Publications by authors named "Hiroyuki Sakamaki"

41 Publications

The technical aspects of a midline robotic thymectomy.

JTCVS Tech 2020 Dec 20;4:368-370. Epub 2020 Aug 20.

Department of Thoracic Surgery, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan.

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http://dx.doi.org/10.1016/j.xjtc.2020.08.046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304867PMC
December 2020

Community-Level Participation in Volunteer Groups and Individual Depressive Symptoms in Japanese Older People: A Three-Year Longitudinal Multilevel Analysis Using JAGES Data.

Int J Environ Res Public Health 2021 07 14;18(14). Epub 2021 Jul 14.

School of Health Innovation, Kanagawa University of Human Services, Kawasaki 210-0821, Japan.

Background: The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people.

Methods: We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model.

Results: The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78-0.98).

Conclusions: Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.
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http://dx.doi.org/10.3390/ijerph18147502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306052PMC
July 2021

Burden of caring for Alzheimer's disease or dementia patients in Japan, the US, and EU: results from the National Health and Wellness Survey: a cross-sectional survey.

J Med Econ 2021 Jan-Dec;24(1):266-278

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

Aims: The growing prevalence of Alzheimer's disease (AD) worldwide has sparked the implementation of national policies to support the growing burden among caregivers of AD/dementia patients. This study aims to quantify and compare the burden of AD/dementia caregivers and evaluate how different living arrangements might impact health outcomes among caregivers in Japan, five European countries (5EU), and the United States (US).

Materials And Methods: This is a cross-sectional study based on existing data from the 2018 National Health and Wellness Survey. Health outcome measures included health-related quality of life (HRQoL), health state utilities, work productivity and activity impairment (WPAI), and measurement of depression and anxiety amongst AD/dementia caregivers and non-caregivers. Pairwise comparisons between AD/dementia caregivers in Japan, 5EU, and the US were conducted. Multivariate analysis was used to compare across groups within each region, with adjustment for potential confounding effects.

Results: A higher proportion of caregivers of AD/dementia patients in Japan were 65 years or older as compared to 5EU and US. On the contrary, female caregivers were significantly higher in the US than Japan and 5EU. The HRQoL and health state utilities index scores amongst AD/dementia caregivers were highest in Japan and lowest in the US. Caregivers in Japan incurred the lowest WPAI among the three regions. The proportion of AD/dementia patients reportedly living in an institution was highest in Japan as compared to the US and EU. Notably, US caregivers whose patients lived in an institution experienced significantly less caregiving burden as compared to caregivers whose patients lived in the community.

Conclusions: The caregiving burden among AD/dementia caregivers was substantial across the three regions, with similarities and differences between the West and Japan. The lower caregiving burden in Japan was potentially associated with national policies supporting long-term healthcare and institutionalized nursing care facilities for AD/dementia patients.
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http://dx.doi.org/10.1080/13696998.2021.1880801DOI Listing
February 2021

Humanistic burden among caregivers of patients with Alzheimer's disease or dementia in Japan: a large-scale cross-sectional survey.

J Med Econ 2021 Jan-Dec;24(1):181-192

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

Aims: As the population in Japan is rapidly aging, the prevalence of dementia, particularly Alzheimer's Disease (AD), is expected to increase, resulting in a growing need for caregivers. This study aims to quantify and compare the humanistic burden of caregivers of AD/dementia patients with caregivers of patients with other conditions in Japan.

Materials And Methods: This cross-sectional study used data from the 2018 Japan National Health and Wellness Survey (NHWS). Outcome measures included the Short-Form 12-item Health Survey (SF-12) for health-related quality-of-life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, impact of health on productivity and activity, and evaluation of depression and anxiety. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects.

Results: A total of 805 caregivers of AD/dementia patients, 1,099 other caregivers, and 27,137 non-caregivers were identified. Both AD/dementia caregivers and other caregivers had lower HRQoL and EQ-5D scores, higher total activity impairment, and more caregivers tended to experience anxiety than non-caregivers. There were no significant differences in the involvment in basic and instrumental activities of daily living (ADL) between AD/dementia caregivers and caregivers of other conditions. Notably, AD/dementia caregivers were more involved in making treatment decisions and finance management than other caregivers. Among AD/dementia caregivers caring for one patient, 395 patients lived in the community and 282 in an institution. AD/dementia caregivers whose patients lived in the community were more significantly involved in basic and instrumental ADL. Caregivers of patients with both AD/dementia and cancer had higher caregiving burden than caregivers of patients with either condition.

Conclusions: Caregivers of AD/dementia patients in Japan reportedly experienced significant humanistic burden which is associated with patients' living arrangements and the presence of an additional chronic condition. Therefore, provision of effective care/support is essential to relieve the burden experienced by the caregivers.
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http://dx.doi.org/10.1080/13696998.2021.1877149DOI Listing
January 2021

Factors associated with humanistic burden and indirect cost among patients with cancer in Japan.

J Med Econ 2020 Dec 5;23(12):1570-1578. Epub 2020 Nov 5.

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

Aims: Patients with cancer experienced reduced health-related quality-of-life (HRQoL), increased work productivity and activity impairment (WPAI), and indirect costs. With the current emphasis on economic evaluation of health technology in Japan, it is important to understand how indirect costs correlate with HRQoL and patient characteristics. It is also crucial to assess the patient characteristics associated with the HRQoL, WPAI, and indirect costs among patients with any types of cancer.

Materials And Methods: This cross-sectional study used data from the 2017 Japan National Health and Wellness Survey (NHWS). Respondents self-reported their HRQoL and WPAI by answering validated SF-12v2 and WPAI questionnaires, respectively. Indirect costs were derived using the human capital method. Correlation between HRQoL components and indirect costs were assessed using Spearman's rank-order correlation. Correlation between patient characteristics and HRQoL, WPAI, and indirect costs were analyzed using generalized linear models.

Results: A total of 1,540 patients with any types of cancer, 254 with breast cancer, and 144 with colorectal cancer were included in the analyses. There was significant negative correlation between the indirect costs and HRQoL components among patients with any types of cancer. Patients with lower comorbid burden, higher household income, employed, married, or living with partner, never smokers, and exercised tended to have higher HRQoL. Being never smokers, having lower comorbid burden, normal weight, and exercised were associated with lower WPAI measures. Additionally, patients who were older, not married, not obese, and not smoking tended to incur lower indirect costs.

Conclusions: The negative correlation between HRQoL and indirect costs among patients with cancer emphasized the needs to improve health outcomes and reduce indirect costs of patients. The factors associated with cancer burden identified in this study provide insights to allow targeted intervention to improve HRQoL and lessen the WPAI and indirect cost among cancer patients in Japan.
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http://dx.doi.org/10.1080/13696998.2020.1839234DOI Listing
December 2020

Syncope Caused by a Giant Mass Occupying the Hemithorax.

Ann Thorac Surg 2021 01 24;111(1):e69. Epub 2020 Sep 24.

Department of Thoracic Surgery, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.athoracsur.2020.06.142DOI Listing
January 2021

Cost-Effectiveness Analysis of Linagliptin in Japan Based on Results from the Asian Subpopulation in the CARMELINA Trial.

Diabetes Ther 2020 Aug 17;11(8):1721-1734. Epub 2020 Jun 17.

Nippon Boehringer Ingelheim Co., Ltd., Tokyo, Japan.

Introduction: We evaluated the cost-effectiveness of linagliptin in Japan by estimating the lifetime outcome based on clinical event rates from the Asian subpopulation of the CARMELINA trial. In CARMELINA, linagliptin added to standard of care (SoC) versus SoC demonstrated noninferiority with regard to risk of composite cardiovascular (CV) outcome in patients with type 2 diabetes at high risk of CV and kidney events. Issues resulting from conducting a cost-effectiveness analysis using data from a clinical noninferiority study were also investigated.

Methods: A microsimulation model was used to evaluate linagliptin/SoC versus SoC in terms of direct costs and quality-adjusted life years (QALYs) from a Japanese public healthcare payer's perspective. Cost data were obtained from recent Japanese publications. The time horizon was defined as lifetime, and the discount rate for costs and effectiveness was 2% per year. One-way and probabilistic sensitivity analyses were performed.

Results: In the base case analysis, and taking medical history into account, the incremental effectiveness of linagliptin/SoC versus SoC was 1.34 QALYs, and the incremental cost for linagliptin was - 545,319 yen. In the one-way sensitivity analysis, the parameter which most affected the results was the hazard ratio for renal failure of linagliptin/SoC compared with SoC. The probabilistic sensitivity analysis showed that the probability of reduced costs and increased effectiveness (dominant) was 48%. Assuming an incremental cost-effectiveness ratio (ICER) threshold of 5 million yen, the probability that the ICER was below the threshold was 89% for linagliptin/SoC compared with SoC.

Conclusions: This evaluation, using Asian subpopulation data from the CARMELINA trial, suggested that the cost-effectiveness of linagliptin for a lifetime outcome was favourable in Japan. However, the results must be interpreted cautiously because of the noninferiority trial data source, which might cause ICER variations for each parameter.
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http://dx.doi.org/10.1007/s13300-020-00852-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376765PMC
August 2020

A population-based study of the humanistic burden among cancer patients in Japan.

J Med Econ 2020 May 31;23(5):429-441. Epub 2019 Dec 31.

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

Understanding the burden of cancer in Japan is becoming increasingly important to address the socio-economic consequences of the disease. This study broadly examined the cancer burden in terms of: Health-Related Quality of Life (HRQoL), work productivity and activity impairment (WPAI), stress-related comorbidities, and indirect costs in patients diagnosed with (i) any type of cancer, (ii) breast cancer, (iii) colorectal cancer, compared to controls without cancer. This cross-sectional study used data from the 2017 Japan National Health and Wellness Survey (NHWS). Patient outcomes included self-reported stress-related comorbidities, HRQoL assessed by Short Form 12-item Health Survey and EuroQoL 5-dimension scale (EQ-5D), and work productivity and indirect costs assessed by WPAI questionnaire. Multivariate analysis was performed to compare outcomes across groups. An ad-hoc analysis compared respondents currently and currently not receiving prescription medication (Rx). A total of 1,540 patients with any type of cancer, 254 with breast cancer, 144 with colorectal cancer were included in the analyses and compared to 28,070 controls without cancer. After adjusting for potential confounding effects patients with any type of cancer had significantly lower mental component summary scores (45.70 46.45,  = .003), physical component summary scores (48.95 50.02,  < .001) and EQ-5D index (0.77 0.79,  < .001), and significantly increased absenteeism (5.13% 2.68%  < .001) compared to controls. No significant differences were detected for indirect costs. Breast cancer patients had significantly increased odds of anxiety and migraine. Colorectal cancer patients had significantly increased odds of insomnia. Patients currently receiving Rx had significantly lower HRQoL and higher WPAI than both controls and cancer patients not receiving Rx. Japanese cancer patients experience a significantly decreased HRQoL, increased absenteeism and higher odds ratio for stress-related comorbidities. This has implications for future policy making and Health Technology Assessment in Japan.
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http://dx.doi.org/10.1080/13696998.2019.1707213DOI Listing
May 2020

Tracheal resection and reconstruction for post-tracheostomy tracheal stenosis treated with T-tube stenting for 10 years.

Gen Thorac Cardiovasc Surg 2020 Nov 16;68(11):1341-1343. Epub 2019 Nov 16.

Department of Thoracic Surgery, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan.

We describe the case of a patient who underwent tracheal resection for post-tracheostomy stenosis following T-tube stenting for 10 years. A 32-year-old female patient with a T-tube in the trachea was referred to us. She had brain surgery for intracranial hemorrhage 10 years ago and developed a post-tracheostomy tracheal stenosis, for which she had been treated with a T-tube. At the time of referral, she was ambulatory with a cane and otherwise independent in her daily life. We assessed her stenosis and determined that it was amenable to tracheal resection as a definitive treatment. We resected the tracheal stenosis including the stoma site and performed an end-to-end tracheal anastomosis. The anastomosis was widely patent at 6 months follow-up. Long-term treatment of tracheal stenosis with T-tube does not preclude tracheal resection as a definitive treatment. A careful review of airway stenosis for resectability on a case-by-case basis is imperative.
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http://dx.doi.org/10.1007/s11748-019-01248-7DOI Listing
November 2020

Cost-Effectiveness of Transcatheter Aortic Valve Implantation Using a Balloon-Expandable Valve in Japan: Experience From the Japanese Pilot Health Technology Assessment.

Value Health Reg Issues 2020 May 25;21:82-90. Epub 2019 Oct 25.

Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan.

Background: Transcatheter aortic valve implantation (TAVI) is an innovative and effective treatment in high-surgical-risk (HR) and inoperable patients with symptomatic severe aortic stenosis.

Objectives: This cost-effectiveness analysis of transfemoral TAVI (TF-TAVI) compared with surgical aortic valve replacement (SAVR) conforms with the methodological guidelines for cost-effectiveness evaluation by the Ministry of Health, Labor, and Welfare in Japan.

Methods: The cost-effectiveness of TF-TAVI using SAPIEN XT was evaluated using a lifetime Markov simulation from the national payer perspective. Comparators were SAVR for HR patients and standard of care (SOC) for inoperable patients. A systematic literature review for clinical evidence of TF-TAVI and comparators was conducted. The evidence for TF-TAVI was derived from the SOURCE XT registry and Japanese post marketing surveillance. Because there was no literature directly or indirectly comparing TF-TAVI using SAPIEN XT with comparators, the comparator data were selected from relevant published studies, considering the similarity of study eligibility criteria and patient backgrounds (eg, age and surgical risk scores). Sensitivity analyses were used to validate the robustness of results.

Results: The incremental cost-effectiveness ratio of TF-TAVI versus SAVR for HR patients was ¥1.3 million/quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio of TF-TAVI versus SOC for inoperable patients was ¥3.5 million/QALY.

Conclusions: TF-TAVI was cost-effective when compared with SAVR for HR patients and when compared with SOC for inoperable patients, using a threshold of ¥5 million/QALY.
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http://dx.doi.org/10.1016/j.vhri.2019.07.013DOI Listing
May 2020

Humanistic and economic burden among caregivers of patients with cancer in Japan.

J Med Econ 2020 Jan 15;23(1):17-27. Epub 2019 Oct 15.

Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.

As the number of cancer patients increases in Japan, and people are living longer with cancer, the need for caregivers of cancer patients is expected to increase substantially. This study intended to reveal the humanistic and economic burden among caregivers of cancer patients, and to compare it with the burden among caregivers of patients with other conditions (other caregivers) and non-caregivers. This cross-sectional analysis used data from the Japan National Health and Wellness Survey 2017. Outcome measures included the Short Form 12-item Health Survey for health-related quality of life (HRQoL), EuroQol 5-dimension scale (EQ-5D) for health states utilities, Work Productivity and Activity Impairment questionnaire for the impact of health on productivity and activity, and indirect costs. Multivariate analysis was used to compare across groups, with adjustment for potential confounding effects. A total of 251 caregivers of cancer patients, 1,543 other caregivers, and 27,300 non-caregivers were identified. Caregivers of cancer patients (average 48.0 years old) tended to be younger than non-caregivers (51.5) and other caregivers (54.4) and had the highest education level (57.8% completed university education). Fewer non-caregivers had stress-related comorbidities than caregivers. Non-caregivers had significantly higher EQ-5D index scores than caregivers (average 0.81 vs. 0.73 vs. 0.74). Caregivers of cancer patients had significantly lower mental component summary scores than non-caregivers (40.18 vs. 46.70), and the difference indicated a clinically meaningful decrease in HRQoL. Caregivers of cancer patients had significantly higher presenteeism (37.31% vs. 20.43%), total work productivity impairment (38.85% vs. 21.98%), and activity impairment (40.94% vs. 25.78%) than non-caregivers. Additionally, caregivers of cancer patients had significantly higher total indirect costs (36.34% vs. 20.03% of average annual income). These results have implications for future healthcare planning, suggesting the importance of healthcare systems in Japan to consider the substantial burden borne by caregivers of cancer patients.
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http://dx.doi.org/10.1080/13696998.2019.1675672DOI Listing
January 2020

Cost-effectiveness Analysis of Empagliflozin in Japan Based on Results From the Asian subpopulation in the EMPA-REG OUTCOME Trial.

Clin Ther 2019 10 25;41(10):2021-2040.e11. Epub 2019 Sep 25.

Nippon Boehringer Ingelheim Co Ltd, Tokyo, Japan.

Purpose: The goal of this study was to assess the cost-effectiveness of empagliflozin in Japan based on the Asian subpopulation in the EMPA-REG OUTCOME trial.

Methods: The trial has shown a reduction in the risk for cardiovascular (CV) and renal events with empagliflozin in patients with type 2 diabetes mellitus and established CV disease. A cost-effectiveness analysis based on the overall population of the EMPA-REG OUTCOME trial was reported previously by using a lifetime discrete event simulation model. The same modeling frame was adapted to evaluate the cost-effectiveness of treatment with empagliflozin added to standard of care (SoC) compared with SoC alone in Japan. The time to relevant clinical events and the hazard ratios were derived from an Asian subpopulation in the EMPA-REG OUTCOME trial. The costs for each event were estimated from a Japanese medical claims database. Direct medical costs, life expectancy, and quality-adjusted life years (QALYs) were calculated from the public health care perspective.

Findings: Treatment with empagliflozin was estimated to increase life expectancy by 6.2 years and 2.7 QALYs, whereas total cost increased by 1,115,475 yen compared with treatment with SoC alone. The incremental cost-effectiveness ratio was 415,849 yen/QALY. In the sensitivity analysis, there was no case that was in excess of the reference value of the incremental cost-effectiveness ratio in the pilot introduction for price revision in Japan (ie, 5 million yen/QALY).

Implications: Based on the Asian subpopulation in the EMPA-REG OUTCOME trial, our results suggest that empagliflozin added to SoC is highly cost-effective compared with SoC alone in Japan.
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http://dx.doi.org/10.1016/j.clinthera.2019.07.016DOI Listing
October 2019

Cost-effectiveness analysis of percutaneous mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation in Japan.

J Med Econ 2019 Dec 27;22(12):1312-1320. Epub 2019 Sep 27.

Crecon Medical Assessment Inc, Tokyo, Japan.

The objective of the study is to evaluate the cost-effectiveness of percutaneous mitral valve repair (TMVr) with the MitraClip NT system (MitraClip procedure) for patients with symptomatic severe mitral regurgitation (MR) at high surgical risk in line with the methodological guideline for cost-effectiveness evaluation by the Ministry of Health, Labour and Welfare. The cost-effectiveness of MitraClip procedure was evaluated using a Markov model. Patients are classified into four New York Heart Association classes in each cycle. The model considered MitraClip complication ("major vascular complication", "major bleeding complication", "non-cerebral thromboembolism"), adverse events, re-implantation with MitraClip device, mitral valve surgery, and congestive heart failure hospitalization. For the evidence on additional benefits, a study compared with propensity score-matched medical therapy group was used in the analysis. The analysis was conducted from the perspective of a public healthcare payer with a discount rate of 2% for both cost and effectiveness. In the base-case analysis, total cost and quality-adjusted life year (QALY) gained (Life year (LY) gained) were 7,541,151 JPY and 3.23 QALYs (3.85 LYs) for MitraClip group, and 4,699,692 JPY and 1.79 QALYs (2.43 LYs) for medical therapy group, respectively. The incremental cost-effectiveness ratio (ICER) of MitraClip procedure versus medical therapy was 1.97 million JPY/QALY (US$18,570/QALY, US$1 = 106 JPY), which was evaluated to be cost-effective. The probability of ICER of MitraClip procedure versus medical therapy being 5 million JPY/QALY was 96.7%. There are two limitations. Firstly, the parameters for the comparators were based on some assumptions. However, it was a conservative setting against MitraClip group. Secondary, the mortality rate and adverse events of MitraClip group in a lifetime were estimated from data during a year after the procedure. MitraClip procedure improved life-years and quality of life in patients at high surgical risk and it was also a cost-effective treatment option.
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http://dx.doi.org/10.1080/13696998.2019.1668132DOI Listing
December 2019

[A Cost-effectiveness Analysis of Sunitinib vs. Interferon-alpha in Patient with Advanced Renal Cell Carcinoma in Japan].

Yakugaku Zasshi 2018 ;138(11):1397-1407

Department of Hospital Pharmaceutics, School of Pharmacy, Showa University.

Sunitinib has been shown to offer clinical benefits during the treatment of advanced renal cell carcinoma. However, molecular targeting drugs are expensive and can have a significant impact on medical expenses. The purpose of this study was to assess the cost-effectiveness of sunitinib as a first-line therapy compared with interferon-alpha (IFN-α) in metastatic renal cell carcinoma patients. A Markov model was used to show the clinical courses of patients with metastatic renal cell carcinoma who received sunitinib or IFN-α. The transition probabilities and utilities employed in this Markov model were derived from two sources. This study focused on the perspective of public healthcare payer, as only direct medical costs were estimated from the treatment schedule for metastatic renal cell cancer. In the cost-effectiveness analysis, outcomes were valued in terms of life years (LYs) and quality-adjusted life years (QALYs). We calculated the incremental cost-effectiveness ratio (ICER) during the cost-effectiveness analysis. The results were tested using Monte Carlo simulations. Sunitinib and IFN-α treatment resulted in LYs of 2.40 years and 2.03 years, QALYs of 1.58 and 1.25, and expected costs of 13,572,629 yen and 6,083,002 yen, respectively. As a result, the ICER associated with replacing IFN-α with sunitinib was 22,695,839 yen/QALYs. Our results suggest that compared with IFN-α, sunitinib prolongs LYs and QALYs, but the increases in quality achieved by sunitinib are more expensive than those produced by IFN-α.
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http://dx.doi.org/10.1248/yakushi.17-00189DOI Listing
November 2018

Health System Development and Performance in Korea and Japan: A Comparative Study of 2000-2013.

J Lifestyle Med 2016 Mar 31;6(1):16-26. Epub 2016 Mar 31.

Yonsei Global Health Center, Yonsei University, Wonju, Korea; Department of Health Administration, Graduate School, Yonsei University, Wonju, Korea; Institute for Poverty and Alleviation and International Development (IPAID), Wonju, Korea.

Background: The Japanese and Korean healthcare systems are very similar and thus, they have the same problems and weaknesses. This study discusses the problems and proposes complementary solutions based on the results of a comparative analysis of conditions in the healthcare systems of the two countries.

Methods: This article presents a comparative analysis of the healthcare status of the two countries based on certain health criteria used worldwide, a literature review, and data from the Korean Ministry of Health and Welfare, Japanese Ministry of Health, Labour and Welfare, World Health Organization (WHO), World Bank, and Organization for Economic Cooperation and Development (OECD).

Results: The scores of the healthcare systems were calculated for quantitative comparison. The performance of the Japanese health system was the best, followed by the Korean health system. Both countries observed an increased life expectancy and decreased infant and under-five mortality rates during the last 14 years. However, lower fertility rates were found, which could lead to a decreased working population and a subsequent increase in the economic burden of governments and households. A higher alcohol consumption rate was found in Korea, which was related to the establishment of interpersonal relationships.

Conclusion: The reform of the healthcare systems in Korea and Japan led to an increased life expectancy; concurrently, reduced fertility rates led to an increasing aging population. As a result, increasing health costs require additional measures to improve health equity and strengthen health promotion.
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http://dx.doi.org/10.15280/jlm.2016.6.1.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915763PMC
March 2016

Solitary pulmonary metastasis from occult papillary thyroid carcinoma.

Thorac Cancer 2016 Mar 15;7(2):261-3. Epub 2015 Jul 15.

Department of Pathology Sagamihara Kyodo Hospital Sagamihara Japan.

Pulmonary metastases from thyroid carcinoma typically cause a micronodular or miliary pattern throughout both lungs. Metastasis consisting of a solitary pulmonary nodule measuring 20 mm in diameter is rare. Here we report a case of a 66-year-old woman without a history of papillary thyroid carcinoma who presented with a pulmonary nodule measuring 20 mm in diameter, found on chest computed tomography during a health checkup. The patient underwent a right lobectomy. Microscopic examination showed well-differentiated papillary adenocarcinoma. Immunohistochemical findings were consistent with a diagnosis of pulmonary metastasis from papillary thyroid carcinoma. Solitary metastasis to the lung from occult thyroid carcinoma is quite rare, but if a pulmonary nodule is encountered in a patient without a history of thyroid carcinoma, the possibility must be considered.
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http://dx.doi.org/10.1111/1759-7714.12295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773299PMC
March 2016

Real-world cost analysis of chemotherapy for colorectal cancer in Japan: detailed costs of various regimens during the entire course of chemotherapy.

BMC Health Serv Res 2016 Jan 4;16. Epub 2016 Jan 4.

Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.

Background: Various chemotherapy regimens for advanced colorectal cancer have been introduced to clinical practice in Japan over the past decade. The cost profiles of these regimens, however, remain unclear in Japan. To explore the detailed costs of different regimens used to treat advanced colorectal cancer during the entire course of chemotherapy in patients treated in a practical setting, we conducted a so-called "real-world" cost analysis.

Method: A detailed cost analysis was performed retrospectively. Patients with advanced colorectal cancer who had received chemotherapy in a practical healthcare setting from July 2004 through October 2010 were extracted from the ordering system database of Showa University Hospital. Direct medical costs of chemotherapy regimens were calculated from the hospital billing data of the patients. The analysis was conducted from a payer's perspective.

Results: A total of 30 patients with advanced colorectal cancer were identified. Twenty patients received up to second-line treatment, and 8 received up to third-line treatment. The regimens identified from among all courses of treatment in all patients were 13 oxaliplatin-based regimens, 31 irinotecan-based regimens, and 11 regimens including molecular targeted agents. The average (95% confidence interval [95% CI]) monthly cost during the overall period from the beginning of treatment to the end of treatment was 308,363 (258,792 to 357,933) Japanese yen (JPY). According to the type of regimen, the average monthly cost was 418,463 (357,413 to 479,513) JPY for oxaliplatin-based regimens, 215,499 (188,359 to 242,639) JPY for irinotecan-based regimens, and 705,460 (586,733 to 824,187) JPY for regimens including molecular targeted agents. Anticancer drug costs and hospital fees accounted for 50 to 77% and 11 to 25% of the overall costs of chemotherapy, respectively.

Conclusion: The costs of irinotecan-based regimens were lower than those of oxaliplatin-based regimens and regimens including molecular targeted agents in Japan. Using a lower cost regimen for first-line treatment can potentially reduce the overall cost of chemotherapy. The main cost drivers were the anticancer drug costs and hospitalization costs.
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http://dx.doi.org/10.1186/s12913-015-1253-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698819PMC
January 2016

Dry pleurisy complicating solitary pulmonary nodules caused by Mycobacterium avium: a case report.

J Med Case Rep 2015 Oct 26;9:238. Epub 2015 Oct 26.

Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.

Introduction: Mycobacterium avium complex (MAC) lung disease presenting as a solitary pulmonary nodule (MAC-SPN) is often asymptomatic, is more common in middle to old age, and mimics lung cancer or tuberculoma. We report herein a case of MAC-SPN in an immunocompetent young adult patient, presenting with persistent chest pain and a subacutely progressive nodule with high intense (18)F-fluorodeoxyglucose uptake. Histological examination of resected specimens revealed pleurisy, which is a rare finding of MAC-SPN.

Case Presentation: A 36-year-old Japanese male presented with chest pain and a subacutely progressive pulmonary nodule. Positron emission tomography-computed tomography showed high intense (18)F-fluorodeoxyglucose uptake in the nodule. Owing to his continuous chest pain and subacutely progressive nodules, wedge resection was performed using video-assisted thoracoscopic surgery. Histological examination revealed an epithelioid granuloma and pleurisy, and the lung tissue culture was positive for mycobacteria identified as M. avium.

Conclusion: This is the first report of MAC-SPN occurring with persistent chest pain, suggesting that MAC should be considered in the differential diagnosis of a solitary pulmonary nodule, even for patients who experience persistent chest pain. As in the present case, surgical resection with video-assisted thoracoscopic surgery is a reasonable approach to the diagnosis and treatment of MAC-SPN with possible malignancy, especially as MAC can be diagnosed using resected lung tissue culture with histological confirmation.
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http://dx.doi.org/10.1186/s13256-015-0723-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623923PMC
October 2015

Pulmonary arterial enlargement predicts cardiopulmonary complications after pulmonary resection for lung cancer: a retrospective cohort study.

J Cardiothorac Surg 2015 Sep 9;10:113. Epub 2015 Sep 9.

Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan.

Background: The finding of pulmonary arterial enlargement on computed tomography has been reported to be associated with pulmonary hypertension. On the other hand, pulmonary hypertension is a known risk factor for thoracic surgery. We investigated whether pulmonary arterial enlargement predicts cardiopulmonary complications following pulmonary resection for lung cancer.

Methods: We reviewed 237 consecutive patients who underwent pulmonary resection for lung cancer. Preoperative patient characteristics (sex, age, Brinkman index, cardiopulmonary comorbidities, cardiothoracic ratio, pulmonary function, and pulmonary arterial enlargement) and surgical data (surgical procedure, pathological stage, postoperative complications, mortality, and length of postoperative hospital stay) were analyzed. In order to evaluate preoperative pulmonary arterial enlargement, we measured the diameter of the main pulmonary artery at its bifurcation and that of the ascending aorta at its widest point using chest computed tomography and calculated the ratio of the former diameter to the latter.

Results: In all, 16 patients developed postoperative cardiopulmonary complications and 221 did not. One patient died from postoperative pneumonia. The mean age of patients who developed postoperative cardiopulmonary complications was significantly higher than that of those who did not (78 ± 5 years vs 69 ± 9 years, P=0.0001). The pulmonary artery-to-ascending-aorta ratio was significantly higher in patients who developed postoperative complications than in those who did not (0.94 ± 0.15 vs. 0.81 ± 0.11, P=0.03). Other preoperative patient characteristics and surgical data did not differ significantly between the groups. On multivariate analysis, pulmonary artery-to-ascending-aorta ratio (0.1-point increase; odds ratio 2.3, 95 % confidence interval 1.5-3.5; P=0.0002) and age (1-year increase; odds ratio 1.2, 95 % confidence interval 1.1-1.3; P=0.03) were found to be independent predictors of postoperative cardiopulmonary complications.

Conclusions: A finding of pulmonary arterial enlargement on computed tomography is a potential predictor of postoperative cardiopulmonary complications after lung cancer surgery.
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http://dx.doi.org/10.1186/s13019-015-0315-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564964PMC
September 2015

[A study of the pharmacist work changes associated with dispensing unit-of-use packaging in community pharmacies].

Yakugaku Zasshi 2014 25;134(7):823-8. Epub 2014 Apr 25.

Faculty of Pharmaceutical Science, Meijo University.

This study aimed to determine how much time can be saved with the use of unit-of-use packaging for prescription drugs as compared with bulk packaging in community pharmacies as well as to determine the number of errors. In a simulation, mock prescriptions were dispensed either in unit-of-use packages or by transferring medication from a bulk container, and a time study was conducted to measure the time spent on dispensing and prescription auditing by pharmacists. Pharmacists' and patients' degree of satisfaction was also surveyed. The time saved with unit-of-use packaging was 66.25 s per prescription. The sole dispensing error that was found in the study occurred with bulk dispensing. Among both pharmacists and patients, many were of the opinion that dispensing with unit-of-use packaging was preferable to bulk dispensing. Unit-of-use packaging shortens the time that pharmacists spend on dispensing activities and increases the efficiency of their work. Unit-of-use packaging is also thought to reduce the number of counting errors.
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http://dx.doi.org/10.1248/yakushi.14-00013DOI Listing
September 2014

Determination of breath isoprene and acetone concentration with a needle-type extraction device in gas chromatography-mass spectrometry.

Clin Chim Acta 2014 Mar 6;430:156-9. Epub 2014 Feb 6.

Department of Environmental and Life Sciences, Toyohashi University of Technology, 1-1 Hibarigaoka, Tempakucho, Toyohashi 441-8580, Japan. Electronic address:

Background: Isoprene in human breath is said to be related to cholesterol metabolism, and the possibility of the correlations with some clinical parameters has been studied. However, at this stage, no clear benefit of breath isoprene has been reported for clinical diagnosis. In this work, isoprene and acetone concentrations were measured in the breath of healthy and obese subjects using a needle-type extraction device for subsequent analysis in gas chromatography-mass spectrometry (GC-MS) to investigate the possibility of these compounds as an indicator of possible diseases.

Methods: After measuring intraday and interday variations of isoprene and acetone concentrations in breath samples of healthy subjects, their concentrations were also determined in 80 healthy and 17 obese subjects. In addition, correlation between these breath concentrations and the blood tests result was studied for these healthy and obese subjects.

Results: The results indicated successful determination of breath isoprene and acetone in this work, however, no clear correlation was observed between these measured values and the blood test results.

Conclusions: Breath isoprene concentration may not be a useful indicator for obesity or hypercholesterolemia.
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http://dx.doi.org/10.1016/j.cca.2014.01.009DOI Listing
March 2014

[Research on the forecasting of trends in demand for pharmacists 2011-2035].

Yakugaku Zasshi 2014 ;134(2):277-91

Faculty of Pharmacy, Meijo University.

The first crop of pharmacists graduating from 6-year programs in pharmaceutical l education arrived in April 2012, and it will be important to incorporate new factors when predicting future trends in supply and demand for pharmacists. If we project supply given an exam pass rate of 75%, the supply of pharmacists will increase for the next 10 years or so if the number of exam takers is about 10000, and no decrease in the total number of pharmacists is expected until 2035. At pharmacies, a high degree of demand for the services of pharmacists can be expected to result from increases in the number of elderly patients and the number of patients receiving prescriptions, together with expanded accommodation of home health care, if the proportion of prescriptions that are actually filled up to 70%. At hospitals, demand has been projected to increase over the short term, owing to such factors as the trend toward having a resident pharmacist in each ward, advances in team medicine, and the spread of outpatient chemotherapy. Given the rising enrollment quotas for schools of pharmacy, and if the current supply and demand for pharmacists are maintained, we cannot rule out the possibility that pharmacists will come to be in excess supply within a 10-year horizon if the number of unemployed continues to decrease and the employment rate continues to improve along with changes in economic conditions and the consciousness of graduates of the 6-year programs.
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http://dx.doi.org/10.1248/yakushi.13-00229DOI Listing
September 2014

Randomized controlled trial of single-agent glimepiride and pioglitazone in Japanese patients with type 2 diabetes: A comparative study.

J Diabetes Investig 2011 Oct;2(5):391-8

Japan Association for Diabetes Education and Care ; Kansai Electric Power Hospital, Osaka, Japan.

Unlabelled: Aims/Introduction:  To compare first-line, single-agent glimepiride and pioglitazone in Japanese patients with type 2 diabetes uncontrolled by diet and exercise with respect to glycemic control, safety and metabolic changes.

Materials And Methods:   Patients with previously untreated type 2 diabetes were enrolled in a multicenter, randomized, non-blind, parallel-group trial of glimepiride (0.5-6 mg/day) or pioglitazone (15-45 mg/day) for 6 months.

Results:   A total of 191 patients aged 30-75 years were randomized. Similar percentages of patients attained the primary end-point, with glycated hemoglobin < 6.9% at month 6 with glimepiride and pioglitazone, respectively (61.2 vs 56.8%, P = 0.64). At month 6, the following significant (P < 0.05) intragroup changes in mean plasma lipid concentrations were noted as compared with baseline: total cholesterol decreased from 203.5 to 195.5 mg/dL and low-density lipoprotein (LDL)-cholesterol decreased from 124.5 to 116.3 mg/dL in the glimepiride group, whereas high-density lipoprotein (HDL)-cholesterol increased from 51.6 to 56.0 mg/dL and triglycerides decreased from 167.6 to 143.6 mg/dL in the pioglitazone group. The only symptomatic adverse events were mild-to-moderate in four patients receiving pioglitazone, and constipation in one patient receiving glimepiride. Similar numbers of patients experienced asymptomatic hypoglycemia (<60 mg/dL) in the glimepiride and pioglitazone groups (n = 7 and 5, respectively).

Conclusions:   There was no statistically significant difference between glimepiride and pioglitazone with respect to glycemic control, and both agents were well tolerated. Glimepiride significantly lowered total cholesterol and LDL-cholesterol, whereas pioglitazone increased HDL-cholesterol. This trial was registered with University Hospital Medical Information Network (UMIN), Japan, UMIN000004582. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00115.x, 2011).
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http://dx.doi.org/10.1111/j.2040-1124.2011.00115.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019308PMC
October 2011

Effects of patient-pharmacist communication in the treatment of asthma.

Yakugaku Zasshi 2009 Apr;129(4):427-33

Osaka University of Pharmaceutical Sciences, Japan.

We studied the relationship between patient-pharmacist communication and asthma treatment, including patient understanding of drug therapy, ability to self-treat with inhaled drugs, and control over asthma. The study was among adult patients who had received inhaled steroidal or other drugs from community pharmacies in Hokkaido, Ibaragi, Tochigi, Kanagawa, and Osaka prefectures for at least one year. During the month of November 2007, pharmacists explained the study to patients and obtain consent before distributing questionnaires to be filled out and mailed back. Survey items covered the nature/extent of the pharmacist's explanation, the patient's degree of understanding, frequency of inhaled steroid use, frequency of asthma attacks, degree of improvement with inhaler use, skill in using inhaled drugs, and self-evaluation of communication with the pharmacist. Analysis was carried out using the 114 valid data sets obtained. The ratio of men to women was 4: 6, and the average age was 61.8 years. Compared with patients citing communication problems with pharmacists, those who had good communication received significantly higher scores in terms of understanding the purpose of inhalers, drug interactions, and side effects, and coping with attacks, as well as in indices of skill in using inhaled drugs. The degree of improvement in asthma attacks was also significantly higher among patients with self-evaluation of good communication with pharmacists. We suggest that communication between patient and pharmacist is associated with understanding of pharmacotherapy, as well as their ability to use inhaled medications and gaining good control over their asthma.
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http://dx.doi.org/10.1248/yakushi.129.427DOI Listing
April 2009

[Study of clarifying incidence of lifestyle-related diseases and related complications and its medical expenses using government-managed health insurance data].

Nihon Eiseigaku Zasshi 2008 May;63(3):651-61

Meijo University, Faculty of Pharmaceutical Science, Nagoya, Japan.

Objectives: In this study, analysis was performed with the objective of clarifying the incidence of lifestyle-related diseases and related complications and its medical expenses.

Methods: A random sample population of people insured under government-managed health insurance in Mie Prefecture, Japan, who had undergone annual health examinations in 1993, 1998, and 2003, and who had incurred medical costs in 2003 was analyzed. The relationship between the results of health examinations in 1993 and medical costs in 2003 was investigated by examining 2,165 individuals whose data were available. The relationship between medical costs and risk factors including diabetes, hypertension, hyperlipemia, cerebrovascular disease, and ischemic heart disease was examined by analysis of covariance adjusted by sex and age.

Results: There was a higher doctor consultation rate for diabetes, hypertension, and hyperlipemia after 10 years among people presenting with high Body Mass Index, blood pressure, serum lipid, and plasma glucose.

Conclusions: It was shown that there is a relationship of having lifestyle-related diseases and related complications with doctor consultation rate and medical expenditure.
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http://dx.doi.org/10.1265/jjh.63.651DOI Listing
May 2008

[Utility-based evaluation of the quality of life of patient's with gastric cancer who receive chemotherapy--comparison of patients' quality of life between oral TS-1 and conventional injectable combination therapy].

Yakugaku Zasshi 2008 May;128(5):783-93

Department of Pharmacy, Showa University Hospital, Shinagawa-ku, Tokyo, Japan.

We tried to clarify the applicability of "utility" for the evaluation of patient's QOL with gastric cancer after chemotherapy and attempted to compare differences in QOL after treatment with the oral antitumor agent TS-1 or with a conventional injectable combination. Three items, moving activity, pain, and gastrointestinal symptoms, were employed as indicators of patient QOL, and then the assessment of utility was compared based on the expected outcomes that 9 pharmacists working on a ward, 9 nurses working on a neurosurgery ward, and 9 nurses working on a gastrointestinal surgery ward estimated directly using the three methods of standard gamble, time trade-off, and rating scale according to predictive scenarios based on each scenario. The QOL of patients who received the two different types of chemotherapy were also compared as the average utilities from the direct estimation depending on patient conditions as used for chart review. Furthermore, the average utilities were compared with the utility of the mapping method, which can be estimated by applying a utility-converting table defined in the EQ-5D survey. The average utility from each practitioner using the direct estimation revealed that the assessed utility from nurses working on a neurosurgery ward was higher than those of the pharmacists. The average utility obtained using the standard gamble method was higher than those using the rating scale and time trade-off methods. The average utility in the TS-1 therapy group was 0.84-0.94, and that in the conventional injectable therapy group was 0.52-0.79 (p<0.05). The result suggests that utility is applicable for estimation of gastric cancer patient QOL after chemotherapy, and that TS-1 therapy is superior to the traditional injectable combination therapy.
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http://dx.doi.org/10.1248/yakushi.128.783DOI Listing
May 2008

Modified sagittal split ramus osteotomy for malpositioned mandibular foramina with prognathia.

J Oral Maxillofac Surg 2007 Sep;65(9):1803-7

Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo, Chiba, Japan.

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http://dx.doi.org/10.1016/j.joms.2006.06.263DOI Listing
September 2007

[A study of the association between the results of health examinations and medical costs 10 years thereafter using government-managed health insurance data].

Nihon Koshu Eisei Zasshi 2007 Jun;54(6):368-77

Toho University, School of Medicine, Tokyo, Japan.

Objectives: Using a data set combining the results of lifestyle-related disease prevention health examinations with medical fee receipts for individuals insured under government managed health insurance, a study was conducted to evaluate the effect of health examination results on medical costs 10 years thereafter.

Methods: A random sample stratified by sex and age was drawn from people insured under the government managed health insurance in Mie Prefecture, Japan, who had undergone annual health examinations in 1993, 1998, and 2003, and who had incurred medical costs in 2003. By examining a sample of 2,165 individuals for whom data were available, an analysis was performed on the relationship between the results of health examinations in 1993 and medical costs in 2003. Costs were converted to a logarithmic scale and analyzed by one way analysis of variance. The relationship between risks and medical costs was examined through analysis of characteristics adjusted for sex and age.

Results: As expected, health examination results and medical costs were related to sex and age. After adjustment for these factors, medical costs were found to be significantly higher in all test categories among individuals with known risk factors, when compared to individuals without such risk factors. Medical costs were approximately four times higher for persons with four risk factors (21,889 points) than for persons with none (5,234 points) (P < 0.001).

Conclusion: It was shown that an analysis of the relationship between health examination results and medical costs can be applied to better target health guidance and to identify high-priority cases.
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June 2007

Microarray analysis of IL-1beta-stimulated chemokine genes in synovial fibroblasts from human TMJ.

J Oral Pathol Med 2007 Apr;36(4):223-8

Department of Maxillofacial Surgery, Nihon University School of Dentistry at Matsudo, Chiba, Japan.

Background: Interleukin (IL)-1beta is thought to play a key role in several pathologic conditions of the temporomandibular joint (TMJ). Gene expression profile of synovial fibroblasts stimulated with IL-1beta was studied by oligonucleotide microarray analysis to elucidate candidate genes associated with intracapsular pathologic conditions of TMJ.

Methods: RNA was isolated from synovial fibroblasts from five patients after IL-1beta treatment. Gene expression profiling was performed with a GeneChip. Changes in gene expression were determined by comparing IL-1beta-treated cells with untreated cells.

Results: A total of 121 genes showed a greater than threefold difference in average intensity between untreated and IL-1beta-treated synovial fibroblasts in five experiments. Five chemokines were among the 10 most upregulated genes, and the most upregulated gene was CCL20. The 121 IL-1beta-responsive genes included 12 chemokines whose mRNA levels were confirmed by real-time PCR.

Conclusion: These data should provided useful information about the pathologic conditions of TMJ, especially in support of diagnosis and therapeutic approaches to TMJ.
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http://dx.doi.org/10.1111/j.1600-0714.2007.00515.xDOI Listing
April 2007

Expression profile of chemokines and chemokine receptors in epithelial cell layers of oral lichen planus.

J Oral Pathol Med 2006 Mar;35(3):167-74

Department of Microbiology and Immunology, Nihon University School of Dentistry at Matsudo, Chiba, Japan.

Background: To understand the immunopathological features of oral lichen planus (OLP), we analyzed the expression of chemokines in the epithelial cell layers.

Methods: Epithelia from OLP or healthy gingiva were collected by laser microdissection. The chemokine and chemokine receptor expressions in the epithelia were analyzed by DNA microarray.

Results: High levels of MIP-3alpha/LARC/CCL20 and its receptor CCR6 were expressed in the lesional epithelia. Furthermore, DC-CK1/CCL18, ELC/CCL19, SDF-1/CXCL12 and CXCR4 expressions were also increased. Immunohistologial analysis showed that high numbers of Langerhans cells (LCs) were present in the epithelia of OLP. Lesional epithelia also expressed high levels of the ligands specific for CXCR3 (e.g. MIG/CXCL9, IP-10/CXCL10 and I-TAC/CXCL11) and CCR5 (e.g. RANTES/CCL5).

Conclusions: Infiltration of LCs is orchestrated by CCR6. Further, LCs residing in the lesional epithelia may be a mature phenotype. Moreover, infiltration of T cells in OLP could be mediated by signaling pathways through CXCR3 and CCR5.
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http://dx.doi.org/10.1111/j.1600-0714.2006.00402.xDOI Listing
March 2006
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