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Pérez-Sáez MJ, Uffing A, Leon J, Murakami N, Watanabe A, Borges TJ, Sabbisetti VS, Cureton P, Kenyon V, Keating L, Yee K, Fernandes Satiro CA, Serena G, Hildebrandt F, Riella CV, Libermann TA, Wang M, Pascual J, Bonventre JV, Cravedil P, Fasano A, Riella LV. Immunological Impact of a Gluten-Free Dairy-Free Diet in Children With Kidney Disease: A Feasibility Study. Front Immunol 2021; 12:624821. [PMID: 34149688 PMCID: PMC8208082 DOI: 10.3389/fimmu.2021.624821] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Kidney disease affects 10% of the world population and is associated with increased mortality. Steroid-resistant nephrotic syndrome (SRNS) is a leading cause of end-stage kidney disease in children, often failing standard immunosuppression. Here, we report the results of a prospective study to investigate the immunological impact and safety of a gluten-free and dairy-free (GF/DF) diet in children with SRNS. The study was organized as a four-week summer camp implementing a strict GF/DF diet with prospective collection of blood, urine and stool in addition to whole exome sequencing WES of DNA of participants. Using flow cytometry, proteomic assays and microbiome metagenomics, we show that GF/DF diet had a major anti-inflammatory effect in all participants both at the protein and cellular level with 4-fold increase in T regulatory/T helper 17 cells ratio and the promotion of a favorable regulatory gut microbiota. Overall, GF/DF can have a significant anti-inflammatory effect in children with SRNS and further trials are warranted to investigate this potential dietary intervention in children with SRNS.
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Watanabe A. Rationale of bedside ultrasound-guided inferior vena cava filter implantation in COVID-19 patients with deep venous thrombosis. QJM 2021; 114:147. [PMID: 33515259 PMCID: PMC7928600 DOI: 10.1093/qjmed/hcaa337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 11/30/2022] Open
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Tada M, Sumi T, Tanaka Y, Hirai S, Yamaguchi M, Miyajima M, Takahashi H, Watanabe A, Sakuma Y. P61.02 MCL1 Inhibition Enhances the Therapeutic Effect of MEK Inhibitors in KRAS-Mutant Lung Adenocarcinoma Cells. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Watanabe A. Potential negative economic effects of diuretic lounge. QJM 2021; 114:72. [PMID: 33031518 DOI: 10.1093/qjmed/hcaa279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Watanabe A, Ito H. The characteristics of patients with possible familial hypercholesterolemia: screening a large payer/provider healthcare delivery system. QJM 2021; 114:66. [PMID: 32810258 DOI: 10.1093/qjmed/hcaa249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Oka S, Kai T, Hoshino K, Watanabe K, Nakamura J, Abe M, Watanabe A. A comparison of rate control and rhythm control in tachycardia induced cardiomyopathy patients with persistent atrial flutter. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Tachycardia induced cardiomyopathy (TIC) is a potentially reversible dysfunction of the left ventricle (LV) caused by tachyarrhythmias. Early recognition of TIC and treatment of the culprit arrhythmia using pharmacological therapy or catheter ablation results in the recovery of LV function. For atrial flutter (AFL)-induced TIC, rhythm control strategy, such as catheter ablation has been recommended. On the other hand, the efficacy of rate control strategy has remained unclear due to the difficulty of control with arrhythmic medications. However, not all patients can take rhythm control treatments due to their backgrounds.
Purpose
The aim of this cohort study was to establish whether rate control strategy using β-blocker is as effective as invasive rhythm control strategy for the recovery of LV function in patients with TIC due to AFL.
Methods
We prospectively assessed 47 symptomatic non-ischaemic heart failure (HF) patients with left ventricular ejection fraction (LVEF) below 50% and suspected TIC induced by persistent AFL. Patients were divided into rhythm control strategy group (n=22, treatment: catheter ablation, electrical cardioversion) and rate control strategy group (n=25, treatment: bisoprolol). As a sub-group study, the rate control strategy group was divided into the strict rate control group (n=12, average heart rate below 80 bpm) and lenient rate control group (n=13, average heart rate below 110 bpm). The primary outcome was the recovery of LV function, defined as an increase of LVEF over 20% or to a value of 55% or greater after 6 months.
Results
There were no significant differences in baseline AFL heart rate, New York Heart Association class, LVEF, estimated glomerular filtration rate, and brain natriuretic peptide between the two groups. A greater proportion of patients who showed the recovery of LVEF after 6 months belonged to the rhythm control strategy group (90.9% vs. 52.0%, p=0.004). The cumulative incidence of HF re-hospitalization was significantly higher in the rate control strategy group than in the rhythm control strategy group (hazard ratio: 4.90, 95% CI: 1.06–22.69). As a result of sub-group study, LVEF recovery was greater in the strict rate control group compared to the lenient rate control group (75.0% vs. 30.8%, p=0.027)
Conclusion
Rate control strategy was significantly inferior to rhythm control strategy for the recovery of LVEF in TIC patients with persistent AFL. Rhythm control should be the first choice in the management of TIC with AFL, and strict rate control should be an alternative if rhythm control is not available.
Primary outcomes
Funding Acknowledgement
Type of funding source: None
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Feitosa VA, Ferreira FT, Neves PDMM, Watanabe A, Watanabe EH, Proença HMS, Azevedo VFS, Pestana JOM, Onuchic LF. Post-transplantation Recurrence of Fibrinogen A-α Amyloidosis. Kidney Int Rep 2020; 6:234-238. [PMID: 33426404 PMCID: PMC7783572 DOI: 10.1016/j.ekir.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
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Neves PD, Bridi RA, Ramalho JA, Jorge LB, Watanabe EH, Watanabe A, Yu L, Woronik V, Pinheiro RB, Testagrossa LA, Cavalcante LB, Malheiros DM, Dias CB, Onuchic LF. Schistosoma mansoni infection as a trigger to collapsing glomerulopathy in a patient with high-risk APOL1 genotype. PLoS Negl Trop Dis 2020; 14:e0008582. [PMID: 33119586 PMCID: PMC7595310 DOI: 10.1371/journal.pntd.0008582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Schistosoma mansoni schistosomiasis (SM) remains a public health problem in Brazil. Renal involvement is classically manifested as a glomerulopathy, most often membranoproliferative glomerulonephritis or focal and segmental glomerulosclerosis. We report a case of collapsing glomerulopathy (CG) associated with SM and high-risk APOL1 genotype (HRG). Case report A 35-year-old male was admitted for hypertension and an eight-month history of lower-limb edema, foamy urine, and increased abdominal girth. He had a recent diagnosis of hepatosplenic SM, treated with praziquantel, without clinical improvement. Laboratory tests revealed serum creatinine 1.89mg/dL, blood urea nitrogen (BUN) 24mg/dL, albumin 1.9g/dL, cholesterol 531mg/dL, low-density lipoprotein 426mg/dL, platelets 115000/mm3, normal C3/C4, antinuclear antibody (ANA), rheumatoid factor (RF), and antineutrophil cytoplasmic antibodies (ANCA), negative serologies for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), HBsAg negative and AntiHBc IgG positive, no hematuria or leukocyturia, 24 hour proteinuria 6.56g and negative serum and urinary immunofixation. Kidney biopsy established the diagnosis of CG. A treatment with prednisone was started without therapeutic response, progressing to end-stage kidney disease 19 months later. Molecular genetics investigation revealed an HRG. Conclusions This is the first report of CG associated with SM in the setting of an HRG. This case highlights the two-hit model as a mechanism for CG pathogenesis, where the high-risk APOL1 genotype exerts a susceptibility role and SM infection serves as a trigger to CG. Schistosomiasis mansoni is still a public health problem in Brazil and renal involvement is described. In such cases, a glomerulopathy is the typical manifestation, most often membranoproliferative glomerulonephritis. In the current article, we report a patient with a recent diagnosis of hepatosplenic SM who was admitted for nephrotic syndrome associated with reduced renal function and hypertension. Kidney biopsy established the diagnosis of collapsing glomerulopathy (CG) and molecular genetics investigation identified a high-risk APOL1 genotype (HRG). Of note, HRG has been associated with increased risk to develop CG, and a two-hit model has been proposed for the genesis of this glomerulopathy. According to this model, a HRG represents the increased-susceptibility component, while an infection or other environmental factors could act as triggers for the development of CG. Based on those data and model, our case raises SM infection as a new trigger for this severe form of glomerulopathy. This is the first description of a case of CG associated with SM in a patient with an HRG. This case corroborates the interactive role between genetic and environmental factors in the pathogenesis of CG but also identifies SM infection as an additional trigger for its development.
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Sakai K, Ooi M, Teshigawara M, Naoe T, Haga K, Watanabe A. Conceptual design of an abnormality sign determination system for the general control system of the Materials and Life Science Experimental Facility at J-PARC. JOURNAL OF NEUTRON RESEARCH 2020. [DOI: 10.3233/jnr-190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The general control system (GCS) in the Materials and Life Science Experimental Facility (MLF) at the Japan Proton Accelerator Research Complex (J-PARC) has a data storage (DS) server that stores operational data on the status of neutron and muon targets in the MLF. It has worked well to detect unusual situations around these target stations and to investigate the causes of accidents by checking data in the DS server for short-term operations. To pick up potential abnormalities in the slight state transitions from the target stations, however, it is necessary to introduce an abnormality sign determination system (ASDS). This ASDS requires an integral data storage (IDS) server that stores various operational data throughout the proton beams, target stations, and secondary beams for long-term operations because it judges potential abnormalities by using algorithms based on analysis of these data. This report describes a present status of the GCS, a conceptual design for the ASDS, and the installation of the IDS server.
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Pereira MFB, Litvinov N, Farhat SCL, Eisencraft AP, Gibelli MABC, de Carvalho WB, Fernandes VR, Fink TDT, Framil JVDS, Galleti KV, Fante AL, Fonseca MFM, Watanabe A, de Paula CSY, Palandri GG, Leal GN, Diniz MDFR, Pinho JRR, Silva CA, Marques HHDS. Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome. Clinics (Sao Paulo) 2020; 75:e2209. [PMID: 32844958 PMCID: PMC7426591 DOI: 10.6061/clinics/2020/e2209] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.
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Hino Y, Muraosa Y, Oguchi M, Yahiro M, Yarita K, Watanabe A, Sakaida E, Yokote K, Kamei K. Drain outlets in patient rooms as sources for invasive fusariosis: an analysis of patients with haematological disorders. J Hosp Infect 2020; 105:S0195-6701(20)30204-8. [PMID: 32360338 DOI: 10.1016/j.jhin.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Invasive fusariosis (IF) is a frequently fatal disease as there are few antifungals to treat it, making the prevention of IF crucial. However, fusarium infections have not been as thoroughly studied as other common pathogenic fungi such as Aspergillus or Candida. AIM To investigate the epidemiology of IF in patients with haematological diseases in Japan and to elucidate the infectious route of fusarium infection. METHODS We retrospectively analysed 29 IF cases in patients with haematological diseases from 2009 to 2019 in Japan. To discover the infectious source of IF, we performed an indoor environment survey targeted at indoor air and drain outlets in medical institutions and residences using culture-based and metagenomic methods. Finally, we performed aerosol- and droplet-mediated dispersion studies. FINDINGS The epidemiological study showed that the primary pathogen of IF was Fusarium solani species complex (FSSC), and the most common species was Fusarium petroliphilum. Most patients were likely to develop IF during hospitalization. A fusarium culture was positive in 26 of 72 drain samples. Few fusarium were detected from air samples; by contrast, 29 of 108 isolates from the drain outlets were identified as fusarium. Furthermore, similar results were obtained in the metagenomic analysis. Interestingly, species belonging to FSSC were isolated from indoor drain outlets, which was similar to those of the IF patients. In the droplet-mediated dispersion study, eight to 17 colonies of fusarium were isolated. CONCLUSION Our study indicates that causative Fusarium spp. could inhabit drain outlets in hospitals or residences, and droplet-mediated fusarium dispersion is a potential cause of IF.
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Watanabe A, Yoshizumi T, Harimoto N, Kogure K, Ikegami T, Harada N, Itoh S, Takeishi K, Mano Y, Yoshiya S, Morinaga A, Araki K, Kubo N, Mori M, Shirabe K. Right hepatic venous system variation in living donors: a three-dimensional CT analysis. Br J Surg 2020; 107:1192-1198. [PMID: 32335898 DOI: 10.1002/bjs.11602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/16/2020] [Accepted: 02/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The right hepatic venous system consists of the right hepatic vein (RHV) and inferior RHVs (IRHVs). When the right posterior section is used as a graft for liver transplantation, understanding variations and relationships between the RHV and IRHVs is critical for graft venous return and hepatic vein reconstruction. This study aimed to evaluate variations in the hepatic veins and the relationships between them. METHODS The medical records and CT images of patients who underwent hepatectomy as liver donors were assessed retrospectively. The relationship between the veins was evaluated by three-dimensional CT. RESULTS The configuration of the posterior section was classified into one of eight types based on the RHV and IRHVs in 307 patients. Type 1a (103 of 307), type 1b (139 of 307) and type 2a (40 of 307) accounted for 91·9 per cent of the total. The diameter of the RHV extending towards the inferior vena cava had a significant inverse correlation with that of the IRHV (r2 = -0·615, P < 0·001). Type 1a, which had no IRHVs, had the RHV with the largest diameter; conversely, type 2a, which had a large IRHV, had the RHV with the smallest diameter. CONCLUSION The hepatic venous system of the right posterior section was classified into eight types, with an inverse relationship between RHV and IRHV sizes. This information is useful for segment VII resection or when the right liver is used as a transplant graft.
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Nour D, Shun-shin M, Fung M, Howard J, Ahmed Y, Allahwala U, Alzuhairi K, Bhindi R, Chamie D, Cook C, Doi S, Funayama N, Hansen P, Horinaka R, Ishibashi Y, Hijikata N, Kaihara T, Kawase Y, Koga M, Kotecha T, Kuwata S, Manica A, Matsuo H, Nakayama M, Nijjer S, Petraco R, Rajkumar C, Ramrakha P, Ruparelia N, Seligman H, Sen S, Takahashi T, Tanabe Y, Warisawa T, Watanabe A, Weaver J, Yong T, Francis D, Al-Lamee R. 834 How Accurately can Physicians Predict Invasive Physiology Using Coronary Angiography? Results of an International Multi-Centre Survey. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kitajima T, Hirose M, Kumagai R, Watanabe A, Esaki Y, Yamamoto S, Ono Y, Morishita H, Terabe M, Funahashi K, Iwata N. The reliability of the scale for symptom severity of circadian rhythm sleep-wake disorders – A preliminary study on draft versions. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ono Y, Kitajima T, Kumagai R, Hirose M, Watanabe A, Yamamoto S, Morishita H, Terabe M, Funahashi K, Iwata N. A case of mood disorder with alternating long and short sleep: a consideration of involvement of circadian disturbance and sleep homeostasis. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Miura H, Watanabe A, Okugawa M, Miura T, Koganeya T. Plant inspection by using a ground vehicle and an aerial robot: lessons learned from plant disaster prevention challenge in world robot summit 2018. Adv Robot 2019. [DOI: 10.1080/01691864.2019.1690575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Onuchic L, Sato VAH, de Menezes Neves PDM, Balbo BEP, Portela-Neto AA, Ferreira FT, Watanabe EH, Watanabe A, de Almeida MCS, de Abreu Testagrossa L, Chocair PR, Onuchic LF. Two cases of fungal cyst infection in ADPKD: is this really a rare complication? BMC Infect Dis 2019; 19:911. [PMID: 31664917 PMCID: PMC6819534 DOI: 10.1186/s12879-019-4444-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cyst infection is a prevalent complication in autosomal dominant polycystic kidney disease (ADPKD) patients, however therapeutic and diagnostic approaches towards this condition remain unclear. The confirmation of a likely episode of cyst infection by isolating the pathogenic microorganism in a clinical scenario is possible only in the minority of cases. The available antimicrobial treatment guidelines, therefore, might not be appropriate to some patients. Case presentation We describe two unique cases of kidney cyst infection by Candida albicans, a condition that has not been previously described in literature. Both cases presented clear risk factors for Candida spp. infection. However, since there was no initial indication of cyst aspiration and culture, antifungal therapy was not immediately started and empirical treatment was initiated as recommended by the current guidelines. Antifungal treatment was instituted in both cases along the clinical course, according to their specificities. Conclusion Our report highlights the possibility of Candida spp. cyst infection. Failure of clinical improvement with antibiotics should raise the suspicion of a fungal infection. Identification of infected cysts should be pursued in such cases, particularly with PET-CT, and when technically possible followed by cyst aspiration and culture to guide treatment. Risk factors for this condition, such as Candida spp. colonization, previous antimicrobial therapy, hemodialysis, necrotizing pancreatitis, gastrointestinal/hepatobiliary surgical procedure, central venous catheter, total parenteral nutrition, diabetes mellitus and immunodeficiency (neutropenia < 500 neutrophils/mL, hematologic malignancy, chemotherapy, immunosuppressant drugs), should be also considered accepted criteria for empirical antifungal therapy.
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Ueno K, Takada H, Matsuo H, Kuru S, Goto K, Mitsui T, Ishizaki M, Sugimoto S, Ogata K, Matsumura T, Suwazono S, Furuya H, Watanabe A, Kawano Y, Yamamoto A, Sasagasako N, Arahata H. P.87Carnitine deficiency in patients with neuromuscular diseases on long-term tube feeding. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Takashima H, Suzuki A, Sakurai S, Ando H, Nakano Y, Watanabe A, Mukai K, Wakabayashi H, Kojima H, Sawada H, Saka Y, Fujimoto M, Tanabe S, Ohashi H, Amano T. P5633Diagnostic impact of resting full-cycle ratio as newly developed non-hyperemic indices for physiological lesion assessment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in the catheterization laboratory, the need of hyperemic condition limits the widespread adoption of FFR. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. It is unclear whether RFR as resting condition could assess physiological lesion severity of coronary artery stenosis. The aim of this study was to evaluate the diagnostic impact of RFR compared to FFR in entire range of coronary artery stenosis.
Method
A total of 53 patients with 70 lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.
Results
In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.3±0.8mm, 44±12%, 14.6±7.2mm, 0.90±0.11, and 0.83±0.11, respectively. Functional significance was observed in 24 lesions (34%) of all lesions. The RFR showed a significant correlation with FFR (y = 0.800x + 0.239, R = 0.817, p<0.001). The Bland-Altman plot demonstrated a good agreement with a mean difference of 0.07 and a standard deviation of 0.06 between RFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of RFR cut-off of ≤0.90 in predicting FFR ≤0.80 which had 78% sensitivity and 87% specificity (AUC 0.87, diagnostic accuracy 84%).
Conclusion
The RFR as newly resting indices is reliable to the assessment of functional lesion severity. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.
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Hosoda K, Azuma M, Katada C, Ishido K, Niihara M, Ushiku H, Sakuraya M, Washio M, Wada T, Watanabe A, Harada H, Tanabe S, Koizumi W, Yamashita K, Hiki N, Watanabe M. A phase I study of docetaxel/oxaliplatin/S-1 (DOS) combination neoadjuvant chemotherapy for patients with locally advanced adenocarcinoma of the esophagogastric junction. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ohori K, Yano T, Katano S, Honma S, Shimomura K, Watanabe A, Ishigo T, Fujito T, Nagano N, Koyama M, Kouzu H, Hashimoto A, Miura T. P4537Impact of body composition analysis on prediction of short-term readmission events in heart failure: muscle wasting vs. obesity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity, defined as higher body mass index (BMI), is associated with better prognosis in patients with chronic heart failure (CHF), though the presence of obesity is a risk factor of development of CHF (Obesity paradox). On the other hand, muscle wasting, i.e. reduction in skeletal muscle mass, is frequently observed in CHF, leading to lower exercise capacity and poor cardiovascular outcome.
Purpose
The aim of this study was to examine whether analysis of body composition improves prediction of short-term readmission rates in patients with CHF.
Methods
We retrospectively analyzed data for 167 consecutive HF patients who were admitted to our institute for management of HF and received a Dual-energy X-ray absorptiometry (DEXA) scan. Muscle wasting was defined as DEXA-measured appendicular skeletal muscle mass index <7.0 kg/m2 in male and <5.4 kg/m2 in female according to the Asian Working Group for Sarcopenia criteria. Obesity was defined according to the criteria by the use of DEXA-measured percent body fat mass: >25% in male, >30% in female. The primary endpoint was readmission due to cardiac events including worsening heart failure, arrhythmia, and cardiopulmonary arrest during a 180-days follow-up period after discharge.
Results
The mean age of the patients was 74±13 years and 46% of them were male. The mean BMI was 21.8±3.8 kg/m2. Forty-seven percent of the patients were classified as NYHA functional class III. The most frequent etiology of HF was cardiomyopathy (30%), followed by ischemic heart disease (27%) and valvular heart disease (27%). The prevalence of muscle wasting and that of obesity were 69% and 59%, respectively. Patients with muscle wasting had lower BMI level, higher prevalence of NYHA functional class III and diabetes mellitus compared with those without muscle wasting. On the other hand, patients with obesity had higher prevalence of hypertension and dyslipidemia, higher level of BMI, fasting plasma insulin and triglyceride, and lower level of HDL-cholesterol compared with those without obesity. During the follow-up period, 34 patients (19%) were re-hospitalized due to cardiac events. Kaplan-Meier survival curves showed that patients with obesity had a significantly lower readmission rate during a 180-days follow-up period than did the patients without obesity (14.3% vs. 29.0%, Log-Rank test, p<0.01). There was no difference in readmission rates between patients with and without muscle wasting (20.0% vs. 21.2%, p=0.88). In multivariate Cox regression analyses adjusted for age, sex, diabetes, and renal function, obesity was independently associated with lower readmission rates (hazard ratio 0.45, 95% confidence interval 0.22–0.93). However, the association between obesity and readmission rate was lost after the adjustment for NT-proBNP levels.
Conclusion
Body composition analysis by DEXA enables to find CHF patients with increased fat mass who have lower risk of short-term readmission.
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Shimomura K, Katano S, Yano T, Ohori K, Honma S, Watanabe A, Ishigo T, Fujito T, Nagano N, Koyama M, Kouzu H, Hashimoto A, Miura T. P1538Low energy intake predicts readmission of elderly heart failure patients independently of nutritional status. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Malnutrition is frequently present and closely associated with poor clinical outcomes in elderly heart failure (HF) patients. Our previous study showed that low energy intake (EI) is associated with worse functional status in elderly HF inpatients after cardiac rehabilitation, but significance of EI in prediction of hospital readmission has not been elucidated fully.
Purpose
We examined whether low EI is a predictor of readmission for cardiac events in elderly HF patients.
Methods
We retrospectively retrieved data for 298 HF patients aged ≥65 years (median age of 77 years, interquartile range [IQR]: 71 - 82, female: 53%) who admitted to our institute for diagnosis and treatment of HF. Medical records were reviewed with regard to demography, medical history, comorbidities, medications, laboratory data, echocardiograms, functional status, nutritional status and total energy intake. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and total EI per day were calculated at discharge by a registered dietitian and a trained physical therapist. The primary endpoint was readmission due to cardiovascular events including worsening HF, arrhythmia, angina pectoris and myocardial infarction during a 1-year follow-up period.
Results
The median period of follow-up was 235 days (IQR: 78–365 days). The 1-year readmission rate for cardiovascular events was 54.4%. The cutoff values of MNA-SF score and EI, calculated by ROC curve analysis to predict the primary endpoint, were 7 points (area under the curve [AUC]: 0.59, sensitivity: 0.65, specificity: 0.50) and 31.8 kcal/kg/day (AUC: 0.59, sensitivity: 0.83, specificity: 0.35), respectively. Patients with low MNF-SF score (≤7) or low EI (≤31.8 kcal/kg/day) had significantly higher readmission rate during a 1-year follow-up period than did the patients with high MNF-SF score or EI (MNA-SF: 60.7% vs. 45.6%, p<0.01, EI: 60.4% vs. 36.8%, p<0.01), respectively. When patients were classified into four groups using cutoff values of MNA-SF score and EI, 1-year readmission rate was significantly higher in patients with low EI than in those with high EI regardless of MNF-SF scores. In multivariate Cox proportional hazard analyses adjusted for known prognostic factors in addition to age and gender, hazard ratios (HR) were significantly higher in patients with high MNA-SF score and low EI (adjusted HR: 2.81, 95% confidential interval [CI]: 1.15 - 9.32, p=0.02) and low MNA-SF score (≤7) and low EI (adjusted HR: 4.16, 95% CI: 1.72 - 13.72, p<0.01) than those with high MNA-SF score and high EI.
Kaplan-Meier curves of readmission rates
Conclusions
Low energy intake is a nutritional status-independent predictor of 1-year readmission rate in elderly HF patients.
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de Souza VC, Garcia CD, Pestana JM, Stopa Martins SB, Porini Custódio LDF, Bittencourt V, Rohde R, Simões Pires I, Camargo MFD, Koch Nogueira P, Feltran LDS, Esmeraldo RDM, Souza Costa RC, Schvartsman B, Watanabe A, Cunha MFMD, Santos R, Prates LC, Belangero VMS, Palma L, Takase HM, de Andrade LGM, Benini V, Laranjo Martins SP, Abbud-Filho M, Fernandes-Charpiot I, Ramalho H, Quaresma Mendonça AC, Vasconcelos MA, Andrade Nunes C, Penido de Paula MG, Moura Diniz Ferreira Leite C, Russo ER, Facincani I, Wagner MB. Collaborative Brazilian pediatric renal transplant registry (CoBrazPed-RTx): A report from 2004 to 2018. Pediatr Transplant 2019; 23:e13463. [PMID: 31332958 DOI: 10.1111/petr.13463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 12/01/2022]
Abstract
The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death.
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Uchida H, Kamata M, Mizukawa I, Watanabe A, Agematsu A, Nagata M, Fukaya S, Hayashi K, Fukuyasu A, Tanaka T, Ishikawa T, Ohnishi T, Tada Y. Real-world effectiveness and safety of dupilumab for the treatment of atopic dermatitis in Japanese patients: a single-centre retrospective study. Br J Dermatol 2019; 181:1083-1085. [PMID: 31127860 DOI: 10.1111/bjd.18163] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bardua C, Felice RN, Watanabe A, Fabre AC, Goswami A. A Practical Guide to Sliding and Surface Semilandmarks in Morphometric Analyses. Integr Org Biol 2019; 1:obz016. [PMID: 33791531 PMCID: PMC7780474 DOI: 10.1093/iob/obz016] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Advances in imaging technologies, such as computed tomography (CT) and surface scanning, have facilitated the rapid generation of large datasets of high-resolution three-dimensional (3D) specimen reconstructions in recent years. The wealth of phenotypic information available from these datasets has the potential to inform our understanding of morphological variation and evolution. However, the ever-increasing ease of compiling 3D datasets has created an urgent need for sophisticated methods of capturing high-density shape data that reflect the biological complexity in form. Landmarks often do not take full advantage of the rich shape information available from high-resolution 3D specimen reconstructions, as they are typically restricted to sutures or processes that can be reliably identified across specimens and exclude most of the surface morphology. The development of sliding and surface semilandmark techniques has greatly enhanced the quantification of shape, but their application to diverse datasets can be challenging, especially when dealing with the variable absence of some regions within a structure. Using comprehensive 3D datasets of crania that span the entire clades of birds, squamates and caecilians, we demonstrate methods for capturing morphology across incredibly diverse shapes. We detail many of the difficulties associated with applying semilandmarks to comparable regions across highly disparate structures, and provide solutions to some of these challenges, while considering the consequences of decisions one makes in applying these approaches. Finally, we analyze the benefits of high-density sliding semilandmark approaches over landmark-only studies for capturing shape across diverse organisms and discuss the promise of these approaches for the study of organismal form.
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