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Takeshi Nishijima,
Misao Takano,
Michiyo Ishisaka,
Hirokazu Komatsu,
Hiroyuki Gatanaga,
Yoshimi Kikuchi,
Tomoyuki Endo,
Masahide Horiba,
Satoru Kaneda,
Hideki Uchiumi, [......],
Yoshiyuki Yokomaku,
Teruhisa Fujii,
Satoshi Higasa,
Kiyonori Takada, Masahiro Yamamoto,
Shuzo Matsushita,
Masao Tateyama,
Yoshinari Tanabe,
Hiroaki Mitsuya,
Shinichi Oka
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ABSTRACT: Objective To compare the efficacy and safety of fixed-dose abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) with ritonavir-boosted atazanavir (ATV/r) in treatment-naïve Japanese patients with HIV-1 infection. Methods A 96-week multicenter, randomized, open-label, parallel group pilot study was conducted. The endpoints were times to virologic failure, safety event and regimen modification. Results 109 patients were enrolled and randomly allocated (54 patients received ABC/3TC and 55 patients received TDF/FTC). All randomized subjects were analyzed. The time to virologic failure was not significantly different between the two arms by 96 weeks (HR, 2.09; 95% CI, 0.72-6.13; p=0.178). Both regimens showed favorable viral efficacy, as in the intention-to-treat population, 72.2% (ABC/3TC) and 78.2% (TDF/FTC) of the patients had an HIV-1 viral load <50 copies/mL at 96 weeks. The time to the first grade 3 or 4 adverse event and the time to the first regimen modification were not significantly different between the two arms (adverse event: HR 0.66; 95% CI, 0.25-1.75, p=0.407) (regimen modification: HR 1.03; 95% CI, 0.33-3.19, p=0.964). Both regimens were also well-tolerated, as only 11.1% (ABC/3TC) and 10.9% (TDF/FTC) of the patients discontinued the allocated regimen by 96 weeks. Clinically suspected abacavir-associated hypersensitivity reactions occurred in only one (1.9%) patient in the ABC/3TC arm. Conclusion Although insufficiently powered to show non-inferiority of viral efficacy of ABC/3TC relative to TDF/FTC, this pilot trial suggested that ABC/3TC with ATV/r is a safe and efficacious initial regimen for HLA-B*5701-negative patients, such as the Japanese population.
Internal Medicine 01/2013; 52(7):735-44. · 0.94 Impact Factor
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ABSTRACT: We report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual
loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse
steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left
eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and
initiation of prompt therapy where ocular manifestations of MPA occur.
KeywordsAcute blindness–Pulse steroid therapy–Microscopic polyangiitis
Central European Journal of Medicine 04/2012; 6(5):631-633. · 0.31 Impact Factor
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ABSTRACT: We report the case of a 31-year-old woman who developed adult-onset Still's disease (AOSD) with a high level of serum interleukin (IL)-18. Although treated with high dose steroids, she suffered repeated remissions and her condition deteriorated. After we administered oral cyclosporine A (CsA), 200 mg/d, monitoring C2 and trough levels, her symptoms improved significantly. We decreased the dose of methylprednisolone slowly without noting a relapse. The use of CsA accompanied by C2 and trough level monitoring should be considered for refractory AOSD patients with high levels of serum IL-18.
Fukuoka igaku zasshi = Hukuoka acta medica 01/2012; 103(1):24-8.
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ABSTRACT: Antiretroviral therapy for HIV infection is associated with lipodystrophy. However, raltegravir (RAL), a new integrase inhibitor, and atazanavir (ATV), a new generation of protease inhibitor (PI), have not been reported to significantly induce metabolic abnormalities in some clinical studies. The aim of this study was to investigate the influence and molecular mechanisms of RAL and compared it with the other three classes of ARVs (nucleoside reverse-transcriptase inhibitors; NRTI, nonnucleoside reverse-transcriptase inhibitor; NNRTI, and PI) on adipogenesis using 3T3-L1 cells. RAL and ATV had minimal effects on the lipid metabolism of 3T3-L1 cells. NRTI induced a moderate change, and NNRTI and some PIs induced a severe reduction in cell lipid content. These ARVs induced a decrease in the expression of genes associated with lipogenic transcription factors (sterol regulatory-element-binding protein-1c, CAAT box enhancer-binding protein-α, and peroxisome proliferator-activated receptor-γ). The differentiated 3T3-L1 cells were less sensitive to ARV-induced metabolic disturbance than were predifferentiated cells. RAL and ATV did not significantly affect the lipid metabolism in our in vitro study. The other ARVs had a direct influence on adipocytes. Degree and underlying mechanisms of metabolic disturbance differed among different ARVs. These data suggest that the distinct metabolic side-effect profiles of ARVs are a consequences of their differential effects on the adipocyte physiology. A better understanding of the mechanism of ARV-induced metabolic abnormalities could lead to safer use of ARVs or selection of alternative agents for further clinical development.
Journal of Infection and Chemotherapy 04/2011; 17(2):183-8. · 1.80 Impact Factor
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Yoshiro Horai,
Tomoya Miyamura,
Hokuto Arase,
Daisaku Kimura,
Karin Shimada,
Motoko Ishida,
Soichiro Takahama,
Junichi Kiyasu,
Rumi Minami, Masahiro Yamamoto,
Eiichi Suematsu,
Yoshifuku Nakayama
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ABSTRACT: A 79-year-old man was diagnosed with relapsing polychondritis, from symptoms of bilateral auricular deformity and pigmentation, polyarthralgia, and audiovestibular damage, and from histological examination of the left auricular cartilage. The left auricular cartilage biopsy specimen revealed cartilage destruction with infiltration of plasmacytes expressing IgG4. This case suggests that IgG4 may be involved in the pathogenesis and etiology of relapsing polychondritis.
Modern Rheumatology 03/2011; 21(5):557-60. · 1.58 Impact Factor
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ABSTRACT: A 58-year-old woman was diagnosed with Churg-Strauss syndrome (CSS) based on the symptoms of bronchial asthma, eosinophilia, mononeuritis multiplex and histological examination of the right sural nerve. Prior to treatment, the serum interleukin (IL)-5 level was high, and rearrangement of the T cell receptor (TCR) gene was identified. This is the first report of TCR gene rearrangement in a patient with CSS. The expanded T cell clone may be responsible for the overproduction of IL-5. Further studies are warranted to disclose a prevalence of TCR gene rearrangement in CSS patients and its pathophysiological roles in the development of this disease.
Modern Rheumatology 02/2011; 21(1):76-8. · 1.58 Impact Factor
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Dai Watanabe,
Shiro Ibe,
Tomoko Uehira,
Rumi Minami,
Atsushi Sasakawa,
Keishiro Yajima,
Hitoshi Yonemoto,
Hiroki Bando,
Yoshihiko Ogawa,
Tomohiro Taniguchi,
Daisuke Kasai,
Yasuharu Nishida, Masahiro Yamamoto,
Tsuguhiro Kaneda,
Takuma Shirasaka
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ABSTRACT: Viral reservoir size refers to cellular human immunodeficiency virus-1 (HIV-1) DNA levels in CD4(+) T lymphocytes of peripheral blood obtained from patients with plasma HIV-1-RNA levels (viral load, VL) maintained below the detection limit by antiretroviral therapy (ART). We measured HIV-1 DNA levels in CD4(+) lymphocytes in such patients to investigate their clinical significance.
CD4(+) T lymphocytes were isolated from the peripheral blood of 61 patients with a VL maintained at less than 50 copies/ml for at least 4 months by ART and total DNA was purified. HIV-1 DNA was quantified by nested PCR to calculate the copy number per 1 million CD4(+) lymphocytes (relative amount) and the copy number in 1 ml of blood (absolute amount). For statistical analysis, the Spearman rank or Wilcoxon signed-rank test was used, with a significance level of 5%.
CD4 cell counts at the time of sampling negatively correlated with the relative amount of HIV-1 DNA (median = 33 copies/million CD4(+) lymphocytes; interquartile range [IQR] = 7-123 copies/million CD4(+) lymphocytes), but were not correlated with the absolute amounts (median = 17 copies/ml; IQR = 5-67 copies/ml). Both absolute and relative amounts of HIV-1 DNA were significantly lower in six patients in whom ART was initiated before positive seroconversion than in 55 patients in whom ART was initiated in the chronic phase, as shown by Western blotting. CD4 cell counts before ART introduction were also negatively correlated with both the relative and absolute amounts of HIV-1 DNA. Only the relative amounts of HIV-1 DNA negatively correlated with the duration of VL maintenance below the detection limit, while the absolute amounts were not significantly correlated with this period.
The amounts of cellular HIV-1 DNA in patients with VLs maintained below the detection limit by the introduction of ART correlated with the timing of ART initiation but not with the duration of ART. In addition, CD4(+) T lymphocytes, which were newly generated by ART, diluted latently infected cells, indicating that measurements of the relative amounts of cellular HIV-1 DNA might be underestimated.
BMC Infectious Diseases 01/2011; 11:146. · 3.12 Impact Factor
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ABSTRACT: A 46-year-old female with a past history of ulcerative colitis (UC) was diagnosed with subacute thyroiditis (SAT), which improved with prednisolone (PSL) treatment (60 mg/day). The dose of PSL was gradually decreased, however upper back and neck pain and chest discomfort developed. The patient was diagnosed with Takayasu's arteritis (TA) based on wall thickening and luminal narrowing of the left common carotid artery and the left subclavian artery. The result of human leukocyte antigen typing analysis was A24 and B52 positive. These findings suggested that common genetic factors may be important for the etiology of TA, UC and SAT. This is the first report of TA that developed following UC and SAT.
Internal Medicine 01/2011; 50(2):151-4. · 0.94 Impact Factor
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ABSTRACT: This report describes a 50-year-old woman with coexisting Basedow's disease and adult-onset Still's disease (AOSD) that relapsed simultaneously. She was diagnosed with Basedow's disease in 1999, and treatment with antithyroid agents was started. However, the treatment was soon stopped because of severe side effects. A partial thyroidectomy was performed and the thyroid function stayed well-controlled after the surgery. In August 2007, she was admitted to our hospital with fever, a sore throat, skin rashes, arthritis and leukocytosis, and was diagnosed with AOSD. At the same time, her laboratory data revealed decreased serum TSH and elevated serum free T4, suggesting a relapse of Basedow's disease. After initiation of steroid pulse therapy accompanied by oral prednisolone, both diseases improved significantly. Prednisolone was gradually reduced, and the disease activity remained in remission. Immediately after prednisolone reached 3 mg/day in November 2009, both diseases relapsed. Prednisolone was increased to 30 mg/day, and the diseases became well-controlled again. In this case, Basedow's disease was aggravated when AOSD was in the active stage. Literature searches revealed five previously reported cases with coexisting Basedow's disease and AOSD. In four of the six cases, including our case, both diseases were activated simultaneously. AOSD in the active stage is known to cause hypercytokinemia and immunological derangement. Our case indicated that the pathogenesis of AOSD might lead to relapse of coexisting Basedow's disease.
Japanese Journal of Clinical Immunology 01/2011; 34(5):426-30.
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Junko Hattori,
Teiichiro Shiino,
Hiroyuki Gatanaga,
Shigeru Yoshida,
Dai Watanabe,
Rumi Minami,
Kenji Sadamasu,
Makiko Kondo,
Haruyo Mori,
Mikio Ueda, [......],
Yoshinari Tanabe,
Ichiro Koga,
Yoko Kojima, Masahiro Yamamoto,
Jiro Fujita,
Yoshiyuki Yokomaku,
Takao Koike,
Takuma Shirasaka,
Shinichi Oka,
Wataru Sugiura
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ABSTRACT: The emergence and transmission of drug-resistant human immunodeficiency virus-1 (HIV-1) compromises antiretroviral treatment for HIV-1. Thus, testing for drug resistance is recommended at diagnosis and before initiating highly active antiretroviral treatment. We conducted an epidemiological study enrolling newly diagnosed patients between 2003 and 2008 in our nationwide surveillance network. In the 6-year study period, the prevalence of drug-resistant HIV-1 among 2573 patients, consisting mainly of Japanese men in their late-30s and infected through male-to-male sexual contacts, followed an increasing trend from 5.9% (16/273) in 2003 to 8.3% (50/605) in 2008. Nucleoside reverse transcriptase inhibitor-associated mutations predominated in each year, with T215 revertants being the most abundant. The predictive factor for drug-resistant HIV-1 transmission was subtype B (OR=2.36; p=0.004), and those for recent HIV-1 infection were male gender (OR=3.79; p=0.009), MSM behavior (OR=1.67; p=0.01), Japanese nationality (OR=2.31; p=0.008), and subtype B (OR=5.64; p<0.05). Continued activities are needed to raise awareness of the risks of HIV-1 infection and complications of drug-resistant strains. Continued surveillance is also needed to understand trends in the HIV-1 epidemic.
Antiviral research 10/2010; 88(1):72-9. · 3.61 Impact Factor
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ABSTRACT: To investigate the clinical characteristics of patients with Churg-Strauss syndrome (CSS), including symptoms, blood chemistry and immunological findings.
We retrospectively investigated the records of 11 patients (six female and five male) with CSS admitted to our hospital from September 2003 to October 2009.
Eight patients had preceding symptoms including bronchial asthma and allergic rhinitis. Seven patients showed eosinophilia. Nine patients had mononeuritis multiplex. Positive findings of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) were found in five patients. Neither clinical manifestations nor laboratory findings were correlated with positivity for MPO-ANCA. However, the MPO-ANCA-positive group showed a higher level of blood urea nitrogen and proteinuria than those negative for MPO-ANCA. Ten patients recovered after starting steroid or immunosuppressive therapy, although one patient died of unknown etiology.
Although general assessments based on various factors such as medical history, clinical manifestation and laboratory studies are indispensable in CSS, MPO-ANCA might be useful as a predictor of renal dysfunction in patients with CSS.
International Journal of Rheumatic Diseases 08/2010; 13(3):e6-e10. · 0.81 Impact Factor
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Ryoji Nagai,
Ryoichi Hajima,
Nobuyuki Nishimori,
Toshiya Muto, Masahiro Yamamoto,
Yosuke Honda,
Tsukasa Miyajima,
Hokuto Iijima,
Masao Kuriki,
Makoto Kuwahara,
Shoji Okumi,
Tsutomu Nakanishi
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ABSTRACT: A high-voltage dc photocathode electron gun was successfully conditioned up to a voltage of 550 kV and a long-time holding test for 8 h was demonstrated at an acceleration voltage of 500 kV. The dc photocathode electron gun is designed for future light sources based on energy-recovery linac and consists of a Cockcroft-Walton generator, a segmented cylindrical ceramic insulator, guard-ring electrodes, a support-rod electrode, a vacuum chamber, and a pressurized insulating gas tank. The segmented cylindrical ceramic insulator and the guard-ring electrodes were utilized to prevent any damage to the insulator from electrons emitted by the support-rod electrode.
The Review of scientific instruments 03/2010; 81(3):033304. · 1.52 Impact Factor
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ABSTRACT: To clarify the clinical usefulness of cerebrospinal fluid (CSF) interleukin-6 (IL-6) measurement in patients with neuropsychiatric systemic lupus erythematosus (NPSLE), we studied CSF IL-6 levels in patients with NPSLE and analyzed the association between CSF IL-6 levels and other clinical findings of NPSLE.
We retrospectively analyzed records of 37 patients (33 females and four males) with NPSLE admitted to our hospital between January 2003 and December 2008.
All patients showed neuropsychiatric symptoms. Fourteen patients showed abnormalities in brain magnetic resonance imaging (MRI) and 12 patients had abnormal findings in electroencephalography (EEG). Increased CSF cell counts and elevated levels of CSF IL-6 were found in 11 and 30 patients, respectively. Elevated levels of CSF IL-6 were not statistically correlated with specific abnormalities in the blood analysis, in increased CSF cell counts, and in abnormalities in the brain MRI and EEG. In addition, a group of NPSLE patients positive for antiphospholipid antibodies (aPL) showed lower CSF IL-6 than the patients negative for aPL.
These results indicated that CSF IL-6 might be useful in diagnosis of NPSLE. However, general assessments of patients based on various factors (clinical manifestations, imaging findings and CSF examinations) are also required.
Fukuoka igaku zasshi = Hukuoka acta medica 02/2010; 101(2):34-40.
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Masahiko Suzuki,
Michihiro Hashimoto,
Tsuneo Yasue,
Takanori Koshikawa,
Yasuhide Nakagawa,
Taro Konomi,
Atsushi Mano,
Naoto Yamamoto,
Makoto Kuwahara, Masahiro Yamamoto,
Shoji Okumi,
Tsutomu Nakanishi,
Xiuguang Jin,
Toru Ujihara,
Yoshikazu Takeda,
Teruo Kohashi,
Takashi Ohshima,
Takashi Saka,
Toshihiro Kato,
Hiromichi Horinaka
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ABSTRACT: We developed a spin-polarized low energy electron microscopy (SPLEEM)
with a highly polarized and high brightness spin electron gun in the
present study. Magnetic structures of Co/W(110) were observed with an
acquisition time of 0.02 s with a field of view of 6 μm. We carried
out a dynamic observation of magnetic structures with the SPLEEM during
the growth of Co on W(110).
Applied Physics Express 01/2010; 3(2):6601. · 3.01 Impact Factor
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ABSTRACT: A 63-year-old-man was diagnosed in March 2002 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis because of mononeuritis multiplex, interstitial pneumonia and a positive finding for myeloperoxidase (MPO)-ANCA. Although treated with prednisolone and oral cyclophosphamide, he suffered repeated remission and deterioration of his conditon, which was complicated by hypertrophic pachymeningitis and sinusitis. In July 2006, he was diagnosed with an exacerbation of ANCA-associated vasculitis because of pyrexia, general malaise, numbness in his face and legs, and elevated serum CRP level. Steroid pulse therapy was thus initiated and the patient's clinical symptoms improved. However, serum CRP levels elevated again (5.18 mg/dl) in September 2006. We began administration of rituximab (500 mg/bodyx4 times) in November 2006 and his symptom and laboratory data significantly improved. The dose of prednisolone was slowly decreased without suffering a relapse. Rituximab has been administered every one year, and good disease control has been achieved. Diagnosis of Wegener's granulomatosis was made from the findings of a nodular lesion in the left lung. Rituximab should be considered for patients with refractory ANCA-associated vasculitis.
Japanese Journal of Clinical Immunology 01/2010; 33(2):105-10.
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ABSTRACT: We herein report a case study of an HIV-1-infected 64-year-old Japanese man who presented, with an abdominal aortic aneurysm due to non-typhoidal Salmonella. He was admitted with a 7-day history of intermittent left back pain. A culture of a blood specimen yielded gram-negative bacilli, which were identified as non-typhoidal Salmonella. Computed tomography showed an abdominal aortic aneurysm due to the non-typhoidal Salmonella infection. Since such a complication is frequently fatal, its management, especially the timing of surgery, is difficult. Further studies are needed to determine the optimal treatment strategy, however, early diagnosis and prompt careful treatment can reduce mortality.
Internal Medicine 01/2010; 49(12):1237-41. · 0.94 Impact Factor
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ABSTRACT: We report a 29-year-old woman with a 2.5 year history of mixed connective tissue disease (MCTD) who developed idiopathic portal hypertension (IPH) and thrombocytopenia as a result of hypersplenism. She had recurrent esophagogastric variceal rupture. Hematological examination also revealed low levels of protein C activity. The liver biopsy specimen showed non-specific mild inflammation and no thrombi. However, portal vein thrombosis developed after splenectomy. This was a rare case of severe complications of IPH accompanying MCTD and protein C deficiency.
Internal Medicine 01/2010; 49(18):2013-6. · 0.94 Impact Factor
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ABSTRACT: A 62-year-old male was admitted to a local hospital due to a clouding of consciousness in October 2006. On admission, his renal function was observed to have severely deteriorated, which is thought to cause disturbance of consciousness. Laboratory data showed blood urea nitrogen to be 160 mg/dl and the serum creatinine level was 25 mg/dl and, as a result, continuous hemodiafiltration (CHDF) was started. Although his general condition improved, his renal function did not recover. Therefore, regular hemodialysis was started in December 2006. The cause of renal dysfunction was uncertain, because MPO-ANCA was negative, and a renal biopsy could not be done due to the lack of a clear corticomedullary border in his kidneys. In January 2008, he was diagnosed to have microscopic polyangiitis (MPA) because of hemoptysis, elevated serum CRP levels and a positive finding for MPO-ANCA (408.0 EU). An alveolar hemorrhage was also ascertained in a broncoscopic examination. Steroid pulse therapy and intravenous pulse therapy of cyclophosphamide were thus started. The patient's clinical symptoms thereafter significantly improved and his MPO-ANCA level became normalized. This is a rare case characterized by a late appearance of MPO-ANCA, which occurred after more than one year after the onset of renal failure in MPA.
Japanese Journal of Clinical Immunology 12/2009; 32(6):506-10.
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ABSTRACT: We report a 24-year-old male with systemic lupus erythematosus (SLE) who developed influenza virus B-associated hemophagocytic syndrome and cardiac tamponade. Although the patient's general condition improved after steroid pulse therapy and pericardiocentesis, pericardial effusion re-accumulated. Colchicine and aspirin were administered, together with prednisolone, after which no further relapses occurred. This was a rare case of severe influenza-associated hemophagocytic syndrome and steroid-resistant pericardial effusion in an SLE patient.
Modern Rheumatology 11/2009; 20(2):178-82. · 1.58 Impact Factor
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ABSTRACT: Relapsing polychondritis (RP) is a rare multisystemic disease characterized by the recurrent inflammation of the cartilaginous structures of the external ear, nose, joint, larynx, and tracheobronchial tree, whose etiology might involve an immunological mechanism. Five patients with RP were analyzed. They consisted of 4 males and 1 female, with ages of onset ranging from 27 to 75. Duration from onset to diagnosis varied from 10 months to 5 years. All 5 patients had auricular chondritis and arthritis. Laringotracheal involvement was detected in 4 patients, scleritis in 2 patients, nasal chondritis, and costal chondritis in one patient. One patient was diagnosed to have MAGIC syndrome, complicated with oral and genital ulcers. Antibodies to type II collagen were detected in 4 patients, and the antibody titer correlated with the level of C-reactive protein. Corticosteroids were given to 5 patients. After treatment, the symptoms improved in 5 patients, but 3 patients had a recurrence as reducing corticosteroids. One of them received steroid pulse therapy, one received immunosuppressive drugs, and one patient received both treatments. To prevent an impairment of organs, an early diagnosis involving the use of antibodies to type II collagen and steroid therapy are important in this disease.
Japanese Journal of Clinical Immunology 09/2009; 32(4):269-73.
