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Biomedical subjects

T Hosaka

Publications and source records attributed to T Hosaka.

At least 55 records · Page 3Linked to original sources
PubMed1999

General hospital psychiatry from the perspective of medical economics.

The purpose of this study was to investigate the efficacy of consultation-liaison (C-L) psychiatry from the perspective of medical economics, by comparing a part-time and full-time psychiatric department. One full-time (5 days per week) psychiatrist began work at a general hospital (GH-A), and one part-time (once per week) psychiatrist had been working at another general hospital (GH-B). Both general hospitals are teaching hospitals of the same size. The number of patients and the medical reimbursements were investigated each month and compared. This study demonstrated that the establishment of C-L psychiatry was economically profitable in contrast with what was the common belief among general hospital administrators. Also, the differences in the total number of patients (GH-A: GH-B = 500:35-50 patients/month) and the total reimbursement (GH-A: GH-B = 3 million: 2-300000 yen/month) was not explained by the number of working days (GH-A: GH-B = 5:1 day/week). The full-time model of C-L psychiatry has also indirect effects (i.e. educational and relieving effects) on the hospital staff. Promoting the establishment of C-L psychiatry requires many evidence-based studies that demonstrate the necessity for C-L psychiatry and can directly persuade hospital directors.

Cost-Benefit Analysis↗
PubMed1999

Separation and properties of two acetylacetoin reductases from Bacillus cereus YUF-4.

The separation and purification of two kinds of acetylacetoin reductases (AACRs) from Bacillus cereus YUF-4 were examined. NADPH-linked AACR (AACR I) and NADH-linked AACR (AACR II) were separated from each other by ammonium sulfate fractionation, DEAE-cellulose chromatography, and hydroxyapatite chromatography. The former was purified 3.4-fold with a yield of 10.0%, and the latter was purified 29-fold with a yield of 15.6%. The two enzymes differ from each other in some enzymic properties such as substrate specificity.

Alcohol Oxidoreductases↗
PubMed1999

Regulation of insulin-stimulated glucose transport by chronic glucose exposure in 3T3-L1 adipocytes.

Chronic hyperglycemia causes insulin resistance, termed glucose toxicity. Herein we studied chronic glucose-dependent regulation of the glucose transport system in adipocytes. 3T3-L1 adipocytes were incubated for up to 24 h with low (1 mM) or high (25 mM) glucose, and glucose transport was subsequently analyzed. 100 nM insulin was present throughout the experiments. 24 h incubation with 1 mM glucose caused a 2.3+/-0.4 fold increase in glucose transport activity, compared to the values obtained with 25 mM glucose. This difference was not observed when 24 h incubation was carried out without insulin. Glucose transport activity was not increased at 3 or 6 h incubation with 1 mM glucose, but was increased at 12 h, which closely paralleled increased expression of GLUT1. In addition to increased GLUT1 expression, more efficient translocation of GLUT1 to the plasma membrane was observed when incubated with 1 mM glucose compared to 25 mM glucose. The addition of azaserin or deprivation of glutamine at 25 mM glucose did not increase the glucose transport activity to the level obtained with 1 mM glucose. PD98059 did not affect glucose transport activity when incubated with 1 mM or 25 mM glucose. In conclusion, the present study is the first to show that, in 3T3-L1 adipocytes, chronic exposure to low (1 mM) and high (25 mM) glucose leads to different insulin-stimulated glucose transport activities. These differences result from the difference in the expression and plasma membrane distribution of GLUT1, but not of GLUT4, and the hexosamine biosynthesis pathway or extracellular signal-regulated protein kinase is not involved.

3T3 Cells↗
PubMed1999

Treatment of intradural paraclinoidal aneurysms.

Intradural paraclinoidal aneurysm still presents conceptual confusion and technical surgical problems. The clinical features of 68 consecutive patients with paraclinoidal aneurysms were analyzed. The pterional approach was used in all patients. Subarachnoid hemorrhage (SAH) occurred in 37 patients from the paraclinoidal aneurysm and in 10 patients from another associated aneurysm. Thirty-four of the 37 ruptured paraclinoidal aneurysms were clipped, two blister-like aneurysms required trapping, and one blister-like aneurysm was coated. Thirteen of the 31 unruptured paraclinoidal aneurysms, consisting of 10 with ruptured associated aneurysm, four symptomatic, and 17 incidental, were clipped and 18 were coated. Favorable outcomes were obtained in 38 of 47 patients with SAH and 17 of 21 patients without SAH. Nine unfavorable outcomes in SAH patients were caused by primary brain damage (5), vasospasm (2), cerebral infarction after trapping (1), and pneumonia (1). All four unfavorable outcomes in non-SAH patients were due to surgical procedures for giant aneurysms or associated basilar artery aneurysm. Removal of the anterior clinoid process was performed to secure the proximal neck in 15 patients with large or giant aneurysms. Multiple clips with or without fenestrated clips were required in all giant aneurysms, and exposure of the cervical internal carotid artery (ICA) in 17 giant or large aneurysms. Fenestrated clips were also useful for one small aneurysm projecting posteriorly. A favorable outcome was achieved in 17 of 19 patients undergoing coating. Coating without clipping might be better for some blister-like ICA aneurysms, even if ruptured. Paraclinoidal aneurysms can be clipped with favorable results using these techniques except for giant aneurysms and associated basilar artery aneurysm.

Adult↗
PubMed1999

Nurses' perspectives concerning do-not-resuscitate (DNR) orders.

The purpose of this study was to investigate the views of the nursing staff concerning do-not-resuscitate (DNR) orders at the Tokai University Hospital where a controversial incident occurred several years ago. A 'Questionnaire on DNR Orders' was circulated and the anonymous answers were collected two weeks later. The questionnaire was returned by 706 of 780 (90.5%) nurses from every ward/specialty, which revealed that 87% of the nurses felt that DNRs were occasionally necessary, with more than 40% of the nurses answering that they took part in DNR. Further, 36% of the nurses stated that patient consent was indispensable, and 64% thought that the patient's family and physician could decide DNR in the event the patient was physically unable to give consent. Moreover, 66% of the nurses expected the establishment of a DNR order sheet to be formulated as a matter of hospital policy; only 5% of the nurses thought that such an order sheet would not be necessary. Comparing these results with a previous study polling physicians at the Tokai University Hospital, nurses are more likely than physicians to think that patient consent is indispensable, and want the establishment of a standardized DNR order sheet as hospital policy. There is, in fact, a "tacit understanding" between physicians and patients' families in medical practice in Japan. However, DNR is definitely a medical decision. Therefore it should be clearly stated in a standardized format, although such a procedure presently seems unlikely, in view of the Japanese traditional value system.

Adult↗
PubMed1999

A structured intervention for family caregivers of dementia patients: a pilot study.

There has been an increasing number of patients with dementia in Japan. Although such patients were hospitalized longer than in other countries, the length of the hospital stay is becoming shorter due to changes in insurance systems. Therefore, the families of such patients are experiencing greater stress. In order to investigate the efficacy of a group structured intervention, 20 family caregivers participated in a series of five weekly sessions, each of which consisted of an educational approach, problem-solving techniques, psychological support, and relaxation. All family caregivers were women whose ages ranged from 47-66 years (mean= 54.7 +/- 4.4). The period of care at home ranged from 1-12 years (mean= 5.8 +/- 2.7). Concerning the original disease of patients, 10 had vascular dementia and 8 had senile dementia of Alzheimer type (Alzheimer disease). Two psychometries, i. e., Profile of Mood States (POMS) and General Health Questionnaire-30 (GHQ-30), were administered pre- and post-intervention. The results indicated that there was significant improvement (p<0.05) in the scores of depression, anger-hostility, fatigue, confusion in the POMS, and physical symptoms, anxiety-mood disorder, and suicidality-depression in the GHQ-30. This preliminary study suggests that this kind of intervention appears quite effective for relieving the emotional and physical discomfort suffered by family caregivers.

Adult↗
PubMed1999

Development of a "Type C" inventory: cross-cultural applications.

The authors are preparing for cross-cultural studies of immunosuppressive behaviors and emotions, commonly called "Type C," in both healthy persons and in patients with cancer. To this end, validity and reliability of a Type C Personality Inventory were assessed in a sample of 128 healthy volunteers. Reliability of the instrument was supported by moderate to high Cronbach alpha coefficients. Acceptable validity was evident by relatively high correlations of the instrument's subscales with other, standardized, psychological tests.

Adaptation, Biological↗
PubMed1998

Purification and properties of acetylacetoin synthase from Bacillus sp. YUF-4.

In Bacillus sp. YUF-4, acetylacetoin synthase was induced by acetoin, while glucose inhibited the induction. The enzyme was purified 111-fold by 6 purification steps, and a further purification followed, by HPLC using a TSK gel, Phenyl-5PW RP. The resulting enzyme gave a single band with a molecular mass of 62 kDa by SDS-PAGE and 220 kDa by gel filtration. Some enzymic characteristics were studied.

Acetoin↗
PubMed1998

Technical points to improve surgical results in cases with basilar tip aneurysms.

Surgical results in 82 cases with aneurysm (61 ruptured and 21 unruptured) of the bifurcation of the basilar artery were analyzed and the causes of unfavorable outcome and its measures were discussed. Operation was performed in grade I, II, III, or IV of the Hunt and Kosnik's classification for the patients with ruptured aneurysm. Both in ruptured and unruptured cases, patient's age was not considered. As it turned out, 10 elderly (70 years old or older) cases (8 ruptured and 2 unruptured) were included in this study. Unilateral pterional approach was adopted for all but one case, and temporary clip and/or division of the hypoplastic posterior communicating artery was actively used. Surgery was completed with clipping of the aneurysm in all but six cases and overall surgical result consists of 70% of favorable outcomes. The main causes of unfavorable outcome were surgical procedures and primary brain damage due to subarachnoid hemorrhage. And the factors influenced to increase surgical technical damage to the brain were the patient's age, size of the aneurysm, and/or height of the neck from biclinoids line. The outcome of the higher grade (grade III or IV) in elderly cases was miserable, whereas it was not different from anterior circulation aneurysms in younger cases. From the result we concluded that the surgical indication for elderly cases should be limited in cases with lower grade (grade I or II) without large and/or high-positioned aneurysm. To obtain further improvement of the surgical result in younger cases, additional surgical techniques have to be considered to avoid the injury of perforating arteries from P1 and to reduce the pressure of the brain retraction which are the most important hazards for aneurysm surgery in this area.

Aged↗
PubMed1998

Identification and functional analysis of sulfonylurea receptor 1 variants in Japanese patients with NIDDM.

The sulfonylurea receptor 1 (SUR1) is an essential regulatory subunit of the beta-cell ATP-sensitive K+ channel (K[ATP]). The possible role of SUR1 gene mutation(s) in the development of NIDDM remains controversial as both a positive association and negative linkage results have been reported. Therefore, we examined the SUR1 gene at the single nucleotide level with single strand conformation polymorphism analysis in 100 Japanese NIDDM patients. We identified a total of five amino acid substitutions and 17 silent mutations by examining all 39 exons of this gene. Two rare novel mutations, D811N in exon 20 and R835C in exon 21, were identified in the first nucleotide-binding fold (NBF), a functionally important region of SUR1, in one patient each, both heterozygotes. To analyze possible functional alterations, we reconstituted the mutant K(ATP) by coexpressing beta-cell inward rectifier (BIR) (Kir 6.2), a channel subunit of K(ATP), and mutant SUR1 in HEK293T and COS-7 cells. As demonstrated by the patch clamp technique and rubidium (Rb+) efflux studies, neither mutation alters the properties of channel activities. Two other rare missense mutations, R275Q in exon 6 and V560M in exon 12, were also identified. The R275Q substitution was not found in 67 control subjects, and V560M was present in three control subjects. Neither of these substitutions appeared to cosegregate with NIDDM in the probands' families. A previously reported S1370A substitution located in the second NBF was also common in the Japanese subjects (allelic frequency 0.37), and was found at an equal frequency in nondiabetic control subjects. In conclusion, SUR1 mutations impairing K(ATP) function do not appear to be major determinants of NIDDM susceptibility in Japanese.

ATP-Binding Cassette Transporters↗
PubMed1997

p85alpha gene generates three isoforms of regulatory subunit for phosphatidylinositol 3-kinase (PI 3-Kinase), p50alpha, p55alpha, and p85alpha, with different PI 3-kinase activity elevating responses to insulin.

Phosphatidylinositol 3-kinase (PI 3-kinase) is stimulated by association with a variety of tyrosine kinase receptors and intracellular tyrosine-phosphorylated substrates. We isolated a cDNA that encodes a 50-kDa regulatory subunit of PI 3-kinase with an expression cloning method using 32P-labeled insulin receptor substrate-1 (IRS-1). This 50-kDa protein contains two SH2 domains and an inter-SH2 domain of p85alpha, but the SH3 and bcr homology domains of p85alpha were replaced by a unique 6-amino acid sequence. Thus, this protein appears to be generated by alternative splicing of the p85alpha gene product. We suggest that this protein be called p50alpha. Northern blotting using a specific DNA probe corresponding to p50alpha revealed 6.0- and 2.8-kb bands in hepatic, brain, and renal tissues. The expression of p50alpha protein and its associated PI 3-kinase were detected in lysates prepared from the liver, brain, and muscle using a specific antibody against p50alpha. Taken together, these observations indicate that the p85alpha gene actually generates three protein products of 85, 55, and 50 kDa. The distributions of the three proteins (p85alpha, p55alpha, and p50alpha), in various rat tissues and also in various brain compartments, were found to be different. Interestingly, p50alpha forms a heterodimer with p110 that can as well as cannot be labeled with wortmannin, whereas p85alpha and p55alpha associate only with p110 that can be wortmannin-labeled. Furthermore, p50alpha exhibits a markedly higher capacity for activation of associated PI 3-kinase via insulin stimulation and has a higher affinity for tyrosine-phosphorylated IRS-1 than the other isoforms. Considering the high level of p50alpha expression in the liver and its marked responsiveness to insulin, p50alpha appears to play an important role in the activation of hepatic PI 3-kinase. Each of the three alpha isoforms has a different function and may have specific roles in various tissues.

Amino Acid Sequence↗
PubMed1997

The sequential change of local cerebral blood flow and local cerebral glucose metabolism after focal cerebral ischaemia and reperfusion in rat and the effect of MK-801 on local cerebral glucose metabolism.

In order to investigate the time course change of local cerebral blood flow (1CBF) and local cerebral glucose metabolism (ICGM) and the effect of MK-801 (dizocilpine), an NMDA receptor antagonist on glucose metabolism in a middle cerebral artery occlusion-reperfusion model, 14C-Iodo-antipyrine and 14C-Deoxyglucose autoradiographic method have been used. The 1CBF was reduced to 0-10% of the control level in the ischaemic core and to 12-40% in the ischaemic penumbra between 60 and 120 min after the onset of the ischaemia. In the ischaemic core, the marked hyperfusion appeared at 15 min and maintained about 30 to 45 min following reperfusion. In the ischaemic penumbra, the hyperfusion during reperfusion was not found. Hypermetabolism occurred at 30 min and reached to the peak at 60 min after the middle cerebral artery (MCA) occlusion both in the ischaemic core and in the penumbra. The shift from hyper- to hypometabolism was observed during the ischaemia. The reperfusion following 2 hours of MCA occlusion facilitated the decrease of cerebral glucose metabolism in the ischaemic region. The pretreatment of MK-801 (0.4 mg/kg) inhibited both increased glucose metabolism during the ischaemia and decreased glucose metabolism during the reperfusion. The effect of limiting decreased glucose metabolism during the reperfusion by MK-801 was remarkable in the ischaemic penumbra. These findings support the hypothesis that excitation-induced hypermetabolism play a major role in the ischaemic insult following focal cerebral vascular occlusion.

Animals↗
PubMed1997

Coronary disease-prone behavior among Japanese men: job-centered lifestyle and social dominance. Type A Behavior Pattern Conference.

In Japan the type A behavior pattern, particularly its component of hostility, is known to have less value as a risk for coronary artery disease (CAD) than in the United States. We developed a questionnaire (Japanese Coronary-prone Behavior Scale [JCBS]) to investigate the behavioral correlates with CAD among contemporary Japanese persons. The JCBS was administered to 419 Japanese men undergoing coronary angiography; 310 of them had angiographic or clinical evidence or both of CAD, and 109 had no evidence of CAD. The group with CAD had more coronary risk factors than the group without CAD, but the two groups did not differ in type A behavior pattern as assessed with the Jenkins Activity Survey. Stepwise discriminant analysis, in which standard coronary risk factors were forced into the model, revealed that inclusion of nine JCBS items (scale C) in the model resulted in the best discrimination between the two groups. Cross-validation results showed that the error-rate estimates for the discriminant models that consisted only of standard coronary risk factors, only of scale C items, and of their combination were 34.7, 32.4, and 27.0%, respectively. The scale C items represented a job-centered lifestyle, social dominance, and suppressed overt type A behaviors. These results indicate that an independent behavior pattern prone to CAD is discernible among Japanese men and suggest that the behavior pattern may contain characteristics that can be differentiated from those that constitute the type A behavior pattern.

Aged↗
PubMed1997

Liaison psychiatry and HIV infection (I): Avoidance coping responses associated with depressive symptoms accompanying somatic complaints.

We examined the relationship of somatic complaints to coping behaviors and mood states among 50 HIV-positive patients without AIDS. Although no patients fulfilled the DSM-III-R criteria for mood disorders including major depression, scores for depressive symptoms were significantly higher in the HIV-positive patients than in healthy persons. Although depressive symptoms in HIV patients may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these patients may be prone to depressive symptoms. The HIV patients indicated a tendency toward somatic complaints more frequently than their healthy counterparts. The scores for depressive symptoms were significantly and positively correlated with scores for avoidance coping responses. The presence or absence of six complaints (i.e., general fatigue, abdominal distress, chest pain or discomfort, and numbness or chills) could be discriminated based on the score of avoidance coping responses. The results of this study suggest that avoidance coping responses associated with depressive symptoms accompany several somatic complaints in HIV patients without AIDS.

Adaptation, Psychological↗
PubMed1997

Liaison psychiatry and HIV infection (II): Application of relaxation in HIV positive patients.

We examined the efficacy of relaxation techniques in a sample of HIV patients without AIDS in the early stages after infection, by comparing the three groups: relaxation group (progressive muscle relaxation and modified autogenic training); ordinary supportive psychotherapy group, and finally no psychiatric treatment group. Scores for anxiety, fatigue, depression and confusion, as measured by the profile of mood states (POMS), were significantly lower after relaxation than before. There were no significant differences in the POMS scores (except for anger) among the three groups. These two results suggest that a combination of progressive muscle relaxation and modified autogenic training is a useful method, which can be easily employed in HIV patients without AIDS.

Adaptation, Psychological↗
PubMed1997

Somatic complaints associated with depressive symptoms in HIV-positive patients.

BACKGROUND: Although several studies have indicated the association of mood states including depression with somatic complaints in HIV patients, there has been no report on Japanese HIV patients. The purpose was to examine the relationship between somatic complaints and mood states in HIV patients without AIDS. METHODS: Subjects were 50 HIV patients without AIDS. As controls, we used 47 healthy persons without HIV, matched for age and gender of the subjects. After the Structured Clinical Interview for the DSM-III-R, several inventories including the Profile of Mood States (POMS) were administered. The presence or absence of somatic complaints were examined. RESULTS: No patients fulfilled the criteria for the DSM-III-R Mood Disorders Including Major Depression. However, scores on depression as measured by the POMS were significantly higher for the HIV group than for the healthy group. Although depressive symptoms in the HIV group may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these HIV patients may be prone to a depressive state. The HIV patients indicated somatic complaints more frequently. Among these, the presence or absence of five complaints (i.e., abdominal distress, sleep disturbance, smothering sensations, chest pain or discomfort, and numbness or chills) was significantly discriminated based on scores on depression. DISCUSSION: The results suggest that depressive symptoms accompany several somatic complaints in HIV patients without AIDS. Although a longitudinal follow-up study is required, the assessments of somatic symptoms may bring clinical benefits such as earlier diagnosis and/or intervention for a depressive state.

Adaptation, Psychological↗
PubMed1997

A comparison of Japanese and American psychiatrists' attitudes towards patients wishing to die in the general hospital.

BACKGROUND: The attitudes of the psychiatrists in Japan and the US were compared in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to do so or be assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes. METHODS: Japanese and American general hospital psychiatrists' attitudes towards the reasonability of suicide, physician-assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and 62 Japanese psychiatrists' data were collected using the Suicidal Attitudes Inventory. RESULTS: The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation or completed suicide in med-surg patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis. CONCLUSIONS: The results indicate that psychiatrists' attitudes towards the relationship of psychopathology with suicidal ideation, the effect of depression, and other cultural factors on the desire to die in the medically ill are issues that need better clarification among both the medical profession as well as within society. Looking at how other societies handle these matters may help to understand one's own approach to them.

Adult↗