Biomedical subjects

S Murashima

Publications and source records attributed to S Murashima.

At least 37 records · Page 2Linked to original sources

PubMed1999

Mutations in the NS5A gene predict response to interferon therapy in Japanese patients with chronic hepatitis C and cirrhosis.

The virus genotype, serum HCV-RNA level and liver histology are reported to be important factors in the response to interferon therapy. Recent studies have revealed that HCV NS5A 2209-2248 amino acid changes affect the response to interferon therapy of genotype 1b chronic hepatitis C. In contrast, some studies done in western countries have reported no such correlation. In the present study, interferon therapy was given to 58 Japanese patients, including 15 liver cirrhosis patients. NS5A 2209-2248 changes, the serum HCV level, ALT level, age and histology were examined in relation to the interferon effect. Twenty-four of the 58 patients (41%) showed a sustained virological response to the therapy. The responses to interferon therapy were significantly correlated with NS5A 2209-2248 changes (p < 0.0001), the HCV-RNA level (p < 0.0001) and histology (p < 0.0060). Among 15 liver cirrhosis patients, 3 of 6 mutant type patients showed a sustained virological response; 5 intermediate and 4 with wild type virus infected patients showed no responses. In conclusion, NS5A 2209-2248 changes may be a useful predictive marker of response to interferon therapy in addition to the serum HCV RNA level even in histologically advanced patients.

Adult↗

PubMed1998

Around-the-clock nursing care for the elderly in Japan.

PURPOSE: To describe the first phase of creating a Japanese model of community-based long-term care, called around-the-clock care (ACC), by operationally defining the components of ACC, identifying those eligible for the program, clarifying methods of planning and organization, and exploring outcomes. DESIGN: Exploratory evaluation for the population of frail elderly Japanese citizens living at home. A convenience sample of 44 patients receiving care from four visiting-nurse-service stations during 3 months in 1994 was used. METHODS: Needs assessments; record reviews of patient encounters; evaluations by patients, families, and visiting nurses; and reviews of administrative data. FINDINGS: Nurses perceived that ACC stabilized medical status, reduced the emotional and physical burden of treatment, and improved hygiene. It also reduced family caregiving burdens and the stress of family caregivers' employment responsibilities. The highest rating of ACC by patient and families was for those with the most complex physical needs. Skilled nursing at home permitted early identification and treatment of problems before they became crises or required hospitalization. CONCLUSIONS: Early findings suggest 24-hour nurse-home helper teamwork may be an effective system of community-based long-term care and should be considered a key element of future Japanese health policy.

Aged↗

PubMed1998

Serum levels of tumor necrosis factor-alpha are increased in obese patients with noninsulin-dependent diabetes mellitus.

To clarify the significance of the serum levels of tumor necrosis factor-alpha (TNF-alpha) in the mechanism of insulin resistance, we studied 12 obese patients with noninsulin-dependent diabetes mellitus (NIDDM). We evaluated the relationship of TNF-alpha levels with the visceral, subcutaneous, and total fat areas measured by computed tomography (CT), and with insulin resistance evaluated by the glucose infusion rate (GIR) observed during an euglycemic hyperinsulinemic clamp study. Controls consisted of 12 normal subjects and 12 nonobese patients with NIDDM. TNF-alpha levels were measured using a high sensitivity enzyme-linked immunosorbent assay. Following admission, all patients with NIDDM participated in a 4-week program of diet and exercise. After this treatment, we evaluated the relationship of the serum levels of TNF-alpha with the area of body fat, the GIR, and the resultant change in the TNF-alpha level. Serum levels of TNF-alpha in the obese patients with NIDDM significantly exceeded those observed in normal subjects (P < 0.01) or in the nonobese patients with NIDDM (P < 0.01). Serum levels of TNF-alpha in obese NIDDM patients showed a significant positive correlation with the area of visceral fat before (r = 0.662, P < 0.03) and after (r = 0.508, P < 0.05) the treatment; similar correlation was observed in all patients with NIDDM before (r = 0.537, P < 0.02) and after (r = 0.430, P < 0.05) the treatment. Serum levels of TNF-alpha in obese NIDDM patients showed a significant negative correlation with GIR after the treatment (r = -0.595, P < 0.05). Serum levels of TNF-alpha were significantly reduced in the obese patients with NIDDM after the treatment (P < 0.01), while those in the nonobese NIDDM patients were unchanged. These results suggest that serum TNF-alpha levels may play an important role in mechanism of insulin resistance associated with obesity.

Adipose Tissue↗

PubMed1998

Mutations of glucocorticoid responsive element of HBV DNA.

The mutation of glucocorticoid responsive element (GRE) of HBV DNA obtained from a patient with chronic hepatitis B was evaluated. This patient showed fatal course by glucocorticoid administration. The HBV DNA from this patient (GRE-M) and two patients with HBeAg positive chronic hepatitis B (GRE-W1,2) whose HBV DNA have few mutations, were examined. The 212 bp region from nt.274 to nt.485 (GRE region) was amplified by PCR and the nucleotide sequence was determined. A base mismatched sequence of the latter half of the GRE consensus sequence was confirmed at nt.296-301 (G1), nt.347-352 (G2), nt.359-364 (G3), and nt.473-478 (G4). Also one base mismatched sequence of the AP-1 response element was detected at nt.331-337 (A1). The nucleotide substitutions in GRE-M generate three putative loop formation sites, four bases in length, from nt.22 to nt.31 (L1), nt.35 to nt.42 (L2), and nt.74 to nt.83 (L3). The L1 was located just upstream of the G1. The L2 was located between the A1 and the G2. These mutations followed by three-dimensional form change may affect the responses to glucocorticoid.

Base Sequence↗

PubMed1998

[Effectiveness of day care service for elderly patients with dementia and their caregivers as observed by comparison of days with and without day care services].

PURPOSE: To explore the effectiveness of day care service for the dementia elderly and their caregivers. METHODS: Subjects were sixty caregivers who took care of dementia elderly and were using day care service in two municipalities. The data on caregiving, care burden of caregivers, and time schedule of daily life were obtained from a questionnaire that was distributed at the five day care centers and collected through home visits. The data from a day with day care were compared with data from a day without. RESULTS & DISCUSSION: 1. Caregivers reported that their care burden was reduced on the day with day care, even though their time schedule for the day was not so different from the day without day care. 2. The harder the caregiving became, the more caregivers felt relieved on the day with day care. 3. Obviously, day care would no be expected to have the same effect in situations in which the caregiver is elderly or works outside the home all day. CONCLUSION: When we think about day care it is important to provide a well adapted home care program which effectively meets the needs of the dementia elderly and their caregivers.

Adult↗

PubMed1998

Increased lung uptake of iodine-123-MIBG in diabetics with sympathetic nervous dysfunction.

UNLABELLED: Scintigraphy with 123I-MIBG and 201TI was compared in patients with various diseases including diabetes mellitus, with and without sympathetic nervous dysfunction. This study was done to assess lung uptake of these tracers semiquantitatively. METHODS: Thirty-eight patients with diabetes mellitus, seven patients with dilated cardiomyopathy (DCM), 12 patients with hypertrophic cardiomyopathy (HCM) and eight healthy subjects were studied. Sympathetic nervous dysfunction was observed in 13 of the 38 diabetic patients. Simultaneous imaging with 123I-MIBG and 201TI was performed. The ratio of lung to total injected dose count and washout rate in the lung were calculated from dynamic images acquired in the initial 2 min and static images acquired at 15 min and at 4 hr after injection of the tracers. RESULTS: Lung uptake of 123I-MIBG at 4 hr was significantly increased in the diabetic group as compared with those in the other groups. In diabetic patients with sympathetic nervous dysfunction, the lung uptake ratio of 123I-MIBG at 4 hr was significantly higher than that in the diabetic patients without sympathetic nervous dysfunction, due to decreased clearance of 123I-MIBG from the lung. On the other hand, increased lung uptake of 201TI was observed in DCM patients at both 15 min and 4 hr. There was no significant difference between lung uptake of 201TI in diabetic patients and that in healthy subjects. CONCLUSION: Lung uptake of 123I-MIBG was increased and lung washout of 123I-MIBG was decreased in diabetic patients with sympathetic nervous dysfunction, while lung uptake of 201TI was not altered. lodine-123-MIBG scintigraphy of the lung may provide information on sympathetic nervous activity in diabetic patients. It is a promising method for studying the kinetics of norepinephrine in the lung because MIBG is taken up in the lung by the same mechanism as norepinephrine.

3-Iodobenzylguanidine↗

PubMed1998

[Home care service utilization by severely mentally and physically handicapped persons].

PURPOSE: To investigate the utilization of in-home services by severely mentally and physically handicapped persons at home in order to clarify the vital factors associated with the services. METHODS: Questionnaires were delivered to 174 severely mentally and physically handicapped persons who were registered with 8 institutions in Tokyo and Kanagawa prefecture through each institution. One hundred and thirteen respondents among them were the subjects of this study. As a conceptual model Andersen's model was adopted. RESULTS: (1) The age of subjects varied from 2 to 50. There were no subjects between the age of 7 to 17. The mean functional handicap severity score (SCORE) was 5.8 +/- 8.4 standard deviation. Ninety seven percent of main caregivers were mothers, even among the aged. (2) Over 1/2 of the subjects reported having utilized institutional services. On the other hand the percentage for visiting nurse service (VNS) and home help services were 28.3% and 7.7% respectively. (3) Subject who used V.N.S. had significantly higher SCORES and higher luck of health of caregivers. Caregivers utilized V.N.S. as a substitute to reduce their burden in activities care at home. On the other hand, users of institutional services showed high scores in difficulties with daily help and perceived difficulties with medical treatments: it showed that they sought institutional care to reduce there careburden. (4) Total number of used by each client for in-home service was explained only by both difficulties of daily help and SCORE from multiple regression analysis. CONCLUSION: Users of visiting nursing service expect highquality care based on current medical knowledge and also with the aim of caregiver's health. With the increasing age of caregivers it appears to be important to enhance visiting nurse services, reduce the caregiver burden, and provide active support of home care for the handicapped.

Activities of Daily Living↗

PubMed1997

High dose rate endobronchial brachytherapy using a new applicator.

BACKGROUND AND PURPOSE: To obtain adequate spatial dose distribution for endobronchial brachytherapy, we applied reference dose points according to the bronchial diameter. For this purpose, we devised a new applicator of which the source transfer tube is contained in the center of the lumen for high dose rate (HDR) brachytherapy. MATERIALS AND METHODS: Thirty-nine patients with endobronchial cancer underwent endobronchial brachytherapy using an HDR afterloading machine with an Ir-192 source. In the nine patients treated with curative intent, treatment consisted of external beam radiotherapy with 40-60 Gy for 4-6 weeks and endobronchial brachytherapy with three fractions of 6 Gy. The 30 patients treated with palliative intent received one fraction of 10 Gy with or without external beam irradiation. The reference dose points were prescribed according to bronchial diameter, which was measured by the applicator's radiopaque wing expansion reflecting the bronchial caliber. RESULTS: The new applicator could be placed at the intended site in 37 lesions. Of 12 lesions which were treated with curative intent, eight (67%) disappeared after brachytherapy. The overall survival at 3 years of all patients and of the patients treated with curative intent was 22 and 64%, respectively. CONCLUSIONS: The source should be positioned in the center of the lumen; this technique is helpful in reducing side-effects caused by inhomogeneous dose distribution of endobronchial brachytherapy.

Adult↗

PubMed1997

Prevalence of hepatitis C antibodies in health care personnel.

To determine the prevalence of hepatitis C virus (HCV) infection in health care personnel in an HCV endemic area, we conducted a seroprevalence study of 1638 Kurume University Hospital physicians, nurses, laboratory staff, and clerical staff (560 men, 1078 women). Antibody to HCV (anti-HCV) was found in 2.8% (46) of subjects and hepatitis B surface antigen was found in 1.1% (18). The anti-HCV positive rate in health care personnel was no higher than reported in the general population of Fukuoka prefecture in Kyushu, Japan. There were no significant differences in anti-HCV positive rate by occupation. However, the prevalence of anti-HCV positive individuals increased significantly as age and length of time in an occupation increased. Anti-HCV positive rate in health care personnel was probably not related to length of time in an occupation. The data suggest that HCV infection is not easily transmitted to health care personnel in an HCV endemic area.

Adult↗

PubMed1997

Systemic sclerosis associated with diabetes insipidus.

A rare case of systemic sclerosis that preceded the development of diabetes insipidus is reported. This 25-year-old man presented with Raynaud's phenomenon and ulceration of the tip of the right thumb. The diagnosis of systemic sclerosis was based on findings of proximal scleroderma, sclerodactyly, serological abnormalities, and skin abnormalities verified histologically. Partial central diabetes insipidus was later diagnosed after the sudden appearance of polyuria and polydipsia. Coexistence of systemic sclerosis with diabetes insipidus suggests that diabetes insipidus in this patient might have occurred via an autoimmune mechanism.

Adult↗

PubMed1997

[Treatments for T4 advanced lung cancer with invasion to the superior vena cava].

We discussed on the treatments for T4 lung cancer with invasion to the superior vena cava, whose prognosis has been poor. However, surgical resection may improve the prognosis compared with radiation therapy. The prosthetic replacement of superior vena cava can be done safely, and its patency is good in cases of ring-enforced ePTFE graft. Although superior vena caval obstruction syndrome had been a hard issue in the advanced cases, stenting in superior vena using the interventional radiological technique is a safe and reliable method. We should consider the stenting as the first choice for superior vena cava obstruction syndrome, because it makes the QOL improve so much.

Adult↗

PubMed1997

[A study on competencies used by public health nurses in creating new health care systems in the community].

The purpose of this study is to clarify the competencies used by public health nurses in creating new health care systems in the community. The subjects were four public health nurses who were nominated by other public health nurses. As a method a qualitative method was used. Each subject was interviewed using a semistructured questionnaire which was made based on each system she had developed. Each interview was tape recorded and transcribed verbatim. Data were analyzed and divided by the seven domains proposed by Benner. The results showed that public health nurses took roles in six out of the seven domains of Benner. Among them the "Organizational and Work-Role Competencies" domain had a lot of content and was divided into more detailed seven subcategories. All four public health nurses were stimulated to create a new care system by exposure to a serious case and being moved deeply through visits to homes and hospital. The desire to solve the problem of individual clients leads to the establishment a new system in the community, showing the originality of the role of public health nurses who have nursing knowledge and who work in a regional government. In the process of building a health care system each public health nurse secured the budget or created a new measure of the regional government. It shows the significance of the role that public health nurses play in the regional government.

Community Health Services↗

PubMed1996

A novel method for the assessment of autonomic neuropathy in type 2 diabetic patients: a comparative evaluation of 123I-MIBG myocardial scintigraphy and power spectral analysis of heart rate variability.

The correlation between the degree of sympathetic denervation measured through 123I-MIBG Myocardial Scintigraphy and Power Spectral Analysis of consecutive R-R records was investigated in order to evaluate their potential application for the assessment of myocardial autonomic neuropathy in patients with diabetes mellitus. This study comprised 42 patients with Type 2 diabetes. Low frequency (0.02-0.09 Hz) components of the power spectral density were measured as markers of sympathetic activity. The myocardial uptake of 123I-MIBG was measured by using the single photon emission computed tomography (SPECT) and the early and delayed images were recorded. Scoring from 0 to 3 of the 123I-MIBG uptake of various cardiac segments (7) was performed and the total uptake was calculated. The washout rate in the whole myocardium was determined. The values obtained in the group with diabetic autonomic neuropathy (DAN) without orthostatic hypotension (OH) were significantly lower as compared to those of the (DAN (-)) group in the delayed images. The washout rate of the OH (-) group was also significantly higher than the DAN (-) group. There was significant difference between the images and the washout rate of OH (+) and OH (-) groups. There was a significant correlation between Power Spectral Analysis and SPECT (early, delayed images, and washout rate). Of these, the delayed image showed the strongest correlation (r = 0.55, p < 0.01). Further, the QTc interval showed a significant inverse correlation with the delayed image (r = -0.44, p < 0.05). In conclusion, these results suggest that the cardiac 123I-MIBG scintigraphy could be a useful method for the assessment of the myocardial autonomic neuropathy in patients with diabetes mellitus.

3-Iodobenzylguanidine↗

PubMed1996

Sequence variation of the hypervariable region in HCV carriers with normal ALT levels: a comparison with symptomatic carriers.

The clinical significance of the hypervariable region (HVR) in the N-terminus of the E2/NS1 region, which encodes the putative envelope glycoprotein (gp 70) of HCV, has not yet been elucidated. We studied the relation between HVR changes and elevation of the alanine aminotransaminase (ALT) level due to liver cell injury as well as the persistence of HCV infection. Three patients (carrier group) who were HCV RNA positive and had normal ALT levels for as long as five years and three patients with high ALT levels were studied. None of the six patients had a history of treatment. HCV RNA was extracted from serum obtained from each patient in 1990 and 1995. The E2/NS1 region, including HVR-1 and HVR-2, was amplified using the RT-PCR method. PCR products were cloned and nucleotide sequences were determined using the dideoxynucleotide chain termination method. No clear correlation was found between the ALT levels and the number of nucleotide substitutions in HVR-1. The number of nucleotide substitutions in HVR-1 during the five years was greater than in other regions. Furthermore, more nucleotide substitutions occurred in the 1st and 2nd codon positions of HVR-1 than in the control region, even in the carrier group. In conclusion, HVR-1 changes are probably a more important factor in persistent viral infection than liver cell injury.

Aged↗

PubMed1996

Biological responses to administered interferon in alcoholics.

To elucidate the influence of chronic alcohol intake on interferon (IFN) therapy in patients with various diseases, 3 million units of natural IFN (nHuIFN-alpha Ly) was administered once to alcoholics, nonalcoholic chronic hepatitis C (CH-C) patients, and healthy subjects. The serial changes of serum activity of 2'-5' oligoadenylate synthetase, serum levels of beta 2-microglobulin, C-reactive protein (CRP), and body temperature were monitored. The increase in the activity of 2'-5' oligoadenylate synthetase, the response of serum-reactive protein, and body temperature after IFN administration were significantly lower in the alcoholics than those in CH-C group, and healthy subjects (control group). The serum beta 2-microglobulin level was already higher in the alcoholics before IFN administration than those of the control group and the CH-C group. These findings suggest that physiological responses to exogenous IFN in alcoholics are generally decreased. Hence, for the maximum effect of IFN therapy, it is important for patients to abstain from alcohol intake and for doctors to carefully consider the timing of initiation.

2',5'-Oligoadenylate Synthetase↗

PubMed1996

Evaluation of interferon treatment in cirrhotic patients with hepatitis C.

The aim of this study was to examine the effects of interferon on cirrhotic patients with hepatitis C and the incidence of adverse reactions. The subjects were 35 cirrhotic patients, and 29 chronic active hepatitis patients without cirrhosis (CAH) served as controls. The cirrhotic patients received 3 or 6 million units of human lymphoblastoid interferon daily for one or two weeks and then three times a week for 22 or 23 weeks, while the CAH patients received 6 million units daily for 2 weeks and then three times a week for 14 or 16 weeks. Discontinuation of interferon treatment or dose reduction was required in the 7 cirrhotic patients. The most frequent reason was thrombocytopenia. Dose reduction alone was necessary in two CAH patients. Five cirrhotic patients (14.3%) and nine CAH patients (31.0%) were classified as complete responders to interferon treatment. In all five complete responders with cirrhosis, the hepatitis C virus RNA level before treatment was less than 5 log copies/50 microliters. The results of this study confirm the beneficial effect of interferon in selected patients with cirrhosis on basis of pre-treatment virus levels and platelet count.

Base Sequence↗

PubMed1996

Acute and chronic regulation of serum sex hormone-binding globulin levels by plasma insulin concentrations in male noninsulin-dependent diabetes mellitus patients.

This study was undertaken to investigate the relationship of the serum sex hormone-binding globulin (SHBG) levels with the plasma insulin concentration and with the insulin resistance in male subjects with noninsulin-dependent diabetes mellitus (NIDDM). This investigation comprised 12 patients with NIDDM and 16 normal subjects matched for age, sex, and body mass index (BMI). There was a significant increase in insulin levels (P < 0.03) and a decrease in SHBG levels (P < 0.01) in the diabetic group as compared with those of the normal group. The sex hormone and plasma insulin levels were measured in NIDDM patients undergoing exercise and dietary therapy. Insulin sensitivity was evaluated by the hyperinsulinemic euglycemic clamp technique expressed as the glucose infusion rate (GIR) before and after the treatment. The SHBG levels correlated significantly with the insulin concentrations (r = -0.643, P < 0.05) and with the GIR (r = 0.615, P < 0.05) before the treatment. The SHBG levels (P < 0.02) and GIR (P < 0.01) increased, and the insulin concentrations (P < 0.01) decreased significantly during the treatment. The SHBG levels showed a negative and significant correlation with the plasma insulin concentrations at the end of the clamp study before (r = -0.615, P < 0.05) and after (r = -0.626, P < 0.05) the treatment. These findings suggest that, in the hyperinsulinemic state, plasma insulin has a direct effect on the SHBG levels. SHBG levels decreased significantly during the clamp study before (P < 0.02) and after (P < 0.01) the treatment. This may represent the acute effect of insulin on the SHBG levels. Briefly, these results suggest that insulin may directly affect the SHBG levels and that SHBG may constitute an index of the insulin resistance only in the hyperinsulinemic state.

Blood Glucose↗

PubMed1996

An experimental animal model of primary biliary cirrhosis induced by lipopolysaccharide and pyruvate dehydrogenase.

Previously, we found that the antibody titer belonging to the IgM class produced against the bacterial antigen (Lipid A) was elevated in sera from patients with primary biliary cirrhosis (PBC). On the other hand, the targets of the mitochondrial autoantibodies have been identified as being components of the pyruvate dehydrogenase complex (PDH). We tried to produce an experimental animal model for the investigation of the association between hepatic bile duct alteration and bacterial infection. Female C57/BL mice, aged 4 weeks, were used. An emulsion consisting of lipopolysaccharide (LPS) derived from Salmonella minnesota Re595, PDH, and Freund's adjuvant was prepared. This emulsion was subcutaneously injected on the back of the mice. The mice were divided into a control group (n = 5), a group given LPS (n = 5) alone, those given PDH alone (n = 5), and those given a combination of LPS and PDH (n = 5). The antigens were administered once a week every week with a maximum duration of administration of 24 weeks. The serum levels of IgM after 24 weeks in the LPS and LPS + PDH groups were 2.5 times higher than those in the control and PDH groups. The light microscopic findings of liver tissue revealed that infiltration of lymphocytes and plasma cells in the portal area, proliferation of the bile duct, and degeneration of the biliary epithelial cells were more prominent in the PDH and LPS + PDH groups than in the other groups. These results indicate that our animal model may be useful in investing the pathogenesis of PBC.

Animals↗