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41.
Manabu Fujimoto Jun Asai Yoshihide Asano Takayuki Ishii Yohei Iwata Tamihiro Kawakami Masanari Kodera Masatoshi Abe Masahiro Amano Ryuta Ikegami Taiki Isei Zenzo Isogai Takaaki Ito Yuji Inoue Ryokichi Irisawa Masaki Ohtsuka Yoichi Omoto Hiroshi Kato Takafumi Kadono Sakae Kaneko Hiroyuki Kanoh Masakazu Kawaguchi Ryuichi Kukino Takeshi Kono Monji Koga Keisuke Sakai Eiichi Sakurai Yasuko Sarayama Yoichi Shintani Miki Tanioka Hideaki Tanizaki Jun Tsujita Naotaka Doi Takeshi Nakanishi Akira Hashimoto Minoru Hasegawa Masahiro Hayashi Kuninori Hirosaki Hideki Fujita Hiroshi Fujiwara Takeo Maekawa Koma Matsuo Naoki Madokoro Sei-Ichiro Motegi Hiroshi Yatsushiro Osamu Yamasaki Yuichiro Yoshino Andres James LE Pavoux Takao Tachibana Hironobu Ihn Japanese Dermatological Association Guidelines 《The Journal of dermatology》2020,47(10):1071-1109
The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS. 相似文献
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44.
Takayoshi Komatsu-Fujii Yuko Chinuki Hiroyuki Niihara Kenji Hayashida Masataka Ohta Ryota Okazaki Sakae Kaneko Eishin Morita 《Allergology international》2018,67(1):90-95
Background
In severe drug eruptions, precise evaluation of disease severity at an early stage is needed to start appropriate treatment. It is not always easy to diagnose these conditions at their early stage. In addition, there are no reported prognostic biomarkers of disease severity in drug eruptions. The aim of this study was to test whether the thymus and activation-regulated chemokine (TARC) level in serum at an early stage of a drug eruption can serve as a prognostic biomarker of systemic inflammation.Methods
Study participants included 76 patients who received a diagnosis of a drug eruption, one of the following: drug rash with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome, maculopapular exanthema, and erythema multiforme. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) was eliminated in this study because scoring system for evaluating the severity was established. Correlation coefficients between serum TARC levels and indicators of systemic inflammation, including the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, modified systemic inflammatory response syndrome (mSIRS) score, and C-reactive protein in serum were evaluated.Results
Serum TARC levels positively correlated with the neutrophil-to-lymphocyte ratio, Glasgow prognostic score, mSIRS score, C-reactive protein, albumin, white blood cell count, body temperature, and pulse rate. TARC levels negatively correlated with systolic blood pressure. Among these parameters, the mSIRS score showed strong correlation (correlation coefficient: 0.68).Conclusions
Serum TARC levels correlate well with indicators of systemic inflammation and of disease severity among patients with a drug eruption except SJS/TEN. Serum TARC may be a prognostic biomarker of severity of inflammation in drug eruptions. 相似文献45.
Sakae Homma Eiki Takimoto Masateru Kawabata Kazuma Kishi Eiyasu Tsuboi Koji Narui Tatsuo Nakatani Yuko Inagawa Kazuhiro Tateda Keizo Yamaguchi Koichiro Nakata 《Journal of infection and chemotherapy》1998,4(4):214-218
A 77-year-old female was admitted because of high fever, cough and sputum. She had been receiving corticosteroid therapy for
4 years for multiple myeloma and was immunosuppressed. A physical examination on admission showed coarse crackles in the right
lower lung field, a chest radiograph showed consolidation in the right middle and lower lung fields, and a blood gas analysis
revealed marked hypoxemia. The patient was diagnosed as having refractory pneumonia associated with acute respiratory failure
and treated with intravenous cefmetazole followed by imipenem. On hospital day 5, erythromycin therapy was started because
of a poor response to the previous antibiotics. The patient became afebrile on the tenth day and was in good health on day
15. A sputum culture on day 4 revealed aLegionella organism on Wadowsky-Yee-Okuda medium, which was subsequently confirmed to beLegionella pneumophila by a DNA hybridization test. This strain was identified at the Centers for Disease Control (Atlanta, GA, USA) by slide agglutination
asL. pneumophila serogroup 9. Although our patient's symptoms are not apparently different from those caused by other serogroup strains ofL. pneumophila, this is the first recognized patient with culture-provenL. pneumophila serogroup 9 pneumonia in Japan. The clinical course of the disease and the diagnostic difficulties in identifying this type
of pneumonia are discussed. 相似文献
46.
Chinori Kurata Sakae Shouda Tadashi Mikami Yasushi Wakabayashi Tomoyasu Nakano Tsuyoshi Sugiyama Kei Tawarahara Kazuyuki Sakata 《Journal of nuclear cardiology》1997,4(6):515-523
Background [123I]Metaiodobenzylguanidine (MIBG) imaging has been used to assess cardiac sympathetic nerve abnormalities. We evaluated the
clinical significance of myocardial MIBG imaging as a measure of cardiac sympathetic nervous system function by comparing
it to heart rate variability and plasma norepinephrine level.
Methods and Results In 211 subjects, we analyzed heart rate variability with 24-hour electrocardiography, performed scintigraphy with MIBG, and
measured plasma norepinephrine levels. Time and frequency domain measures of heart rate variability were calculated with the
Marquette heart rate variability program (Marquette Electronics, Milwaukee, Wis.). Early and late myocardial MIBG uptakes
were measured at 15 and 150 minutes after injection, respectively. MIBG clearance rate from the heart and heart-to-lung and
heart-to-mediastinum ratios of MIBG activities were calculated. On the whole, heart rate variability, including low-frequency
power, correlated positively, but modestly so, with late MIBG uptake and negatively with MIBG clearance rate. The plasma norepinephrine
level correlated negatively with late MIBG uptake and with heart rate variability, including low-frequency power, and positively
with MIBG clearance rate. Similar correlations were also observed in patient subgroups with coronary artery disease, diabetes
mellitus, and renal failure, but these correlations were weak (R
2<0.5).
Conclusions Increased cardiac sympathetic nervous system activity may be associated with increased myocardial MIBG clearance and decreased
heart rate variability, including low-frequency power. Because these associations were not strong, however, the combination
of heart rate variability with MIBG may allow an interactive assessment of the cardiac autonomic nervous system. 相似文献
47.
Takeshi Oichi Hirotaka Chikuda Junichi Ohya Ryo Ohtomo Kojiro Morita Hiroki Matsui Kiyohide Fushimi Sakae Tanaka Hideo Yasunaga 《The spine journal》2017,17(4):531-537
Background Context
There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).Purpose
This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes.Study Design
This is a retrospective matched-pair cohort study.Patient Sample
Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.Outcome Measures
In-hospital mortality and occurrence of postoperative complications.Methods
For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data.Results
Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37–2.22; p<.001).Conclusions
Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication. 相似文献48.
32例国产人工髋关节翻修手术的临床体会 总被引:5,自引:3,他引:5
目的:探讨国产人工髋关节翻修原因。方法:回顾总结32例人工髋关节翻修中发现的问题,分析翻修原因。结果:32例中术前诊断松动16例,脱位4例,深部感染2例,白磨通3例,断柄2例,髋周及股部疼痛4例,股骨柄穿通皮质1例。26例取出假体顺利,6部部分骨长入珍珠面而取出假体困难。25例作全髋置换翻修,4例臼怀松动或位置不良致脱位仅翻修髋臼,1例股骨柄穿通皮质更换双动头,2例因深部感染严重而作单纯假体取出、清创术。全组病例经6个月-5年随访,Harris评分术前平均43分,术后平均81分,平均增加38分。结论:目前翻修病例仍以国产人工关节为主。翻修原因主要是:人工关节质量因素和手术技术因素。造成假体过早松动或种种其它并发症,最终失败。提示国产人工关节质量需改进,需相应配套器械,手术操作技术有待提高。 相似文献
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50.
Hiroki Yamaguchi Koiti Inokuchi Hideki Hanawa Sakae Tanosaki Isao Shinozawa Hiroki Matuoka & Kazuo Dan 《British journal of haematology》1999,105(3):764-767
We report a rare large B-cell non-Hodgkin's lymphoma having a characteristic near-triploid cell population with add(17)(p22) and t(14;18)(q32;q21) translocation. We also established and characterized a new cell line (TK cell) derived from the present lymphoma. A codon 180 mutation (GAG --> GAT) in the p53 gene was detected. t(14;18)(q32;q21) was revealed juxtaposition of the bcl-2 and JH genes. Immunoprecipitation analyses of p53 and bcl-2 revealed that abnormality of the p53 protein and aberrant bcl-2 expression, which may protect cells from apoptosis, may be critical to the development of leukaemogenesis exhibiting near-triploid chromosomes. 相似文献