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Suzuki Y, Kaneko H, Okada A, Ohno R, Yokota I, Fujiu K, Jo T, Takeda N, Morita H, Node K, Yasunaga H, Komuro I. Comparison of SGLT2 inhibitors vs. DPP4 inhibitors for patients with metabolic dysfunction associated fatty liver disease and diabetes mellitus. J Endocrinol Invest 2024; 47:1261-1270. [PMID: 38114769 PMCID: PMC11035461 DOI: 10.1007/s40618-023-02246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE This study aimed to examine the potential benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with metabolic dysfunction-associated fatty liver disease (MAFLD) and diabetes mellitus (DM) using a real-world database. METHODS We analyzed individuals with MAFLD and DM newly initiated on SGLT2 or dipeptidyl peptidase 4 (DPP4) inhibitors from a large-scale administrative claims database. The primary outcome was the change in the fatty liver index (FLI) assessed using a linear mixed-effects model from the initiation of SGLT2 or DPP4 inhibitors. A propensity score-matching algorithm was used to compare the change in FLI among SGLT2 and DPP4 inhibitors. RESULTS After propensity score matching, 6547 well-balanced pairs of SGLT2 and 6547 DPP4 inhibitor users were created. SGLT2 inhibitor use was associated with a greater decline in FLI than DPP4 inhibitor use (difference at 1-year measurement, - 3.8 [95% CI - 4.7 to - 3.0]). The advantage of SGLT2 inhibitor use over DPP4 inhibitor use for improvement in FLI was consistent across subgroups. The relationship between SGLT2 inhibitors and amelioration of FLI was comparable between individual SGLT2 inhibitors. CONCLUSIONS Our analysis using large-scale real-world data demonstrated the potential advantage of SGLT2 inhibitors over DPP4 inhibitors in patients with MAFLD and DM.
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Grants
- 21AA2007 Ministry of Health, Labour and Welfare
- 20H03907 the Ministry of Education, Culture, Sports, Science and Technology
- 21H03159 the Ministry of Education, Culture, Sports, Science and Technology
- 21K08123 the Ministry of Education, Culture, Sports, Science and Technology
- 22K21133 the Ministry of Education, Culture, Sports, Science and Technology
- The University of Tokyo
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Affiliation(s)
- Y Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - H Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - A Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - R Ohno
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - I Yokota
- Department of Biostatistics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - K Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - T Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - N Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - H Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - K Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - I Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- International University of Health and Welfare, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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2
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Michitsuji T, Fukui S, Morimoto S, Endo Y, Nishino A, Nishihata S, Tsuji Y, Shimizu T, Umeda M, Sumiyoshi R, Koga T, Iwamoto N, Origuchi T, Ueki Y, Yoshitama T, Eiraku N, Matsuoka N, Okada A, Fujikawa K, Ohtsubo H, Takaoka H, Hamada H, Tsuru T, Nawata M, Arinobu Y, Hidaka T, Tada Y, Kawakami A, Kawashiri SY. Clinical and ultrasound features of difficult-to-treat rheumatoid arthritis: A multicenter RA ultrasound cohort study. Scand J Rheumatol 2024; 53:123-129. [PMID: 38085537 DOI: 10.1080/03009742.2023.2277542] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/27/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The optimal strategy for difficult-to-treat (D2T) rheumatoid arthritis (RA) has not been identified, and the ultrasound characteristics of D2T RA have not been reported. We investigated the clinical characteristics and factors contributing to the outcome in D2T RA in a multicentre RA ultrasound observational cohort. METHOD We reviewed 307 Japanese patients diagnosed with RA who underwent treatment with biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). We compared the differences in patient characteristics between the D2T RA and non-D2T RA groups. We examined the factors contributing to a good response [defined as b/tsDMARD continuation and Clinical Disease Activity Index (CDAI) ≤ 10 at 12 months] in the D2T RA patient group. RESULTS Forty-three patients (14%) were categorized as D2T RA and the remaining 264 (86%) as non-D2T RA at baseline. The grey-scale (GS) score, disease duration, and CDAI at the initiation of treatment were significantly higher in the D2T RA group than in the non-D2T RA group. In contrast, the power Doppler (PD) score was not significantly different between the two groups. Of the 43 D2T RA patients, 20 achieved a good response. The introduction of CTLA4-Ig (n = 5) was significantly associated with a good response in analysis based on inverse probability weighting with propensity score. GS and PD scores at baseline were not significantly associated with therapeutic response at 12 months in D2T RA patients. CONCLUSIONS Patients with D2T RA had high clinical and ultrasound activity and poor responses to treatment with b/tsDMARDs. CTLA4-Ig was associated with a good response at 12 months in D2T RA patients.
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Affiliation(s)
- T Michitsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Fukui
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Morimoto
- Innovation Platform & Office for Precision Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Y Endo
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Nishino
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - S Nishihata
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Umeda
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - R Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Ueki
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Yoshitama
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Eiraku
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Matsuoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Okada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - K Fujikawa
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Ohtsubo
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Takaoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Hamada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Tsuru
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - M Nawata
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Arinobu
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Hidaka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Tada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S-Y Kawashiri
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Center for Collaborative Medical Education and Development, Nagasaki University Institute of Biomedical Sciences, Nagasaki, Japan
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Komatsu T, Okada A, Kuwahara K. Two different right ventricular pacing waveforms. Eur Heart J Case Rep 2024; 8:ytae119. [PMID: 38487590 PMCID: PMC10939170 DOI: 10.1093/ehjcr/ytae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Toshinori Komatsu
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Nagano 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Nagano 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Nagano 390-8621, Japan
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Kanai M, Minamisawa M, Motoki H, Seko Y, Kimura K, Okano T, Ueki Y, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Ozasa N, Kato T, Kuwahara K. Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure - Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry. Circ J 2023; 88:33-42. [PMID: 37544741 DOI: 10.1253/circj.cj-22-0712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure (ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF.Methods and Results: We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5-9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio [HR] per additional increase in the number of medications, 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02-1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92-1.10; P=0.95). CONCLUSIONS Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.
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Affiliation(s)
- Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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5
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Machida K, Minamisawa M, Motoki H, Teramoto K, Okuma Y, Kanai M, Kimura K, Okano T, Ueki Y, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Clinical Profile and Prognosis of Dementia in Patients With Acute Decompensated Heart Failure - From the CURE-HF Registry. Circ J 2023; 88:93-102. [PMID: 37438112 DOI: 10.1253/circj.cj-23-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) has a poor prognosis and common comorbidities may be contributory. However, evidence for the association between dementia and clinical outcomes in patients with is sparse and it requires further investigation into risk reduction.Methods and Results: We assessed the clinical profiles and outcomes of 1,026 patients (mean age 77.8 years, 43.2% female) with ADHF enrolled in the CURE-HF registry to evaluate the relationship between investigator-reported dementia status and clinical outcomes (all-cause death, cardiovascular (CV) death, non-CV death, and HF hospitalization) over a median follow-up of 2.7 years. In total, dementia was present in 118 (11.5%) patients, who experienced more drug interruptions and HF admissions due to infection than those without dementia (23.8% vs. 13.1%, P<0.01; 11.0% vs. 6.0%, P<0.01, respectively). Kaplan-Meier analysis revealed that dementia patients had higher mortality rates than those without dementia (log-rank P<0.001). After multivariable adjustment for demographics and comorbidities, dementia was significantly associated with an increased risk of death (adjusted hazard ratio, 1.43; 95% confidence interval, 1.06-1.93, P=0.02) and non-CV death (adjusted hazard ratio, 1.65; 95% confidence interval, 1.04-2.62, P=0.03), but no significant associations between dementia and CV death or HF hospitalization were observed (both, P>0.1). CONCLUSIONS In ADHF patients dementia was associated with aggravating factors for HF admission and elevated risk of death, primarily non-CV death.
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Affiliation(s)
- Keisuke Machida
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Kanako Teramoto
- Department of Biostatics, National Cerebral and Cardiovascular Center
| | - Yukari Okuma
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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Komatsu T, Minamisawa M, Okada A, Motoki H, Kasai T, Kuwahara K, Ikeda U. Real-world Practical Experience of Angiotensin Receptor-neprilysin Inhibitor in Older Japanese Patients with Chronic Heart Failure. JMA J 2023; 6:489-498. [PMID: 37941691 PMCID: PMC10628264 DOI: 10.31662/jmaj.2023-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/08/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), is superior to enalapril for chronic heart failure (CHF) with reduced ejection fraction (EF). However, its efficacy and safety in older Japanese patients in clinical practice are poorly understood. We aimed to investigate the efficacy and safety of ARNI compared with angiotensin receptor blocker (ARB) in older patients with CHF in real-world clinical practice. In addition, nutritional status and body composition were investigated as essential indicators of efficacy. Methods This retrospective single-center observational study enrolled 55 consecutive older patients (aged ≥75 years) with CHF who received ARNI (n = 27) or ARB (n = 28) therapy between October 2020 and March 2021. Blood samples were collected before (baseline) and 4, 12, and 24 weeks after ARNI or ARB therapy initiation. Furthermore, echocardiography was performed before (baseline) and 24 weeks after ARNI or ARB therapy initiation. The efficacy endpoints were changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, left ventricular EF, nutritional status, and body composition changes. The controlling nutritional status (CONUT) score and geriatric nutritional risk index were investigated as nutritional status indices. The safety endpoints were symptomatic hypotension, renal function exacerbation, and hyperkalemia in patients who continued ARNI or ARB therapy for >24 weeks without additional nonpharmacological treatment. Results There were no significant changes in NT-proBNP levels and estimated glomerular filtration rates; however, there was a significant CONUT score improvement in the ARNI group (least-squares mean difference, -1.0; 95% confidence interval, -1.4 to -0.3; p = 0.04). The initial ARNI dose could not be uptitrated in five patients (19%) due to hypotension. Conclusions ARNI exhibited significant improvement in the nutritional status in older patients with CHF compared with ARB. However, the ARNI dose should be adjusted according to the patient's blood pressure.
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Affiliation(s)
- Toshinori Komatsu
- Department of Cardiology, Shinshu University School of Medicine, Nagano, Japan
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | | | - Ayako Okada
- Department of Cardiology, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiology, Shinshu University School of Medicine, Nagano, Japan
| | - Toshio Kasai
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiology, Shinshu University School of Medicine, Nagano, Japan
| | - Uichi Ikeda
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
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Hasegawa Y, Okada A, Fujii K. Can golfers choose low-risk routes in steep putting based on visual feedback of ball trajectory? Front Sports Act Living 2023; 5:1131390. [PMID: 37674636 PMCID: PMC10477702 DOI: 10.3389/fspor.2023.1131390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
This study aims to clarify why the aiming method in golf putting in risky situations differs based on skill level. This study set up a difficult challenge (steep slopes and fast ball rolling greens), which required even professional golfers to change their aim. A total of 12 tour professionals and 12 intermediate amateurs were asked to perform a steep-slope task with no visual feedback of outcomes (no FB) followed by a task with visual feedback (with FB). The aim of the task was for the ball to enter the hole in one shot. Additionally, the participants were told that if the ball did not enter the hole, it was to at least stop as close to it as possible. The participant's aim (as an angle) and the kinematics of the putter head and ball were measured. The results indicated that professionals' highest ball trajectory points were significantly higher than that of amateurs, especially with FB. Additionally, professionals had higher ball-launch angles (the direction of the ball when the line connecting the ball and the center of the hole is 0 degrees) and lower peak putter head velocities than amateurs. Furthermore, the aim angle, indicating the golfer's decision-making, was higher for professionals under both conditions. However, even with FB, the amateurs' aim angles were lower and the difference between trials was smaller than that of professionals. Therefore, this study confirmed that the professionals made more drastic changes to their aim to find low-risk routes than the amateurs and that the amateurs' ability to adjust their aim was lower than that of professionals. The results suggest that the reason for the amateurs' inability to find low-risk routes lies in their decision-making. The professionals found better routes; however, there were individual differences in their routes.
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Affiliation(s)
- Yumiko Hasegawa
- Faculty of Humanities and Social Sciences, Iwate University, Iwate, Japan
| | - Ayako Okada
- Japan Ladies Professional Golfers’ Association, Tokyo, Japan
| | - Keisuke Fujii
- Graduate School of Informatics, Nagoya University, Aichi, Japan
- RIKEN Center for Advanced Intelligence Project, RIKEN, Fukuoka, Japan
- PRESTO, Japan Science and Technology Agency, Kawaguchi, Japan
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Kato T, Ueki Y, Minamisawa M, Miura T, Oyama Y, Hashizume N, Yokota D, Taki M, Senda K, Okina Y, Wakabayashi T, Fujimori K, Karube K, Sakai T, Nomi H, Yui H, Kanzaki Y, Machida K, Maruyama S, Nagae A, Saigusa T, Ebisawa S, Okada A, Motoki H, Kuwahara K. Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry. Heart Vessels 2023:10.1007/s00380-023-02251-y. [PMID: 37052610 DOI: 10.1007/s00380-023-02251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023]
Abstract
Peripheral artery disease (PAD) is commonly caused by atherosclerosis and has an unfavorable prognosis. Complete revascularization (CR) of the coronary artery reduces the risk of major adverse cardiovascular event (MACE) in patients with coronary artery disease (CAD). However, the impact of CR in patients with PAD has not been established to date. Therefore, we evaluated the impact of CR of CAD on the five-year clinical outcomes in patients with PAD. This study was based on a prospective, multicenter, observational registry in Japan. We enrolled 366 patients with PAD undergoing endovascular treatment. The primary endpoint was MACE, defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. After excluding ineligible patients, 96 and 68 patients received complete revascularization of the coronary artery (CR group) and incomplete revascularization of the coronary artery (ICR group), respectively. Freedom from MACE in the CR group was significantly higher than in the ICR group at 5 years (66.7% vs 46.0%, p < 0.01). Multivariate analysis revealed that CR emerged as an independent predictor of MACE (Hazard ratio: 0.56, 95% confidential interval: 0.34-0.94, p = 0.03). CR of CAD was significantly associated with improved clinical outcomes in patients with PAD undergoing endovascular treatment.
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Affiliation(s)
- Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Yushi Oyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiology, Nagano Red-Cross Hospital, Nagano, Japan
| | | | - Minami Taki
- Department of Cardiology, Saku General Hospital, Nagano, Japan
| | - Keisuke Senda
- Department of Cardiology, Aizawa Hospital, Nagano, Japan
| | - Yoshiteru Okina
- Department of Cardiology, Joetsu General Hospital, Niigata, Japan
| | | | - Koki Fujimori
- Department of Cardiology, Suwa Red-Cross Hospital, Nagano, Japan
| | - Kenichi Karube
- Department of Cardiology, Okaya City Hospital, Nagano, Japan
| | - Takahiro Sakai
- Department of Cardiology, Ina Central Hospital, Nagano, Japan
| | - Hidetomo Nomi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Keisuke Machida
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Okada A, Higuchi S, Shoda M, Tabata H, Kataoka S, Shoin W, Kobayashi H, Okano T, Yoshie K, Kato K, Saigusa T, Ebisawa S, Motoki H, Kuwahara K. Utility of a multipurpose catheter for transvenous extraction of old broken leads: A novel technique for fragile leads. Heart Rhythm 2023:S1547-5271(23)00514-3. [PMID: 37001747 DOI: 10.1016/j.hrthm.2023.03.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Transvenous lead extraction has been possible since the 1980s. However, complications during lead extraction, such as the distal end fragment of the lead remaining in the myocardium or venous system and injury to the veins or heart, have been reported. OBJECTIVE The purpose of this study was to examine our method for complete removal of a separated lead, as extraction of long-term implanted devices is difficult using standard methods and may require additional procedures. The removal of leads with inner conductor coil and lead tip separated from outer insulation, conductor coil, and proximal ring electrode using a multipurpose catheter is reported. METHODS In total, 345 consecutive patients who underwent transvenous lead extraction (TLE) from April 2014 to March 2021 were retrospectively analyzed. Lead characteristics, device type, and indications for extraction were further analyzed in 20 patients who developed separation of the proximal ring electrode and outer conductor coil from the inner conductor and distal tip at the time of extraction. RESULTS Extractions were performed using an excimer laser sheath laser and a Byrd polypropylene telescoping sheath (n = 15); laser, Byrd polypropylene telescoping sheath, and Evolution RL (n = 2); laser and Evolution RL (n = 3); Byrd polypropylene telescoping sheath and Evolution RL (n = 1); Byrd polypropylene telescoping sheath only (n = 4); and Evolution RL only (n = 2). Twenty-seven leads implanted for more than 10 years had lead separation. A multipurpose catheter was used to protect the fragile leads from further damage. All leads were completely extracted. CONCLUSION All distal tip-to-proximal ring electrode separated leads were successfully removed using laser and other sheaths with the assistance of a multipurpose catheter, without any part of the leads remaining in the heart.
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Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tama Metropolitan Medical Center, Tokyo, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Okumura Y, Nagashima K, Watanabe R, Yokoyama K, Kato T, Fukaya H, Hayashi H, Nakahara S, Shimizu W, Iwasaki YK, Fujimoto Y, Mukai Y, Ejima K, Otsuka T, Suzuki S, Murakami M, Kimura M, Harada M, Koyama J, Okamatsu H, Yamane T, Yamashita S, Tokuda M, Narui R, Takami M, Shoda M, Harada T, Nakajima I, Fujiu K, Hiroshima K, Tanimoto K, Fujino T, Nakamura K, Kumagai K, Okada A, Kobayashi H, Hayashi T, Watari Y, Hatsuno M, Tachibana E, Iso K, Sonoda K, Aizawa Y, Chikata A, Sakagami S, Inoue M, Minamiguchi H, Makino N, Satomi K, Yazaki Y, Aoyagi H, Ichikawa M, Haruta H, Hiro T, Okubo K, Arima K, Tojo T, Kihara H, Miyanaga S, Fukuda Y, Oiwa K, Fujiishi T, Akabane M, Ishikawa N, Kusano K, Miyamoto K, Tabuchi H, Shiozawa T, Miyamoto K, Mase H, Murotani K. Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes after Catheter Ablation of Atrial Fibrillation in the Very Elderly (REHEALTH AF) study: rationale and design of a prospective, multicentre, observational, comparative study. BMJ Open 2023; 13:e068894. [PMID: 36792334 PMCID: PMC9933749 DOI: 10.1136/bmjopen-2022-068894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Data are lacking on the extent to which patients with non-valvular atrial fibrillation (AF) who are aged ≥80 years benefit from ablation treatment. The question pertains especially to patients' postablation quality of life (QoL) and long-term clinical outcomes. METHODS AND ANALYSIS We are initiating a prospective, registry-based, multicentre observational study that will include patients aged ≥80 years with non-valvular AF who choose to undergo treatment by catheter ablation and, for comparison, such patients who do not choose to undergo ablation (either according to their physician's advice or their own preference). Study subjects are to be enrolled from 52 participant hospitals and three clinics located throughout Japan from 1 June 2022 to 31 December 2023, and each will be followed up for 1 year. The planned sample size is 660, comprising 220 ablation group patients and 440 non-ablation group patients. The primary endpoint will be the composite incidence of stroke/transient ischaemic attack (TIA) or systemic embolism (SE), another cardiovascular event, major bleeding and/or death from any cause. Other clinical events such as postablation AF recurrence, a fall or bone fracture will be recorded. We will collect standard clinical background information plus each patient's Clinical Frailty Scale score, AF-related symptoms, QoL (Five-Level Version of EQ-5D) scores, Mini-Mental State Examination (optional) score and laboratory test results, including measures of nutritional status, on entry into the study and 1 year later, and serial changes in symptoms and QoL will also be secondary endpoints. Propensity score matching will be performed to account for covariates that could affect study results. ETHICS AND DISSEMINATION The study conforms to the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies issued by the Ministry of Health, Labour and Welfare, Japan. Results of the study will be published in one or more peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000047023.
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Affiliation(s)
- Yasuo Okumura
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Koichi Nagashima
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Ryuta Watanabe
- Department of Cardiology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Katsuaki Yokoyama
- Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Takeshi Kato
- Department of Cardiovascular and Internal Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate Schoool of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Japanese Red Cross Fukuoka Hospital, Fukuoka City, Fukuoka, Japan
| | - Koichiro Ejima
- Department of Cardiology, Minamino Cardiovascular Hospital, Hachioji, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Minato-ku, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Minato-ku, Tokyo, Japan
| | - Masato Murakami
- Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Masaomi Kimura
- Divison of Cardiology, Pulmonary Medicine and Nephrology, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan
| | - Masahide Harada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Junjiroh Koyama
- Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Hideharu Okamatsu
- Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine, The Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Ryohsuke Narui
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Tomoo Harada
- Department of Cardiology, St.Marianna University School of Medicine Hospital, Kawasaki, Kanagawa, Japan
| | - Ikutaro Nakajima
- Department of Cardiology, St.Marianna University School of Medicine Hospital, Kawasaki, Kanagawa, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kenichi Hiroshima
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Kojiro Tanimoto
- Deparatment of Cardiology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo, Japan
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Meguro-ku, Tokyo, Japan
| | - Koji Kumagai
- Department of Cardiovascular Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Tatsuya Hayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Yuji Watari
- Department of Cardiology, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Mina Hatsuno
- Department of Cardiology, Teikyo University Hospital, Itabashi-ku, Tokyo, Japan
| | - Eizo Tachibana
- Division of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Kazuki Iso
- Division of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Kazumasa Sonoda
- Division of Cardiology, Department of Medicine, Tokyo Rinkai Hospital, Edogawa-ku, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama City, Toyama, Japan
| | - Satoru Sakagami
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Masaru Inoue
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | | | - Nobuhiko Makino
- Department of Cardiology, Osaka Police Hospital, Osaka City, Osaka, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshinao Yazaki
- Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hideshi Aoyagi
- Department of Cardiovascular Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Makoto Ichikawa
- Department of Cardiology, Sekishin Clinic, Kawagoe, Saitama, Japan
| | - Hironori Haruta
- Department of Cardiology, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Takafumi Hiro
- Circulatory medicine, Akabane Central General Hospital, Kita-ku, Tokyo, Japan
| | - Kimie Okubo
- Department of Cardiology, Itabashi Medical Association Hospital, Itabashi-ku, Tokyo, Japan
| | - Ken Arima
- Department of Cardiology, Kasukabe Medical Center, Kasukabe, Saitama, Japan
| | - Taiki Tojo
- Department of Cardiovascular medicine, Kitasato University Kitasato Institute Hospital, Minato-ku, Tokyo, Japan
| | - Hajime Kihara
- Department of Internal Medicine, Kihara Cardiovascular Clinic, Asahikawa, Hokkaido, Japan
| | - Satoru Miyanaga
- Division of Cardiology, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan
| | - Yoshiaki Fukuda
- Department of Cardiology, Higashi Saitama General Hospital, Satte, Saitama, Japan
| | - Koji Oiwa
- Cardiology, Japan Community Health are Organization, Yokohama Chuo Hospital, Yokohama, Kanagawa, Japan
| | - Tamami Fujiishi
- Department of Cardiology, JCHO Sagamino Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Akabane
- Department of Cardiology, Akabane Clinic, Outawara, Tochigi, Japan
| | - Norikazu Ishikawa
- Department of Cardiology, Zengyodanchi Ishikawa Clinic, Fujisawa, Kanagawa, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Haruna Tabuchi
- Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Tomoyuki Shiozawa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Kenjiro Miyamoto
- Department of Cardiology, Sapporo Shiroishi Memorial Hospital, Hokkaido, Sapporo, Japan
| | - Hiroshi Mase
- Department of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Taguchi K, Hamamoto S, Sugino T, Yanase T, Unno R, Okada A, Yasui T. Evaluating learning curve for renal access during mini-ECIRS: Robotic-assisted fluoroscopic-guidance vs. ultrasound-guidance. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00984-3] [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: 02/12/2023]
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Etani T, Morikawa T, Gonda M, Aoki M, Nagai T, Iida K, Taguchi K, Naiki T, Hamamoto S, Okada A, Kawai N, Yasui T. Usefulness of stone culture in endoscopic combined intra-renal surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00781-9] [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: 02/12/2023]
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Nishikawa K, Ebisawa S, Miura T, Kato T, Yusuke K, Abe N, Yokota D, Yanagisawa T, Senda K, Wakabayashi T, Oyama Y, Karube K, Itagaki T, Yui H, Maruyama S, Nagae A, Sakai T, Okina Y, Nakazawa S, Tsukada S, Saigusa T, Okada A, Motoki H, Kagoshima M, Kuwahara K. Impact of Frailty and Age on Clinical Outcomes in Patients Who Underwent Endovascular Therapy. J Endovasc Ther 2022; 29:845-854. [PMID: 34969317 DOI: 10.1177/15266028211067729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Information on the relationship between frailty and the outcome of endovascular therapy (EVT) in elderly patients with lower extremity peripheral artery disease (PAD) is scarce. This study aimed to reveal the impact of frailty on the prognosis of super-elderly patients who underwent EVT. MATERIALS AND METHODS From August 2015 to August 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we categorized 323 patients into 4 groups according to age and the presence or absence of frailty as follows: elderly with frailty (age ≥ 75, Clinical Frailty Scale [CFS] ≥ 5), elderly without frailty (age ≥ 75, CFS ≤ 4), young with frailty (age < 75, CFS ≥ 5), and young without frailty (age < 75, CFS ≤ 4); we analyzed them accordingly. The primary endpoints were major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation, and revascularization. The secondary endpoint was cardiovascular death. RESULTS The median follow-up period was 2.7 years. In the elderly with frailty, elderly without frailty, young with frailty, and young without frailty groups, the freedom rates from MACLE were 34.9%, 55.7%, 35.4%, and 63.0%, respectively (p<0.001) and from all-cause death were 43.5%, 73.4%, 50.7%, and 90.9%, respectively (p<0.001). The freedom rates from MACLE were significantly higher among elderly patients with frailty than among young patients without frailty (55.7% vs 35.4%, p=0.01). In multivariate analysis, frailty was independently associated with MACLE incidence. CONCLUSION Frailty as defined by CFS might be a predictor of MACLE incidence in patients with PAD who underwent EVT. By considering treatment indications for patients with PAD by focusing on frailty rather than age, we may examine whether EVT policies are appropriate and manage patient and caregiver expectations for potential improvement in functional outcomes. Further studies are expected to investigate whether changes in frailty after EVT change prognosis.
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Affiliation(s)
- Ken Nishikawa
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine, Nagano Municipal Hospital, Nagano, Japan
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Kanzaki Yusuke
- Department of Cardiovascular Medicine, Shinonoi General Hospital, Nagano, Japan
| | - Naoyuki Abe
- Department of Cardiovascular Medicine, Japanese Red Cross Society Nagano Hospital, Nagano, Japan
| | - Daisuke Yokota
- Department of Cardiovascular Medicine, Iida Hospital, Nagano, Japan
| | - Takashi Yanagisawa
- Department of Cardiovascular Medicine, Saku Central Hospital, Nagano, Japan
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Aizawa Hospital, Nagano, Japan
| | | | - Yushi Oyama
- Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Kenichi Karube
- Department of Cardiovascular Medicine, Okaya City Hospital, Nagano, Japan
| | - Tadashi Itagaki
- Department of Cardiovascular Medicine, Ina Central Hospital, Nagano, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yoshiteru Okina
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Shun Nakazawa
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Shunichi Tsukada
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Mitsuru Kagoshima
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Hasegawa Y, Okada A, Fujii K. A sense of distance and movement characteristics of golfers tested without visual feedback of outcomes: Is a putt that feels subjectively good also physically good? Front Sports Act Living 2022; 4:987493. [DOI: 10.3389/fspor.2022.987493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
For motor tasks that require fine-tuning, such as adjusting the applied force according to the distance to the target, as required for driving and putting in golf, it is important to develop a high degree of sensitivity of one's movement-produced feedback. In previous research focusing on mental representation in golf, this ability to control distance has been called “a sense of distance”. In particular, this study focused on three skills: motor control of the putter head, perception of the impact force, and prediction of the ball's travel distance. However, the relationship between the motor control of the putter head and the error of the outcome estimation is yet to be clarified. The purpose of the present study is two-fold: first, to clarify whether kinematic variation of putter head is correlated with error in estimating the outcome and, second, to quantitatively evaluate the performer's sensations of good and poor performance generated by the ball's impact, for a comparison of the kinematics and impact force of the putter head based on their assessment. Twelve professionals and 12 intermediate amateurs played two distance targets (at 2.4 and 4.8 m) without visual feedback of the outcomes. The kinematics of the putter head, impact force, final ball position, outcome estimation, and subjective assessment were measured. Our results show that the variability in the peak velocity was moderately correlated with the error of the outcome estimation in amateurs' 4.8-m putting task. In addition, amateurs estimated undershoots (overshoots) when they provided worse (better) evaluations. However, the amateurs' trials that were rated as better putts were actually overshoots. These results suggest that the subjectively “good putt” of amateurs was not physically good, and the amateurs putted hard to compensate for the risk of undershoots. However, no remarkable feature of the professional's sense of distance was found. This suggests that professional golfers' sensation is not significantly different from the outcomes that can be physically detected.
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Nagae A, Ebisawa S, Saigusa T, Nishikawa K, Fujimori K, Yui H, Maruyama S, Nakamura C, Kashiwagi D, Kobayashi H, Sakai T, Senda K, Kato T, Miura T, Okada A, Motoki H, Kuwahara K. The Impact of Hyperuricemia on Patients With Low Body Mass Index After Endovascular Treatments: Data From the I-PAD Registry. Angiology 2022; 73:753-763. [PMID: 35077237 PMCID: PMC9485156 DOI: 10.1177/00033197211072344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We investigated the prognostic effects of hyperuricemia and high or low body mass index (BMI) in peripheral artery disease (PAD) after endovascular therapy (EVT). Between July 2015-2016, 357 consecutive patients with PAD who underwent EVT were enrolled. Patients were divided into 2 groups: BMI < 25 kg/m2 (low BMI) and ≥ 25 kg/m2 (high BMI); they were also divided into 2 more groups based on the presence/absence of hyperuricemia. The primary and secondary endpoints were major adverse cardiovascular and limb events (MACLE), and all-cause death at 3 years post-EVT. Patients with hyperuricemia had significantly lower freedom from MACLE than patients without hyperuricemia at 3 years (57.0 vs 71.9%, p = .0068). The overall survival of patients with hyperuricemia was significantly lower than that of patients without hyperuricemia (63.9 vs 81.7%, p = .0012). Patients with hyperuricemia who had low BMI experienced significantly lower freedom from MACLE than those without hyperuricemia who had low BMI (48.2 vs 69.9%, p = .002). The overall survival of patients with hyperuricemia who had low BMI was significantly lower than that of patients without hyperuricemia who had low BMI (55.2 vs 77.1%, p = .003). Patients with hyperuricemia had significantly more MACLE and a lower survival at 3 years than patients without hyperuricemia, even if they had a low BMI.
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Affiliation(s)
- Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan,Soichiro Ebisawa, Department of Cardiovascular Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto City, Nagano 390-8621, Japan.
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Ken Nishikawa
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Koki Fujimori
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Chie Nakamura
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Daisuke Kashiwagi
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University, Matsumoto, Japan
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Kato T, Fuke M, Nagai F, Nomi H, Kanzaki Y, Yui H, Maruyama S, Nagae A, Sakai T, Saigusa T, Ebisawa S, Okada A, Motoki H, Kuwahara K. Successful endovascular treatment with a stent graft for chronic deep vein thrombosis with multiple arteriovenous fistulas: a case report. J Med Case Rep 2022; 16:257. [PMID: 35778762 PMCID: PMC9250182 DOI: 10.1186/s13256-022-03480-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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep vein thrombosis with arteriovenous fistulas is rare, with few therapeutic options available for chronic-phase deep vein thrombosis. Moreover, the effectiveness of endovascular treatment for chronic-phase deep vein thrombosis with arteriovenous fistulas has not been established. We describe herein a case of successful endovascular treatment for chronic deep vein thrombosis with multiple arteriovenous fistulas. Case presentation We describe the case of a 72-year-old Asian woman who had begun experiencing left leg swelling and intermittent claudication 2 years prior. Enhanced computed tomography revealed left common iliac vein occlusion with vein-to-vein collateral formation and several arteriovenous fistulas. Angiography and ultrasound showed the arteriovenous fistulas to run from the common and internal iliac arteries to the external iliac and superficial femoral veins. We opted against surgical repair for the arteriovenous fistulas due to their complex nature and complicated morphology. Since her condition was progressive, endovascular treatment with a stent graft was performed for the deep vein thrombosis, after which her symptoms gradually improved. Four months following the procedure, enhanced computed tomography confirmed remarkable reduction of the vein-to-vein collaterals and arteriovenous fistulas. Conclusions In the present case, enhanced computed tomography with a stent graft was effective in improving symptoms. This strategy may therefore be a treatment option for intractable chronic deep vein thrombosis with arteriovenous fistulas.
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Affiliation(s)
- Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Megumi Fuke
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumio Nagai
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidetomo Nomi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Tabata H, Okada A, Kobayashi H, Shoin W, Okano T, Higuchi S, Yagishita D, Ebisawa S, Motoki H, Shoda M, Kuwahara K. Usefulness of the controlled-rotation dilator sheath "Evolution RL" for extraction of old leads in two Japanese centers - An experience in use. J Cardiol 2022; 80:339-343. [PMID: 35701313 DOI: 10.1016/j.jjcc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is an established procedure for the management of cardiovascular implantable electronic devices. However, some difficulties and risks of complications still exist, especially in old and adhered leads. Evolution RL (Cook Medical, Bloomington, IN, USA) is a newly introduced device for TLE; however, no clinical results have been reported in Japan, and the results with older leads are unknown. We investigated the efficacy and safety of Evolution RL and its usefulness for old leads at two TLE centers in Japan. METHODS A total of 27 consecutive patients who underwent lead extraction using Evolution RL at Shinshu University Hospital and Tokyo Women's Medical University Hospital from September 2017 to December 2019 were retrospectively enrolled. We examined the backgrounds of the patients and leads and investigated the efficacy and safety of the procedures. We divided the leads into two groups according to the number of years of implantation (10 years) and compared the results. RESULTS Among the 27 patients, 20 (74.1%) were men, and the median age was 62 (14-91) years. The total number of leads was 58, and the median implantation duration was 136 months (8-448). We achieved clinical success in all patients and complete procedural success in 24 patients (88.9%). In three patients, the broken tip of the lead remained in the heart. No major complications were noted. Of the 58 leads, there were 34 leads with more than 10 years of implantation, with significantly more Evolution RLs used (94.1% vs. 54.2%, p = 0.001) and significantly higher percentages of Evolution 11Fr, 13Fr, and steady sheaths used (79.4% vs. 33.3%, p = 0.001, 52.9% vs. 16.7%, p = 0.006, and 64.7% vs. 20.8%, p = 0.001, respectively). CONCLUSIONS In two TLE centers in Japan, Evolution RL was shown to be safe and effective, even in leads older than 10 years.
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Affiliation(s)
- Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Iwamoto N, Chiba K, Sato S, Shiraishi K, Watanabe K, Ohki N, Okada A, Koga T, Kobayashi M, Saito K, Okubo N, Kawakami A. POS0687 INHIBITION OF BONE EROSION, DETERMINED BY HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY (HR-pQCT), IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING A CONVENTIONAL SYNTHETIC DMARD (csDMARD) PLUS DENOSUMAB VS csDMARD THERAPY ALONE: RESULTS OF AN OPEN-LABEL, RANDOMIZED, PARALLEL-GROUP STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDenosumab, a human IgG2 monoclonal antibody with high affinity for RANKL, is approved for treatment of bone erosion (ER) in patients with RA, based on the results of clinical trials. However, its effectiveness in combination with conventional therapy in RA patients has not been fully investigated in clinical practice.ObjectivesThis exploratory study aimed to compare, in patients receiving conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) for treatment of RA, the effectiveness of combined use of csDMARD and denosumab vs csDMARD alone, in terms of inhibition of ER determined by HR-pQCT.MethodsDetail protocol of this open-label, randomized, parallel-group study has been published previously.1 RA patients with moderate or low disease activity and progressive ER were eligible, and were randomly assigned to receive denosumab in addition to the csDMARD (denosumab) group or to continued use of the csDMARD alone (csDMARD) group. Denosumab was administered every 6 months during the 12-month study period. The primary endpoint was change in ER-depth at the second and third metacarpal bones, determined by HR-pQCT at month 6. For the primary endpoint, a linear mixed effect model analysis was performed using treatment group, sex, anti-cyclic citrullinated peptide (CCP) antibody (positive vs negative), and baseline disease activity (DAS28-ESR) as fixed effects, patients as random effects, and baseline values as covariates. For extension data, measurement time-point and the interaction between treatment group and measurement time-point was further added as fixed effects. The adverse events (AEs) were recorded.ResultsA total of 46 patients were randomized to denosumab and csDMARD groups (both N=23), and baseline characteristics were similar between both groups. Although the difference was not significant, the estimate mean (95%CI) change of ER-depth at month 6 from baseline as the primary endpoint was −0.57 (−1.52, 0.39) in the denosumab group vs −0.22 (−0.97, 0.53) in the csDMARD group, respectively. At months 6 and 12, ER-depth, -width, and -volume (extension data) were numerically lower in the denosumab group than in the csDMARD group (Table 1). Compared with patients in the csDMARD group, those in the denosumab group had significantly higher volumetric bone mineral density (vBMD) at month 12. AEs were reported in 12 (52.2%) and 13 (56.5%) of patients in the denosumab and csDMARD groups, respectively. The most common AEs of denosumab groups was hypocalcemia (reported in 4), and all the events were causally related with denosumab. Serious AEs were reported in 1 (4.3%) and 2 (8.7%) of patients in the denosumab and csDMARD groups, and which were not related to treatment drug.Table 1.ER and microstructure in denosumab group vs csDMARD groupMonthDenosumab group (n=21)csDMARDs group (n=22)Difference (Denosumab- csDMARDs)n1Estimate Means [95%CI]n1Estimate Means [95%CI]Estimate Means [95%CI]ER-depth617−0.46 [−1.31, 0.39]25−0.20 [−0.89, 0.49]−0.27 [−0.86, 0.32]1217−0.56 [−1.41, 0.29]22−0.20 [−0.90, 0.49]−0.35 [−0.95, 0.24]ER-width617−0.26 [−1.10, 0.57]25−0.06 [−0.73, 0.61]−0.20 [−0.81, 0.40]1217−0.27 [−1.10, 0.56]22−0.03 [−0.70, 0.64]−0.24 [−0.85, 0.38]ER-volume616−6.21 [−23.89, 11.46]24−1.71 [−16.07, 12.66]−4.51 [−16.67, 7.65]1217−6.25 [−23.94, 11.44]21−3.18 [−17.56, 11.20]−3.07 [−15.32, 9.17]vBMD6426.41 [2.78, 10.03]442.46 [−1.33, 6.24]3.95 [−0.05, 7.94]12389.20 [5.46, 12.95]423.66 [−0.15, 7.46]5.55 [1.46, 9.63]*These were extension data.This is the efficacy analysis set which excluded 3 patients from the full analysis set.*; p<0.01n, number of patients; n1, number of measurement pointsConclusionOur results suggest that adding denosumab to csDMARD therapy may help prevent ER, promote ER repair, and improve bone microstructure.References[1]Iwamoto N, et al., Trials. 2019;20(1):1–8.Disclosure of InterestsNaoki Iwamoto Speakers bureau: Daiichi Sankyo Co., Ltd., Grant/research support from: Daiichi Sankyo Co., Ltd., Ko Chiba Speakers bureau: Daiichi Sankyo Co., Ltd., Shuntaro Sato: None declared, Kazuteru Shiraishi: None declared, Konosuke Watanabe: None declared, Nozomi Ohki: None declared, Akitomo Okada: None declared, Tomohiro Koga: None declared, Makiko Kobayashi Employee of: Daiichi Sankyo Co., Ltd. (retired at submission), Kengo Saito Employee of: Daiichi Sankyo Co., Ltd., Naoki Okubo Employee of: Daiichi Sankyo Co., Ltd., Atsushi Kawakami Speakers bureau: Daiichi Sankyo Co., Ltd., Grant/research support from: Daiichi Sankyo Co., Ltd.
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Akashi N, Okada A, Nakamura K, Masuda T, Kuroda M, Hanafusa Y, Shibahara T. Bovine Pulmonary Mucormycosis by Rhizomucor pusillus. Mycopathologia 2022; 187:317-320. [PMID: 35179684 DOI: 10.1007/s11046-022-00617-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Natsuki Akashi
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoino-oka, Imabari, Ehime, 794-8555, Japan.
| | - Ayako Okada
- Tottori Prefectural Kurayoshi Livestock Hygiene Service Center, 2-132 Seidanicho, Tottori, Tottori, 682-0017, Japan
| | - Koutaro Nakamura
- Tottori Prefectural Kurayoshi Livestock Hygiene Service Center, 2-132 Seidanicho, Tottori, Tottori, 682-0017, Japan
| | - Tsuneyuki Masuda
- Tottori Prefectural Kurayoshi Livestock Hygiene Service Center, 2-132 Seidanicho, Tottori, Tottori, 682-0017, Japan
| | - Moegi Kuroda
- Tottori Prefectural Kurayoshi Livestock Hygiene Service Center, 2-132 Seidanicho, Tottori, Tottori, 682-0017, Japan
| | - Yasuko Hanafusa
- National Institute of Animal Health, National Agriculture and Food Research Organization (NARO), 3-1-5 Kannondai, Tsukuba, Ibaraki, 305-0856, Japan
| | - Tomoyuki Shibahara
- National Institute of Animal Health, National Agriculture and Food Research Organization (NARO), 3-1-5 Kannondai, Tsukuba, Ibaraki, 305-0856, Japan
- Department of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-oraikita, Izumisano, Osaka, 598-8531, Japan
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Sakai T, Motoki H, Suzuki S, Fuchida A, Takeuchi T, Otagiri K, Kanai M, Kimura K, Minamisawa M, Yoshie K, Saigusa T, Ebisawa S, Okada A, Kitabayashi H, Kuwahara K. Gender difference in heart failure with preserved ejection fraction: clinical profiles, examinations, and prognosis. Heart Vessels 2022; 37:1710-1718. [PMID: 35461354 PMCID: PMC9399051 DOI: 10.1007/s00380-022-02067-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) has currently become a major concern in the aging society owing to its substantial and growing prevalence. Recent investigations regarding sacubitril/valsartan have suggested that there is a gender difference in the efficacy of the medication in HFpEF cohort. However, information of gender difference in clinical profiles, examination, and prognosis have not been well investigated. The present study aimed to evaluate the differences in baseline characteristics and outcomes between women and men in a Japanese HFpEF cohort. We analyzed the data from our prospective, observational, and multicenter cohort study. Overall, 1036 consecutive patients hospitalized for acute decompensated heart failure were enrolled. We defined patients with an ejection fraction (EF) of ≥ 50% as HFpEF. Patients with severe valvular disease were excluded; the remaining 379 patients (women: n = 201, men: n = 178) were assessed. Women were older than men [median: 85 (79–89) years vs. 83 (75–87) years, p = 0.013]. Diabetes mellitus, hyperuricemia, and coronary artery disease were more prevalent in men than in women (34.8% vs. 23.9%, p = 0.019, 23.6% vs. 11.4%, p = 0.002, and 23.0% vs. 11.9%, p = 0.005, respectively). EF was not significantly different between women and men. The cumulative incidence of cardiovascular death or hospitalization for congestive heart failure (CHF) was significantly lower in women than in men (log-rank p = 0.040). Women with HFpEF were older and less often exhibited an ischemic etiology; further, they were associated with a lower risk for cardiovascular death or hospitalization for CHF compared with men in the Japanese population.
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HASEGAWA S, Okada A, Yasunaga H, Nangaku M. POS-293 IMPACT OF DIABETES ON MAJOR BLEEDING COMPLICATIONS OF RENAL BIOPSY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.313] [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: 10/19/2022] Open
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22
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Okada A, Imai S, Kikuchi T, Matin K, Otsuka R, Terai T, Okumura T, Yamamoto T, Hanada N. Evaluation of the cariogenic potential of a probiotic candidate strain Lactobacillus gasseri YIT 12321. Arch Oral Biol 2022; 136:105364. [DOI: 10.1016/j.archoralbio.2022.105364] [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] [Received: 08/21/2021] [Revised: 12/12/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022]
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Sakai T, Motoki H, Fuchida A, Takeuchi T, Otagiri K, Kanai M, Kimura K, Minamisawa M, Yoshie K, Saigusa T, Ebisawa S, Okada A, Kitabayashi H, Kuwahara K. Comparison of prognostic impact of anticoagulants in heart failure patients with atrial fibrillation and renal dysfunction: direct oral anticoagulants versus vitamin K antagonists. Heart Vessels 2022; 37:1232-1241. [PMID: 35064298 PMCID: PMC9142422 DOI: 10.1007/s00380-022-02027-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
AbstractAlthough high thromboembolic risk was assumed in elderly patients with heart failure (HF) and atrial fibrillation (AF), inadequate control of prothrombin time/international normalized ratio was often observed in patients using vitamin K antagonists (VKAs). We hypothesized that patients treated with direct oral anticoagulants (DOAC) would have a better outcome than those treated with VKAs. The aim of this study was to compare the efficacies of DOACs and VKAs in elderly patients with HF and AF. We retrospectively analyzed data from a multicenter, prospective observational cohort study. A total of 1036 patients who were hospitalized for acute decompensated HF were enrolled. We assessed 329 patients aged > 65 years who had non-valvular AF and divided them into 2 groups according to the anticoagulant therapy they received. A subgroup analysis was performed using renal dysfunction based on estimated glomerular filtration rate (eGFR; mL/min/1.73 m2). The primary outcome was all-cause mortality, and the secondary outcomes were non-cardiovascular death or stroke. The median follow-up period was 730 days (range 334–1194 days). The primary outcome was observed in 84 patients; non-cardiovascular death, in 25 patients; and stroke, in 14 patients. The Kaplan–Meier analysis revealed that all-cause mortality was significantly lower in the DOAC group than in the VKA group (log-rank p = 0.033), whereas the incidence rates of non-cardiovascular death (log-rank p = 0.171) and stroke (log-rank p = 0.703) were not significantly different in the crude population. DOAC therapy was not associated with lower mortality in the crude population (log-rank p = 0.146) and in the eGFR ≥ 45 mL/min/1.73 m2 subgroup (log-rank p = 0.580). However, DOAC therapy was independently associated with lower mortality after adjustments for age, diabetes mellitus, and albumin level (hazard ratio, 0.55; 95% confidence interval, 0.30–0.99; p = 0.045) in the eGFR < 45 mL/min/1.73 m2 subgroup. Compared with VKA therapy, DOAC therapy was associated with lower risk of all-cause mortality in the elderly HF patients with AF and renal dysfunction.
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Affiliation(s)
- Takahiro Sakai
- Department of Cardiovascular Medicine, Ina Central Hospital, Ina, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Aya Fuchida
- Department of Cardiovascular Medicine, Ina Central Hospital, Ina, Japan
| | - Takahiro Takeuchi
- Department of Cardiovascular Medicine, Ina Central Hospital, Ina, Japan
| | - Kyuhachi Otagiri
- Department of Cardiovascular Medicine, Ina Central Hospital, Ina, Japan
| | - Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | | | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Okano T, Okada A, Shoda M, Kuwahara K. Gigantic Pacemaker Pocket Abscess Infected by Staphylococcus epidermidis. Intern Med 2022; 61:593-594. [PMID: 35173138 PMCID: PMC8907780 DOI: 10.2169/internalmedicine.8035-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Japan
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Hasegawa Y, Okada A, Fujii K. Skill Differences in a Discrete Motor Task Emerging From the Environmental Perception Phase. Front Psychol 2021; 12:697914. [PMID: 34659013 PMCID: PMC8517186 DOI: 10.3389/fpsyg.2021.697914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022] Open
Abstract
Because of the challenges associated with measuring human perception and strategy, the process of human performance from perception to motion to results is not fully understood. Therefore, this study clarifies the phase at which errors occur and how differences in skill level manifest in a motor task requiring an accurate environmental perception and fine movement control. We assigned a golf putting task and comprehensively examined various errors committed in five phases of execution. Twelve tour professionals and twelve intermediate amateur golfers performed the putting task on two surface conditions: flat and a 0.4-degree incline. The participants were instructed to describe the topographical characteristics of the green before starting the trials on each surface (environmental perception phase). Before each attempt, the participants used the reflective markers to indicate their aim point from which the ball would be launched (decision-making phase). We measured the clubface angle and impact velocity to highlight the pre-motion and motion errors (pre-motion and motion phase). In addition, mistakes in the final ball position were analyzed as result errors (post-performance phase). Our results showed that more than half of the amateurs committed visual–somatosensory errors in the perception phase. Moreover, their aiming angles in the decision-making phase differed significantly from the professionals, with no significant differences between slope conditions. In addition, alignment errors, as reported in previous studies, occurred in the pre-motion phase regardless of skill level (i.e., increased in the 0.4-degree condition). In the motion phase, the intermediate-level amateurs could not adjust their clubhead velocity control to the appropriate level, and the clubhead velocity and clubface angle control were less reproducible than those of the professionals. To understand the amateur result errors in those who misperceived the slopes, we checked the individual results focusing on the final ball position. We found that most of these participants had poor performance, especially in the 0.4-degree condition. Our results suggest that the amateurs’ pre-motion and strategy errors depended on their visual–somatosensory errors.
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Affiliation(s)
- Yumiko Hasegawa
- Faculty of Humanities and Social Sciences, Iwate University, Morioka, Japan
| | - Ayako Okada
- Japan Ladies Professional Golfers' Association, Tokyo, Japan
| | - Keisuke Fujii
- Graduate School of Informatics, Nagoya University, Nagoya, Japan.,RIKEN Center for Advanced Intelligence Project, RIKEN, Fukuoka, Japan.,PRESTO, Japan Science and Technology Agency, Kawaguchi, Japan
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Kanai M, Kimura K, Motoki H, Suzuki S, Okano T, Minamisawa M, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Cardio-renal protective effects of SGLT2 inhibitors in patients with type 2 diabetes mellitus and severely impaired renal function. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2958] [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: 11/13/2022] Open
Abstract
Abstract
Background
Prognostic impact of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors on cardiovascular and renal outcome was unknown in patients with type-2 diabetes mellitus (DM) and severely impaired renal function.
Methods
From July 2015 to December 2020, patients with type-2 DM who were taken SGLT2 inhibitors for more than six months were retrospectively screened. Patients with estimated glomerular filtration rate (eGFR) over 60ml/min/1.73m2 were excluded. We divided those patients into two groups by eGFR; less than 45ml/min/1,73m2 were group A and 46–60ml/min/m2 were group B. Randomly selected patients with DM not taking SGLT2 inhibitors and having severe renal dysfunction: eGFR less than 45ml/min/m2 (Group C) were set as controls. The primary outcome was a composite of cardiovascular/renal death, initiation of dialysis, doubling of the serum creatine level, decline in the eGFR more than 30%, nonfatal myocardial infraction, nonfatal stroke, and hospitalization for heart failure.
Results
Totally 418 patients were enrolled. Median age was 71 years (group A, n=106), 64 years (group B, n=115), and 77 years (group C, n=201) (p<0.001). After median 24 months follow-up, primary endpoints were observed 24.5% in group A, 4.3% in group B, 36.8% in group C (p<0.001). In Kaplan-Meier analysis, significantly lower incidence of primary endpoints were observed in SGLT2 groups (group A and B) than controls (p<0.001, Figure 1). In patients with severe renal dysfunction, taking SGLT2 inhibitors tended to decrease future renal event (Figure 2). The incidence of SGLT2 related adverse events was not different between 2 groups (A and B).
Conclusions
Even in patients with severe renal dysfunction, SGLT2 inhibitors would have cardio-renal protective effects without drug-related adverse effects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kanai
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kimura
- Shinshu University Hospital, Matsumoto, Japan
| | - H Motoki
- Shinshu University Hospital, Matsumoto, Japan
| | - S Suzuki
- Shinshu University Hospital, Matsumoto, Japan
| | - T Okano
- Shinshu University Hospital, Matsumoto, Japan
| | | | - K Yoshie
- Shinshu University Hospital, Matsumoto, Japan
| | - T Kato
- Shinshu University Hospital, Matsumoto, Japan
| | - T Saigusa
- Shinshu University Hospital, Matsumoto, Japan
| | - S Ebisawa
- Shinshu University Hospital, Matsumoto, Japan
| | - A Okada
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kuwahara
- Shinshu University Hospital, Matsumoto, Japan
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Kanai M, Motoki H, Okano T, Kimura K, Minamisawa M, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Impact of polypharmacy on prognosis in patients with acute decompensated heart failure: from the CURE-HF registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0909] [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: 11/14/2022] Open
Abstract
Abstract
Background
Polypharmacy would be associated with poor prognosis in patients with heart failure (HF).
Methods
In 863 patients who discharged after treatment for HF were prospectively enrolled. Number of tablets prescribed at discharge was counted. Death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for HF were tracked.
Results
In our study cohort (median age, 78), 447 patients experienced adverse events during median 503 days follow-up. In Kaplan-Meier analysis, a greater number of prescribed tablets was associated with future adverse cardiac events in the crude population. Although patients with the greater number of non-HF medications showed worse outcome, those of HF medications were not associate with the outcome (Figure). Furthermore, the number of tablets was an independent predictor of future cardiovascular events after adjustment for age, gender, B-type natriuretic peptide, hemoglobin, albumin, estimated glomerular filtration rate, and left ventricular ejection fraction (HR 95% CI: 1.295 (1.066–1.573), p=0.009).
Conclusions
Polypharmacy was associated with poor prognosis. Although the numbers of tablets and non-HF medications were significantly associated with worse out come in HF patients, the number of HF medications was not.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Kanai
- Shinshu University Hospital, Matsumoto, Japan
| | - H Motoki
- Shinshu University Hospital, Matsumoto, Japan
| | - T Okano
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kimura
- Shinshu University Hospital, Matsumoto, Japan
| | | | - K Yoshie
- Shinshu University Hospital, Matsumoto, Japan
| | - T Kato
- Shinshu University Hospital, Matsumoto, Japan
| | - T Saigusa
- Shinshu University Hospital, Matsumoto, Japan
| | - S Ebisawa
- Shinshu University Hospital, Matsumoto, Japan
| | - A Okada
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kuwahara
- Shinshu University Hospital, Matsumoto, Japan
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Okada A, Murata T, Matin K, Ariyoshi M, Otsuka R, Yamashita M, Suzuki M, Wakiyama R, Tateno K, Suzuki M, Aoyagi H, Uematsu H, Imamura A, Kosaka M, Mizukaki T, Sato T, Kawahara H, Hanada N. Effect of advanced periodontal self-care in patients with early-stage periodontal diseases on endothelial function: An open-label, randomized controlled trial. PLoS One 2021; 16:e0257247. [PMID: 34555048 PMCID: PMC8459983 DOI: 10.1371/journal.pone.0257247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/17/2021] [Indexed: 01/10/2023] Open
Abstract
Although a significant association between periodontal disease and atherosclerotic cardiovascular disease has been reported, their cause-to-effect relationship remains controversial. This randomized controlled clinical trial aimed to investigate the effect of advanced self-care on atherosclerotic cardiovascular disease-related vascular function markers flow-mediated brachial artery dilatation (FMD) and serum asymmetric dimethylarginine (ADMA) level in patients with early-stage periodontal disease. The study was designed as a parallel group, 3-month follow-up, open-label, randomized controlled trial. The control group received standard care for periodontal diseases, whereas the test group additionally applied disinfectant using a custom-fabricated prescription tray for advanced self-care twice a day. Overall, 110 patients provided data for FMD and serum ADMA level. No significant improvements in FMD were observed in the control (mean increase, −0.1%; 95% confidence interval [CI], −1.0–0.8; P = 0.805) or test (mean increase, −0.3%; 95% CI, −1.1–0.4; P = 0.398) group. No significant changes in serum ADMA levels were observed (mean reduction, 0.01 μmol/L; 95% CI, −0.00–0.02; P = 0.366 and mean reduction, 0.00 μmol/L; 95% CI, −0.01–0.01; P = 0.349, respectively). No significant between-group differences were found in FMD (mean difference, −0.2%; 95% CI, −1.4–0.9; p = 0.708) or serum ADMA levels (mean difference, 0.01 nmol/L; 95% CI, −0.00–0.03; p = 0.122). Significant improvements in the average probing pocket depth were observed in the control and test groups. The bleeding on probing score in the test group was significantly reduced, while that in the control group was reduced, although not significantly. Periodontal care for a 3-month duration did not provide better endothelial function although improvements of periodontal status in patients with early-stage periodontal diseases. This trial is registered in UMIN Clinical Trials Registry (www.umin.ac.jp/ctr/; ID: UMIN000023395).
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Affiliation(s)
- Ayako Okada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Takatoshi Murata
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
- * E-mail:
| | - Khairul Matin
- Endowed Department of International Oral Health Science, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Department of Cariology and Operative Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Meu Ariyoshi
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Department of Cariology and Operative Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoko Otsuka
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Mamiko Yamashita
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Masayuki Suzuki
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Rumi Wakiyama
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Ken Tateno
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Anesthesiology, Saitama Medical University Hospital, Iruma-gun, Japan
| | - Megumi Suzuki
- Department of Dental Hygiene, The Nippon Dental University College at Tokyo, Tokyo, Japan
| | | | | | | | - Miki Kosaka
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
- Department of Dentistry, Tokyo Children Rehabilitation Hospital, Tokyo, Japan
| | - Tomoko Mizukaki
- Department of Oral and Maxillofacial Surgery, St. Marianna University School of Medicine Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Tsutomu Sato
- Division of Basic Medical Science, Tokai University School of Medicine, Isehara, Japan
- Louis Pasteur Center for Medical Research, Kyoto, Japan
| | - Hiroshi Kawahara
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama, Japan
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Endo Y, Kawashiri SY, Nishino A, Michitsuji T, Tomokawa T, Nishihata S, Okamoto M, Tsuji Y, Tsuji S, Shimizu T, Sumiyoshi R, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Ueki Y, Yoshitama T, Eiraku N, Matsuoka N, Okada A, Fujikawa K, Otsubo H, Takaoka H, Hamada H, Tsuru T, Nawata M, Arinobu Y, Hidaka T, Tada Y, Kawakami A. Ultrasound efficacy of targeted-synthetic disease-modifying anti-rheumatic drug treatment in rheumatoid arthritis: a multicenter prospective cohort study in Japan. Scand J Rheumatol 2021; 51:259-267. [PMID: 34474646 DOI: 10.1080/03009742.2021.1927389] [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: 10/20/2022]
Abstract
OBJECTIVE This study investigated the effectiveness of treatment with Janus kinase (JAK) inhibitors in rheumatoid arthritis (RA) assessed by ultrasonography (US) activity, and the influence of patient characteristics and previous treatments. METHOD This prospective study assessed 60 treatment initiations among 53 Japanese patients diagnosed with RA who underwent treatment with JAK inhibitors during June 2013 to February 2020. Of the 53 patients, seven patients were enrolled in duplicate because they were treated with two different JAK inhibitors at different periods. For each case, the improvement rate on the power Doppler (PD) score was assessed at 6 month follow-up. Median improvement rate of PD score was used to classify cases as either US responders or non-responders, and patient characteristics were compared between the two groups. RESULTS All indicators of clinical disease activity and US activity showed a significant improvement at 3 months compared with baseline. Although the JAK inhibitor-cycler group and the interleukin-6 (IL-6) inhibitor inadequate response (IR) group tended to show a later improvement for US activity, all indicators of clinical disease activity and US activity showed a significant improvement at 6 months compared with baseline for both groups. Multivariate analysis showed that concomitant methotrexate use and an IR to the previous biologic or targeted-synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) treatment were independently and significantly associated with US responders. CONCLUSION Use of a JAK inhibitor in combination with methotrexate and an absence of IR to any previous b/tsDMARDs demonstrated superior effectiveness for patients with RA.
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Affiliation(s)
- Y Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - S-Y Kawashiri
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Nishino
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Michitsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Tomokawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - S Nishihata
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - M Okamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Y Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - S Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - R Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Igawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - K Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - H Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Y Ueki
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Yoshitama
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Eiraku
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Matsuoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Okada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - K Fujikawa
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Otsubo
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Takaoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Hamada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Tsuru
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - M Nawata
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Arinobu
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Hidaka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Tada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
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Yoshie K, Okada A, Shoda M, Kuwahara K. Unique Atrial Tachycardia From the Right Inferior Pulmonary Vein Mimicking Multiple Focal Patterns in the Bilateral Atria and Aorta. Circ Rep 2021; 3:472-473. [PMID: 34414337 PMCID: PMC8338434 DOI: 10.1253/circrep.cr-21-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Matsumoto Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Matsumoto Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Matsumoto Japan.,Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Matsumoto Japan
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Fujimori K, Okada A, Tabata H, Shoda M, Kuwahara K. Percutaneous Removal of a Displaced Inferior Vena Cava Filter Using a Loop-Wire Technique and Lead-Extraction Sheaths. Circ J 2021; 85:1403. [PMID: 34039833 DOI: 10.1253/circj.cj-21-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koki Fujimori
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine.,Department of Cardiology, Tokyo Women's Medical University
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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Iwamoto N, Suzuki T, Okada A, Fujikawa K, Aramaki T, Mizokami A, Ueki Y, Kawakami A. POS0674 DIRECT COMPARISON OF EFFECTIVENESS AND SAFETY OF TOFACITINIB AND BARICITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD SETTINGS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tofacitinib is a non-selective first-generation JAK inhibitor and baricitinib was approved for the treatment of Rheumatoid arthritis several years after approve of tofacitinib. Randomized controlled trials have shown good treatment response for RA in these two drugs. However, the evaluation of these two drugs in real-world setting have been rarely reported, moreover, until now, no published data of a direct comparison among JAK inhibitors in RA have been available.Objectives:To compare the efficacy and safety of the JAK inhibitors tofacitinib and baricitinib in patients with rheumatoid arthritis (RA) by using propensity score matching in a real-world setting.Methods:A total of 242 patients with RA who were treated with tofacitinib (n=161) or baricitinib (n=81) were enrolled. To avoid confounding, we performed propensity score matching based on multiple baseline characteristic variables, and then 80 baricitinib-treated patients and 57 tofacitinib-treated patients were extracted for the direct comparison. A mixed effect model with a repeated measures analysis of variance (ANOVA) was performed to ascertain whether there were significant differences in clinical efficacy between the two treatment groups during the treatment period.Finally, We evaluated the predictive factor of clinical responses by performing univariate and multivariable logistic regression analyses.Results:The mean delta disease activity scores (DAS)28-ESR from baseline to 6 months were −1.60 (tofacitinib) and −1.46 (baricitinib). The remission rate defined by the DAS28-ESR at 24 weeks were 21.1% (tofacitinib) and 25.0% (baricitinib). There was no significant difference in the clinical response between the baricitinib-treated and tofacitinib-treated groups. Although there was no significant difference, the concomitant use of methotrexate (MTX) showed better clinical efficacy in the cases of baricitinib treatment as compared with in the case of tofacitinib treatment. In both groups, the most common AE was herpes zoster infection, and the AE rates were similar between the two groups. However, the predictive factors contributing to clinical response differed. The concomitant use of oral steroid was independently associated with the achievement of DAS-low disease activity in both groups, whereas in the baricitinib group, the number of biological and/or targeted synthetic DMARDs previously used and the DAS28-ESR at the time of initiation were associated with DAS-low disease activity.Conclusion:This study indicate that tofacitinib and baricitinib had comparable efficacies and safety profiles in a real-world setting. However, the influence of clinical characteristics on the treatment response differed between these two drugs. Direct comparison between two JAK inhibitors provide useful information to optimal use of JAK inhibitors in real-world settings.Disclosure of Interests:None declared
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Taguchi K, Yamashita S, Hamamoto S, Deguchi R, Kawase K, Okada T, Sugino T, Unno R, Kato T, Ando R, Okada A, Kohjimoto Y, Hara I, Yasui T. Ureteroscopy-assisted versus conventional ultrasound-guided renal access for miniaturised endoscopic combined intrarenal surgery: A multicentre comparative study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00677-1] [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: 11/27/2022]
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Nagai T, Taguchi K, Isobe T, Matsuyama N, Hattori T, Unno R, Kato T, Etani T, Hamakawa T, Fujii Y, Ikegami Y, Kamiya H, Hamamoto S, Nakane A, Ando R, Maruyama T, Okada A, Kawai N, Yasui T. A multicenter, propensity score-matched retrospective study of preventing postoperative infection in robotic and laparoscopic minimally invasive surgeries; double-versus single-gloving. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00561-3] [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: 10/20/2022]
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35
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Taguchi K, Unno R, Sugino T, Kawase K, Yang H, Hamamoto S, Okada A, Stoller M, Chi T, Yasui T. Fatty acid binding protein 4 attenuates macrophage and tubular cells crystal phagocytosis to drive renal calcium oxalate stone development. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00612-6] [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: 11/30/2022]
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Ohara Y, Nomura Y, Yamamoto Y, Okada A, Hosoya N, Hanada N, Hirano H, Takei N. Daily Tasks and Willingness to Work of Dental Hygienists in Nursing Facilities Using Japanese Dental Hygienists' Survey 2019. Int J Environ Res Public Health 2021; 18:ijerph18063152. [PMID: 33803749 PMCID: PMC8003160 DOI: 10.3390/ijerph18063152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
Oral health care by dental hygienists contributes to the maintenance of nutritional and general health for older people in nursing facilities. This study aimed to investigate daily tasks and willingness to work among dental hygienists working in nursing facilities in Japan. In 2019, using a self-administered questionnaire, a postal cross-sectional survey was conducted among members of the Japanese Dental Hygienists’ Association. Questionnaires were distributed to all 16,722 Association members (responses, n = 8932; return rate, 53.4%). We analysed data from 368 dental hygienists currently working in nursing facilities. Item response theory and correspondence analyses were performed. In total, >90% of dental hygienists undertook oral examinations and provided oral hygiene instructions to residents and facility staff. In contrast, the implementation rate of tasks related to interprofessional collaboration was relatively low (approximately 50%), and 72.6% of dental hygienists indicated that they wanted to continue working in nursing facilities. Their willingness to work was closely associated with work involving interprofessional collaboration. Our study findings showed that dental hygienists’ work content in nursing facilities was diverse, but that there was variation in implemented tasks. Willingness to continue working in nursing facilities was associated with interprofessional collaboration among dental hygienists.
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Affiliation(s)
- Yuki Ohara
- Japan Dental Hygienists’ Association, Tokyo 169-0071, Japan;
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Yoshiaki Nomura
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (Y.N.); (N.H.)
| | - Yuko Yamamoto
- Department of Endodontology, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (Y.Y.); (N.H.)
| | - Ayako Okada
- Department of Operative Dentistry, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan;
| | - Noriyasu Hosoya
- Department of Endodontology, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (Y.Y.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (Y.N.); (N.H.)
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
- Department of Dental and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan
| | - Noriko Takei
- Japan Dental Hygienists’ Association, Tokyo 169-0071, Japan;
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Nomoto F, Suzuki S, Hashizume N, Kanzaki Y, Maruyama T, Kozuka A, Saigusa T, Ebisawa S, Okada A, Motoki H, Yahikozawa K, Kuwahara K. A case of Dressler's syndrome successfully treated with colchicine and acetaminophen. J Cardiol Cases 2021; 23:131-135. [PMID: 33717379 PMCID: PMC7917394 DOI: 10.1016/j.jccase.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/18/2020] [Accepted: 10/03/2020] [Indexed: 11/05/2022] Open
Abstract
The incidence of Dressler’s syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler’s syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler’s syndrome. <Learning objective: Guidelines recommend high-dose aspirin for the treatment of Dressler’s syndrome based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era. However, bleeding and thrombotic concerns are present upon high-dose aspirin administration in patients who have undergone PCI. Therefore, a combination therapy of low-dose colchicine and acetaminophen could be a treatment option for patients with Dressler’s syndrome who have undergone recent coronary stenting.>
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Affiliation(s)
- Fumika Nomoto
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Sho Suzuki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Endo Y, Kawashiri SY, Nishino A, Okamoto M, Tsuji S, Shimizu T, Sumiyoshi R, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Ueki Y, Yoshitama T, Eiraku N, Matsuoka N, Okada A, Fujikawa K, Otsubo H, Takaoka H, Hamada H, Tsuru T, Nagano S, Arinobu Y, Hidaka T, Tada Y, Kawakami A. Discrepancy between clinical and ultrasound remissions in rheumatoid arthritis: a multicentre ultrasound cohort study in Japan. Scand J Rheumatol 2021; 50:436-441. [PMID: 33719841 DOI: 10.1080/03009742.2021.1876914] [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: 10/21/2022]
Abstract
Objectives: Using multicentre ultrasound (US) cohort data among patients with rheumatoid arthritis (RA), we aimed to identify baseline factors that permit differentiation between two patient cohorts achieving US remission and clinical remission, and to determine the factors contributing to the discrepancy.Method: We reviewed 248 Japanese patients diagnosed with RA who underwent treatment with biological disease-modifying anti-rheumatic drugs at 13 centres. We performed US assessments of the synovia of 22 joints. We assessed the percentages of patients with clinical remission and US remission, defined as total power Doppler scores of 0 at 12 months.Results: The 87 patients who achieved US remission were divided into a group that achieved both clinical and US remission (n = 53) and a group that achieved US remission only (n = 34). Baseline factors that were significantly and independently associated with clinical remission at 12 months among patients who also achieved US remission included short disease duration, the presence of concomitant methotrexate use, and low patient global assessment score (p < 0.05, p < 0.05, and p < 0.005, respectively).Conclusions: RA patients with baseline high patient global assessment scores and long disease duration at baseline were unlikely to achieve clinical remission even after achieving US remission. Objective joint assessments using US provide additional information of potential importance for the management of RA.
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Affiliation(s)
- Y Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - S-Y Kawashiri
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Nishino
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - M Okamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - S Tsuji
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - R Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Igawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - K Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - H Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Y Ueki
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Yoshitama
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Eiraku
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - N Matsuoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Okada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - K Fujikawa
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Otsubo
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Takaoka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - H Hamada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Tsuru
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - S Nagano
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Arinobu
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - T Hidaka
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - Y Tada
- Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
| | - A Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Kyushu Multicenter Rheumatoid Arthritis Ultrasound Prospective Observational Cohort Study Group, Kyushu, Japan
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Okada A, Kato K, Shoda M, Tabata H, Yoshie K, Kuwahara K. Successful catheter ablation of atrial tachycardia in cor triatriatum sinister: A figure-of-8 reentry in the left atrial membrane. HeartRhythm Case Rep 2021; 7:109-111. [PMID: 33665113 PMCID: PMC7897740 DOI: 10.1016/j.hrcr.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.,Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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40
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Yamamoto Y, Nomura Y, Okada A, Kakuta E, Yoshida N, Hosoya N, Hanada N, Takei N. Improvement of Workplace Environment That Affects Motivation of Japanese Dental Hygienists. Int J Environ Res Public Health 2021; 18:ijerph18031309. [PMID: 33535631 PMCID: PMC7908268 DOI: 10.3390/ijerph18031309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/23/2022]
Abstract
Dental hygienists are in high demand due to insufficient workforce and a lack of an effective reinstatement support system. We investigated the reasons for willingness to work by analyzing the survey results of the employment status of Japanese dental hygienists conducted by Japan Dental Hygienists’ Association. In total, we mailed 16,113 questionnaires to all members of the association (response rate 53.4%). We carried out statistical analysis to determine the specific items to improve the hygienists’ working environment. Fourteen factors of working conditions that they wish to improve were determined. Structural equation modeling showed that a path, “Reduction of work volume”, “Reduction of working hours” and “Increased number of holidays” were higher than other items. A decision analysis demonstrated that most of the respondents answered “Yes” to “Improvement in working conditions including higher salary” out of those who answered, “Strongly disagree” for “Do you feel that dental hygienist work is rewarding?”. Improving workplace environment is integral to keeping high levels of work motivation and a low turnover rate. Most of the hygienists wish for a salary raise among all the conditions. The transition from conventional work styles to non-conventional flexible working patterns is needed.
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Affiliation(s)
- Yuko Yamamoto
- Department of Endodontology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (Y.Y.); (N.H.)
| | - Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan;
- Correspondence:
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan;
| | - Erika Kakuta
- Department of Oral Microbiology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan;
| | - Naomi Yoshida
- Japan Dental Hygienists’ Association, Tokyo 169-0072, Japan; (N.Y.); (N.T.)
| | - Noriyasu Hosoya
- Department of Endodontology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan; (Y.Y.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan;
| | - Noriko Takei
- Japan Dental Hygienists’ Association, Tokyo 169-0072, Japan; (N.Y.); (N.T.)
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Shimizu T, Koga T, Furukawa K, Horai Y, Fujikawa K, Okada A, Okamoto M, Endo Y, Tsuji S, Takatani A, Umeda M, Fukui S, Sumiyoshi R, Kawashiri SY, Iwamoto N, Igawa T, Ichinose K, Tamai M, Sakamoto N, Nakamura H, Origuchi T, Mukae H, Kuwana M, Kawakami A. IL-15 is a biomarker involved in the development of rapidly progressive interstitial lung disease complicated with polymyositis/dermatomyositis. J Intern Med 2021; 289:206-220. [PMID: 32691471 DOI: 10.1111/joim.13154] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 04/21/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Polymyositis/dermatomyositis (PM/DM) is an autoimmune disease that is sometimes complicated with rapidly progressive interstitial lung disease (RPILD). However, serum and lung biomarkers that can predict RPILD development remain unclear. OBJECTIVES To determine potential serum and lung biomarkers that can predict RPILD development in patients with PM/DM-ILD. METHODS In total, 49 patients with PM/DM-ILD were enrolled. We measured the serum levels of 41 cytokines/chemokines, ferritin and anti-MDA5 antibody, compared them between the RPILD (n = 23) and non-RPILD (n = 26) groups, and ranked them by their importance through random forest analysis. To distinguish the two groups, we determined biomarker combinations by logistic regression analysis. We also measured the bronchoalveolar lavage fluid (BALF) levels of 41 cytokines/chemokines. Using immunohistochemistry, we examined IL-15 expression in lung tissues. The IL-15 production was also investigated using A549 and BEAS-2B cells. RESULTS The RPILD group had significantly higher IL-15, IL-1RA, IL-6, CXCL10, VCAM-1, anti-MDA5 antibody and ferritin serum levels than the non-RPILD group, but it had a significantly low CCL22 level. Meanwhile, anti-MDA5 antibody, IL-15, CXCL8, CCL22, IL-1RA and ferritin were the best combination to distinguish the two groups. IL-15 and CCL22 were also predictive marker for RPILD development in anti-MDA5 antibody-positive patients. Additionally, the RPILD group had significantly high IL-15 levels in BALF. The lung tissues expressed IL-15, which increased after cytokine stimulation in the A549 cells. CONCLUSION This study identified a combination of biomarkers predicting PM/DM-RPILD progression, and IL-15 is an important cytokine for predicting RPILD development and reflecting ILD severity.
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Affiliation(s)
- T Shimizu
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - T Koga
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - K Furukawa
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - K Fujikawa
- Department of Rheumatology, Japan Community Health care Organization Isahaya General Hospital, Isahaya, Japan
| | - A Okada
- Department of Rheumatology, Japan Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - M Okamoto
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Y Endo
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Tsuji
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Takatani
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Umeda
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Fukui
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - R Sumiyoshi
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - S-Y Kawashiri
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Igawa
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - K Ichinose
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Nakamura
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - A Kawakami
- From the, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kobayashi H, Tabata H, Shoin W, Okano T, Yoshie K, Okada A, Shoda M, Kuwahara K. A case of transient ventricular pre-excitation associated with takotsubo cardiomyopathy. J Electrocardiol 2021; 65:73-75. [PMID: 33556738 DOI: 10.1016/j.jelectrocard.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
A 75-year-old woman, who had never exhibited a delta wave before, was diagnosed with sigmoid colon cancer and underwent surgical operation. Takotsubo cardiomyopathy (TC) occurred shortly after the operation. About 2 weeks following the onset of TC, a 12‑lead electrocardiogram revealed a delta wave that was present for 50 days, and the patient was diagnosed with transient ventricular pre-excitation. The delta wave disappeared prior to patient's discharge and was never observed thereafter. This transient appearance of a delta wave may be related to a pathological modulation of the autonomic nervous system during the acute phase of TC.
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Affiliation(s)
- Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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43
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Ohara Y, Nomura Y, Yamamoto Y, Okada A, Hosoya N, Hanada N, Hirano H, Takei N. Job Attractiveness and Job Satisfaction of Dental Hygienists: From Japanese Dental Hygienists' Survey 2019. Int J Environ Res Public Health 2021; 18:ijerph18020755. [PMID: 33477353 PMCID: PMC7830899 DOI: 10.3390/ijerph18020755] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 01/19/2023]
Abstract
Job attractiveness and job satisfaction are important factors in the continuity of employment among healthcare professionals. The aim of this study was to assess job satisfaction and job attractiveness among dental hygienists in Japan. The Japan Dental Hygienists Association conducted a survey of the employment status of Japanese dental hygienists in 2019. Questionnaires were distributed to all 16,722 members, and 8932 were returned (Collection rate: 53.4%). Data from 7869 currently working dental hygienists were analysed in this study. We analysed seven items of job attractiveness, 14 items of job satisfaction, and 13 items of request for improving the working environment. Item response theory and structural equation modelling (SEM) were utilized for the analysis. For attractiveness of dental hygienists’ work, respondents placed greater emphasis on the fact that dental hygienists needed national qualifications rather than on income stability. SEM showed that job satisfaction consisted of two factors, ‘Value for work’ and ‘Working environment’, as did job attractiveness, with ‘Contribution’ and ‘Assured income’. Value for work affects the contribution to people, and, employment environment affects assured income. Improving job satisfaction and work environments could help to improve the employment rate of dental hygienists, which could positively influence patient care.
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Affiliation(s)
- Yuki Ohara
- Japanese Dental Hygienists’ Association, Tokyo 169-0071, Japan;
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (Y.N.); (N.H.)
| | - Yuko Yamamoto
- Department of Endodontology, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (Y.Y.); (N.H.)
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Noriyasu Hosoya
- Department of Endodontology, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (Y.Y.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (Y.N.); (N.H.)
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
- Department of Dental and Oral Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan
| | - Noriko Takei
- Japanese Dental Hygienists’ Association, Tokyo 169-0071, Japan;
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44
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Okada A, Shoda M, Tabata H, Kobayashi H, Shoin W, Okano T, Yoshie K, Kato K, Motoki H, Kuwahara K. Simultaneous infection of abandoned leads and newly implanted leadless cardiac pacemaker: Why did this occur? J Cardiol Cases 2021; 23:35-37. [PMID: 33437338 DOI: 10.1016/j.jccase.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022] Open
Abstract
An 80-year-old man with a history of dilated hypertrophic cardiomyopathy received a dual-chamber pacemaker for sick sinus syndrome and atrioventricular block in February 2010. On May 30, 2019, he developed pocket erosion, with streaks of pus exuding from the pocket. The pacemaker generator was removed, although both capping leads were left buried under the skin, and a leadless pacemaker was implanted into the right ventricular (RV) apex the next day. Blood and pus cultures on July 15, 2019 indicated methicillin-resistant Staphylococcus aureus (MRSA). The patient was transferred to our hospital for simultaneous removal of both devices in August 2019. The RV lead and right atrial lead were extracted using a laser sheath and a mechanical sheath. A 23 Fr MICRA® sheath was inserted from the right femoral vein to accommodate an 8.5 Fr Agillis sheath. An Osypka LASSO snare catheter was advanced through the sheath to catch the distal aspect of the MICRA® body. Finally, the MICRA® device was completely removed through the sheath. Culture results for the lead tip and MICRA® were both MRSA positive. This is the first report of late-phase simultaneous infection of abandoned leads and implanted leadless cardiac pacemaker extraction. <Learning objective: Leadless pacemakers are becoming increasingly popular in high-risk patients due to no lead-associated complications. As a result of the incomplete removal, the remaining leads caused a drug-refractory blood stream infection, which secondarily infected the MICRA® device. Thus, an insufficiently treated pocket infection resulted in persistent methicillin-resistant Staphylococcus aureus bacteremia in this case.>.
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Affiliation(s)
- Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
- Department of Cardiology, Tokyo Metroporitan Tama Medical Center, Tokyo, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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45
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Nomura Y, Ishii Y, Chiba Y, Suzuki S, Suzuki A, Suzuki S, Morita K, Tanabe J, Yamakawa K, Ishiwata Y, Ishikawa M, Sogabe K, Kakuta E, Okada A, Otsuka R, Hanada N. Does Last Year's Cost Predict the Present Cost? An Application of Machine Leaning for the Japanese Area-Basis Public Health Insurance Database. Int J Environ Res Public Health 2021; 18:ijerph18020565. [PMID: 33445431 PMCID: PMC7827468 DOI: 10.3390/ijerph18020565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
The increasing healthcare cost imposes a large economic burden for the Japanese government. Predicting the healthcare cost may be a useful tool for policy making. A database of the area-basis public health insurance of one city was analyzed to predict the medical healthcare cost by the dental healthcare cost with a machine learning strategy. The 30,340 subjects who had continued registration of the area-basis public health insurance of Ebina city during April 2017 to September 2018 were analyzed. The sum of the healthcare cost was JPY 13,548,831,930. The per capita healthcare cost was JPY 446,567. The proportion of medical healthcare cost, medication cost, and dental healthcare cost was 78%, 15%, and 7%, respectively. By the results of the neural network model, the medical healthcare cost proportionally depended on the medical healthcare cost of the previous year. The dental healthcare cost of the previous year had a reducing effect on the medical healthcare cost. However, the effect was very small. Oral health may be a risk for chronic diseases. However, when evaluated by the healthcare cost, its effect was very small during the observation period.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
- Correspondence:
| | - Yoshimasa Ishii
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Yota Chiba
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Shunsuke Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Akira Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Senichi Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Kenji Morita
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Joji Tanabe
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Koji Yamakawa
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Yasuo Ishiwata
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Meu Ishikawa
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Kaoru Sogabe
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Erika Kakuta
- Department of Oral Microbiology, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Ryoko Otsuka
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
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46
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Tabata H, Okada A, Kobayashi H, Shoin W, Okano T, Yoshie K, Motoki H, Shoda M, Kuwahara K. "Alpha"-Looped Broken Pacemaker Lead Inside the Heart. Circ J 2020; 85:77. [PMID: 33132229 DOI: 10.1253/circj.cj-20-0680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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47
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Nomura Y, Shimada M, Kakuta E, Okada A, Otsuka R, Tomizawa Y, Taguchi C, Arikawa K, Daikoku H, Sato T, Hanada N. Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study. Int J Environ Res Public Health 2020; 17:ijerph17249584. [PMID: 33371399 PMCID: PMC7768389 DOI: 10.3390/ijerph17249584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Mortality is obviously intended for epidemiological studies of community-dwelling older adults. There are several health-related factors associated with nutritional status and mortality. The aim of this study was to elucidate the risk factor for mortality in community-dwelling oldest-older adults at the age of 90 and clarify the structure of health-related factors associated with mortality. A 10-year follow-up study was performed for 93 subjects at the age of 90. The mean and median of their survival days were 2373 and 2581 days for women, and 1694 and 1793 days for men. By Cox's proportional hazards model, health-related factors associated with mortality were self-assessed for chewing ability, activities of daily living (ADLs), serum albumin, total cholesterol, serum creatinine, and gripping power for women but not for men. These factors interacted with each other, and the association of these factors was different in women and men. Self-assessed chewing ability was a powerful risk factor for mortality in women at the age of 90. It acted independently from nutritional status. For older adults, addressing healthy food choices together with improved oral functions is useful. However, risk factors for mortality may depend on the life stage of subjects. To investigate the risk factor for the mortality, the life course approach is necessary.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
- Correspondence: ; Tel.: +81-45-580-8462
| | - Mieko Shimada
- Department of Dental Hygiene, Chiba Prefectural University of Health Sciences, Chiba 261-0014, Japan;
| | - Erika Kakuta
- Department of Oral Bacteriology, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan;
| | - Ayako Okada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Ryoko Otsuka
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
| | - Yasuko Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Chieko Taguchi
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Kazumune Arikawa
- Department of Preventive and Public Oral Health, School of Dentistry at Matsudo, Nihon University, Matsudo 470-2101, Japan; (C.T.); (K.A.)
| | - Hideki Daikoku
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Tamotsu Sato
- Iwate Dental Association, Morioka 020-0045, Japan; (H.D.); (T.S.)
| | - Nobuhiro Hanada
- Department of Translational Research, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan; (A.O.); (R.O.); (N.H.)
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48
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Kanai M, Motoki H, Okano T, Kimura K, Minamisawa M, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Prognostic impact of free-fat mass index on elderly patients with acute decompensated heart failure: from CURE-HF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1195] [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: 11/13/2022] Open
Abstract
Abstract
Background
Free-Fat Mass Index (FFMI) is an indicator of malnutrition and sarcopenia. We hypothesized that low FFMI would be associated with worse prognosis in elderly patients with heart failure.
Methods
In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Free-Fat Mass Index was calculated dividing the square of the patients heights in meters into lean body mass. All-cause mortality (cardiovascular, non-cardiovascular) was followed-up by telephone interview and chart review.
Results
In our study cohort (median age, 78 [range 72–87]), FFMI was 16.7 [15.2, 18.0]. All-cause mortality was observed in 211 patients during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower FFMI was associated with all-cause mortality. Furthermore, FFMI was an independent predictor of mortality after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, low FFMI was associated with both cardiac and non-cardiac mortality in patients with HF with reduced ejection fraction (EF) (Log-rank p=0.002, p=0.013, respectively) (Figure). Furthermore, low FFMI was significantly associated non-cardiac death in patients with preserved EF (Log-rank p=0.033) (Figure).
Conclusions
Free-Fat Mass Index was significantly associated with mortality in elderly patients with HF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Kanai
- Shinshu University Hospital, Matsumoto, Japan
| | - H Motoki
- Shinshu University Hospital, Matsumoto, Japan
| | - T Okano
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kimura
- Shinshu University Hospital, Matsumoto, Japan
| | | | - K Yoshie
- Shinshu University Hospital, Matsumoto, Japan
| | - T Kato
- Shinshu University Hospital, Matsumoto, Japan
| | - T Saigusa
- Shinshu University Hospital, Matsumoto, Japan
| | - S Ebisawa
- Shinshu University Hospital, Matsumoto, Japan
| | - A Okada
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kuwahara
- Shinshu University Hospital, Matsumoto, Japan
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49
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Kanai M, Motoki H, Okano T, Kimura K, Minamisawa M, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Phenotypic difference of sarcopenia in the prediction of mortality for elderly patients with heart failure: from CURE-HF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2858] [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: 11/14/2022] Open
Abstract
Abstract
Background
Sarcopenia and malnutrition are associated with mortality in elderly patients with heart failure (HF). However, impact of phenotypic difference of sarcopenia on mortality is not well investigated. We hypothesized that evaluation using both body mass index (BMI) and free-fat mass index (FFMI) enabled distinction of phenotypic difference of sarcopenia and risk stratification for mortality in elderly patients with heart failure.
Methods
In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Body mass index and FFMI was evaluated. Free-fat mass index was calculated dividing the square of the patients' heights in meters into lean body mass. All-cause mortality was followed-up. Patients were divided into 3 subgroups according to BMI and FFMI values, and compared incidence of mortality among them.
Results
In our study cohort (median age, 78 [range 72–87]), BMI was 21.1 [18.9, 23.8] and FFMI was 16.7 [15.2, 18.0]. 211 patients were experienced all-cause mortality during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower BMI and lower FFMI was associated with all-cause mortality (Log-rank p<0.001, p<0.001, respectively). Furthermore, FFMI was an independent predictor of adverse events after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, comparing with low-BMI and low-FFMI subgroup, better prognosis was observed in the other 2 subgroups (Log-rank p<0.001, p=0.022, Figure 1).
Conclusions
Phenotypic difference was evident in elderly patients with HF. A combination of BMI and FFMI would be useful for risk stratification of mortality in those patients.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Kanai
- Shinshu University Hospital, Matsumoto, Japan
| | - H Motoki
- Shinshu University Hospital, Matsumoto, Japan
| | - T Okano
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kimura
- Shinshu University Hospital, Matsumoto, Japan
| | | | - K Yoshie
- Shinshu University Hospital, Matsumoto, Japan
| | - T Kato
- Shinshu University Hospital, Matsumoto, Japan
| | - T Saigusa
- Shinshu University Hospital, Matsumoto, Japan
| | - S Ebisawa
- Shinshu University Hospital, Matsumoto, Japan
| | - A Okada
- Shinshu University Hospital, Matsumoto, Japan
| | - K Kuwahara
- Shinshu University Hospital, Matsumoto, Japan
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50
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Tanizawa K, Nishimura Y, Okada A, Nishikawa M, Tamaru S, Nagai N. Stroke, systemic embolism and bleeding rate in non-valvular atrial fibrillation patients without anticoagulation on the real world data in Japan. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2816] [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: 11/13/2022] Open
Abstract
Abstract
Background
Anticoagulant therapy is recommended in patients with non-valvular atrial fibrillation (NVAF) for those with CHADS2 ≥2. However, there have been significant number of subjects with CHADS2 ≥2 who receive no anticoagulation. Most of reported real world data have been collected mainly before wide spread use of DOAC. This study evaluated the clinical outcome of no anticoagulant drug therapy in NVAF.
Methods
This study is a non-interventional, observational, retrospective cohort study of NVAF patients in Mie-LIP Database, which is a regional clinical database joining 1 university hospital and 8 general hospitals in Mie prefecture in Japan. Patient enrolment was conducted from 1st Jan. 2016 to 31st Dec. 2018. The primary outcome events are ischemic stroke, systemic embolism, and bleeding events (bleeding to need a blood transfusion, intracranial bleeding, intraocular bleeding, and gastrointestinal bleeding).
Results
7001 patients were included in the current analysis, 2550 patients, 36.4% were treated without any anticoagulant drug therapy. Table 1 shows patients with no anticoagulant drug therapy, mean age was 75.4 years and 42.2% of patients were female. The most frequent comorbidities included hypertension (50.0%), diabetes mellitus (28.2%), heart failure (14.0%), ischemic stroke (12.7%), vascular disease (14.4%) respectively. The annual incidence of ischemic stroke, systemic embolism per 100 person-years is 3.7, and that in each CHADS2 group is 0: 1.4, 1: 1.4, 2: 3.2, 3–6: 8, respectively in Figure 1. The annual incidence of bleeding events is 1.5, and that in each CHADS2 group is 0: 0.7, 1: 1.0, 2: 1.2, 3–6: 2.9, respectively.
Conclusions
Approximately one-thirds of subjects have not received any anticoagulation in the modern DOAC in daily clinical practice in Japan. The rate of ischemic stroke and systemic embolism increased by CHADS2. Stroke or SEE rate was very low in subjects with CHADS2 ≤1, supporting no indication of anticoagulation in current guidelines. Regarding subjects with CHADS2>2, considering the higher risk of stroke, use of anticoagulant drug therapy is recommended.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Tanizawa
- Daiichi Sankyo Co.,Ltd., / Musashino University, Tokyo, Japan
| | - Y Nishimura
- Mie University Hospital, Clinical Research Support Center, Tsu, Mie, Japan
| | - A Okada
- Musashino University, Nishitokyo-shi, Tokyo, Japan
| | - M Nishikawa
- Mie Health Checkup Clinic, Kinki Health Care Center, Tsu, Mie, Japan
| | - S Tamaru
- Mie University Hospital, Clinical Research Support Center, Tsu, Mie, Japan
| | - N Nagai
- Musashino University, Nishitokyo-shi, Tokyo, Japan
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