Publications by authors named "Kazuo Maeda"

24 Publications

  • Page 1 of 1

Enarodustat, Conversion and Maintenance Therapy for Anemia in Hemodialysis Patients: A Randomized, Placebo-Controlled Phase 2b Trial Followed by Long-Term Trial.

Nephron 2019 22;143(2):77-85. Epub 2019 May 22.

Fukuoka Renal Clinic, Fukuoka, Japan.

Background: Enarodustat (JTZ-951) is an orally available hypoxia-inducible factor prolyl hydroxylase inhibitor that increases endogenous erythropoietin levels in the treatment of anemia associated with chronic kidney disease (CKD).

Objective: A phase 2b study of enarodustat to assess the hemoglobin (Hb) response, safety, and maintenance dosage was conducted in Japanese anemic patients with hemodialysis-dependent CKD.

Methods: Subjects receiving a stable dose of an erythropoiesis-stimulating agent were randomized to receive once-daily enarodustat at a dose of 2, 4, or 6 mg or placebo in a double-blind manner for 6 weeks (Period 1) followed by 24-week open treatment with enarodustat, adjusted in the range of 2-8 mg to maintain Hb within a target range (10.0-12.0 g/dL; Period 2).

Results: Change in Hb from baseline increased with enarodustat dose in Period 1. In Period 2, the proportion of subjects who maintained their Hb level within the target range at the end of treatment was 65.1%. To maintain Hb levels within the target range over the course of Period 2, approximately 80% of subjects required 2 dose adjustments or fewer. Enarodustat decreased hepcidin and ferritin levels, increased total iron-binding capacity, and was generally well tolerated.

Conclusions: Enarodustat corrected and maintained Hb levels in anemic patients with hemodialysis-dependent CKD. Phase 3 studies of enarodustat are currently ongoing.
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http://dx.doi.org/10.1159/000500487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878752PMC
May 2020

A Social Program for the Early Detection of Pancreatic Cancer: The Kishiwada Katsuragi Project.

Oncology 2017 20;93 Suppl 1:89-97. Epub 2017 Dec 20.

Department of Gastroenterology, Katsuragi Hospital, Osaka-Sayama, Japan.

Objectives: The early-stage pancreatic cancer (e-PC; stage I/II) detection rate is quite low at approximately 25%. The aim of this study was to evaluate the feasibility of a social program (the Kishiwada Katsuragi project) wherein our hospital, which specializes in PC, and primary care medical offices (PMOs) used clinical findings to detect e-PC.

Methods: Patients with a score of ≥2 points on clinical findings were enrolled: symptoms of abdominal pain/back pain (1 point), new-onset diabetes (1 point), high amylase (AMY) and/or pancreaitc AMY (P-AMY) (1 point), high carbohydrate antigen 19-9 (1 point), and ultrasonography (US) findings including direct (e.g., a solid pancreatic tumor) and/or indirect findings (e.g., dilatation of a pancreatic diameter of ≥2.5 mm and/or cystic lesions) (2 points) were evaluated using the protocol for social programs.

Results: Between November 2014 and December 2016, 244 patients were enrolled by 41 PMOs as cooperative facilities, and 15 e-PC cases (53.6%) of the 28 PC patients were detected. The mean clinical finding score of the e-PC group (3.13 ± 1.9) was significantly higher than that of the overall non-PC group (2.1 ± 0.4) (p < 0.05). "High AMY/P-AMY" and "symptoms" were significantly more frequent in the e-PC group than in the non-PC group (p < 0.05). Although the sensitivity of direct findings by US was 40.0%, that of indirect-findings was 93.3% in the e-PC group. Nine and 6 of the 15 patients with e-PC were enrolled via general internal medicine offices (GIMs) and other PMOs without GIMs (general surgery, n = 3; urology, n = 2; otolaryngology, n = 1).

Conclusion: This social program with collaborations between medical centers that specialize in PC and PMOs used clinical findings, suggesting that not only GIMs but also other PMOs and indirect findings by US may play an important role in improving the e-PC detection rate.
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http://dx.doi.org/10.1159/000481239DOI Listing
December 2017

Invention of ultrasonic Doppler fetal actocardiograph and continuous recording of fetal movements.

Authors:
Kazuo Maeda

J Obstet Gynaecol Res 2016 Jan 29;42(1):5-10. Epub 2015 Dec 29.

Department of Obstetrics and Gynecology (Emeritus), Tottori University Medical School, Yonago, Japan.

Aims: To enable scientific studies on fetal movements and its relation to fetal heart rate directly detecting fetal chest motion with ultrasonic Doppler method.

Methods: A prototype of an ultrasonic Doppler fetal actocardiograph (ACG) was designed and handmade by the author. A 2 MHz ultrasound fetal heart rate (FHR) monitor was remodeled to detect fetal heartbeat and chest movement Doppler signals with a single ultrasound probe. The fetal movement Doppler signal was 20-50 Hz using 2 MHz ultrasound, separated from the fetal heartbeat Doppler signal, which was 100 or more Hz and sent to the autocorrelation FHR meter to record FHR curve, while fetal movement Doppler signals were detected through 20-80 Hz band-pass filter, and changed to spikes recorded on a cardiotocography chart.

Results: The spike amplitudes of a moving steel ball expressed fetal movement on the ACG. FHR acceleration synchronized with fetal movement bursts. Fetal resting and active states are separated using the ACG. Fetal hiccupping movements on ACG were regular continuous spikes with 2-3 s intervals.

Conclusion: Fetal movements and hiccups were correctly recorded with the FHR curve. The relation of FHR and movement will be further clarified in future ACG readings.
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http://dx.doi.org/10.1111/jog.12855DOI Listing
January 2016

Electroencephalographic studies of eclampsia and pre-eclampsia.

Authors:
Kazuo Maeda

J Obstet Gynaecol Res 2016 Jan 8;42(1):11-20. Epub 2015 Dec 8.

Department of Obstetrics and Gynecology (Emeritus), Tottori University Medical School, Yonago, Japan.

Aims: To investigate eclampsia and pre-eclampsia electroencephalograms (EEGs) and related animal experiments, and to publish a Japanese article in English.

Materials And Methods: A two channel EEG system constructed with a self-made vacuum tube amplifier, optical recorder, signal generator, a magic-eye signal monitor and a shield room were prepared by the author. EEGs were recorded in five admitted eclamptic and 35 pre-eclamptic cases before, during and after convulsion until clinical recovery. The hypothalami of female rabbits were stimulated with Kurotsu's electrode, and blood pressure and urinary proteins were studied before and after stimulation. The rabbits cortical and hypothalamic EEGs were studied.

Results: Frontal and occipital EEG waves synchronized immediately before and during eclamptic convulsions and during coma. Large δ waves were characteristic during the coma after convulsions. Moderately slow waves were recorded in cases of pre-eclampsia. In animal experiments, hypertension and proteinuria appeared in cases of hypothalamic sympathetic zone stimulation, while there was no change in parasympathetic stimulation.

Conclusion: Eclamptic convulsion is evoked by synchronization of the whole cortex controlled by a heavily excited hypothalamus. Pregnancy hypertension and proteinuria is caused by the excited sympathetic center of the hypothalamus.
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http://dx.doi.org/10.1111/jog.12856DOI Listing
January 2016

3D/4D sonography - any safety problem.

J Perinat Med 2016 Mar;44(2):125-9

Gray-scale image data are processed in 3D ultrasound by repeated scans of multiple planes within a few seconds to achieve one surface rendering image and three perpendicular plane images. The 4D image is achieved by repeating 3D images in short intervals, i.e. 3D and 4D ultrasound are based on simple B-mode images. During 3D/4D acquisition, a fetus in utero is exposed by ultrasound beam for only a few seconds, and it is as short as real-time B-mode scanning. Therefore, simple 3D imaging is as safe as a simple B-mode scan. The 4D ultrasound is also as safe as a simple B-mode scan, but the ultrasound exposure should be shorter than 30 min. The thermal index (TI) and mechanical index (MI) should both be lower than 1.0, and the ultrasound study is regulated by the Doppler ultrasound if it is combined with simple 3D or 4D ultrasound. Recently, some articles have reported the functional changes of animal fetal brain neuronal cells and liver cell apoptosis with Doppler ultrasound. We discuss cell apoptosis by ultrasound in this report. Diagnostic ultrasound safety is achieved by controlling the output pulse and continuous ultrasound waves using thermal and mechanical indices, which should be <1.0 in abdominal and transvaginal scan, pulsed Doppler, as well as 3D and 4D ultrasound. The lowest spatial peak temporal average (SPTA) intensity of the ultrasound to suppress cultured cell growth is 240 mW/cm2, below which no ultrasound effect has been reported. An ultrasound user must be trained to recognize the ultrasound bioeffects; thermal and mechanical indices, and how to reduce these when they are higher than 1.0 on the monitor display; and guide the proper use of the ultrasound under the ALARA principle, because the user is responsible for ensuring ultrasound safety.
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http://dx.doi.org/10.1515/jpm-2015-0225DOI Listing
March 2016

Highly improved perinatal states in Japan.

Authors:
Kazuo Maeda

J Obstet Gynaecol Res 2014 Aug;40(8):1968-77

Department of Obstetrics and Gynecology (Emeritus), Tottori University Medical School, Yonago, Japan.

To report on improved perinatal states in Japan, governmental and United Nations Children's Fund reports were analyzed. Initial maternal mortality, which was 409.8 in 1899, decreased to 4.1 in 2010, with a reduction rate of 409.8/4.1 (102.4) in 111 years: 2.5 in the initial 50 years in home delivery and 39.3 in the later 60 years in hospital births. The difference between 2.5 versus 39.3 was attributed to the medicine and medical care provided in hospital births. The total reduction of neonatal mortality was 77.9/1.1 (70.8), and the rate in the initial 50 versus later 60 years was 2.8/25. Also, there was a big difference after introduction of extensive neonatal care. Virtual perinatal mortality after 22 weeks was estimated to be 428 in 1000 births in 1900 (i.e. those infants born at 22-28 weeks were unlikely to survive at that time), while the perinatal mortality was reported to be 22 weeks or more in 1979 (i.e. premature babies born at ≥22 weeks survived in 1979 because of the improved neonatal care). Actually, 60% of premature infants of 400-500 g survived in the neonatal intensive care unit. In a recent report, 36% of infants born at 22 weeks survived to 3 years. Although there were neurodevelopmental impairments, outcomes were improved. In conclusion, perinatal states have remarkably improved in Japan.
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http://dx.doi.org/10.1111/jog.12485DOI Listing
August 2014

Modalities of fetal evaluation to detect fetal compromise prior to the development of significant neurological damage.

Authors:
Kazuo Maeda

J Obstet Gynaecol Res 2014 Oct 11;40(10):2089-94. Epub 2014 Aug 11.

Department of Obstetrics and Gynecology, Tottori University Medical School, Yonago, Japan.

Aims: The aim of this study was to clarify the developmental mechanism underlying fetal heart rate (FHR) long-term variability (LTV) and acceleration with respect to fetal brain damage.

Material And Methods: The fetal state was deduced from the developmental mechanism of FHR variability analyzed by actocardiogram, animal experiments, and simulations.

Results: LTV develops due to minor fetal movements in the fetal midbrain, moderate LTV by fetal periodic movements and triangular accelerations by large fetal movement bursts. Stimulation of the fetal midbrain by sound and light produces fetal movements that lead to FHR acceleration. Severe hypoxia can result in the loss of LTV and neuronal necrosis that may damage the fetal brain. Therefore, a cesarean section is recommended prior to the loss of LTV, rather than after its loss. The vagal center of the fetal medulla oblongata is excited by hypoxia and produces FHR bradycardia. The heart rate of hypoxic rabbits was found to be closely correlated with the PaO₂, thus the impact of hypoxia could be estimated by the hypoxia index, which is calculated from the reciprocal of nadir FHR and bradycardia duration.

Conclusions: Analyzing the development of FHR signs could help to diagnose fetal state. An early cesarean section is recommended before the loss of LTV as indicated by the hypoxia index, which will contribute to prevent fetal brain damage and neurological sequels.
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http://dx.doi.org/10.1111/jog.12481DOI Listing
October 2014

Origin of the long-term variability and acceleration of FHR studied for the prevention of cerebral palsy in fetal hypoxia and general insults.

Authors:
Kazuo Maeda

J Perinat Med 2014 May;42(3):401-3

Aims: The development of fetal heart rate (FHR) variability and acceleration, and their loss in the hypoxic brain damage and cerebral palsy (CP) is investigated.

Methods: FHR, movements in physiologic sinusoidal FHR and fetal movements were studied by actocardiogram.

Results: Periodic fetal respiratory movements evoked moderate FHR variation similar to medium variability. Small fetal movements provoked FHR variability, and large fetal movement burst developed the acceleration. The brain centers should be midbrain for variability and acceleration. FHR variability and acceleration develop by the reaction of fetal brain to fetal movements. As severe organic fetal brain damage could develop through fetal hypoxia in the loss of variability, early delivery before the loss of variability will prevent infantile CP. As the abnormal FHR would be developed by fetal brain damage in non-hypoxic fetal insults, early delivery before the loss of variability could also prevent the brain damage in viral and bacterial infections.
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http://dx.doi.org/10.1515/jpm-2013-0134DOI Listing
May 2014

Preeclampsia is caused by continuous sympathetic center excitation due to an enlarged pregnant uterus.

Authors:
Kazuo Maeda

J Perinat Med 2014 Mar;42(2):233-7

Aims: To deduce the origin of preeclampsia characterized by hypertension and proteinuraia on the basis of results from animal studies and its therapeutic strategies.

Methods: Sympathetic and parasympathetic zones of female non-pregnant rabbit brain were stimulated electrically with Kurotu's electrodes. Systolic blood pressure, urine volume, and proteinuria were evaluated before and after the stimulation of autonomic zones.

Results: Excitation, hypertension, urine reduction, cloudy urine, and proteinuria were observed following stimulation of the sympathetic zone. A stable state, low blood pressure, increased urine volume, and no proteinuria were observed following stimulation of the parasympathetic zone.

Conclusion: Hypertension and proteinuria in preeclampsia are caused by continuous stimulation of the sympathetic nervous center in the hypothalamus through the innervation between the enlarged uterus and hypothalamus in the latter stages of pregnancy or in a complete hydatidiform mole. Future studies are needed to address the potential of pharmacological suppression of an overactive sympathetic nerve system.
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http://dx.doi.org/10.1515/jpm-2013-0096DOI Listing
March 2014

A Case of Cystic Basal Cell Carcinoma Which Shows a Homogenous Blue/Black Area under Dermatoscopy.

J Skin Cancer 2011 23;2011:450472. Epub 2010 Sep 23.

Department of Dermatology, School of Medicine, Sapporo Medical University, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan.

Basal cell carcinoma (BCC) is the most common skin tumor and contains several different histopathological types. Here, we report a case of cystic basal cell carcinoma, which is relatively rare and might be clinically misdiagnosed. A dermatoscopic examination of the case revealed a homogenous blue/black area usually not seen in BCC. We reviewed 102 BCC cases resected and diagnosed at Sapporo Medical University Hospital between April 2005 and March 2010. Among them, only three were the cystic type.
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http://dx.doi.org/10.1155/2011/450472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989656PMC
July 2011

Noninvasive fetal lung maturity prediction based on ultrasonic gray level histogram width.

Ultrasound Med Biol 2010 Dec 15;36(12):1998-2003. Epub 2010 Oct 15.

Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan.

The aim of this work was to noninvasively predict fetal lung immaturity with the ultrasonic gray level histogram width (GLHW), a form of clinical tissue characterization. The study included 22 fetuses in which infant respiratory distress syndrome (IRDS) developed post-delivery, and 25 fetuses without IRDS development. Independent receiver operating characteristic (ROC) analysis of fetal lung-to-liver GLHW ratios, fetal weights, gestational ages and the product of GLHW ratios by gestational ages for this cohort indicated that optimal thresholds for these parameters to differentiate immature from mature were 0.94, 1.750 g, 31 weeks and 29, respectively. With the optimal decision threshold of 0.94, the GLHW ratio provided sensitivity and specificity of 0.86 and 0.72, respectively. The corresponding values for gestational age were 0.77 and 0.68, 0.77 and 0.60 for fetal weight versus 0.96 and 0.72 for the product of GLHW ratio by fetal age, which was comparable with invasive amniotic fluid tests. The areas under the ROC curve for these parameters were 0.82, 0.82, 0.70 and 0.91. We found that GLHW is a noninvasive, stable and reliable measure of fetal lung maturity using commercial scanners.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2010.08.011DOI Listing
December 2010

Loss of FHR variability diagnosed by frequency analysis.

J Perinat Med 2010 03;38(2):197-201

Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.

Aims: To determine the loss of fetal heart rate (FHR) baseline variability by frequency analysis.

Methods: The FHR tracings of 12 normal fetuses and others with various conditions, as well as flat FHR tracings of a late deceleration (LD) and anencephaly recorded with Doppler fetal monitors, were scanned and processed using fast Fourier transform (FFT) analysis. The ratio of the area under the low frequency spectrum divided by the area under the whole spectrum (La/Ta) and the peak power spectrum density (PPSD) were determined.

Results: Long-term variability (LTV) measures >10 bpm revealed significantly more La/Ta and PPSD than LTV <10 bpm in normal FHR tracings. The La/Ta and PPSD were >15% and 60 bpm(2)/Hz, respectively, in representative values of normal FHR cases and in those of fetal respiration, hiccupps and non-reactive FHR, whereas those of the flat baseline of LD and anencephaly were <15% and 60 bpm(2)/Hz.

Conclusion: Loss of baseline variability is diagnosed when the La/Ta ratio and PPSD are <15% and 60 bpm(2)/Hz, respectively, based on the FFT frequency analysis of the FHR baseline.
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http://dx.doi.org/10.1515/jpm.2010.036DOI Listing
March 2010

Detailed multigrade evaluation of fetal disorders with the quantified actocardiogram.

J Perinat Med 2009 ;37(4):392-6

Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.

Aims: To evaluate fetal disorders using detailed quantitative values from the actocardiogram (ACG) involving simultaneous tracing of ultrasonic Doppler fetal movement bursts and fetal heart rate (FHR).

Methods: Duration of FHR accelerations and fetal movement bursts were measured manually in 20 common fetal disorders. The severity of the fetal disorder was estimated using the FHR acceleration duration to movement burst ratio (A/B ratio) and 10-0 clinical severity ranks derived from the A/B ratio. The correlation of the A/B ratio and 1 and 5 min Apgar scores, as well as numerically expressed long-term outcomes were studied.

Results: A/B ratios were significantly correlated with the 1 and 5 min Apgar scores and the numerically evaluated long-term outcomes. Controversial cases of FHR pattern were more easily understood using the A/B ratio. The 10-0 severity derived from the A/B ratio was useful in clinical fetal studies.

Conclusion: Common fetal disorders were evaluated quantitatively and in more detail using the A/B ratio from the actocardiogram than when using common binary good or bad evaluation. The A/B ratio was useful in outcome estimation, where the prognostic capability of the A/B ratio was confirmed by significant correlation with 1 and 5 min Apgar scores and long-term outcomes of fetal disorders.
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http://dx.doi.org/10.1515/JPM.2009.056DOI Listing
September 2009

Time-lapse cinematography of dynamic changes occurring during in vitro development of human embryos.

Am J Obstet Gynecol 2008 Dec 27;199(6):660.e1-5. Epub 2008 Sep 27.

Reproductive Centre, Mio Fertility Clinic, Tottori University Medical School, Yonago, Japan.

Objective: The purpose of this study was to clarify developmental changes of early human embryos by using time-lapse cinematography (TLC).

Study Design: For human ova, fertilization and cleavage, development of the blastocyst, and hatching, as well as consequent changes were repeatedly photographed at intervals of 5-6 days by using an inverse microscope under stabilized temperature and pH. Photographs were taken at 30 frames per second and the movies were studied.

Results: Cinematography has increased our understanding of the morphologic mechanisms of fertilization, development, and behavior of early human embryos, and has identified the increased risk of monozygotic twin pregnancy based on prolonged incubation in vitro to the blastocyst stage.

Conclusion: Using TLC, we observed the fertilization of an ovum by a single spermatozoon, followed by early cleavages, formation of the morula, blastocyst hatching, changes in the embryonic plates, and the development of monozygotic twins from the incubated blastocysts.
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http://dx.doi.org/10.1016/j.ajog.2008.07.023DOI Listing
December 2008

Fetal extremity kinetics quantified with Doppler ultrasonography.

J Perinat Med 2008 ;36(1):82-6

Unit of Ultrasound and Fetal Medicine, University Hospital of Canary Islands, Tenerife, Spain.

Aims: To assess the responsive fetal extremity movement to vibro-acoustic stimulation test (VAST).

Methods: The moving velocity of fetal femur was assessed after VAST by pulsed Doppler device. The ultrasonic beam was insonated at a right angle to the fetal femur. The following parameters were determined: limb retreat velocity in accelerative slope (Pk1); limb replenishment velocity in decelerative slope (Pk2); mean flexion to extension velocity; and the response time to VAST. Among 80 normal singleton pregnancies in 33-41 weeks, 68 were weekly evaluated and the others were assessed for two or more times during the study period, for a total of 680 studies of fetal kinetics.

Results: The Pk1 declined from 9.6 to 6.26 cm/s; Pk2 decreased from 2.6 to 1.3 cm/s; mean velocity was reduced from 6.0 to 4.25 cm/s; whereas the response time increased from 0.1 to 0.3 s throughout the study period, i.e., fetal response reduces and the response time increases as maturation progresses.

Conclusion: The pulsed Doppler may assess fetal activity in any body structure. Reflex responses become slow and complex on both the velocity and response time as maturation increases with gestational age. Our observations have resulted in a novel and easy method for the quantitative assessment of fetal reflex reactivity to external stimuli.
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http://dx.doi.org/10.1515/JPM.2008.008DOI Listing
May 2008

Tissue characterization of uterine myometrium using the ultrasound gray-level histogram width.

J Med Ultrason (2001) 2007 Dec 14;34(4):189-92. Epub 2007 Dec 14.

Tottori University, Tottori, Japan.

Purpose: The purpose of this study was to clarify the usefulness of the gray-level histogram width for tissue characterization of the uterine myometrium.

Methods: Thirty-five patients with uterine fibroids, 5 patients with adenomyosis, and 9 patients with extensive myometrial invasion by endometrial carcinoma were studied. The gray-level histogram width was determined by transvaginal ultrasonography. The Mann-Whitney U test was used for statistical analysis. Receiver operating characteristic curves were generated for use in tissue characterization.

Results: Significant differences in the gray-level histogram width were found between normal myometrium (54.2% ± 4.2%) and carcinoma (58.2% ± 3.9%), normal myometrium and fibroid (64.3% ± 5.2%), and carcinoma and fibroid. However, it was difficult to identify adenomyosis. The cutoff values to distinguish normal myometrium from carcinoma, normal myometrium from fibroid, and carcinoma from fibroid are 56, 58, and 64, respectively.

Conclusion: The gray-level histogram width is useful for tissue characterization of the uterine myometrium.
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http://dx.doi.org/10.1007/s10396-007-0153-zDOI Listing
December 2007

The status of the embryo in Buddhism: opinions on scientific and religious controversies about the beginning of human life.

Authors:
Kazuo Maeda

J Perinat Med 2007 ;35(5):384

Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.

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http://dx.doi.org/10.1515/JPM.2007.105DOI Listing
December 2007

Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions.

J Perinat Med 2006 ;34(5):398-403

Department of Obstetrics and Gynecology Emeritus, Tottori University, Yonago, Japan.

Aims: This study examined whether analysis of fetal behavioral states by monitoring fetal heart rate and movement using an actocardiogram (ACG), could provide prognostic information related to fetal central nervous system (CNS) lesions.

Methods: The ACG simultaneously records fetal heart rate (FHR) and fetal movement bursts composed of spikes of ultrasonic Doppler signals. Durations of FHR accelerations and fetal movement bursts were measured manually. Five actocardiographic indices were studied in 12 fetuses with CNS lesions and in 14 normal pregnancies of 28-38 weeks.

Results: Severity of the fetal CNS lesions was estimated from the acceleration/burst (A/B) duration ratio, which correlated with the rank of the sonographic fetal functional test in cases with CNS lesions. Severity of a fetal lesion may also be estimated by the regression equation of the A/B duration ratio and behavioral ranking.

Conclusion: The severity of fetal CNS lesions may be estimated by quantitative analysis of ACG usings the measurement of A/B duration ratio to provide a prognosis. An ACG may demonstrate a loss of CNS control in cases with severe brain damage.
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http://dx.doi.org/10.1515/JPM.2006.079DOI Listing
February 2007

"Proton-pump inhibitor-first" strategy versus "step-up" strategy for the acute treatment of reflux esophagitis: a cost-effectiveness analysis in Japan.

J Gastroenterol 2005 Nov;40(11):1029-35

Department of Gastroenterology, Saiseikai-Noe Hospital, 2-2-33 Imafuku-Higashi Joto-ku, Osaka 536-0002, Japan.

Background: Gastroesophageal reflux disease (GERD) is a common condition, and acid-suppressing agents are the mainstays of treatment. For the acute medical management of GERD, two different strategies can be proposed: either the most effective therapy, i.e., proton-pump inhibitors (PPIs), can be given first, or histamine H2-receptor antagonists (H2RAs) can be attempted first (the "step-up" approach).

Methods: A clinical decision analysis comparing the PPI-first strategy and the H2RA-first "step-up" strategy for the acute treatment of reflux esophagitis in Japan was performed, using a Markov chain approach.

Results: The PPI-first strategy was consistently superior to the step-up strategy with regard to clinical outcomes for the patient and with regard to cost-effectiveness (direct cost per patient to achieve clinical success). This superiority was robust within the plausible range of probabilities according to the sensitivity analyses.

Conclusions: The PPI-first strategy is superior to the H2RA-first "step-up" strategy with regard to both efficacy and cost-effectiveness and therefore, the PPI-first strategy is the preferred therapeutic approach for the acute medical treatment of reflux esophagitis.
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http://dx.doi.org/10.1007/s00535-005-1704-yDOI Listing
November 2005

Quantitative studies on fetal actocardiogram.

Authors:
Kazuo Maeda

Croat Med J 2005 Oct;46(5):792-6

Kazuo Maeda, 3-125, Nadamachi, Yonago, Tottoriken, 68-0835 Japan.

Aim: To quantitatively analyze actocardiography as a method to differentiate between active and resting fetal states.

Methods: We established five new quantitative parameters for actocardiogram; they include duration, occupancy, and frequency of movement bursts, and fetal heart rate acceleration to movement ratio (A/B ratio) in duration and number. These parameters were analyzed and compared in 14 normal late pregnancies and in non-hypoxic sinus bradycardia due to fetal cardiac sick sinus syndrome (n=1), hypoxic non-reactive non-stress test (n=3), hypoxic fetal distress (n=1), and that ensuing in death (n=1).

Results: Fetal hypoxic disorders differed from non-hypoxic states in the significant reductions of burst frequency (normal pregnancy mean was 0.65-/+0.22 cpm and fetal distress 0.24 cpm), occupancy (32.67% and 10.00%, respectively), and the ratio of durations of acceleration to movement burst (1.03 and 0, respectively).

Conclusion: Our study of quantitative actocardiogram parameters in normal pregnancy and various hypoxic fetal disorders demonstrated new characteristics of fetal movement and its relation to fetal heart rate. The results are promising for further analysis of fetal behavior and abnormalities.
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October 2005

Automatic computerized diagnosis of fetal sinusoidal heart rate.

Fetal Diagn Ther 2005 Sep-Oct;20(5):328-34

Professor Emeritus, Department of Obstetrics and Gynecology, Tottori University School of Medicine, 3-125 Nadamachi, Yonago, Tottoriken, Japan.

Objectives: Computerized automatic detection of pathologic fetal sinusoidal heart rate (FSHR) and its differentiation from physiologic FSHR is the purpose of this study. The results will be applied in the objective evaluation of fetal heart rate (FHR) with artificial neural network computer.

Methods: FHR tracings of pathologic FSHR of 9 cases of fetal-neonatal anemia, death, or severe asphyxia, those of 7 physiologic FSHR followed by normal outcome, and those of 5 normal FHR are processed with fast Fourier transform (FFT) analysis after digitization, and their power spectrums are obtained. The peak power spectrum frequency (PPSF), peak power spectrum density (PPSD), the area under the power spectrum of 0.03125-0.1 Hz (La), the area under the whole power spectrum (Ta), and the ratio of La/Ta (%) of pathologic FSHR are compared to those of physiologic FSHR and normal FHR.

Results: The La/Ta ratio and PPSD are significantly larger in the pathologic FSHR than those of physiologic FSHR and normal FHR. The true positive rate is 100%, false negative and false positive rates are 0%, respectively, when the pathologic FSHR is diagnosed by such combined criteria as 39% or more of La/Ta ratio and 300 or more of PPSD.

Conclusion: Pathologic FSHR is clearly separated from physiologic FSHR and normal FHR by the La/Ta ratio and PPSD obtained by FFT frequency analysis of FHR. Consequently, it is capable to automatically diagnose pathologic FSHR, and to apply it to neural network computer evaluation of FHR.
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http://dx.doi.org/10.1159/000086807DOI Listing
December 2005

Evaluation of prolonged fetal monitoring with normal and pathologic outcome probabilities determined by artificial neural network.

Fetal Diagn Ther 2003 Sep-Oct;18(5):370-5

Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.

Objective: The purpose of this study was to objectively evaluate prolonged fetal heart rate (FHR) monitoring, which has been difficult to do with conventional cardiotocogram (CTG).

Methods: FHR was analyzed by an artificial neural network computer that calculates probabilities of normal, pathologic and suspicious outcome. Earlier normal and pathologic outcome probabilities (OPs) recorded during 15-min intervals are averaged every 5 min. Initially, two curves (the averaged normal and pathologic OPs) are compared. Furthermore, a single curve traced for each difference between the averaged normal and pathologic OPs and its value are studied. Our FHR probability data are of 9 cases reported in a previous paper on neural network FHR analysis.

Results: In the 4 cases of normal neonatal condition, the trends of the averaged curves and the last averaged values were higher for normal OP than for pathologic OP, and the final values of the difference were >0. On the other hand, in the 5 cases of neonatal depression, the trend of the two curves and the final values were lower for normal than for pathologic OP; and the final difference values of averaged probabilities were <0. For prolonged monitoring, the single parameter is more useful than the comparison of the two curves.

Conclusion: A useful single parameter is obtained for the accurate and objective evaluation of prolonged FHR monitoring. The present method is promising for prospective studies using the combined system of experts and neural computers.
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http://dx.doi.org/10.1159/000071982DOI Listing
December 2003

[Factors associated with self-rated health for non-institutionalized aged persons].

Nihon Koshu Eisei Zasshi 2002 May;49(5):409-16

Department of Sociology, Hokkaido University Graduate School of Letters.

Objective: To determine factors affecting self-rated health among the non-institutionalized elderly in Japan.

Methods: In 20 municipalities in Japan, 6,094 persons aged 65 years and older who were not institutionalized were selected at random. A questionnaire survey was conducted from September through November 2000. The distribution of self-rated health was rated in terms of dependent variables, with odds ratios and their 95% confidence intervals calculated using unconditional logistic models.

Results: Of the study population, 5,565 persons (91.8%) responded to the survey. Of the respondents, 64.4% answered that they were healthy, while 28.8% were not. The necessity for periodical visit to hospitals and clinics, and lowering of the activity of daily living greatly lowered self-rated health. Compared with those who were 85 years of age or older, a high health status was observed among those aged between 75 and 84 years, but not those aged 65 to 74 years. Those who tried to have exercise periodically, who had a vice-leadership role in a group, who joined social activities, who lived what they considered a worthwhile life, and who had positive positive activities in daily life, had high levels of self-rated health. Joining social activities for passive reasons elevated the health as well as joining for active reasons such as "because it is fun."

Conclusion: Even if the reason is passive, joining social activities may elevate the self-rated health levels of elderly people.
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May 2002