Y Akiyama

Fukujuji Hospital, Edo, Tōkyō, Japan

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Publications (46)133.15 Total impact

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    ABSTRACT: A male patient in his 30s was referred to our hospital after multiple nodular shadows were noted on a periodical chest x-ray examination. Two weeks later, he complained of hemoptysis, dyspnea, and malaise, and abnormal shadows on chest CT rapidly progressed. Metastatic lung tumors were diagnosed from transbronchial brushing cytology, but the primary site of the cancer could not be detected. Systemic chemotherapy was performed, but his general condition deteriorated and he died 6 days after first administration. Histological examination of the autopsy specimens revealed choriocarcinoma of the testis and pulmonary metastases.
    No preview · Article · Jan 2013
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    ABSTRACT: A male patient in his 60s was admitted to the Hokkaido Social Insurance hospital. He was diagnosed with acute pneumonia, respiratory failure, and diabetic nephropathy. The initial response upon empirical treatment with antibiotics was unsatisfactory. The patient's renal function rapidly deteriorated, and hemodialysis was eventually initiated. A urinary detection of the Legionella antigen led to the diagnosis of Legionella pneumonia. The patient's condition gradually improved upon intravenous administration of ciprofloxacin, leading to discontinuation and eventual freedom from hemodialysis.
    No preview · Article · Jan 2013
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    ABSTRACT: In recent years, many novel nontuberculous mycobacterial species have been discovered through genetic analysis. Mycobacterium massiliense and M. bolletii have recently been identified as species separate from M. abscessus. However, little is known regarding their clinical and microbiological differences in Japan. We performed a molecular identification of stored M. abscessus clinical isolates for further identification. We compared clinical characteristics, radiological findings, microbiological findings, and treatment outcomes among patients with M. abscessus and M. massiliense lung diseases. An analysis of 102 previous isolates of M. abscessus identified 72 (71%) M. abscessus, 27 (26%) M. massiliense, and 3 (3%) M. bolletii isolates. Clinical and radiological findings were indistinguishable between the M. abscessus and M. massiliense groups. Forty-two (58%) patients with M. abscessus and 20 (74%) patients with M. massiliense infections received antimicrobial treatment. Both the M. abscessus and M. massiliense groups showed a high level of resistance to all antimicrobials, except for clarithromycin, kanamycin, and amikacin. However, resistance to clarithromycin was more frequently observed in the M. abscessus than in the M. massiliense group (16% and 4%, respectively; P = 0.145). Moreover, the level of resistance to imipenem was significantly lower in M. abscessus isolates than in M. massiliense isolates (19% and 48%, respectively; P = 0.007). The proportions of radiological improvement, sputum smear conversion to negativity, and negative culture conversion during the follow-up period were higher in patients with M. massiliense infections than in those with M. abscessus infections. Patients with M. massiliense infections responded more favorably to antimicrobial therapy than those with M. abscessus infections.
    Full-text · Article · Aug 2012 · Journal of clinical microbiology
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    ABSTRACT: Although the rate of annual decline in FEV1 is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about intersubject variability based on clinical phenotypes. To examine the intersubject variability in a 5-year observational cohort study, particularly focusing on emphysema severity. A total of 279 eligible patients with COPD (stages I-IV: 26, 45, 24, and 5%) participated. We conducted a detailed assessment of pulmonary function and computed tomography (CT) at baseline, and performed spirometry every 6 months before and after inhalation of bronchodilator. Smoking status, exacerbation, and pharmacotherapy were carefully monitored. Emphysema severity was evaluated by CT and annual measurements of carbon monoxide transfer coefficient. Using mixed effects model analysis, the annual decline in post-bronchodilator FEV1 was -32±24 (SD) ml/yr (n=261). We classified the subjects of less than the 25th percentile as Rapid decliners, the 25th to 75th percentile as Slow decliners, and greater than the 75th percentile as Sustainers (-63±2, -31±1, and -2±1 [SE] ml/yr). Emphysema severity, but not %FEV1, showed significant differences among the three groups. Multiple logistic regression analysis demonstrated that the Rapid decliners were independently associated with emphysema severity assessed either by CT or carbon monoxide transfer coefficient. The Sustainers displayed less emphysema and higher levels of circulating eosinophils. Emphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice.
    Full-text · Article · Jan 2012 · American Journal of Respiratory and Critical Care Medicine
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    ABSTRACT: Seven isolates of a slowly growing, non-chromogenic Mycobacterium species were obtained from sputum and bronchial lavage fluid samples from elderly patients in different regions of Japan. These isolates were distinguished from related non-tuberculous species by colony morphology, positive results for Tween hydrolysis, catalase at 68 °C, nitrate reductase and pyrazinamidase and negative results for semi-quantitative catalase, urease and arylsulfatase. The mycolic acid pattern obtained by HPLC revealed a single cluster of late-eluting mycolic acids similar to but different from those of Mycobacterium malmoense ATCC 29571(T). The 16S rRNA gene, 16S-23S internal transcribed spacer (ITS), rpoB and hsp65 sequences were unique in comparison with those of other mycobacteria. Comparison of 16S rRNA gene sequences showed that the isolates were most closely related to Mycobacterium tuberculosis H37Rv(T) (21 base differences in 1508 bp; 98.6 % 16S rRNA gene sequence similarity). A representative strain, GTC 2738(T), showed 91.9 % rpoB sequence similarity with Mycobacterium marinum strain M, 95 % hsp65 sequence similarity with Mycobacterium kansasii CIP 104589(T) and 81.1 % 16S-23S ITS sequence similarity with Mycobacterium gordonae ATCC 14470(T). Phylogenetic analysis of concatenated sequences of the 16S rRNA, rpoB and hsp65 genes showed that strain GTC 2738(T) was located on a distinct clade adjacent to M. tuberculosis, M. ulcerans and M. marinum, with bootstrap values of 81 %. DNA-DNA hybridization demonstrated less than 70 % reassociation with type strains of genetically related species and supported the novel species status of the isolates. On the basis of this evidence, a novel species with the name Mycobacterium shinjukuense sp. nov. is proposed. The type strain, isolated from a sputum sample, is strain GTC 2738(T)( = JCM 14233(T) = CCUG 53584(T)).
    Preview · Article · Aug 2011 · International Journal of Systematic and Evolutionary Microbiology
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    ABSTRACT: A 50-year-old man was referred and admitted to our hospital because of pneumonia and pleuritis. The patient had attempted suicide by inhaling automobile exhaust 3 years ago. Carbon monoxide intoxication had caused persistent disturbance of consciousness and quadriplegia. He had been tracheostomised and under nutrition by percutaneous endoscopic gastrostomy. On admission the presence of left pleural fluid with thickening of the pleura was shown on computed tomography. Thoracocentesis produced suppurative fluid with Actinomyces species nova identified by the 16S rRNA method. The patient was successfully treated with antibiotics and drainage of suppurative fluid.
    Full-text · Article · Aug 2009
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    ABSTRACT: We describe herein a newly defined pulmonary tumor presenting as an irregular shaped nodule in the peripheral lung, arising in a 62-year-old man. Histologically, the tumor showed papillary configuration, bronchioloalveolar spread, and a mucus lake, consisting of ciliated columnar cells and goblet cells with basaloid cell proliferation. The tumor was diagnosed as ciliated muconodular papillary tumor of the peripheral lung.
    Full-text · Article · Dec 2008 · Respiratory Medicine CME
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    ABSTRACT: Isolates of M. tuberculosis were analyzed for their DNA fingerprints to facilitate understanding of ongoing transmission of tuberculosis in Sapporo (population 1.87 million), Japan, where the incidence rate of tuberculosis was 15.0 per 100,000 in 2004. Out of all tuberculosis patients registered in the city from November 1998 to December 2003, isolates from culture-positive respiratory tuberculosis cases for whom written informed consent had been obtained, were analyzed by restriction fragment length polymorphism (RFLP). The study included 345 cases (249 men and 96 women) whose isolates were available for DNA patterns. Using standard IS6110-RFLP typing, cases whose isolates shared identical fingerprints were considered to belong to the same cluster. Proportions of clustered cases were evaluated according to their clinical and socio-economical characteristics. Out of 345 cases, 207 (60.0%) were classified into 59 clusters, and 15% of clustered cases having definite epidemiological links. Multiple logistic regression analysis in men showed that age and infectiousness were significantly related to clustering. The adjusted odds ratios (OR) [95% confidence intervals (CI)] were 0.17 [0.03-0.79] for 30-59 years, 0.15 [0.03-0.69] for 60 years or over and 2.35 [1.17-4.70] for those cases assigned as the highest level of transmission of tuberculosis from the infectiousness index of cases. For women the final model showed the adjusted OR [95% CI] were 0.52 [0.22-1.22] for those with previous history of tuberculosis and 0.33 [0.06-1.85] for diabetics. In male cases with a previous history of tuberculosis, most highly infectious cases were significantly associated with clustering (OR [95% CI], 4.53 [1.16-17.68]). The results suggest that highly infectious male tuberculosis cases with endogenous reactivation have contributed to recent transmission of tuberculosis in the studied area.
    No preview · Article · Jun 2007 · Kekkaku: [Tuberculosis]
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    ABSTRACT: To find a new method to predict the result of the egg based Ogawa medium using the Mycobacterium Growth Indicator Tube (MGIT) system and to evaluate the usefulness of a new discharge criterion that uses the new prediction method for smear positive pulmonary tuberculosis patients. We compared mycobacterial growth of sputum specimens weekly between the Mycobacterium Growth Indicator Tube (MGIT) and the egg based Ogawa solid media, using a total of 3952 sputum specimens of patients with pulmonary tuberculosis (TB) who underwent chemotherapy in our hospital from September 2001 to March 2006 to find relationship between the results of the two culture methods and to utilize the findings to new discharge criteria of pulmonary TB patients. And we compared the duration of hospitalization between two patients' group: one group using the new discharge criterion, the other the old one. We found that if a specimen shows negative culture on the MGIT system within the first two weeks, the same specimen shows negative or scant growth on the Ogawa media in the 8th week. Introducing this fact as a part of new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened from 121 days to 71 days and no patient showed treatment failure. We have used the result of sputum culture on Ogawa medium as a standard when we judge infectivity of patients with pulmonary tuberculosis in Japan, but it was one of the reasons why Japanese pulmonary tuberculosis patients stay long in TB hospital. Using our finding, we can predict the results of Ogawa system six weeks earlier, when a specimen shows negative culture on the MGIT system in the first 2 weeks. After we introduced this fact into new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened and no patient shows treatment failure until now. We highly recommend the usefulness of the MGIT system (especially when a specimen shows negative growth in the first two weeks) as a reliable method of predicting infectivity of patients with pulmonary tuberculosis and propose that the new TB discharge criterion should be widely confirmed and used in other hospitals.
    No preview · Article · Feb 2007 · Kekkaku: [Tuberculosis]

  • No preview · Article · Feb 2007 · Internal Medicine

  • No preview · Article · Aug 2006 · Nihon Naika Gakkai Zasshi
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    ABSTRACT: A 48-year-old man with dyspnea, cough, and fever was found to have a diffuse ground-glass pulmonary lesion without lymphadenopathy on chest X-ray. The lesion shifted to the peripheral lung zones 2 months later when transbronchial biopsy demonstrated noncaseating granulomas with Langhans type giant cells. After 6 more months, prominent bilateral hilar lymphadenopathy and highly elevated serum angiotensin-converting enzyme confirmed the diagnosis of pulmonary sarcoidosis. Such a course is quite rare in that it goes the opposite way of the conventional staging system.
    No preview · Article · Feb 2006 · Internal Medicine
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    ABSTRACT: We propose (-deltaG(rs)/deltat)/G(rs) obtained from Astograph as an index of dynamic property of the airway. G(rs) represents respiratory conductance. Fluid mechanics suggests that (- deltaG(aw)/deltat)/G(aw) is related to a coefficient of airway contraction or dilatation. G(aw) represents airway conductance. R(rs) (=1/G(rs)) is approximately equal to R(aw) (=1/G(aw)) + Constant. R(rs) and R(aw) represent respiratory and airway resistance, respectively. As R(rs) is thought to be closely correlated to R(aw), G(rs) should be correlated to G(aw). Thus, if G(rs) is used as a substitute for G(aw), (-deltaG(rs)/deltat)/G(rs) should also be related to a coefficient of airway contraction or dilatation. We found that asthmatics had significantly higher (-deltaG(rs)/deltat)/G(rs) than normal subjects. That is, the airway smooth muscles of the asthmatics are more contractive than those of normal subjects.
    No preview · Article · Feb 2006 · [Hokkaido igaku zasshi] The Hokkaido journal of medical science
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    ABSTRACT: To assess the role of contrast-enhanced dynamic CT in the diagnosis of active tuberculoma. Hospitals with an isolated ward for tuberculosis. Fifty-five subjects with newly diagnosed active tuberculoma and 24 subjects with inactive tuberculoma were examined and evaluated retrospectively. Six subjects with active tuberculomas and seven subjects with inactive tuberculomas were confirmed by histologic and microbiologic evaluation of resected specimens, whereas the remainder of the subjects with tuberculoma were confirmed clinically. The subjects were receiving iopamidol, 370 mg/mL IV, at a rate of 3.0 mL/s on contrast-enhanced dynamic CT. The time-attenuation curve was obtained and adapted to a gamma function. The peak height (PH), maximum attenuation subtracted by the background attenuation, relative flow (RF), and mean regional flow were used for comparison. Measurements and results: In the surgically confirmed group, the PH and RF values of six subjects with active tuberculomas were significantly higher than those of the seven subjects with inactive tuberculoma (p < 0.05). Similarly, in the subjects with noninvasive diagnoses, the PH and RF values of 49 subjects with active tuberculoma were significantly higher than those of the subjects with inactive tuberculoma (mean +/- SD PH, 43.4 +/- 4.1 Hounsfield units [HU] vs 11.6 +/- 2.7 HU, p < 0.0001; RF, 0.012 +/- 0.001/s vs 0.006 +/- 0.001/s, p < 0.05). When the cutoff value was defined as mean +/- 2 SD, the sensitivity and specificity of the diagnosis for active tuberculoma were 77.1% and 96.4% in PH, and 68.5% and 88.8% in RF, respectively. Contrast-enhanced dynamic CT is a potentially valuable tool for the diagnosis of active tuberculoma.
    No preview · Article · Oct 2002 · Chest
  • Y Naya · M Ohe · M Fujino · Y Akiyama · T Kirisawa · Y Kawakami
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    ABSTRACT: A 60-year-old woman was admitted for evaluation of an abnormal shadow in her chest X-ray. A chest roentgenogram revealed middle lobe atelectasis and a tomogram showed masses mainly in the right intermediate bronchus. In bronchoscopy, the bronchus was severely narrowed by irregularly surfaced masses. Microscopic examinations of transbronchial biopsy specimen showed the mucosal and submucosal tissue diffusedly infiltrated mainly by lymphocytes composed of small lymphocytes, centrocyte-like cells and monocytoid cells. The B-cell origin was suggested by a positive L-26 stain. Monoclonality of lymphocytes was proven by Southern blot analysis and in situ hybridization. The diagnosis was primary endobronchial lymphoma of mucosa-associated lymphoid tissue. The case was treated with chemotherapy protocol (CAMBO-VIP) and has been in complete remission for 20 months.
    No preview · Article · Dec 1997 · Nihon Kyōbu Shikkan Gakkai zasshi
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    ABSTRACT: The purpose of this study is to examine the relationship between breathlessness and the ventilatory response to hypercapnia or hypoxia in patients with chronic obstructive pulmonary disease (COPD). Fifteen male patients (mean forced expiratory volume in one second (FEV1): 1.13 L) underwent tests to determine hyperoxic hypercapnic ventilatory response (HCVR) and isocapnic hypoxic ventilatory response (HVR) with simultaneous quantification of breathlessness by modified Borg scale. The ventilatory output was evaluated by the ratio of minute ventilation (V'E) divided by measured maximal voluntary ventilation (MVV). The magnitude of HCVR or HVR was assessed as the slope value of the V'E/MVV-end-tidal carbon dioxide pressure (PET,CO2) or arterial oxygen saturation (Sa,O2) regression line, respectively. The breathlessness during the tests was evaluated not only linearly in relation to V'E/MVV, but also at given levels of PET,CO2 or Sa,O2. The mean value of the breathlessness at two different levels of ventilation was greater during HVR than during HCVR, suggesting that hypoxia is dyspnogenic independently of ventilatory stimulation. The HCVR was inversely correlated with the breathlessness response to ventilation, while similar correlation was partly present for HVR. The HVR was positively correlated with the breathlessness at an Sa,O2 of 80%, whilst there was no such correlation between the HCVR and the breathlessness related to PET,CO2. Therefore, patients with a higher breathlessness related to increased ventilation had a lower HCVR and HVR, whilst those with a higher breathlessness with desaturation, which might include a direct influence of hypoxia, had a higher HVR. These findings suggest an interaction between ventilatory response and breathlessness during the test, which may partly include behavioural modulation of HCVR and HVR through the breathlessness in various ways, depending on the origin and nature of the sensation.
    Full-text · Article · Dec 1996 · European Respiratory Journal
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    ABSTRACT: We examined effects of selective M1 antagonists on hypercapnic and hypoxic ventilatory responses in 17 healthy human volunteers. Subjects were intravenously treated with placebo, pirenzepine (10 mg) and biperiden lactate (4 mg) on three separate days in a randomized double-blind design. Ventilatory responses to hyperoxic progressive hypercapnia and isocapnic progressive hypoxia were studied after the drug administration. There were no statistically significant differences in the mean ΔV̇e/ΔPetCO2 or ΔV̇e/ΔSaO2 among the three treatments. However, the ΔV̇e/ΔPetCO2 with placebo negatively correlated with the difference in ΔV̇e/ΔPetCO2 between the biperiden and placebo studies (r = −0.65, P < 0.01), but not with that between the pirenzepine and placebo studies. On the other hand, the V̇e/ΔSaO2 with placebo negatively correlated with the difference in V̇e/ΔSaO2 between the pirenzepine and placebo studies (r = −0.79, P < 0.001), but not with that between the biperiden and placebo studies. These data suggest the possible involvement of M1 cholinergic receptors in the central CO2 and peripheral O2 sensing mechanisms in humans, although the degree of its involvement is not consistent among subjects. These findings may explain the interindividual variation in the control of breathing in humans.
    No preview · Article · Feb 1996 · Respiration Physiology
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    ABSTRACT: To examine the role of endogenous adenosine on the hypoxic ventilatory response (HVR) enhanced during exercise, we measured HVR at rest and during mild exercise (12.5 W) in nine healthy men in a supine position after pretreatment with aminophylline (5 mg/kg), an adenosine receptor blocker, or dipyridamole (0.6 mg/kg), an adenosine uptake blocker, by using a 3-day double-blind placebo-controlled design. Although HVR was enhanced during exercise on all occasions, HVR with aminophylline [0.42 +/- 0.07 (SE) l.min-1.%fall-1 of arterial O2 saturation] was significantly lower than that with placebo (0.64 +/- 0.13 l.min-1.%fall-1) or dipyridamole (0.64 +/- 0.08 l.min-1.%fall-1) during exercise (P < 0.05 for both) at similar end-tidal PCO2 on the 3 days but not at rest. We then examined the changes in plasma K+ concentration ([K+]) and catecholamines, the other possible endogenous potentiators of the carotid body activity. The exercise- and hypoxia-induced increases in plasma [K+] were significantly lower with aminophylline (0.23 +/- 0.09 meq/l) than with the placebo (0.51 +/- 0.10 meq/l) or dypyridamole (0.58 +/- 0.13 meq/l) (P < 0.05 for both). We therefore conclude that aminophylline attenuates the enhancement of HVR during mild exercise and that this might be due to its attenuating effect on exercise- and hypoxia-associated increases in plasma [K+] rather than due to its antagonizing effect on endogenous adenosine.
    No preview · Article · Oct 1994 · Journal of Applied Physiology
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    ABSTRACT: The purpose of this study is to examine the relationship between mechanical factors and the load compensation during hypercapnia in emphysema. In 36 clinically stable patients, we conducted pulmonary function tests and hypercapnic ventilatory response (HCVR) tests with and without inspiratory flow-resistive loading (IRL) (17 cm H2O/L/s). The mean value of HCVR significantly decreased with IRL, while that of the mouth occlusion pressure (P0.1) response increased. Regardless of IRL, the HCVR values were correlated with FEV1/FVC and airway resistance. The load compensation, evaluated by the ratio of the HCVR value and the P0.1 response before and after IRL, was inversely correlated with percent FRC (r = -0.38, r = -0.39; both p < 0.05). Breathing pattern analysis at the end-tidal pressure of carbon dioxide of 55 mm Hg elicited the decrease of (tidal volume/inspiratory time (VT/TI) and the increase of TI and TI/TTOT. Although the absolute changes of VT and f were inconsistent among subjects, each relative ratio before and after IRL was correlated again with percent FRC (r = -0.46, r = 0.44: both p < 0.01). Therefore, the position of the inspiratory muscles at the onset of inspiration may influence the load compensation during hypercapnia in emphysema.
    Full-text · Article · May 1994 · Chest
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    ABSTRACT: To examine the role of endogenous adenosine in hypoxic ventilatory response, we measured, in nine normal young adults, ventilatory responses to isocapnic progressive hypoxia and subsequent sustained hypoxia [arterial O2 saturation (SaO2); 80%, 20 min] with and without pretreatment with dipyridamole in a double-blind crossover fashion. Dipyridamole, an adenosine uptake blocker, was expected to enhance the effect of endogenous adenosine. Pretreatment with dipyridamole (0.5 mg/kg) significantly augmented the slope of the ventilatory response to isocapnic progressive hypoxia from 0.35 +/- 0.13 (SE) to 0.70 +/- 0.25 l.min-1.%fall of SaO2(-1) (P < 0.01), although there were no significant changes in resting ventilation. On the other hand, minute ventilation, when expressed as a percentage of peak ventilation, declined to 68.4 +/- 4.3% with dipyridamole at the 9-11th min of sustained hypoxia, which was significantly lower than the 90.2 +/- 8.3% with a placebo (P < 0.05), and finally reached 56.1 +/- 7.2% with dipyridamole and 78.7 +/- 9.2% with the placebo (P < 0.1) at the 18-20th min of sustained hypoxia. In an attempt to more specifically examine the role of adenosine, aminophylline (5 mg/kg), an adenosine receptor antagonist, was injected before pretreatment with dipyridamole in four subjects. Aminophylline infusion abolished or at least attenuated the effect of dipyridamole in all four subjects. These data suggest that endogenous adenosine has a modulatory role in hypoxic ventilatory response in adult humans.
    No preview · Article · Feb 1994 · Journal of Applied Physiology

Publication Stats

380 Citations
133.15 Total Impact Points

Institutions

  • 2012
    • Fukujuji Hospital
      Edo, Tōkyō, Japan
  • 2006-2008
    • Social Insurance Chukyo Hospital
      Nagoya, Aichi, Japan
  • 1989-1996
    • Hokkaido University
      • Department of Medicine II
      Sapporo, Hokkaidō, Japan