1.Changes in prescription of antibiotics based on Gram stains in an otorhinolaryngology outpatient clinic : A pilot study
Masako Maeda ; Toshihiko Maeda ; Kana Matsumoto ; Kunihiko Morita
An Official Journal of the Japan Primary Care Association 2015;38(4):335-339
Purpose : This preliminary study was aimed to investigate potentially beneficial changes in prescription of antibiotics by use of Gram staining in an otorhinolaryngology outpatient clinic.
Methods : This study was done in a single clinic. Changes in the type and amount of antibiotics prescribed, in addition to the clinical outcomes prior to and following introduction of Gram staining, were analyzed retrospectively.
Results : Following introduction of Gram staining in 2005, the costs for antibiotics per person per year decreased to about one-fifth. The number of prescriptions per 100 patients decreased from 20.9 in 2006 to 3.6 in 2012 for macrolides, from 7.9 in 2005 to 2.4 in 2012 for third-generation cephalosporins, and increased from 1.6 in 2004 to 3.9 in 2012 for penicillins. In addition, for every 50 pediatric cases of acute sinusitis, the number of patients to whom no antibiotics were prescribed increased 9-fold and the number of patients to whom 2 or more types of antibiotics were prescribed decreased from 26 to 9 cases, while the mean period in days until resolution was shortened by 6 days.
Conclusion : The results of this pilot study suggest that the use of Gram staining for diagnosis and prescription of antibiotics in an otorhinolaryngology outpatient clinic may lead to significantly improved antibiotic prescription practices. Further study through proper controlled studies are felt to be neceesary.
2.Clinical Comparison of a New Non-Sealed Woven Dacron Graft and Sealed Woven Dacron Grafts
Takuma Satsu ; Takehiro Inoue ; Takako Nishino ; Kousuke Fujii ; Junko Okamoto ; Ken Okamoto ; Terufumi Matsumoto ; Susumu Nakamoto ; Hitoshi Kitayama ; Toshihiko Saga
Japanese Journal of Cardiovascular Surgery 2006;35(6):319-323
The UBE woven 150cc WYK graft is a non-sealed graft that became available commercially in January 2005, and does not need to be preclotted before implantation. Subjects in this study comprised 50 patients with abdominal aortic aneurysms or common iliac arterial aneurysms, who received prosthetic Y grafts in our institution. Subjects were divided into 2 groups: the U group (n=26), with implantation of the UBE graft, and the I group (n=24) who received implantation of an INTERGARDTM woven Y graft. Intraoperative bleeding, inflammatory response and duration of postoperative hospitalization were evaluated in each group. Significant differences were noted between C-reactive protein levels, frequency of recurrence of fever and duration of postoperative hospitalization. No differences were noted between intraoperative bleeding and time. The UBE woven 150cc WYK graft, compared with the INTERGARDTM woven Y graft, required no extra time for implantation and appeared to offer advantages such reduced immunoreaction after surgery. However, follow-up for sufficient late-phase evaluation of the grafts is required.
3.Retrospective Study of Surgical Gastrojejunostomy versus Gastroduodenal Stenting for Malignant Gastroduodenal Obstruction
Toshihiko Matsumoto ; Kaori Hino ; Hiroyuki Terasawa ; Akio Nakasya ; Kazuhiro Uesugi ; Norifumi Nishide ; Takeshi Kajiwara ; Akinori Asagi ; Tomohiro Nishina ; Junichirou Nasu ; Shinichiro Hori ; Seijin Nadano ; Hiroshi Ishii
Palliative Care Research 2016;11(2):166-173
Background: We retrospectively compared endscopic gastroduodenal stenting with gastrojejunostomy as a means of palliating malignant gastric and duodenal obstruction. Methods: This retrospective study investigated patients treated for malignant gastric and duodenal obstruction from April 2011 to April 2015 at Shikoku Cancer Center. Results: Of the 40 patients in this study, 25 underwent gastroduodenal stenting and 15 had operative gastrojejunostomy. Comparing the stenting and operative patients, technical success rate was 100% in both group, clinical success rate was 84% in stenting patients and 93% in operative patients. The median time to fluid intake was significantly shorter in stenting patients than operative patients(0 day vs 2 days, p=0.0003), and the median time to intake of solids was also significantly shorter in stenting patients(1day vs 3 days, p<0.0001).The median hospital stay was significantly shorter in stenting patients(9 days vs 23 days, p=0.0116). Median cost of hospitalization is more expensive in operative patients than stenting patients(¥1,106,170 vs ¥752,290, p=0.0052). Conclusion: Our study suggested that gastoroduodenal stent was less length of time to fluid/solid intake, and less costly than gastrojejunostomy.
4.Genetic Polymorphisms in Dopamine- and Serotonin-Related Genes and Treatment Responses to Risperidone and Perospirone.
Atsushi TSUTSUMI ; Tetsufumi KANAZAWA ; Hiroki KIKUYAMA ; Gaku OKUGAWA ; Hiroyuki UENISHI ; Toshio MIYAMOTO ; Naoki MATSUMOTO ; Jun KOH ; Kazuhiro SHINOSAKI ; Toshifumi KISHIMOTO ; Hiroshi YONEDA ; Toshihiko KINOSHITA
Psychiatry Investigation 2009;6(3):222-225
We investigated the possible association between genetic polymorphisms in the dopamine receptor and serotonin transporter genes and the responses of schizophrenic patients treated with either risperidone or perospirone. The subjects comprised 27 patients with schizophrenia who were clinically evaluated both before and after treatment. The genotyping of the polymorphisms of the dopamine D2 receptor gene (DRD2) (rs1801028 and rs6277), the dopamine D4 receptor gene (DRD4) (120-bp tandem repeats and rs1800955), and serotonin transporter gene (5HTT)(variable number of tandem repeats; VNTR) were performed using the real-time polymerase chain reaction and sequencing. In DRD2 and 5HTT-VNTR, there were no significant correlations between clinical response and polymorphism in the case of risperidone, and for perospirone treatment it was impossible to analyze the clinical evaluation due to the absence of genotype information. On the other hand, in DRD4 there were significant correlations in the two-factor interaction effect on the Positive and Negative Syndrome Scale (PANSS) between the two drugs [120-bp tandem repeat, p=0.003; rs1800955, p=0.043]. Although the small sample represents a serious limitation, these results suggest that variants in DRD4 are a predictor of whether treatment will be more effective with risperidone or with perospirone in individual patients.
Genotype
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Hand
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Humans
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Isoindoles
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Polymorphism, Genetic
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Real-Time Polymerase Chain Reaction
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Receptors, Dopamine
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Receptors, Dopamine D2
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Receptors, Dopamine D4
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Risperidone
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Schizophrenia
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Serotonin Plasma Membrane Transport Proteins
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Tandem Repeat Sequences
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Thiazoles
5.Rehabilitation in a Patient with POEMS Syndrome Following High-dose Chemotherapy with Autologous Peripheral Blood Stem Cell Transplantation
Emi MATSUMOTO ; Hiroshi YAMAMOTO ; Akiko MORI ; Toshiaki HAMANO ; Toshihiko EBISU
The Japanese Journal of Rehabilitation Medicine 2019;56(10):815-822
POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome is an extremely rare neurological disease exhibiting various symptoms. Few reports have investigated rehabilitation in this disease. The present study reported the details of rehabilitation in a 40-year-old man with POEMS syndrome. Abnormal sensation was initially observed in the distal legs, followed by deterioration of muscle strength. He was admitted to our hospital 2 months after onset and received high-dose chemotherapy with autologous peripheral blood stem cell transplantation for acute exacerbation of polyneuropathy. Electrophysiological examination revealed axonal neuropathy. Gradual improvement in muscle strength was observed after high-dose chemotherapy with autologous peripheral blood stem cell transplantation. He was able to walk with a knee-ankle-foot orthosis and crutches at the time of discharge, but he used a wheelchair for routine activities. He could ascend and descend stairs in his house with bottom shuffling. As it is difficult to predict the extent of ultimate improvement and timing of remission in this disease, it is important to devise a rehabilitation program from a long-term perspective and to aim at recovery of independence for daily living activities and social reintegration using supportive devices and compensatory methods.
6.Rehabilitation in a Patient with POEMS Syndrome Following High-dose Chemotherapy with Autologous Peripheral Blood Stem Cell Transplantation
Emi MATSUMOTO ; Hiroshi YAMAMOTO ; Akiko MORI ; Toshiaki HAMANO ; Toshihiko EBISU
The Japanese Journal of Rehabilitation Medicine 2019;():18022-
POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome is an extremely rare neurological disease exhibiting various symptoms. Few reports have investigated rehabilitation in this disease. The present study reported the details of rehabilitation in a 40-year-old man with POEMS syndrome. Abnormal sensation was initially observed in the distal legs, followed by deterioration of muscle strength. He was admitted to our hospital 2 months after onset and received high-dose chemotherapy with autologous peripheral blood stem cell transplantation for acute exacerbation of polyneuropathy. Electrophysiological examination revealed axonal neuropathy. Gradual improvement in muscle strength was observed after high-dose chemotherapy with autologous peripheral blood stem cell transplantation. He was able to walk with a knee-ankle-foot orthosis and crutches at the time of discharge, but he used a wheelchair for routine activities. He could ascend and descend stairs in his house with bottom shuffling. As it is difficult to predict the extent of ultimate improvement and timing of remission in this disease, it is important to devise a rehabilitation program from a long-term perspective and to aim at recovery of independence for daily living activities and social reintegration using supportive devices and compensatory methods.
7.Glycosylation engineering of therapeutic IgG antibodies: challenges for the safety, functionality and efficacy.
Yusuke MIMURA ; Toshihiko KATOH ; Radka SALDOVA ; Roisin O'FLAHERTY ; Tomonori IZUMI ; Yuka MIMURA-KIMURA ; Toshiaki UTSUNOMIYA ; Yoichi MIZUKAMI ; Kenji YAMAMOTO ; Tsuneo MATSUMOTO ; Pauline M RUDD
Protein & Cell 2018;9(1):47-62
Glycosylation of the Fc region of IgG has a profound impact on the safety and clinical efficacy of therapeutic antibodies. While the biantennary complex-type oligosaccharide attached to Asn297 of the Fc is essential for antibody effector functions, fucose and outer-arm sugars attached to the core heptasaccharide that generate structural heterogeneity (glycoforms) exhibit unique biological activities. Hence, efficient and quantitative glycan analysis techniques have been increasingly important for the development and quality control of therapeutic antibodies, and glycan profiles of the Fc are recognized as critical quality attributes. In the past decade our understanding of the influence of glycosylation on the structure/function of IgG-Fc has grown rapidly through X-ray crystallographic and nuclear magnetic resonance studies, which provides possibilities for the design of novel antibody therapeutics. Furthermore, the chemoenzymatic glycoengineering approach using endoglycosidase-based glycosynthases may facilitate the development of homogeneous IgG glycoforms with desirable functionality as next-generation therapeutic antibodies. Thus, the Fc glycans are fertile ground for the improvement of the safety, functionality, and efficacy of therapeutic IgG antibodies in the era of precision medicine.
Animals
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Antibodies, Monoclonal
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adverse effects
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pharmacokinetics
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therapeutic use
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Glycosylation
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Humans
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Immunoglobulin G
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chemistry
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metabolism
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Protein Engineering
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methods
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Receptors, Fc
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chemistry
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metabolism
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Treatment Outcome