1
|
Shimada H, Matsuoka Y, Miyakoshi C, Ito J, Seo R, Ariyoshi K, Yamamoto Y, Mima H. Predictive performance of the sequential organ failure assessment score for in-hospital mortality in patients with end-stage kidney disease in intensive care units: A multicenter registry in Japan. Ther Apher Dial 2024; 28:305-313. [PMID: 37985004 DOI: 10.1111/1744-9987.14089] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION There is limited evidence regarding whether the performance of the Sequential Organ Failure Assessment (SOFA) score differs between patients with and without end-stage kidney disease (ESKD) in intensive care units (ICUs). METHODS We used a multicenter registry (Japanese Intensive care Patient Database) to enroll adult ICU patients between April 2018 and March 2021. We recalibrated the SOFA score using a logistic regression model and evaluated its predictive ability in both ESKD and non-ESKD groups. The primary outcome was in-hospital mortality. RESULTS 128 134 patients were enrolled. The AUROC of the SOFA score was lower in the ESKD group than in the non-ESKD group [0.789 (95% CI, 0.774-0.804) vs. 0.846 (95% CI, 0.841-0.850)]. The calibration plot revealed good performance in both groups. However, it overestimated in-hospital mortality in ESKD groups. CONCLUSION The SOFA score demonstrated good predictive ability in patients with and without ESKD, but it overestimated the in-hospital mortality in ESKD patients.
Collapse
Affiliation(s)
- Hiroki Shimada
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chisato Miyakoshi
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Jiro Ito
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mima
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| |
Collapse
|
2
|
Nishikubo M, Shimomura Y, Yamamoto R, Maruoka H, Nasu S, Sakizono K, Nagai Y, Hiramoto N, Yonetani N, Kondo T, Miyakoshi C, Doi A, Ishikawa T. Sequential cellular and humoral responses after repetitive COVID-19 vaccination in patients treated with anti-CD20 antibodies. Br J Haematol 2024; 204:821-825. [PMID: 37964419 DOI: 10.1111/bjh.19207] [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: 10/24/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023]
Abstract
Patients treated with anti-CD20 antibodies for haematological disorders have insufficient immune responses to mRNA COVID-19 vaccines; however, relevant sequential data are lacking. We sequentially evaluated the humoral and cellular immune responses in 22 patients who had received anti-CD20 antibodies within 12 months before the first vaccination, before and after the third and fourth vaccinations. Humoral responses improved gradually, along with the resolution of B-cell depletion. A steady increase was noted in cellular responses, regardless of the B-cell status. Our findings suggest the potential benefit of repeated vaccinations in these patients until B-cell recovery is confirmed while enhancing cellular responses.
Collapse
Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kenji Sakizono
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yuya Nagai
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Tadakazu Kondo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| |
Collapse
|
3
|
Hayashi K, Miyakoshi C, Hoshino S, Kobayashi N, Nakajima R, Sagawa H, Hayashiya T, Suzuki A, Aota C, Nishijima S, Shimizu Y, Yamakawa M, Tsuda E. Initial intravenous immunoglobulin therapy without aspirin for acute Kawasaki disease: a retrospective cohort study with a Bayesian inference. BMJ Paediatr Open 2024; 8:e002312. [PMID: 38233084 PMCID: PMC10806463 DOI: 10.1136/bmjpo-2023-002312] [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] [Received: 09/28/2023] [Accepted: 12/26/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To clarify the necessity of acetylsalicylic acid (ASA) administration combined with intravenous immunoglobulin (IVIG) therapy in the treatment of acute Kawasaki disease. DESIGN Retrospective cohort study. SETTING Multicentre. PARTICIPANTS This study included 735 patients with Kawasaki disease aged ≤10 years and hospitalised between 4 and 10 days of illness in eight Japanese hospitals from January 2016 to December 2020. EXPOSURES High-dose (HD) ASA was administered with initial IVIG to 333 patients in 6 hospitals (HD group). ASA was not administered routinely to 402 patients in the other two hospitals, and low-dose ASA was only administered when patients developed coronary artery lesions or pericardial effusion (non-HD group). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the presence of coronary artery lesions, defined as a coronary artery diameter >+2.5 SD of body surface area within 1 month of onset. The secondary outcome was responsiveness to the initial IVIG therapy. Adjusted risk ratios for the outcomes were calculated using modified Poisson regression models. Bayesian analysis was conducted to estimate the posterior probability of the treatment effect of HD ASA under several prior distributions. RESULTS The incidence of coronary artery lesions was not significantly higher in the HD group than in the non-HD group (12/333 (3.6%) vs 15/402 (4.0%)). The proportion of non-responders to initial IVIG was similar between the two groups (HD group: 78/333 (23%); non-HD group: 83/402 (22%)). In the Bayesian analysis, considering a difference of ≤2% to be of no clinical importance, there was only a 9.3% chance of reduced risk of coronary artery lesions in the HD group compared with the non-HD group even with a strongly enthusiastic prior for HD treatment. CONCLUSIONS Compared with HD ASA treatment, treatment without ASA in the acute phase of Kawasaki disease was not associated with increased complications from Kawasaki disease.
Collapse
Affiliation(s)
- Ken Hayashi
- Department of Pediatrics, Osaka University Hospital, Suita, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics and Neonatology, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Hoshino
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Naho Kobayashi
- Department of Pediatrics, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Ryo Nakajima
- Department of Pediatrics, Saiseikai Shiga Hospital, Ritto, Japan
| | - Hironori Sagawa
- Department of Pediatrics, Omihachiman Community Medical Center, Oumihachiman, Japan
| | - Toshikazu Hayashiya
- Department of Pediatrics, Omihachiman Community Medical Center, Oumihachiman, Japan
| | - Atsushi Suzuki
- Department of Pediatrics, Oumikusatsu Tokushukai Hospital, Kusatsu, Japan
| | - Chie Aota
- Department of Pediatrics and Neonatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Yasuyo Shimizu
- Department of Pediatrics, Nagahama Red Cross Hospital, Nagahama, Japan
| | - Masaru Yamakawa
- Department of Pediatrics and Neonatology, Kobe City Medical Center General Hospital, Kobe, Japan
- Sonoda Women's University, Amagasaki, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan
| |
Collapse
|
4
|
Sasada T, Hayashi K, Okafuji I, Miyakoshi C, Tsuruta S. Incidence and causative agent distribution of viral-induced paediatric asthma exacerbations under strict infection control measures: a single-centre retrospective study in Japan. BMC Pulm Med 2023; 23:480. [PMID: 38031001 PMCID: PMC10685531 DOI: 10.1186/s12890-023-02779-9] [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] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The prevalence of respiratory viruses in children changed under strict infection control measures during the coronavirus disease 2019 (COVID-19) outbreak. In this study, we investigated the frequency of viral detection in the nasopharynx of paediatric patients with asthma exacerbations requiring hospitalization during the COVID-19 pandemic, as well as the distribution of causative viruses. METHODS We included paediatric patients admitted for asthma exacerbations between November 2020 and December 2022 at a single centre in Kobe, Japan. Demographic, clinical, and laboratory data were collected from their medical records and using additional questionnaires. All patients enrolled in this study met the diagnostic criteria for asthma exacerbations outlined in the Japanese Pediatric Guideline for the Treatment and Management of Bronchial Asthma 2020. Statistical differences were calculated using univariate analyses (chi-square or Mann‒Whitney U test). RESULTS We enrolled 203 children hospitalized for asthma attacks and collected nasopharyngeal samples from 189 patients. The median patient age was 3.0 years. Asthma severity was classified as mild (4.0%), moderate (82.3%), or severe (13.8%). The proportion of viral respiratory infections was 95.2% (180/189). The rate of patients with multiple viral infections was 20.6% (39/189). The most frequently detected pathogens were rhinovirus and enterovirus (RV/EV) at 69.3% (131/189), allowing for duplicate detection, followed by respiratory syncytial virus (RSV) at 28.6% (54/189). We also detected RV/EV almost every month compared to RSV and other viruses. In addition, RV/EV-positive patients were significantly older (p = 0.033), exhibited higher WBC counts (p < 0.001) and higher Eos counts (p < 0.001), had elevated total IgE levels (p < 0.001) and house dust mite-specific IgE levels (p = 0.019), had a shorter duration of hospitalization (p < 0.001), and had a shorter duration of oxygen therapy (p < 0.001). In patients positive for RV/EV, the use of ICSs significantly reduced the severity of the condition (p < 0.001). CONCLUSION Even under strict infection control measures, respiratory viruses were detected in the nasopharynx of almost all paediatric patients who had asthma exacerbations requiring hospitalization.
Collapse
Affiliation(s)
- Tsuyoshi Sasada
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan.
| | - Ken Hayashi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| | - Satoru Tsuruta
- Department of Pediatrics, Kobe City Medical Center General Hospital, 1-1, Minatojima-Minamimachi 2-Chome, Chuo-Ku, Kobe, 650-0047, Japan
| |
Collapse
|
5
|
Iseri K, Miyakoshi C, Joki N, Onishi Y, Fukuma S, Honda H, Tsuruya K. α-Blocker Use in Hemodialysis: The Japan Dialysis Outcomes and Practice Patterns Study. Kidney Med 2023; 5:100698. [PMID: 37663953 PMCID: PMC10470217 DOI: 10.1016/j.xkme.2023.100698] [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] [Indexed: 09/05/2023] Open
Abstract
Rationale & Objective Despite α-blockers' use for hypertension as add-on therapy in patients treated with hemodialysis, scant information is available on their association, particularly with safety, in these patients. Study Design Prospective cohort study. Setting & Participants patients treated with hemodialysis and receiving antihypertensive agents in the Japan Dialysis Outcomes and Practice Patterns Study, phases 4-6, were analyzed. Exposure Primary exposure was the prescription of α-blocking antihypertensive agents at baseline. Outcomes Incident fractures, falls, and all-cause mortality. Analytical Approach Multivariable Cox and modified Poisson regression analysis. Results Of 5,149 patients treated with hemodialysis (mean age, 65 years; 68% men) receiving antihypertensive drugs, 717 (14%) received α-blocking agents. During a mean follow-up period of 2.0 years, 247 fractures, 525 falls, and 498 deaths occurred. Multivariable analysis showed no significant association of α-blocker use and increased risk of fractures (hazard ratio [HR], 0.92 [95% confidence interval {CI}, 0.61-1.38]), falls (HR, 0.94 [95% CI, 0.74-1.20]), or all-cause deaths (HR, 0.87 [95% CI, 0.64-1.20]) compared with α-blocker nonuse. α-Blocker use was, however, significantly associated with a decreased risk of all-cause mortality in the subgroup analysis, for example, patients who were older (HR, 0.71 [95% CI, 0.51-0.99]), were women (HR, 0.68 [95% CI, 0.48-0.95]), or reported a history of cardiovascular disease (HR, 0.67 [95% CI, 0.48-0.95]) or a predialysis blood pressure of ≥140 mm Hg (HR, 0.69 [95% CI, 0.49-0.98]). Limitations Selection bias cannot be ruled out given the prevalent user analysis. Conclusions No significant association between α-blocker use and the risk of worse safety-related outcomes was seen, indicating that clinicians may safely prescribe α-blockers to patients receiving hemodialysis who require blood pressure lowering. Plain-Language Summary α-Blockers have been generally reserved for use as add-on therapy for resistant or refractory hypertension. However, little is known about the safety of α-blockers in patients treated by hemodialysis. We analyzed 5,149 patients receiving hemodialysis in Japan who were receiving antihypertensive drugs from the Japan Dialysis Outcomes and Practice Patterns Study. The results showed no significant increase in the risk of fractures, falls, or deaths for patients using α-blockers compared with those who did not, suggesting that α-blockers may be safely prescribed for patients receiving hemodialysis who need to lower their blood pressure.
Collapse
Affiliation(s)
- Ken Iseri
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
6
|
Maekawa K, Ohara N, Takasugi J, Fujiwara S, Okada T, Miyakoshi C, Imamura H, Kawamoto M, Sakai N. Low left atrial volume is an independent predictor of persistent hypotension after carotid artery stenting. J Neurointerv Surg 2023; 15:914-918. [PMID: 35918131 DOI: 10.1136/jnis-2022-019094] [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] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/23/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Persistent hypotension (PH) after carotid artery stenting (CAS) is a relatively common complication; however, it is unclear which patients are more likely to experience this phenomenon. Recently, lower left atrial (LA) volume was associated with vasovagal syncope, which has a similar neurological mechanism to hypotension after CAS. This study aimed to investigate whether LA volume can predict PH after CAS. METHODS This single center retrospective analysis used data from 316 patients who had undergone CAS between March 2013 and February 2021. After the exclusion of urgent CAS, 212 procedures (202 patients) with transthoracic echocardiograms were included. The procedures were divided among two groups according to the presence or absence of PH for more than 1 hour after CAS. RESULTS The mean age of the patients was 73.0±7.5 years. PH was observed during 52 (24.5%) procedures. The PH group exhibited a lower LA volume index (LAVI) than the no-PH group (29.7±9.1 vs 37.7±12.5 mL/m2, respectively; p<0.001). The area under the receiver operating characteristic curve was 0.716. The optimal cut-off value was 33.5 mL/m2 (sensitivity 0.750, specificity 0.625). Multiple logistic regression analysis showed that LAVI <33.5 mL/m2 was an independent predictor for PH after CAS (OR 4.950, 95% CI 2.190 to 11.200; p<0.001). Preoperative hydration was negatively associated with PH (OR 0.235, 95% CI, 0.070 to 0.794; p=0.020). CONCLUSIONS A lower LA volume can predict PH after CAS, and preoperative hydration may prevent PH after CAS.
Collapse
Affiliation(s)
- Kota Maekawa
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Junji Takasugi
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Satoru Fujiwara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Taiji Okada
- Cardiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Chisato Miyakoshi
- Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hirotoshi Imamura
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Michi Kawamoto
- Neurology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| |
Collapse
|
7
|
Fukushima H, Imai H, Miyakoshi C, Naito A, Otani K, Matsuishi K. The sustained psychological impact of coronavirus disease 2019 pandemic on hospital workers 2 years after the outbreak: a repeated cross-sectional study in Kobe. BMC Psychiatry 2023; 23:313. [PMID: 37143062 PMCID: PMC10157547 DOI: 10.1186/s12888-023-04788-8] [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: 01/03/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Healthcare workers who are exposed to coronavirus disease 2019 are psychologically distressed. This study aimed to evaluate the mental health outcomes of hospital workers 2 years after the outbreak of coronavirus disease 2019 and to identify changes in the stress of hospital workers and predicted risk factors. METHODS This survey was conducted 2 years after the initial evaluation performed under the first emergency declaration of the coronavirus disease 2019 pandemic among hospital workers at the same hospital in an ordinance-designated city in Japan from June to July 2022. Sociodemographic data, 19 stress-related question responses, the Impact of Event Scale-Revised, and the Maslach burnout inventory-general survey were collected. Multiple regression models were used to identify factors associated with each of the mental health outcomes 2 years after the coronavirus disease 2019 outbreak. RESULTS We received 719 valid responses. Between 2020 and 2022, hospital workers' anxiety about infection decreased, whereas their exhaustion and workload increased. Multiple regression analysis revealed that 2 years after the coronavirus disease 2019 outbreak, nurses and young people were at a higher risk of experiencing stress and burnout due to emotional exhaustion, respectively. CONCLUSIONS This is the first study to examine the long-term stress of hospital workers measured in Japan. Exhaustion and workload were worsened 2 years into the pandemic. Therefore, health and medical institutions should continuously monitor the physical and psychological health of staff members.
Collapse
Affiliation(s)
- Haruko Fukushima
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Hissei Imai
- Health Promotion and Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Ohashi Clinic, Kyoto, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsumi Naito
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kyohei Otani
- Department of Psychiatry, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Kunitaka Matsuishi
- Department of Psychiatry, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
8
|
Iwata K, Miyakoshi C. Detection of outlier prefectures on the mortality due to COVID-19 in Japan. J Infect Chemother 2023; 29:427-429. [PMID: 36702206 PMCID: PMC9870611 DOI: 10.1016/j.jiac.2023.01.016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
Japan has suffered from COVID-19 with significant mortality, but its prefectural differences are not well investigated. Since the mortality due to COVID-19 was likely to be associated with the number of infected cases, the population density, and the proportion of the elderly population, we tried to detect the outlier prefectures by multiple linear regression analyses. With the use of the Hampel identifier, we found that Hokkaido and Hyogo were the outlier prefectures with higher mortality after adjusting the variables above. Further studies should delineate the causes of these differences.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Japan.
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
9
|
Wada S, Matsubara K, Miyakoshi C, Iwata A, Isome K, Hori M, Kawasaki Y, Naito A, Kim K, Iio K, Yamaguchi Y. Effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia. Int J Hematol 2023:10.1007/s12185-023-03582-2. [PMID: 36947369 DOI: 10.1007/s12185-023-03582-2] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
We aimed to determine the effect of delivery mode on postnatal platelet count dynamics in neonates born to mothers with immune thrombocytopenia (ITP). This single-center, retrospective study included 41 mothers with ITP and their 65 infants born by vaginal delivery (VD, n = 30) and cesarean section (CS, n = 35) between January 1997 and March 2022. The median difference in platelet counts from day 0 to day 2 (ΔPlt [D 0-2]) was significantly lower in the VD group (- 39 × 109/L, interquartile range [IQR]: - 47 to - 24 × 109/L) than the CS group (15 × 109/L, IQR: - 6.5 to 33 × 109/L) (p < 0.001). The median ΔPlt (D 0-5) was significantly lower in the VD group (- 55 × 109/L, IQR: - 85 to - 31 × 109/L) than the CS group (33 × 109/L, IQR: 1-69 × 109/L) (p < 0.001). Multivariate analysis also showed a significant association of delivery mode with ΔPlt (D 0-2) and ΔPlt (D 0-5) (both p < 0.001). VD neonates with platelet counts ≥ 100 × 109/L at birth were significantly more likely than CS neonates to develop thrombocytopenia < 100 × 109/L at nadir (1/26 vs. 6/25) (p = 0.0496). Our findings indicate that mode of delivery is a useful predictor of postnatal platelet count dynamics in neonates born to mothers with ITP.
Collapse
Affiliation(s)
- Shoichiro Wada
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kousaku Matsubara
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan.
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Aya Iwata
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kenichi Isome
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Masayuki Hori
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Yu Kawasaki
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Akiyoshi Naito
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kaya Kim
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Kyohei Iio
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| | - Yoshimichi Yamaguchi
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan
| |
Collapse
|
10
|
Nishikubo M, Shimomura Y, Maruoka H, Nasu S, Nishioka T, Sakizono K, Mitsuyuki S, Kubo T, Okada N, Nakagawa D, Kamijo K, Imoto H, Yamamoto R, Nagai Y, Hiramoto N, Yoshioka S, Yonetani N, Matsushita A, Miyakoshi C, Doi A, Ishikawa T. Humoral response and safety of the BNT162b2 and mRNA-1273 COVID-19 vaccines in allogeneic hematopoietic stem cell transplant recipients: An observational study. J Infect Chemother 2023; 29:274-280. [PMID: 36442827 PMCID: PMC9699714 DOI: 10.1016/j.jiac.2022.11.010] [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: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effectiveness of mRNA COVID-19 vaccines and the optimal timing of vaccine administration in allogeneic hematopoietic stem cell transplantation (Allo-HSCT) recipients remains inadequately investigated. We examine the effectiveness and safety of mRNA COVID-19 vaccines in allo-HSCT recipients. METHOD This prospective observational study included 44 allo-HSCT recipients and 38 healthy volunteers. The proportion of subjects acquiring anti-S1 IgG antibodies were considered as the primary endpoint. The occurrence of adverse events after vaccination and objective deterioration of chronic graft-versus-host disease (GVHD) were defined as secondary endpoints. In addition, we compared the geometric mean titers (GMT) of anti-S1 antibody titers in subgroups based on time interval between transplantation and vaccination. RESULTS A humoral response to the vaccine was evident in 40 (91%) patients and all 38 healthy controls. The GMT of anti-S1 titers in patients and healthy controls were 277 (95% confidence interval [CI]: 120-643) BAU/mL and 532 (95% CI 400-708) BAU/mL, respectively. (p = 0.603). A short time interval between transplantation and vaccination (≤6 months) was associated with low anti-S1 IgG antibody titers. No serious adverse events and deterioration of chronic GVHD were observed. Only one case of new development of mild chronic GVHD was recorded. CONCLUSION Messenger RNA COVID-19 vaccines induce humoral responses in allo-HSCT recipients and can be administered safely.
Collapse
Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan,Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan,Corresponding author. Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomomi Nishioka
- LSI Medience Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kenji Sakizono
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Mitsuyuki
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomoyo Kubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Daishi Nakagawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kimimori Kamijo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hiroharu Imoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yuya Nagai
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Akiko Matsushita
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| |
Collapse
|
11
|
Shirakawa C, Tachikawa R, Yamamoto R, Miyakoshi C, Iwata K, Endo K, Shimada Y, Shima Y, Matsunashi A, Osaki M, Hirabayashi R, Sato Y, Nagata K, Nakagawa A, Tomii K. Longitudinal changes in mental health outcomes after COVID-19 hospitalization: A prospective study. Respir Investig 2023; 61:321-331. [PMID: 36889020 PMCID: PMC9886665 DOI: 10.1016/j.resinv.2022.12.010] [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: 08/30/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 04/14/2023]
Abstract
BACKGROUND The long-term trends of COVID-19 mental sequelae remain unknown. Thus, this study aimed to survey the one-year temporal trends of PTSD and health-related quality of life of COVID-19 survivors. METHODS Patients hospitalized with COVID-19 were followed up at three, six, and 12 months after discharge. Patients with COVID-19 who were able to communicate and complete the questionnaires were included in the study. All participants were asked to complete the Medical Outcomes Study 36-Item Short-Form Health (SF-36) survey and the Impact of Event Scale-Revised (IES-R). The cutoff point of 24/25 of IES-R was defined as preliminary PTSD. Patients exhibiting PTSD symptoms at six months or later were regarded as "delayed patients," while those exhibiting PTSD symptoms at all the time points were "persistent patients." RESULTS Of the 98 patients screened between June and November 2020, 72 participated in the study. A total of 11 (15.3%) had preliminary PTSD at three months, 10 (13.9%) at six months, and 10 (13.9%) at 12 months; delayed and persistent patients were four patients (7.54%) each. Patients with preliminary PTSD had lower mental summary scores in SF-36; 47 (IQR 45, 53) for patients with preliminary PTSD and 60 (49, 64) without preliminary PTSD at three months, 50 (45, 51) and 58 (52, 64) at six months, and 46 (38, 52) and 59 (52, 64) at 12 months. CONCLUSION Healthcare providers should care about the courses of PTSD in COVID-19 survivors and be aware that patients with PTSD symptoms may have a lower health-related quality of life.
Collapse
Affiliation(s)
- Chigusa Shirakawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan.
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Kei Endo
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Yuri Shimada
- Department of Respiratory Medicine, Kansai Electric Power Hospital, 2-1-7, Fukushima, Fukushima-ku, Osaka, 553-0003, Japan
| | - Yusuke Shima
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Atsushi Matsunashi
- Department of Respiratory Medicine Graduate School of Medicine Kyoto University Kawahara 54, Shogoin, Sakyo-ku, Kyoto-city, Kyoto, 606-8501, Japan
| | - Megumu Osaki
- Department of Respiratory Medicine, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka-city, Osaka, 560-8565, Japan
| | - Ryosuke Hirabayashi
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| |
Collapse
|
12
|
Nishikubo M, Shimomura Y, Yamamoto R, Yoshioka S, Maruoka H, Nasu S, Nishioka T, Sakizono K, Mitsuyuki S, Kubo T, Okada N, Nakagawa D, Kamijo K, Imoto H, Nagai Y, Hiramoto N, Yonetani N, Kondo T, Miyakoshi C, Doi A, Ishikawa T. Humoral and cellular responses after COVID-19 booster vaccination in patients recently treated with anti-CD20 antibodies. Blood Cancer J 2023; 13:17. [PMID: 36690628 PMCID: PMC9868506 DOI: 10.1038/s41408-023-00792-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan.
- Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan.
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomomi Nishioka
- LSI Medience Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kenji Sakizono
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Mitsuyuki
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomoyo Kubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Daishi Nakagawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kimimori Kamijo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hiroharu Imoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yuya Nagai
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tadakazu Kondo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Asako Doi
- Department of Infectious diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| |
Collapse
|
13
|
Kitai T, Nabeta T, Naruse Y, Taniguchi T, Yoshioka K, Miyakoshi C, Kurashima S, Miyoshi Y, Tanaka H, Okumura T, Baba Y, Furukawa Y, Matsue Y, Izumi C. Comparisons between biopsy-proven versus clinically diagnosed cardiac sarcoidosis. Heart 2022; 108:1887-1894. [PMID: 35790370 DOI: 10.1136/heartjnl-2022-320932] [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: 02/08/2022] [Accepted: 06/10/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Diagnosis of cardiac sarcoidosis (CS) without histological evidence remains controversial. This study aimed to compare characteristics and outcomes of histologically proven versus clinically diagnosed cases of CS, which were adjudicated using Heart Rhythm Society or Japanese Circulation Society criteria. METHODS A total of 512 patients with CS (age: 62±11 years, female: 64.3%) enrolled in the multicentre registry were studied. Histologically confirmed patients were classified as 'biopsy-proven CS', while those with the presence of strongly suggestive clinical findings of CS without histological evidence were classified as 'clinical CS'. Primary outcome was a composite of all-cause death, heart failure hospitalisation and ventricular arrhythmia event. RESULTS In total, 314 patients (61.3%) were classified as biopsy-proven CS, while 198 (38.7%) were classified as clinical CS. Patients classified under clinical CS were associated with higher prevalence of left ventricular dysfunction, septal thinning, and positive findings in fluorodeoxyglucose-positron emission tomography or Gallium scintigraphy than those under biopsy-proven CS. During median follow-up of 43.7 (23.3-77.3) months, risk of primary outcome was comparable between the groups (adjusted HR: 1.24, 95% CI: 0.88 to 1.75, p=0.22). Similarly, the risks of primary outcome were comparable between patients with clinical isolated CS who did not have other organ/tissue involvement, and biopsy-proven isolated CS (adjusted HR: 1.23, 95% CI: 0.56 to 2.70, p=0.61). CONCLUSIONS A substantial number of patients were diagnosed with clinical CS without confirmatory biopsy. Considering the worse clinical outcomes irrespective of the histological evidence, the diagnosis of clinical CS is justifiable if imaging findings suggestive of CS are observed.
Collapse
Affiliation(s)
- Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan .,Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yutaro Miyoshi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.,Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
14
|
Nezu M, Shiima Y, Kurosawa H, Miyakoshi C. Outcomes of Pediatric Patients in Secondary Transport to Tertiary Hospital: A Retrospective Observational Study. Pediatr Emerg Care 2022; 38:283-289. [PMID: 35436767 DOI: 10.1097/pec.0000000000002711] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Emergency medical service (EMS) providers play an important role in determining which hospital to choose. To date, there is no evidence-based guideline to support their decisions, except for major trauma cases. Secondary transport is considered when a patient needs further investigation or treatment after primary transport, but this can delay treatment and put patients at unnecessary risk. The objective of this study was to investigate the outcomes of pediatric secondary transport patients to tertiary hospitals. METHODS This was a citywide population-based observational study conducted in Kobe, Japan. We reviewed the EMS registry to identify secondary transport patients younger than 19 years and investigated their clinical characteristics. We excluded cases of unknown hospital destinations, nontransported cases, and major trauma patients who followed a different protocol for a hospital destination. The primary endpoint was the hospital outcome 12 hours after transport. Because there was no link between the EMS patient transport data and the hospital medical records, a probabilistic linkage was performed to obtain the hospital outcomes. Patients who required secondary transport were compared with patients transported directly to tertiary hospitals. RESULTS A total of 13,720 pediatric patients were transported from the field by Kobe EMS between January 2013 and December 2015. Among them, 81 pediatric patients (0.6%) required secondary transport to tertiary hospitals within 24 hours of the primary transport, whereas a total of 3673 patients (27%) were transported directly to tertiary hospitals. Despite no apparent difference in prehospital severity, secondary transport patients were associated with higher hospitalization rates and a need for critical care compared with those who had direct transport. Seizure was the most common reason for the use of secondary transport, and 89% of the seizure patients were hospitalized after undergoing secondary transport; minor trauma was the second most common reason for the use of secondary transport, and 53% of the patients were hospitalized. CONCLUSIONS In this study, the characteristics of the secondary transport patients and hospital outcomes revealed a heterogeneity in pediatric prehospital transport. It is recommended that the development of pediatric EMS destination guidelines cover children's diverse conditions. Further studies are required, and linkages between prehospital and hospital data will help promote a better understanding of appropriate hospital destinations.
Collapse
Affiliation(s)
- Mari Nezu
- From the Department of Pediatrics, Kobe City Medical Center General Hospital
| | - Yuko Shiima
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Hyogo, Japan
| |
Collapse
|
15
|
Fukushima H, Imai H, Miyakoshi C, Miyai H, Otani K, Aoyama S, Matsuishi K. Psychological impact of the COVID‐19 pandemic on hospital workers in Kobe: A cross‐sectional survey. PCN Reports 2022. [PMID: 37522091 PMCID: PMC9088612 DOI: 10.1002/pcn5.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim Many health‐care workers exposed to coronavirus disease 2019 (COVID‐19) are psychologically distressed. This study aimed to investigate the psychological impact of the COVID‐19 pandemic on hospital workers under the emergency declaration in Japan. Methods This cross‐sectional, survey‐based study collected sociodemographic data and responses to 19 stress‐related questions and the Impact of Event Scale‐Revised (IES‐R), which measures post‐traumatic stress disorder (PTSD) symptoms, from all 3217 staff members at Kobe City Medical Center General Hospital from April 16, 2020 to June 8, 2020. Exploratory factor analysis was applied to the 19 stress‐related questions. Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES‐R. Results We received 951 valid responses; 640 of these were by females, and 311 were by respondents aged in their 20s. Nurses accounted for the largest percentage of the job category. Women, those aged in their 30s–50s, nurses, and frontline workers had a high risk of experiencing stress. The prevalence of stress (IES‐R ≥ 25) was 16.7%. The psychological impact was significantly greater for those aged in their 30s–50s and those who were not medical doctors. Conclusions This is the first study to examine the stress of hospital workers, as measured by the IES‐R, under the emergency declaration in Japan. It showed that women, those aged in their 30s–50s, nurses, and frontline workers have a high risk of experiencing stress. Health and medical institutions should pay particular attention to the physical and psychological health of these staff members.
Collapse
Affiliation(s)
- Haruko Fukushima
- Department of Psychiatry Kobe City Medical Center General Hospital Kobe Japan
| | - Hissei Imai
- Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health Kyoto University, Kyoto, and Ohashi Clinic Kyoto Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation Kobe City Medical Center General Hospital Kobe Japan
| | - Hiroyuki Miyai
- Department of Psychiatry Kobe City Medical Center General Hospital Kobe Japan
| | - Kyohei Otani
- Department of Psychiatry Kobe City Medical Center General Hospital Kobe Japan
| | - Shinsuke Aoyama
- Department of Psychiatry Kobe University Graduate School of Medicine Kobe Japan
| | - Kunitaka Matsuishi
- Department of Psychiatry Kobe City Medical Center General Hospital Kobe Japan
| |
Collapse
|
16
|
Shimizu H, Oka H, Sumitomo S, Kanamori M, Miyakoshi C, Yoshimoto A, Nishioka H, Ohmura K. AB0439 COMPARATIVE EFFECTIVENESS OF RAPID AND CONVENTIONAL GLUCOCORTICOID TAPERING REGIMENS IN TREATING PATIENTS WITH PROLIFERATIVE LUPUS NEPHRITIS IN THE REAL WORLD SETTING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3626] [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
BackgroundRapid glucocorticoid (GC) tapering is recommended for lupus nephritis (LN) by 2019 EULAR/ERA-EDTA recommendations [1]. However, slower conventional GC tapering regimen is still common in the real world setting, and it is controversial whether a rapid GC tapering regimen is as effective as the conventional regimen.ObjectivesWe aimed to compare the renal outcomes between rapid and slower GC tapering regimens in patients with LN.MethodsWe retrospectively surveyed the medical records of 27 patients with proliferative LN (class Ⅲ or Ⅳ) at Kobe City Medical Center General Hospital. These patients were divided into two groups (rapid GC tapering group and conventional GC tapering group) according to GC dosage at month 6. Logistic regression analyses were performed to examine the association of GC tapering regimens with achievement of primary efficacy renal response (PERR) and complete renal response (CRR) which were defined by Furie et al. [2] at month 24.ResultsTwenty-seven patients (19 women and 8 men) with class Ⅲ or Ⅳ LN were included. The mean age was 43 years. The mean eGFR and urine protein-to-creatinine ratio at baseline were 66.7 mL/min/1.73m2 and 3.125 g/gCr, respectively. Concomitant class Ⅴ LN was present in 26.0%. The rapid GC tapering group (PSL≦10 mg/day at month 6) and the conventional GC tapering group (PSL>10 mg/day at month 6) were 11 and 16 patients, respectively. Baseline characteristics were balanced between the two groups except for use of cyclophosphamide or mycophenolate mofetil. Mean urine protein-to-creatinine ratio at month 24 were 0.46 g/gCr in the rapid GC tapering regimen group and 1.08 g/gCr in the conventional GC tapering regimen group (p=0.790). Achievements of PERR and CRR at month 24 were 54.0% and 43.8% in the rapid GC tapering group and 54.5% and 25.0% in the conventional GC tapering group, respectively. After adjustment of cyclophosphamide or mycophenolate mofetil usage and urine protein-to-creatinine ratio at baseline, adjusted odds ratio was 1.52 (95% confidence interval [0.126 to 18.29], p=0.743) and 2.99 (95% confidence interval [0.34 to 28.52], p=0.341), respectively.ConclusionOur results suggest rapid GC tapering regimen is as effective as conventional slower tapering regimen for patients with proliferative LN.References[1]Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis 2020;79:713–723.[2]Furie R, Rovin BH, Houssiau F, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med 2020;383:1117–1128.Table 1.Baseline patients characteristics.Rapid GC tapering group(n=11)Conventional GC tapering group(n=16)P valueAge – years41.7 ± 14.743.9 ± 16.20.863Female – no. (%)9 (81.8)10 (62.5)0.405Class Ⅲ LN – no. (%)6 (54.5)7 (43.8)0.704Class Ⅳ LN – no. (%)6 (45.5)9 (56.3)0.704Concomitant Class Ⅴ LN – no. (%)4 (36.4)3 (18.8)0.391Induction therapy (use of CY or MMF) – no. (%)10 (90.9)8 (50.0)0.042Serum creatinine – mg/dL1.15 ± 0.721.14 ± 0.800.882eGFR – mL/min/1.73m265.2 ± 39.067.8 ± 34.50.835UPCR – g/gCr3.29 ± 2.963.01 ± 3.250.604C3 – mg/dL41.1 ± 20.145.0 ± 21.50.639C4 – mg/dL6.8 ± 4.710.1 ± 8.00.346GC, glucocorticoid; LN, lupus nephritis; UPCR, urine protein-to-creatinine ratio; CY, cyclophosphamide; MMF, mycophenolate mofetilDisclosure of InterestsNone declared
Collapse
|
17
|
Iwata K, Miyakoshi C. Is COVID-19 mortality associated with test number? J Family Med Prim Care 2022; 11:1842-1844. [PMID: 35800487 PMCID: PMC9254805 DOI: 10.4103/jfmpc.jfmpc_1633_21!] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction With the ongoing pandemic of coronavirus disease 2019 (COVID-19), there is an argument on whether we should increase the number of testing for the coronavirus (SARS-CoV-2) to mitigate the epidemic in a given country. Therefore, we investigated the correlation between testing number and mortality to evaluate the hypothesis. Methods Data on an open-access database of COVID-19 was retrieved. Member countries of the Organization for Economic Co-operation and Development (OECD), BRICs nations (Brazil, Russia, India, and China), and Taiwan were included in the analysis, but 2 countries were removed as outliers. Results There was a weak, positive correlation between mortality and testing (r = 0.34, P = 0.03). On regression analysis, there was a positive slope but the coefficient was very small (0.00064). Conclusions We found a very small positive correlation between testing number and mortality for COVID-19.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan,Address for correspondence: Dr. Kentaro Iwata, Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo 650-0017, Japan. E-mail:
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
18
|
Nishikubo M, Shimomura Y, Maruoka H, Nasu S, Nishioka T, Sakizono K, Mitsuyuki S, Kubo T, Okada N, Nakagawa D, Kamijo K, Imoto H, Yamamoto R, Nagai Y, Hiramoto N, Yoshioka S, Yonetani N, Matsushita A, Miyakoshi C, Doi A, Ishikawa T. Humoral response and safety of the BNT162b2 and mRNA-1273 COVID-19 vaccines in patients with haematological diseases treated with anti-CD20 antibodies: An observational study. Br J Haematol 2022; 197:709-713. [PMID: 35262920 PMCID: PMC9111764 DOI: 10.1111/bjh.18151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/30/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Masashi Nishikubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan.,Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomomi Nishioka
- LSI Medience Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kenji Sakizono
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Mitsuyuki
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Tomoyo Kubo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Daishi Nakagawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Kimimori Kamijo
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Hiroharu Imoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Yuya Nagai
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Noboru Yonetani
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Akiko Matsushita
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Asako Doi
- Department of Infectious diseases, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, 650-0047, Japan
| |
Collapse
|
19
|
Iwata K, Miyakoshi C. Is COVID-19 mortality associated with test number? J Family Med Prim Care 2022. [DOI: 10.4103/jfmpc.jfmpc_1633_21] [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: 11/04/2022] Open
|
20
|
Yamamoto-Kataoka S, Kataoka Y, Tochitani K, Miyakoshi C, Yamamoto Y. Influence of anti-coronavirus disease 2019 policies on 10 pediatric infectious diseases. Pediatr Int 2022; 64:e14958. [PMID: 34388287 PMCID: PMC8447317 DOI: 10.1111/ped.14958] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND To combat the coronavirus disease 2019 pandemic, many countries, including Japan, implemented policies limiting social activities and encouraging preventive behaviors. This study examines the influence of such policies on the trends of 10 infectious pediatric diseases: pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; herpangina; respiratory syncytial virus; exanthem subitum; and mumps. METHODS The research adopted a retrospective cohort study design. We collected data from Japan's National Epidemiological Surveillance Program detailing the incidences of the 10 diseases per pediatric sentinel site for a period beginning at 9 weeks before government-ordered school closures and ending at 9 weeks after the end of the state of emergency. We obtained corresponding data for the equivalent weeks in 2015-2019. We estimated the influence of the policies using a difference-in-differences regression model. RESULTS For seven diseases (pharyngoconjunctival fever; group A streptococcal pharyngitis; infectious gastroenteritis; chickenpox; erythema infectiosum; hand, foot, and mouth disease; and herpangina), the incidence in 2020 decreased significantly during and after the school closures. Sensitivity analysis, in which the focus area was limited to the policy-implementation period or existing trend patterns, replicated these significant decreases for one of the above mentioned seven diseases - infectious gastroenteritis. CONCLUSIONS Policies such as school closures and encouragement of preventive behaviors were associated with significant decreases in the incidences of most of the 10 diseases, which sensitivity analysis replicated in infectious gastroenteritis. To determine the long-term effects of these policies, prospective cohort studies are needed.
Collapse
Affiliation(s)
- Sachiko Yamamoto-Kataoka
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Kentaro Tochitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
21
|
Shiroshita A, Miyakoshi C, Tsutsumi S, Shiba H, Shirakawa C, Sato K, Matsushita S, Kimura Y, Tomii K, Ohgiya M, Kataoka Y. Effectiveness of empirical anti-pseudomonal antibiotics for recurrent COPD exacerbation: a multicenter retrospective cohort study. Sci Rep 2021; 11:20066. [PMID: 34625632 PMCID: PMC8501095 DOI: 10.1038/s41598-021-99640-y] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. This multicenter retrospective cohort study evaluated whether the empirical use of anti-pseudomonal antibiotics improves the length of the hospital stay in patients with recurrent COPD exacerbation (≥ 2 admissions from April 1, 2008 to July 31, 2020). For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and the number of recurrences. Hospital-specific effects were specified as fixed effects. In total, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.039 days [95% confidence interval; - 0.083, 0.162]. Anti-pseudomonal antibiotics could not shorten the length of the hospital stay.
Collapse
Affiliation(s)
- Akihiro Shiroshita
- Department of Respiratory Medicine, Ichinomiyanishi Hospital, 1 Kaimeihira, Ichinomiya, Aichi, 494-0001, Japan.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-004, Japan
| | - Shunta Tsutsumi
- General Medicine, Awa Regional Medical Center, Tateyama, Japan
| | - Hiroshi Shiba
- Post Graduate Education Center, Kameda Medical Center, Kamogawa, Japan
| | - Chigusa Shirakawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-004, Japan
| | - Kenya Sato
- Department of Thoracic Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi Ward, Yokohama, Kanagawa, 230-0012, Japan
| | - Shinya Matsushita
- Department of Thoracic Medicine, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi Ward, Yokohama, Kanagawa, 230-0012, Japan
| | - Yuya Kimura
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-004, Japan
| | - Masahiro Ohgiya
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Yuki Kataoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Sakyo-ku, Kyoto, 606-8226, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| |
Collapse
|
22
|
Fujiwara T, Miyakoshi C, Kanemitsu T, Okumura Y, Tokumasu H. Identification and Validation of Hemophilia-Related Outcomes on Japanese Electronic Medical Record Database (Hemophilia-REAL V Study). J Blood Med 2021; 12:571-580. [PMID: 34267569 PMCID: PMC8275174 DOI: 10.2147/jbm.s313371] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Routinely collected data are useful for epidemiological study in hemophilia, but few studies validated the algorithm accuracy. We aimed to develop and validate algorithms to identify patients with hemophilia A and hemophilia A-related events. Patients and Methods This validation study compared data from medical chart reviews to a database of routinely collected health data, including claims data and discharge abstracts, and especially electronic medical records (EMR), at a single Japanese hospital (Kurashiki Central Hospital) using a stratified sampling method. Two physicians reviewed the charts for all patients at high risk for hemophilia A, and randomly sampled patients with moderate risk. Diagnostic accuracy was determined based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Results There were 1,033,845 eligible patients, of whom 31 had a diagnosis of hemophilia A. ICD-10 diagnosis code D66 in the EMR identified hemophilia A with a sensitivity of 93.5% (95% confidence interval: 78.6-99) and PPV of 61.7% (95% confidence interval: 46.4-75.5). The administration of ≥10,000 units/month of factor VIII products, as documented in the EMR, identified 81.3% of patients with prophylactic factor replacement therapy. The ICD-10 diagnosis code for intracranial bleeding in the EMR identified 75.0% of patients with intracranial bleeding, but those of gastrointestinal bleeding and major joint bleeding identified only 11.1% and 1.7%, respectively. Conclusion We developed and validated algorithms to identify congenital hemophilia A and hemophilia A-related events. Hemophilia A could be identified with high sensitivity and PPV, but it was still challenging to identify hemophilia A-related events.
Collapse
Affiliation(s)
- Takashi Fujiwara
- Department of Management, Clinical Research Center, Kurashiki Central Hospital, Okayama, Japan.,Department of Public Health Research, Kurashiki Clinical Research Institute, Okayama, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takashi Kanemitsu
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Yasuyuki Okumura
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hironobu Tokumasu
- Department of Public Health Research, Kurashiki Clinical Research Institute, Okayama, Japan.,Real World Data Co., Kyoto, Japan
| |
Collapse
|
23
|
Banno M, Tsujimoto Y, Luo Y, Miyakoshi C, Kataoka Y. CAST-HSROC: A Web Application for Calculating the Summary Points of Diagnostic Test Accuracy From the Hierarchical Summary Receiver Operating Characteristic Model. Cureus 2021; 13:e13257. [PMID: 33717762 PMCID: PMC7953362 DOI: 10.7759/cureus.13257] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Researchers have been advised to report the point estimate of either sensitivity or specificity and its 95% credible interval (CrI) for a fixed specificity or sensitivity value in the summary of findings (SoF) table for diagnostic test accuracy (DTA) when they use the hierarchical summary receiver operating characteristic (HSROC) model. However, there is no other tool that easily calculates the statistics. Results: We developed the calculator for the summary points from the HSROC model (CAST-HSROC), a web application for calculating the statistics easily. The existing graphical user interface software such as Review Manager and MetaDTA cannot calculate the statistics. Users should check whether convergence is reached before interpreting the results. Conclusions: CAST-HSROC can easily calculate the point estimate of either sensitivity or specificity and its 95% CrI for a fixed specificity or sensitivity value on the HSROC model. The application can help to create an SoF table for DTA when systematic reviewers or guideline developers estimate the certainty of evidence on the HSROC model.
Collapse
Affiliation(s)
- Masahiro Banno
- Department of Psychiatry, Seichiryo Hospital, Nagoya, JPN.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, JPN.,Department of Systematic Reviewers, Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JPN.,Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, JPN.,Department of Systematic Reviewers, Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, JPN
| | - Yan Luo
- Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN.,Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN.,Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JPN.,Department of Systematic Reviewers, Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, JPN
| |
Collapse
|
24
|
Iio K, Matsubara K, Miyakoshi C, Ota K, Yamaoka R, Eguchi J, Matsumura O, Okutani T, Ueda I, Nishiyama M. Incidence of Kawasaki disease before and during the COVID-19 pandemic: a retrospective cohort study in Japan. BMJ Paediatr Open 2021; 5:e001034. [PMID: 33884312 PMCID: PMC8023747 DOI: 10.1136/bmjpo-2021-001034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Epidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology. During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms. The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections. METHODS A retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan. We collected information of hospitalised KD children in Kobe. Child population was identified through the resident registry system. Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system. Monthly change of KD incidence was analysed using a difference-in-difference regression model. RESULTS Throughout the study period, 1027 KD children were identified. KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic. The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016-2019 (165/year). Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0-4 years in 2016-2020, respectively. The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (-15.8, 95% CI -28.0 to -3.5), compared with that in 2016-2019. Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic. There were 86 COVID-19 cases aged <10 years and no KD children associated with COVID-19. CONCLUSION This study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan. This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD.
Collapse
Affiliation(s)
- Kyohei Iio
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | - Kousaku Matsubara
- Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kunitaka Ota
- Department of Pediatrics, Konan Medical Center, Kobe, Hyogo, Japan
| | - Rika Yamaoka
- Department of Pediatrics, National Hospital Organization Kobe Medical Center, Kobe, Hyogo, Japan
| | - Junji Eguchi
- Department of Pediatrics, Kobe City Medical Center West Hospital, Kobe, Hyogo, Japan
| | - Osamu Matsumura
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Takahiro Okutani
- Department of Pediatrics, Saiseikai Hyogo-ken Hospital, Kobe, Hyogo, Japan
| | - Ikuyo Ueda
- Department of Pediatrics, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Hyogo, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
25
|
Wakamatsu T, Iwasaki Y, Yamamoto S, Matsuo K, Goto S, Narita I, Kazama JJ, Tanaka K, Ito A, Ozasa R, Nakano T, Miyakoshi C, Onishi Y, Fukuma S, Fukuhara S, Yamato H, Fukagawa M, Akizawa T. Type I Angiotensin II Receptor Blockade Reduces Uremia-Induced Deterioration of Bone Material Properties. J Bone Miner Res 2021; 36:67-79. [PMID: 32786093 PMCID: PMC9328427 DOI: 10.1002/jbmr.4159] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) is associated with a high incidence of fractures. However, the pathophysiology of this disease is not fully understood, and limited therapeutic interventions are available. This study aimed to determine the impact of type 1 angiotensin II receptor blockade (AT-1RB) on preventing CKD-related fragility fractures and elucidate its pharmacological mechanisms. AT-1RB use was associated with a lower risk of hospitalization due to fractures in 3276 patients undergoing maintenance hemodialysis. In nephrectomized rats, administration of olmesartan suppressed osteocyte apoptosis, skeletal pentosidine accumulation, and apatite disorientation, and partially inhibited the progression of the bone elastic mechanical properties, while the bone mass was unchanged. Olmesartan suppressed angiotensin II-dependent oxidation stress and apoptosis in primary cultured osteocytes in vitro. In conclusion, angiotensin II-dependent intraskeletal oxidation stress deteriorated the bone elastic mechanical properties by promoting osteocyte apoptosis and pentosidine accumulation. Thus, AT-1RB contributes to the underlying pathogenesis of abnormal bone quality in the setting of CKD, possibly by oxidative stress. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Takuya Wakamatsu
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshiko Iwasaki
- Department of Health Sciences, Oita University of Nursing and Health Sciences, Oita, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Matsuo
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Junichiro J Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Kennichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Akemi Ito
- Ito Bone Histomorphometry Institute, Niigata, Japan
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Suita, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Suita, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Yoshihiro Onishi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Hideyuki Yamato
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
26
|
Iwata K, Morishita N, Nishiwaki M, Miyakoshi C. Use of Rifampin Compared with Isoniazid for the Treatment of Latent Tuberculosis Infection in Japan: A Bayesian Inference with Markov Chain Monte Carlo Method. Intern Med 2020; 59:2687-2691. [PMID: 32669488 PMCID: PMC7691023 DOI: 10.2169/internalmedicine.3477-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Treating latent tuberculosis infection (LTBI) is essential for eliminating the serious endemicity of tuberculosis. A shorter regimen is preferred to longer regimens because the former has better adherence with a better safety profile. However, lengthy treatment with isoniazid is still recommended in Japan. Based on the latest evidence, we switched from a conventional nine-month isoniazid regimen to a shorter four-month rifampin regimen for the treatment of LTBI. Methods To evaluate the safety and efficacy of the shorter regimen, we conducted Bayesian analyses using a stochastic mathematical model to calculate the posterior probabilities of several parameters. Patients Clinical data of 13 patients in the isoniazid group and 5 in the rifampin group were used for the Bayesian analyses. The outcomes measured were completion of the treatment, adverse effects, number of clinic visits, and medical costs. Results The medial posterior probability of the isoniazid group completing the treatment was 66% [95% credible interval (CrI) 43-89%], whereas that of the rifampin group was 86% (95% CrI 60-100%). The probability that the completion rate in the rifampin group was better than that in the isoniazid group was as high as 88% (95% CrI 0-100%). Other parameters, such as the number of clinical visits and duration of treatment, were better with rifampin therapy than with isoniazid therapy, with comparable medical costs. Conclusion Four months of rifampin therapy might be preferred to isoniazid for treating LTBI in Japan.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, Japan
| | - Naomi Morishita
- Department of Nursing, Hyogo Prefectural Kakogawa Medical Center, Japan
| | - Masami Nishiwaki
- Department of Cardiovascular Surgery, Hyogo Prefectural Kakogawa Medical Center, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
27
|
Kato C, Fujii N, Miyakoshi C, Asada S, Onishi Y, Fukuma S, Nomura T, Wada M, Fukagawa M, Fukuhara S, Akizawa T. Changes in 3-month mineral and bone disorder patterns were associated with all-cause mortality in prevalent hemodialysis patients with secondary hyperparathyroidism. BMC Nephrol 2020; 21:432. [PMID: 33045994 PMCID: PMC7552558 DOI: 10.1186/s12882-020-02088-x] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence on the association between short-term changes in mineral and bone disorder parameters and survival in maintenance hemodialysis patients. METHODS We investigated the association between changing patterns of phosphorus, calcium and intact parathyroid hormone levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism. Each parameter was divided into three categories (low [L], middle [M] and high [H]), and the changing patterns between two consecutive visits at 3-month intervals were categorized into nine groups (e.g., L-L and M-H). The middle category was defined as 4.0-7.0 mg/dL for phosphorous, 8.5-9.5 mg/dL for calcium and 200-500 pg/mL for intact parathyroid hormone. Adjusted incidence rates and rate ratios were analyzed by weighted Poisson regression models accounting for time-dependent exposures. RESULTS For phosphorus, shifts from low/high to middle category (L-M/H-M) were associated with a lower mortality compared with the L-L and H-H groups, whereas shifts from middle to low/high category (M-L/M-H) were associated with a higher mortality compared with the M-M group. For calcium, shifts from low/middle to high category (L-H/M-H) were associated with a higher mortality compared with the L-L and M-M groups, whereas shifts from high to middle category (H-M) were associated with a lower mortality compared with the H-H group. For intact parathyroid hormone, shifts from low to middle category (L-M) were associated with a lower mortality compared with the L-L group. CONCLUSIONS Changes in the 3-month patterns of phosphorus and calcium toward the middle category were associated with lower mortality. Our study also suggests the importance of avoiding hypercalcemia.
Collapse
Affiliation(s)
- Chihiro Kato
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Naohiko Fujii
- Department of Internal Medicine (Nephrology Unit), Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan.
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Michihito Wada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
28
|
Iwata K, Doi A, Miyakoshi C. Was school closure effective in mitigating coronavirus disease 2019 (COVID-19)? Time series analysis using Bayesian inference. Int J Infect Dis 2020; 99:57-61. [PMID: 32745628 PMCID: PMC7836901 DOI: 10.1016/j.ijid.2020.07.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 06/26/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
The effectiveness of school closure to mitigate the epidemic of COVID-19 remains unknown. Time series analyses were conducted using the Bayesian method to evaluate the effectiveness of school closure in Japan. The intervention of school closure did not appear to decrease the incidence of coronavirus infection.
Objectives The Coronavirus disease 2019 (COVID-19) pandemic is causing significant damage to many nations. For mitigating its risk, Japan called on all elementary, junior high, and high schools nationwide to close beginning March 1, 2020. However, its effectiveness in decreasing the disease burden has not been investigated. Methods We used daily data of the COVID-19 and coronavirus infection incidence in Japan until March 31, 2020. Time-series analyses were conducted using the Bayesian method. Local linear trend models with interventional effects were constructed for the number of newly reported cases of COVID-19, including asymptomatic infections. We considered that the effects of the intervention started to appear nine days after the school closure. Results The intervention of school closure did not appear to decrease the incidence of coronavirus infection. If the effectiveness of school closure began on March 9, the mean coefficient α for the effectiveness of the measure was calculated to be 0.08 (95% confidence interval −0.36 to 0.65), and the actual reported cases were more than predicted, yet with a rather wide confidence interval. Sensitivity analyses using different dates also did not demonstrate the effectiveness of the school closure. Discussion School closure carried out in Japan did not show any mitigating effect on the transmission of novel coronavirus infection.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo 650-0017, Japan.
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamicho, Chuoku, Kobe, Hyogo 650-0047, Japan.
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamicho, Chuoku, Kobe, Hyogo 650-0047, Japan.
| |
Collapse
|
29
|
Asada S, Yokoyama K, Miyakoshi C, Fukuma S, Endo Y, Wada M, Nomura T, Onishi Y, Fukagawa M, Fukuhara S, Akizawa T. Relationship between serum calcium or phosphate levels and mortality stratified by parathyroid hormone level: an analysis from the MBD-5D study. Clin Exp Nephrol 2020; 24:630-637. [PMID: 32236781 PMCID: PMC7271007 DOI: 10.1007/s10157-020-01879-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 03/14/2020] [Indexed: 10/31/2022]
Abstract
INTRODUCTION There is limited evidence about the association between calcium and phosphate levels and mortality stratified by intact parathyroid hormone (iPTH) level. METHODS We investigated whether differences in iPTH level affect the relationship between calcium and phosphate levels and all-cause mortality in hemodialysis patients with secondary hyperparathyroidism (SHPT). Calcium and phosphate levels were categorized as low (< 8.5 mg/dL, < 4.0 mg/dL), medium (≥ 8.5-< 9.5 mg/dL, ≥ 4.0-< 7.0 mg/dL), and high (≥ 9.5 mg/dL, ≥ 7.0 mg/dL), respectively. iPTH levels were grouped into < 300 or ≥ 300 pg/mL. Adjusted incidence rate ratios (aIRRs) were analyzed by weighted Poisson regression. RESULTS For calcium, patients with higher iPTH (≥ 300 pg/mL) had significantly higher all-cause mortality rates in the high than in the medium category (aIRR 1.99, 95% confidence interval [CI] 1.16-3.42), and tended to have a higher mortality rate in the low category (aIRR 2.04, 95% CI 0.94-4.42). Patients with lower iPTH (< 300 pg/mL) had higher mortality rates in the high than in the medium category (aIRR 1.65, 95% CI 1.39-1.96). For phosphate, the mortality rate was significantly higher in the high than in the medium category in patients with higher and lower iPTH (aIRR 3.23, 95% CI 1.63-6.39 for iPTH ≥ 300 pg/mL; aIRR 1.58, 95% CI 1.06-2.36 for iPTH < 300 pg/mL). CONCLUSION High calcium and phosphate levels were associated with increased risk of mortality irrespective of iPTH level.
Collapse
Affiliation(s)
- Shinji Asada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan.
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Jikei University Harumi Triton Clinic, Jikei University School of Medicine, Tokyo, Japan
| | - Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | - Yuichi Endo
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Michihito Wada
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Takanobu Nomura
- Medical Affairs Department, Kyowa Kirin Co., Ltd, Otemachi Financial City Grand Cube, 1-9-2 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
30
|
Kitai T, Miyakoshi C, Morimoto T, Yaku H, Murai R, Kaji S, Furukawa Y, Inuzuka Y, Nagao K, Tamaki Y, Yamamoto E, Ozasa N, Tang WHW, Kato T, Kimura T. Mode of Death Among Japanese Adults With Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction. JAMA Netw Open 2020; 3:e204296. [PMID: 32379331 PMCID: PMC7206504 DOI: 10.1001/jamanetworkopen.2020.4296] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Despite intensive treatment, hospitalized patients with acute decompensated heart failure (ADHF) have a substantial risk of postdischarge mortality. Limited data are available on the possible differences in the incidence and mechanisms of death among patients with heart failure with reduced ejection fraction (HFrEF), heart failure with midrange ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). OBJECTIVES To examine the incidences and mode of postdischarge mortality among patients with ADHF and to compare the risk profile among patients with HFrEF, HFmrEF, and HFpEF. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study of 4056 patients hospitalized for ADHF analyzed data from 3717 patients who were discharged from October 1, 2014, to March 31, 2016. Data analysis was performed from April 1 to August 31, 2019. EXPOSURES Death among patients with ADHF after hospital discharge. MAIN OUTCOMES AND MEASURES All-cause death and cause of postdischarge mortality after the index hospitalization by left ventricular ejection fraction (LVEF) subgroup. RESULTS A total of 3717 patients (mean [SD] age, 77.7 [12.0] years; 2049 [55.1%] male) were included in the study. The mean (SD) LVEF at baseline was 46.4% (16.2%). Among 3717 enrolled patients, 1383 (37.2%) were categorized as having HFrEF (LVEF, <40%), 703 (18.9%) as having HFmrEF (LVEF, 40%-49%), and 1631 (43.9%) as having HFpEF (LVEF, ≥50%). The incidence and causes of death were evaluated after discharge from the index hospitalization. The median follow-up period was 470 days (interquartile range, 357-649 days), and the 1-year follow-up rate was 96%. During follow-up, all-cause death occurred in 848 patients (22.8%; HFrEF group: 298 [21.5%; 95% CI, 19.5%-23.8%]; HFmrEF group: 158 [22.5%; 95% CI, 19.5%-25.7%]; and HRpEF group: 392 [24.0%; 95% CI, 22.0%-26.2%]; P = .26), cardiovascular deaths occurred in 523 patients (14.1%; HFrEF group: 203 [14.7%; 95% CI, 12.9%-16.6%]; HFmrEF group: 97 [13.8%; 95% CI, 11.4%-16.5%]; and HFpEF group: 223 [13.7%; 95% CI, 12.1%-15.4%]; P = .71), and sudden cardiac death occurred in 98 patients (2.6%; HFrEF group: 44 [3.2%; 95% CI, 2.4%-4.2%]; HFmrEF group: 14 [2.0%; 95% CI, 1.2%-3.3%]; and HFpEF group: 40 [2.5%; 95% CI, 1.8%-3.3%]; P = .23). The risks of causes of death were similar among the subtypes. CONCLUSIONS AND RELEVANCE The mode of death was similar among the heart failure subtypes. Given the nonnegligible incidence of sudden cardiac death in patients with HFpEF found in this study, further studies appear to be warranted to identify a high-risk subset in this population.
Collapse
Affiliation(s)
- Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chisato Miyakoshi
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga General Hospital, Moriyama, Japan
| | - Kazuya Nagao
- Division of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - W. H. Wilson Tang
- Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
31
|
Iwata K, Miyakoshi C. A Simulation on Potential Secondary Spread of Novel Coronavirus in an Exported Country Using a Stochastic Epidemic SEIR Model. J Clin Med 2020; 9:E944. [PMID: 32235480 PMCID: PMC7230280 DOI: 10.3390/jcm9040944] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 02/16/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/08/2023] Open
Abstract
Ongoing outbreak of pneumonia caused by novel coronavirus (2019-nCoV) began in December 2019 in Wuhan, China, and the number of new patients continues to increase. Even though it began to spread to many other parts of the world, such as other Asian countries, the Americas, Europe, and the Middle East, the impact of secondary outbreaks caused by exported cases outside China remains unclear. We conducted simulations to estimate the impact of potential secondary outbreaks in a community outside China. Simulations using stochastic SEIR model were conducted, assuming one patient was imported to a community. Among 45 possible scenarios we prepared, the worst scenario resulted in the total number of persons recovered or removed to be 997 (95% CrI 990-1000) at day 100 and a maximum number of symptomatic infectious patients per day of 335 (95% CrI 232-478). Calculated mean basic reproductive number (R0) was 6.5 (Interquartile range, IQR 5.6-7.2). However, better case scenarios with different parameters led to no secondary cases. Altering parameters, especially time to hospital visit. could change the impact of a secondary outbreak. With these multiple scenarios with different parameters, healthcare professionals might be able to better prepare for this viral infection.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, Kobe 650-0017, Japan
| | - Chisato Miyakoshi
- Department of Research Support, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| |
Collapse
|
32
|
Kitai T, Okamoto T, Miyakoshi C, Niikawa H, Alvarez PA, Krittanawong C, Xanthopoulos A, McCurry KR. Impact of combined heart and lung transplantation on bronchiolitis obliterans syndrome, cardiac allograft vasculopathy, and long-term survival. J Heart Lung Transplant 2019; 38:1170-1177. [DOI: 10.1016/j.healun.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/16/2019] [Indexed: 01/06/2023] Open
|
33
|
Kuragaichi T, Kataoka Y, Miyakoshi C, Miyamoto T, Sato Y. External validation of pooled cohort equations using systolic blood pressure intervention trial data. BMC Res Notes 2019; 12:271. [PMID: 31088530 PMCID: PMC6518641 DOI: 10.1186/s13104-019-4293-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
Abstract
Objective The risk of atherosclerotic cardiovascular disease (ASCVD) is estimated using the American College of Cardiology (ACC)/American Heart Association (AHA) Pooled Cohort Equations (PCEs). However, the accuracy of this tool remains controversial, particularly among patients who are recommended statin therapy according to the ACC/AHA guidelines. We performed external validation of PCEs among patients eligible for statin therapy using data from the systolic blood pressure intervention trial (SPRINT). Results Our study included 4057 patients from among the 9361 patients in SPRINT. The mean patient age was 64.5 years, and the median predicted 10-year risks of ASCVD were 17.2% and 12.3% for men and women, respectively. Over a median follow-up of 3.3 years, 133 primary events (including 23 cardiovascular deaths) were noted, whereas 304 events were predicted by the PCEs. The PCEs demonstrated poor calibration (Hosmer–Lemeshow test, p < 0.001) and overestimated the probability consistently. Additionally, they showed moderate discrimination [area under the curve: 0.65 (95% confidence interval, 0.60–0.69)]. This study demonstrates that PCEs might overestimate the risk of ASCVD in patients who are recommended statin therapy.
Collapse
Affiliation(s)
- Takashi Kuragaichi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Tadashi Miyamoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| |
Collapse
|
34
|
Yokoyama T, Yoshioka H, Fujimoto D, Demura Y, Hirano K, Kawai T, Kagami R, Washio Y, Ishida T, Kogo M, Tomii K, Okuno T, Akai M, Hirabayashi M, Nishimura T, Nakahara Y, Kim YH, Miyakoshi C, Yoshimura K, Hirai T. A phase II study of low starting dose of afatinib as first-line treatment in patients with EGFR mutation-positive non-small-cell lung cancer (KTORG1402). Lung Cancer 2019; 135:175-180. [PMID: 31446992 DOI: 10.1016/j.lungcan.2019.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/07/2019] [Revised: 02/28/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Afatinib is an effective treatment in patients who have epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC), but its toxicities often require dose adjustment. Exploratory analyses of previous trials have suggested that reducing the dose of afatinib can decrease treatment-related adverse events without negatively affecting effectiveness. The aim of this study was to assess the efficacy and safety of low starting dose of afatinib with dose modification according to its toxicity in patients with EGFR mutation-positive NSCLC. MATERIALS AND METHODS This study was a multicenter, single-arm, open-label phase II trial. Treatment-naïve patients with advanced NSCLC positive for common EGFR mutations received afatinib starting in a dose of 20 mg/day. If tolerated, the dose was increased in 10-mg increments up to 50 mg/day. The primary endpoint was progression-free survival (PFS). RESULTS From February 2015 through March 2016, 46 patients were enrolled. The median age was 73 years (range, 43-86), and 35 patients (72%) were women.EGFR mutation subtypes included exon 19 deletion (54%) and Leu858Arg point mutation (46%). Most patients had a performance status of 0 or 1 (91%) and a histological diagnosis of adenocarcinoma (98%). As of the data cut-off date of June 2017, the median follow-up was 18.9 months. The median PFS was 15.2 months (95% CI: 13.2-not estimable). The 1-year overall survival rate was 95.6% (95% CI: 89.7%-100%). The objective response rate was 81.8% (95% CI, 81.3%-98.6%). Adverse events of grade 3 or higher occurred in 14 patients (30.4%) and included rash/acne in 4 patients (8.7%), paronychia in 4 patients (8.7%), diarrhea in 2 patients (4.3%). There was no treatment-related death. CONCLUSIONS Low starting dose of afatinib therapy showed promising clinical efficacy and good tolerability. Further investigations are warranted.
Collapse
Affiliation(s)
- Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan; Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan.
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshiki Demura
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Katsuya Hirano
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takahiro Kawai
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Ryogo Kagami
- Department of Respiratory Medicine, Himeji Medical Center, Himeji, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Mariko Kogo
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takehiro Okuno
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Masaya Akai
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Masataka Hirabayashi
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takashi Nishimura
- Department of Respiratory Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yasuharu Nakahara
- Department of Respiratory Medicine, Himeji Medical Center, Himeji, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Chisato Miyakoshi
- Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan
| | | |
Collapse
|
35
|
Fukuzawa H, Urushihara N, Miyakoshi C, Kajihara K, Kawahara I, Isono K, Samejima Y, Miura S, Uemura K, Morita K, Nakao M, Yokoi A, Fukumoto K, Yamoto M, Maeda K. Clinical features and risk factors of bile duct perforation associated with pediatric congenital biliary dilatation. Pediatr Surg Int 2018; 34:1079-1086. [PMID: 30076449 DOI: 10.1007/s00383-018-4321-6] [Citation(s) in RCA: 6] [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] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to investigate the clinical features and risk factors of bile duct perforation in pediatric congenital biliary dilatation (CBD) patients. METHODS CBD patients, whose initial symptom was abdominal pain, were enrolled in this study and were divided into perforated and non-perforated groups. The clinical features of the perforated group were investigated. Moreover, the age at operation, sex, and morphologic features of the extrahepatic bile duct were compared between the groups. RESULTS Fifteen cases of bile duct perforation (10.4%) were identified among the 144 CBD patients who had abdominal pain. Majority of bile duct perforation occurred in patients aged < 4 years. The median duration from onset of abdominal pain to bile duct perforation was 6 (4-14) days. Age at onset [< 4 years old; P = 0.02, OR 13.9, (1.663, 115.3)], shape of extrahepatic bile duct [non-cystic type; P = 0.009, OR 8.36, (1.683, 41.5)], and dilatation of the common channel [P = 0.02, OR 13.6, (1.651, 111.5)] were risk factors of bile duct perforation. CONCLUSIONS Emergent bile duct drainage might be planned to prevent bile duct perforation if CBD patients have the abovementioned risk factors and experience persistent abdominal pain lasting for a few days from onset.
Collapse
Affiliation(s)
- Hiroaki Fukuzawa
- Division of Pediatric Surgery, Department of Surgery, Kobe University School of Medicine, Kobe, Japan. .,Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan.
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Chisato Miyakoshi
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Kajihara
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Insu Kawahara
- Division of Pediatric Surgery, Department of Surgery, Kobe University School of Medicine, Kobe, Japan.,Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Kaori Isono
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Yoshitomo Samejima
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Shizu Miura
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Kotaro Uemura
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Keiichi Morita
- Division of Pediatric Surgery, Department of Surgery, Kobe University School of Medicine, Kobe, Japan.,Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Makoto Nakao
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kosaku Maeda
- Division of Pediatric Surgery, Department of Surgery, Kobe University School of Medicine, Kobe, Japan.,Department of Pediatric Surgery, Kobe Children's Hospital, Chuou-ku minatojimaminami 1-6-7, Kobe, 650-0047, Japan
| |
Collapse
|
36
|
Miyakoshi C, Yamamoto Y, Yamakawa M, Fukuhara S. Heart Rate, Responsiveness to Intravenous Immunoglobulin, and Coronary Artery Aneurysms in Kawasaki Disease. J Pediatr 2018; 200:160-165.e5. [PMID: 29793867 DOI: 10.1016/j.jpeds.2018.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/08/2017] [Revised: 04/02/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate whether heart rate (HR) was associated with intravenous immunoglobulin (IVIG) responsiveness or development of coronary artery lesions (CALs) in patients with Kawasaki disease. STUDY DESIGN We conducted a retrospective cohort study using data from in patients with Kawasaki disease who were hospitalized in our institution from 2006 to 2016. The patients were divided into 5 groups according to the age- and temperature-adjusted HR z score (HRZage/temp) just before IVIG administration. The ORs of outcomes were estimated by using logistic regression models, with the middle group set as the reference. RESULTS Of the 322 patients, a total of 98 patients (30%) were refractory to initial IVIG treatment. The patients whose HRZage/temp belonged to the lowest group were at the highest risk of being refractory to the initial IVIG treatment (OR 2.10 [95% CI 1.01-4.37]). Multivariable analyses showed the same trend, though this was not statistically significant. The patients with the highest HRZage/temp were most likely to develop CALs (OR 2.61 [95%CI 0.86-7.92]). CONCLUSIONS In patients with Kawasaki disease , HRs has a different relationship with IVIG responsiveness and CALs. Low HRZage/temp might be associated with high risk of being refractory to the initial IVIG treatment, while the risk of developing CALs increased among those whose HRs were high. Further studies are necessary to investigate the mechanisms regarding HR and these outcomes in Kawasaki disease.
Collapse
Affiliation(s)
- Chisato Miyakoshi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Masaru Yamakawa
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
37
|
Fukunaga N, Miyakoshi C, Sakata R, Koyama T. Impact of valve type on outcomes after redo mitral valve replacement in patients aged 50 to 69 years. Interact Cardiovasc Thorac Surg 2018; 27:322-327. [PMID: 29617819 DOI: 10.1093/icvts/ivy109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Little data are available with regard to valve selections in redo valvular surgery. We investigated the impact of valve types on late outcomes after redo mitral valve replacement (MVR). METHODS We retrospectively reviewed 66 patients aged 50-69 (mean age 62.2 ± 5.1) years who underwent redo MVR over the past 25 years. In redo MVR, 46 (69.7%) redo procedures were the 1st redo valvular surgeries, 16 (24.2%) were 2nd redos, 3 (4.5%) were 3rd redos and 1 was a 4th (1.5%) redo. We classified 66 patients into 2 groups: mechanical MVR group (M-MVR, n = 44) and biological MVR group (B-MVR, n = 22). The mean follow-up period was 8.2 ± 6.3 years. RESULTS Hospital mortality rates were 3.3% in M-MVR and 9.7% in B-MVR (P = 0.3328). Survival rates in M-MVR and B-MVR at 5 and 10 years were 93.0 ± 4.8% vs 76.0 ± 10.5% and 77.6 ± 9.1% vs 51.3 ± 13.7%, respectively (log-rank test, P = 0.0072). Late death occurred in 7 patients in M-MVR and 9 in B-MVR. Freedom rates from valve-related events in M-MVR and B-MVR at 5 and 10 years were 100.0 ± 0.0% vs 76.5 ± 10.3% and 93.3 ± 6.4% vs 52.4 ± 13.6%, respectively (log-rank test, P < 0.0001). No bleeding and thromboembolic events were observed in M-MVR, whereas gastrointestinal bleeding (n = 1), subarachnoid haemorrhage (n = 1) and cerebral infarction (n = 2) were observed in B-MVR. A predictor of late death was a biological valve in redo MVR (P = 0.0206, hazard ratio = 3.402, 95% confidence interval 1.207-9.591). CONCLUSIONS It would seem that redo MVR using a mechanical valve was associated with better early and late outcomes in this age group.
Collapse
Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Clinical Research Center, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Chisato Miyakoshi
- Department of Cardiovascular Surgery, Clinical Research Center, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Clinical Research Center, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Clinical Research Center, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| |
Collapse
|
38
|
Takagi S, Hirami Y, Takahashi M, Fujihara M, Mandai M, Miyakoshi C, Tomita G, Kurimoto Y. Optical coherence tomography angiography in patients with retinitis pigmentosa who have normal visual acuity. Acta Ophthalmol 2018; 96:e636-e642. [PMID: 29498230 PMCID: PMC6175316 DOI: 10.1111/aos.13680] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/10/2017] [Accepted: 11/21/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate flow area changes measured using optical coherence tomography angiography (OCTA; RTVue XR Avanti® ) in patients with retinitis pigmentosa (RP) with preserved visual acuity (VA). METHODS This was an age- and refraction-matched case-control study. Consecutive patients with a best-corrected visual acuity (BCVA) of ≥20/20 and normal subjects were recruited. Fifty eyes (32 patients) and 22 eyes (12 controls) were included. The flow area and foveal avascular zone (FAZ) were measured in both superficial and deep layers within a 3 × 3 mm central area of the fovea. Association between OCTA parameters and the length of the inner segment ellipsoid (ISe) and external limiting membrane (ELM), the area without abnormal fluorescence in fundus autofluorescence (normal FAF area ratio) and the area of I-2e of the Goldmann perimeter were analysed using mixed-effects regression analysis. RESULTS Foveal avascular zones were significantly smaller in patients with RP than in controls in superficial (p = 0.004) but not in deep layers (p = 0.25). The flow area in superficial (p = 0.007) and deep layers (p = 0.004) was significantly smaller in patients with RP than in controls. In patients with RP, flow areas in the superficial layers, but not in the deep layers, were significantly associated with the lengths of ISe (p = 0.001) and ELM (p = 0.002) and the I-2e area (p = 0.036), but not with the normal FAF area ratio (p = 0.399). CONCLUSION Optical coherence tomography angiography (OCTA)-measured flow area in superficial layers gradually reduced with RP progression and may be a useful parameter of RP pathogenesis.
Collapse
Affiliation(s)
- Seiji Takagi
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- Department of Translational Research, Division of Ophthalmology; Institute of Biomedical Research and Innovation; Kobe Japan
- Department of Ophthalmology; Toho University Ohashi Medical Center; Tokyo Japan
| | - Yasuhiko Hirami
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- Department of Translational Research, Division of Ophthalmology; Institute of Biomedical Research and Innovation; Kobe Japan
- RIKEN Center for Developmental Biology; Kobe Japan
| | - Masayo Takahashi
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- Department of Translational Research, Division of Ophthalmology; Institute of Biomedical Research and Innovation; Kobe Japan
- RIKEN Center for Developmental Biology; Kobe Japan
| | - Masashi Fujihara
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- Department of Translational Research, Division of Ophthalmology; Institute of Biomedical Research and Innovation; Kobe Japan
| | - Michiko Mandai
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- RIKEN Center for Developmental Biology; Kobe Japan
| | - Chisato Miyakoshi
- Department of Pediatrics; Kobe City Medical Center General Hospital; Kobe Japan
| | - Goji Tomita
- Department of Ophthalmology; Toho University Ohashi Medical Center; Tokyo Japan
| | - Yasuo Kurimoto
- Department of Ophthalmology; Kobe City Medical Center General Hospital; Kobe Japan
- Department of Translational Research, Division of Ophthalmology; Institute of Biomedical Research and Innovation; Kobe Japan
- RIKEN Center for Developmental Biology; Kobe Japan
| |
Collapse
|
39
|
Abstract
BACKGROUND Maternal employment may affect child care styles and contribute to the increasing prevalence of overweight children. We explored the potential risk factors for becoming overweight during early childhood, especially in the child care environment. METHODS We conducted a retrospective cohort study using data from health check-up services from 2007 to 2015 in Kobe, Japan. The main outcome was being overweight at age 3 years, which was defined by the International Obesity Task Force cutoffs. Environmental, maternal, and infantile factors were examined as possible risk factors for childhood overweight. RESULTS Of 31,463 infants, 1315 (4.2%) were classified as overweight at age 3 years. Compared with children who were cared for by their mothers during the day at 4 and 18 months, the adjusted odds ratio (aOR) for becoming overweight for those who were not cared for by their mothers was 1.52: 95% confidence interval (CI), 1.16-1.99. Long sleep duration was associated with lower risk of childhood overweight: aOR, 0.79; 95% CI, 0.66-0.96. CONCLUSION Less daytime care by mothers and shorter sleep duration were associated with increased risk of becoming overweight during childhood. Further studies are needed to determine on how the effect of those factors may be diminished with respect to childhood overweight.
Collapse
Affiliation(s)
- Chisato Miyakoshi
- 1 Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University , Kyoto, Japan .,2 Department of Pediatrics, Kobe City Medical Center General Hospital , Kobe, Japan
| | - Yosuke Yamamoto
- 1 Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University , Kyoto, Japan
| | | | | | - Ichiro Morioka
- 5 Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Shunichi Fukuhara
- 1 Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University , Kyoto, Japan .,6 Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University , Fukushima, Japan
| |
Collapse
|
40
|
Tsutsumi Y, Tsutsumi I, Tsujimoto Y, Takahashi S, Tsuchiya A, Miyakoshi C, Fukuma S, Furukawa TA. Hyperbaric oxygen therapy for persistent post-concussion syndrome following mild traumatic brain injury. Cochrane Database of Systematic Reviews 2017. [DOI: 10.1002/14651858.cd012727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yusuke Tsutsumi
- School of Public Health in the Graduate School of Medicine, Kyoto University; Department of Healthcare Epidemiology; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
- National Hospital Organization Mito Medical Center; Department of Emergency Medicine; 280 Sakuranosato Ibarakimachi Ibaraki Ibaraki Japan 311-3117
| | - Ikuyo Tsutsumi
- Kyoto University School of Public Health; Department of Healthcare Economics and Quality Management; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
- National Hospital Organization Mito Medical Center; Department of Hematology; Ibaraki Japan
| | - Yasushi Tsujimoto
- School of Public Health in the Graduate School of Medicine, Kyoto University; Department of Healthcare Epidemiology; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
- Kyoritsu Hospital; Department of Nephrology and Dialysis; Chuo-cho 16-5 Kawanishi Hyogo Japan 666-0016
| | - Sei Takahashi
- School of Public Health in the Graduate School of Medicine, Kyoto University; Department of Healthcare Epidemiology; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
- Fukushima Medical University; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE); 1 Hikarigaoka Fukushima Fukushima Japan 960-1295
| | - Asuka Tsuchiya
- National Hospital Organization Mito Medical Center; Department of Emergency Medicine; 280 Sakuranosato Ibarakimachi Ibaraki Ibaraki Japan 311-3117
- School of Public Health, Graduate School of Medicine, The University of Tokyo; Department of Clinical Epidemiology and Health Economics; Tokyo Japan
| | - Chisato Miyakoshi
- School of Public Health in the Graduate School of Medicine, Kyoto University; Department of Healthcare Epidemiology; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
- Kobe City Medical Center General Hospital; Clinical Research Center; Kobe Japan
| | - Shingo Fukuma
- School of Public Health in the Graduate School of Medicine, Kyoto University; Department of Healthcare Epidemiology; Yoshida Konoe-cho, Sakyo-ku Kyoto Japan 606-8501
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public Health; Department of Health Promotion and Human Behavior; Yoshida Konoe-cho, Sakyo-ku, Kyoto Japan 606-8501
| |
Collapse
|
41
|
Miura S, Hamamoto N, Osaki M, Nakano S, Miyakoshi C. Extubation Failure in Neonates After Cardiac Surgery: Prevalence, Etiology, and Risk Factors. Ann Thorac Surg 2016; 103:1293-1298. [PMID: 27720369 DOI: 10.1016/j.athoracsur.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates. METHODS Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected. Multiple logistic regression models were constructed to identify the risk factors for EF. RESULTS The median age at surgery was 10 days. Extubation failure occurred in 25 of 156 cases (16.0%; 95% confidence interval: 10.6% to 22.7%), because of respiratory dysfunction (n = 16), hemodynamic instability (n = 4), upper airway obstruction (n = 4), or gastrointestinal bleeding (n = 1). Subsequent extubations were successful in 17 cases (68%) because of medical optimization of the causes of reintubation. The remaining 8 cases needed surgical reintervention, including tracheostomy and cardiac surgery. The inhospital mortality rate was 2.6%. In a bivariate analysis, younger age, airway diseases, ventilation before surgery, prolonged mechanical ventilation, and delayed sternal closure were associated with EF. The multivariable analysis identified airway diseases (adjusted odds ratio 18.2, 95% confidence interval: 3.8 to 88.6, p = 0.0003) and mechanical ventilation longer than 7 days (adjusted odds ratio 8.2, 95% confidence interval: 1.9 to 34.9, p = 0.0046) as risk factors for EF. CONCLUSIONS The prevalence of EF is relatively high in neonatal cardiac surgery. The etiologies can be diverse. Extubation of neonates at high risk after cardiac surgery, based on these possible risk factors, requires more diligent approaches.
Collapse
Affiliation(s)
- Shinya Miura
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Nao Hamamoto
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaki Osaki
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Satoshi Nakano
- Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Chisato Miyakoshi
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan; School of Mathematics and Statistics, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
42
|
Kazama JJ, Yamamoto S, Narita I, Miyakoshi C, Onishi Y, Fukuma S, Fukuhara S, Fukagawa M, Akizawa T. MP354NO CLEAR ASSOCIATION WAS FOUND BETWEEN HIGH FRACTURE RISK AND MINERAL METABOLIC MARKERS AMONG JAPANESE DIALYSIS PATIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw190.11] [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: 11/14/2022] Open
|
43
|
Sugimoto A, Ota N, Miyakoshi C, Murata M, Ide Y, Tachi M, Ito H, Ogawa H, Sakamoto K. Mid- to long-term aortic valve-related outcomes after conventional repair for patients with interrupted aortic arch or coarctation of the aorta, combined with ventricular septal defect: the impact of bicuspid aortic valve. Eur J Cardiothorac Surg 2014; 46:952-60; discussion 960. [DOI: 10.1093/ejcts/ezu078] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
44
|
Sugimoto A, Ota N, Ibuki K, Miyakoshi C, Murata M, Tosaka Y, Yamazaki T, Sakamoto K. Risk factors for adverse neurocognitive outcomes in school-aged patients after the Fontan operation. Eur J Cardiothorac Surg 2013; 44:454-61; discussion 461. [PMID: 23423918 DOI: 10.1093/ejcts/ezt062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES As the surgical results for Fontan candidates improve, much attention has been given to the long-term cognitive outcomes. This study aimed to assess the neurocognitive outcomes after Fontan completion, and to determine the factors associated with an extremely low intelligence quotient (IQ <70). METHODS A total of 70 local eligible school-aged patients were enrolled in the study (hypoplastic left heart syndrome, 17; right atrial isomerism, 15 and others, 38). Fontan operations were performed at a median age of 1.8 (range, 0.5-8.9) years (primary Fontan, 4 of 70 [6%]). The Wechsler Intelligence Test was taken at a median age of 9 (range, 5.1-14.4) years for the purpose of neurocognitive evaluation. Patients' data were collected from medical records, and a retrospective analysis of potential predictors for an IQ <70 was performed. RESULTS The median full-scale IQ (FSIQ) for the entire cohort was 85 (range, 43-118). Of the lower order composites, the perceptual reasoning index and the working memory index were significantly lower in low-FSIQ patients (P < 0.05). Overall, 15 of 70 (21%) of the cohort had an IQ <70. Univariate analysis identified three significant risk factors for FSIQ <70 (15 of 70, 21%): body weight <2.5 kg at initial palliative surgery (P < 0.05), low 5-min Apgar score <4 (P < 0.05) and inter-stage events requiring cardiopulmonary resuscitation (CPR) (P < 0.05). No other patient-specific factors (e.g. cardiac morphology) or modifiable surgical factors (e.g. the use of hypothermic cardiac arrest) were associated with FSIQ <70. CONCLUSIONS Low body weight (<2.5 kg) at initial operation, low 5-min Apgar score (<4) and inter-stage CPR were significant risk factors for impaired neurocognitive outcomes. An evolving strategy for preventing inter-stage CPR may improve cognitive outcomes.
Collapse
Affiliation(s)
- Ai Sugimoto
- Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Cholestasis in neonates is infrequently associated with Rh isoimmunization, and usually resolves within a month. The suggested pathophysiology is inspissated bile and hepatocellular damage. We report a rare case of refractory cholestasis presenting with cholangiolitis in a newborn with anti-E isoimmunisation. The cholangiolitis was disclosed by immunohistochemical investigation of conjugated hyperbilirubinaemia and by liver biopsy, which showed a number of CD8(+) lymphocytes within the portal tract damaging the interlobular bile duct. Bilirubin levels dramatically decreased after 14-day corticosteroid therapy (prednisolone, 2 mg/kg/day) implying that the cause of cholestasis could be immune-mediated cholangiolitis.
Collapse
Affiliation(s)
- Ryusuke Taba
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan.
| | | | | | | |
Collapse
|
46
|
Tsuji M, Yoshida T, Miyakoshi C, Haruta T. Is a reversible splenial lesion a sign of encephalopathy? Pediatr Neurol 2009; 41:143-5. [PMID: 19589466 DOI: 10.1016/j.pediatrneurol.2009.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/16/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
A reversible splenial lesion of the corpus callosum has been recognized in patients with mild encephalitis/encephalopathy associated with various infectious diseases. All reported cases of encephalitis/encephalopathy, by definition, present with neurologic signs, many of which involve seizures or mildly altered states of consciousness, such as drowsiness. We report an 8-year-old boy with influenza A infection not associated with neurologic signs, whose brain magnetic resonance images incidentally revealed a reversible splenial lesion in the corpus callosum. This case indicates that a transient splenial lesion in the corpus callosum may occur during a febrile illness, without neurologic manifestations. Therefore, physicians should not diagnose or treat a patient as encephalopathic merely because of the presence of a splenial lesion on magnetic resonance imaging.
Collapse
Affiliation(s)
- Masahiro Tsuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan.
| | | | | | | |
Collapse
|
47
|
Kitahara M, Kanaki T, Toyoda K, Miyakoshi C, Tanaka S, Tamaki T, Saito Y. NK-104, a newly developed HMG-CoA reductase inhibitor, suppresses neointimal thickening by inhibiting smooth muscle cell growth and fibronectin production in balloon-injured rabbit carotid artery. Jpn J Pharmacol 1998; 77:117-28. [PMID: 9681568 DOI: 10.1254/jjp.77.117] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have been reported to suppress smooth muscle cell growth and arterial neointimal thickening. In this study, to elucidate the potency and mechanisms of NK-104 ((+)-monocalcium bis[(3R,5S,6E)-7-[2-cyclopropyl-4-(4-fluorophenyl)-3-quinolyl]-3,5-dihydroxy-6-heptenoate], CAS 147526-32-7) in neointimal thickening, the effect of NK-104 on the neointimal thickening, Br-dU-labeled cell number and extracellular matrix immunohistochemistry were examined in balloon-injured rabbit carotid artery. NK-104 suppressed the neointimal thickening dose-dependently, and the suppression was 69.5% at 1.0 mg/kg. NK-104 suppressed the intimal total and Br-dU-labeled cell number. Fibronectin and type I collagen were observed in 81% and 38% of the total intimal area in the control arteries, respectively, and the areas occupied by fibronectin and type I collagen were significantly decreased by 1.0 mg/kg NK-104 to 39% and 22%, respectively. The decrease in fibronectin per cell was more potently demonstrated. Aortic total and activated TGF-beta contents that were markedly increased in the injured artery were increased further by NK-104. NK-104 concentration-dependently suppressed fibronectin content of the basement lesion in rabbit primary cultured smooth muscle cells. These findings suggest that NK-104 suppresses balloon-injury-induced neointimal thickening through inhibition of intimal smooth muscle cell growth and extracellular matrix accumulation.
Collapse
Affiliation(s)
- M Kitahara
- Shiraoka Research Station of Biological Science, Nissan Chemical Industries, Ltd., Minamisaitama, Saitama, Japan
| | | | | | | | | | | | | |
Collapse
|