Curriculum Vitaes
Profile Information
- Affiliation
- School of Medicine, Faculty of Medicine, Fujita Health University
- Degree
- 博士(医学）(名古屋大学)
- J-GLOBAL ID
- 201501014100305701
- researchmap Member ID
- 7000012806
Papers
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Frontiers in neurology, 9 528-528, 2018 Peer-reviewedBackground: The development of acute multiple embolic infarctions (AMEI) resulting from cancer is known as Trousseau's syndrome (TS). At present, however, there is no good marker for predicting the prognosis of TS patients. In the present study, we evaluated the use of serial D-dimer levels as a prognostic marker for TS. Methods: This retrospective cohort study included 1,409 consecutive acute ischemic stroke patients. We selected a group of patients with TS showing AMEI (n = 38; TS group) and a group of patients with atrial fibrillation (Af) and AMEI (n = 35; Af group) as controls. Serial D-dimer levels were measured between days 7 and 28 after stroke (sub-acute phase) in 21 patients of the TS group and 24 patients of the Af group. Results: D-dimer levels at onset (acute phase) were significantly higher in the TS group (8.45 ± 1.79 μg/mL, n = 38) compared with the Af group (1.14 ± 0.14 μg/mL, n = 35) (p < 0.0001). In patients for whom serial D-dimer measurements were made, D-dimer levels measured at the sub-acute phase decreased to 0.48 ± 0.12 μg/mL (n = 24) in the Af group, but remained elevated in the TS group during the sub-acute phase (11.20 ± 2.77 μg/mL, n = 21) (p < 0.0001). In all TS patients in whom serial D-dimer measurements were made, D-dimer levels in 17 patients who died within 500 days (13.31 ± 3.23 μg/mL) were significantly higher than those of the four surviving patients (2.23 ± 0.38 μg/mL) (cut-off D-dimer level = 3.0 μg/mL) during this period. Moreover, serial D-dimer levels of 10 patients who died within 90 days (17.78 ± 4.60 μg/mL) were significantly higher than those of the 11 patients who survived up to 90 days (5.21 ± 2.12 μg/mL) (p < 0.05). Conclusions: Serial D-dimer levels may be a good biomarker for TS as well as a useful predictor of the prognosis of TS patients.
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JOURNAL OF THE NEUROLOGICAL SCIENCES, 377 174-178, Jun, 2017 Peer-reviewedBackground: Although single-photon emission computerized tomography of the dopamine transporter (DATSPECT) is useful for diagnosing parkinsonian syndrome, its applicability toward the early phase of Parkinson's disease remains unknown. Methods: We enrolled 32 patients showing parkinsonism with normal cardiac I-123-metaiodobenzylguanidine (MIBG) uptake and abnormal DAT-SPECT findings among 84 consecutive patients with parkinsonism. We divided these patients into two groups (group 1: Parkinson's disease, group 2: corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy), and compared their clinical characteristics, specific binding ratios, and striatal asymmetry indexes on DAT-SPECT examinations. Results: The striatal asymmetry indexes were significantly lower in group 1 than in group 2 (p < 0.05), but there were no differences in the specific binding ratios between the two groups. Conclusion: The combined use of striatal asymmetry index on DAT-SPEC' and cardiac MIBG scintigraphy might offer useful clues for the differential diagnosis of the early phase Parkinson's disease from other parkinsonian syndromes. (C) 2017 Elsevier B.V. All rights reserved.
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MUSCLE & NERVE, 55(4) 483-489, Apr, 2017 Peer-reviewedIntroduction: To visualize peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy (CIDP), we used MR imaging. We also quantified the volumes of the brachial and lumbar plexus and their nerve roots. Methods: Thirteen patients with CIDP and 12 healthy volunteers were enrolled. Whole- body MR neurography based on diffusionweighted whole- body imaging with background body signal suppression ( DWIBS) was performed. Peripheral nerve volumes were calculated from serial axial MR images. Results: The peripheral nervous system was visualized with 3-dimensional reconstruction. Volumes ranged from 8.7 to 49.5 cm(3)/m(2) in the brachial plexus and nerve roots and from 10.2 to 53.5 cm(3)/m(2) in the lumbar plexus and nerve roots. Patients with CIDP had significantly larger volumes than controls ( P < 0.05), and volume was positively correlated with disease duration. Conclusions: MR neurography and the measurement of peripheral nerve volume are useful for diagnosing and assessing CIDP.
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JOURNAL OF THE NEUROLOGICAL SCIENCES, 368 344-348, Sep, 2016 Peer-reviewedObjective: Acute multifocal embolic infarction (AMEI) is conventionally caused by etiologies such as cardioembolism due to atrial fibrillation (AO, but can also be caused by serious underlying diseases such as cancer. We characterized cancer-related AMEI and identified useful indicators for cancer-associated strokes. Methods: A retrospective analysis was performed on 35 patients with Af-related AMEI and 35 patients with cancer -related AMEI selected from 1235 consecutive patients with acute infarcts. All patients received diffusion weighted magnetic resonance (MR) imaging. Cerebral MR angiography, carotid and cardiac ultrasonography, electrocardiogram-monitoring and whole body computed tomography were also performed on these patients. D-dimer levels were evaluated on admission, and were measured during the sub-acute phase in 19 of the patients with Af and 27 of the patients with cancer. Results: Acute phase D-dimer levels were significantly higher in patients with cancer than in patients with Af alone. The cut-off D-dimer value to identify cancer-associated infarcts was 2.0 mu g/mL. D-dimer levels during the sub-acute phase remained elevated in the cancer patients. Conclusions: We may differentiate cancer-associated AMEI from Af using a D-dimer level >= 2.0 mu g/mL, which does not decrease during the sub-acute phase. (C) 2016 Elsevier B.V. All rights reserved.
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Neurol Clin Neurosci, 4(1) 31-33, 2016 Peer-reviewedA 47-year-old man with a subdural abscess was initially diagnosed with endogenous depression at another hospital. He presented with a chronic illness, but without any typical symptoms, such as headache and fever. Antidepressants were ineffective and brain magnetic resonance imaging showed areas of abnormal high-signal intensity along the surface of the bilateral frontoparietal lobes. We diagnosed him with a subdural abscess based on magnetic resonance imaging and cerebrospinal fluid findings, which was successfully managed with antibiotic treatment alone. This case highlights the possibility that depressive state can be an initial symptom of a subdural abscess.
Misc.
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臨床神経学, 51(4) 243-247, Apr, 2011 Peer-reviewed肥厚性硬膜炎の自験例3症例と、文献例66症例の臨床的特徴と治療反応性を検討した。症状は頭痛が最多で、脳神経障害は視神経、動眼・滑車・外転神経障害の割合が高い。検査所見はCRPあるいは赤沈の上昇例が約95%と高率である。治療法はステロイド使用例が多い。初回平均投与prednisolone(PSL)量は42.7mg/day、平均維持量はPSL12.4mg/dayであった。再発率は初回ステロイド治療が奏効した例でも43%と高率であった。自己免疫異常を背景とすると考えられる肥厚性硬膜炎では、疾病初期の症状コントロールの難しい症例、治療開始15ヵ月以内に炎症反応の再上昇する症例、PSL20mg/day未満での再発が多いことに注意して、PSLの減量はきわめてゆっくり長時間をかけておこなうことが重要と考えられた。(著者抄録)
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EUROPEAN NEUROLOGY, 65(3) 138-143, 2011 Peer-reviewedBackground: The data on cerebrospinal fluid (CSF) levels of neurotrophins (NTs) in patients with meningoencephalitis are scarce, especially in adult patients. Methods: We measured CSF levels of NTs such as nerve growth factor (NGF), brain-derived neurotrophic factor, and neurotrophin-3 (NT-3) in adult patients with various meningitis (n = 10) and encephalitis (n = 10) in both acute phase and recovery phase and adult control subjects (n = 21) by the enzyme-linked immunosorbent assay for NTs. Results: Data show that NGF and NT-3 CSF levels were markedly elevated in the patient group in the acute phase compared with non-neurological controls (p < 0.001 and p < 0.05, respectively) and later returned to the levels of controls. Most intriguingly, we only recognized a significant correlation between NGF and NT-3 CSF levels in the patients in the acute phase. Conclusion: Such strong correlation of NGF and NT-3 CSF levels strongly suggests that in adult patients, some common regulatory mechanism(s) might be present among various kinds of NTs to cope with central nervous system infection. Copyright (C) 2011 S. Karger AG, Basel
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INTERNAL MEDICINE, 50(8) 915-918, 2011 Peer-reviewedA 26-year-old man was admitted to our hospital because of high fever, drowsiness, memory disturbance, and disorientation due to H1N1 influenza virus-associated encephalitis/encephalopathy. All of his symptoms rapidly improved following methylprednisolone pulse therapy. The diffusion-weighted image of brain magnetic resonance imaging (MRI) revealed a large transient hyperintense signal lesion on the central splenium of the corpus callosum. This MRI finding in conjunction with a complete clinical recovery has been previously observed in cases of clinically mild seasonal influenza-associated encephalitis/encephalopathy, and can be also a useful clue for the diagnosis of new type of influenza, H1N1 influenza virus infection complicated by encephalitis/encephalopathy.
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BLOOD PURIFICATION, 32(1) 57-62, 2011 Peer-reviewedBackground/Aims: Rapid removal of plasma amyloid-beta (A beta) by blood purification may serve as a peripheral A beta sink from the brain for Alzheimer's disease therapy. We investigated the reduction of plasma A beta during hemodialysis and cognitive states. Methods: A beta concentrations and Mini-Mental State Examinations (MMSE) were investigated in 37 hemodialysis patients (68.9 +/- 4.1 years). Results: The dialyzers effectively removed A beta(1-40) and A beta(1-42), 63.9 +/- 14.4 and 51.6 +/- 17.0% at 4 h dialysis, resulting in the reduction of A beta s in whole-body circulation by 51.1 +/- 8.9 and 32.7 +/- 12.0%, respectively. Although the plasma A beta s before dialysis (750.8 +/- 171.3 pg/ml for A beta(1-40)) were higher than those reported for Alzheimer's disease patients, the cognitive states of hemodialysis patients were relatively normal, especially of longer dialysis vintages. Conclusions: Dialyzers effectively reduced A beta s in whole-body circulation. Repeated rapid decrease of plasma A beta s might maintain cognitive state. Copyright (C) 2011 S. Karger AG, Basel
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MOLECULAR AND CELLULAR NEUROSCIENCE, 45(4) 355-362, Dec, 2010 Peer-reviewedPrevious studies have shown that patients with the axonal form of Guillain-Barre syndrome (CBS) develop autoantibodies against GM1 ganglioside (GM1) Nerve growth factor (NGF) is essential for neuronal survival in vivo and its functional receptor is Trk-tyrosine kinase Here we examined the biological effects of sera from patients with the axonal form of GBS on the morphology and the phosphorylation state of Trk-tyrosine kinase in PC12 cells Furthermore we examined the effect of the sera on the integrity of membrane lipid rafts biochemically The data show that anti GM1 antibodies found in patients sera but not control sera inhibit NGF-induced Trk autophosphorylation Most intriguingly the autoantibodies alter the distribution of Trk in lipid rafts without shifting the distribution of a rafts marker protein These data strongly suggest that anti GM1 antibodies directly influence the integrity of the signaling platform lipid rafts implicating the importance of lipid rafts in the development of this disorder (C) 2010 Elsevier Inc All rights reserved
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MOLECULAR AND CELLULAR NEUROSCIENCE, 45(3) 226-233, Nov, 2010 Peer-reviewedExpression of brain-derived neurotrophic factor (BDNF) was stimulated in human neuroblastoma SH-SY5Y cells by a nonprotein extract of inflamed rabbit skin inoculated with vaccinia virus (Neurotropin (R)), an analgesic widely used in Japan for treatment of disorders associated with chronic pain, with the optimal dosage at 10 mNU/mL This stimulation was accompanied by activations of p42/44 MAP kinase, CREB and c-Fos expression. Inhibitors of MAP kinases or PI 3-kinase prevented the stimulatory action of Neurotropin, indicating that neuronal TrkB/CREB pathway mediates the action. Repetitive oral administration of Neurotropin (200 NU/kg/day, 3 months) prevented the age-dependent decline in hippocampal BDNF expression in Ts65Dn mice, a model of Down's syndrome. This effect was associated with the improvement of spatial cognition of the mice. These results open an intriguing new strategy in which Neurotropin may prove beneficial treatment for neurodegenerative disorders. (C) 2010 Elsevier Inc. All rights reserved.
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JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 18(1) 60-67, Jan, 2009 Peer-reviewedObjective: This study was performed to analyze the locomotion outcome of hemiplegic patients with stroke and to explore the factors influencing it. Methods: A total of 247 patients (mean age 65.6 +/- 10.5 years) admitted to our hospital for rehabilitation were included in the study. Their cardinal neurologic sign was hemiplegia caused by infarction in the middle cerebral artery as a result of a first stroke. When rehabilitation programs were completed, the final motor outcome was evaluated and compared between patients with right and left hemispheric infarct. In addition, the following items were analyzed: size, location, and subtype of the infarct; hemispatial neglect and aphasia; cerebral blood flow (CBF); and periventricular lucency on computed tomography scan. Results: (1) There was a negative relationship between the infarct size and the locomotion outcome. The difference in locomotion outcome was not significant between the patients with infarction of the perforating arteries and those of the cortical arteries. No significant difference in the locomotion outcome was found between the patients with an atherothrombotic or cardioembolic infarction. (2) In spite of the existence of hemispatial neglect or aphasia, the patients with a right-sided infarction were significantly inferior to patients with a left-sided one in locomotion outcome, except for those with a large infarction. (3) In patients with infarction in the territory of the perforating arteries, there was a negative relationship between the area of decreased CBF or periventricular lucency and the locomotion outcome. When the area of decreased CBF on the homolateral hemisphere involving the infarction extended to less than or equal to two cerebral lobes, the locomotion outcome was significantly worse in the patients with a right-sided infarction. Conclusions: Overall, for the patients with middle cerebral artery infarction, the locomotion Outcome was poorer in patients with a right hemispheric infarction than a left-sided one, except in the case of a large infarction.
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医療, 62(4) 236-239, Apr, 2008入院患者の半数以上が経管栄養を行っている神経難病病棟において、簡易懸濁法を導入し、その前後で与薬業務の変化および看護師の与薬に関する意識調査を検討した。錠剤の一包化調剤により薬袋数が減少し、1週間分の与薬セットに要する時間は平均で5時間から3時間45分へ減少し、各勤務帯での確認から与薬までの時間は平均最大33分から23分へと時間が短縮された。また看護師に対する意識調査では、9割以上が「1週間分の与薬セットに要する時間が簡易懸濁法導入後短縮された」、7割以上が「薬剤が確認しやすくなった」、9割近くが「簡易懸濁法を導入してよかった」と回答していた。簡易懸濁法導入により安全に与薬することが可能となり、与薬に関する看護業務改善につながった。(著者抄録)
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医療, 61(1) 52-56, Jan, 2007神経難病患者は病気の進行にともなって日常生活動作が低下し、多くは介護に人手を要するようになる。そのため、病状の安定している入院患者とその家族に対して在宅療養を提案しても、それを躊躇してしまうケースが多い。しかし、在宅療養の現場では重度障害の神経難病患者を在宅で介護している症例が多数あるのも事実である。そこで、在宅療養を勧めていくにあたり私たち自身が難病患者とその家族の生活の実態を把握する必要があると考え、入院から在宅療養に移行した患者とその介護者を対象にアンケート調査した。結果、実際に在宅療養するまでは不安な介護者がほとんどであるが、患者が喜ぶ姿を原動力にして在宅療養を継続している介護者が多かった。一方、気管切開または胃瘻造設している患者は、デイケアサービスやショートステイに受け入れてもらえないという問題点が明らかとなった。介護負担が大きいにもかかわらずサービスの利用制限があり、介護者は介護から解放されストレスを軽減する機会がない。したがって、長期にわたる介護が必要な神経難病患者介護者の負担を軽減し支援するためには、介護保険のみに頼るのではなく、レスパイト入院を取り入れ、問題発生時には緊急入院できる体制を整える必要がある。(著者抄録)