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81.
Chikaraishi Yohei Arakaki Yoshikuni Koizumi Hideki 《International ophthalmology》2021,41(7):2485-2494
International Ophthalmology - To evaluate the temporary changes in visual outcomes and anterior segment parameters after cataract surgery plus low-add bifocal intraocular lens (IOL) implantation... 相似文献
82.
Jun Takahashi Hirokazu Kobayashi Shinji Wakabayashi Masao Deguchi Hidehiro Ito Yuji Mogami Hirotaka Tanikawa Hiroyuki Nakagawa Hideki Moriya Ryohei Ashizawa Kenji Takahara Hisatoshi Kinoshita Yutaka Tateiwa Hiromichi Misawa Takahiro Tsutsumimoto Taku Nakakohji Yohei Yuzawa Akihito Sawaumi Yohei Hidai Satoshi Matsuda Isao Nakamura Shigeyuki Toba Mikio Kamimura Takeshi Nakane Hiroki Hirabayashi Hiroyuki Hashidate Nobuhide Ogihara Keijiro Mukaiyama Hiroyuki Kato Kuniyoshi Ohtsuka 《Journal of orthopaedic science》2013,18(2):208-215
Background
Quality of life (QOL) is a concern for patients with lumbar spinal stenosis (LSS). In this study, QOL was examined using the 5-item EuroQol (EQ-5D).Methods
QOL and activities of daily living (ADL) were surveyed for 91 patients who visited 18 medical institutions in our prefecture and were diagnosed with LSS-associated intermittent claudication. A second survey was performed after ≥6 weeks for 79 of the subjects to evaluate therapy with limaprost (an oral prostaglandin E1 derivative) or etodolac (an NSAID). Symptoms, maximum walking time, QOL, ADL items, and relationships among these variables were investigated for all 91 patients. Leg pain, leg numbness, and low back pain while walking were surveyed by use of VAS scores (0–100).Results
Leg pain, leg numbness, and low back pain while walking (VAS ≥25) were present in 83.5, 62.6, and 54.9 % of the patients in the first survey, and approximately half of the patients had a maximum walking time <15 min. The mean EQ-5D utility value for QOL was 0.59 ± 0.12. This value was significantly associated with maximum walking time (p = 0.030) based on classification of patients into groups with walking times <7.5, 7.5–15, 15–30, and >30 min, showing that maximum walking time affected health-related QOL. Of the 79 patients who completed the second survey, 56 had taken limaprost and 23 (control group) had received etodolac. Limaprost improved possible walking time, reduced ADL interference, and significantly increased the EQ-5D utility score, whereas no significant changes occurred in the control group. Maximum walking time was prolonged by ≥10 min and the EQ-5D utility value was improved by ≥0.1 points in significantly more patients in the limaprost group than in the control group.Conclusion
According to the findings of this survey, at an average of 8 weeks after administration limaprost improved symptoms, QOL, and ADL in LSS patients whereas treatment with an NSAID reduced pain but did not have any other effects. 相似文献83.
84.
Hiroshi Shinohara Kiyoshi Matsuo Yoshiroh Osada Tatsuya Kawamura Yohei Tanaka 《Journal of plastic surgery and hand surgery》2013,47(1):17-22
We have created a new way of reanimating the face, involving transposition of the masseter muscle combined with tensor fascia lata, and using the zygomatic arch as a trochlea to reconstruct the inferior facial paralysis. We used it on five patients who had facial palsy after excision of malignant parotid tumours. The wide skin defect that exposed the masseter muscle after total parotidectomy was reconstructed with a free flap. This method differs from those of other methods of transposing the masseter muscle in that force is applied at an upper lateral angle. Our method provided dynamic raising of the upper lip, the corner of the mouth, and the nasolabial fold in four patients. We consider it to be useful, particularly for prompt surgical reconstruction of facial palsy after total parotidectomy with a wide defect in the skin of the cheek. 相似文献
85.
86.
Kozaki Yohei Morinaga Takatoshi Fukatsu Atsushi Ito Takeshi Ishimoto Takuji Kosugi Tomoki Inaguma Daijo Tamai Hirofumi Maruyama Shoichi 《Clinical and experimental nephrology》2022,26(5):466-475
Clinical and Experimental Nephrology - A Dialysis Outcomes and Practice Patterns Study (DOPPS) has shown a one-to-one male-to-female mortality ratio, notwithstanding the statistically longer life... 相似文献
87.
Yohei Ozawa Takashi Kamei Toru Nakano Yusuke Taniyama Shigehito Miyagi Noriaki Ohuchi 《World journal of surgery》2016,40(7):1663-1671
Background
This study aimed to evaluate the recurrence rates, timings, locations, and risk factors, and survival in patients with lymph node-negative superficial esophageal squamous cell carcinomas (ESCCs).Methods
We investigated 167 patients with pathological T1 thoracic ESCC who underwent curative esophagectomy with lymphadenectomy between 1986 and 2013. They were classified into lymph node-negative and lymph node-positive groups, each of which included 15 relapsed patients. The recurrence rates, timings, locations, and risk factors, and survival were examined retrospectively.Results
Significantly better recurrence (12.4 %) and the 5-year overall survival (85.7 %) rates were seen in patients with node-negative superficial ESCC compared with those with node-positive superficial ESCC. Relapsed patients with node-negative superficial ESCC showed a 5-month delay in the time to recurrence compared with relapsed patients with node-positive superficial ESCC, but the recurrence locations were similar. Upper thoracic tumors and the presence of lymph node metastases were independent risk factors for recurrence in superficial ESCC patients, but we did not determine any risk factors in patients who were node negative only. The 5-year overall survival rates did not differ between relapsed node-negative and node-positive patients. Furthermore, the mean times to death and the survival rates from recurrence to death were similar in the node-negative (20.3 months and 9.3 %, respectively) and in the node-positive patients (19.1 months and 13.6 %, respectively) who had relapsed.Conclusions
Node-negative and node-positive superficial ESCC patients should be followed up similarly, because when recurrences occur, the prognoses and the times to death are similar in node-negative and node-positive superficial ESCC patients.88.
89.
Sakuma Y Matsukuma S Yoshihara M Nakamura Y Noda K Nakayama H Kameda Y Tsuchiya E Miyagi Y 《American journal of clinical pathology》2007,128(1):100-108
Although adenocarcinomas of the lung are associated with epidermal growth factor receptor (EGFR) gene mutations and sensitivity to EGFR tyrosine kinase inhibitors, it remains unclear whether bronchioloalveolar carcinoma (BAC) components and/or subtypes affect these associations. We aimed to clarify correlations between EGFR gene mutations and BAC components and to establish the histologic features as reliable predictors for the mutations. We examined 141 non-small cell lung cancers (NSCLCs), including 118 adenocarcinomas, for mutations in exons 19 and 21 of the EGFR gene together with mutations in codon 12 of the K-ras gene using loop-hybrid mobility shift assays, a highly sensitive polymerase chain reaction-based method. Adenocarcinomas were subdivided into subtypes with a nonmucinous or mucinous BAC component and those without BAC components. In NSCLCs, EGFR mutations were detected in 75 cases (53.2%) and were significantly associated with adenocarcinoma, female sex, and never smoking. Among adenocarcinomas, nonmucinous and mucinous BAC components were significantly associated with EGFR and K-ras gene mutations, respectively. Because EGFR mutations were detected even in most pure nonmucinous BACs, ie, lung adenocarcinoma in situ, EGFR mutation is considered a critical event in the pathogenesis of nonmucinous BAC tumors. 相似文献
90.
High prevalence of metallo-beta-lactamase and 16S rRNA methylase coproduction among imipenem-resistant Pseudomonas aeruginosa isolates in Brazil
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Doi Y Ghilardi AC Adams J de Oliveira Garcia D Paterson DL 《Antimicrobial agents and chemotherapy》2007,51(9):3388-3390
Rates of metallo-β-lactamase and 16S rRNA methylase production were investigated in 51 imipenem-resistant Pseudomonas aeruginosa clinical isolates collected from hospitals in São Paulo, Brazil. Of them, 57% and 75% produced SPM-1 and RmtD, respectively. Of note, 51% produced both enzymes, suggesting that their coproduction is already common in this geographic area.Treatment of infections due to Pseudomonas aeruginosa is becoming increasingly complicated by its tendency to acquire resistance to multiple classes of antimicrobials (12). The agents typically used to treat these infections include antipseudomonal penicillins, cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides. The production of metallo-β-lactamases (MBLs) contributes substantially to panresistant phenotypes in P. aeruginosa because they confer resistance to all classes of β-lactam antimicrobials except aztreonam (10). Various MBLs including IMP, VIM, SPM, and GIM types have been reported for P. aeruginosa (12). Of note, SPM-type MBLs have been found only in Brazil thus far (13).Methylation of 16S rRNA has emerged as a mechanism of high-level aminoglycoside resistance among gram-negative pathogens in recent years (3). Five such methylases, ArmA and RmtA through RmtD, have been reported to date. The most recently identified methylase is RmtD, which we reported previously for a panresistant P. aeruginosa strain isolated near São Paulo, Brazil (4). This enzyme confers high-level resistance to most aminoglycosides in clinical use. In this particular strain, the coproduction of RmtD and SPM-1 played a substantial role in the panresistant phenotype. The present study was conducted to determine the prevalence of coproduction of these enzymes among P. aeruginosa clinical isolates in Brazil.Nonrepetitive imipenem-resistant P. aeruginosa isolates from a total of 49 patients hospitalized at seven hospitals in the São Paulo area in 2005 and 2006 were collected. One patient had two isolates with different pulsed-field gel electrophoresis (PFGE) patterns, and another patient had two isolates with identical PFGE patterns but markedly different susceptibility patterns. Thus, 51 imipenem-resistant P. aeruginosa isolates were included in the study. Sites of the specimens were as follows: 28 from urine, 8 from blood, 7 secretions from various sites, 3 from cerebrospinal fluid, 2 from catheter tip, 1 from bronchoalveolar lavage fluid, 1 from ascitic fluid, and 1 from nasal swab.The MICs of imipenem, meropenem, aztreonam, amikacin, gentamicin, arbekacin, ciprofloxacin, and colistin were obtained using either the standard agar dilution method or Etest (AB Biodisk, Solna, Sweden) (2). The MICs of imipenem were 32 μg/ml or higher for all the isolates, verifying the high degree of resistance to this agent in this collection. For meropenem, MICs were 8 μg/ml or higher. When the phenotypic test using sodium mercaptoacetic acid was performed to detect MBL production (1), 29 of 51 isolates (57%) yielded a positive result.PFGE was performed with SpeI (New England Biolabs, Beverly, MA) as the restriction enzyme for the genomic DNA. Electrophoresis was performed with the CHEF III DR system (Bio-Rad, Hercules, CA). The pulses were increased linearly from 5.3 to 34.9 s for 24 h at 14°C. Seventeen pulsotypes were observed among the 51 isolates by PFGE. Eight of the pulsotypes comprising 32 isolates from six hospitals were possibly related to each other (“pulsotype A,” consisting of subtypes A1 through A8), whereas the other nine pulsotypes were unrelated (pulsotypes B through J) according to criteria described previously by Tenover et al. (Table (Table11 and Fig. Fig.1)1) (14). Pulsotype A was thus the most prevalent genotype in hospitals in this area.Open in a separate windowFIG. 1.PFGE patterns of the study isolates. The pulsotypes were aligned using Bionumerics software version 4.0 (Applied Maths, Sint-Martens-Latem, Belgium).
Open in a separate windowPCR was conducted to detect the MBL gene blaSPM (6) and the 16S rRNA methylase gene rmtD. PCR for blaIMP-1, blaIMP-2, and blaVIM-2 was performed for all the blaSPM-negative isolates (11). For rmtD, the following primers were used to produce a 401-bp amplicon: rmtD-F (5′-CGGCACGCGATTGGGAAGC-3′) and rmtD-R (5′-CGGAAACGATGCGACGAT-3′). The thermal cycle conditions included an initial denaturation step at 96°C for 5 min followed by 30 cycles at 96°C for 30 s, 55°C for 30 s, and 72°C for 1 min, with a final extension step at 72°C for 5 min. All the 29 isolates that produced a positive phenotypic test for MBL production yielded an amplicon consistent with blaSPM. When representative amplicons from different PFGE pulsotypes were sequenced, their deduced amino acid sequences matched that of SPM-1 within the amplicons (15). PCR results for blaIMP-1, blaIMP-2, and blaVIM-2 were all negative. These results suggested that SPM-1 is indeed the most predominant MBL among P. aeruginosa isolates in this geographic area. The median MIC of imipenem was greater than 256 μg/ml for blaSPM-positive isolates and 64 mg/ml for blaSPM-negative isolates (Table (Table2).2). For rmtD, 38 isolates (75%) yielded an amplicon. Deduced amino acid sequences of representative amplicons from different PFGE profiles were identical to that of RmtD within the amplicons. The MICs of arbekacin, amikacin, and gentamicin for the rmtD-positive isolates were always greater than 256 μg/ml. Of the 29 blaSPM-positive isolates, 26 were positive for rmtD as well. Thus, the prevalence of coproduction of SPM-1 and RmtD in this collection of imipenem-resistant P. aeruginosa isolates was 51% (26/51), and that among the SPM-1-producing isolates reached 90% (26/29). All of the blaSPM-positive isolates belonged to pulsotype A. Most of the rmtD-positive strains were also observed within pulsotype A, whereas some belonged to pulsotypes E, H, and J. These results suggest that the rmtD and blaSPM genes are spreading in São Paulo hospitals mostly by means of interhospital transmission of strains belonging to pulsotype A.
Open in a separate windowWhen the MICs of aminoglycosides were stratified according to the PCR results for rmtD, the sensitivities of arbekacin, amikacin, and gentamicin MICs greater than 256 μg/ml in predicting the presence of rmtD were all 100% (Table (Table3).3). On the other hand, the specificities of their MICs equal to or less than 256 μg/ml were 77%, 100%, and 54%, respectively. Therefore, amikacin was the best single agent to predict aminoglycoside resistance mediated by the production of RmtD. This result is in contrast with a previous finding with a collection of Acinetobacter sp. strains, where arbekacin displayed better specificity than amikacin (8). Although arbekacin generally retains better activity than amikacin in the presence of an aminoglycoside-modifying enzyme among gram-negative bacteria, this advantage may be lost when multiple modifying enzymes with different substrate specificities are produced simultaneously in a bacterium (5). Both agents are also known to be substrates of efflux pumps in P. aeruginosa (9). A combination of these resistance mechanisms may thus lead to high aminoglycoside MICs even in the absence of 16S rRNA methylase. The MICs of imipenem, meropenem, aztreonam, amikacin, ciprofloxacin, and colistin were then stratified depending on the PCR results for blaSPM (Table (Table2).2). Higher MICs of the carbapenems and lower MICs of aztreonam were observed in blaSPM-positive isolates, as expected, reflecting the substrate specificities of the MBL (10). High-level amikacin resistance was more frequent in blaSPM-positive isolates due to the frequent coproduction of RmtD. MICs of ciprofloxacin were variable regardless of the presence or absence of blaSPM. Some isolates with elevated colistin MICs (8 to 16 μg/ml) were observed in both groups, which differed from a previous study that reported 100% susceptibility to this agent for imipenem-resistant P. aeruginosa isolates in Brazil (6).
Open in a separate windowIn summary, our study demonstrates that the coproduction of SPM-1 and RmtD is a common phenomenon observed in half of the imipenem-resistant P. aeruginosa isolates in hospitals in São Paulo, Brazil. A recent nationwide surveillance study from Brazil reported that as many as 37% of P. aeruginosa isolates recovered in Brazilian hospitals were resistant to imipenem (7). Furthermore, it was also reported that MIC90s of amikacin, tobramycin, and gentamicin against P. aeruginosa were all greater than 256 μg/ml. Our findings, coupled with those surveillance data, suggest that high-level aminoglycoside resistance mediated by the production of 16S rRNA methylase may already be disseminated in Brazilian hospitals. 相似文献
TABLE 1.
Characteristics of study isolatesPulsotype and subtype | Total no. of isolates | Hospital(s) | No. of isolates (%)
| |
---|---|---|---|---|
blaSPM positive | rmtD positive | |||
A | 32 | b, c, d, e, f, g | 29 (91) | 29 (91) |
1 | 12 | b, c, e, f, g | 11 | 12 |
2 | 10 | b, d, g | 9 | 8 |
3 | 1 | g | 1 | 1 |
4 | 3 | b | 2 | 3 |
5 | 3 | b | 3 | 3 |
6 | 1 | b | 1 | 1 |
7 | 1 | b | 1 | 1 |
8 | 1 | b | 1 | 0 |
B | 1 | a | 0 (0) | 0 (0) |
C | 5 | b | 0 (0) | 0 (0) |
D | 1 | a | 0 (0) | 0 (0) |
E | 7 | b | 0 (0) | 7 (100) |
F | 1 | g | 0 (0) | 0 (0) |
G | 1 | b | 0 (0) | 0 (0) |
H | 1 | d | 0 (0) | 1 (100) |
I | 1 | a | 0 (0) | 0 (0) |
J | 1 | b | 0 (0) | 1 (100) |
TABLE 2.
MICs of imipenem, meropenem, aztreonam, amikacin, ciprofloxacin, and colistin in the presence or absence of blaSPMblaSPM status (no. of isolates) | Antibiotic | No. of isolates with MICs (μg/ml) of:
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
>256 | 256 | 128 | 64 | 32 | 16 | 8 | 4 | 2 | ≤1 | ||
Positive (29) | Imipenem | 21 | 6 | 2 | |||||||
Meropenem | 17 | 10 | 1 | 1 | |||||||
Aztreonam | 5 | 19 | 5 | ||||||||
Amikacin | 26 | 3 | |||||||||
Ciprofloxacin | 1 | 1 | 8 | 15 | 2 | 1 | 1 | ||||
Colistin | 12 | 8 | 7 | 2 | |||||||
Negative (22) | Imipenem | 17 | 5 | ||||||||
Meropenem | 2 | 10 | 9 | 1 | |||||||
Aztreonam | 1 | 2 | 3 | 4 | 7 | 3 | 2 | ||||
Amikacin | 12 | 4 | 1 | 4 | 1 | ||||||
Ciprofloxacin | 4 | 3 | 3 | 7 | 1 | 1 | 3 | ||||
Colistin | 2 | 3 | 11 | 5 | 1 |
TABLE 3.
MICs of aminoglycosides in the presence or absence of rmtDrmtD status (no. of isolates) | Aminoglycoside | No. of isolates with MIC (μg/ml) of:
| |||||||
---|---|---|---|---|---|---|---|---|---|
>256 | 256 | 128 | 64 | 32 | 16 | 8 | 4 | ||
Positive (38) | Arbekacin | 38 | |||||||
Amikacin | 38 | ||||||||
Gentamicin | 38 | ||||||||
Negative (13) | Arbekacin | 3 | 2 | 1 | 6 | 1 | |||
Amikacin | 4 | 1 | 7 | 1 | |||||
Gentamicin | 6 | 1 | 3 | 3 |