 frail elderly in a community dwelling center. Intervention The intervention was occupation-based practice involving setting of client-centered goals, observation of real living situations, and provision of advice on the individual problem of real occupation. Outcome The outcome was the Frenchay Activities Index (FAI), which is used to evaluate the instrumental activities of daily living (IADL). Additionally, the frequency, duration, and cost of the intervention were calculated. Results Regarding the FAI score before and after the interventions, there were significant improvements in all items except work (P<0.05, effect size [r]: 0.67–0.93). A total of 15 people out of 26 (57.7%) showed improvement in activities of daily living. The frequency of interventions was 3.7 (95% confidence interval [CI]: 2.83–4.48), and the duration was 7.4 weeks (95% CI: 5.27–9.42). The average intervention cost was $258 (95% CI: 200.4–317.4). Conclusion The results of this study showed that occupation-based practice has a potential to improve IADL in frail elderly, with low frequency of intervention, within a short-term, and direct cost reduction. We believe that this pilot study will contribute to future clinical studies for frail elderly, and the findings can be easily applied to daily clinical intervention. A well-designed prospective randomized-controlled trial is necessary to verify these results.
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Affiliation(s)
- Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Norikazu Kobayashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Yu Ishibashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Ryuji Kobayashi
- Division of Occupational Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Arakawa, Japan
| | - Chika Murai
- Department of Occupational Therapy, Ishikawa Prefectural Takamatsu Hospital, Kahoku, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Fujisawa, Japan
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Ohno K, Tomori K, Takebayashi T, Sawada T, Nagayama H, Levack WMM, Domen K, Higashi T. Development of a tool to facilitate real life activity retraining in hand and arm therapy. Br J Occup Ther 2017. [DOI: 10.1177/0308022617692602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced). Method We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility. Results After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps. Conclusion The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.
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Affiliation(s)
- Kanta Ohno
- Master of Health Science, IMS Itabashi Rehabilitation Hospital, Tokyo, Japan
| | - Kounosuke Tomori
- Visiting Researcher, Department of Community-Based Rehabilitation Sciences, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Tatsunori Sawada
- Associate Professor, Tokyo Koka Daigaku Ringgold Standard Institution, Ota-ku, Tokyo, Japan
| | | | - William MM Levack
- Senior Lecturer, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kazuhisa Domen
- Professor, Hyogo Medical University Hospital, Nishinomiya, Japan
| | - Toshio Higashi
- Professor, Department of Community-Based Rehabilitation Sciences, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Nagayama H, Tomori K, Ohno K, Takahashi K, Nagatani R, Izumi R, Moriwaki K, Yamauchi K. Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial. Top Stroke Rehabil 2017; 24:337-344. [PMID: 28198661 DOI: 10.1080/10749357.2017.1289686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach. METHODS We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. RESULTS The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p = 0.001, difference 95% CI: 0.002-0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%. CONCLUSIONS The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.
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Affiliation(s)
- Hirofumi Nagayama
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan.,g Graduate School of Health Management , Keio University , Fujisawa , Japan
| | - Kounosuke Tomori
- b Unit of Rehabilitation Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kanta Ohno
- c IMS Itabashi Rehabilitation Hospital , Itabashi , Japan
| | - Kayoko Takahashi
- d Department of Occupational Therapy, School of Allied Health Sciences , Kitasato University , Sagamihara , Japan
| | - Ryutaro Nagatani
- a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan
| | - Ryota Izumi
- e Department of Occupational Therapy , Seirei Christopher University , Hamamatsu , Japan
| | - Kensuke Moriwaki
- f Department of Medical Statistics , Kobe Pharmaceutical University , Kobe , Japan
| | - Keita Yamauchi
- g Graduate School of Health Management , Keio University , Fujisawa , Japan
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Fujita T, Nagayama H, Sato A, Yamamoto Y, Yamane K, Otsuki K, Tsuchiya K, Tozato F. Correction: Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study. PLoS One 2017; 12:e0170519. [PMID: 28081220 PMCID: PMC5231375 DOI: 10.1371/journal.pone.0170519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Fujita T, Nagayama H, Sato A, Yamamoto Y, Yamane K, Otsuki K, Tsuchiya K, Tozato F. Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study. PLoS One 2016; 11:e0151162. [PMID: 26954499 PMCID: PMC4783045 DOI: 10.1371/journal.pone.0151162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/24/2016] [Indexed: 11/30/2022] Open
Abstract
Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.
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Affiliation(s)
- Takaaki Fujita
- Department of Rehabilitation, Faculty of Health Sciences, Tohoku Fukushi University, Sendai, Miyagi, Japan
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
- * E-mail:
| | - Hirofumi Nagayama
- Department of Rehabilitation, Faculty of Health and Welfare, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Atsushi Sato
- Department of Physical Therapy, Yachiyo Rehabilitation College, Yachiyo, Chiba, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan
| | - Kazuhiro Yamane
- Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Northern Fukushima Medical Center, Date, Fukushima, Japan
| | - Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
- Department of Rehabilitation, Japan Community Healthcare Organization Gunma Chuo Hospital, Maebashi, Gunma, Japan
| | - Fusae Tozato
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
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Nagayama H, Tomori K, Ohno K, Takahashi K, Ogahara K, Sawada T, Uezu S, Nagatani R, Yamauchi K. Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial. PLoS One 2016; 11:e0150374. [PMID: 26930191 PMCID: PMC4773241 DOI: 10.1371/journal.pone.0150374] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Care-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial. Method In this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months. Main Outcome Measures Short Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost. Results We randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1. Conclusion The results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible. Trial Registration UMIN Clinical Trials Registry UMIN000012994
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Affiliation(s)
- Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- * E-mail:
| | - Kounosuke Tomori
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
| | - Kanta Ohno
- Graduate Course of Health and Social, Kanagawa University of Human Services, Kanagawa, Japan
| | - Kayoko Takahashi
- School of Allied Health, Department of Occupational Therapy, Kitasato University, Kanagawa, Japan
| | - Kakuya Ogahara
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
| | | | - Sei Uezu
- Naha City Ajya Complex Welfare Facility, Okinawa, Japan
| | - Ryutaro Nagatani
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Kanagawa, Japan
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Nagayama H, Tomori K, Ohno K, Takahashi K, Yamauchi K. Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials. Occup Ther Int 2015; 23:103-20. [PMID: 26381549 DOI: 10.1002/oti.1408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 01/20/2023] Open
Abstract
A systematic review of the cost-effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial-based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1-5) that were randomized controlled trials with high-quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost-effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost-effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client-centred approach) suggested potentially cost-effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future studies on the cost-effectiveness of occupational therapy in older people are strongly warranted. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan.,Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Kounosuke Tomori
- Department of Occupational Therapy, Kanagawa University of Human Services, Kanagawa, Japan
| | - Kanta Ohno
- Graduate Course of Health and Social Services, Kanagawa University of Human Services, Kanagawa, Japan
| | - Kayoko Takahashi
- School of Allied Health, Department of Occupational Therapy, Kitasato University, Kanagawa, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University, Kanagawa, Japan
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Tomori K, Nagayama H, Ohno K, Nagatani R, Saito Y, Takahashi K, Sawada T, Higashi T. Comparison of occupation-based and impairment-based occupational therapy for subacute stroke: a randomized controlled feasibility study. Clin Rehabil 2014; 29:752-62. [PMID: 25381345 DOI: 10.1177/0269215514555876] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/25/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare occupation-based and impairment-based approaches in occupational therapy and determine the feasibility of patient recruitment and retention. DESIGN A multicenter, randomized, controlled pilot trial with a single blind assessor. SETTING Ten subacute rehabilitation units in Japan. PARTICIPANTS Fifty-four patients with subacute stroke. INTERVENTIONS The experimental group used the iPad application, Aid for Decision-making in Occupation Choice, to establish occupation-based goals, and evaluation and intervention were conducted mainly through real occupations. The control group was evaluated according to patients' generic abilities and activities of daily living (ADL), and the intervention mainly involved the impairment-based approach. MAIN OUTCOME MEASURES Short Form-36, Functional Independence Measure, Brunnstrom recovery stages, The Client Satisfaction Questionnaire, and length of hospital stay. RESULTS Of the 1465 potential participants, 54 (3%) subacute stroke patients were enrolled over 16 months and 68% (n = 36) were retained to the 2-month assessment: experimental group (n = 16); control group (n = 21). Although there was no significant intergroup difference for any outcomes, the experimental group had a small effect size advantage on the Short Form-36 "General health" (d = 0.42) and "Role emotional" (d = 0.43) subscales relative to the control group. A sample of 118 subacute stroke patients per group would be required for a lager study. CONCLUSIONS Results suggest that the occupation-based approach has more potential to improve "General health" and "Role emotional" scores on the Short Form-36 than the impairment-based approach. Further investigation of study protocol with interventions and recruiting is needed prior to a larger trial.
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Affiliation(s)
- Kounosuke Tomori
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Hirofumi Nagayama
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Kanta Ohno
- Graduate Course in Health and Social Care, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Ryutaro Nagatani
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Yuki Saito
- Department of Occupational Therapy, Koriyama Institute of Health Science, Koriyama, Fukushima, Japan
| | - Kayoko Takahashi
- Department of Occupational Therapy, Kitasato University, Sagamihara, Kanagawa, Japan
| | | | - Toshio Higashi
- Department of Community-Based Rehabilitation Sciences, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
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Sueyoshi E, Nagayama H, Hayashida T, Sakamoto I, Uetani M. Fate of aorta and clinical outcomes in patients with chronic type B aortic dissection: over 20-year experience. J Cardiovasc Surg (Torino) 2014; 55:247-255. [PMID: 23138605] [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: 06/01/2023]
Abstract
AIM In type B double-barrel aortic dissection (AD), the fate of the affected aorta, causes of death, and very long-term clinical outcomes have not been completely elucidated. The purpose of this study was to clarify the fate of the affected aorta and long-term clinical outcomes in patients with type B AD during the chronic phase. MEHODS One hundred and four patients were entered into this study, and regular follow-up CT studies (mean; 87.6 months) were performed. Also, clinical data including AD-related events (including aneurysm formation, rupture, ischemia, and re-dissection), AD-related deaths, and long-term survival were retrospectively reviewed. RESULTS Forty-six of 104 patients (44.2%) had one more AD-related event during the follow-up period. The actuarial event-free rates for any AD-related events of all patients were 95±2%, 75±5%, 53±6%, and 13±7% at 1, 5, 10, and 20 years, respectively. Initial aortic diameter ≥40 mm and blood flow in the false lumen were significant risk factors for AD-related events in univariate and multivariate analysis. CONCLUSION In type B chronic aortic dissection, the affected aortas have a high incidence of AD-related events during the follow-up period. Prophylactic surgery or endovascular treatment for patients at high risk may reduce the AD-related events.
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Affiliation(s)
- E Sueyoshi
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan -
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Sueyoshi E, Nagayama H, Sakamoto I, Uetani M. Carbon dioxide digital subtraction angiography: an alternative for detection endoleaks at endovascular abdominal aortic aneurysm repairs procedure. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tomori K, Nagayama H, Saito Y, Ohno K, Nagatani R, Higashi T. Examination of a cut-off score to express the meaningful activity of people with dementia using iPad application (ADOC). Disabil Rehabil Assist Technol 2013; 10:126-31. [PMID: 24364813 DOI: 10.3109/17483107.2013.871074] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine a quantifiable measure to identify patients with dementia who can choose an illustration of meaningful activity using an iPad application, Aid for Decision-making in Occupation Choice (ADOC). METHOD We recruited 116 patients from 5 institutions in Japan. Occupational therapists interviewed patients with dementia to determine meaningful activities using ADOC. The most meaningful activity was confirmed by their primary caregivers. The cut-off was estimated from Mini-Mental State Examination (MMSE). RESULTS Receiver operating characteristic analysis indicated that an MMSE score of 8 was the cut-off for choosing meaningful activities using ADOC. Sensitivity and specificity was 91.0% and 74.1%, respectively, and the area under the curve value was 0.89. CONCLUSION ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia. Implications for Rehabilitation As dementia progresses, difficulty in expressing needs or desires regarding meaningful activity may increase. The iPad application (Aid for Decision-making in Occupation Choice; ADOC) can be useful to promote shared decision-making through a systematic goal-setting process involving a choice of 95 illustrations describing daily activities. Mini-Mental State Examination (MMSE) score greater than 8 points is required to use the ADOC to choose most meaningful activities. ADOC provides individual information regarding meaningful activities for patients with moderate dementia.
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Affiliation(s)
- Kounosuke Tomori
- Department of Occupational Therapy, Kanagawa University of Human Services , Yokosuka, Kanagawa , Japan
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21
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Tomori K, Saito Y, Nagayama H, Seshita Y, Ogahara K, Nagatani R, Higashi T. Reliability and validity of individualized satisfaction score in aid for decision-making in occupation choice. Disabil Rehabil 2012; 35:113-7. [DOI: 10.3109/09638288.2012.689919] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sasaki Y, Nagayama H, Araoka F, Yao H, Takezoe H, Ema K. Distinctive thermal behavior and nanoscale phase separation in the heterogeneous liquid-crystal B4 matrix of bent-core molecules. Phys Rev Lett 2011; 107:237802. [PMID: 22182125 DOI: 10.1103/physrevlett.107.237802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/13/2011] [Indexed: 05/31/2023]
Abstract
By means of high-resolution calorimetry, we studied thermodynamic properties of the liquid-crystal B(4) phase where bent-core molecules form a helical nanofilament structure. Distinctive thermal behavior characterizing the growth process of the B(4) phase was obtained in undergoing the phase transition with many sharp peaks, indicating a highly heterogeneous structure. It has been demonstrated that such unusual behavior is commonly seen for two types of rodlike molecules as well as for various mixture compositions. We speculate that mixture systems involve a nanoscale phase-separated structure due to the remarkable aggregation effect in the bent-core molecules and that the helical nanofilament structure independently grows in the isotropic state of rodlike molecules. We also propose that the asymmetry in viscoelastic property plays a role in yielding unusual behavior.
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Affiliation(s)
- Y Sasaki
- Department of Physics, Tokyo Institute of Technology, O-okayama, Meguro, Tokyo 152-8551, Japan
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23
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Kurajoh M, Inaba M, Okuno S, Nagayama H, Yamada S, Imanishi Y, Ishimura E, Shoji S, Yamakawa T, Nishizawa Y. Reduction of whole PTH/intact PTH ratio as a predictor of bone metabolism in cinacalcet treatment of hemodialysis patients with secondary hyperparathyroidism. Osteoporos Int 2011; 22:923-30. [PMID: 20449572 DOI: 10.1007/s00198-010-1262-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED In cinacalcet treatment of hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), not only intact parathyroid hormone (I-PTH), whole PTH (W-PTH), and bone markers, but also W-PTH/I-PTH ratio as proportion of active PTH(1-84) molecules were decreased. Changes in W-PTH/I-PTH ratio significantly correlated and predicted changes in bone marker. INTRODUCTION Cinacalcet partly suppresses the secretion of PTH by enhancing PTH(1-84) degradation into N-truncated fragments. The objectives of this study is to investigate the significance of the N-truncated PTH/PTH(1-84) ratio for the prediction of the effect of cinacalcet in HD patients. METHODS Serum parameters were measured during 12 weeks of oral cinacalcet administration at 25 mg daily in 39 HD patients with SHPT. RESULTS Serum Ca, Pi, W-PTH, I-PTH, and W-PTH/I-PTH ratio all decreased significantly in a time-dependent manner during cinacalcet administration. Serum tartrate-resistant acid phosphatase (TRAP) 5b reflected these changes more precisely than serum N-telopeptide of type-I collagen. At 1 week, changes in I-PTH and W-PTH correlated significantly with those in serum Pi, but not Ca. Changes in serum Pi (but not Ca) and serum W-PTH also correlated significantly with changes in serum TRAP5b at both 4 and 12 weeks, while changes in serum I-PTH correlated significantly with those in serum TRAP5b only at 12 weeks. Changes in the serum W-PTH/I-PTH ratio correlated significantly with those in serum TRAP5b at both 4 and 12 weeks, and changes in serum W-PTH/I-PTH ratio at 4 weeks showed a tendency for a correlation with changes in serum TRAP5b at 12 weeks. HD patients with a reduced W-PTH/I-PTH ratio after 4 weeks had a significantly greater reduction of TRAP5b over 12 weeks. CONCLUSION W-PTH and the W-PTH/I-PTH ratio allow estimation of the potency of cinacalcet in enhancement of PTH degradation, and thus no less reliable markers than I-PTH for reflecting cinacalcet-induced bone resorption.
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Affiliation(s)
- M Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Internal Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Abstract
AIM To evaluate the reliability of [(123)I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for diagnosing Parkinson's disease (PD). PATIENTS/METHODS A series of 391 outpatients showing one or more parkinsonian-like symptoms was longitudinally followed up for accurate clinical diagnosis. MIBG scintigraphy was performed in the patients and 10 normal controls of similar age. The heart to mediastinum uptake ratio was calculated in each person, and the values were considered abnormal if they were greater than two standard deviations below the control mean. RESULTS MIBG uptake was decreased in most patients with PD (87.7%), and was seen in all advanced cases with Hohen-Yahr stage III or more; the sensitivity and specificity of scintigraphy for detecting PD were 87.7% and 37.4%, respectively. Surprisingly, over half of the patients without PD (66.5%) also exhibited low uptake, resulting in considerable overlap in the ratios between PD and the other disorders. CONCLUSION MIBG scintigraphy is a sensitive, but not specific, test for PD. Low MIBG uptake does not necessarily indicate PD, but is essential for diagnosing advanced PD.
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Affiliation(s)
- H Nagayama
- Department of Neurology, Tokyo Metropolitan Tama Geriatric Hospital, Tokyo 189-8511, Japan.
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Nagayama H. Maxillofacial bone fracture treatment using distraction osteogenesis technique. Int J Oral Maxillofac Surg 2005. [DOI: 10.1016/s0901-5027(05)81516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kobayashi J, Nagayama H, Uchida H, Oikawa T, Numabe T, Takada N, Sasada H, Sato E. Selection of sexed bovine embryos using rapid fluorescence in situ hybridisation. Vet Rec 2004; 154:789-91. [PMID: 15233457 DOI: 10.1136/vr.154.25.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J Kobayashi
- Miyagi Agricultural College, Sendai 982-0231, Japan
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Igarashi H, Hamamoto M, Yamaguchi H, Ookubo S, Nagashima J, Nagayama H, Amemiya S, Arii K, Sakamaki M, Katayama Y. Cerebral blood flow index image as a simple indicator for the fate of acute ischemic lesion. Acta Neurochir Suppl 2004; 86:241-6. [PMID: 14753444 DOI: 10.1007/978-3-7091-0651-8_52] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the feasibility of utilizing cerebral blood flow (CBF) index images, we attempted to investigate 1) whether CBF index images can reveal the resulting infracted area, 2) whether the CBF index can correlate other modality (SPECT). METHODS DWI and DPI were obtained in 17 patients within 12 hours of stroke onset and follow up MRI. On three DPI delivered images, namely relative regional cerebral blood volume (rrCBV), uncorrected mean transit time (MTTu) and CBF index images, correlations between initial lesion volume of and follow up infarction volume of three images and rCBF images delivered with singular value decomposition (SVD) methods were assessed. Then 99mTc-ECD SPECT was taken immediately after MRI to correlate to MRI data. RESULTS Among the three images, lesion volume of CBF index images against follow up infarct volume had the highest correlation (r = 0.995) to a linear fit and the slope was closest to 1.0 (0.91) and had identical accuracy to the regression coefficient of rCBF images. CBF index well correlated to SPECT delivered CBF. CONCLUSION CBF index images can accurately predict final infarct volume. Evaluating CBF index images together with DWI can guide the initial assessment in the acute stage of cerebral ischemia.
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Affiliation(s)
- H Igarashi
- The Second Internal Medicine, Nippon Medical School, Tokyo, Japan.
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Nakamura M, Hamamoto M, Uchida S, Nagayama H, Amemiya S, Okubo S, Tanaka K. A case of micrographia after subcortical infarction: possible involvement of frontal lobe function. Eur J Neurol 2003; 10:593-6. [PMID: 12940845 DOI: 10.1046/j.1468-1331.2003.00641.x] [Citation(s) in RCA: 15] [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] [Indexed: 11/20/2022]
Abstract
Most reports of micrographia associated with focal brain lesions have related this finding to damage in the left basal ganglia. Here we describe the case of a 68-year-old man presenting with reversible micrographia accompanied by hypophonia in the absence of extrapyramidal signs after cerebral infarction in the left subcortical region. At the time of the patient's admission, diffusion-weighted magnetic resonance imaging sequence showed the lesion to principally involve the corona radiata, with some involvement of the putamen. Neurologically, mild right-sided brachiofacial hemiparesis and grasp reflexes - a frontal lobe sign - were observed. As his micrographia and hypophonia improved, the patient's grasp reflexes improved in parallel. In addition, recovery of regional cerebral blood flow in the left frontal lobe was confirmed by single photon emission computed tomography (technetium-99 m HMPAO). The present case suggests the possibility that the function of frontal-subcortical circuit might also be involved in the production and improvement of micrographia and that micrographia and hypophonia may share a common pathophysiology.
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Affiliation(s)
- M Nakamura
- Department of Neurology, Tokyo Metropolitan Tama Geriatric Hospital, Tokyo, Japan.
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Tsukada Y, Nagayama H, Mori T, Shimizu T, Sato N, Takayama N, Ishida A, Handa M, Ikeda Y, Okamoto S. Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor. Bone Marrow Transplant 2003; 31:69-72. [PMID: 12621511 DOI: 10.1038/sj.bmt.1703780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/09/2022]
Abstract
Bacterial meningoencephalitis occurring in the pre-engraftment period after bone marrow transplantation (BMT) is a rare complication, and the feasibility of granulocyte transfusion (GTX) in such cases remains to be elucidated. A 37-year-old man developed enterococcal meningoencephalitis during a severely granulocytopenic pre-engraftment period after BMT. Despite therapy with appropriate antibiotics, cultures of blood and cerebro-spinal fluid (CSF) continued to grow Enterococcus faecalis, and he developed rapid mental deterioration and seizure. Granulocytes were collected from his HLA-mismatched, ABO-matched sibling with subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) and oral dexamethazone. Transfusion of 4.4 x 10(10) granulocytes resulted in a 12-h post-transfusion granulocyte increment of 2.0 x 10(9)/l, and maintained peripheral blood granulocyte counts above 0.5 x 10(9)/l for 3 days. A rapid increase of granulocytes in CSF was also observed, and cultures of blood and CSF became negative after GTX. A transient worsening of seizure was observed as a potential side effect of GTX. The patient subsequently developed septic shock because of Pseudomonas aeruginosa and died. Further studies are warranted to evaluate the clinical efficacy of GTX for the treatment of uncontrolled infections in granulocytopenic stem cell transplant recipients.
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Affiliation(s)
- Y Tsukada
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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30
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Isogawa K, Fujiki M, Akiyoshi J, Tsutsumi T, Horinouchi Y, Kodama K, Nagayama H. Anxiety induced by repetitive transcranial magnetic stimulation is suppressed by chronic treatment of paroxetine in rats. Pharmacopsychiatry 2003; 36:7-11. [PMID: 12649768 DOI: 10.1055/s-2003-38085] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been shown to have a therapeutic effect on affective disorder and anxiety disorders. However, some reports have linked rTMS to a significant increase in anxiety in normal volunteers. This study investigates the effect of rTMS on anxiety and the use of acute and chronic paroxetine treatment on this animal model of anxiety. In normal rats, rTMS for 10 days induced anxiety, as shown by elevated plus maze, black and white box, and conditioned fear tests. This anxiety was suppressed by chronic, but not acute, paroxetine. These results suggest that rats receiving chronic rTMS treatment can be used as a model of anxiety and that the anxiety induced by rTMS might involve the serotonergic system.
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Affiliation(s)
- K Isogawa
- Department of Neuropsychiatry, Oita Medical University, Hasama-Machi, Japan
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31
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Enomoto M, Nagayama H, Sato K, Xu Y, Asano S, Takahashi TA. In vitro generation of dendritic cells derived from cryopreserved CD34+ cells mobilized into peripheral blood in lymphoma patients. Cytotherapy 2002; 2:95-104. [PMID: 12042046 DOI: 10.1080/146532400539099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
BACKGROUND Dendritic cells (DC) are APC that initiate primary T-cell dependent immune responses. They have been shown to be generated from CD34+ cells in BM, placental/umbilical cord blood (CB), and G-CSF mobilized peripheral blood CD34+ cells (PBSC). In recent clinical studies, DC were used as a vaccine for cancer patients and showed induction of their antitumor effects. Cryopreservation of CD34+ cells is important to extend the availability of cellular therapy with DC. However, little is known about the effect of cryopreservation on the functional maturation of DC. METHODS PBSC harvested from lymphoma patients mobilized with G-CSF and undergoing leukapheresis were cryopreserved at -135 degrees C for 3 days. Freshly isolated or cryopreserved PBSC were cultured with GM-CSF/SCF/tumor necrosis factor-alpha (TNF-alpha). After 14 days of culture, DC were harvested, washed, and used for phenotypical and functional analysis. RESULTS Cryopreserved PBSC, as well as freshly-isolated PBSC cultured for 14 days, gave rise to CD1a+ /CD4+ /CD11c+ /CD14low+ /CD25( -)/CD40+ / CD45RO+/CD80+/CD83+/CD86+/HLA-DR+ cells with dendritic morphology. DC derived from cryopreserved PBSC mobilized with G-CSF showed a similar endocytic capacity and chemotactic migratory capacities when compared with DC derived from freshly-isolated G-CSF mobilized PBSC. These DC also exhibited similar capacities in the primary allogeneic T-cell response. DISCUSSION These results indicate that cryopreserved G-CSF mobilized PBSC cultured with GM-CSF/SCF/TNF-alpha gave rise to DC that were morphologically, phenotypically and functionally similar to DC derived from fresh G-CSF mobilized PBSC. The observation indicates the clinical usefulness of cryopreserved CD34+ cells from lymphoma patients.
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Affiliation(s)
- M Enomoto
- Department of Cell Processing, The Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedia, Minato-ku, Tokyo 108-8639, Japan
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32
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Mori T, Okamoto S, Watanabe R, Yamazaki R, Tsukada Y, Nagayama H, Ishida A, Ikeda Y. Incidence of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell recipients at low risk of CMV infection. Bone Marrow Transplant 2002; 29:1005-6. [PMID: 12098071 DOI: 10.1038/sj.bmt.1703588] [Citation(s) in RCA: 3] [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: 01/29/2023]
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33
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Enomoto M, Nagayama H, Takahashi TA. Enhancement of migratory and aggregate activities of human peripheral blood monocyte-derived dendritic cells by stimulation with RANTES. Microbiol Immunol 2002; 45:639-47. [PMID: 11694076 DOI: 10.1111/j.1348-0421.2001.tb01297.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the effects of various chemokines on the functional activation of granulocyte-macrophage colony-stimulating factor (GM-CSF) plus interleukin-4 (IL-4)-generated human peripheral blood monocyte-derived immature dendritic cells (iDC). Stimulation of iDC with regulated on activation normal T cell expressed and secreted (RANTES) resulted in the promotion of their chemotactic migratory capacity in response to RANTES when compared with that of unstimulated cells. TNF-alpha induced a homotypic aggregated cluster formation of iDC in a dose-dependent manner, whereas the combination of TNF-alpha and RANTES exhibited more potent induction. IDC stimulated with RANTES were more efficient than unstimulated iDC in the production of endogenous RANTES. Treatment of iDC with the combination of TNF-alpha and RANTES was just little effective for the enhancement of allogeneic T-cell stimulatory capacity as compared with that of TNF-alpha treated iDC. These results suggest that endogenous secretions of RANTES from iDC stimulated with RANTES be potentially involved in RANTES-induced changes of properties with respect to morphology and function.
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Affiliation(s)
- M Enomoto
- Division of Cell Processing, The Institute of Medical Science, The University of Tokyo, Minato-kui, Tokyo 108-8639, Japan
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34
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Mori T, Okamoto S, Watanabe R, Yajima T, Iwao Y, Yamazaki R, Nakazato T, Sato N, Iguchi T, Nagayama H, Takayama N, Hibi T, Ikeda Y. Dose-adjusted preemptive therapy for cytomegalovirus disease based on real-time polymerase chain reaction after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:777-82. [PMID: 12040476 DOI: 10.1038/sj.bmt.1703542] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [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: 09/11/2001] [Accepted: 02/20/2002] [Indexed: 11/09/2022]
Abstract
We have prospectively evaluated the efficacy of real-time PCR-guided preemptive therapy for CMV diseases in allogeneic hematopoietic stem cell transplant recipients with grades II-IV acute GVHD. The dose of ganciclovir was adjusted according to the viral load determined by real-time polymerase chain reaction (PCR). On detecting CMV reactivation in the plasma, ganciclovir was initiated at a dose of 5 mg/kg body weight once daily, and the dose was increased to twice daily if viral load continued to increase after initiating ganciclovir. In 39 evaluable patients, CMV reactivation assessed by real-time PCR became positive in 30 (77%). One developed CMV gastroenteritis before PCR became positive. Thus the remaining 29 patients were treated preemptively with ganciclovir. The dose of ganciclovir was increased in 12 patients (41%) of preemptively treated patients for increasing viral load. CMV diseases were diagnosed in two patients (one gastroenteritis and one retinitis), and late CMV disease was diagnosed in one patient (gastritis). The treatment was generally well-tolerated, but three patients (10%) developed neutropenia (neutrophil count less than 1.0 x 10(9)/l). In conclusion, real-time PCR-guided preemptive therapy with decreased dose of ganciclovir is feasible and does not increase the frequency of CMV diseases if the dose is adjusted according to the viral load.
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Affiliation(s)
- T Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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35
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Nagayama H, Misawa K, Tanaka H, Ooi J, Iseki T, Tojo A, Tani K, Yamada Y, Kodo H, Takahashi TA, Yamashita N, Shimazaki S, Asano S. Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim. Bone Marrow Transplant 2002; 29:197-204. [PMID: 11859391 DOI: 10.1038/sj.bmt.1703356] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [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: 04/19/2001] [Accepted: 08/23/2001] [Indexed: 01/13/2023]
Abstract
We performed stem cell rescue and allogeneic skin transplantation on a lethally neutron-irradiated nuclear accident victim. HLA-DRB1 mismatched unrelated umbilical cord blood cells (2.08 x 10(7)/kg recipient body weight) were transplanted to an 8-10 Gy equivalent neutron-irradiated patient because of a lack of a suitable bone marrow or peripheral blood donor. Pre-transplant conditioning consisted of anti-thymocyte gamma-globulin alone, and GVHD prophylaxis was a combination of cyclosporine (CYA) and methylprednisolone (mPSL). Granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), and thrombopoietin (TPO) were concurrently administered after transplantation. The absolute neutrophil count reached 0.5 x 10(9)/l on day 15, the reticulocyte count rose above 1% on day 23, and the platelet count was over 50 x 10(9)/l on day 27, respectively. Cytogenetic studies of blood and marrow showed donor/recipient mixed chimerism. Rapid autologous hematopoietic recovery was recognized after withdrawal of CYA and mPSL. Repeated pathological examinations of the skin revealed no evidence of acute GVHD. Eighty-two days after the irradiation, skin transplantation was performed to treat radiation burns. Almost 90% of the transplanted skin engrafted. Immunological examination after autologous hematopoietic recovery revealed an almost normal T cell count. However, immune functions were severely impaired. The patient died from infectious complication 210 days after the accident.
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Affiliation(s)
- H Nagayama
- Institute of Medical Science, University of Tokyo, Tokyo, Japan
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36
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Katsuragi S, Kiyota A, Tsutsumi T, Isogawa K, Nagayama H, Arinami T, Akiyoshi J. Lack of association between a polymorphism in the promoter region of the dopamine D2 receptor and personality traits. Psychiatry Res 2001; 105:123-7. [PMID: 11740982 DOI: 10.1016/s0165-1781(01)00331-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disturbances of the dopaminergic neurotransmitter system have been associated with a personality trait that involves novelty seeking. A functional polymorphism in the promoter region of the dopamine D2 receptor gene (DRD2) has been reported to be associated with schizophrenia. We examined the association between this polymorphism in the DRD2 promoter region and personality traits, as assessed with the Tridimensional Personality Questionnaire. No significant association emerged between the polymorphism in the DRD2 promoter region and personality traits. Entering sex and age as covariates in an analysis of covariance did not change the results. These data fail to confirm an association between a polymorphism in the promoter region of the DRD2 and personality traits.
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Affiliation(s)
- S Katsuragi
- Department of Neuropsychiatry, Oita Medical University, Hasama-Machi, 879-5593, Oita, Japan
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37
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Nagayama H, Hojo M, Ueda T, Nishimori Y, Okamura M, Daike C. Effects of electrolytes on the configuration change of cobalt(II)-halide complexes in chloroform/water reverse micelle systems. ANAL SCI 2001; 17:1413-20. [PMID: 11783791 DOI: 10.2116/analsci.17.1413] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of various salts and HClO4 on the configuration change of cobalt(II)-halide complexes in CHCl3/CTAC or CTAB/H2O reverse micelle systems were examined at 25 degrees C by means of spectrophotometry, where CTAC and CTAB represent cetyltrimethylammonium chloride and bromide, respectively. The formation of the [CoCl4]> or [CoBr4]2- species of the tetrahedral configuration from [Co(H2O)6]2+ of the octahedral configuration in the reverse micelles was greatly promoted not only by a decrease in the W value (W = [H2O]/[surfactant]), but also, at a constant W value (e.g., W = 2.0), by the addition of relatively low concentrations of salts or the acid (e.g., 4.0 mol dm(-3) in the aqueous phase or 4.0 x 10(-2) mol dm(-3) in the whole reverse micelle system). The effects of perchlorate salts increased as Na+ < or = Li+ approximately H+ < Sr2+ < Ca2+ < Mg2+. Non-metallic salts, various tetraalkylammonium (R4N+) salts at lower concentrations, gave minor effects. The enhanced effects of metal salts on the configuration change of the cobalt(II)-halide complexes were interpreted by a further distortion of the hydrogen-bonded structure of the water in a "water pool" in the presence of salts of even relatively low concentrations. A conformation change with increasing temperature was also attributed to a further distortion of the water structure. An almost completed formation of [CoBr4]2- as well as [CoCl4]2- was attained in the reverse micelles at a low W value of 0.69 containing LiClO4 or HClO4. A partial transfer of the [CoX4]2- species from a "water pool" into the CHCl3 phase by the addition of the metal salts may be suspected. An examination of cobalt(II)-bromide complexes in dichloromethane/CTAB/H2O at W = 1.3 - 5.55 justified all the arguments concerning the chloroform systems. The Raman spectra of D2O containing concentrated LiBr and LiClO4 have supplied conclusive evidence that the hydrogen-bonded structure of the bulk water is completely distorted by extremely concentrated salts.
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Affiliation(s)
- H Nagayama
- Department of Chemistry, Faculty of Science, Kochi University, Japan
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38
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Tsutsumi T, Akiyoshi J, Hikichi T, Kiyota A, Kohno Y, Katsuragi S, Yamamoto Y, Isogawa K, Nagayama H. Suppression of conditioned fear by administration of CCKB receptor antisense oligodeoxynucleotide into the lateral ventricle. Pharmacopsychiatry 2001; 34:232-7. [PMID: 11778143 DOI: 10.1055/s-2001-18030] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We investigated the role of CCK in the development of anxiety by determining whether CCKB receptor antisense suppressed intracellular Ca(2+) concentration in vitro or suppressed conditioned fear stress in vivo. First, for the in vitro studies, we used rat pituitary tumor GH3 cells since these cells have CCKB receptors. GH3 cells were stimulated by 10 microM CCK-4; intracellular Ca(2+) concentration was measured. The CCKB receptor antisense at 1 or 10 microM reduced the subsequent response to 10 microM CCK-4 in a time-dependent manner. Second, for the in vivo studies, the CCKB receptor antisense, sense, random sense, or saline was infused at a constant rate for 6 days into rat lateral ventricles via mini-osmotic pumps. Individual rats were then subjected to 30 min of inescapable electric footshock in a chamber with a grid floor. Twenty-four hours later, the rat was again placed in the chamber and observed for 5 min without shocks. This study showed that CCKB receptor antisense significantly suppressed intracellular Ca(2+) concentration in GH3 cells and significantly reduced freezing behavior in rats, indicating that the CCKB receptor plays an important role in anxiety.
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Affiliation(s)
- T Tsutsumi
- Department of Neuropsychiatry, Oita Medical University, Oita, Japan
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39
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Ooi J, Iseki T, Nagayama H, Tomonari A, Ito K, Shirafuji N, Tojo A, Tani K, Asano S. Unrelated cord blood transplantation for adult patients with myelodysplastic syndrome-related secondary acute myeloid leukaemia. Br J Haematol 2001; 114:834-6. [PMID: 11564071 DOI: 10.1046/j.1365-2141.2001.03049.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seven adult patients with myelodysplastic syndrome (MDS)-related secondary acute myeloid leukaemia (AML) were treated with total body irradiation (TBI), cytosine arabinoside (Ara-C) and cyclophosphamide (CY), followed by unrelated human leucocyte antigen (HLA)-mismatched cord blood transplantation (CBT). Granulocyte colony-stimulating factor (G-CSF) was infused continuously from 12 h before until the end of Ara-C therapy to enhance the antileukaemia effect of Ara-C. Five patients are alive and free of disease at 7-31 months after transplantation. These preliminary results suggest that adult MDS-related secondary AML patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT.
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Affiliation(s)
- J Ooi
- Department of Haematology and Oncology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
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40
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Ueda K, Nagayama H, Narita K, Kusano M, Aiba M, Yamada M, Takaba T, Shirasawa K. Extended surgery with en bloc resection of the right common iliac vessels for lymph node metastasis of mucinous colon carcinoma: report of a case. Surg Today 2001; 31:238-41. [PMID: 11318128 DOI: 10.1007/s005950170176] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report herein the case of a 63-year-old woman who underwent surgery for recurrent mucinous carcinoma of the cecum. Recurrent metastatic lymph nodes had invaded the right common iliac vessels and right ureter, but she had no distant metastases and no peritoneal dissemination. Extended surgery with en bloc resection of the right iliac vessels and right ureter, and femorofemoral bypass were performed. Postoperatively, several complications developed which were successfully treated by further operations. By 1 year after surgery, she had no recurrent tumors on radiological examination, suggesting that our aggressive surgery with resection of the invaded regional vessels had effectively removed the recurrent tumors. This procedure may therefore significantly prolong the survival time and improve the quality of life of such patients.
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Affiliation(s)
- K Ueda
- Department of Surgery, Yamanashi Red Cross Hospital, Minamitsuru-gun, Japan
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41
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Tomonari A, Tojo A, Lseki T, Ooi J, Nagayama H, Ogami K, Maekawa T, Shirafuji N, Tani K, Asano S. Severe autoimmune thrombocytopenia after allogeneic bone marrow transplantation for aplastic anemia. Int J Hematol 2001; 74:228-32. [PMID: 11594527 DOI: 10.1007/bf02982010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autoimmune thrombocytopenia (AITP) after bone marrow transplantation (BMT) was suggested to occur by immune dysregulation mainly in association with graft-versus-host disease (GVHD). Here we present a patient who developed severe AITP after BMT. A 40-year-old woman with severe aplastic anemia received a BMT from a partially HLA-matched brother. Despite myeloid and erythroid engraftments, platelet recovery was delayed. All bone marrow cells were 46,XY and were derived from the donor. Grade I acute GVHD involving skin developed from day 34 posttransplantation, but promptly responded to prednisolone in addition to a prophylactic dose of tacrolimus. With the tapering of prednisolone, thrombocytopenia progressed without substantial changes in the white blood cell count, hemoglobin concentration, or reticulocyte count. On day 188, the patient developed chronic GVHD involving skin and liver, which promptly responded to the readministration of prednisolone and increased tacrolimus. However, the patient's platelet count decreased to 9 x 10(9) cells/L on day 222. The platelet-associated immunoglobulin G (PAIgG) values were elevated. Bone marrow examination showed hypercellularity with plentiful megakaryocytes. The number of colony-forming units-megakaryocyte was within the normal range. The elevated PAIgG values and a correlation between thrombocytopenia and the intensity of the immunosuppressive agents strongly suggested a causative role of the autoimmune mechanisms for thrombocytopenia in this patient.
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Affiliation(s)
- A Tomonari
- Department of Hematology/Oncology, Institute of Medical Science, The University of Tokyo, Japan.
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42
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Horinouchi Y, Nagayama H. [Role of life events on onset of major depression]. Nihon Rinsho 2001; 59:1471-6. [PMID: 11519144] [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: 02/21/2023]
Abstract
Many kinds of stressful life events have been regarded as important factors in the causation and management of depression, based on empirical and descriptive studies. The instrument for assessment of life events has been established. There is consistent evidence for dose-response relationship between stressful events and depression. The effect of life events close to onset is more important, but sometimes the expected response appears after a delay. The effect of life events varies by early adverse experience, cognition and genetics. The association between life events exposure and risk of major depression progressively declines, it is consistent with the kindling hypothesis.
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Affiliation(s)
- Y Horinouchi
- Department of Neuropsychiatry, Oita Medical University
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43
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Ueda M, Hamamoto M, Nagayama H, Okubo S, Amemiya S, Katayama Y. Biochemical alterations during medication withdrawal in Parkinson's disease with and without neuroleptic malignant-like syndrome. J Neurol Neurosurg Psychiatry 2001; 71:111-3. [PMID: 11413275 PMCID: PMC1737455 DOI: 10.1136/jnnp.71.1.111] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [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: 11/04/2022]
Abstract
The object was to assess alterations in CSF concentrations of monoamine metabolites during withdrawal of medication in patients with Parkinson's disease in relation to the presence or absence of episodes resembling neuroleptic malignant syndrome (NMS). This syndrome is a fatal condition developing after neuroleptic therapy, and a neuroleptic malignant-like syndrome (NMLS) may also occur after withdrawal of antiparkinsonian drugs in patients with Parkinson's disease. Previous biochemical assays showed that the CSF concentration of the dopamine metabolite homovanillic acid (HVA) is an independent prognostic factor for development of NMLS in patients with Parkinson's disease. In the present study, CSF concentrations of HVA, the noradrenaline (norepinephrine) metabolite 3-methoxy-4-hydroxyphenylethylene glycol, and the serotonin metabolite 5-hydroxyindole acetic acid were assayed using high performance liquid chromatography with electrochemical detection. The study population consisted of nine patients with Parkinson's disease with NMLS and 12 without NMLS, in whom metabolites were assayed during both withdrawal and remedicated periods. Concentrations of HVA in the CSF were significantly lower during the withdrawal period than the medicated period regardless of whether patients developed NMLS, and HVA concentrations were comparably increased after remedication in both groups. However, HVA concentrations were significantly lower in patients with NMLS than in those without NMLS during both withdrawal and medicated periods. Other metabolites showed no significant differences. The present data provide further biochemical evidence for extremely suppressed central dopaminergic activity during NMLS, which may indicate a narrow safety margin for medication withdrawal in patients with Parkinson's disease.
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Affiliation(s)
- M Ueda
- Department of Neurology, Tokyo Metropolitan Tama Geriatric Hospital, Tokyo, Japan.
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44
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Hatamochi A, Nagayama H, Kuroda K, Shinkai H, Ishikiriyama S, Kobayashi M, Kobayashi K. Costello syndrome with decreased gene expression of elastin in cultured dermal fibroblasts. Dermatology 2001; 201:366-9. [PMID: 11146354 DOI: 10.1159/000051558] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of Costello syndrome. A 2-year-old Japanese boy presented with a 'coarse' face, curly hair and loose skin of the dorsal aspect of the hands and feet with dark pigmentation. A skin biopsy of the dorsal aspect of the left hand revealed hyperkeratosis and papillomatosis of the epidermis, hyperpigmentation of the basal layer, and shortening and rupture of elastic fibers of the dermis. Electron microscopy of dermal elastic fibers showed a decreased amount of elastin with an exposed appearance of microfibrils. In Northern blot analysis of cultured dermal fibroblasts, elastin mRNA levels were reduced, suggesting a decrease in elastin production at the lesions of loose skin.
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Affiliation(s)
- A Hatamochi
- Department of Dermatology, Chiba University School of Medicine, Chiba, Japan.
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45
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Sato K, Kawasaki H, Nagayama H, Enomoto M, Morimoto C, Tadokoro K, Juji T, Takahashi T. Chemokine receptor expressions and responsiveness of cord blood T cells. J Immunol 2001; 166:1659-66. [PMID: 11160208 DOI: 10.4049/jimmunol.166.3.1659] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chemokines and their receptors play a critical role in the selective attraction of various subsets of leukocytes. We examined the chemokine receptor expressions and responsiveness of cord blood (CB) T cells. Flow-cytometric analysis revealed that peripheral blood (PB) T cells expressed CCR-1, CCR-2, CCR-5, CCR-6, CXC chemokine receptor-3 (CXCR-3), and CXCR-4, while CB T cells expressed only CXCR-4 on their surface. Chemotactic migratory response of CB T cells to macrophage-inflammatory protein (MIP)-1alpha, monocyte chemoattractant protein-1, RANTES, MIP-3alpha, monokine induced by IFN-gamma, and IFN-gamma-inducible protein-10 was significantly impaired compared with those of PB T cells. In contrast, the ability of CB T cells to migrate to MIP-3beta, 6Ckine, and stromal cell-derived factor-1alpha was greater than that of PB T cells, and these events were correlated with the expression levels of CCR-7 and CXCR-4, respectively. Engagement of CD3 and CD28 specifically up-regulated CXCR-3 expression and chemotaxis to monokine induced by IFN-gamma and IFN-gamma-inducible protein-10, whereas this stimulation down-regulated CCR-7 expression and chemotaxis to MIP-3beta and 6Ckine in PB T cells, but not in CB T cells. These results suggest that PB T cells and CB T cells exhibit distinct chemokine responsiveness via different chemokine receptor repertoire.
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MESH Headings
- Antibodies, Monoclonal/pharmacology
- CD28 Antigens/immunology
- CD3 Complex/immunology
- Cells, Cultured
- Chemokines, CC/blood
- Chemokines, CC/physiology
- Chemokines, CXC/blood
- Chemokines, CXC/physiology
- Chemotaxis, Leukocyte/immunology
- Fetal Blood/cytology
- Fetal Blood/immunology
- Fetal Blood/metabolism
- Humans
- Immunophenotyping
- Infant, Newborn
- Leukocyte Common Antigens/biosynthesis
- Ligands
- Receptors, Chemokine/biosynthesis
- Receptors, Chemokine/blood
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
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Affiliation(s)
- K Sato
- Department of Cell Processing and Clinical Immunology and AIDS Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Sato K, Kawasaki H, Nagayama H, Enomoto M, Morimoto C, Tadokoro K, Juji T, Takahashi TA. Signaling events following chemokine receptor ligation in human dendritic cells at different developmental stages. Int Immunol 2001; 13:167-79. [PMID: 11157850 DOI: 10.1093/intimm/13.2.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Responsiveness of dendritic cells (DC) to inflammatory CC chemokines is down-regulated during their maturation. We analyzed the mechanism underlying these events. Cell-surface expression of CC chemokine receptor (CCR)-1, -3 and -5 was increased during differentiation of immature DC (iDC) from monocytes. In contrast, these expressions were decreased during development of iDC into mature DC (mDC) to levels similar to those of monocytes. Transcriptional expression of CCR-1, -3 and -5 was increased during differentiation of iDC from monocytes, while the expression was decreased during development of iDC into mDC. Expression of CCR-7 transcript was detected in mDC, but not in monocytes or iDC. Both monocytes and iDC, but not mDC, migrated in response to inflammatory CC chemokines such as regulated on activation normal T cell expressed and secreted (RANTES)/CCL5, whereas mDC, but not monocytes or iDC, migrated to macrophage inflammatory protein (MIP)-3ss/CCL19. Receptor engagement of monocytes or iDC by RANTES (for CCR-1, -3 and -5) resulted in protein tyrosine phosphorylation events including activation of focal adhesion kinase as well as mitogen-activated protein kinase, whereas this stimulation induced little activation of these molecular events in mDC when compared with monocytes or iDC. On the other hand, stimulation with MIP-3ss (for CCR-7) induced tyrosine phosphorylation events in mDC, but not in monocytes or iDC. These results suggest that the down-regulation of cell-surface expression of CCR and of their downstream signaling events may be involved in the reduced chemotaxis of DC to inflammatory CC chemokines during their maturation.
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Affiliation(s)
- K Sato
- Department of Cell Processing, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
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Nagayama H. [Drug therapy for patients with depression]. Seishin Shinkeigaku Zasshi 2001; 103:596-601. [PMID: 11692390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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48
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Yamamoto Y, Akiyoshi J, Kiyota A, Katsuragi S, Tsutsumi T, Isogawa K, Nagayama H. Increased anxiety behavior in OLETF rats without cholecystokinin-A receptor. Brain Res Bull 2000; 53:789-92. [PMID: 11179844 DOI: 10.1016/s0361-9230(00)00407-x] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cholecystokinin (CCK) may have a role in the mediation of human panic disorder and anxiogenic (anxiolytic)-like activity in an animal model of anxiety. Otsuka Long Evans Tokushima Fatty (OLETF) rats lacked CCK A receptors (CCKAR) because of a genetic abnormality. In order to elucidate the involvement of CCKAR in the regulation of anxiety, we investigated the exploratory behavior on elevated plus-maze test, the black and white box test, and open field test with OLETF rats in comparison with normal [Long-Evans Tokushima Otsuka (LETO)] rats. And OLETF rats increased the number of stretched attend postures and decreased open arm entry and the % time of open arm in an elevated plus-maze test. Time spent in the white box decreased significantly in OLETF rats than LETO rats. The total line crossing decreased significantly in OLETF rats compared to LETO rats. The missing CCKAR had a significant anxiogenic-like effect. These data support the involvement of the CCKAR in the neurobiological mechanism of anxiety.
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Affiliation(s)
- Y Yamamoto
- Department of Neuropsychiatry, Oita Medical University, Hasama-Machi, Oita, Japan
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Hikichi T, Akiyoshi J, Yamamoto Y, Tsutsumi T, Isogawa K, Nagayama H. Suppression of conditioned fear by administration of CRF receptor antagonist CP-154,526. Pharmacopsychiatry 2000; 33:189-93. [PMID: 11071021 DOI: 10.1055/s-2000-7587] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In order to examine the involvement of corticotropin-releasing hormone (CRF) receptor in the formation of anxiety, we investigated whether CRF receptor antagonist CP-154,526 suppressed conditioned fear stress. First, rats were individually subjected to 30 min of footshock. Twenty-four hours after footshock, the rats were again placed in the chamber and observed for 5 min without shock. CP-154,526 was administered 30 min before placing the rats in the chamber again. After that, CP-154,526 was once more administered 30 min before applying footshock. Administration of CP-154,526 30 min both before conditioned fear stress (placing the rats inside the cage but not applying footshock) and before actual footshock significantly reduced freezing behavior. These results show that CP-154,526 blocked both the acquisition and expression of conditioned fear, thus suggesting that the CRF receptor might be related to anxiety.
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Affiliation(s)
- T Hikichi
- Department of Neuropsychiatry, Oita Medical University, Japan
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Tanigawa T, Nakagawa T, Kimata K, Nagayama H, Hosoya K, Tanaka N. Stationary phase structures enhancing electroosmotic flow in capillary electrochromatography. J Chromatogr A 2000; 887:299-305. [PMID: 10961321 DOI: 10.1016/s0021-9673(00)00468-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/18/2022]
Abstract
Several chemically bonded silicas with C18 groups were examined with respect to electroosmotic flow (EOF) velocities under CEC conditions. Stationary phases with low hydrophobic selectivity generally provided high EOFs. The stationary phases prepared by using octadecyltrichlorosilane showed greater EOF than those from octadecyldimethylchlorosilane. Restricted-access reversed-phase (RARP) packing materials having C18 groups inside the pores and silanols on the external surfaces showed higher EOF than monomeric C18 phases with similarly high hydrophobic selectivity. The RARP-type structure having silanols at the external surface seems to be effective for increasing EOF while maintaining the hydrophobic character of the solute binding sites.
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Affiliation(s)
- T Tanigawa
- Kyoto University, Graduate School of Pharmaceutical Science, Japan
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