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1.
Eur J Cancer ; 159: 144-153, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34749119

RESUMO

BACKGROUND: Osimertinib is the standard of care in the initial treatment for advanced epidermal growth factor receptor (EGFR) mutation-positive lung cancer. However, clinical data and reliable prognostic biomarkers are insufficient. METHODS: We performed a retrospective multicentre cohort study for 538 EGFR mutation-positive patients, who received osimertinib as the initial treatment between August 2018 and December 2019. The main outcome was progression-free survival (PFS). RESULTS: The median observation period was 14.7 months (interquartile range 11.4-20.0). The median PFS was 20.5 months (95% confidence interval [CI] 18.6-not reached). Multivariate analysis showed that sex (male) (hazard ratio [HR] 1.99, 95% CI 1.35-2.93, P = 0.001), malignant effusions (HR 1.51, 95% CI 1.11-2.04, P = 0.008), liver metastasis (HR 1.55, 95% CI 1.03-2.33, P = 0.037), advanced unresectable cases (HR 1.71, 95% CI, 1.04-2.82, P = 0.036), mutation type and programmed cell death-ligand 1 (PD-L1) expression were associated with PFS. The L858R (HR 1.55, 95% CI 1.01-2.38, P = 0.043) and uncommon mutations (HR 3.15, 95% CI 1.70-5.83, P < 0.001) were associated with PFS. PD-L1 expression of 1-49% (HR 1.66, 95% CI 1.05-2.63, P = 0.029), ≥50% (HR 2.24, 95% CI 1.17-4.30, P = 0.015) and unknown (HR 1.53, 95% CI 1.05-2.22, P = 0.026) was associated with PFS. The main reasons for treatment discontinuation among 219 patients were disease progression (44.3%), pneumonitis (25.5%) and other adverse events (16.0%). CONCLUSION: During initial treatment with osimertinib, PD-L1 expression is significantly related to PFS. Adverse events are a noteworthy reason for discontinuation.

2.
Clin Nutr ESPEN ; 44: 204-210, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34330467

RESUMO

BACKGROUND & AIMS: Amino acids play an important role in immune responses and as neurotransmitters. During the course of a bacterial pneumonia episode, from the onset to the recovery phase, immune responses dramatically change, as does the metabolism of amino acids, a concept referred to as immuno-nutrition. We investigated the differences in plasma amino acid levels (PAA) between the acute and recovery phases in individuals with community-acquired pneumonia (CAP) and healthy controls. METHODS: Two groups of participants were recruited: Healthy adults aged over 60 years and patients hospitalized with CAP. Samples were collected on Day 0 (the day of admission) and Day 7 (after 6-8 days treatment). RESULTS: A total of 93 healthy adults and 60 patients with CAP participated in the study. Of those with CAP, 43 had their amino acids measured on Day 7. Patients with CAP had markedly decreased PAA of 12 amino acids on Day 0. Citrulline, histidine, and tryptophan remained low in male, while aspartic acid, asparagine, ornithine, proline, and threonine were higher on Day 7 in both males and females. Phenylalanine increased at Day 0 and Day7. CONCLUSIONS: The findings suggest that the host response against bacterial infection changed the plasma amino acid levels. PAA on Day 7 (representing convalescence) continued to display an amino acid profile distinct from that observed in healthy individuals. Based on these findings, reconsideration for providing amino acids to patients with bacterial pneumonia should be needed depending on stage of the pneumonia from the perspective of immuno-nutrition.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Bacteriana , Citrulina , Feminino , Hospitalização , Humanos , Masculino , Estado Nutricional
3.
Respirol Case Rep ; 9(6): e00763, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33976892

RESUMO

Chrysosporium zonatum is a soil-dwelling fungus that rarely causes pulmonary infections, and a small number of cases have been reported to date. A 74-year-old man, who had previously been treated for tuberculosis, presented with symptoms of low-grade fever, anorexia, cough, and bloody sputum. Chest computed tomography (CT) showed a thick-walled cavitary lesion in the right upper lobe, in which there was a suspected mycotic mass. Initially, the patient was suspected to have chronic aspergillosis due to positive serum anti-Aspergillus antibodies. However, bronchoscopic culture revealed the growth of C. zonatum. Symptoms and imaging findings improved with administration of voriconazole for 18 months. Infection by C. zonatum is very rare and is difficult to differentiate from aspergillosis by clinical features. Clinicians should be aware of the possibility of coinfection with C. zonatum and Aspergillus sp. Voriconazole may be an effective treatment option.

4.
Int J Clin Oncol ; 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33783658

RESUMO

Aging leads to numerous changes that affect many components of the immune system, called "immunosenescence". Indeed, elderly individuals exhibit dysregulated immune responses against pathogens, poor responses to vaccination, and increased susceptibility to many diseases including cancer, autoimmune disorders, and other chronic inflammatory diseases. Despite progressed understanding of immunosenescence, its detailed mechanisms are still not fully understood. With advances in medicine, the population of older cancer patients is expected to rapidly increase in the coming years. Cancer immunotherapies, including immune checkpoint inhibitors (ICIs), have been shown to be effective for multiple cancer types, whereas to date, few specific data for elderly individuals have been published. Some systemic reviews have demonstrated that ICIs exhibit similar efficacy in older cancer patients, but they seem to be less effective in very old patients. In addition, toxicities might be more frequently observed in such patients. Here, we provide a summary to better understand immunosenescence and an overview of its relationship with cancer and antitumor immunity, including the efficacy and toxicity of ICIs.

5.
Am J Case Rep ; 21: e924476, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32796809

RESUMO

BACKGROUND The effect of corticosteroids in the management of patients with coronavirus disease 2019 (COVID-19) is unclear. CASE REPORT A 67-year-old man who tested positive for COVID-19 by reverse-transcription PCR (RT-PCR) analysis was admitted to our hospital. On admission, he had no dyspnea and his oxygen saturation (SpO2) level was normal. Chest imaging revealed ground-glass opacities (GGO) distributed in both lung fields. Four days after admission, bilateral lung shadows worsened, with a slight reduction in SpO2 levels. Short-term corticosteroid therapy was initiated, and SpO2 and radiographic findings promptly improved without use of antiviral agents. CONCLUSIONS More data are required to ascertain the role of corticosteroids in the management of COVID-19 pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Idoso , COVID-19 , Infecções por Coronavirus/diagnóstico , Esquema de Medicação , Humanos , Pulmão/diagnóstico por imagem , Masculino , Oxigênio/sangue , Pandemias , Pneumonia Viral/diagnóstico , SARS-CoV-2 , Tomografia Computadorizada por Raios X
6.
Clin Nutr ESPEN ; 38: 201-210, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32690159

RESUMO

BACKGROUND & AIMS: Plasma concentrations of branched-chain amino acids (BCAAs) are known to exhibit strong intercorrelations; however, the associated regulatory mechanism is not sufficiently understood. Furthermore, the mechanisms underlying the intercorrelation changes in metabolic disorders with the disease are unclear. Therefore, plasma BCAAs in patients with chronic kidney disease (CKD) were examined. METHODS: This study included a healthy group of older participants (Group C; n = 87, 46 males, 41 females) who had undergone health examinations at Sanyudo Hospital and a group of CKD patients (Group CKD; n = 71, 49 males, 22 females) receiving maintenance hemodialysis at the same hospital. Samples from Group C were collected 12 h after fasting. CKD samples were collected before and after hemodialysis (pre-HD and post-HD, respectively), without 12 h fasting. The samples were analyzed for 38 amino acids by SRL Inc., using liquid chromatography-mass spectrometry (LC-MS). RESULTS: Differences between the plasma BCAA concentrations of Group C and pre-HD were determined. Dialysis-induced BCAA losses were different for each BCAA. However, strong intercorrelations between the plasma concentrations of each BCAA were maintained. In addition, the regression lines did not converge at the origin and were in different positions for groups C, pre-HD, and post-HD. A different distribution of the constant (b) for each group was observed for each BCAA correlation when a in the regression line (Y = aX + b) was fixed at the value for Group C, and b was calculated. CONCLUSION: Strong intercorrelations among plasma concentrations of BCAAs were maintained in CKD patients both pre- and post-dialysis, whereas the changes in the plasma concentrations of each BCAA were different. We speculate that there is a novel mechanism that selectively regulates each BCAA and suggest that changes in the constant of the regression formula for correlation may have a novel function as an index for renal contribution to BCAA metabolism.


Assuntos
Aminoácidos de Cadeia Ramificada , Insuficiência Renal Crônica , Jejum , Feminino , Voluntários Saudáveis , Humanos , Masculino , Diálise Renal , Insuficiência Renal Crônica/terapia
7.
J Infect Chemother ; 26(9): 873-881, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32565151

RESUMO

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2016. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between February 2016 and August 2016 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standards Institute. Susceptibility testing was evaluated in 1062 strains (143 Staphylococcus aureus, 210 Streptococcus pneumoniae, 17 Streptococcus pyogenes, 248 Haemophilus influenzae, 151 Moraxella catarrhalis, 134 Klebsiella pneumoniae, and 159 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 48.3%, and those of penicillin-susceptible S. pneumoniae was 99.5%. Among H. influenzae, 14.1% of them were found to be ß-lactamase-producing ampicillin-resistant strains, and 41.1% to be ß-lactamase-non-producing ampicillin-resistant strains. Extended spectrum ß-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo ß-lactamase were 4.5% and 0.6%, respectively.


Assuntos
Doenças Transmissíveis , Staphylococcus aureus Resistente à Meticilina , Infecções Respiratórias , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Farmacorresistência Bacteriana , Haemophilus influenzae , Humanos , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia
8.
Am J Case Rep ; 21: e919267, 2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31924748

RESUMO

BACKGROUND Pulmonary cryptococcosis can be associated with various imaging findings and can occur in immunocompetent hosts. It is sometimes difficult to distinguish pulmonary cryptococcosis from pulmonary tuberculosis based on imaging findings. CASE REPORT A 34-year-old female nurse who worked in an endoscopy examination room visited our hospital because of an abnormal lung shadow. At her workplace, a gastrointestinal endoscopy had been performed on a patient with infectious tuberculosis. The nurse was asymptomatic, and acid-fast staining and culture of her sputum were negative. Chest computed tomography depicted multiple nodules distributed along the bronchi. An acid-fast smear test of bronchial lavage was negative and cytological investigations revealed many yeast-like fungi. Fluconazole was administered and the computed tomography findings improved. CONCLUSIONS It is important to consider cryptococcosis, even in patients suspected of having tuberculosis.


Assuntos
Criptococose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Adulto , Líquido da Lavagem Broncoalveolar/citologia , Broncoscopia , Criptococose/tratamento farmacológico , Diagnóstico Tardio , Feminino , Fluconazol/uso terapêutico , Humanos , Pneumopatias Fúngicas/tratamento farmacológico , Enfermeiras e Enfermeiros , Teste de Papanicolaou , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar
9.
Artigo em Inglês | MEDLINE | ID: mdl-30880947

RESUMO

Purpose: No consensus has been reached regarding appropriate nutritional intervention and rehabilitation during early acute exacerbation of COPD (AECOPD). Given the individual differences in symptoms of AECOPD, patients should be classified by their pathology. For example, it is known that there are differences in the inflammatory response between AECOPD with and without bacterial infection. However, there have been few reports on AECOPD from a nutritional perspective. The aim of this study was to investigate amino acid levels in patients with AECOPD. Patients and methods: Blood was collected from patients who were hospitalized with AECOPD and from patients with COPD that was in a stable state. We divided the patients with AECOPD into those without bacterial infection (group A) and those with bacterial infection (group B). The patients with COPD that was stable served as controls (group C). The plasma levels of 9 essential amino acids, 13 nonessential amino acids, and total amino acids were compared between the three groups. Results: In the early stages of AECOPD, differences in plasma levels of only three amino acids (glycine, phenylalanine, and arginine) were observed between groups C and A. Differences in total amino acids and 13 amino acids were observed between groups C and B. Group B had lower levels of total amino acids and of seven amino acids (asparagine, citrulline, glutamine, histidine, methionine, serine, and threonine) compared with the other study groups. Conclusion: The findings of this study show that amino acid levels in plasma differ in patients with AECOPD depending on whether or not bacterial infection is present. Our results suggest that specific amino acids (ie, asparagine, citrulline, glutamine, histidine, serine, and threonine) have potential utility as diagnostic markers to distinguish between bacterial and nonbacterial AECOPD.


Assuntos
Aminoácidos/sangue , Pulmão/microbiologia , Estado Nutricional , Doença Pulmonar Obstrutiva Crônica/sangue , Infecções Respiratórias/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Progressão da Doença , Feminino , Hospitalização , Humanos , Pulmão/fisiopatologia , Masculino , Avaliação Nutricional , Fenótipo , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/microbiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Infecções Respiratórias/fisiopatologia , Fatores de Tempo
10.
J Clin Exp Hematop ; 57(2): 47-53, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29021514

RESUMO

Many patients with immunoglobulin M (IgM) monoclonal gammopathy remain asymptomatic and, consequently, untreated; however, few studies have evaluated the clinical course and prognosis of these patients. Using the screening procedures at our hospital, 74 patients with IgM monoclonal gammopathy were selected. We excluded 11 patients in whom the treatment for lymphoid neoplasms had been initiated at the time of IgM monoclonal protein detection. The remaining 63 patients were considered to be the patient population with IgM MGUS and asymptomatic WM, and were analyzed. In these patients, the median overall survival was longer than 14 years. More than half of these patients died from causes other than lymphoid neoplasm. The cumulative incidence of lymphoid neoplasm requiring treatment was 17.5%. In five of eight patients requiring treatment for lymphoid neoplasms, the causes of death were related with these lymphoid neoplasms. Our study suggests that not all patients with IgM monoclonal gammopathy require uniform treatment for prolonged survival; however, most lymphoid neoplasms requiring treatment are refractory diseases. Our findings may help manage patients with macroglobulinemia.


Assuntos
Imunoglobulina M , Gamopatia Monoclonal de Significância Indeterminada , Macroglobulinemia de Waldenstrom , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/sangue , Gamopatia Monoclonal de Significância Indeterminada/mortalidade , Gamopatia Monoclonal de Significância Indeterminada/terapia , Estudos Retrospectivos , Taxa de Sobrevida , Macroglobulinemia de Waldenstrom/sangue , Macroglobulinemia de Waldenstrom/mortalidade , Macroglobulinemia de Waldenstrom/terapia
11.
J Infect Chemother ; 23(9): 587-597, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28669567

RESUMO

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by Japanese Society of Chemotherapy, Japanese association for infectious diseases and Japanese society for Clinical Microbiology in 2012. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between January and December in 2012 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standard Institutes. Susceptibility testing was evaluated in 1236 strains (232 Staphylococcus aureus, 225 Streptococcus pneumoniae, 16 Streptococcus pyogenes, 231 Haemophilus influenzae, 147 Moraxella catarrhalis, 167 Klebsiella pneumoniae and 218 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 51.3%, and those of penicillin-intermediate S. pneumoniae was 0.4%. Among H. influenzae, 5.6% of them were found to be ß-lactamase-producing ampicillin-resistant strains, and 37.2% to be ß-lactamase-non-producing ampicillin-resistant strains. Extended spectrum ß-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo ß-lactamase were 4.2% and 3.2%, respectively. Continuous national surveillance is important to determine the actual situation of the resistance shown by bacterial respiratory pathogens to antimicrobial agents.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Sistema Respiratório/microbiologia , Infecções Respiratórias/microbiologia , Farmacorresistência Bacteriana , Haemophilus influenzae/efeitos dos fármacos , Haemophilus influenzae/isolamento & purificação , Humanos , Japão , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/efeitos dos fármacos , Moraxella catarrhalis/isolamento & purificação , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Vigilância em Saúde Pública , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/isolamento & purificação , beta-Lactamases/análise
12.
Kansenshogaku Zasshi ; 89(5): 597-600, 2015 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-26630793

RESUMO

We report herein on two cases of Japanese spotted fever (JSF) treated with intravenous minocycline (MINO) and levofloxacin (LVFX). An 80 year-old woman (Case1) and a 63 year-old man (Case2) with high fever (> 39 degrees C) and wide-spread skin erythema were admitted because they were suspected of having developed JSF. After admission, we treated them with intravenous MINO and LVFX. The patients' fevers were resolved within 36 hours after antibiotics. They were diagnosed as having JSF based on the serological test, and Rickettsia japonica was detected from the genetic findings (PCR analysis from eschar) only in case 1. In the treatment of fulminant JSF (body temperature > 39 degrees C) the prompt administration of a combination of tetracycline and new quinolone has been recommended. The number of cases of JSF and its endemic area are gradually increasing in Japan. As for new quinolones, ciprofloxacin and tosufloxacin have been used against to JSF in Japan, but LVFX may become a new option.


Assuntos
Antibacterianos/uso terapêutico , Febre/etiologia , Levofloxacino/uso terapêutico , Minociclina/uso terapêutico , Infecções por Rickettsia/tratamento farmacológico , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Levofloxacino/administração & dosagem , Masculino , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Infecções por Rickettsia/complicações
13.
PLoS One ; 10(5): e0128304, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26020948

RESUMO

BACKGROUND AND OBJECTIVES: Recent reports indicate that the incidence of nontuberculous mycobacterial-lung disease (NTM-LD) is increasing. This study aimed to investigate the epidemiology and clinical features of NTM-LD patients in Nagasaki prefecture, Japan to identify the negative prognostic factors for NTM-LD in Japan. METHODS: The medical records of patients newly diagnosed with NTM-LD in eleven hospitals in Nagasaki prefecture between January 2001 and February 2010 were reviewed. Data regarding the annual population of each region and the incidence of all forms of tuberculosis were collected to assess geographic variations in NTM-LD incidence, isolates, and radiological features. RESULTS: A total 975 patients were diagnosed with NTM-LD. The incidence increased over the study period and reached 11.0 and 10.1 per 100,000 population in 2008 and 2009, respectively. M. intracellulare was the most common pathogen in the southern region, and M. avium most common in other regions. The most common radiographic pattern was the nodular-bronchiectatic pattern. Age >60 years, body mass index <18.5 kg/m2, underlying lung disease, and cavitary pattern were the negative prognostic factors at the 1-year follow-up. CONCLUSIONS: The incidence of NTM-LD has been increasing in Nagasaki prefecture. The isolates and radiographic features of patients vary markedly by region.


Assuntos
Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium/fisiologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Radiografia , Fatores Sexuais
14.
BMC Public Health ; 13: 754, 2013 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-23945173

RESUMO

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is similar in Japan and China and is increasing due to high rates of smoking in these countries. Reducing COPD is an important public health issue. The goals of this study were to verify the reliability and validity of the Japanese version of the COOP/WONCA charts, a tool for measuring health status, and to examine the qualitative differences in health status between Japanese and Chinese patients with COPD and between these patients and healthy subjects. METHODS: From 2008 to 2011, we examined the factors affecting the health status of Japanese and Chinese populations living in six cities. Participants were patients with COPD staged according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (140 Japanese, 201 Chinese) and healthy subjects (243 Japanese, 199 Chinese), all 50 to 79 years old. Health status was measured by using the COOP/WONCA charts, and basic information such as smoking status and medical history was reported by the participants. RESULTS: The Japanese and Chinese versions of the COOP/WONCA charts were shown to be reliable and valid by test-retest, comparison with the SF-36 and respiratory symptoms, and correlation of results obtained from patients and their physicians. Stepwise multiple regression analyses demonstrated that "Physical fitness", "Daily activities", and "Social activities" were predicted by COPD status and/or respiratory symptoms; "Feelings" by nationality and respiratory symptoms; "Pain" by sex and respiratory symptoms; and "Overall health" by nationality. When the COOP/WONCA scores were stratified by nationality, age, sex, and COPD status, the difference of each score between the patients and healthy subjects was larger for the Chinese subjects than for the Japanese. The physical, psychosocial activities, and pain scores increased significantly as COPD status worsened in Chinese subjects, whereas these scores were not affected by sex, age, or COPD status for Japanese subjects. Brinkman index and use of smoky fuel indoors affected the COOP/WONCA scores in Chinese patients but not in Japanese patients. CONCLUSIONS: The Japanese COOP/WONCA charts are reliable and valid. COPD more severely affected the health status of Chinese participants than of Japanese participants. These results suggest that countermeasures against insufficient health care and smoky environments may improve the health status of Chinese patients with COPD.


Assuntos
Nível de Saúde , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Inquéritos e Questionários , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Reprodutibilidade dos Testes
15.
J Infect Chemother ; 18(5): 609-20, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22766652

RESUMO

For the purpose of nationwide surveillance of antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, the Japanese Society of Chemotherapy (JSC) started a survey in 2006. From 2009, JSC continued the survey in collaboration with the Japanese Association for Infectious Diseases and the Japanese Society for Clinical Microbiology. The fourth-year survey was conducted during the period from January and April 2009 by the three societies. A total of 684 strains were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections. Susceptibility testing was evaluable with 635 strains (130 Staphylococcus aureus, 127 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 123 Haemophilus influenzae, 70 Moraxella catarrhalis, 78 Klebsiella pneumoniae, and 103 Pseudomonas aeruginosa). A maximum of 45 antibacterial agents including 26 ß-lactams (four penicillins, three penicillins in combination with ß-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), four aminoglycosides, four macrolides (including ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standard Institute (CLSI). Incidence of methicillin-resistant S. aureus (MRSA) was as high as 58.5 %, and that of penicillin-intermediate and penicillin-resistant S. pneumoniae (PISP and PRSP) was 6.3 % and 0.0 %, respectively. Among H. influenzae, 21.1 % of them were found to be ß-lactamase-non-producing ampicillin (ABPC)-intermediately resistant (BLNAI), 18.7 % to be ß-lactamase-non-producing ABPC-resistant (BLNAR), and 5.7 % to be ß-lactamase-producing ABPC-resistant (BLPAR) strains. A high frequency (76.5 %) of ß-lactamase-producing strains has been suspected in Moraxella catarrhalis isolates. Four (3.2 %) extended-spectrum ß-lactamase-producing K. pneumoniae were found among 126 strains. Four isolates (2.5 %) of P. aeruginosa were found to be metallo-ß-lactamase-producing strains, including three (1.9 %) suspected multi-drug resistant strains showing resistance against imipenem, amikacin, and ciprofloxacin. Continuous national surveillance of the antimicrobial susceptibility of respiratory pathogens is crucial to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Infecções Respiratórias/microbiologia , Bactérias/classificação , Infecções Bacterianas/epidemiologia , Distribuição de Qui-Quadrado , Farmacorresistência Bacteriana , Humanos , Japão/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Vigilância em Saúde Pública , Infecções Respiratórias/epidemiologia , Sociedades Científicas
16.
J Infect Chemother ; 18(2): 160-8, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22041987

RESUMO

Clinical results for linezolid (LZD) treatment of hospital-acquired pneumonia (HAP) caused by methicillin-resistant Staphylococcus aureus (MRSA), particularly microbiologically evaluable or severe cases, are limited in Japan. A prospective observational study was conducted in order to assess the usefulness of LZD in Japanese patients with MRSA pneumonia. The study tracked fifteen participants treated with LZD for pneumonia who met the criteria of the HAP guidelines and were confirmed to have pneumonia caused by MRSA. Of these, six were severe and 13 had received antibiotic treatment before treatment with LZD. Of the 13 participants assessed for their clinical responses, seven were rated as cures, three were rated as failures, and three were indeterminate. The overall cure rate (cure/cure + failure) was 70.0% (7/10), and the cure rate by severity was 33.3% (1/3) for severe cases and 85.5% (6/7) for moderate cases. The one severe case with a clinical response rating of cure had failed to respond to vancomycin. Among the seven participants with a clinical response rating of cure, the microbiological response was eradication in three, presumed eradication in three, and indeterminate in one. Three serious adverse events occurred in two of the 15 participants, but none were considered to be causally related to LZD. The results suggest that LZD has high potential for severe and multidrug-resistant cases. A higher cure rate was achieved in moderate cases. In cases of pneumonia that are most likely MRSA infections with poor prognosis, it was suggested to be important for patient outcome to implement the most effective therapy before the patient's condition becomes serious.


Assuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Acetamidas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/efeitos adversos , Feminino , Humanos , Japão , Linezolida , Masculino , Pessoa de Meia-Idade , Oxazolidinonas/efeitos adversos , Pneumonia Estafilocócica/microbiologia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
Med Mycol ; 50(6): 631-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22149972

RESUMO

Aspergillus udagawae and A. fumigatus share similar morphological features but they differ genetically. There is also an important clinical distinction as A. udagawae is less sensitive to amphotericin B than A. fumigatus. We encountered a rare case of bronchial infection due to A. udagawae that was successfully treated with voriconazole. An 82-year-old woman with diabetes mellitus complained of bloody sputum. Bronchoscopy revealed a white plugged region at the origin of the right bronchi B5. Cytological study revealed a clot composed of filamentous fungi and Aspergillus spp. was detected by culture. Molecular analysis revealed that the causative agent was A. udagawae, and voriconazole was used for the treatment. In comparison to A. fumigatus, the A. udagawae strain isolated in this case was less sensitive to amphotericin B, less virulent in immunosuppressed mice, and more sensitive to hydrogen peroxide, features that are almost identical to those of the previously reported isolates of the fungus. We should be aware of the emergence of new Aspergillus species that might pose a clinical threat.


Assuntos
Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Broncopatias/microbiologia , Idoso de 80 Anos ou mais , Animais , Aspergilose/tratamento farmacológico , Aspergillus/classificação , Aspergillus/efeitos dos fármacos , Aspergillus/patogenicidade , Broncopatias/tratamento farmacológico , Broncopatias/patologia , Broncoscopia/métodos , Diabetes Mellitus/patologia , Feminino , Humanos , Peróxido de Hidrogênio/farmacologia , Hospedeiro Imunocomprometido , Pulmão/microbiologia , Pulmão/patologia , Camundongos , Pirimidinas/uso terapêutico , Triazóis/uso terapêutico , Voriconazol
18.
Biol Bull ; 221(3): 248-60, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22186913

RESUMO

Production of podocysts is the exclusive form of asexual reproduction by polyps of the giant jellyfish Nemopilema nomurai, which has been recurrently blooming in the East Asian seas in the last decade. Podocycts consist of a dome-shaped chitinous capsule with laminated structure that encapsulates a mass of cyst cells filled with granules containing nutrient reserves such as proteins, carbohydrates, and lipids. Mitochondria, rough endoplasmic reticulum, and Golgi complexes are scarce in the cytoplasm of these cells, and the staining reaction for RNA is weak, indicating very low metabolic activity. Podocysts are capable of dormancy for at least 5 years without significant change of internal structure or nutrient reserves. Integrated information about spontaneous and artificially induced metamorphosis suggests that the following processes occur during excystment: (1) nematocyst formation in the internal cell mass, (2) stratification of the cell mass into endoderm and ectoderm, (3) extrusion of the cell mass through a gradual opening of the capsule, (4) formation of primordial polyp mouth and tentacles, and (5) metamorphosis to a polyp. We morphologically confirmed that N. nomurai podocysts have the capacity for long-term dormancy, an ability that should contribute to the periodic nature of the massive blooms of medusae of this species.


Assuntos
Reprodução Assexuada , Cifozoários/fisiologia , Animais , Histocitoquímica , Japão , Metamorfose Biológica , Morfogênese , Nematocisto , Cifozoários/química , Cifozoários/ultraestrutura
19.
J Prosthet Dent ; 105(4): 256-65, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21458651

RESUMO

STATEMENT OF PROBLEM: It is not clear if the interaction of craniofacial form with type of prosthetic restoration (conventional or implant-assisted) is related to masticatory function in complete denture patients. PURPOSE: The purpose of this study was to investigate the relationships among facial form, skeletal class, alveolar residual ridge heights and masticatory function in subjects treated with implant-assisted or conventional mandibular dentures with lateral cephalometric evaluation. MATERIAL AND METHODS: Data from a previously reported randomized controlled clinical trial were accessed to compare treatment success rates, functional and perceptual outcomes, dietary intake, and craniofacial relationships between mandibular complete dentures and implant overdentures in edentulous diabetic subjects. Evaluation of the digitized post-insertion lateral cephalometric radiographs provided measures of facial form (mesocephalic "medium", brachycephalic "broad and square", dolichocephalic "vertical and long"), skeletal class (Class I, Class II, Class III), and alveolar ridge height (mm), which were compared to results of standardized masticatory tests as evaluated using MANOVA and REGW post-hoc evaluation (α=.05). RESULTS: Masticatory performance on the preferred side was slightly reduced in the dolichocephalic group, compared to brachycephalic and mesocephalic groups (P=.085). Swallowing threshold performance was significantly less in skeletal Class II subjects compared to Class I (P=.034). Maxillary residual alveolar ridge height was significantly less in the brachycephalic group compared to the dolichocephalic group (P<.001). No differences in mandibular ridge height were seen associated with facial form or skeletal class groups. CONCLUSIONS: Facial form may be related to masticatory function with conventional and implant-assisted mandibular dentures, but larger controlled studies are needed to confirm this relationship. Alveolar ridge height is reduced in edentulous subjects with a brachycephalic facial form.


Assuntos
Prótese Dentária Fixada por Implante , Prótese Total Inferior , Revestimento de Dentadura , Face/anatomia & histologia , Mastigação , Idoso , Processo Alveolar/anatomia & histologia , Análise de Variância , Cefalometria , Retenção de Dentadura/instrumentação , Retenção de Dentadura/métodos , Humanos , Arcada Edêntula/reabilitação , Má Oclusão/classificação , Mandíbula , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento , Dimensão Vertical
20.
J Infect Chemother ; 17(4): 510-23, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21409533

RESUMO

For the purpose of nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens collected from patients in Japan, the Japanese Society of Chemotherapy conducted a third year of nationwide surveillance during the period from January to April 2008. A total of 1,097 strains were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections. Susceptibility testing was evaluable with 987 strains (189 Staphylococcus aureus, 211 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 187 Haemophilus influenzae, 106 Moraxella catarrhalis, 126 Klebsiella pneumoniae, and 162 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 ß-lactams (four penicillins, three penicillins in combination with ß-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including a ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standard Institute (CLSI). The incidence of methicillin-resistant S. aureus (MRSA) was as high as 59.8%, and those of penicillin-intermediate and penicillin-resistant S. pneumoniae (PISP and PRSP) were 35.5 and 11.8%, respectively. Among H. influenzae, 13.9% of them were found to be ß-lactamase-non-producing ampicillin (ABPC)-intermediately resistant (BLNAI), 26.7% to be ß-lactamase-non-producing ABPC-resistant (BLNAR), and 5.3% to be ß-lactamase-producing ABPC-resistant (BLPAR) strains. A high frequency (76.5%) of ß-lactamase-producing strains was suspected in Moraxella catarrhalis isolates. Four (3.2%) extended-spectrum ß-lactamase-producing K. pneumoniae were found among 126 strains. Four isolates (2.5%) of P. aeruginosa were found to be metallo ß-lactamase-producing strains, including three (1.9%) suspected multidrug-resistant strains showing resistance to imipenem, amikacin, and ciprofloxacin. Continual national surveillance of the antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/microbiologia , Infecções Respiratórias/microbiologia , Adulto , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Farmacorresistência Bacteriana , Haemophilus influenzae/efeitos dos fármacos , Humanos , Concentração Inibidora 50 , Japão/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/efeitos dos fármacos , Vigilância da População , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Respiratórias/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos
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