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Biomedical subjects

Noriaki Aoki

Publications and source records attributed to Noriaki Aoki.

At least 19 recordsLinked to original sources
PubMed2006

Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions.

OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.

Adult↗
PubMed2004

Autoantibodies to DFS70/LEDGF are increased in alopecia areata patients.

Alopecia areata (AA) has been suspected to be an autoimmune disease, although there is no distinct evidence, we investigated the relationship between AA and autoantibodies against dense fine speckles 70 kDa (DFS70) in 111 patients with alopecia and 105 healthy controls. The sera from 59 out of 111 (53%) Japanese alopecia patients were positive for anti-nuclear antibody (ANA), as compared to the sera of 16 out of 105 (15%) healthy controls (p < 0.001). Twenty percent (22/111) of the alopecia patients were shown to be positive for the prevalence of anti-DFS70 antibodies, as compared to 8% (8/105) of the healthy controls (p < 0.01). IgG subclass analysis by ELISA showed that IgG1 and IgG2-anti-DFS70 antibodies were dominant in alopecia patients. The DFS70 gene expression in the hair structures was clearly detected in both those with and those without the anti-DFS70 antibody by RT-PCR. Immunohistochemical techniques showed that the DFS70 was localized predominantly in the outer root sheath (ORS) cells. The elevated anti-DFS70 antibodies in alopecia patients and the localization of the DFS70 in the ORS suggest that autoantibodies against the DFS70 are related to the etiology in a certain population of AA.

Adaptor Proteins, Signal Transducing↗
PubMed2004

Pseudohyperkalaemia at commercial laboratories in Japan: a questionnaire survey.

BACKGROUND: Pseudohyperkalaemia caused by recentrifugation after storage or delay in separation of serum from blood cells is not uncommon. The purpose of this study was to audit pseudohyperkalaemia at commercial laboratories in Japan. METHODS: A questionnaire asking about how samples are handled for potassium measurement and information on pseudohyperkalaemia was sent to 431 commercial laboratories. RESULTS: A total of 263 (response rate 61%) questionnaires were returned and suitable for analysis. Pseudohyperkalaemia caused by recentrifugation was seen at 145 (70%) laboratories. Pseudohyperkalaemia caused by delay in separation of serum was also seen in many laboratories. Blood samples were centrifuged on site in only 46% of hospitals and in 17% of clinics served by these laboratories. The longest average time from venesection to centrifugation was 18 h. Although half the laboratories had asked their client facilities to centrifuge blood samples on site, very few complied. CONCLUSION: Pseudohyperkalaemia is not uncommon at commercial laboratories in Japan. Further efforts are necessary to avoid inappropriate handling at blood collection sites and in laboratories.

Blood Specimen Collection↗
PubMed2004

Cost-effectiveness analysis of telemedicine to evaluate diabetic retinopathy in a prison population.

OBJECTIVE: A cost-effectiveness analysis was conducted to investigate the clinical and economic impact of teleophthalmology in evaluating diabetic retinopathy in prison inmates with type 2 diabetes. RESEARCH DESIGN AND METHODS: Based on a hypothetical teleophthalmology system to evaluate diabetic retinopathy patients with type 2 diabetes in a prison care setting, a Markov decision model was developed with probability and cost data derived primarily from published epidemiological and outcome studies. A 40-year-old African-American man with type 2 diabetes was used as a reference case subject. The number of quality-adjusted life-years (QALYs) gained was used as the clinical outcome, and the cost in U.S. dollars from the year 2003 was used as the economic outcome. Teleophthalmology and nonteleophthalmology strategies were compared using an expected QALYs calculation and two types of sensitivity analyses: probabilistic and traditional n-way sensitivity analyses. RESULTS: The teleophthalmology strategy dominates in the cost-effectiveness analysis for the reference case subject: 16,514/18.73 dollars QALYs for teleophthalmology and 17,590/18.58 dollars QALYs for nonteleophthalmology. Ninety percent of the Monte Carlo simulations showed cost effectiveness (annual cost/QALYs < or = 50,000 dollars) in the teleophthalmology strategy based on an assumed inmate population. Teleophthalmology is the better strategy if the number of diabetic inmates in the prison community is >500. CONCLUSIONS: Our cost-effectiveness analysis demonstrates that teleophthalmology holds great promise to reduce the cost of inmate care and reduce blindness caused by diabetic retinopathy in type 2 diabetic patients.

Blindness↗
PubMed2004

Edutainment tools for initial education of type-1 diabetes mellitus: initial diabetes education with fun.

PURPOSE: Appropriate initial education for type-1 diabetes mellitus patients is important to prevent late complications. However, type-1 diabetic children have not appreciated traditional learning methods since they rarely contain the elements of fun and interactivity. In this study, we developed, implemented and evaluated a preliminary version of edutainment tools for initial education for type-1 diabetic children. METHODS: Three games running on either personal computer (PC) and GameBoy Advance were developed. All games were designed to educate patients about relationships among food (carbohydrate), plasma glucose level, exercise, and insulin dose. A total of 58 testers evaluated degree of entertainment, usability and clinical usefulness of the games. RESULTS: Generally, testers felt all games were intuitive and fun and the usability of games was highly scored. More than 90% of testers showed an interest in the edutainment approach, and approximately 60% agreed that these games could provide attractive educational environment compared to traditional education, especially for children. CONCLUSIONS: Our edutainment systems were accepted as attractive learning tools for type-1 diabetic children who need initial education.

Blood Glucose↗
PubMed2003

Chemical taxonomy of the Xibei tree peony from China by floral pigmentation.

Petal flavonoid compositions of 39 tree peony cultivars from Xibei (northwest China) were investigated in order to study the chemotaxonomic relationship among tree peony species. Six anthocyanins, the 3- O-glucosides and 3,5-di- O-glucosides of three anthocyanidins-pelargonidin (Pg), cyanidin (Cy), and peonidin (Pn)-exist in petals without a blotch at the base. The flowers are classified into three anthocyanidin phenotypes: 'Pn, Pg>Cy'; 'Pn, Cy'; and 'Pn, Cy>Pg'. Furthermore, the yellow pigments are identified as three flavones and three flavonols: apigenin, luteolin, chrysoeriol, and kaempferol, quercetin, and isorhamnetin, respectively. Ward's minimum-variance cluster analysis with principal component analysis produced a dendrogram using standardized scores of 20 pigment variables. Of 39 cultivars, 11 clustered with white flowered Paeonia rockii and 17 with pink flowered P. rockii. The other 11 cultivars matched either P. delavayi or P. potaninii. The result suggests that the Xibei tree peony originated mainly from P. rockii.

Anthocyanins↗
PubMed2003

Gene expression of Sh3d19, a novel adaptor protein with five Src homology 3 domains, in anagen mouse hair follicles.

BACKGROUND: Sh3yl1, which contains one Src homology (SH) 3 domain, has been previously identified from mouse skin and considered to play an important role in hair follicle formation by interacting with other proteins. OBJECTIVE: We performed this study to identify proteins capable of associating with Sh3yl1. METHODS: We screened a mouse skin cDNA library using the SH3 domain of Sh3yl1 as bait in the yeast two-hybrid system. RESULTS: We identified a 420-amino acid-long protein containing a proline-rich stretch and five carboxyl-terminal SH3 domains, which we have termed Sh3d19. We confirmed the interactions between Sh3yl1 and Sh3d19 by in vitro binding assays. Northern blot analysis showed that Sh3d19 transcripts in mouse skin were expressed in accordance with the hair cycle. Furthermore, RNA in situ hybridization studies demonstrated that its transcripts were detected predominantly in the medulla cells at the level corresponding to the keratogenous zone of the hair follicles during the mid and late anagen phases. CONCLUSION: Sh3d19 is a novel adaptor protein that may be involved in the development of medulla cells during the anagen phase.

Adaptor Proteins, Vesicular Transport↗
PubMed2003

Characterization of human keratin-associated protein 1 family members.

Keratin-associated proteins are involved in the formation of the cross-linked network of the keratin-intermediate filament proteins that support hair fibers. In recent years, several keratin-associated protein genes have been identified and become an attractive topic in hair research. More recently, we isolated two cDNA encoding novel members of the human keratin-associated protein 1 family (human keratin-associated protein 1.6 and human keratin-associated protein 1.7), and described their expression in the hair follicle by RNA in situ hybridization. A comparison of human keratin-associated protein 1.6 and human keratin-associated protein 1.7 with other human keratin-associated protein 1 members revealed that keratin-associated protein 1 proteins are fundamentally composed of five distinct domains, and that they can be classified primarily by a striking variation in double cysteine-containing pentapeptide repeats in the repetitive I domain. The sum of the data analyzed suggests that human keratin-associated protein 1 family genes may have arisen mainly through gene duplication of the cysteine-repeat motifs during evolution.

Amino Acid Sequence↗
PubMed2003

Outcomes and methods in telemedicine evaluation.

One hundred and four articles, published from 1966 to 2000, were reviewed to investigate telemedicine evaluation studies in terms of methods and outcomes. A total of 112 evaluations were reported in these 104 articles. Two types of evaluations were evaluated: clinical and nonclinical. Within the clinical evaluations, three were on clinical effectiveness, 26 on patient satisfaction, 49 on diagnostic accuracy, and nine on cost. In the non-clinical evaluations, 15 articles discussed technical issues relating to digital images, such as bandwidth, resolution, and color, and 10 articles assessed management issues concerning efficiency of care, such as avoiding unnecessary patient transfer, or saving time. Of the 112 evaluations, 72 were descriptive in nature. The main methods used in the remaining 40 articles used quantitative methods. Nineteen articles employed statistical techniques, such as receiver operating characteristics curve (three evaluations) and kappa values (seven evaluations). Only one article utilized a qualitative approach to describe a telemedicine system. Currently, there are a number of good reports on diagnostic accuracy, satisfaction, and technological evaluation. However, clinical effectiveness and cost-effectiveness are important parameters, and they have received limited attention. Since telemedicine evaluations tend to explore various outcomes, it may be appropriate to evaluate from a multidisciplinary perspective, and to utilize various methodologies.

Humans↗
PubMed2002

Polymorphisms in the human high sulfur hair keratin-associated protein 1, KAP1, gene family.

Hair fiber differentiation and maturation involves the close interaction between hair keratins and their associated proteins, KAPs. Recently, a cluster of seven human KAP multigen families has been identified on chromosome 17q12-21 among which were four hKAP1 genes (hKAP1.1B, hKAP1.3, hKAP1.4, and hKAP1.5). In addition, there were previous as well as recent reports on four additional hKAP1 genes (hKAP1.1A, hKAP1.2, hKAP1.6, and hKAP1.7) with unknown chromosomal location. In this study, we have analyzed these eight hKAP1 genes in unrelated Japanese and Caucasian individuals and discovered that hKAP1.1A, hKAP1.6, and hKAP1.7 represent size polymorphisms of the hKAP1.1B gene. In addition, we show that hKAP1.2 as well as three hitherto unknown genes (hKAP1.8A, hKAP1.8B, and hKAP1.9) are size polymorphisms of the hKAP1.3 gene. In contrast, no polymorphic alleles were found for the hKAP1.4 and hKAP1.5 genes. We provide evidence that the polymorphic hKAP1.1B and hKAP1.3 alleles arose mainly by intragenic deletion and/or duplication events of distinct pentapeptide repeats typical for hKAP1 genes. We also demonstrate the occurrence of both frequent and rare population-specific hKAP1.1B and hKAP1.3 alleles, which were obviously generated after the divergence of the Caucasian and Japanese lineage. In addition, by means of a pan-hKAP1 antibody, we confirm the previous hKAP1 family mRNA localization data in the middle to upper cortex of the human anagen hair follicle.

Alleles↗
PubMed2002

Determinants of mortality in patients with severe blunt head injury.

CONTEXT: Head injury is the leading cause of traumatic death in the United States. HYPOTHESIS: A set of clinical parameters available soon after injury can be used to accurately predict outcome in patients with severe blunt head trauma. DESIGN: Validation cohort study. SETTING: Urban level I trauma center. PATIENTS AND METHODS: Data from patients with severe blunt head injury, as defined by inability to follow commands, were prospectively entered into a neurosurgical database and analyzed. The impact on survival of 23 potentially predictive parameters was studied using univariate analysis. Logistic regression models were used to control for confounding factors and to assess interactions between variables, whose significance was determined by univariate analysis. Goodness of fit was calculated with the Hosmer-Lemeshow c statistic. The predictability of the logistic model was evaluated by measuring the area under the receiver operating characteristic curve (AUC). RESULTS: Logistic regression analysis revealed that 5 risk factors were independently associated with death. These variables included systemic hypotension in the emergency department, midline shift on computed tomographic scan, intracranial hypertension, and absence of pupillary light reflex. A low Glasgow Coma Scale score and advanced age were found to be highly correlated risk factors that, when combined, were independently associated with mortality. The model showed acceptable goodness of fit, and the AUC was 80.5%. CONCLUSIONS: Systemic hypotension and intracranial hypertension are the only independent risk factors for mortality that can be readily treated during the initial management of patients with severe head injuries. When used together, Glasgow Coma Scale score and age are significant predictors of mortality.

Adolescent↗
PubMed2002

hKAP1.6 and hKAP1.7, two novel human high sulfur keratin-associated proteins are expressed in the hair follicle cortex.

Hair fiber differentiation involves the expression of both hair keratin intermediate filament proteins and their associated proteins, termed keratin-associated proteins. In this study, cDNA clones encoding two novel keratin-associated proteins were isolated from human hair follicle mRNA. The predicted amino acid sequence derived from these clones revealed that these proteins represent members of the human keratin-associated protein 1 family. They show strong sequence homology to two previously described keratin-associated protein 1 family members hKAP1.1 A and hKAP1.1B. We have called these new proteins hKAP1.6 and hKAP1.7, respectively. RNA in situ hybridization studies of human anagen hair follicles using a conserved probe for these four keratin-associated protein 1 members demonstrated the expression of this group in the differentiated portions of the hair cortex.

Amino Acid Sequence↗
PubMed2002

A novel epithelial keratin, hK6irs1, is expressed differentially in all layers of the inner root sheath, including specialized huxley cells (Flügelzellen) of the human hair follicle.

In this study we have characterized a novel human type II keratin, hK6irs1, which is specifically expressed in the inner root sheath of the hair follicle. This keratin represents the ortholog of the recently described mouse inner root sheath keratin mK6irs. The two keratins were highly related and migrated at the same height as keratin 6 in two-dimensional gel electrophoresis. Both RNA in situ hybridization and indirect immunofluorescence studies of human hair follicles demonstrated hK6irs1 expression in the Henle and Huxley layers as well as in the cuticle of the inner root sheath. In all three layers, the expression of hK6irs1 mRNA and protein began simultaneously in adjacent cells of the lowermost bulb above the germinative cell pool. Higher up in the follicle, the detection limits for both hK6irs1 mRNA and protein precisely coincided with the asynchronous onset of abrupt terminal differentiation of the Henle layer, inner root sheath cuticle, and Huxley layer. Mainly above the level of terminal Henle cell differentiation, both indirect immunofluorescence and immunoelectron microscopy revealed the occurrence of distinct Huxley cells that developed pseudopodal hK6irs1-positive extensions passing through the fully keratinized Henle layer. These outwardly protruding foot processes abutted upon cells of the companion layer, with which they were connected by numerous desmosomes. These specialized Huxley cells have previously been termed "Flügelzellen", which means "winged cells", with reference to their characteristic foot processes. We provide evidence that, together with Henle cells, Flügelzellen ensure the maintenance of a continuous desmosomal anchorage of the companion layer along the entire inner root sheath. This tightly connected companion layer/inner root sheath unit provides an optimal molding and guidance of the growing hair shaft.

Amino Acid Sequence↗
PubMed2002

Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.

BACKGROUND: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills. METHODS: The pilot study evaluated 10 three-person military resuscitation teams from community hospitals that participated in a 28-day rotation at a civilian trauma center. Each team consisted of physicians, nurses, and medics. Using the HPS, teams were evaluated on arrival and again on completion of the rotation. In addition, the 10 trauma teams were compared with 5 expert teams composed of experienced trauma surgeons and nurses. Two standardized trauma scenarios were used, representing a severely injured patient with multiple injuries and with an Injury Severity Score of 41 (probability of survival, 50%). Performance was measured using a unique human performance assessment tool that included five scored and eight timed tasks generally accepted as critical to the initial assessment and treatment of a trauma patient. Scored tasks included airway, breathing, circulation, and disability assessments as well as overall organizational skills and a total score. The nonparametric Wilcoxon test was used to compare the military teams' scores for scenarios 1 and 2, and the comparison of the military teams' final scores with the expert teams. A value of p < 0.05 was considered significant. RESULTS: The 10 military teams demonstrated significant improvement in four of the five scored (p < or = 0.05) and six of the eight timed (p < or = 0.05) tasks during the final scenario. This improvement reflects the teams' cumulative didactic and clinical experience during the 28-day trauma refresher course as well as some degree of simulator familiarization. Improved final scores reflected efficient and coordinated team efforts. The military teams' initial scores were worse than the expert group in all categories, but their final scores were only lower than the expert groups in 2 of 13 measurements (p < or = 0.05). CONCLUSION: No studies have validated the use of the HPS as an effective teaching or evaluation tool in the complex field of trauma resuscitation. These pilot data demonstrate the ability to evaluate trauma team performance in a reproducible fashion. In addition, we were able to document a significant improvement in team performance after a 28-day trauma refresher course, with scores approaching those of the expert teams.

Computer Simulation↗
PubMed2002

Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence.

BACKGROUND: The sequence of surgical repair for penetrating extremity injuries requiring both vascular repair and fracture fixation is controversial. The optimal determination of repair order and its consequences is the purpose of this study. METHODS: A retrospective review was performed of 27 patients over a 10-year period requiring acute revascularization and fracture fixation for isolated gunshot wound injuries. Injuries to the brachial artery and the femoral and popliteal vessels with accompanying fractures requiring operative stabilization were considered. The Mangled Extremity Severity Score, surgical sequence, limb viability, fasciotomy, incidence of iatrogenic vascular repair disruption, and length of hospitalization were analyzed. RESULTS: There were 17 lower and 10 upper extremity injuries, with a mean Mangled Extremity Severity Score of 4.1. Fracture fixation preceded vascular repair in five cases, whereas revascularization preceded bone fixation in 22 cases. A temporary vascular shunt was used in 13 and definitive vascular repair with used in 9 patients. There were no cases of vascular repair, shunt disruption, or amputation after fracture fixation. Four of five (80%) patients with orthopedic fixation before revascularization required fasciotomies, whereas 8 of 22 (36%) patients with revascularization before fixation required fasciotomies, and this difference approached significance (p = 0.10). Patients with fasciotomies had a significantly longer mean length of hospitalization, 18.3 +/- 8.6 days compared with 10.8 +/- 8.1 days (p = 0.03). CONCLUSION For patients with combined injuries, priority should be given to revascularization before orthopedic fixation because of shorter hospitalization and a trend toward lower fasciotomy rates. Revascularization before fracture fixation did not result in iatrogenic disruption of the vascular repair.

Adolescent↗
PubMed2002

Generating a mortality model from a pediatric ICU (PICU) database utilizing knowledge discovery.

Current models for predicting outcomes are limited by biases inherent in a priori hypothesis generation. Knowledge discovery algorithms generate models directly from databases, minimizing such limitations. Our objective was to generate a mortality model from a PICU database utilizing knowledge discovery techniques. The database contained 5067 records with 192 clinically relevant variables. It was randomly split into training (75%) and validation (25%) groups. We used decision tree induction to generate a mortality model from the training data, and validated its performance on the validation data. The original PRISM algorithm was used for comparison. The decision tree model contained 25 variables and predicted 53/88 deaths; 29 correctly (Sens:33%, Spec:98%, PPV:54%). PRISM predicted 27/88 deaths correctly (Sens:30%, Spec:98%, PPV:51%). Performance difference between models was not significant. We conclude that knowledge discovery algorithms can generate a mortality model from a PICU database, helping establish validity of such tools in the clinical medical domain.

Algorithms↗