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Nagata K, Takiyama H, Tashiro K, Yamadera M, Okamoto K, Kajiwara Y, Shinto E, Kishi Y, Matsukuma S, Yamada S, Ueno H. Multidisciplinary management of locally recurrent rectal cancer with carbon ion radiotherapy followed by prophylactic removal of the irradiated bowel: a case report. Surg Case Rep 2024; 10:13. [PMID: 38196031 PMCID: PMC10776531 DOI: 10.1186/s40792-024-01811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Locally recurrent rectal cancer (LRRC) involving the upper sacrum is typically incurable, and palliative treatment is the only option for most patients, resulting in a poor prognosis and reduced quality of life. Carbon ion radiotherapy (CIRT) has emerged as a promising modality for treating LRRC. This report presents a case of LRRC with sacral involvement that was managed via multidisciplinary therapy incorporating CIRT. CASE PRESENTATION A 55-year-old male was diagnosed with an anastomotic recurrence of rectal cancer 15 months after undergoing anterior resection. Computed tomography (CT) suggested that the lesion was at an anastomosis site and broadly adherent to the upper sacrum, and colonoscopy confirmed the diagnosis of LRRC. Histopathological examination of the biopsy specimens revealed adenocarcinoma cells and that lesion was genetically RAS-wild. Induction chemotherapy with mFOLFOX6 and panitumumab was used as the first treatment. The recurrent lesion shrank and no signs of distant metastasis were observed after 11 cycles, although the range of the lesions attached to the sacrum remained unchanged. Therefore, we provided CIRT for this inoperable lesion and prophylactically removed the radiation-exposed bowel including the recurrent lesion, because radiation-induced ulcers can cause bleeding and perforation. Despite the presence of considerable fibrosis in the irradiated region, the operation was successful and the postoperative course had no untoward incidents. He is still recurrence-free 24 months following surgery, despite the lack of adjuvant chemotherapy. This is the first report of CIRT followed by CIRT-irradiated bowel removal for an unresectable anastomosis recurrent lesion. CONCLUSIONS The clinical course of this case suggests that CIRT could be a potentially effective therapeutic option for LRRC involving the bowel, as long as the prophylactic removal of the irradiated bowel is performed at the optimal time. Further research involving larger sample sizes is warranted to validate the findings and conclusions of this case report.
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Affiliation(s)
- K Nagata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - H Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - K Tashiro
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - M Yamadera
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - K Okamoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Y Kajiwara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - E Shinto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Y Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - S Matsukuma
- Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - S Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - H Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Matsuda Y, Tanimukai H, Inoue S, Hirayama T, Kanno Y, Kitaura Y, Inada S, Sugano K, Yoshimura M, Harashima S, Wada S, Hasegawa T, Okamoto Y, Dotani C, Takeuchi M, Kako J, Sadahiro R, Kishi Y, Uchida M, Ogawa A, Inagaki M, Okuyama T. A revision of JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements. Jpn J Clin Oncol 2023; 53:808-822. [PMID: 37190819 DOI: 10.1093/jjco/hyad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer have recently revised the clinical practice guidelines for delirium in adult cancer patients. This article reports the process of developing the revised guidelines and summarizes the recommendations made. METHODS The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multi-disciplinary members, created three new clinical questions: non-pharmacological intervention and antipsychotics for the prevention of delirium and trazodone for the management of delirium. In addition, systematic reviews of nine existing clinical questions have been updated. Two independent reviewers reviewed the proposed articles. The certainty of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development, and Evaluation system. The modified Delphi method was used to validate the recommended statements. RESULTS This article provides a compendium of the recommendations along with their rationales, as well as a short summary. CONCLUSIONS These revised guidelines will be useful for the prevention, assessment and management of delirium in adult cancer patients in Japan.
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hitoshi Tanimukai
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Hospital, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Kanno
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Kitaura
- Department of Psychiatry, Panasonic Health Insurance Organization Matsushita Memorial Hospital, Moriguchi, Japan
| | - Shuji Inada
- Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Koji Sugano
- Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Masafumi Yoshimura
- Department of Occupational Therapy, Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Saki Harashima
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Saho Wada
- Department of Neuropsychiatry, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshiaki Okamoto
- Department of pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Chikako Dotani
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Ryoichi Sadahiro
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Toru Okuyama
- Department of Psychiatry/Palliative Care Center, Nagoya City University West Medical Center, Nagoya, Japan
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Shimizu K, Abe F, Kishi Y, Kita R, Shinyashiki N, Yagihara S. Dielectric Study on Supramolecular Gels by Fiber Structure Formation from Low-Molecular-Weight Gelator/Water Mixtures. Gels 2023; 9:gels9050408. [PMID: 37233000 DOI: 10.3390/gels9050408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
There are various types of gel materials used in a wide range of fields, and their gelation mechanisms are extremely diverse. Furthermore, in the case of hydrogels, there exist some difficulties in understanding complicated molecular mechanisms especially with water molecules interacting through hydrogen bonding as solvents. In the present work, the molecular mechanism of the structural formation of fibrous super-molecular gel by the low molecular weight gelator, N-oleyl lactobionamide/water mixture was elucidated using the broadband dielectric spectroscopy (BDS) method. The dynamic behaviors observed for the solute and water molecules indicated hierarchical structure formation processes in various time scales. The relaxation curves obtained at various temperatures in the cooling and heating processes showed relaxation processes respectively reflecting the dynamic behaviors of water molecules in the 10 GHz frequency region, solute molecules interacting with water in MHz region, and ion-reflecting structures of the sample and electrode in kHz region. These relaxation processes, characterized by the relaxation parameters, showed remarkable changes around the sol-gel transition temperature, 37.8 °C, determined by the falling ball method and over the temperature range, around 53 °C. The latter change suggested a structure formation of rod micelles appearing as precursors before cross-linking into the three-dimensional network of the supramolecular gels. These results clearly demonstrate how effective relaxation parameter analysis is for understanding the gelation mechanism in detail.
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Affiliation(s)
- Kenta Shimizu
- Graduate School of Science, Tokai University, 4-1-1 Kitakaname, Hiratsuka-shi 259-1292, Japan
| | - Fumiya Abe
- Graduate School of Science, Tokai University, 4-1-1 Kitakaname, Hiratsuka-shi 259-1292, Japan
| | - Yasuhiro Kishi
- Graduate School of Science, Tokai University, 4-1-1 Kitakaname, Hiratsuka-shi 259-1292, Japan
| | - Rio Kita
- Department of Physics, School of Science, Tokai University, Hiratsuka-shi 259-1292, Japan
- Micro/Nano Technology Center, Tokai University, Hiratsuka-shi 259-1292, Japan
| | - Naoki Shinyashiki
- Department of Physics, School of Science, Tokai University, Hiratsuka-shi 259-1292, Japan
- Micro/Nano Technology Center, Tokai University, Hiratsuka-shi 259-1292, Japan
| | - Shin Yagihara
- Department of Physics, School of Science, Tokai University, Hiratsuka-shi 259-1292, Japan
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Trzepacz PT, Franco JG, Meagher D, Kishi Y, Sepúlveda E, Gaviria AM, Chen CH, Huang MC, Furlanetto LM, Negreiros D, Lee Y, Kim JL, Kean J. Delusions and Hallucinations Are Associated With Greater Severity of Delirium. J Acad Consult Liaison Psychiatry 2022; 64:236-247. [PMID: 36539078 DOI: 10.1016/j.jaclp.2022.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The 3 core domains of delirium (cognitive, higher level thinking, circadian) do not include the less common noncore psychotic symptoms. However, psychosis might inform about perturbations of neural circuitry, outcomes, or suggest tailored clinical management. OBJECTIVE We assessed for the first time the relationships between psychosis and other characteristics of delirium in patients without confounders for delirium phenotype, such as dementia or antipsychotics treatment. METHODS Cross-sectional analysis of 366 adults with delirium per the Delirium Rating Scale Revised-98, whose items distinguish hallucinations and delusions from other types of misperceptions and abnormal thought content, assessed during the preceding 24 hours to capture symptom severity fluctuation. The relationship of psychosis with other delirium characteristics was assessed using bivariate comparisons and analysis of variance as appropriate for groups with no psychosis and any psychosis (hallucinations and/or delusions), and subgroups with only hallucinations, only delusions, or both. A discriminant logistic model assessed variables associated with presence of any psychotic features versus none. RESULTS Delirium with any psychotic features occurred in 44.5% (163 of 366). Of the 366, 119 (32.5%) had only hallucinations (Hall), 14 (3.8%) had only delusions (Del), and 30 (8.2%) had both (Both). In the psychotic group (n = 163), 73.0% were Hall, 8.6% Del, and 18.4% Both. All psychotic patient groupings had significantly greater delirium severity on the Delirium Rating Scale Revised-98. Delusions and hallucinations were discordant for occurring together. The discriminant model found increased odds of having psychosis as 3 symptom severities increased (visuospatial ability, thought process, and sleep-wake cycle) where these each represented a delirium core domain. The noncore symptom of lability of affect had high odds ratio for psychosis, while motor retardation reduced odds of psychosis in this model. CONCLUSIONS Consistent with prior reports, psychosis occurred in less than half of delirious patients with delusions being infrequent, and an association with affective lability was found. We are the first to report that psychotic features are a marker for more severe delirium affecting all core domains. Given that previous functional magnetic resonance imaging research found a correlation between neural network dysconnectivity with greater severity of delirium, psychotic symptoms might be a clinical marker for greater underlying cerebral cortical neural circuitry dysfunction.
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Affiliation(s)
- Paula T Trzepacz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - José G Franco
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - David Meagher
- Cognitive Impairment Research Group (CIRG), Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Esteban Sepúlveda
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Reus, Spain; Universitat Rovira i Virgili, Tarragona, Spain
| | - Ana M Gaviria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, Reus, Spain; Facultad de Ciencias de la Salud, Fundación Universitaria María Cano, Medellín, Colombia
| | - Chun-Hsin Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Leticia M Furlanetto
- Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Daniel Negreiros
- Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Yanghyun Lee
- Chilgok Yeonhap Mental Health Clinic, Daegu, South Korea
| | - Jeong-Lan Kim
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Yokokawa D, Shikino K, Kishi Y, Ikusaka M. Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment. Int J Gen Med 2022; 15:6309-6313. [PMID: 35924175 PMCID: PMC9342889 DOI: 10.2147/ijgm.s369056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Correspondence: Daiki Yokokawa, Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan, Tel/Fax +81-43-224-4758, Email
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Yokokawa D, Shikino K, Kishi Y, Ban T, Miyahara S, Ohira Y, Yanagita Y, Yamauchi Y, Hayashi Y, Ishizuka K, Hirose Y, Tsukamoto T, Noda K, Uehara T, Ikusaka M. Does scoring patient complexity using COMPRI predict the length of hospital stay? A multicentre case-control study in Japan. BMJ Open 2022; 12:e051891. [PMID: 35450890 PMCID: PMC9024233 DOI: 10.1136/bmjopen-2021-051891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To clarify the factors associated with prolonged hospital stays, focusing on the COMplexity PRediction Instrument (COMPRI) score's accuracy in predicting the length of stay of newly hospitalised patients in general internal medicine wards. DESIGN A case-control study. SETTING Three general internal medicine wards in Chiba Prefecture, Japan. PARTICIPANTS Thirty-four newly hospitalised patients were recruited between November 2017 and December 2019, with a final analytic sample of 33 patients. We included hospitals in different cities with general medicine outpatient and ward facilities, who agreed to participate. We excluded any patients who were re-hospitalised within 2 weeks of a prior discharge. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' COMPRI scores and their consequent lengths of hospital stay. RESULTS The 17 patients (52%) allocated to the long-term hospitalisation group (those hospitalised ≥14 days) had a significantly higher average age, COMPRI score and percentage of participants with comorbid chronic illnesses than the short-term hospitalisation group (<14 days). A logistic regression model (model A, comprising only the COMPRI score as the explanatory variable) and a multiple logistic regression model (model B, comprising variables other than the COMPRI score as explanatory variables) were created as prediction models for the long-term hospitalisation group. When age ≥75 years, a COMPRI score ≥6 and a physician with 10 years' experience were set as explanatory variables, model A showed better predictive accuracy compared with model B (fivefold cross-validation, area under curve of 0.87 vs 0.78). The OR of a patient with a COMPRI score of ≥6 joining the long-term hospitalisation group was 4.25 (95% CI=1.43 to 12.63). CONCLUSIONS Clinicians can use the COMPRI score when screening for complexity assessment to identify hospitalised patients at high risk of prolonged hospitalisation. Providing such patients with multifaceted and intensive care may shorten hospital stays.
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Affiliation(s)
- Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Toshiaki Ban
- Department of Internal Medicine, Isumi Medical Center, Isumi, Japan
| | | | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of General Medicine, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Yasutaka Yanagita
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yosuke Yamauchi
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yasushi Hayashi
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of General Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Yuta Hirose
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Internal Medicine, Funabashi Futawa Byoin, Funabashi, Japan
| | - Tomoko Tsukamoto
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Nagata K, Shinto E, Yamadera M, Shiraishi T, Kajiwara Y, Okamoto K, Mochizuki S, Hase K, Kishi Y, Ueno H. Prognostic and predictive values of tumour budding in stage IV colorectal cancer. BJS Open 2020; 4:693-703. [PMID: 32472647 PMCID: PMC7397347 DOI: 10.1002/bjs5.50300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/20/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Tumour budding is an important prognostic feature in early-stage colorectal cancer, but its prognostic significance in metastatic disease has not been fully investigated. METHODS Patients with stage IV disease who had primary colorectal tumour resection without previous chemotherapy or radiotherapy from January 2000 to December 2018 were reviewed retrospectively. Budding was evaluated at the primary site and graded according to the criteria of the International Tumor Budding Consensus Conference (ITBCC) (BD1, low; BD2, intermediate; BD3, high). Patients were categorized by metastatic (M1a, M1b) and resectional (R0/R1, R2/unresected) status. Subgroups were compared for overall (OS) and recurrence-free (RFS) survival in R0/R1 subgroups; R2/unresected patients were evaluated for the rate of tumour progression, based on change in tumour size from baseline. RESULTS Of 371 patients observed during the study, 362 were analysed. Patients with BD3 had a lower 5-year OS rate than those with BD1 + BD2 (18·4 versus 40·5 per cent; P < 0·001). Survival analyses according to metastatic and resection status also showed that BD3 was associated with shorter OS than BD1 + BD2. In multivariable analysis, BD3 (hazard ratio (HR) 1·51, 95 per cent c.i. 1·11 to 2·10; P = 0·009), T4 status (HR 1·39) and R2/unresected status (HR 3·50) were associated with decreased OS. In the R0/R1 subgroup, the 2-year RFS rate was similar for BD3 and BD1 + BD2 according to metastatic status. There was no significant difference between BD3 and BD1 + BD2 for change in tumour size in the R2/unresected subgroup (P = 0·094). Of 141 patients with initially unresectable metastases who had chemotherapy, 35 achieved conversion from unresectable to resectable status. The conversion rate was significantly higher for BD1 + BD2 than for BD3 (36 versus 18 per cent; P = 0·016). CONCLUSION Stage IV colorectal cancer with high-grade tumour budding according to ITBCC criteria correlates with poor prognosis.
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Affiliation(s)
- K. Nagata
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - E. Shinto
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - M. Yamadera
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - T. Shiraishi
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - Y. Kajiwara
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - K. Okamoto
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - S. Mochizuki
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - K. Hase
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - Y. Kishi
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
| | - H. Ueno
- Department of SurgeryNational Defence Medical College3‐2 NamikiTokorozawa359‐8513Japan
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Matsuda Y, Tanimukai H, Inoue S, Inada S, Sugano K, Hasuo H, Yoshimura M, Wada S, Dotani C, Adachi H, Okamoto Y, Takeuchi M, Fujisawa D, Kako J, Sasaki C, Kishi Y, Akizuki N, Inagaki M, Uchitomi Y, Matsushima E, Okuyama T. JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements. Jpn J Clin Oncol 2020; 50:586-593. [PMID: 32215557 PMCID: PMC7202141 DOI: 10.1093/jjco/hyaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Japanese Psycho-Oncology Society and Japanese Association of Supportive Care in Cancer recently launched the clinical practice guidelines for delirium in adult cancer patients. The aim of the guidelines was to provide evidence-based recommendations for the clinical assessment and management of delirium in cancer patients. This article reports the process of developing the guideline and summarizes the recommendations made. METHODS The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multidisciplinary members, formulated nine clinical questions. A systematic literature search was conducted to identify relevant articles published prior to through 31 May 2016. Each article was reviewed by two independent reviewers. The level of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development and Evaluation system. The modified Delphi method was used to validate the recommendation statements. RESULTS This article provides a summary of the recommendations with rationales for each, as well as a short summary. CONCLUSIONS These guidelines will support the clinical assessment and management of delirium in cancer patients. However, additional clinical studies are warranted to further improve the management of delirium.
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hitoshi Tanimukai
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Shuji Inada
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Sugano
- Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Masafumi Yoshimura
- Department of Neuropsychiatry, Kansai Medical University, Moriguchi, Japan
| | - Saho Wada
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Chikako Dotani
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Yoshiaki Okamoto
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Mari Takeuchi
- Department of Palliative Care, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Division of Patient Safety, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kako
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Chiyuki Sasaki
- Nursing Department, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki 211-8533, Japan
| | - Nobuya Akizuki
- Department of Psycho-Oncology/Psychiatry, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Eisuke Matsushima
- Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
| | - Toru Okuyama
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Abstract
OBJECTIVES To evaluate the magnitude of general medical claims expenditures (ie, medical service use) for individuals who use and do not use behavioral health (BH) services in the Japanese free-access medical insurance system to determine if BH patients use substantially more health services, as has consistently been reported in the United States. STUDY DESIGN Retrospective comparison of Japanese occupation-based total health services use for enrollees with and without comorbid BH conditions. METHODS The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 years and older) who had at least 1 diagnosis of a chronic medical condition were included in the study (N = 192,613). Measurements were total claims expenditures for BH and medical services. RESULTS The proportion of enrollees using BH services was 14.3%. BH service users accounted for 21.1% of total health service spending. Annual total costs of BH service users were 1.6 times higher than those of non-BH users. Annual medical costs of BH users were 1.3 times higher than those of non-BH users. CONCLUSIONS The results of this Japanese cohort study show that patients with concurrent BH conditions and chronic medical illnesses have substantially lower total health care costs than numerous studies have demonstrated in US populations. This is perhaps in part due to the integration of medical and BH claims payment and care delivery in Japan, an approach that the US health system may wish to consider testing.
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Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-ku Kawasaki City, Japan.
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Hatta K, Kishi Y, Wada K, Takeuchi T, Hashimoto N, Suda K, Taira T, Tsuchida K, Ohmori T, Akizuki N, Nishio Y, Nakanishi Y, Usui C, Kurata A, Horikawa N, Eguchi H, Ito S, Muto H, Nakamura H, Uchimura N. Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors. J Clin Psychiatry 2019; 81. [PMID: 31851436 DOI: 10.4088/jcp.19m12865] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. METHODS This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. RESULTS Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). CONCLUSIONS Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, Tokyo 177-8521, Japan. .,Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Hashimoto
- Department of Psychiatry, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kiyoko Suda
- Department of Psycho-oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshihiro Taira
- Department of Psychiatry, Fukuyama City Hospital, Fukuyama, Japan
| | - Kazuo Tsuchida
- Department of Psychiatry, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Ohmori
- Department of Psychiatry, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Nobuya Akizuki
- Department of Psycho-oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuko Nishio
- Department of Psycho-oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yukiko Nakanishi
- Department of Psycho-oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Akiko Kurata
- Department of Psychiatry and Neurosciences, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Horikawa
- Department of Psychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Hiroshi Eguchi
- Department of Psychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Shigeo Ito
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hitoshi Muto
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Naohisa Uchimura
- Department of Psychiatry, Kurume University School of Medicine, Kurume, Japan
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11
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Trzepacz PT, Franco JG, Meagher DJ, Lee Y, Kim JL, Kishi Y, Furlanetto LM, Negreiros D, Huang MC, Chen CH, Kean J, Leonard M. Delirium Phenotype by Age and Sex in a Pooled Data Set of Adult Patients. J Neuropsychiatry Clin Neurosci 2019; 30:294-301. [PMID: 30045679 DOI: 10.1176/appi.neuropsych.18020024] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors aimed to evaluate whether the clinical phenotype of delirium differs if dichotomized either by sex or age (cutoff age, 65 years old) in a pooled sample of 406 nondemented adult patients with delirium as defined by DSM-IV criteria. Delirium characteristics were measured with the Delirium Rating Scale-Revised-98 (DRS-R-98). DRS-R-98 items were subgrouped to represent subscores representing the three core domains of delirium (cognitive, higher-order thinking, and circadian), noncore accessory symptoms (psychotic and affective), and diagnostic characteristics (temporal onset, fluctuation, and physical disorder). The authors compared means of the DRS-R-98 subscores and medians of individual items. Exploratory factor analyses evaluated delirium characteristics for each subgroup for each of the four groups-male, female, nongeriatric, and geriatric-while taking into account active medical diagnoses. Males had higher scores on motor agitation and affective lability (behavioral), whereas females had a higher frequency of hypoactive delirium. Delirium had a two-factor structure that emerged in all four study groups, and all its core domains loaded (i.e., correlated together) onto some of these two factors and with circadian domain correlating with accessory symptoms. Although the influence of a variety of active diagnoses on delirium was small and complex, traumatic brain injury had a clear influence on cognitive domain and abrupt onset. Age had a mild influence over delirium characteristics for both males and females. In conclusion, the authors confirmed a two-factor structure for delirium phenomenology, regardless of age and sex, with few significant differences between etiological groups.
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Affiliation(s)
- Paula T Trzepacz
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - José G Franco
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - David J Meagher
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Yanghyun Lee
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Jeong-Lan Kim
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Yasuhiro Kishi
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Leticia M Furlanetto
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Daniel Negreiros
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Ming-Chyi Huang
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Chun-Hsin Chen
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Jacob Kean
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
| | - Maeve Leonard
- From the Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA (PTT); Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); Department of Psychiatry, Graduate Entry Medical School, University of Limerick, and Clinical Education and Research Centre, University Hospital Limerick, Limerick, Ireland, V94 F858 (DJM, ML); Department of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan (YK); Department of Internal Medicine, Federal University of Santa Catarina, Brazil (LMF, DN); Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, and Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (CHC); VA Salt Lake City Health Care System, and Health System Innovation and Research, Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT (JK)
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Kataoka K, Caballero C, Suto T, Masayuki O, Hyunseon C, Troisi R, Yasumasa T, Uetake H, Nobuhiro T, Kazuhiro Y, Hitoshi O, Kishi Y, Shiomi A, Ducreux M, Bonhomme B, Collette L, Rubbia-Brandt L, Brown G, Shiozawa M, Evrard S. Implementing Integrated Quality Assurance (SURCARE) for EORTC-JCOG 1527 / ESSO 02: Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Assessment of Liver Metastasis to Improve Surgical Planning (DREAM). Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.121] [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: 12/01/2022] Open
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Kishi Y, Nara S, Esaki M, Hiraoka N, Shimada K. Feasibility of resecting the portal vein only when necessary during pancreatoduodenectomy for pancreatic cancer. BJS Open 2019; 3:327-335. [PMID: 31183449 PMCID: PMC6551409 DOI: 10.1002/bjs5.50130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022] Open
Abstract
Background Whether the portal/superior mesenteric vein (PV) should be resected during pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) based on preoperative CT or intraoperative findings is controversial. Methods This was a retrospective study with data of patients who had undergone pancreatoduodenectomy for PDAC between 2002 and 2016 in a tertiary referral centre. Based on the extent of contact between the PV and tumour on CT, patients were categorized into: group 1, no contact; group 2, contact 180° or less; group 3, contact greater than 180°. Extent of pathological PV invasion (pPV) (no invasion, pv0; invasion to tunica adventitia, pv1; invasion to media, pv2; invasion to intima, pv3) was compared with patient survival. To assess the feasibility of performing PV resection (PVR) based on intraoperative findings, the prognosis of patients in groups 1 and 2 with pv0 and no PVR (PVR(−)pv0) was compared with that of patients who had PVR (PVR(+)pv0), selected using propensity score matching. Results Groups 1, 2 and 3 comprised 230, 232 and 38 patients respectively, and PVR was performed in 10·9, 73·3 and 95 per cent of them (P < 0·001). Extent of pPV differed significantly (P < 0·001). The positive predictive value of radiological tumour contact with PV in predicting positive pPV was 42·6 per cent. In 64 patients with PVR(−)pv0 and 64 matched patients with PVR(+)pv0, the R0 resection rate (66 versus 73 per cent respectively; P = 0·337) and survival (median 32·4 versus 32·1 months; P = 0·780) were not significantly different. Conclusion PVR is needed only when the tumour is in clear contact with the PV and cannot be detached during surgery.
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Affiliation(s)
- Y Kishi
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital Tokyo Japan
| | - S Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital Tokyo Japan
| | - M Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital Tokyo Japan
| | - N Hiraoka
- Division of Molecular Pathology National Cancer Centre Research Institute Tokyo Japan
| | - K Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital Tokyo Japan
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14
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Kishi Y, Nara S, Esaki M, Hiraoka N, Shimada K. Extent of lymph node dissection in patients with gallbladder cancer. Br J Surg 2018; 105:1658-1664. [DOI: 10.1002/bjs.10913] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Definitions of regional lymph nodes for gallbladder cancer differ according to staging system. Hence, the appropriate extent of lymph node dissection has not yet been standardized.
Methods
Pathological stages and disease-specific survival (DSS) of patients who had undergone surgical resection of gallbladder cancer between 1990 and 2016 were reviewed. Patients with nodal metastases limited to the hepatoduodenal ligament or common hepatic artery, extending to the posterosuperior pancreatic head lymph nodes (PSPLNs), or in nodes along the coeliac axis or superior mesenteric vessels were grouped as having Na, Nb and Nc disease respectively. Metastases beyond these regions were defined as distant metastases (M1). Absence of distant metastasis was expressed as M0.
Results
A total of 259 patients were evaluated. There were 74, 31 and nine patients respectively in the Na, Nb and Nc groups. Twenty-five, nine and four patients in the respective groups had M1 disease (P = 0·682). The 5-year DSS rate was comparable between patients with Na M0 and those with Nb M0 disease (36 versus 34 per cent respectively; P = 0·950), whereas the rate in patients with Nc M0 status (0 per cent) was worse than that of patients with Nb M0 (P = 0·017) and comparable to that of patients with M1 disease (14 per cent; P = 0·590). Among 22 patients with Nb M0 disease, the 5-year DSS rate did not differ between those who had undergone pancreatoduodenectomy and those who had had dissection of PSPLNs without pancreatoduodenectomy (50 versus 30 per cent respectively; P = 0·499).
Conclusion
PSPLNs and nodes along the hepatoduodenal ligament and hepatic artery should be considered regional nodes for gallbladder cancer, and should be resected.
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Affiliation(s)
- Y Kishi
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - S Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - M Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - N Hiraoka
- Division of Molecular Pathology, National Cancer Centre Research Institute, Tokyo, Japan
| | - K Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
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15
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Affiliation(s)
- T Shigekiyo
- The First Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - A Tomonari
- The First Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Y Uno
- The First Department of Internal Medicine, School of Medicine, The University of Tokushima, Tokushima, Japan
| | - Y Kishi
- The Department of Obstetrics and Gynecology, Tokushima-teishin Hospital, Tokushima, Japan
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16
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Hatta K, Kishi Y, Wada K, Takeuchi T, Ito S, Kurata A, Murakami K, Sugita M, Usui C, Nakamura H. Preventive Effects of Suvorexant on Delirium: A Randomized Placebo-Controlled Trial. J Clin Psychiatry 2017; 78:e970-e979. [PMID: 28767209 DOI: 10.4088/jcp.16m11194] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium. METHODS We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d; 36 patients) or placebo (36 patients) every night for 3 days. The primary outcome measure was incidence of delirium as determined by the DSM-5. Trained psychiatrists assessed for delirium. RESULTS We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% [n/N = 0/36] vs 17% [6/36], respectively, P = .025). Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (χ² = 6.46, P = .011). Analysis of variance revealed a tendency for main effect of treatment (F = 3.79, P = .053) on the sleep-wake cycle disturbance score (item 1) of the Japanese version of the Delirium Rating Scale-Revised-98 (DRS-R-98-J). There were no significant differences in adverse events. CONCLUSIONS Suvorexant administered nightly to elderly patients admitted for acute care may provide protection against delirium. Larger studies are needed to show the potential of suvorexant to improve the circadian core domain of delirium. TRIAL REGISTRATION UMIN Clinical Trials Registry identifier: UMIN000015681.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, Tokyo 177-8521, Japan. .,Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeo Ito
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Akiko Kurata
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Kazunori Murakami
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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17
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Kishi Y. Weight change in Alzheimer’s patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1891] [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: 11/17/2022]
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18
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Kishi Y, Nara S, Esaki M, Hiraoka N, Shimada K. Salvage hepatectomy for local recurrence of hepatocellular carcinomas offers survival comparable to that of matched patients who undergo primary hepatectomies. Eur J Surg Oncol 2017; 43:1076-1082. [PMID: 28456443 DOI: 10.1016/j.ejso.2017.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/21/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The feasibility of salvage hepatectomy for locally recurrent hepatocellular carcinomas (HCCs) is unclear, especially for patients with viable parts of previously multinodular tumors. METHODS We reviewed charts of patients who underwent initial hepatectomies between 2000 and 2014 to select those with local recurrences (LR) after non-surgical treatments. Their postoperative outcomes, including morbidity, recurrence-free survival (RFS), and overall survival (OS) were compared with matched patients who underwent initial hepatectomies for primary HCCs (PR). Their local recurrence patterns were divided into recurrent solitary tumors (Subgroup A); and recurrent parts of multinodular tumors (Subgroup B). RESULTS Among 664 patients, hepatectomy for LR was performed in 62 patients. Matched 59 patients were selected as PR. Clinicopathologic profiles at initial surgery were comparable between the LR and PR groups. Incidence of major morbidity (LR vs. PR, 7% vs. 5%, P = 1.00), 5-year RFS (21% vs. 37%, P = 0.28), and 5-year OS (69% vs. 69%, P = 0.62) were comparable. In the LR group, Subgroup B showed worse 5-year RFS (A vs. B, 29% vs. 0%, P < 0.01) and 5-year-OS (80% vs. 53%, P = 0.01). Postoperative recurrence occurred in 46 patients, but local and extrahepatic recurrence was seen only in 2 patients and 2 patients, respectively. CONCLUSION Salvage hepatectomy for locally recurrent HCCs is feasible, and results in prognosis comparable with hepatectomy for primary HCCs. Although the risk of postoperative recurrence was high in Subgroup B, rare local recurrence suggests the usefulness of salvaging uncontrolled tumor by nonsurgical treatment.
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Affiliation(s)
- Y Kishi
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
| | - S Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - M Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - N Hiraoka
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - K Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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19
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Kishi Y, Pointillart F, Lefeuvre B, Riobé F, Le Guennic B, Golhen S, Cador O, Maury O, Fujiwara H, Ouahab L. Isotopically enriched polymorphs of dysprosium single molecule magnets. Chem Commun (Camb) 2017; 53:3575-3578. [DOI: 10.1039/c7cc00317j] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The magnetic memory effect of mononuclear DyIII-based single molecule magnets can be tuned by playing with polymorphism as well as isotopic enrichment.
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20
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Yamamura E, Matsuda K, Kikuchi H, Ishimaru N, Endo H, Kurokawa A, Kishi Y. A case of suicide by helium gas. Chudoku Kenkyu 2016; 29:355-359. [PMID: 30461232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Helium is a colorless, tasteless, and odorless gas that is used as a lifting gas for air balloons and small airships due to its high level of safety. In recent years, it has become easy to search the Internet for methods to commit suicide, and the use of helium gas for this purpose has recently been garnering attention. We report a case of a male in his 30's in which helium gas was used to commit suicide. He was found unconscious on a bed with a plastic bag covering his head. When emergency personnel arrived at the scene, he was in cardiac arrest and remained in cardiac arrest at the time of his arrival at the hospital. Continued cardiopulmonary resuscitation resulted in a return of spontaneous circulation. Head computed tomography showed the corticomedullary border was indistinct. Fifteen hours at the hospital, the patient died. Recently, there has been an increasing trend for suicide being performed according to methods obtained through the Internet or mass media. Although there are only a few cases of suicide by helium gas in Japan, attention must be paid to this issue as the number of such cases may increase in the future.
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21
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Kishi Y, Kondo T, Xiao S, Yosef N, Gaublomme J, Wu C, Wang C, Chihara N, Regev A, Joller N, Kuchroo VK. Protein C receptor (PROCR) is a negative regulator of Th17 pathogenicity. J Exp Med 2016; 213:2489-2501. [PMID: 27670590 PMCID: PMC5068226 DOI: 10.1084/jem.20151118] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/30/2016] [Indexed: 01/10/2023] Open
Abstract
Kishi et al. find that protein C receptor (PROCR) is specifically expressed on the surface of Th17 cells and its loss exacerbates encephalitogenic Th17 cell responses. Th17 cells are key players in defense against pathogens and maintaining tissue homeostasis, but also act as critical drivers of autoimmune diseases. Based on single-cell RNA-seq profiling of pathogenic versus nonpathogenic Th17 cells, we identified protein C receptor (PROCR) as a cell surface molecule expressed in covariance with the regulatory module of Th17 cells. Although PROCR expression in T cells was controlled by the cooperative action of the Th17 lineage-specific transcription factors RORγt, IRF4, and STAT3, PROCR negatively regulated Th17 differentiation. CD4+ T cells from PROCR low expressor mutant mice readily differentiated into Th17 cells, whereas addition of the PROCR ligand, activated protein C, inhibited Th17 differentiation in vitro. In addition, PROCR acted as a negative regulator of Th17 pathogenicity in that it down-regulated expression of several pathogenic signature genes, including IL-1 and IL-23 receptors. Furthermore, T cell–specific deficiency of PROCR resulted in the exacerbation of experimental autoimmune encephalomyelitis (EAE) and higher frequencies of Th17 cell in vivo, indicating that PROCR also inhibits pathogenicity of Th17 cells in vivo. PROCR thus does not globally inhibit Th17 responses but could be targeted to selectively inhibit proinflammatory Th17 cells.
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Affiliation(s)
- Yasuhiro Kishi
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115.,Mitsubishi Tanabe Pharma Corporation, Kamoshida-cho 1000, Yokohama 227-0033, Japan
| | - Takaaki Kondo
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115.,Mitsubishi Tanabe Pharma Corporation, Kamoshida-cho 1000, Yokohama 227-0033, Japan
| | - Sheng Xiao
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115
| | - Nir Yosef
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115.,Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | | | - Chuan Wu
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115
| | - Chao Wang
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115
| | - Norio Chihara
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115
| | - Aviv Regev
- Broad Institute of MIT and Harvard, Cambridge, MA 02142
| | - Nicole Joller
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115 .,Institute of Experimental Immunology, University of Zurich, 8006 Zurich, Switzerland
| | - Vijay K Kuchroo
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115 .,Broad Institute of MIT and Harvard, Cambridge, MA 02142
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22
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Kishi Y, Otsuka K, Akiyama K, Yamada T, Sakamoto Y, Yanagisawa Y, Morimura H, Kawanishi C, Higashioka H, Miyake Y, Thurber S. Effects of a training workshop on suicide prevention among emergency room nurses. Crisis 2016; 35:357-61. [PMID: 25163847 DOI: 10.1027/0227-5910/a000268] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. AIMS The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. METHOD In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. RESULTS It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. CONCLUSION It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.
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Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Kotaro Otsuka
- Department of Disaster and Community Psychiatry and Department of Neuropsychiatry, Iwate Medical University, Morioka, Japan
| | - Keiko Akiyama
- Department of Psychiatry, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tomoki Yamada
- Department of Critical Care and Emergency Center and Department of Psychiatry, Yokohama City University Medical Center, Yokohama, Japan
| | - Yumiko Sakamoto
- Department of Nursing, Kanto Rosai Hospital, Kawasaki, Japan
| | - Yaeko Yanagisawa
- Department of Nursing, St. Luke's International Hospital, Tokyo, Japan
| | | | - Chiaki Kawanishi
- Health Management andPromotion Center, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroaki Higashioka
- Department of Emergency and Critical Care Medicine, Kanto Rosai Hospital, Kawasaki, Japan
| | - Yasushi Miyake
- Department of Emergency and Critical Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Steven Thurber
- Department of Psychology, Woodland Centers, Willmar, MN, USA
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23
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Kawaguchi K, Nakaoka K, Kishi Y, Ogasawara K, Saida N, Hamada Y. Efficacy and Safety of Stereotactic Radiosurgery in Advanced and/or Recurrent Head and Neck Cancer: Over 5-year Follow-up. J Oral Maxillofac Surg 2016. [DOI: 10.1016/j.joms.2016.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Kishi Y, Nara S, Esaki M, Shimada K. 453. The outcomes of hepatectomy for colorectal liver metastases located in the right side of caudate lobe. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.281] [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: 11/15/2022] Open
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25
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Thurber S, Kishi Y, Trzepacz PT, Franco JG, Meagher DJ, Lee Y, Kim JL, Furlanetto LM, Negreiros D, Huang MC, Chen CH, Kean J, Leonard M. Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98). J Neuropsychiatry Clin Neurosci 2016; 27:e122-7. [PMID: 25923855 DOI: 10.1176/appi.neuropsych.13110345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516; nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation's role may not be solely as a circadian activity indicator.
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Affiliation(s)
- Steven Thurber
- From the Child and Adolescent Behavioral Health Services, Minnesota Dept. of Human Services, Willmar, MN (ST); the Dept. of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-City, Kanagawa, Japan (YK); Lilly Research Laboratories and the Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (PTT); Hospital Psiquiatric Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Reus, Tarragona, Spain and, Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia (JGF); the Dept. of Psychiatry, University of Limerick School of Medicine, Limerick, Ireland, and School of Medicine, University College Dublin, Ireland (DJM, ML); the Dept. of Psychiatry, Mungyeong Jeil General Hospital, Mungyeong, South Korea (YL); the Dept. of Psychiatry, College of Medicine, Chungnam National University, Daejeon, South Korea (JLK); the Dept. of Internal Medicine, Federal University of Santa Catarina, Santa Catarina, Brazil (LMF, DN); the Dept. of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan (MCH); the Dept. of Psychiatry, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan (CHC); and the Dept. of Rehabilitation Medicine, Indiana University School of Medicine, Indianapolis, IN (JK)
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26
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Wang C, Yosef N, Gaublomme J, Wu C, Lee Y, Clish CB, Kaminski J, Xiao S, Meyer Zu Horste G, Pawlak M, Kishi Y, Joller N, Karwacz K, Zhu C, Ordovas-Montanes M, Madi A, Wortman I, Miyazaki T, Sobel RA, Park H, Regev A, Kuchroo VK. CD5L/AIM Regulates Lipid Biosynthesis and Restrains Th17 Cell Pathogenicity. Cell 2015; 163:1413-27. [PMID: 26607793 DOI: 10.1016/j.cell.2015.10.068] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 12/31/2022]
Abstract
Th17 cells play a critical role in host defense against extracellular pathogens and tissue homeostasis but can induce autoimmunity. The mechanisms implicated in balancing "pathogenic" and "non-pathogenic" Th17 cell states remain largely unknown. We used single-cell RNA-seq to identify CD5L/AIM as a regulator expressed in non-pathogenic, but not in pathogenic Th17 cells. Although CD5L does not affect Th17 differentiation, it is a functional switch that regulates the pathogenicity of Th17 cells. Loss of CD5L converts non-pathogenic Th17 cells into pathogenic cells that induce autoimmunity. CD5L mediates this effect by modulating the intracellular lipidome, altering fatty acid composition and restricting cholesterol biosynthesis and, thus, ligand availability for Rorγt, the master transcription factor of Th17 cells. Our study identifies CD5L as a critical regulator of the Th17 cell functional state and highlights the importance of lipid metabolism in balancing immune protection and disease induced by T cells.
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Affiliation(s)
- Chao Wang
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Nir Yosef
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA; Department of Electrical Engineering and Computer Science, University of California, Berkeley, Berkeley, CA 94720, USA; Center for Computational Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Jellert Gaublomme
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA; Department of Chemistry and Chemical Biology and Department of Physics, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Chuan Wu
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Youjin Lee
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Jim Kaminski
- Center for Computational Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Sheng Xiao
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Gerd Meyer Zu Horste
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Mathias Pawlak
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Yasuhiro Kishi
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA; Mitsubishi Tanabe Pharma Corporation, Kamoshida-cho 1000, Yokohama, 225-0002, Japan
| | - Nicole Joller
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Katarzyna Karwacz
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Chen Zhu
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Maria Ordovas-Montanes
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Asaf Madi
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Ivo Wortman
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Toru Miyazaki
- Laboratory of Molecular Biomedicine for Pathogenesis, Center for Disease Biology and Integrative Medicine, Faculty of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Raymond A Sobel
- Palo Alto Veteran's Administration Health Care System and Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hongkun Park
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA; Department of Chemistry and Chemical Biology and Department of Physics, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Aviv Regev
- Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA; Howard Hughes Medical Institute and David H. Koch Institute for Integrative Cancer Research, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 20140, USA.
| | - Vijay K Kuchroo
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
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27
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Yabuta M, Kishi Y, Koike N, Yamaguchi M, Taniguchi F. The Importance of the Accurate Diagnostic Preoperational Magnetic Resonance Imaging (MRI) Examinations: Review of 1059 Cases That Undergoing Laparoscopic Surgery for Diagnosed Benign Uterine Myoma. J Minim Invasive Gynecol 2015; 22:S196. [DOI: 10.1016/j.jmig.2015.08.713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
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29
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Yamamoto N, Kawaguchi K, Fujihara H, Yasukawa M, Kishi Y, Hasebe M, Kumagai K, Hamada Y. Autofluorescence Visualization Detection for Oral Epithelial Dysplasia. J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.joms.2015.06.121] [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: 10/23/2022]
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30
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Meller W, Specker S, Schultz P, Kishi Y, Thurber S, Kathol R. Using the INTERMED complexity instrument for a retrospective analysis of patients presenting with medical illness, substance use disorder, and other psychiatric illnesses. Ann Clin Psychiatry 2015; 27:38-43. [PMID: 25696780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The financial and treatment challenges of complex patients must be addressed with adequate assessment and evaluation. The INTERMED complexity instrument (INTERMED) has been developed for this purpose, but to date has not been used retrospectively. The current study represents a retrospective validity investigation of INTERMED with patients with substance use disorder comorbid with other psychiatric and medical conditions (triple diagnoses). Such patients were expected to generate high complexity scores on the INTERMED instrument. METHODS Information on 66 patients with triple diagnoses was submitted to the INTERMED complexity grid. These data were subjected to cluster analysis and other analytic procedures. RESULTS Total INTERMED scores reflected elevated complexity for patients with triple diagnoses. As a group, they represented a single cluster of complex patients. CONCLUSIONS The validity of the INTERMED complexity assessment was corroborated in relation to retrospective data. In addition to elevations in the biological domain that hospital personnel typically confront, findings related to coping deficiencies and problems in living conditions were noteworthy in requiring comprehensive interventions.
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Affiliation(s)
- William Meller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA, USA. E-mail:
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Abstract
Increasing awareness of mental illness's impact on medical and psychiatric health has accelerated global efforts to integrate medical and behavioural health services. As the field of integration has advanced, numerous integrated programmes have been implemented. In examining the impact of these programmes, it is important to maintain a standardized vocabulary to describe the various components of their integration. Additionally important is examination of how these programmes impact elements of patient care and the healthcare system. Specifically, what value do they bring? This article will discuss the importance of carefully assessing the value integrated services bring to patients, and questioning whether they do so in ways in which today's segregated world of medical and behavioural health cannot. This article will also explore the various settings in which medical and behavioural integration can bring added value.
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Affiliation(s)
- Heather Huang
- Departments of Psychiatry and Internal Medicine, University of Wisconsin , Madison, Wisconsin , USA
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Abstract
OBJECTIVE Delirium in the intensive care unit (ICU) is recognized as a major public health problem. Few Japanese outcome studies have been reported. The purpose of the study was to investigate the hospital outcomes of ICU delirium in a Japanese general hospital. METHODS Patients were drawn from consecutive admissions to an ICU at a tertiary care university hospital. Delirium assessments were conducted using the Intensive Care Delirium Screening Checklist (ICDSC). The following information was recorded: age, sex, the reason for ICU admission, the ICDSC scores, the COmplexity PRediction Instrument (COMPRI) scores, the length of stay (LOS) in the ICU, the total hospital LOS, hospital outcomes and social worker's consultation. RESULTS Of the 126 patients who were evaluated, 35 (27.8%) developed delirium during the ICU stay. Older age and biopsychosocial vulnerability assessed by the COMPRI were risk factors of ICU delirium. ICU delirium was a predictor of increased mortality and associated with prolonged ICU and hospital LOS. ICU delirium was an independent risk factor for having social worker's consultation after ICU discharge. CONCLUSIONS ICU delirium is associated with worse outcomes including mortality and LOS in Japan. ICU delirium is independently associated with further social worker's consultations, suggesting that early proactive social worker's intervention may be beneficial for the patients with ICU delirium.
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Affiliation(s)
- Takako Yamaguchi
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan.
| | - Etsuko Tsukioka
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan.
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki-city, Kanagawa, Japan.
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Kishi Y, Hazama Y, Komagata Y, Karube M, Takahashi J. Can quick first step bio-psycho-social screening, COMPRI (COMplexity PRediction Instrument), predict length of hospital stay in a general hospital in Japan? J Psychosom Res 2014; 77:330-1. [PMID: 25280830 DOI: 10.1016/j.jpsychores.2014.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
| | - Yuri Hazama
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
| | - Yumika Komagata
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
| | - Minato Karube
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
| | - Junko Takahashi
- Department of Nursing, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
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Kishi Y, Kurosawa H, Horikawa N, Hatta K, Meller W. Diagnoses of psychiatric disorders in hypothetical patients by non-psychiatric physicians in Japan. Int J Psychiatry Med 2014; 47:65-74. [PMID: 24956918 DOI: 10.2190/pm.47.1.f] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study was undertaken to investigate non-psychiatric physicians' diagnoses of hypothetical patients in clinical scenarios with comorbid medical and psychiatric disease in Japan. METHODS The non-psychiatric physicians were asked to diagnose eight clinical scenarios describing several typical behavioral health problems in the medical settings. RESULTS A total of 155 non-psychiatric physicians participated. Many physicians had problems correctly diagnosing depression and hypoactive delirium with medically ill patients. CONCLUSIONS It is time to incorporate new efficient and effective approaches, such as collaborative care system and proactive delirium prevention programs, to improve overall behavioral health diagnosis and treatment, rather than relying on the rapid recognition of behavioral health problems in primary care/general medical settings.
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Affiliation(s)
- Yasuhiro Kishi
- Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan; Saitama Medical Center, Saitama, Japan; and, Itasca Brain Behavioral Science Associations, Minnesota
| | | | | | - Kotaro Hatta
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - William Meller
- University of Minnesota, Itasca Brain Behavioral Science Associations, Minnesota
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Abstract
IMPORTANCE No highly effective interventions to prevent delirium have been identified. OBJECTIVE To examine whether ramelteon, a melatonin agonist, is effective for the prevention of delirium. DESIGN, SETTING, AND PARTICIPANTS A multicenter, rater-blinded, randomized placebo-controlled trial was performed in intensive care units and regular acute wards of 4 university hospitals and 1 general hospital. Eligible patients were 65 to 89 years old, newly admitted due to serious medical problems, and able to take medicine orally. Patients were excluded from the study if they had an expected stay or life expectancy of less than 48 hours. INTERVENTIONS Sixty-seven patients were randomly assigned using the sealed envelope method to receive ramelteon (8 mg/d; 33 patients) or placebo (34 patients) every night for 7 days. MAIN OUTCOMES AND MEASURES Incidence of delirium, as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). RESULTS Ramelteon was associated with a lower risk of delirium (3% vs 32%; P = .003), with a relative risk of 0.09 (95% CI, 0.01-0.69). Even after risk factors were controlled for, ramelteon was still associated with a lower incidence of delirium (P = .01; odds ratio, 0.07 [95% CI, 0.008-0.54]). The Kaplan-Meier estimates of time to development of delirium were 6.94 (95% CI, 6.82-7.06) days for ramelteon and 5.74 (5.05-6.42) days for placebo. Comparison by log-rank test showed that the frequency of delirium was significantly lower in patients taking ramelteon than in those taking placebo (χ(2) = 9.83; P = .002). CONCLUSIONS AND RELEVANCE Ramelteon administered nightly to elderly patients admitted for acute care may provide protection against delirium. This finding supports a possible pathogenic role of melatonin neurotransmission in delirium. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry Identifier: UMIN000005591.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshinari Odawara
- Psychiatric Center Yokohama City University Medical Center, Yokohama, Japan
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Hatta K, Kishi Y, Wada K, Odawara T, Takeuchi T, Shiganami T, Tsuchida K, Oshima Y, Uchimura N, Akaho R, Watanabe A, Taira T, Nishimura K, Hashimoto N, Usui C, Nakamura H. Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study. Int J Geriatr Psychiatry 2014; 29:253-62. [PMID: 23801358 PMCID: PMC4229063 DOI: 10.1002/gps.3999] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/31/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Attention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting. METHODS A prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events. RESULTS Among 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions-Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%). CONCLUSIONS In the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima HospitalTokyo, Japan,Correspondence to: K. Hatta, MD, PhD, E-mail:
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi HospitalKawasaki, Japan
| | - Ken Wada
- Department of Psychiatry, Hiroshima City HospitalHiroshima, Japan
| | - Toshinari Odawara
- Psychiatric Center, Yokohama City University Medical CenterYokohama, Japan
| | - Takashi Takeuchi
- Department of Psychiatry, Tokyo Medical and Dental UniversityTokyo, Japan
| | - Takafumi Shiganami
- Department of Psychiatry, Saitama Medical Center, Saitama Medical UniversityKawagoe, Japan
| | - Kazuo Tsuchida
- Department of Psychiatry, Kurashiki Central HospitalKurashiki, Japan
| | - Yoshio Oshima
- Psycho-Oncology Division, National Cancer Center HospitalTokyo, Japan
| | - Naohisa Uchimura
- Department of Psychiatry, Kurume University School of MedicineKurume, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyo, Japan
| | - Akira Watanabe
- Department of Psychiatry, Japanese Red Cross Kyoto Daiichi HospitalKyoto, Japan
| | - Toshihiro Taira
- Department of Psychiatry, Fukuyama City HospitalFukuyama, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women’s Medical UniversityTokyo, Japan
| | - Naoko Hashimoto
- Department of Psychiatry, Tokushima Prefectural Central HospitalTokushima, Japan
| | - Chie Usui
- Department of Psychiatry, Juntendo University Nerima HospitalTokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical ScienceKanazawa, Japan
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Hatta K, Kishi Y, Takeuchi T, Wada K, Odawara T, Usui C, Machida Y, Nakamura H. The predictive value of a change in natural killer cell activity for delirium. Prog Neuropsychopharmacol Biol Psychiatry 2014; 48:26-31. [PMID: 24063857 DOI: 10.1016/j.pnpbp.2013.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Few studies looking for an effective biomarker to predict delirium have been performed. This study was designed to investigate whether a change in inflammatory status, indicated by blood natural killer (NK) cell activity, predicts delirium. METHODS This prospective study, performed in 4 university and 1 general hospital from September, 2011 to October, 2012, included 29 patients. Eligible patients were 65-89years old, newly and emergently admitted. Patients were assessed daily, up to 7days, for occurrence of DSM-IV-defined delirium. The main outcome measure was change in blood NK cell activity between the first and second mornings after admission. RESULTS The mean change in blood NK cell activity on the second morning, compared to the first morning, in patients developing delirium (n=9) was significantly greater than that in patients without delirium (n=20) (6.0% [SD 8.4] vs. -1.4% [9.0], respectively, t=2.10, P=0.045). Significant difference between the groups was still found after adjusting for age, the history of previous delirium, and the Clinical Dementia Rating score (F=6.63, P=0.017). Of note is that 8 of 9 (89%) patients developing delirium had increased blood NK cell activity, as did only 8 of 20 (40%) patients without delirium, giving measurement of this parameter, for distinguishing the two groups, a sensitivity of 89%, specificity 60%, positive predictive value 50%, negative predictive value 92%, positive likelihood ratio 2.22, and negative likelihood ratio 0.19. When combining this predictor with another predictor, a Delirium Rating Scale-Revised-98 severity score of 5 or more at baseline, positive and negative likelihood ratios were 7.80 and 0.24, respectively. CONCLUSION Increase in blood NK cell activity may be associated with developing delirium. Further studies including larger numbers of patients are needed to justify the preventive use of drugs for patients meeting criteria for both predictors.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, 177-8521 Tokyo, Japan.
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Eguchi Y, Nakae H, Furuya T, Isono M, Kishi Y, Yoshioka T. Plasma filtration with dialysis (plasma diafiltration) in critically ill patients with acute liver failure. Crit Care 2014. [PMCID: PMC4069413 DOI: 10.1186/cc13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kishi Y. [Delirium]. Nihon Rinsho 2013; 71:1738-1742. [PMID: 24261201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Delirium is an acute condition often affecting acutely ill hospitalized patients, particularly in the elderly patients. Delirium is under-detected and associated with adverse healthcare outcomes, including institutionalization and elevated mortality. In the elderly patients, delirium and dementia have overlapping features that complicate differential diagnosis. There is neither any medication approved for the treatment of delirium nor strong evidence supporting the effectiveness of medications. In the management of delirium, recent studies show that delirium prevention(i.e., multidisciplinary delirium prevention programs) leads to improved outcomes, rather than waiting for delirium to develop and then intervening.
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Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital
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Nagatomo H, Kagawa S, Kishi Y, Takuma T, Sada A, Yamanaka KI, Abe Y, Wada Y, Takahashi M, Kono T, Kawahara M. Transcriptional Wiring for Establishing Cell Lineage Specification at the Blastocyst Stage in Cattle. Biol Reprod 2013; 88:158. [DOI: 10.1095/biolreprod.113.108993] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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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41
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Franco JG, Trzepacz PT, Meagher DJ, Kean J, Lee Y, Kim JL, Kishi Y, Furlanetto LM, Negreiros D, Huang MC, Chen CH, Leonard M, de Pablo J. Three Core Domains of Delirium Validated Using Exploratory and Confirmatory Factor Analyses. Psychosomatics 2013; 54:227-38. [DOI: 10.1016/j.psym.2012.06.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 11/17/2022]
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Wu C, Yosef N, Thalhamer T, Zhu C, Xiao S, Kishi Y, Regev A, Kuchroo V. Induction of pathogenic Th17 cells by inducible salt sensing kinase SGK1 (P1145). The Journal of Immunology 2013. [DOI: 10.4049/jimmunol.190.supp.50.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Th17 cells are highly proinflammatory cells that are critical for clearing extracellular pathogens and induction of multiple autoimmune diseases. IL-23 plays a critical role in stabilizing and endowing Th17 cells with pathogenic effector functions. IL-23 has been shown to reinforce the Th17 phenotype by increasing expression of IL-23 receptor (IL-23R). However, the molecular mechanism by which IL-23 sustains the Th17 response and induces pathogenic effector functions is unclear. Here we used unbiased transcriptional profiling of developing Th17 cells to construct a model of their signaling network and identify major nodes that regulate Th17 development. We identified serum glucocorticoid kinase-1 (SGK1) is critical for regulating IL-23R expression and for stabilizing the Th17 cell by deactivation of Foxo1, a direct repressor of IL-23R expression. SGK1 has been shown to govern Na+ transport and homeostasis. We show that a modest increase in salt (NaCl) concentration induces SGK1 expression, promotes IL-23R expression and enhances Th17 cell differentiation in vitro and in vivo, ultimately accelerating the development of autoimmunity. The loss of SGK1 resulted in abrogation of Na+-mediated Th17 differentiation in an IL-23-dependent manner. These data indicate that SGK1 is critical for the induction of pathogenic Th17 cells and provides a molecular insight by which an environmental factor such as a high salt diet could trigger Th17 development and promote tissue inflammation.
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Affiliation(s)
- Chuan Wu
- 1Brigham and Women's Hosp., Boston, MA
| | - Nir Yosef
- 2Broad Inst. of MIT and Harvard, Boston, MA
| | | | - Chen Zhu
- 1Brigham and Women's Hosp., Boston, MA
| | | | | | - Aviv Regev
- 2Broad Inst. of MIT and Harvard, Boston, MA
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Wu C, Yosef N, Thalhamer T, Zhu C, Xiao S, Kishi Y, Regev A, Kuchroo VK. Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1. Nature 2013; 496:513-7. [PMID: 23467085 PMCID: PMC3637879 DOI: 10.1038/nature11984] [Citation(s) in RCA: 745] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 02/06/2013] [Indexed: 01/09/2023]
Abstract
Th17 cells are highly proinflammatory cells critical for clearing extracellular pathogens and for induction of multiple autoimmune diseases1. IL-23 plays a critical role in stabilizing and reinforcing the Th17 phenotype by increasing expression of IL-23 receptor (IL-23R) and endowing Th17 cells with pathogenic effector functions2, 3. However, the precise molecular mechanism by which IL-23 sustains the Th17 response and induces pathogenic effector functions has not been elucidated. Here, we used transcriptional profiling of developing Th17 cells to construct a model of their signaling network and nominate major nodes that regulate Th17 development. We identified serum glucocorticoid kinase-1 (SGK1), a serine-threonine kinase4, as an essential node downstream of IL-23 signaling. SGK1 is critical for regulating IL-23R expression and stabilizing the Th17 cell phenotype by deactivation of Foxo1, a direct repressor of IL-23R expression. SGK1 has been shown to govern Na+ transport and salt (NaCl) homeostasis in other cells5, 6, 7, 8. We here show that a modest increase in salt concentration induces SGK1 expression, promotes IL-23R expression and enhances Th17 cell differentiation in vitro and in vivo, accelerating the development of autoimmunity. Loss of SGK1 abrogated Na+-mediated Th17 differentiation in an IL-23-dependent manner. These data demonstrate that SGK1 plays a critical role in the induction of pathogenic Th17 cells and provides a molecular insight into a mechanism by which an environmental factor such as a high salt diet triggers Th17 development and promotes tissue inflammation.
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Affiliation(s)
- Chuan Wu
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Esaki M, Shimada K, Nara S, Kishi Y, Sakamoto Y, Kosuge T, Sano T. Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma. Br J Surg 2013; 100:801-7. [PMID: 23460314 DOI: 10.1002/bjs.9099] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Data on outcomes of left hepatic trisectionectomy (LT) for perihilar cholangiocarcinoma are limited. The aim of this study was to clarify short- and long-term outcomes of LT for perihilar cholangiocarcinoma. METHODS Patients with perihilar cholangiocarcinoma who underwent LT between January 2000 and October 2011 were analysed. Surgical variables, mortality, morbidity (Clavien grade I-V), recurrence sites and survival were compared between subjects who underwent LT, right hemihepatectomy or left hemihepatectomy. RESULTS A total 214 patients underwent resection for perihilar cholangiocarcinoma, 25 (11·7 per cent) of whom underwent LT, 88 (41·1 per cent) right hemihepatectomy and 94 (43·9 per cent) left hepatectomy. There were no deaths among those who had LT, but 20 patients developed complications. The incidence of grade IIIa complications was significantly higher among patients who underwent LT than in patients who had right or left hemihepatectomy (P = 0·001 and P < 0·001 respectively). Only one patient developed a grade IIIb or IV complication (liver failure) after LT. The overall 5-year survival rate after LT was 39 per cent and median survival was 45 months. There were no significant differences in survival between patients who underwent LT and those who had a right or left hemihepatectomy. CONCLUSION LT may provide a good outcome for advanced perihilar cholangiocarcinoma.
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Affiliation(s)
- M Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan.
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Hirata M, Kawanishi C, Oyama N, Miyake Y, Otsuka K, Yamada T, Kishi Y, Ito H, Arakawa R. Training workshop on caring for suicide attempters implemented by the Ministry of Health, Labour and Welfare, Japan. Psychiatry Clin Neurosci 2013; 67:64. [PMID: 23331291 DOI: 10.1111/pcn.12004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Maki Hirata
- Yokohama City University School of Medicine; Yokohama; Japan
| | - Chiaki Kawanishi
- Health Management and Promotion Centre; Yokohama City University Graduate School of Medicine; Yokohama; Japan
| | - Nene Oyama
- Health Management and Promotion Centre; Yokohama City University Graduate School of Medicine; Yokohama; Japan
| | - Yasushi Miyake
- Department of Emergency Medicine; Showa University; Tokyo; Japan
| | - Kotaro Otsuka
- Department of Neuropsychiatry; Iwate Medical University; Morioka; Japan
| | - Tomoki Yamada
- Health Management and Promotion Centre; Yokohama City University Graduate School of Medicine; Yokohama; Japan
| | - Yasuhiro Kishi
- Department of Psychiatry; Nippon Medical School Musashikosugi Hospital; Kawasaki; Japan
| | - Hiroto Ito
- Department of Social Psychiatry; National Institute of Mental Health; National Center of Neurology and Psychiatry; Tokyo; Japan
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Kishi Y, Kurosawa H, Horikawa N, Hatta K, Meller W. Preferences of help regarding behavioral health problems among the Japanese general population. Psychiatry Clin Neurosci 2012; 66:460-1. [PMID: 22834667 DOI: 10.1111/j.1440-1819.2012.02369.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIM Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. METHODS The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 ± 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 ± 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). RESULTS Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. CONCLUSIONS Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition.
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Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
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Trzepacz PT, Franco JG, Meagher DJ, Lee Y, Kim JL, Kishi Y, Furlanetto LM, Negreiros D, Huang MC, Chen CH, Kean J, Leonard M. Phenotype of subsyndromal delirium using pooled multicultural Delirium Rating Scale--Revised-98 data. J Psychosom Res 2012; 73:10-7. [PMID: 22691554 DOI: 10.1016/j.jpsychores.2012.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE There is no consensus definition for the phenotype of subsyndromal delirium (SSD), a subthreshold state to full delirium. Without an a priori definition we applied advanced analytic techniques to discern SSD. METHOD We pooled Delirium Rating Scale-Revised-98 (DRS-R98) data from 859 DSM-IV diagnosed nondemented delirious adults and nondelirious controls collected by investigators in 7 countries. Discriminant analyses defined an SSD group that was then compared to Nondelirium and Delirium groups. RESULTS SSD (n=138) had intermediate DRS-R98 item severities between Delirium (n=497) and Nondelirium (n=224) groups, where groups significantly differed on all DRS-R98 items (ANOVA p<.001) except delusions. Discriminant analysis found SSD phenomenologically closer to Delirium than Nondelirium. Using full multinomial logistical regression, SSD was distinguished from Nondelirium by temporal onset, sleep-wake cycle, perceptual disturbances, motor retardation, delusion, affective lability, and all cognitive items; SSD was similar to Delirium in thought process, language, motor agitation or retardation, sleep-wake cycle, all cognitive items, fluctuation and physical disorder. The multivariate model correctly classified 94.2% of Nondelirium, 75.4% of SSD and 97.2% of Delirium subjects. Binary logistic regression of six core domain symptoms (sleep-wake cycle, thought process, language, attention, orientation, and visuospatial ability) together were found as highly differentiating of SSD from Nondelirium, which correctly classified almost 80% of SDD. CONCLUSIONS SSD is intermediate in severity between nondelirious controls and full syndromal delirium, but its phenotype is more like delirium. Core domain delirium symptoms present at milder severity in SSD should be evaluated further for utility in detecting and managing SSD, preventing delirium, and possible inclusion in DSM-V.
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Kishi Y, Hasegawa K, Kaneko J, Aoki T, Beck Y, Sugawara Y, Makuuchi M, Kokudo N. Resection of segment VIII for hepatocellular carcinoma. Br J Surg 2012; 99:1105-12. [DOI: 10.1002/bjs.8790] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2012] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Anatomical resection of segment VIII (SVIII) is technically demanding. Only two small studies have published short-term outcomes. The aim of the present study was to evaluate short- and long-term outcomes after anatomical resection involving SVIII for hepatocellular carcinoma (HCC), and to compare long-term outcomes with those after non-anatomical resection of SVIII.
Methods
Outcomes after anatomical resection of SVIII or its subsegments for HCC were compared with those in patients who underwent primary non-anatomical resection of SVIII during the same period.
Results
A total of 154 patients underwent anatomical resection involving SVIII and 122 had non-anatomical resection. In patients undergoing anatomical resection, the preoperative indocyanine green retention rate at 15 min ranged from 2·9 to 32·2 (median 13·6) per cent, and was 10 per cent or more in 109 patients (70·8 per cent). Median duration of operation and blood loss were 378 min and 705 ml respectively. There were no postoperative deaths, but major adverse events occurred in ten patients (6·5 per cent). The cumulative 5-year recurrence-free and overall survival rates were 28·5 and 79·6 per cent, which were significantly better than rates of 19·4 and 64·8 per cent respectively after non-anatomical resection (P = 0·036 and P < 0·001).
Conclusion
Complete resection of SVIII or its subsegments can be performed safely and the long-term outcomes seem acceptable. This can be a curative procedure for HCC, especially in patients with limited liver function reserve, in whom right hepatectomy or right paramedian sectorectomy might otherwise be needed.
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Affiliation(s)
- Y Kishi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - K Hasegawa
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - J Kaneko
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - T Aoki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Y Beck
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Y Sugawara
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - M Makuuchi
- Department of Hepato-Biliary-Pancreatic Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - N Kokudo
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
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Abstract
The internal consistency reliability of a measure can be a focal point in an evaluation of the potential adequacy of an instrument for adaptation to another cultural setting. Cronbach’s alpha (α) coefficient is often used as the statistical index for such a determination. However, alpha presumes a tau-equivalent test and may constitute an inaccurate population estimate for multidimensional tests. These notions are expanded and examined with a Japanese version of a questionnaire on nursing attitudes toward suicidal patients, originally constructed in Sweden using the English language. The English measure was reported to have acceptable internal consistency (α) albeit the dimensionality of the questionnaire was not addressed. The Japanese scale was found to lack tau-equivalence. An alternative to alpha, “composite reliability,” was computed and found to be below acceptable standards in magnitude and precision. Implications for research application of the Japanese instrument are discussed.
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Affiliation(s)
| | - Yasuhiro Kishi
- Nippon Medical School and Musashikosugi Hospital, Tokyo, Japan
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