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Umemura A, Oyama G, Shimo Y, Nakajima A, Jo T, Nakajima M, Ishii H, Arai H, Hattori N. Usefulness of interleaving programing in pallidal stimulation for Parkinson’s disease. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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102
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Yamaguchi K, Nishimura T, Ishiba H, Seko Y, Okajima A, Fujii H, Tochiki N, Umemura A, Moriguchi M, Sumida Y, Mitsuyoshi H, Yasui K, Minami M, Okanoue T, Itoh Y. Blockade of interleukin 6 signalling ameliorates systemic insulin resistance through upregulation of glucose uptake in skeletal muscle and improves hepatic steatosis in high-fat diet fed mice. Liver Int 2015; 35:550-61. [PMID: 25066281 DOI: 10.1111/liv.12645] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Mice fed high-fat diet (HFD) demonstrate obesity-related systemic insulin resistance (IR). Aim of this study is to clarify the role of interleukin (IL)-6 in IR in vivo focusing on skeletal muscle, adipose tissue and liver. METHODS Plasma markers of IR and hepatic IL-6 signalling were examined in eight-week HFD feeding C57/BL6 mice. Furthermore, IR-related molecules in skeletal muscles, adipose tissues and livers were investigated following a single injection of anti- IL-6 receptor neutralizing antibody (MR16-1) in two-week HFD feeding mice. To investigate the role of IL-6 in hepatic steatosis by prolonged HFD, hepatic triglyceride accumulation was assessed in eight-week HFD feeding mice with continuous MR16-1 treatment. RESULTS High-fat diet for both 2 and 8 weeks elevated plasma IL-6, insulin and leptin, which were decreased by MR16-1 treatment. A single injection of MR16-1 ameliorated IR as assessed by glucose and insulin tolerance test, which may be attributable to upregulation of glucose transporter type 4 via phosphorylation of AMP-activated protein kinase as well as upregulation of peroxisome proliferator-activated receptor alpha in livers and, particularly, in skeletal muscles. MR16-1 also decreased mRNA expression of leptin and tumour necrosis factor-alpha and increased that of adiponectin in adipose tissue. High-fat diet for 8 weeks, not 2 weeks, induced hepatic steatosis and increased hepatic triglyceride content, all of which were ameliorated by MR16-1 treatment. CONCLUSIONS Blockade of excessive IL-6 stimulus ameliorated HFD-induced IR in a skeletal muscle and modulated the production of adipokines from an early stage of NAFLD, leading to prevention of liver steatosis for a long term.
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Affiliation(s)
- Kanji Yamaguchi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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103
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Umemura A, Miyata M, Oka Y, Okita K, Oyama G, Shimo Y, Hattori N. Five-Year Outcomes of Bilateral Subthalamic Nucleus Stimulation in Japanese Patients with Parkinson’s Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/apd.2015.42004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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104
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Nakagawa H, Umemura A, Taniguchi K, Font-Burgada J, Dhar D, Ogata H, Zhong Z, Valasek MA, Seki E, Hidalgo J, Koike K, Kaufman RJ, Karin M. ER stress cooperates with hypernutrition to trigger TNF-dependent spontaneous HCC development. Cancer Cell 2014; 26:331-343. [PMID: 25132496 PMCID: PMC4165611 DOI: 10.1016/j.ccr.2014.07.001] [Citation(s) in RCA: 362] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/28/2014] [Accepted: 07/01/2014] [Indexed: 02/06/2023]
Abstract
Endoplasmic reticulum (ER) stress has been implicated in the pathogenesis of viral hepatitis, insulin resistance, hepatosteatosis, and nonalcoholic steatohepatitis (NASH), disorders that increase risk of hepatocellular carcinoma (HCC). To determine whether and how ER stress contributes to obesity-driven hepatic tumorigenesis we fed wild-type (WT) and MUP-uPA mice, in which hepatocyte ER stress is induced by plasminogen activator expression, with high-fat diet. Although both strains were equally insulin resistant, the MUP-uPA mice exhibited more liver damage, more immune infiltration, and increased lipogenesis and, as a result, displayed classical NASH signs and developed typical steatohepatitic HCC. Both NASH and HCC development were dependent on TNF produced by inflammatory macrophages that accumulate in the MUP-uPA liver in response to hepatocyte ER stress.
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MESH Headings
- Animals
- Carcinoma, Hepatocellular/etiology
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Cells, Cultured
- Diet, High-Fat/adverse effects
- Endoplasmic Reticulum Chaperone BiP
- Endoplasmic Reticulum Stress
- Fatty Liver/etiology
- Fatty Liver/metabolism
- Heat-Shock Proteins/metabolism
- Lipogenesis
- Liver Neoplasms, Experimental/etiology
- Liver Neoplasms, Experimental/metabolism
- Liver Neoplasms, Experimental/pathology
- Male
- Mice
- Mice, Transgenic
- Overnutrition/complications
- Receptors, Tumor Necrosis Factor, Type I/metabolism
- Signal Transduction
- Tumor Burden
- Tumor Necrosis Factor-alpha/physiology
- Urokinase-Type Plasminogen Activator/genetics
- Urokinase-Type Plasminogen Activator/metabolism
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Affiliation(s)
- Hayato Nakagawa
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Atsushi Umemura
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Koji Taniguchi
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Joan Font-Burgada
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Debanjan Dhar
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Hisanobu Ogata
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Zhenyu Zhong
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Mark A Valasek
- Department of Pathology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Ekihiro Seki
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Juan Hidalgo
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autonoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Kazuhiko Koike
- Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Randal J Kaufman
- Program in Degenerative Diseases, Sanford-Burnham Medical Research Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Michael Karin
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Department of Pathology, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
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105
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Umemura A, Park EJ, Taniguchi K, Lee JH, Shalapour S, Valasek MA, Aghajan M, Nakagawa H, Seki E, Hall MN, Karin M. Liver damage, inflammation, and enhanced tumorigenesis after persistent mTORC1 inhibition. Cell Metab 2014; 20:133-44. [PMID: 24910242 PMCID: PMC4079758 DOI: 10.1016/j.cmet.2014.05.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/21/2014] [Accepted: 03/31/2014] [Indexed: 12/13/2022]
Abstract
Obesity can result in insulin resistance, hepatosteatosis, and nonalcoholic steatohepatitis (NASH) and increases liver cancer risk. Obesity-induced insulin resistance depends, in part, on chronic activation of mammalian target of rapamycin complex 1 (mTORC1), which also occurs in human and mouse hepatocellular carcinoma (HCC), a frequently fatal liver cancer. Correspondingly, mTORC1 inhibitors have been considered as potential NASH and HCC treatments. Using a mouse model in which high-fat diet enhances HCC induction by the hepatic carcinogen DEN, we examined whether mTORC1 inhibition attenuates liver inflammation and tumorigenesis. Notably, rapamycin treatment or hepatocyte-specific ablation of the specific mTORC1 subunit Raptor resulted in elevated interleukin-6 (IL-6) production, activation of signal transducer and activator of transcription 3 (STAT3), and enhanced HCC development, despite a transient reduction in hepatosteatosis. These results suggest that long-term rapamycin treatment, which also increases IL-6 production in humans, is unsuitable for prevention or treatment of obesity-promoted liver cancer.
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Affiliation(s)
- Atsushi Umemura
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Eek Joong Park
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Koji Taniguchi
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Jun Hee Lee
- Department of Molecular and Integrative Physiology, University of Michigan Geriatrics Center, 109 Zina Pitcher Place, 3019 BSRB, Ann Arbor, MI 48109-2200, USA
| | - Shabnam Shalapour
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Mark A Valasek
- Department of Pathology, Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Mariam Aghajan
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Hayato Nakagawa
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ekihiro Seki
- Department of Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Michael N Hall
- Biozentrum, University of Basel, Klingelbergstrasse 70, 4056 Basel, Switzerland
| | - Michael Karin
- Laboratory of Gene Regulation and Signal Transduction, Department of Pharmacology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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106
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Umemura A, Oeda T, Tomita S, Hayashi R, Kohsaka M, Park K, Sugiyama H, Sawada H. Delirium and high fever are associated with subacute motor deterioration in Parkinson disease: a nested case-control study. PLoS One 2014; 9:e94944. [PMID: 24887491 PMCID: PMC4041721 DOI: 10.1371/journal.pone.0094944] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background In Parkinson disease (PD), systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients. Purpose To identify factors associated with subacute motor deterioration in PD patients with systemic inflammation. Methods The association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H–Y) stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H–Y stage, dementia, and psychosis history) and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium), the odds ratios for these factors were estimated as relative risks. Results Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up). Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P = 0.001 for delirium and P = 0.026 for body temperature), the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23–78.14) and 2.78 (95% CI: 1.13–6.83), respectively. Conclusions In patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration can persist for over 6 months.
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Affiliation(s)
- Atsushi Umemura
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Tomoko Oeda
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Satoshi Tomita
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Ryutaro Hayashi
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Kwiyoung Park
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Hiroshi Sugiyama
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Hideyuki Sawada
- Clinical Research Center, National Hospital of Utano, Kyoto, Japan
- Department of Neurology, National Hospital of Utano, Kyoto, Japan
- * E-mail:
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107
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Oyama G, Umemura A, Shimo Y, Nishikawa N, Nakajima A, Jo T, Nakajima M, Ishii H, Yamada D, Takanashi M, Arai H, Nanba E, Hattori N. Posterior subthalamic area deep brain stimulation for fragile X-associated tremor/ataxia syndrome. Neuromodulation 2014; 17:721-3. [PMID: 24528808 DOI: 10.1111/ner.12150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/07/2013] [Accepted: 11/19/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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108
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Sawada H, Oeda T, Umemura A, Tomita S, Hayashi R, Kohsaka M, Yamamoto K, Sudoh S, Sugiyama H. Subclinical elevation of plasma C-reactive protein and illusions/hallucinations in subjects with Parkinson's disease: case-control study. PLoS One 2014; 9:e85886. [PMID: 24497930 PMCID: PMC3908859 DOI: 10.1371/journal.pone.0085886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/03/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Though infections are associated with psychotic symptoms, whether or not subclinical inflammation is associated with hallucinations is not known in Parkinson's disease (PD). PURPOSE To investigate the association of illusions/hallucinations and plasma CRP levels in PD patients without symptomatic infections. METHODS PD patients not diagnosed as having infections were assessed for illusions and hallucinations using the Parkinson Psychosis Questionnaire (PPQ). It comprises four-domain questions: PPQ-A for sleep problems, PPQ-B for hallucinations/illusions, PPQ-C for delusions, and PPQ-D for disorientation. Assigning patients with ≥1 points in the PPQ-B score to be cases and others as controls, the association of hallucinations/illusions and clinical features (age, sex, duration of PD, Unified Parkinson's Disease Rating Scale part 3 (UPDRS-3), Mini-Mental State Examination (MMSE) score, sleep disturbance (PPQ-A score) as well as daily doses of L-Dopa, dopamine agonists, amantadine, and selegiline) were analyzed using a case-control design. RESULTS A total of 111 patients were examined and plasma CRP levels were <0.1-6.0 mg/L. Hallucinations or illusions were detected in 28 (25.2%). There were significant differences in age, UPDRS-3 score, MMSE score, PPQ-A, daily doses of L-Dopa and dopamine agonists and plasma CRP levels between cases and controls. A multivariate logistic regression model revealed that UPDRS-3 scores and plasma CRP levels were significantly associated with hallucinations/illusions with an adjusted odds ratio of 1.96 (95% confidence interval (CI) 1.20-3.20) per 10 points and 1.57 (95% confidence interval 1.13-2.16) per two-fold, respectively. Dividing patients into thirds by CRP levels (≤0.2, 0.3-0.6, ≥0.7 mg/L), the prevalence of hallucinations/illusions was 13.2%, 21.6%, and 41.7%, in the bottom-, middle-, and top-thirds, respectively (for trend p = 0.012). CONCLUSIONS Subclinical elevation of plasma CRP levels was associated with hallucinations or illusions after adjustment for motor disability, suggesting that subclinical elevations of CRP levels might be an independent risk for hallucinations/illusions.
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Affiliation(s)
- Hideyuki Sawada
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Tomoko Oeda
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Atsushi Umemura
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Satoshi Tomita
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Ryutaro Hayashi
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Kenji Yamamoto
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Shinji Sudoh
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Hiroshi Sugiyama
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
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109
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Abstract
Deep brain stimulation (DBS) has been widely performed for various medically refractory movement disorders. For Parkinson disease (PD), target of DBS is subthalamic nucleus (STN) or globus pallidus internus (GPi). There are some evidences to demonstrate its effectiveness on motor function and QOL. DBS effectively improves levodopa-responsive motor symptoms, and significantly reduces dyskinesia and motor fluctuations. STN DBS particularly decreases the need for dopaminergic medication. A combination of medical treatment and DBS would provide longer relief of motor symptoms than medical treatment only. Currently new evidence supporting early introduction of DBS for better future outcome is published. DBS of Vim thalamus has been indicated for intractable tremor with various etiologies. Recently posterior subthalamic area (PSA) is introduced as an alternative target to Vim for tremor. GPi DBS is also effective treatment option for generalized dystonia.
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Affiliation(s)
- Atsushi Umemura
- Department of Research and Therapeutics for Movement Disorders, Juntendo University
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110
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Umemura A, Oka Y, Yamada K, Oyama G, Shimo Y, Hattori N. Validity of single tract microelectrode recording in subthalamic nucleus stimulation. Neurol Med Chir (Tokyo) 2013; 53:821-7. [PMID: 24140767 PMCID: PMC4508719 DOI: 10.2176/nmc.oa2012-0412] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In surgery for subthalamic nucleus (STN) deep brain stimulation (DBS), precise implantation of the lead into the STN is essential. Physiological refinement with microelectrode recording (MER) is the gold standard for identifying STN. We studied single tract MER findings and surgical outcomes and verified our surgical method using single tract MER. The number of trajectories in MER and the final position of lead placement were retrospectively analyzed in 440 sides of STN DBS in 221 patients. Bilateral STN DBS yielded marked improvement in the motor score, dyskinesia/fluctuation score, and reduced requirement of dopaminergic medication in this series. The number of trajectories required to obtain sufficient activity of the STN was one in 79.0%, two in 18.2%, and three or more in 2.5% of 440 sides. In 92 sides requiring altered trajectory, the final direction of trajectory movement was posterior in 73.9%, anterior in 13.0%, lateral in 5.4%, and medial in 4.3%. In 18 patients, posterior moves were required due to significant brain shift with intracranial air caused by outflow of CSF during the second side procedure. Sufficient STN activity is obtained with minimum trajectories by proper targeting and precise interpretation of MER findings even in the single tract method. Anterior–posterior moves rather than medial–lateral moves should be attempted first in cases with insufficient recording of STN activity.
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Affiliation(s)
- Atsushi Umemura
- Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine
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111
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Sawada H, Oeda T, Yamamoto K, Umemura A, Tomita S, Hayashi R, Kohsaka M, Kawamura T. Trigger medications and patient-related risk factors for Parkinson disease psychosis requiring anti-psychotic drugs: a retrospective cohort study. BMC Neurol 2013; 13:145. [PMID: 24119306 PMCID: PMC3879653 DOI: 10.1186/1471-2377-13-145] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 10/09/2013] [Indexed: 11/21/2022] Open
Abstract
Background Psychoses such as hallucinations are a frequent non-motor problem in patients with Parkinson disease (PD) and serious psychosis requires anti-psychotic medications that worsen Parkinsonism. Although psychosis could be associated with patient-related or biological factors such as cognition, age, and severity of PD, it can also be associated with medications. Therefore we aimed to investigate patient-related and medication-related risks of psychosis requiring anti-psychotic medications (serious psychosis). Methods A retrospective cohort of 331 PD patients was followed for 2 years. Patient-related factors associated with risk of psychosis were identified by a survival time analysis. In patients who developed psychosis, medications during the hazard period (1-14 days before psychosis) were contrasted with those during the control periods (1 and 3 months before psychosis) using a case–crossover analysis to identify medication-related risks of psychosis. Results Serious psychosis was detected in 52 patients and the incidence was estimated to be 116 (95% confidence interval [CI], 85-148) per 1,000 person-years. Analyses of baseline characteristics revealed the risk to be higher in patients with a modified Hoehn–Yahr stage of ≥4 (hazard ratio [HR], 2.22; 95% CI, 1.11-4.40), those with a longer duration of PD (HR, 1.25; 95% CI, 1.00-1.55, per 5 years) and those with Mini-Mental State Examination scores of ≤24 (HR, 2.66; 95% CI, 1.37-5.16). The case-crossover analysis revealed that anti-cholinergics use (HR, 19.7; 95% CI, 2.39-162) elevated the risk, while donepezil use reduced it (HR, 0.48; 95% CI, 0.27-0.85). Conclusions Risk of psychosis was elevated by increasing severity of PD, cognitive dysfunction and duration of the disease. It was elevated by use of anti-cholinergic drugs and reduced by use of donepezil. The medication-related risk was higher in patients aged ≥ 70 years. In contrast, there was no significant medication-related risk in younger patients, suggesting different pathomechanisms between young and old patients.
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Affiliation(s)
- Hideyuki Sawada
- Clinical Research Center, 8 Ondoyamacho, Narutaki, Ukyoku Kyoto 616-8255, Japan.
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112
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Oeda T, Umemura A, Tomita S, Hayashi R, Kohsaka M, Sawada H. Clinical factors associated with abnormal postures in Parkinson's disease. PLoS One 2013; 8:e73547. [PMID: 24069205 PMCID: PMC3777935 DOI: 10.1371/journal.pone.0073547] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/21/2013] [Indexed: 11/28/2022] Open
Abstract
Background Abnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication. Purpose To clarify factors associated with neck and thoracolumbar AP. Methods Neck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ΔNFA and ΔTLA, respectively. The association of ΔNFA or ΔTLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H–Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ΔNFA or ΔTLA. The association between predictable factors and ΔNFA or ΔTLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis. Results Compared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ΔNFA, the highest quartile was associated with H–Y stage ≥3 [OR 2.99, 95% confidence interval (CI) 1.33–6.70, p = 0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ΔTLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42–23.8), p = 0.014], and UPDRS-3 score [OR 3.04 (1.80–5.15)/10 points, p<0.0001]. Conclusion Thoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.
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Affiliation(s)
- Tomoko Oeda
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
| | - Atsushi Umemura
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
| | - Satoshi Tomita
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
| | - Ryutaro Hayashi
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
| | - Hideyuki Sawada
- Clinical Research Center and Department of Neurology, National Hospital of Utano, National Hospital Organization, Kyoto City, Kyoto, Japan
- * E-mail:
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113
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Nishimura T, Yamaguchi K, Fujii H, Okada Y, Yokomizo C, Niimi T, Sumida Y, Yasui K, Mitsuyoshi H, Minami M, Umemura A, Shima T, Okanoue T, Itoh Y. Prediction of a favorable clinical course in hepatitis C virus carriers with persistently normal serum alanine aminotransferase levels: A long-term follow-up study. Hepatol Res 2013; 43:557-62. [PMID: 22978477 DOI: 10.1111/j.1872-034x.2012.01091.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/15/2012] [Accepted: 08/19/2012] [Indexed: 02/08/2023]
Abstract
AIM This study examined serum alanine aminotransferase (ALT) levels at first visit and their relationship with long-term normal serum ALT levels in hepatitis C virus (HCV) carriers with persistently normal ALT (PNALT). METHODS HCV carriers with PNALT were identified as those patients with positivity of serum HCV RNA, ALT levels of 30 IU/L or less over a 12-month period on at least three different occasions, platelet count of more than 15 × 10(4) μl/mL and body mass index of 30 kg/m(2) or less. Outcome was retrospectively studied in 49 HCV carriers with PNALT, who were followed up for more than 10 years. RESULTS During the mean follow-up period of 14.7 ± 2.5 years, ALT levels of 30 IU/L or less were preserved in only eight patients (8/49; 16.3%). Among the 17 patients with initial ALT levels of 19 IU/L or less, nine patients remained with ALT levels of 30 IU/L or less after 10 years (9/17; 52.9%). The probability of ALT levels in PNALT being maintained at 30 IU/L or less was significantly higher (P = 0.001) in these patients than in those with initial ALT levels of 20 IU/L or more (n = 32). Abnormal ALT levels were more common in female PNALT patients aged 45-55 years, which is usually the time of menopause onset. CONCLUSION Because antiviral therapy in the treatment of chronic hepatitis C is rapidly advancing, waiting for more effective and safer treatments may be an option. The results of this study provide an important insight into this issue.
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Affiliation(s)
- Takeshi Nishimura
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto
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114
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Shima T, Uto H, Ueki K, Takamura T, Kohgo Y, Kawata S, Yasui K, Park H, Nakamura N, Nakatou T, Tanaka N, Umemura A, Mizuno M, Tanaka J, Okanoue T. Clinicopathological features of liver injury in patients with type 2 diabetes mellitus and comparative study of histologically proven nonalcoholic fatty liver diseases with or without type 2 diabetes mellitus. J Gastroenterol 2013; 48:515-25. [PMID: 22911170 DOI: 10.1007/s00535-012-0653-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/23/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Japan Society of Diabetes Mellitus reported that the leading cause of death in patients with diabetes mellitus (DM) was chronic liver disease; however, there are limited studies investigating the cause of liver injury in these patients. Our study aimed to clarify the clinicopathological features of liver injury and the characteristics of nonalcoholic fatty liver disease (NAFLD) in DM patients. METHODS In total, 5,642 DM patients and 365 histologically proven NAFLD patients were enrolled. Clinical and laboratory parameters and liver biopsy results were, respectively, recorded and analyzed for the two sets of patients. RESULTS Positivity rates for Hepatitis B surface antigens (HBsAg) and anti-hepatitis C virus antibodies (anti-HCV Ab) were 1.7 and 5.1 %, respectively. The proportion of drinkers consuming 20-59 g and ≥60 g alcohol daily was 14.9 and 4.3 %, respectively. The percentage of DM patients with elevated serum alanine aminotransferase (ALT) levels (≥31 IU/L) was 28.6 %. Alcohol consumption had no significant effect on serum ALT levels. Seventy-two percent of HBsAg-positive patients were serum hepatitis B virus (HBV)-DNA negative, whereas 10 % exhibited high levels of the same (>4.0 log copies/ml). Thirty-eight percent of anti-HCV Ab-positive patients were serum HCV-RNA negative. Among the NAFLD patients, the frequencies of NASH and advanced stage NASH were significantly higher in male DM patients than in male patients without DM. CONCLUSIONS Although HBsAg- and anti-HCV Ab-positivity rates were high in our Japanese DM patients, a majority of liver injuries could be associated with NAFLD/nonalcoholic steatohepatitis.
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Affiliation(s)
- Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
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115
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Sakurai T, Kudo M, Umemura A, He G, Elsharkawy AM, Seki E, Karin M. p38α inhibits liver fibrogenesis and consequent hepatocarcinogenesis by curtailing accumulation of reactive oxygen species. Cancer Res 2012; 73:215-24. [PMID: 23271722 DOI: 10.1158/0008-5472.can-12-1602] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most hepatocellular carcinomas (HCC) develop in the context of severe liver fibrosis and cirrhosis caused by chronic liver inflammation, which also results in accumulation of reactive oxygen species (ROS). In this study, we examined whether the stress-activated protein kinase p38α (Mapk14) controls ROS metabolism and development of fibrosis and cancer in mice given thioacetamide to induce chronic liver injury. Liver-specific p38α ablation was found to enhance ROS accumulation, which appears to be exerted through the reduced expression of antioxidant protein HSP25 (Hspb1), a mouse homolog of HSP27. Its reexpression in p38α-deficient liver prevents ROS accumulation and thioacetamide-induced fibrosis. p38α deficiency increased expression of SOX2, a marker for cancer stem cells and the liver oncoproteins c-Jun (Jun) and Gankyrin (Psmd10) and led to enhanced thioacetamide-induced hepatocarcinogenesis. The upregulation of SOX2 and c-Jun was prevented by administration of the antioxidant butylated hydroxyanisole. Intriguingly, the risk of human HCC recurrence is positively correlated with ROS accumulation in liver. Thus, p38α and its target HSP25/HSP27 appear to play a conserved and critical hepatoprotective function by curtailing ROS accumulation in liver parenchymal cells engaged in oxidative metabolism of exogenous chemicals. Augmented oxidative stress of liver parenchymal cells may explain the close relationship between liver fibrosis and hepatocarcinogenesis.
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Affiliation(s)
- Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kinki University, Ohnohigashi, Osaka-Sayama, Osaka, Japan
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116
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Umemura A. [The role of neurologists in deep brain stimulation for Parkinson disease: a neurosurgical perspective]. Rinsho Shinkeigaku 2012. [PMID: 23196529 DOI: 10.5692/clinicalneurol.52.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Deep brain stimulation (DBS) has been accepted as an effective treatment for medically refractory Parkinson disease (PD). Appropriate patient selection, safe and precise surgery, and proper postoperative adjustment of stimulation and medication, are essential for the success of DBS. Patient selection is the most important role for the neurologist in DBS treatment. Neurologists treating PD should understand the correct indications and contraindications for DBS, and introduce it in a timely manner to patients who can be expected to benefit substantially from it. For long term treatment of PD, ideally the neurologist in charge of the patient should adjust both the stimulation parameters and medication. Neurologists engaged in this treatment should also have a comprehensive understanding of the probable complications and how to avoid them.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Graduate School of Medicine
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117
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Nishimura T, Yamaguchi K, Hashimoto H, Niimi T, Yokomizo C, Fujii H, Minami M, Sakamoto M, Ohnish N, Nagao Y, Okita M, Umemura A, Shima T, Okanoue T, Itoh Y. Treatment extension may benefit female genotype 1 chronic hepatitis C patients with complete early virological response to peginterferon-alpha-2b and ribavirin combination therapy. Hepatol Res 2012; 42:966-73. [PMID: 22548706 DOI: 10.1111/j.1872-034x.2012.01016.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Little is known about the appropriate use of peginterferon-α-2b (PEG IFN-α-2b) or ribavirin (RBV) in genotype 1 chronic hepatitis C (CH-C) patients with complete early virological response (cEVR). Female patients, especially the older, are known to experience inferior treatment outcomes. METHOD A total of 150 CH-C patients with cEVR treated for 48 weeks (n = 104) or 52-64 weeks (n = 46) with PEG IFN-α-2b and RBV combination therapy were retrospectively analyzed to evaluate the benefits of extended treatment. RESULTS In the 48-week group, patients without a sustained virological response (SVR) were more often female (P = 0.004) and had received a significantly lower total RBV dose (P = 0.003) than those with SVR. The SVR rate in these female patients was similar to males with hepatitis C virus (HCV) RNA negativity at treatment week 8 (P = 0.413); however, it was lower than that in males with HCV RNA negativity at treatment week 12 (P = 0.005). In the 52-64-week group, although the total RBV dose (mg/kg) after treatment week 48 was less in females than in males (P = 0.027), the SVR rate in females was equivalent to that in males (P = 0.604). CONCLUSION Genotype 1 CH-C patients treated with PEG IFN-α-2b and RBV combination therapy without SVR were more often female and had received a lower total RBV dose than males. The smaller SVR rate in female patients with cEVR compared to males may be overcome by extending treatment even if the RBV dose is lowered due to anemia.
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Affiliation(s)
- Takeshi Nishimura
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science Department of Internal Medicine, Aiseikai Yamashina Hospital, Kyoto Hepatology Center, Saiseikai Suita Hospital Department of Gastroenterology, Matsushita Memorial Hospital, Osaka, Japan
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118
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Kawaguchi T, Sumida Y, Umemura A, Matsuo K, Takahashi M, Takamura T, Yasui K, Saibara T, Hashimoto E, Kawanaka M, Watanabe S, Kawata S, Imai Y, Kokubo M, Shima T, Park H, Tanaka H, Tajima K, Yamada R, Matsuda F. Genetic polymorphisms of the human PNPLA3 gene are strongly associated with severity of non-alcoholic fatty liver disease in Japanese. PLoS One 2012; 7:e38322. [PMID: 22719876 PMCID: PMC3375283 DOI: 10.1371/journal.pone.0038322] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/03/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) includes a broad range of liver pathologies from simple steatosis to cirrhosis and fibrosis, in which a subtype accompanying hepatocyte degeneration and fibrosis is classified as nonalcoholic steatohepatitis (NASH). NASH accounts for approximately 10-30% of NAFLD and causes a higher frequency of liver-related death, and its progression of NASH has been considered to be complex involving multiple genetic factors interacting with the environment and lifestyle. PRINCIPAL FINDINGS To identify genetic factors related to NAFLD in the Japanese, we performed a genome-wide association study recruiting 529 histologically diagnosed NAFLD patients and 932 population controls. A significant association was observed for a cluster of SNPs in PNPLA3 on chromosome 22q13 with the strongest p-value of 1.4 × 10(-10) (OR = 1.66, 95%CI: 1.43-1.94) for rs738409. Rs738409 also showed the strongest association (p = 3.6 × 10(-6)) with the histological classifications proposed by Matteoni and colleagues based on the degree of inflammation, ballooning degeneration, fibrosis and Mallory-Denk body. In addition, there were marked differences in rs738409 genotype distributions between type4 subgroup corresponding to NASH and the other three subgroups (p = 4.8 × 10(-6), OR = 1.96, 95%CI: 1.47-2.62). Moreover, a subgroup analysis of NAFLD patients against controls showed a significant association of rs738409 with type4 (p = 1.7 × 10(-16), OR = 2.18, 95%CI: 1.81-2.63) whereas no association was obtained for type1 to type3 (p = 0.41). Rs738409 also showed strong associations with three clinical traits related to the prognosis of NAFLD, namely, levels of hyaluronic acid (p = 4.6 × 10(-4)), HbA1c (p = 0.0011) and iron deposition in the liver (p = 5.6 × 10(-4)). CONCLUSIONS With these results we clearly demonstrated that Matteoni type4 NAFLD is both a genetically and clinically different subset from the other spectrums of the disease and that the PNPLA3 gene is strongly associated with the progression of NASH in Japanese population.
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Affiliation(s)
- Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Institut National de la Sante et de la Recherche Medicale (INSERM) Unite U852, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshio Sumida
- Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Atsushi Umemura
- Center of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Japan
| | - Meiko Takahashi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshinari Takamura
- Department of Disease Control and Homeostasis, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Kohichiroh Yasui
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiji Saibara
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - Etsuko Hashimoto
- Department of Internal Medicine and Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Miwa Kawanaka
- Center of Liver Diseases, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sumio Kawata
- Department of Gastroenterology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yasuharu Imai
- Department of Internal Medicine, Ikeda Municipal Hospital, Ikeda, Japan
| | - Miki Kokubo
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshihide Shima
- Center of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Hyohun Park
- Center of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan
| | - Hideo Tanaka
- Division of Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Japan
| | - Kazuo Tajima
- Division of Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Institut National de la Sante et de la Recherche Medicale (INSERM) Unite U852, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
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Yamanaka T, Ishii F, Umemura A, Miyata M, Horiba M, Oka Y, Yamada K, Okita K, Matsukawa N, Ojika K. Temporary deterioration of executive function after subthalamic deep brain stimulation in Parkinson's disease. Clin Neurol Neurosurg 2012; 114:347-51. [DOI: 10.1016/j.clineuro.2011.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 08/03/2011] [Accepted: 11/05/2011] [Indexed: 11/26/2022]
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Umemura A, Oka Y, Yamamoto K, Okita K, Matsukawa N, Yamada K. Complications of subthalamic nucleus stimulation in Parkinson's disease. Neurol Med Chir (Tokyo) 2012; 51:749-55. [PMID: 22123476 DOI: 10.2176/nmc.51.749] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Graduate School of Medicine, Aichi.
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121
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Nagaishi A, Takagi M, Umemura A, Tanaka M, Kitagawa Y, Matsui M, Nishizawa M, Sakimura K, Tanaka K. Clinical features of neuromyelitis optica in a large Japanese cohort: comparison between phenotypes. J Neurol Neurosurg Psychiatry 2011; 82:1360-4. [PMID: 21665917 DOI: 10.1136/jnnp-2011-300403] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse clinicoepidemiological features of neuromyelitis optica in a large cohort and to compare the differences between onset age, gender and clinical phenotypes. METHODS Antiaquaporin-4 antibody (AQP4-ab) levels were tested in 2366 serum samples of patients diagnosed as having central nervous system inflammatory demyelinating disorders by their referring physicians. AQP4-ab was measured by indirect immunofluorescence staining using human AQP4-transfected HEK 293 cells. A blinded analysis was performed and was combined with clinical information. RESULTS A total of 583 patients (91.4% women) were AQP4-ab-positive. The average onset age was 42.9±15.9 years. According to MRI studies, spinal-cord lesions were detected in 85.3% of the patients, longitudinally extensive transverse myelitis in 72.7% and cerebral lesions in 51.1%. Unilateral or bilateral blindness was observed in 16.2% of patients, 19.8% were associated with Sjögren syndrome, and 13.6% were associated with thyroid diseases. Myelin basic protein was detected in the cerebrospinal fluid of 57.5% patients. In addition, men presented with an older onset age, a greater number of brainstem MRI lesions and positive myelin basic protein in the cerebrospinal fluid. All child-onset patients (<15 years, n=9) presented with optic neuritis as the first symptom, while older-onset patients presented with myelitis. Twenty patients initially developed limited brain lesions, and seven of these patients did not develop optic or spinal lesions during the 1-5-year follow-up period. CONCLUSIONS The clinical characteristics of AQP4-ab-positive patients were similar. However, optic neuritis was more common in paediatric patients, while myelitis was more common in older patients. A small number of patients exhibited only cerebral, brainstem, or cerebellar lesions during the initial several years and lower Extended Disability Status Scale scores.
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Affiliation(s)
- Akiko Nagaishi
- Department of Neurology, Kanazawa Medical University, 11 Daigaku, Uchinadamachi, Kahokugun, Ishikawa, Japan
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Itoh Y, Nishimura T, Yamaguchi K, Yokomizo C, Fujii H, Minami M, Nagao Y, Sumida Y, Hashimoto H, Umemura A, Shima T, Okanoue T, Yoshikawa T. Hepatic steatosis in chronic hepatitis C patients infected with genotype 2 is associated with insulin resistance, hepatic fibrosis and affects cumulative positivity of serum hepatitis C virus RNA in peginterferon and ribavirin combination therapy. Hepatol Res 2011; 41:1145-52. [PMID: 21951359 DOI: 10.1111/j.1872-034x.2011.00886.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM Hepatic steatosis is one of the factors limiting the virological response to interferon-based antiviral therapy for chronic hepatitis C (CH-C) patients infected with genotype 1, while contradictory results have been reported for genotype 2. We aimed to clarify the effect of hepatic steatosis on therapeutic outcome and cumulative positivity of serum HCV RNA in CH-C patients infected with genotype 2 treated by peginterferon (PEG-IFN)α2b and ribavirin (RBV) combination therapy. METHODS A total of 74 treatment-naïve non-cirrhotic CH-C patients infected with genotype 2 who received PEG-IFNα2b and RBV according to the standard regimen were divided into hepatic steatosis 0-10% and >10% groups. The clinical backgrounds, sustained virological response (SVR) rates and cumulative positivity of serum HCV RNA were compared between the two groups. RESULTS Among the 74 patients, 61 (82.4%) had hepatic steatosis 0-10% and 13 (17.6%) had hepatic steatosis >10%. Scores of homeostasis model assessment-insulin resistance and hepatic fibrosis were higher in patients with hepatic steatosis >10% than hepatic steatosis 0-10% (P = 0.040 and 0.042, respectively). Non-SVR was more frequent in patients with hepatic steatosis >10% than hepatic steatosis 0-10% (P = 0.003). Cumulative positivity of serum HCV RNA was significantly higher in patients with hepatic steatosis >10% than hepatic steatosis 0-10% (P = 0.004). CONCLUSIONS In CH-C patients infected with genotype 2 treated by PEG-IFNα2b and RBV combination therapy, hepatic steatosis >10% was associated with increased insulin resistance, advanced hepatic fibrosis and higher cumulative positivity of serum HCV RNA, which lead to a higher risk of non-SVR.
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Affiliation(s)
- Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto Department of Gastroenterology, Matsushita Memorial Hospital Hepatology Center, Saiseikai Suita Hospital, Osaka Department of Gastroenterology and Hepatology Nara City Hospital, Nara, Japan
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Yokomizo C, Yamaguchi K, Itoh Y, Nishimura T, Umemura A, Minami M, Yasui K, Mitsuyoshi H, Fujii H, Tochiki N, Nakajima T, Okanoue T, Yoshikawa T. High expression of p300 in HCC predicts shortened overall survival in association with enhanced epithelial mesenchymal transition of HCC cells. Cancer Lett 2011; 310:140-7. [PMID: 21764211 DOI: 10.1016/j.canlet.2011.06.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 01/11/2023]
Abstract
P300 impacts the transcription of several genes involved in biological behavior of human malignancies including hepatocellular carcinomas (HCC). We found p300 is highly expressed in 47% of surgically resected HCC specimens by immunohistochemistry, which correlated with advanced TNM staging (P = 0.034), vascular invasion (P = 0.036), intrahepatic metastasis (P = 0.001) and shortened overall survival (P = 0.028). In vitro study, knocking down of p300 expression in hepatoma cells recovered E-cadherin expression, inhibited the translocation of beta (β)-catenin into the nuclei, decreased cyclin D1 activity and suppressed the migration/invasion of HCC cells. Furthermore, suppression of p300 led to down-regulation of epithelial-mesenchymal transition (EMT)-related molecules such as Snail, Twist and HIF-1 alpha. These observations suggest that p300 contributes to the EMT-related progression of HCCs.
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Affiliation(s)
- Chihiro Yokomizo
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Umemura A, Oka Y, Okita K, Matsukawa N, Yamada K. Subthalamic nucleus stimulation for Parkinson disease with severe medication-induced hallucinations or delusions. J Neurosurg 2011; 114:1701-5. [DOI: 10.3171/2011.2.jns101261] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Subthalamic nucleus deep brain stimulation (STN DBS) improves cardinal motor symptoms of Parkinson disease (PD) and reduces antiparkinsonian medication. Therefore, STN DBS seems to be well indicated for patients suffering from medication-induced psychotic symptoms. However, there are few available data dealing with the effect of STN DBS in this kind of patient. The authors studied the effect of STN DBS in patients with PD and severe medication-induced hallucinations or delusions.
Methods
The authors retrospectively reviewed the clinical course of 10 patients who suffered from severe medication-induced hallucinations or delusions and underwent bilateral STN DBS. Patients whose preoperative thought disorder score (Unified Parkinson's Disease Rating Scale Part I, item 2) was 3 or more were enrolled in this study. All patients underwent cognitive function examination and brain perfusion SPECT preoperatively to exclude dementia with Lewy bodies.
Results
Subthalamic nucleus DBS yielded significant improvement of motor function in all patients. In 8 patients, psychotic symptoms completely disappeared with significant reduction of dopaminergic medication. In 2 patients, hallucinations and delusions deteriorated immediately after surgery despite complete withdrawal of antiparkinsonian medication. However, these psychotic symptoms completely disappeared after a few months with administration of antipsychotics, and no recurrence was observed afterward in either patient.
Conclusions
Subthalamic nucleus DBS is a good treatment option for patients with PD who are suffering severe medication-induced hallucinations or delusion. However, vigilance is needed, because temporary deterioration of psychotic symptoms may occur after surgery.
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Affiliation(s)
| | | | - Kenji Okita
- 2Neurology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Matsukawa
- 2Neurology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
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Yamaguchi K, Itoh Y, Yokomizo C, Nishimura T, Niimi T, Umemura A, Fujii H, Okanoue T, Yoshikawa T. Blockade of IL-6 signaling exacerbates liver injury and suppresses antiapoptotic gene expression in methionine choline-deficient diet-fed db/db mice. J Transl Med 2011; 91:609-18. [PMID: 21321532 DOI: 10.1038/labinvest.2011.2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Our previous study revealed that blockade of interleukin-6 (IL-6)-STAT3 signaling ameliorated liver injury, although hepatic STAT3(-/-) or GP130(-/-) mice have been reported to develop severe liver injury, in a murine methionine choline deficient (MCD) diet-induced model of non-alcoholic steatohepatitis (NASH). In this study, to determine whether profound blockade of IL-6-STAT3 signaling may still ameliorate liver injury, we studied db/db mice, which have impaired leptin-mediated STAT3 activation, using the MCD diet-induced NASH model. Male lean and db/db mice (6 weeks old) were fed either control chow or an MCD diet for 8 or 12 weeks. Half of the mice were treated with 15 mg/kg rat anti-mouse IL-6 receptor neutralizing antibody (MR16-1) intraperitoneally twice weekly, the remainder were injected with 15 mg/kg rat IgG as a control. Hepatic steatosis, injury, fibrosis, markers of lipid peroxidation/oxidant stress and antiapoptotic gene expression were evaluated. Plasma IL-6 levels were elevated in all groups of db/db mice. Although hepatic IL-6/ GP130 signaling was activated in chow-fed db/db mice, this was suppressed in MCD diet-fed db/db mice, accompanied by downregulation of hepatic IL-6 receptor and GP130 mRNA expression. MR16-1 treatment of MCD diet-fed db/db mice further repressed STAT3 activities and expression of STAT3-related antiapoptotic genes, such as Bcl-2 and Ref-1, but increased plasma-free fatty acid and hepatic markers of lipid peroxidation/oxidant stress, leading to increased liver injury, hepatocyte apoptosis and liver fibrosis. Although 'moderate' blockade of enhanced IL-6-STAT3 signaling may be beneficial in NASH, as we reported previously, these findings demonstrate that a profound defect in STAT3 activation is detrimental in terms of liver injury, hepatocyte apoptosis and liver fibrosis, indicating the hepato-protective role of IL-6 signaling in this severe NASH model.
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Affiliation(s)
- Kanji Yamaguchi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
During the past 20 to 30 years, the frequency of patients presenting with nonalcoholic fatty liver diseases (NAFLD) has increased gradually in Japan in proportion to the increase in the population with life-style related diseases. We describe here the current status of the clinical and basic aspects of research into NAFLD in Japan. The increase in the incidence of life-style-related diseases has resulted in an increase in NAFLD throughout the past 20 to 30 years. The rate of obesity in the population is not high compared to western countries but the incidence of NAFLD is similar to those countries. In 2008 we started a nationwide study of NAFLD which has been supported by the Ministry of Labor and Welfare Japan. In this project, we planned to investigate the epidemiology, genetic backgrounds and biochemical markers, and liver injury in patients with diabetes mellitus (DM) and hepatocellular carcinoma in NASH, and treatment of NASH. Approximately 20 to 25% of DM patients showed NAFLD in which the prevalence of NASH might be more than 30 to 40%. Fortunately, we have been able to obtain very interesting results from our group studies, including single necleotide polymorphisms (SNPs) which will be published in the near future.
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Affiliation(s)
- Takeshi Okanoue
- Center of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan.
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127
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Abstract
During the past 20 to 30 years, the frequency of patients presenting with nonalcoholic fatty liver diseases (NAFLD) has increased gradually in Japan in proportion to the increase in the population with life-style related diseases. We describe here the current status of the clinical and basic aspects of research into NAFLD in Japan. The increase in the incidence of life-style-related diseases has resulted in an increase in NAFLD throughout the past 20 to 30 years. The rate of obesity in the population is not high compared to western countries but the incidence of NAFLD is similar to those countries. In 2008 we started a nationwide study of NAFLD which has been supported by the Ministry of Labor and Welfare Japan. In this project, we planned to investigate the epidemiology, genetic backgrounds and biochemical markers, and liver injury in patients with diabetes mellitus (DM) and hepatocellular carcinoma in NASH, and treatment of NASH. Approximately 20 to 25% of DM patients showed NAFLD in which the prevalence of NASH might be more than 30 to 40%. Fortunately, we have been able to obtain very interesting results from our group studies, including single necleotide polymorphisms (SNPs) which will be published in the near future.
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Affiliation(s)
- Takeshi Okanoue
- Center of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Osaka, Japan.
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Umemura A, Oka Y, Okita K, Toyoda T, Matsukawa N, Yamada K. Predictive factors affecting early deterioration of axial symptoms after subthalamic nucleus stimulation in Parkinson's disease. Parkinsonism Relat Disord 2010; 16:582-4. [PMID: 20678955 DOI: 10.1016/j.parkreldis.2010.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/09/2010] [Accepted: 07/11/2010] [Indexed: 10/19/2022]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment option for medically refractory Parkinson's disease (PD). However, some patients show deterioration of axial symptoms within a short time after surgery. We studied 43 patients who underwent bilateral STN-DBS and investigated predictive factors affecting early deterioration of axial symptoms. Among 43 patients, 16 patients showed obvious deterioration of axial symptoms within three years of surgery. Multiple logistic regression analysis indicated that the significant independent variables related to early deterioration of axial symptoms were rapidly progressive short duration of the disease and advanced age at surgery. These results suggest that patients with rapidly progressing PD, who need early surgical intervention, tend to show early deterioration of axial symptoms after STN-DBS.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Graduate School of Medicine, Mizuho-ku, Nagoya 467-8601, Japan.
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Umemura A, Oka Y, Ohkita K, Yamawaki T, Yamada K. Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease. J Neurosurg 2010; 112:1283-8. [PMID: 19895200 DOI: 10.3171/2009.10.jns09917] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECT Parkinson disease (PD) is often accompanied by various postural abnormalities such as camptocormia (bent spine) or Pisa syndrome (lateral flexion). The authors studied the effect of subthalamic nucleus deep brain stimulation (STN DBS) on postural abnormality in patients with PD. METHODS The authors retrospectively reviewed the clinical course of 18 patients who suffered from significant postural abnormality and underwent bilateral STN DBS. Patients whose preoperative posture score (Unified Parkinson's Disease Rating Scale III, item 28) was 2 or more in the "medication-on" state were enrolled in this study. Eight patients were considered to have camptocormia, and 10 patients were considered to have so-called Pisa syndrome. Nine patients showed apparent thoracolumbar spinal deformity on radiography. Most patients had significant motor fluctuations from levodopa. RESULTS In 13 patients with moderate postural abnormality (score of 2 on item 28), 9 patients improved soon after surgery, but 1 patient relapsed. Two patients improved gradually over a long period after surgery, whereas 2 patients did not improve at all. In 5 patients with severe postural abnormality (score of 3 or 4 on item 28), 2 patients improved slightly in the long-term follow-up period after surgery, but 3 patients did not improve at all. CONCLUSIONS Postural abnormality in patients with PD could be ameliorated by STN DBS, and therefore surgery should be considered before irreversible spinal deformity develops.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Medical School, Nagoya, Japan.
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Katano H, Kato K, Umemura A, Yamada K. Perioperative evaluation of carotid endarterectomy by 3D-CT angiography with refined reconstruction: preliminary experience of CEA without conventional angiography. Br J Neurosurg 2009; 18:138-48. [PMID: 15176555 DOI: 10.1080/02688690410001680993] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Three-dimensional CT angiography (3D-CTA) was employed for perioperative evaluation of carotid endarterectomy (CEA) as an alternative to conventional angiography. A total of 62 carotid arteries were examined before and after CEA, 26 with an early 3D-CT system and 36 with multidetector helical CT allowing sophisticated reconstruction by a personal workstation. In addition to patients who had undergone conventional angiography at other institutes, 10 subjects underwent CEA on the basis of 3D-CTA findings alone. The findings provided detailed information with an excellent view of carotid stenoses. Volume rendering images comprehensively visualized lesions and surrounding structures as well as calcifications, which were also well depicted by maximum intensity projection images. Evaluation of the cerebral circulation is one problem that still requires solution, although cerebral vessels were delineated by 3D-CTA. One patient experienced transient hemiparesis, but no significant permanent deficit. We conclude that 3D-CTA is a safe and accurate modality that is a practical alternative to conventional perioperative angiography.
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Affiliation(s)
- H Katano
- Department of Neurosurgery and Restorative Neuroscience, Nagoya City University Graduate School of Medical Sciences, Japan.
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Okanoue T, Shima T, Mizuno M, Matsumoto M, Umemura A. [Management of hepatitis C and fatty liver: a consciousness survey among gastroenterologists and general internists]. Nihon Shokakibyo Gakkai Zasshi 2008; 105:1737-1748. [PMID: 19057159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A questionnaire survey including hepatic function test values was performed to elucidate the medical treatment of hepatic diseases by gastroenterologists and general internists. Serum ALT level was considered to be an index of destruction of hepatic cells in 94 and 80% of gastroenterologists and general internists, respectively. Serum gamma-GTP values were used as an index of bile stasis and destruction of the bile duct cells by 93% and 70% of the gastroenterologists, respectively and in 61% and 49% of the internists, respectively. In addition, for hepatitis C, gastroenterologists considered the mean serum ALT values (standard values for drug therapy introduction) as > or =62IU/L, while general internists considered it as > or =79IU/L. In the case of fatty liver, the mean serum ALT values considered by gastroenterologists and general internists were > or =93IU/L and > or =90IU/L, respectively. These survey results suggest that there is a need for research-based clarification of hepatic function test values regulating therapy and unification of guidelines for standard values in medical treatment.
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Umemura A, Toyoda T, Yamamoto K, Oka Y, Ishii F, Yamada K. Apraxia of eyelid opening after subthalamic deep brain stimulation may be caused by reduction of levodopa. Parkinsonism Relat Disord 2008; 14:655-7. [PMID: 18316231 DOI: 10.1016/j.parkreldis.2007.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Revised: 12/06/2007] [Accepted: 12/14/2007] [Indexed: 11/19/2022]
Abstract
Apraxia of eyelid opening (ALO) is an infrequent side effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). However, the pathogenesis of ALO after STN DBS is not well understood. We report on two patients who suffered from disabling ALO after bilateral STN DBS. Their ALO improved by resuming the levodopa medication that had been discontinued after the surgery. Although ALO after STN DBS is considered as an adverse effect of STN stimulation, postoperative modification of dopaminergic medication may be a cause of ALO after STN DBS.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Medical School, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
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Umemura A, Itoh Y, Itoh K, Yamaguchi K, Nakajima T, Higashitsuji H, Onoue H, Fukumoto M, Okanoue T, Fujita J. Association of gankyrin protein expression with early clinical stages and insulin-like growth factor-binding protein 5 expression in human hepatocellular carcinoma. Hepatology 2008; 47:493-502. [PMID: 18161051 DOI: 10.1002/hep.22027] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Gankyrin (also known as PSMD10) is a liver oncoprotein that interacts with multiple proteins including MDM2 and accelerates degradation of the tumor suppressors p53 and Rb. We produced a monoclonal anti-gankyrin antibody and immunohistochemically assessed the clinicopathological significance of gankyrin overexpression in 43 specimens of human hepatocellular carcinoma (HCC). Specific cytoplasmic staining for gankyrin was observed in 62.8% (27/43) of HCCs, which was significantly associated with low TNM stage (P = 0.004), no capsular invasion (P = 0.018), no portal venous invasion (P = 0.008), and no intrahepatic metastasis (P = 0.012). The cumulative survival rate of patients with gankyrin-positive HCC was significantly higher than that with gankyrin-negative HCC (P = 0.037). p53 and MDM2 were positively stained by antibodies in 30.2% and 23.3%, respectively, of HCCs, but neither was inversely associated with gankyrin expression. In the Huh-7 human HCC cell line, overexpression of gankyrin up-regulated expression of insulin-like growth factor binding protein 5 (IGFBP-5), whereas suppression of gankyrin expression by siRNA down-regulated it. Supression of IGFBP-5 expression inhibited proliferation of Huh-7 cells as well as U-2 OS osteosarcoma cells. In HCC specimens, positive staining for IGFBP-5 was observed by immunohistochemistry in 41.9% (18/43), and the level of expression was significantly correlated with that of gankyrin (rho = 0.629, P < 0.001). CONCLUSION These results suggest that gankyrin plays an oncogenic role(s) mainly at the early stages of human hepatocarcinogenesis, and that IGFBP-5 inducible by gankyrin overexpression may be involved in it.
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Affiliation(s)
- Atsushi Umemura
- Department of Clinical Molecular Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yu Y, Ugawa S, Ueda T, Ishida Y, Inoue K, Kyaw Nyunt A, Umemura A, Mase M, Yamada K, Shimada S. Cellular localization of P2X7 receptor mRNA in the rat brain. Brain Res 2008; 1194:45-55. [DOI: 10.1016/j.brainres.2007.11.064] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 11/06/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
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Umemura A, Yamada K. [Clinical statistical study in subarachnoid hemorrhage]. Nihon Rinsho 2006; 64 Suppl 8:546-9. [PMID: 17469608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery and Restorative Neuroscience, Nagoya City University Graduate School of Medical Sciences
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Yamaguchi K, Itoh K, Masuda T, Umemura A, Baum C, Itoh Y, Okanoue T, Fujita J. In vivo selection of transduced hematopoietic stem cells and little evidence of their conversion into hepatocytes in vivo. J Hepatol 2006; 45:681-7. [PMID: 16837099 DOI: 10.1016/j.jhep.2006.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 03/29/2006] [Accepted: 04/14/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIMS FMEV-type retroviral vector provides high transgene expression in hepatocytes and hematopoietic stem cells (HSCs). Here, we examined whether these vectors could provide a sufficient drug-resistance gene expression in HSCs and whether transduced HSCs could differentiate into hepatocytes in vivo. METHODS The CD45(+)/Lin(-) cells were transduced in vitro by FMEV-type vectors containing human O(6)-methylguanine-DNA methyltransferase (MGMT)/reporter genes and transferred into recipient mice. After the treatment with temozolomide and O(6)-benzylguanine (TMZ/BG) in vivo, we analyzed the transgene expression in peripheral blood cells by flow-cytometry. Immunohistochemistry was performed on the liver slices in partial hepatectomized recipient mice. RESULTS After TMZ/BG treatment, transduced host cells were enriched in recipient mice. In the liver, we observed the efficient transgene expression in many small cells along sinusoids. However, only few large cells in hepatic lobules expressed albumin. They also expressed both a transgene and a recipient marker gene, suggesting the fusion of donor HSCs with recipient hepatocytes. CONCLUSIONS This vector expressed a drug-resistance gene in HSCs highly enough to protect them from the drugs. But, the conversion of HSCs into hepatocytes in vivo might be a rare event in this model.
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Affiliation(s)
- Kanji Yamaguchi
- Department of Clinical Molecular Biology, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Umemura A, Samadani U, Jaggi JL, Hurtig HI, Baltuch GH. Thalamic deep brain stimulation for posttraumatic action tremor. Clin Neurol Neurosurg 2004; 106:280-3. [PMID: 15297000 DOI: 10.1016/j.clineuro.2003.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2003] [Revised: 12/08/2003] [Accepted: 12/17/2003] [Indexed: 11/25/2022]
Abstract
We report a case of thalamic deep brain stimulation (DBS) for treatment of posttraumatic tremor. An 18-year-old right-handed man developed a disabling and medically refractory action tremor in the right upper extremity 9 months after sustaining diffuse axonal injury in a motor vehicle collision. DBS of the left ventral intermediate nucleus of the thalamus (Vim) suppressed the tremor without complication and should be considered as an option for the management of intractable posttraumatic tremor.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Penn Neurological Institute at Pennsylvania Hospital, University of Pennsylvania, 330 South, 9th Street, Philadelphia, PA 19107, USA
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Jaggi JL, Umemura A, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH. Bilateral stimulation of the subthalamic nucleus in Parkinson's disease: surgical efficacy and prediction of outcome. Stereotact Funct Neurosurg 2004; 82:104-14. [PMID: 15305083 DOI: 10.1159/000078145] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Over the last decade neurosurgery has reemerged as a valid therapy for patients with advanced Parkinson's disease. Previously, we have addressed safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS). In this study, we extended these observations and analyzed factors that affect surgical outcome and its predictive value. METHODS Thirty-nine patients were enrolled in an open-label prospective protocol designed to evaluate safety and efficacy of bilateral STN DBS in patients with advanced Parkinson's disease between January 1999 and July 2002. Electrodes were stereotactically implanted with electrophysiological conformation of the target location. All patients were evaluated in the medication 'off' and 'on' state preoperatively and at 3, 6, and 12 months after surgery in medication 'on' and 'off' as well as in the stimulation 'off' and 'on' state. Tests included Unified Parkinson's Disease Rating Scales (UPDRS) as well as timed tests. All data was analyzed by means of Analysis of Variance. For outcome prediction, correlation and linear regression analyses were utilized. Stimulation produced significant improvements in all 'off' mediation conditions, resulting in a 42% improvement in UPDRS III score at 12 months compared to the preoperative status. Stimulation in conjunction with medication did not produce any significant change when compared to the preoperative medication 'on' state. Dyskinesia, motor fluctuations, and duration of 'off' periods were significantly reduced with stimulation. Significant outcome predictor variables were age, preoperative percent change of UPDRS III score from medication 'off' to medication 'on' state, and the duration of disease. CONCLUSIONS Bilateral STN DBS produces robust improvements in parkinsonian motor symptoms. Surgical outcome can reliably be predicted.
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Affiliation(s)
- Jurg L Jaggi
- Parkinson's Disease and Movement Disorders Center at Pennsylvania Hospital, Department of Neurology, University of Pennsylvania, Philadelphia 19107, USA.
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Umemura A, Jaggi JL, Dolinskas CA, Stern MB, Baltuch GH. Pallidal deep brain stimulation for longstanding severe generalized dystonia in Hallervorden-Spatz syndrome. Case report. J Neurosurg 2004; 100:706-9. [PMID: 15070127 DOI: 10.3171/jns.2004.100.4.0706] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Generalized dystonia is one of the most disabling movement disorders. Ablative stereotactic surgery such as pallidotomy has been performed for medically refractory dystonia. Recently, deep brain stimulation (DBS) has appeared as an alternative to ablative procedures. Nevertheless, there have been few published reports detailing improvement in dystonia with DBS. This 36-year-old man with Hallervorden-Spatz syndrome suffered from intractable primary generalized dystonia for 28 years. He was completely dependent for activities of daily living and wheelchair bound because of continuous severe dystonic movements in the face, tongue, neck, trunk, and upper and lower extremities while at rest. The Burke-Fahn-Marsden (BFM) Dystonia Rating Scale score was 112 (maximum 120 points). Bilateral DBS of the globus pallidus internus was performed and resulted in marked improvement in motor functioning and dystonic symptoms with a significant reduction in disability. The BFM score improved to 22.5 points (80% improvement) at 3 months postsurgery and the patient's dystonia was still well suppressed 1 year after surgery. Bilateral pallidal stimulation is an effective and safe treatment for intractable generalized dystonia in Hallervorden-Spatz syndrome, even if the disability is severe and longstanding.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Penn Neurological Institute at Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA
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Samadani U, Umemura A, Jaggi JL, Colcher A, Zager EL, Baltuch GH. Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. Case report. J Neurosurg 2003; 98:888-90. [PMID: 12691417 DOI: 10.3171/jns.2003.98.4.0888] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thalamic deep brain stimulation (DBS) has been demonstrated to be effective for the treatment of parkinsonian or essential tremor. To date, however, few data exist to support the application of this method to treat midbrain tremor. A 24-year-old right-handed man underwent radiosurgery and subsequent resection of a recurrently hemorrhaging cavernous angioma located in the left side of the midbrain. The surgery exacerbated severe choreoathetotic resting and action tremors of his right extremities and trunk. The patient underwent placement of a deep brain stimulator into the left ventral intermediate nucleus of the thalamus (Vim). Postoperatively, decreased truncal ataxia and right-sided choreoathetotic tremor were demonstrated, with a 57% increase in dexterity as measured by task testing. The authors demonstrate that DBS can be an effective treatment modality for disabling tremor after resection of a midbrain cavernous angioma.
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Affiliation(s)
- Uzma Samadani
- Department of Neurosurgery and Neurology, Penn Neurological Institute at Pennsylvania Hospital, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA
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Umemura A, Jaggi JL, Hurtig HI, Siderowf AD, Colcher A, Stern MB, Baltuch GH. Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2003; 98:779-84. [PMID: 12691402 DOI: 10.3171/jns.2003.98.4.0779] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Deep brain stimulation (DBS) has been advocated as a more highly effective and less morbidity-producing alternative to ablative stereotactic surgery in the treatment of medically intractable movement disorders. Nevertheless, the exact incidence of morbidity and mortality associated with the procedure is not well known. In this study the authors reviewed the surgical morbidity and mortality rates in a large series of DBS operations. METHODS The authors retrospectively analyzed surgical complications in their consecutive series of 179 DBS implantations in 109 patients performed by a single surgical team at one center between July 1998 and April 2002. The mean follow-up period was 20 months. There were 16 serious adverse events related to surgery in 14 patients (12.8%). There were two perioperative deaths (1.8%), one caused by pulmonary embolism and the second due to aspiration pneumonia. The other adverse events were two pulmonary embolisms, two subcortical hemorrhages, two chronic subdural hematomas, one venous infarction, one seizure, four infections, one cerebrospinal fluid leak, and one skin erosion. The incidence of permanent sequelae was 4.6% (five of 109 patients). The incidence of device-related complications, such as infection or skin erosion, was also 4.6% (five of 109 patients). CONCLUSIONS There is a significant incidence of adverse events associated with the DBS procedure. Nevertheless, DBS is clinically effective in well-selected patients and should be seriously considered as a treatment option for patients with medically refractory movement disorders.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery and Neurology, Penn Neurological Institute at Pennsylvania Hospital, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA
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Umemura A, Yamada K, Masago A, Kanda Y, Matsumoto T, Shimazu N. Hemodynamic flow patterns evaluated by transcranial color-coded duplex sonography after STA-MCA bypass for internal carotid artery occlusion. Cerebrovasc Dis 2003; 14:143-7. [PMID: 12403945 DOI: 10.1159/000065671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Extracranial-intracranial (EC-IC) bypass surgery had been widely performed for the treatment of internal carotid artery occlusion. However, it is presently difficult to predict how the bypass flow will contribute to intracranial circulation. We examined intracranial hemodynamics by transcranial color-coded duplex sonography (TCCD) after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and retrospectively studied the relationship between the postoperative contribution of the bypass flow and the preoperative collateral circulation and cerebrovascular perfusion status in 10 patients. Hemodynamics in the MCA detected by TCCD were classified into three patterns. In pattern A, perfusion of the whole MCA area is completely dependent on the bypass flow. In pattern B, perfusion of the M2 segment is dependent on the bypass flow, but perfusion of the M1 segment is independent of the bypass flow. In pattern C, perfusion of the whole MCA area is supplied by collateral flow and the bypass does not function efficiently. Preoperative absence of collateral flow via anterior communicating artery and cerebral perfusion status type 3 (reduced regional cerebral blood flow and regional cerebral vasoreactivity) seems to predict hemodynamic usefulness of the bypass flow after surgery. TCCD is an easy and noninvasive method for evaluating intracranial cerebral circulation after EC-IC bypass surgery.
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Affiliation(s)
- Atsushi Umemura
- Department of Neurosurgery, Nagoya City University Medical School, Nagoya, Japan.
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Ishikawa T, Sumita S, Kimura K, Kikuchi M, Matsushita K, Ohkusu Y, Nakagawa T, Kosuge M, Usui T, Umemura A. Optimization of atrioventricular delay and follow-up in a patient with congestive heart failure and with bi-ventricular pacing. Jpn Heart J 2001; 42:781-7. [PMID: 11933927 DOI: 10.1536/jhj.42.781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Cardiac function is improved by bi-ventricular pacing in patients with severe reduced cardiac function. Atrioventricular (AV) delay optimization is also important in this therapy. However, the AV delay required to achieve the optimal AV synchrony varied from time to time. We have reported that the critical AV delay that induces diastolic mitral regurgitation (MR) may represent the upper limit of the optimal AV delay. The optimal AV delay can be predicted by a simple method; slightly prolonged AV delay-interval between the end of atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting. [Case] 60 year old Japanese male with dilated cardiomyopathy. He was repeatedly admitted to our hospital due to congestive heart failure. Ejection fraction was 14%. ECG showed complete left bundle branch block and his PQ interval was 0.22 sec. He was dependent on intravenous injections of catecolamine and could not be discharged from the hospital for over one year. Optimal AV delay was predicted as 80 msec during bi-ventricular pacing by our formula. Cardiac output was 4.9, 6.0, 5.1 l/min when the AV delay was set at 50, 80, 110 msec. Cardiac function was improved from NYHA class III to II and he has been relieved from the dependency on intravenous catecholamine injections. AV delay was optimized (70-100 msec) by our method during follow-up for one year. This case indicates that AV delay optimization is important in bi-ventricular pacing.
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Affiliation(s)
- T Ishikawa
- Second Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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Monaco AP, Maki T, Hale D, Umemura A, Morita H. The enigma of tolerance and chimerism: variable role of T cells and chimerism in induction of tolerance with bone marrow. Transplant Proc 2001; 33:3837-9. [PMID: 11750635 DOI: 10.1016/s0041-1345(01)02625-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- A P Monaco
- Transplant Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA
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Umemura A, Morita H, Li XC, Tahan S, Monaco AP, Maki T. Dissociation of hemopoietic chimerism and allograft tolerance after allogeneic bone marrow transplantation. J Immunol 2001; 167:3043-8. [PMID: 11544287 DOI: 10.4049/jimmunol.167.6.3043] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Creation of stable hemopoietic chimerism has been considered to be a prerequisite for allograft tolerance after bone marrow transplantation (BMT). In this study, we demonstrated that allogeneic BMT with bone marrow cells (BMC) prepared from either knockout mice deficient in both CD4 and CD8 T cells or CD3E-transgenic mice lacking both T cells and NK cells maintained a high degree of chimerism, but failed to induce tolerance to donor-specific wild-type skin grafts. Lymphocytes from mice reconstituted with T cell-deficient BMC proliferated when they were injected into irradiated donor strain mice, whereas lymphocytes from mice reconstituted with wild-type BMC were unresponsive to donor alloantigens. Donor-specific allograft tolerance was restored when donor-type T cells were adoptively transferred to recipient mice given T cell-deficient BMC. These results show that donor T cell engraftment is required for induction of allograft tolerance, but not for creation of continuous hemopoietic chimerism after allogeneic BMT, and that a high degree of chimerism is not necessarily associated with specific allograft tolerance.
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Affiliation(s)
- A Umemura
- Department of Surgery, Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Abstract
BACKGROUND AND PURPOSE B-mode ultrasonography has been used to evaluate cervical carotid artery lesions. Recently, the technology for direct visualization of blood reflectors has made B-mode flow imaging (B-flow) possible without the limitations of Doppler technology. We evaluated the efficacy of B-flow in examining the cervical carotid artery. METHODS Sixty patients with ischemic cerebrovascular disease were examined. Conventional B-mode imaging and blood flow images by power Doppler imaging (PDI) and B-flow were obtained. RESULTS B-flow enabled simultaneous imaging of tissue and blood flow. Compared with PDI, B-flow provided higher spatial resolution and higher frame rate hemodynamic imaging. Consequently, a clear definition of the vessel lumen was obtained even in the stenotic portion of the carotid artery. In evaluating the degree of carotid stenosis, B-flow measurement agreed with digital subtraction angiography as well as PDI measurement. In addition, bloodstream swirl at the site of wall ulceration or vascular elongation was observed. CONCLUSIONS B-flow was prominent in visualizing hemodynamic flow and detection of stenotic lesion in the cervical carotid artery. Combined with conventional B-mode technique, B-flow seems to be useful in evaluating carotid stenosis.
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Affiliation(s)
- A Umemura
- Department of Neurosurgery, Nagoya City University Medical School, Nagoya, Japan.
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Umemura A, Yamada K, Suzuka T, Tateyama H. Common carotid-internal carotid interposition vein graft bypass for carotid restenosis after repeated percutaneous transluminal angioplasty. Acta Neurochir (Wien) 2001; 142:947-9. [PMID: 11086837 DOI: 10.1007/s007010070084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Umemura
- Department of Neurosurgery, Nagoya City University Medical School, Nagoya, Japan
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148
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Affiliation(s)
- A Umemura
- Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Umemura A, Monaco AP, Maki T. Expression of MHC class II antigen is essential in tolerance induction by donor bone marrow cell in antilymphocyte serum-treated and rapamycin-treated mice. Transplant Proc 2001; 33:148. [PMID: 11266751 DOI: 10.1016/s0041-1345(00)01947-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Umemura
- Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medial School, Boston, Massachusetts, USA
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Umemura A, Monaco AP, Maki T. Donor T cells are not required for induction of allograft tolerance in mice treated with antilymphocyte serum, rapamycin, and donor bone marrow cells. Transplantation 2000; 70:1005-9. [PMID: 11045634 DOI: 10.1097/00007890-200010150-00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postgraft infusion of donor bone marrow cells (BMC) effectively induces tolerance to skin allografts in antilymphocyte serum- and rapamycin-treated recipients in fully major histocompatibility complex-mismatched mouse strain combinations. We used various gene knockout mice to examine the role of donor T cells and B cells in BMC-induced allograft tolerance. METHODS All recipient mice received ALS on days -1 and 2 and rapamycin (6 mg/kg) on day 7 relative to fully major histocompatibility complex-mismatched skin grafting on day 0. Donor BMC prepared either from mice lacking CD4- and/or CD8a-, or CD3epsilon-expressing cells or B cells, or from corresponding wildtype mice, were given on day 7. The level and phenotypes of chimerism was determined by flow cytometry. RESULTS All T cell- and B cell-deficient BMC were as effective as wild-type BMC in inducing prolongation of skin graft survival. A low degree of chimerism without donor type T cells was detected in tolerant mice given T cell-deficient BMC or wild-type BMC 60 days after transplantation. Chimeric cells were composed of B cells and macrophages/monocytes. Low level chimerism without donor T or B cells was also present in tolerant mice given B cell-deficient BMC. CONCLUSION Donor type T cells and T cell chimerism are not required for induction of allograft tolerance by the antilymphocyte serum/rapamycin/donor BMC-infusion protocol. Donor B cells also do not participate in tolerance induction. Thus, infusion of T cell-depleted BMC in conjunction with conventional immunosuppressive regimens will be a simple, safe, and effective way to induce allograft tolerance in clinical organ transplantation.
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Affiliation(s)
- A Umemura
- Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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