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Biomedical subjects

H Yoshihara

Publications and source records attributed to H Yoshihara.

At least 37 records · Page 2Linked to original sources
PubMed1998

Development of the electronic health record in Japan.

In Japan, the order entry system has been employed in almost all university hospitals and popularisation of this system has also started in medium-sized hospitals. However, there has been a tendency in general hospitals in Japan to consider the electronic chart system where there has been no order entry system. Moreover, in small-scale clinics, there is no benefit in using the order entry system. Young doctors in Japan are beginning to employ the electronic chart system directly for the first time, without experience with the order entry system. In this paper, the development of the hospital information system in Japan and that of the electronic health record system are described.

Computer Communication Networks↗
PubMed1998

MERIT-9: a patient information exchange guideline using MML, HL7 and DICOM.

To realize clinical data exchange between healthcare providers, there must be many standards in many layers. Terms and codes should be standardized, syntax to wrap the data must be mutually parsable, then transfer protocol or exchange media should be agreed. Among many standards for the syntax, HL7 and DICOM are most successful. However, everything could not be handled by HL7 solely. DICOM is good for radiology images, but, other clinical images are already handled by other 'lighter' data formats like JPEG, TIFF. So, it is not realistic to use only one standard for every area of clinical information. For description of medical records, especially for narrative information, an standard generalized mark-up language, document type definition (SGML DTD) for medical information, called MML (medical markup language) had been created in Japan. It is already implemented in more than ten healthcare providers. However, it is again not realistic to use MML solely for clinical information in various level of detail. Therefore, we proposed a guideline for use of available medical standards to facilitate clinical information exchange between healthcare providers. It is called MERIT-9 (Medical Records, Images, Texts, -Information Exchange). A typical use is HL7 messages, DICOM files, referred from an MML file in a patient record, as external entities. Both MML and MERIT-9 have been research projects of Japanese Ministry of Health and Welfare and the purpose is to facilitate clinical data exchanges. They are becoming to be used in technical specifications for new hospital information systems in Japan.

Community Networks↗
PubMed1998

[A study of the differences between the sexes in epidemiology of urolithiasis].

PURPOSE: Uroithiasis seems to be the dominant disease for male. In the recent Japanese epidemiological report, the sexual ratio was reported 2.3:1. This sexual ratio is almost stable from 1960. We studied epidemiologically based on age and stone components the differences between the sexes. PATIENTS AND METHOD: From 1977 to 1996 the upper urinary tract stones which spontaneous excretion or surgical removal in our hospital were the subjects of study, Stone analysis was carried out infrared spectrometer. The statistical analyses were performed by the chi-square test and Mann-Whitney's U test. Significance was declared for a probability value of less than 0.05. RESULTS: In the epidemiology of our treated patients sexual ratio was 1.83:1. We studied sexual ration in age and stone components. The sexual ratio of the patients, 60 years and over was decreased compared with that of the patients under 60 years of age. We found the tendency that the sexual ratio was decreased at 60 years old and over. In the female urolithiasis patients less than 60 years old the frequency of calcium oxalate contained stone patients was predominantly smaller than male. In the female urolithiasis patients of 60 years and over the stone component ratio was similar to male urolithiasis patients. CONCLUSION: In point of frequency sexual ratio was decreased at 60 years old and over. In the female patients less than 60 years old the frequency of calcium oxalate contained stone was predominantly small. This low frequency of calcium oxalate contained stone in the female less than 60 years old seemed to be a factor of the sex differences of frequency.

Adolescent↗
PubMed1998

Patient information exchange guideline MERIT-9 using medical markup language MML.

To realize clinical data exchange between healthcare providers, there must be many standards in many layers. Terms and codes should be standardized, syntax to wrap the data must be mutually parsable, then transfer protocol or exchange media should be agreed. Among many standards for the syntax, HL7 and DICOM are most successful. However, everything could not be handled by HL7 solely. DICOM is good for radiology images, but, other clinical images are already handled by other "lighter" data formats like JPEG, TIFF. So, it is not realistic to use only one standard for every area of clinical information. For description of medical records, especially for narrative information, we created SGML DTD for medical information, called MML (Medical Markup Language). It is already implemented in more than 10 healthcare providers in Japan. As it is a hierarchical description of information, it is easily used as a basis of object request brokering. It is again not realistic to use MML solely for clinical information in various level of detail. Therefore, we proposed a guide-line for use of available medical standards to facilitate clinical information exchange between healthcare providers. It is called MERIT-9 (MEdical Records, Images, Texts,--Information eXchange). A typical use is HL7 files, DICOM files, referred from an MML file in a patient record, as external entities. Both MML and MERIT-9 are research projects of Japanese Ministry of Health and Welfare, and the purpose is to facilitate clinical data exchanges. They are becoming to be used in technical specifications for new hospital information systems in Japan.

Hospital Information Systems↗
PubMed1997

Disease stage of chronic hepatitis C assessed by both peritoneoscopic and histologic findings and its relationship with response to interferon therapy.

BACKGROUND: Disease stage in patients with chronic hepatitis C was assessed by both peritoneoscopy and histology and correlated with responses to interferon therapy. METHODS: The subjects were 105 patients with chronic hepatitis C treated with interferon who were classified into 28 sustained responders, 34 transient responders, and 43 nonresponders according to alanine aminotransferase normalization. The influence of various patient's characteristics on responses to interferon therapy was investigated by multivariate analysis. RESULTS: Patients were categorized into 21 patients who exhibited a "smooth liver" on peritoneoscopy and did not demonstrate histologic bridging fibrosis (group I) and 84 patients who exhibited a "granular" or "nodular liver" on peritoneoscopy and/or had histologic bridging fibrosis (group II). Multivariate analysis showed that genotype 2a/2b (p = .0002), low viremia (p = .0048), and early disease stage (group I) (p = .0290) were significant independent factors contributing to sustained response, and that early disease stage (group I) (p = .0010) and genotype 2a/2b (p = .0085) were those contributing to sustained or transient response. Neither peritoneoscopic nor histologic findings alone were a significant factor influencing responses to interferon therapy. CONCLUSION: Disease stage assessed by both peritoneoscopic and histologic findings may serve as a reliable marker for predicting responses to interferon therapy in chronic hepatitis C.

Adult↗
PubMed1997

Circulating matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-1 as serum markers of fibrosis in patients with chronic hepatitis C. Relationship to interferon response.

BACKGROUND/AIMS/METHODS: The imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) is considered to be an important determinant of extracellular matrix deposition and breakdown. We measured serum MMP-1, MMP-2, TIMP-1 and TIMP-2 levels using the respective one-step sandwich enzyme immunoassays in 98 patients with chronic hepatitis C treated with interferon beta to examine their clinical significance for assessment of liver histology and to determine whether they can be useful as predictors of the interferon response. RESULTS: Serum TIMP-1 levels showed a positive correlation with the degree of fibrosis (r(s)=0.30, p= 0.004). Serum MMP-2 levels revealed positive relationships with the degree of periportal necrosis (r(s)= 0.32, p=0.002), the degree of fibrosis (r(s)=0.26, p= 0.01) and total score of histological activity index (r(s)=0.24, p=0.02). Serum MMP-2 levels were significantly higher in patients with no response than in those with sustained and transient response (p<0.01 and p<0.05, respectively), while serum MMP-1 levels did not differ among the three groups. Compared with the levels in sustained responders, the total amounts of serum TIMP-1 were significantly lower in transient responders and non-responders (p<0.01 and p<0.001, respectively). As for serum TIMP-2 levels, a significant decrease was found in transient responders and non-responders (p<0.01). The ratios of serum MMP-2 to TIMP-1 levels were significantly higher in transient responders and non-responders than in sustained responders (p<0.001, respectively) even when HCV RNA levels were low in patients with HCV genome subtype 1b or when the HCV genome subtype was 2a or 2b. Sustained response was never found in type 1b patients with ratios of serum MMP-2 to TIMP-1 levels of over 6.0. In logistic multivariate regression analysis, the ratios of serum MMP-2 to TIMP-1 level (p=0.0001), HCV genome subtype (p=0.005) and serum TIMP-2 level (p=0.03) were the independent predictors for sustained response, while serum MMP-2 level (p=0.0006) was the only predictor for no response. CONCLUSIONS: Serum MMP-2 and TIMP-1 levels might be useful for estimating the degree of liver fibrosis. The ratio of serum MMP-2 to TIMP-1 levels may serve as a new predictor of interferon response in patients with chronic hepatitis C.

Alanine Transaminase↗
PubMed1996

Expression of vascular permeability factor/vascular endothelial growth factor in human hepatocellular carcinoma.

Vascular permeability factor (VPF)/vascular endothelial growth factor (VEGF) is unique in its ability to promote vascular permeability and endothelial cell growth, and its role in tumor development has received considerable attention. In this report, we describe the elevation of VPF/VEGF transcript expression in human hepatocellular carcinoma. Surgical samples of 23 patients with hepatocellular carcinoma were studied using reverse transcription-PCR analysis. The oligonucleotide primers were designed to amplify all four known splicing variants that could be expressed in the samples studied. Sixteen cases showed VPF/VEGF transcript expression in the tumor (16/23, 69.6%), whereas only 9 of the 23 patients showed it in the corresponding nontumoral part. There was no difference between the pattern of expression of VPF/VEGF isoforms in tumoral and nontumoral tissues. VPF/VEGF mRNA expression in the liver tumors was associated with fibrous capsule formation and septal formation (P < 0.05 respectively, Fisher's exact P test). In situ hybridization confirmed the presence of VPF/VEGF mRNA expression in tumor cells and less intensely in hepatocytes of nontumoral liver. We also found that VPF/VEGF expression in the tumor cell was increased in the area adjacent to necrotic regions (presumably hypoxic regions). As a regulator of vascular permeability and endothelial cell growth factor, VPF/VEGF may play an important role in the development of hepatocellular carcinoma.

Adult↗
PubMed1996

Long-term biochemical and virological response to natural interferon-alpha in patients with chronic hepatitis C.

To determine the long-term response to interferon-alpha, 134 patients with chronic hepatitis C were followed for more than a year after therapy. Follow-up was stopped for 14 patients and 43 patients received retreatment. The remaining 77 patients were followed for 26-46 months, and 39 of them achieved long-term sustained alanine aminotransferase (ALT) normality. This normality was achieved in 35/38 short-term sustained responders, which was significantly higher (P < 0.001) than in the short-term relapsers (2/38) and the short-term nonresponders (2/44). Hepatitis C virus (HCV) RNA remained negative in 27 (73%) of 37 patients in the long-term sustained ALT normality group. However, only one (1.6%) of 63 long-term responders was negative for HCV RNA. The results of HCV RNA testing for the long-term period agreed with those at three to six months after therapy. Serum ALT levels during the first six months after therapy and HCV RNA testing at three to six months after therapy are important for predicting long-term sustained ALT normality and HCV RNA negativity.

Adult↗
PubMed1996

Progression of type C chronic hepatitis to liver cirrhosis and hepatocellular carcinoma--its relationship to alcohol drinking and the age of transfusion.

Alcohol drinking has been reported to be an important factor that modulates the development and prognosis of chronic hepatitis B; however, little is known about an interrelationship between alcohol intake and the progression of chronic hepatitis C to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). We attempted to clarify this interrelationship in patients with hepatitis C and history of blood transfusion. Thirty LC and 85 HCC patients were enrolled. In patients with LC, no significant correlation was observed between the amount of alcohol intake and the period from transfusion to diagnosis. The period from transfusion to diagnosis in HCC patients with alcohol intake > or = 46 g/day and < 46 g/day were 26 +/- 6 and 31 +/- 9 years, respectively, resulting in a significant difference (p < 0.05). The period from transfusion to diagnosis of LC and/or HCC showed significant negative correlation with the age of transfusion (r = 0.82, Y = -0.67X + 48.0, p < 0.01; r = 0.76, Y = -0.70X + 54.1, p < 0.001, respectively). This correlation was also observed in patients with HCC, regardless of the amount of alcohol intake. In conclusion, these data suggest that alcohol drinking might be an important factor that promotes an occurrence of HCC in patients with hepatitis C, and that hepatitis C virus infection in the elderly promotes development of liver disease via LC to HCC.

Adult↗
PubMed1996

A prospective study of hepatitis C virus infection after needlestick accidents.

There have been few prospective studies of hepatitis C virus (HCV) infection after needlestick accidents in hospital employees. In the present study, the prevalence and features of HCV infection after needlestick accidents were evaluated prospectively measuring serum HCV-RNA. Subjects were 56 employees who had HCV needlestick accidents. To monitor the development of hepatitis, the serum ALT levels and HCV-related seromarkers, such as first generation anti-HCV (RIA), second generation anti-HCV (PHA) and HCV-RNA (RT-PCR) were measured every month for at least 12 months after the accidents. Three of 56 (5.4%) recipients developed HCV infection. HCV-RNA was detected in all three recipients within 4 months after the exposure, and second-generation HCV antibody was detected in two of three recipients. The detection of HCV-RNA was earlier than that of HCV antibody. Two of three HCV-infected recipients developed type C acute hepatitis and one of two received interferon therapy; however, the other case received no medication. The detection of HCV-related seromarkers and the elevation of ALT levels were transient in these three recipients: thus, none developed chronic hepatitis. In conclusion, HCV infection developed in 5.4% of recipients within 4 months after HCV accidents. All of these HCV-infected recipients showed fair prognosis. HCV-RNA was a beneficial parameter for early detection of HCV infection.

Accidents, Occupational↗
PubMed1996

Fetal circulatory responses during maternal bleeding.

The purpose of this study was to investigate the fetal circulatory responses during maternal hemorrhage. Five pregnant goats with fetuses with a mean gestational age of 132 +/- 2 days were used. The maternal blood was withdrawn at 350 ml/h for 2 hours (e.g. 700 ml, 11.9 ml/kg maternal weight) and reinfused at the same speed. During maternal bleeding, maternal arterial pressure (MAP) gradually decreased. As a result of this maternal hypotension, fetal arterial pO2 and pH decreased, and PCO2 increased. After the reinfusion, fetal pO2 recovered but pH and PCO2 did not recover. Fetal arterial pressure (FAP) increased and heart rate (FHR) decreased during maternal bleeding and returned to the control level, after the reinfusion. Fetal arginine vasopressin (AVP) concentration increased to 401.2 +/- 318.5 pg/ml at the maximum bleeding. There were significant positive correlation between AVP concentration and FAP, and negative correlation between AVP and FHR during maternal bleeding. Therefore, we concluded that 700 ml maternal bleeding for 2 hours resulted the decrease in fetal pH, pO2, and FHR, and increase in PCO2, FAP, and AVP concentration. Fetal pH, PCO2, and AVP did not return to the control level in spite of reinfusion.

Animals↗
PubMed1996

Induction of antinuclear antibody after interferon therapy in patients with type-C chronic hepatitis: its relation to the efficacy of therapy.

BACKGROUND: The prevalence of antinuclear antibody (ANA) and interferon (IFN)-induced ANA has been documented in patients with chronic hepatitis C. In the present study we evaluated whether the induction pattern of ANA after IFN therapy is related to the efficacy of IFN therapy. METHODS: Forty-four patients with chronic hepatitis C were enrolled. Autoimmune hepatitis was excluded in all. ANA was measured every month before, during, and for 6 months after IFN therapy (total dose, 336-480 M units). RESULTS: Eight of the 44 (18%) patients were positive for ANA before IFN therapy (group I). In group I six of the eight ANA-positive patients showed an increase in ANA titers during the therapy. Twenty-two of 36 (61%) ANA-negative patients turned positive for ANA, with titers of 1:80 or less during IFN therapy (group II). In 14 of the 36 (39%) ANA-negative patients ANA remained negative throughout the therapy (group III). The rates of sustained responders with a negativity of serum hepatitis C virus RNA and with normal alanine aminotransferase levels for at least 6 months after the cessation of therapy in groups I, II, and III were 25%, 23%, and 21%, respectively, giving no significant difference in the efficacy of therapy. No serious side effect was observed during the therapy. CONCLUSIONS: Administration of IFN frequently produced an induction of ANA or an increase in its titer, which did not affect the efficacy of IFN therapy.

Antibodies, Antinuclear↗
PubMed1996

[Comparison of fetal circulatory responses during maternal bleeding and fetal bleeding].

The purpose of this study was to compare the fetal circulatory responses during maternal hemorrhage and fetal hemorrhage. Four pregnant goats, gestational age 131 +/- 7 days for the fetal hemorrhage and 5 goats, 132 +/- 2 days (term 145 days) for the maternal hemorrhage were used. The amounts of hemorrhage were 700ml per 2 hours for the maternal hemorrhage and 40ml per 2 hours for the fetal hemorrhage. Although fetal arterial pH decreased during both hemorrhages, fetal arterial pO2 increased during the fetal hemorrhage and decreased in the maternal hemorrhage. The fetal arginine vasopressin concentration and plasma renin activity increased during both hemorrhages, but the rates of change in the hormone concentrations were higher during the fetal hemorrhage. The fetal aldosterone concentration decreased during maternal hemorrhage but increased during fetal hemorrhage. FAP increased and FHR decreased during maternal hemorrhage. FAP and FHR were significantly correlated to the AVP concentration. These relationships were not found during fetal hemorrhage. We therefore concluded that fetal responses were completely different in pO2, FAP and FHR during the maternal and fetal hemorrhages.

Aldosterone↗
PubMed1995

[Clinical evaluation of enzyme immuno assay systems for HCV antibody--synthetic peptide antigen and recombinant antigen].

To evaluate the frequency of the false positive results, we examined 168 patients for the presence of HCV using two HCV antibody assay systems, Synpep HCV-EIA (Synpep) and Abbott EIA II (Abbott). The results obtained by the two methods were significantly different in 22 patients. Cases in 17 of these patients, the results were positive with Abbott but negative with Synpep, and there were no clinical signs or delectable virus RNA. However, in 2 cases, the results were markedly positive with Abbott and weakly positive with Synpep. The presence of virus RNA and the increase of transaminase were observed in one case but both were noted in the other case. The serum of these two patients reacted with the C33C and C22-3 regions in RIBA II. We observed another 2 cases in which the elevation of the cut-off index with Synpep preceded that with Abbott at the early stage of acute hepatitis C. We also compared the cut-off index with the histology activity index (HAI) score determined by liver biopsy. The average cut-off index with Synpep was proportional to the HAI score in the range between 0 and 13. Based on the cut-off index/HAI score relationship, we suggest that patients with inactive chronic hepatitis show a Synpep cut-off index less than 11.

Antigens, Viral↗
PubMed1995

Ethanol induces heterogeneous reduction of cytochrome aa3 within perfused rat liver lobule assessed using microspectroscopy.

The redox state of cytochrome aa3 was measured at microspots (20 microns diameter) within the lobule of perfused rat livers, using reflectance microspectroscopy, and the effect of ethanol infusion on sublobular distribution of the redox states was evaluated. A sigmoidal relationship was observed between oxygen delivery and the reduction of cytochrome aa3 in both the periportal and pericentral regions of the liver lobule when the influent O2 concentration was decreased in a graduated manner. This sigmoidal curve was shifted to the more reduced state by ethanol infusion, with ethanol (25-100 mM) increasing the degree of cytochrome aa3 reduction in a dose-dependent manner according to the distance from the periportal region along a sinusoid. This increase was spatially heterogeneous within a liver lobule. These data indicate that ethanol accelerates cytochrome aa3 reduction, with a distinct gradient of reduction along sinusoids but a heterogeneous distribution within the liver lobule.

Animals↗
PubMed1995

Ability of prolonged interferon treatment to suppress relapse after cessation of therapy in patients with chronic hepatitis C: a multicenter randomized controlled trial.

The aim of this study was to determine whether 12 months course of interferon alfa (IFN-alpha) therapy could improve the beneficial effect of IFN in chronic hepatitis C. Eighty-eight patients were treated with natural IFN-alpha for either 28 weeks (45 cases) or 52 weeks (43 cases). Sustained response was achieved in 15 (33.3%) of 45 cases treated for 28 weeks and in 23 (53.5%) of 43 cases treated for 52 weeks. Transient response with relapse of alanine transaminase (ALT) after completion of therapy was observed in 13 cases (28.9%) treated for 28 weeks and in 4 cases (9.3%) treated for 52 weeks. Thus, ALT relapse was suppressed by prolonged IFN treatment. No response was found in 17 cases (37.8%) treated for 28 weeks and in 16 cases (37.2%) treated for 52 weeks, indicating that approximately 38% of the patients with chronic hepatitis C were resistant to IFN therapy even with prolonged treatment. The rate of sustained response was significantly higher in patients with type 2a or 2b than in those with type 1b. Even in type 1b cases, it was higher in the 52-week treatment group than in the 28-week treatment group, and the rate of transient response was lower in the 52-week treatment group, indicating that relapse in type 1b cases was suppressed by prolonged IFN therapy. IFN therapy was not effective for patients with advanced liver fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗