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Tsukijima M, Teramoto A, Kojima A, Yamamuro O, Tamaki T, Fujita H. A position-adaptive noise-reduction method using a deep denoising filter bank for dedicated breast positron emission tomography images. Phys Eng Sci Med 2024; 47:73-85. [PMID: 37870728 DOI: 10.1007/s13246-023-01343-3] [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: 07/08/2022] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
Dedicated breast positron emission tomography (db-PET) is more sensitive than whole-body positron emission tomography and is thus expected to detect early stage breast cancer and determine treatment efficacy. However, it is challenging to decrease the sensitivity of the chest wall side at the edge of the detector, resulting in a relative increase in noise and a decrease in detectability. Longer acquisition times and injection of larger amounts of tracer improve image quality but increase the burden on the patient. Therefore, this study aimed to improve image quality via reconstruction with shorter acquisition time data using deep learning, which has recently been widely used as a noise reduction technique. In our proposed method, a multi-adaptive denoising filter bank structure was introduced by training the training data separately for each detector area because the noise characteristics of db-PET images vary at different locations. Input and ideal images were reconstructed based on 1- and 7-min collection data, respectively, using list mode data. The deep learning model used residual learning with an encoder-decoder structure. The image quality of the proposed method was superior to that of existing noise reduction filters such as Gaussian filters and nonlocal mean filters. Furthermore, there was no significant difference between the maximum standardized uptake values before and after filtering using the proposed method. Taken together, the proposed method is useful as a noise reduction filter for db-PET images, as it can reduce the patient burden, scan time, and radiotracer amount in db-PET examinations.
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Affiliation(s)
- Masahiro Tsukijima
- Imaging Diagnostic Technology Department, East Nagoya Imaging Diagnosis Center, 3-4-26 Jiyugaoka, Chikusa-ku, Nagoya, Aichi, Japan
- Graduate School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | | | - Akihiro Kojima
- Nagoya PET Imaging Center, 1-162 Hokke, Nakagawa-ku, Nagoya, Aichi, Japan
| | - Osamu Yamamuro
- Imaging Diagnostic Technology Department, East Nagoya Imaging Diagnosis Center, 3-4-26 Jiyugaoka, Chikusa-ku, Nagoya, Aichi, Japan
| | - Tsuneo Tamaki
- Imaging Diagnostic Technology Department, East Nagoya Imaging Diagnosis Center, 3-4-26 Jiyugaoka, Chikusa-ku, Nagoya, Aichi, Japan
| | - Hiroshi Fujita
- Faculty of Engineering, Gifu University, 1-1 Yanagido, Gifu, Japan
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Iwase T, Otsuka H, Katayama N, Fujita H. Impaction bone grafting for femoral revision hip arthroplasty with Exeter stem in Japan: An extended 10- to 15-year stem survival analysis of the previously reported series. J Orthop Sci 2024; 29:151-156. [PMID: 36610839 DOI: 10.1016/j.jos.2022.12.009] [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: 09/07/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Femoral impaction bone grafting (IBG) was introduced in the late 1990s in Japan and has gradually become recognized as a useful option for femoral revision. The aim of the present study was to retrospectively analyze 10 to 15 years of clinical results of femoral revision arthroplasties of IBG using Exeter stem performed by experienced Japanese surgeons. METHODS We investigated radiographic and clinical records more than 2 years after surgery in 99 hips of 93 patients. The average age was 66.3 years (36-84 years) and the average follow-up period was 11 years (2-23 years and 8 months). Merle d'Aubigné and Postel hip score was used for clinical assessment, and re-operations for any reason were recorded. The survival curve was estimated using Kaplan-Meier method. RESULTS The mean Merle d'Aubigné and Postel hip score improved from 9.0 points to 14.5 points at the final follow-up. Re-operations were undertaken in 15 hips of 14 patients for aseptic acetabular component loosening (n = 1 hip), recurrent dislocation (n = 2 hips), infection (n = 4 hips), and periprosthetic femoral fracture (n = 8 hips). The survival rates at 10 and 15 years after operation were 87.1% and 81.1% with any type of re-operation as the endpoint, 92.2% and 92.2% with stem removal or exchange as the endpoint, 94.9% and 88.1% with re-operation for periprosthetic femoral fracture as the endpoint, and 99.0% and 99.0% with re-operation for aseptic stem loosening as the endpoint, respectively. CONCLUSIONS The present study showed encouraging results of femoral IBG over 10 years by experienced surgeons in Japan. Although femoral IBG is recognized as a technically complex procedure, survivorship of the stem is excellent, with a 15-year stem survival rate of 99.0% at the end point of aseptic loosening.
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Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka 432-8580, Japan.
| | - Hiromi Otsuka
- Department of Orthopedic Surgery, School of Medicine Aichi Medical University, Aichi, Japan
| | - Naoyuki Katayama
- Department of Orthopedic Surgery, Hokkaido Orthopedic Memorial Hospital, Sapporo, Japan
| | - Hiroshi Fujita
- Center for Hip Arthroplasty, Senshunkai Hospital, Kyoto, Japan
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Saito T, Shiono Y, Nagamine S, Fujita M, Okimoto T, Okabe T, Keida T, Ohira H, Kawase Y, Murata N, Yamashita J, Matsuo A, Fujita H, Takashima H, Amano T, Hokama Y, Matsuo H, Tanaka N, Akasaka T. Prognostic Values of Fractional Flow Reserve Based on Clinical Outcomes in Patients on Chronic Hemodialysis. Am J Cardiol 2023; 207:441-447. [PMID: 37797551 DOI: 10.1016/j.amjcard.2023.08.135] [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: 05/04/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 10/07/2023]
Abstract
The fractional flow reserve (FFR) cut-off values of 0.75 or 0.8 have been widely used; however, whether they apply to patients on hemodialysis remains unknown. We aimed to investigate the cut-off value of FFR associated with clinical outcomes in patients on hemodialysis. Using the Japanese multicenter registry, we analyzed data of patients on hemodialysis with measured FFR between January 2010 and December 2016. Survival classification and regression tree analysis for the composite primary outcome of cardiovascular mortality, myocardial infarction, and target vessel revascularization revealed a threshold FFR of 0.83. Multivariate Cox regression analyses were performed for the clinical outcomes. Additionally, the primary outcome was analyzed using propensity score matching by dividing the patients into complete and incomplete revascularization groups according to the presence of residual lesions with an FFR of ≤0.83 after the intervention. Of the 212 included patients, 112 (52.8%) had lesions with an FFR of ≤0.83. After adjusting for confounders, an FFR of ≤0.83 was associated with a higher risk for the primary outcome (adjusted hazard ratio 2.01, 95% confidence interval 1.11 to 3.66, p = 0.021). Propensity score matching showed that complete revascularization for lesions with an FFR of ≤0.83 was associated with a reduced risk for the primary outcome compared with incomplete revascularization (hazard ratio 0.38, 95% confidence interval 0.20 to 0.71, log-rank p = 0.0016). In conclusion, an FFR of ≤0.83 was an independent predictor of clinical events in patients on hemodialysis. Furthermore, complete revascularization was associated with better clinical outcomes. Thus, this population may require a distinct FFR cut-off value.
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Affiliation(s)
- Tetsuya Saito
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sho Nagamine
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Masaki Fujita
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Teruo Okabe
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Takehiko Keida
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine. Gifu Heart Center, Gifu, Japan
| | - Naotaka Murata
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Akiko Matsuo
- Department of Cardiology, Kyoto City Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Kyoto City Hospital, Kyoto, Japan
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine. Gifu Heart Center, Gifu, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Yokoi M, Ito T, Kawada Y, Mizoguchi T, Yamamoto J, Mori K, Nakasuka K, Kikuchi S, Fujita H, Kitada S, Goto T, Seo Y. Malondialdehyde-Modified Low-Density Lipoprotein as a Predictor of Major Adverse Limb Events after Endovascular Therapy in Patients with Lower Extremity Arterial Disease. J Atheroscler Thromb 2023; 30:1612-1621. [PMID: 36889737 PMCID: PMC10627766 DOI: 10.5551/jat.64091] [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: 11/26/2022] [Accepted: 02/05/2023] [Indexed: 03/10/2023] Open
Abstract
AIM Adverse limb events after endovascular therapy (EVT) are a major concern. This study aimed to investigate the relationship between serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a potentially potent indicator of atherosclerosis, and clinical outcomes after EVT in patients with lower extremity arterial disease (LEAD). METHODS A total of 208 LEAD patients who underwent EVT and MDA-LDL measurements were retrospectively analyzed. Those with chronic limb-threatening ischemia (CLTI) were included in the CLTI subgroup (n=106). Patients were further categorized into the High or Low MDA-LDL groups according to the cut-off value calculated by receiver operating characteristic analysis. Major adverse limb events (MALE), a composite of cardiovascular death, limb-related death, major amputation, and target-limb revascularization, were evaluated. RESULTS MALE occurred in 73 (35%) patients. The median follow-up interval was 17.4 months. The MDA-LDL cut-off values were 100.5 U/L (area under the curve [AUC] 0.651) in the overall population and 98.0 U/L (AUC 0.724) in the CLTI subgroup. Overall, the High MDA-LDL group showed significantly higher total cholesterol (189.7±37.5 mg/dL vs. 159.3±32.0 mg/dL, p<0.01), low-density lipoprotein cholesterol (114.3±29.7 mg/dL vs. 87.3±25.3 mg/dL, p<0.01), and triglyceride (166.9±91.1 mg/dL vs. 115.8±52.3 mg/dL, p<0.01) than the Low MDA-LDL group. Multivariate Cox regression analyses revealed that MDA-LDL and C-reactive protein were independent predictors of MALE. In the CLTI subgroup, MDA-LDL was an independent predictor of MALE. The High MDA-LDL group showed worse MALE-free survival rates than the Low MDA-LDL group in overall (p<0.01) and in the CLTI subgroup (p=0.01). CONCLUSIONS Serum MDA-LDL level was associated with MALE after EVT.
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Affiliation(s)
- Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kento Mori
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Tanaka A, Fujita H, Ohashi K, Tsujikawa A, Uchiyama K, Ito T, Kawashima K, Kodama R, Mine T, Okuda M, Endoh T, Fukuyoshi Y, Kitazawa J, Sueoka E, Nagai K, Ishida A, Matsuzaki K, Kato Y, Takanashi K, Takahashi K. Home transfusions are implemented using diverse approaches in Japan. Vox Sang 2023; 118:938-946. [PMID: 37671662 DOI: 10.1111/vox.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/04/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Japan's ageing society has increased the need for home healthcare, including home transfusions. We hence aimed to elucidate the purpose and utilization of home transfusions in Japan, which has not been clarified to date. MATERIALS AND METHODS Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The study period was February to December 2019, and information of patients receiving home red blood cell transfusions, including patient background, pre-transfusion laboratory data and the purpose of the transfusions, was collected. RESULTS Haematological malignancies and solid tumours accounted for 70% of the patients' underlying diseases, with the former being significantly more common in urban areas. Regarding the purpose of the home transfusions, haematologists focused on symptom improvement, whereas gastroenterology surgeons focused on life support. Furthermore, maintenance of life was more likely to be the aim in the group of patients with the lowest level of activities of daily living. The main items that were significantly associated with a low haemoglobin level before transfusion included age ≥90 years and a gastroenterologist being the physician in charge. CONCLUSION Home transfusions were found to be performed in a restrictive and diverse manner in Japan. Life support is the second most common purpose of home transfusion in Japan, and optimizing effective home transfusion remains a challenge.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kota Ohashi
- TOTUS Home Care Clinic, Hemato-Homecare Network, Tokyo, Japan
| | | | | | - Tatsuya Ito
- Nishiosu Ito Internal Medicine and Department of Hematology, Hemato-Homecare Network, Aichi, Japan
| | | | | | - Takashi Mine
- Donated Blood Distribution Foundation, Tokyo, Japan
| | - Makoto Okuda
- Division of Blood Transfusion, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruo Endoh
- Department of Clinical Laboratory Science, School of Medical Technology, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Youko Fukuyoshi
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | - Junichi Kitazawa
- Division of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Eisaburo Sueoka
- Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Akaru Ishida
- Division of Transfusion Medicine and Cell Transplantation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Yoko Kato
- Department of Transfusion Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuo Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Arima K, Uemura N, Tsuneyoshi K, Fujita H, Kuroki H, Uemura S, Hanada N, Baba H, Komohara Y. Microsatellite Instability-high Signet Ring Cell Carcinoma of the Colon Treated With Immunotherapy: Report of a Case. Anticancer Res 2023; 43:4729-4733. [PMID: 37772544 DOI: 10.21873/anticanres.16669] [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: 07/12/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are attracting increasing attention as a novel and potentially curative therapy for microsatellite instability-high (MSI-H) colorectal cancer (CRC). CASE REPORT An 80-year-old female visited our hospital with complaints of lower abdominal pain due to bowel obstruction caused by descending colon cancer. After 1 month of metallic stent detention, she underwent radical surgery, although laparotomy showed broad peritoneal dissemination. Based on the genetic finding of MSI-H status, pembrolizumab therapy was administered in two cycles. Unfortunately, the therapy was ineffective, and the patient died after being discharged 5 months after surgery. CONCLUSION The findings in this case of MSI-H CRC with a poor response to an ICI suggest the importance of confirming HLA status, including beta-2-microglobulin and HLA expression, before starting ICI therapy in cases of MSI-H CRC.
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Affiliation(s)
- Kota Arima
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Norio Uemura
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kengo Tsuneyoshi
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Hiroshi Fujita
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Hideyuki Kuroki
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichiro Uemura
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Norihisa Hanada
- Department of Surgery, Izumi General Medical Center, Kagoshima, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Osada H, Seto M, Nakase K, Ezoe K, Miyauchi O, Fujita H, Miyakawa Y, Nagaishi M, Kato K, Teramoto S, Shozu M. Prevalence of chronic endometritis in patients with infertility due to hydrosalpinx or pelvic peritubal adhesions and effect of laparoscopic surgical correction on pregnancy rates post in vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2023; 284:143-149. [PMID: 36996643 DOI: 10.1016/j.ejogrb.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE(S) To assess the prevalence of chronic endometritis (CE) in patients with infertility and hydrosalpinx or peritubal adhesions and to examine the effects of laparoscopic surgical correction (LSC) on CE and pregnancy rates post in vitro fertilization and embryo transfer (IVF-ET). STUDY DESIGN This is a retrospective cohort study at private IVF-ET centers. A total of 438 patients, known to have hydrosalpinx (n = 194) or peritubal adhesions (n = 244), and undergoing IVF treatment between April 1, 2018 and September 30, 2020 were included in the study. Hysterosalpingography, magnetic resonance imaging, and transvaginal ultrasonography were used to diagnose the hydrosalpinx or peritubal adhesions. Laparoscopic examination and surgical correction were performed on patients with CE. IVF-ET was performed after recovery from LSC. RESULTS CE was present in 45.9% of patients (89/194) with hydrosalpinx and 14.3% with peritubal adhesions (35/244). All the 89 patients with CE and hydrosalpinx underwent laparoscopic salpingostomy and/or fimbrioplasty, and 64 (71.9%) further underwent proximal tubal occlusion. All the 35 patients with CE and peritubal adhesions underwent laparoscopic adhesiolysis and/or fimbrioplasty, and 19 (54.3%) further underwent proximal tubal occlusion. CD138 PC levels after LSC decreased to < 5 in 70 of 124 patients (56.5%) in one menstrual cycle and decreased to < 5 in all cases within 6 months. Of the 66 patients who underwent a single blastocyst transfer, 57 delivered (cumulative live birth rate (LBR): 86.3%). The cumulative LBR of patients treated for CE with LSC (86.3%) was significantly different from those given antibiotic therapy (320 patients; 38.4%; p <.0001) and the CD138-negative groups (811; 31.8%; p <.0001). CONCLUSION CE is prevalent in patients with hydrosalpinx and/or peritubal adhesions who present with infertility. LSC improved CE without antibiotic therapy, improving the CP and LBR after IVF-ET.
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Affiliation(s)
- Hisao Osada
- Natural ART Clinic Nihombashi, Tokyo Nihombashi Tower (8F), 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6028, Japan.
| | - Michiharu Seto
- Seto Hospital, 8-6 Kanayama-cho, Tokorozawa-shi, Saitama 359-1128, Japan.
| | - Kaori Nakase
- Kato Ladies Clinic, 7-20-3, Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Kenji Ezoe
- Kato Ladies Clinic, 7-20-3, Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Osamu Miyauchi
- Natural ART Clinic Nihombashi, Tokyo Nihombashi Tower (8F), 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6028, Japan.
| | - Hiroshi Fujita
- Kato Ladies Clinic, 7-20-3, Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Yasuji Miyakawa
- Nihon University Hospital, 1-6, Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
| | - Masaji Nagaishi
- Nihon University Hospital, 1-6, Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan.
| | - Keiichi Kato
- Kato Ladies Clinic, 7-20-3, Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Shokichi Teramoto
- Natural ART Clinic Nihombashi, Tokyo Nihombashi Tower (8F), 2-7-1 Nihombashi, Chuo-ku, Tokyo 103-6028, Japan.
| | - Makio Shozu
- Chiba University Postgraduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture 260-0876, Japan.
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Kimizu T, Ida S, Oki K, Shima M, Nishimoto S, Nakajima K, Ikeda T, Mogami Y, Yanagihara K, Matsuda K, Nishi E, Hasegawa Y, Nozaki M, Fujita H, Irie A, Katayama T, Okamoto N, Imai K, Nishio H, Suzuki Y. Newborn screening for spinal muscular atrophy in Osaka -challenges in a Japanese pilot study. Brain Dev 2023:S0387-7604(23)00058-X. [PMID: 36973114 DOI: 10.1016/j.braindev.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/21/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This study aimed to establish an optional newborn screening program for spinal muscular atrophy (SMA-NBS) in Osaka. METHODS A multiplex TaqMan real-time quantitative polymerase chain reaction assay was used to screen for SMA. Dried blood spot samples obtained for the optional NBS program for severe combined immunodeficiency, which covers about 50% of the newborns in Osaka, were used. To obtain informed consent, participating obstetricians provided information about the optional NBS program to all parents by giving leaflets to prospective parents and uploading the information onto the internet. We prepared a workflow so that babies that were diagnosed with SMA through the NBS could be treated immediately. RESULTS From 1 February 2021 to 30 September 2021, 22,951 newborns were screened for SMA. All of them tested negative for survival motor neuron (SMN)1 deletion, and there were no false-positives. Based on these results, an SMA-NBS program was established in Osaka and included in the optional NBS programs run in Osaka from 1 October 2021. A positive baby was found by screening, diagnosed with SMA (the baby possessed 3 copies of the SMN2 gene and was pre-symptomatic), and treated immediately. CONCLUSION The workflow of the Osaka SMA-NBS program was confirmed to be useful for babies with SMA.
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Affiliation(s)
- Tomokazu Kimizu
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan.
| | - Shinobu Ida
- Department of Laboratory Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Keisuke Oki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Morimasa Shima
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Shizuka Nishimoto
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Ken Nakajima
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tae Ikeda
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yukiko Mogami
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Keiko Yanagihara
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Keiko Matsuda
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Eriko Nishi
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuiko Hasegawa
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Masatoshi Nozaki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Hiroshi Fujita
- Department of Laboratory Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Akemi Irie
- Department of Laboratory Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Toru Katayama
- Department of Laboratory Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kohsuke Imai
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan; Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Hisahide Nishio
- Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
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9
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Fujita H, Makino S, Hasegawa T, Saima Y, Tanaka Y, Nagashima S, Kakehashi A, Kaburaki T. Thyroid eye disease following administration of the BNT162B2 COVID-19 vaccine. QJM 2023; 116:130-132. [PMID: 36448695 DOI: 10.1093/qjmed/hcac265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- H Fujita
- From the Department of Ophthalmology, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
| | - S Makino
- Inoda Eye Clinic, Nasushiobara-shi, Tochigi-ken, Japan
- Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
| | - T Hasegawa
- From the Department of Ophthalmology, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
| | - Y Saima
- Division of Ophthalmology, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
| | - Y Tanaka
- From the Department of Ophthalmology, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
| | - S Nagashima
- Department of Endocrinology and Metabolism, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
| | - A Kakehashi
- From the Department of Ophthalmology, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
| | - T Kaburaki
- From the Department of Ophthalmology, Saitama Medical Center Jichi Medical University, Saitama-shi, Saitama-ken, Japan
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10
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Kondo T, Teramoto A, Watanabe E, Sobue Y, Izawa H, Saito K, Fujita H. Prediction of Short-Term Mortality of Cardiac Care Unit Patients Using Image-Transformed ECG Waveforms. IEEE J Transl Eng Health Med 2023; 11:191-198. [PMID: 36994109 PMCID: PMC10042295 DOI: 10.1109/jtehm.2023.3250352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The early detection of cardiac disease is important because the disease can lead to sudden death and poor prognosis. Electrocardiograms (ECG) are used to screen for cardiac diseases and are useful for the early detection and determination of treatment strategies. However, the ECG waveforms of cardiac care unit (CCU) patients with severe cardiac disease are often complicated by comorbidities and patient conditions, making it difficult to predict the severity of further cardiac disease. Therefore, this study predicts the short-term prognosis of CCU patients to detect further deterioration in CCU patients at an early stage. METHODS The ECG data (II, V3, V5, aVR induction) of CCU patients were converted to image data. The transformed ECG images were used to predict short-term prognosis with a two-dimensional convolutional neural network (CNN). RESULTS The prediction accuracy was 77.3%. Visualization by GradCAM showed that the CNN tended to focus on the shape and regularity of waveforms, such as heart failure and myocardial infarction. CONCLUSION These results suggest that the proposed method may be useful for short-term prognosis prediction using the ECG waveforms of CCU patients. CLINICAL IMPACT The proposed method could be used to determine the treatment strategy and choose the intensity of treatment after admission to the CCU.
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Affiliation(s)
- Terumasa Kondo
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Atsushi Teramoto
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Eiichi Watanabe
- Department of Internal Medicine, Division of Cardiology, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Yoshihiro Sobue
- Department of Internal Medicine, Division of Cardiology, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Aichi, Japan
| | - Kuniaki Saito
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
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11
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Tanaka A, Fujita H, Ohashi K, Tsujikawa A, Uchiyama K, Ito T, Kawashima K, Kodama R, Mine T, Okuda M, Endoh T, Fukuyoshi Y, Kitazawa J, Sueoka E, Nagai K, Ishida A, Matsuzaki K, Kato Y, Takanashi K, Takahashi K. Management system of home transfusion in Japan: A nationwide survey in 2019. Vox Sang 2023; 118:59-67. [PMID: 36454538 DOI: 10.1111/vox.13380] [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: 04/20/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES In Japan, there are various opinions on the pros and cons of home transfusion because of safety concerns. We hence aimed to elucidate the safety and availability of home transfusion in Japan, which has not been clarified to date. MATERIALS AND METHODS Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The analysis period was February to December 2019. Basic information about the clinics, their collaboration system with core hospitals, storage method of red blood cells (RBCs) and the system for the management of patient information regarding transfusion reactions were investigated. RESULTS Detailed information was obtained regarding the implementation of home transfusions by 51 clinics. The proportion of home care clinics performing home transfusions was 17.6%, and they were more frequently performed in urban regions. Approximately half of the clinics collaborated with a core hospital for emergency responses to transfusion reactions. At 84% of the clinics, RBC units were stored in refrigerators that were not exclusively allocated to blood storage. Nurses and family members were involved as patient attendants in 83% and 77% of the home transfusions, respectively. No serious transfusion reactions were reported among the 150 patients in 2019, nor the 623 patients up to 2018. CONCLUSION From data on its availability and safety, home transfusions are considered to be in the developing phase in Japan. Increased cooperation between hospitals and clinics is crucial towards improving the home transfusion system in Japan in the future.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kota Ohashi
- TOTUS Home Care Clinic, Hemato-Homecare Network, Tokyo, Japan
| | | | | | - Tatsuya Ito
- Nishiosu Ito Internal Medicine and Department of Hematology, Hemato-Homecare Network, Aichi, Japan
| | | | | | - Takashi Mine
- Donated Blood Distribution Foundation, Tokyo, Japan
| | - Makoto Okuda
- Division of Blood Transfusion, Toho University Omori Medical Center, Tokyo, Japan
| | - Teruo Endoh
- Department of Clinical Laboratory Science, School of Medical Technology, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Youko Fukuyoshi
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | - Junichi Kitazawa
- Division of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Eisaburo Sueoka
- Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Akaru Ishida
- Division of Transfusion Medicine and Cell Transplantation, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Yoko Kato
- Department of Transfusion Medicine, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuo Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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12
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Watanabe D, Yoshida T, Nanri H, Watanabe Y, Itoi A, Goto C, Ishikawa-Takata K, Yamada Y, Fujita H, Miyachi M, Kimura M. Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study. J Nutr Health Aging 2023; 27:1228-1237. [PMID: 38151874 DOI: 10.1007/s12603-023-2041-7] [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: 09/07/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Although better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS We used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study. MESUREMENTS Dietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. RESULTS During the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54-1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52-1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. CONCLUSIONS Our findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.
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Affiliation(s)
- D Watanabe
- Daiki Watanabe, RD, PhD, Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama 359-1192, Japan. Tel.: +81-4-2947-6936. E-mail:
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13
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Fujita H, Ito T, Kikuchi S, Seo Y. Postprocedural ascending aortic dissection after transcatheter aortic valve implantation: a case report. Eur Heart J Case Rep 2022; 7:ytac486. [PMID: 36685099 PMCID: PMC9843675 DOI: 10.1093/ehjcr/ytac486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/10/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) has been established as an effective and safe treatment for patients with severe aortic stenosis (AS). It is reported that vascular complications, especially aortic dissection, are rare. However, aortic dissection may be a serious consequence if it occurs. We experienced a case of delayed onset of ascending aortic dissection after TAVI. Case summary An 82-year-old woman presented with dyspnoea and general fatigue. Echocardiography revealed severe AS and she was diagnosed with heart failure associated with AS. She had difficulty controlling heart failure and required the intervention of the aortic valve. We evaluated the aortic valve and access routes with contrast-enhanced computed tomography (CT), which showed marked dilatation of the ascending aorta. Transcatheter aortic valve implantation was performed and the procedure was completed without major complications. Transoesophageal echocardiography during the procedure did not detect any obvious arterial injury. However, on the second postoperative day, the patient suddenly became unconscious and a CT indicated an ascending aortic dissection. Unfortunately, she passed away. An autopsy revealed the fragility of the ascending aorta. Conclusion Patients with AS and aortic root dilatation may develop delayed onset of ascending aortic dissection after TAVI.
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Affiliation(s)
| | - Tsuyoshi Ito
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shohei Kikuchi
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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14
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Teramoto A, Tsukamoto T, Michiba A, Kiriyama Y, Sakurai E, Imaizumi K, Saito K, Fujita H. Automated Classification of Idiopathic Pulmonary Fibrosis in Pathological Images Using Convolutional Neural Network and Generative Adversarial Networks. Diagnostics (Basel) 2022; 12:diagnostics12123195. [PMID: 36553202 PMCID: PMC9777207 DOI: 10.3390/diagnostics12123195] [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: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Interstitial pneumonia of uncertain cause is referred to as idiopathic interstitial pneumonia (IIP). Among the various types of IIPs, the prognosis of cases of idiopathic pulmonary fibrosis (IPF) is extremely poor, and accurate differentiation between IPF and non-IPF pneumonia is critical. In this study, we consider deep learning (DL) methods owing to their excellent image classification capabilities. Although DL models require large quantities of training data, collecting a large number of pathological specimens is difficult for rare diseases. In this study, we propose an end-to-end scheme to automatically classify IIPs using a convolutional neural network (CNN) model. To compensate for the lack of data on rare diseases, we introduce a two-step training method to generate pathological images of IIPs using a generative adversarial network (GAN). Tissue specimens from 24 patients with IIPs were scanned using a whole slide scanner, and the resulting images were divided into patch images with a size of 224 × 224 pixels. A progressive growth GAN (PGGAN) model was trained using 23,142 IPF images and 7817 non-IPF images to generate 10,000 images for each of the two categories. The images generated by the PGGAN were used along with real images to train the CNN model. An evaluation of the images generated by the PGGAN showed that cells and their locations were well-expressed. We also obtained the best classification performance with a detection sensitivity of 97.2% and a specificity of 69.4% for IPF using DenseNet. The classification performance was also improved by using PGGAN-generated images. These results indicate that the proposed method may be considered effective for the diagnosis of IPF.
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Affiliation(s)
- Atsushi Teramoto
- School of Medical Sciences, Fujita Health University, Toyoake 470-1192, Japan
- Correspondence:
| | - Tetsuya Tsukamoto
- Graduate School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Ayano Michiba
- Graduate School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Yuka Kiriyama
- Graduate School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Eiko Sakurai
- Graduate School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kazuyoshi Imaizumi
- Graduate School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kuniaki Saito
- School of Medical Sciences, Fujita Health University, Toyoake 470-1192, Japan
| | - Hiroshi Fujita
- Faculty of Engineering, Gifu University, Gifu 501-1194, Japan
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15
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Matsubara T, Soma K, Yamada I, Fujita H, Yoshitani J, Oka H, Okada H, Tanaka S. Offset nail fixation for intertrochanteric fractures improves reduction and lag screw position. PLoS One 2022; 17:e0276903. [PMCID: PMC9668128 DOI: 10.1371/journal.pone.0276903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background
Surgery for intertrochanteric fractures using intramedullary hip nails (IHNs) is among the most common surgical procedures in the orthopedic field. Although IHNs provide good overall outcomes, they sometimes cause complications, such as loss of reduction and cut-out. Here, we investigated the usefulness of IHNs with an anterior offset (Best Fit Nail® [BFN]) in maintaining fragment reduction and ensuring proper lag screw position compared with conventional non-offset nails (Proximal Femoral Nail Antirotation® [PFNA]), using postoperative computed tomography (CT).
Methods
Fifty consecutive patients with intertrochanteric fractures who underwent surgery with BFNs (BFN group) and 50 patients who underwent surgery with PFNAs (PFNA group) were retrospectively analyzed. Indices evaluated by postoperative CT were displacement distance of proximal fragment relative to distal fragment, reduction status (intramedullary, anatomical, and extramedullary types), lag screw direction, and angle between lag screw and femoral neck axis (deviation angle).
Results
Median [interquartile range] displacement distance was significantly smaller in the BFN group (0 [0, 0] mm) compared with the PFNA group (5.2 [3.6, 7.1] mm) (p<0.001). Reduction status was significantly better in the BFN group (anatomical type, 40 cases; intramedullary type, in 9 cases, and extramedullary type in 1 case) than in the PFNA group (anatomical type, 6 cases; intramedullary type, 43 cases; extramedullary type, 1 case) (p<0.001). Deviation of lag screw direction was observed in significantly fewer cases in the BFN group (20 cases; 40%) compared with the PFNA group (36 cases; 72%). Lag screw deviation angle was significantly smaller in the BFN group (−0.71°±4.0°) compared with the PFNA group (6.9°±7.1°). No adverse events related to surgery were observed in either group.
Conclusions
Intertrochanteric fracture surgery using offset BFNs exhibited significantly smaller displacement distance, better reduction status, and higher frequency of no deviation with central lag screw position, compared with surgery using non-offset PFNAs.
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Affiliation(s)
- Takehiro Matsubara
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | | - Ikufumi Yamada
- Fushimi Momoyama General Hospital, Fushimi-ku, Kyoto, Japan
| | - Hiroshi Fujita
- Hip Joint Center of Rakuyo Hospital, Sakyo-ku, Kyoto, Japan
| | | | - Hiroyuki Oka
- Faculty of Medicine, Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Okada
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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16
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Yokoi M, Ito T, Yamamoto J, Mori K, Nakasuka K, Fujita H, Kitada S, Goto T, Seo Y. A Case of Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention Due to Acquired Antithrombin Deficiency-related Heparin Resistance Successfully Treated with Antithrombin Gamma Supplementation. Intern Med 2022. [PMID: 36351584 DOI: 10.2169/internalmedicine.0720-22] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 75-year-old man receiving treatment for necrotizing pancreatitis developed septic disseminated intravascular coagulation and acute coronary syndrome (ACS). During percutaneous coronary intervention (PCI), a large amount of fresh thrombi appeared after balloon dilatation for the ACS-culprit lesion. Given the low plasma AT activity and poorly prolonged activated clotting time (ACT), we suspected that acquired AT deficiency-related heparin resistance (HR) was responsible for the thrombus formation. Administration of AT gamma markedly improved ACT, and we successfully completed PCI. We suggest that AT gamma be considered a treatment option for AT deficiency-related HR and subsequent intraprocedural thrombotic events.
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Affiliation(s)
- Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kento Mori
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Japan
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17
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Otsuka Y, Ishii M, Nakamura T, Tsujita K, Fujita H, Matoba T, Kohro T, Kabutoya T, Kario K, Kiyosue A, Mizuno Y, Nakayama M, Miyamoto Y, Sato H, Nagai R. Impact of BNP level in patients with heart failure on major bleeding events after percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) presents a bleeding risk assessment in antithrombotic therapy for patients post percutaneous coronary intervention (PCI). In Japanese patients, heart failure (HF), peripheral vascular disease, and frailty are established as bleeding risk factors in addition to ARC-HBR. However, it is unknown whether left ventricular function or severity of HF is associated with HBR. The aim of this study was to investigate the association between the severity of HF measured by BNP and future bleeding events after PCI.
Methods
Clinical Deep Data Accumulation System (CLIDAS), a multicenter database with 7 tertiary medical hospitals in JAPAN, was developed to collect data directly for patient characteristics, medications, laboratory test, physiological test, cardiac catheterization and PCI treatment in electronic medical records using Standardized Structured Medical Information eXchange Extended Storage (SS-MIX). This retrospective analysis using CLIDAS database included 7160 patients who underwent PCI during April 2014 and March 2020 in the participating hospitals and also who have completed 3-year follow-up were divided into two groups: No HF (n=6645) and HF (n=515). HF patients were furthermore divided based on high BNP (≥100 pg/ml) group (n=384) and low BNP (<100 pg/ml) group (n=131). Primary outcome was defined as bleeding events according to the moderate and severe bleeding in the GUSTO classification. In addition, secondary endpoint was major adverse cardiovascular events (MACE) defined as a composite of cardiac death, myocardial infraction and stroke.
Results
Multivariable Cox regression adjusted for age, sex, BMI, acute coronary syndrome, hypertension, diabetes, dyslipidemia, chronic kidney disease, hemodialysis, previous PCI, previous coronary artery bypass grafting, prior myocardial infraction, prior stroke, prior atrial fibrillation, prior PVD, left main trunk disease, multivessel disease, and anticoagulants use showed that HF with high BNP was significantly associated with bleeding events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.10–2.50), MACE (HR, 2.16; 95% CI, 1.60–2.90), and all-cause death (HR, 1.74; 95% CI, 1.30–2.33), but not HF with low BNP.
Conclusions
The CLIDAS real-world database revealed that HF with high BNP was associated with future bleeding events, suggesting that bleeding risk might be altered depending on severity of HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Otsuka
- Kumamoto University Hospital , Kumamoto , Japan
| | - M Ishii
- Kumamoto University Hospital , Kumamoto , Japan
| | - T Nakamura
- Kumamoto University Hospital , Kumamoto , Japan
| | - K Tsujita
- Kumamoto University Hospital , Kumamoto , Japan
| | - H Fujita
- Jichi Medical University , Tochigi , Japan
| | - T Matoba
- Kyushu University , Fukuoka , Japan
| | - T Kohro
- Jichi Medical University , Tochigi , Japan
| | - T Kabutoya
- Jichi Medical University , Tochigi , Japan
| | - K Kario
- Jichi Medical University , Tochigi , Japan
| | | | - Y Mizuno
- University of Tokyo , Tokyo , Japan
| | | | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital , Osaka , Japan
| | - H Sato
- Precision K.K. , Tokyo , Japan
| | - R Nagai
- Jichi Medical University , Tochigi , Japan
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Akashi N, Fujita H, Matoba T, Kohro T, Kabutoya T, Imai Y, Kario K, Kiyosue A, Nakayama M, Miyamoto Y, Nakamura T, Tsujita K, Matoba Y, Sato H, Nagai R. Hyperuricemia predicts worse prognosis in patients with chronic coronary syndrome after percutaneous coronary intervention: insights from Japanese real-world database using a storage system. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The relationship between hyperuricemia (HUA) and cardiovascular disease was observed in some epidemiological studies. However, the association between HUA and chronic coronary syndrome (CCS) after percutaneous coronary intervention (PCI) is not fully elucidated.
Purpose
The purpose of this study was to investigate the prognostic impact of HUA in patients with CCS after PCI.
Methods
This study is a retrospective, multicenter, observational study. We developed the Clinical Deep Data Accumulation System (CLIDAS), which consists of 6 university hospitals and the national cardiovascular center in Japan, directly obtains clinical data including patients background, laboratory data, echocardiogram, electrocardiogram, cardiac catheterization report, prescription, and long-term outcome from electronic medical records. A total of 9936 consecutive patients after PCI were analyzed. Of them, 5138 patients with CCS after PCI during April 2013 and March 2019 were analyzed, and divided into HUA group (patients with HUA at baseline, n=1724) and non-HUA group (patients without HUA at baseline, n=3414). HUA was defined as a serum uric acid levels ≥7.0 mg/dL for men or ≥6.0 mg/dL for women and/or taking urate-lowering drugs. The primary outcome was the major cardiovascular events (MACE) defined as being the composite of cardiovascular death, myocardial infarction, and hospitalization for heart failure.
Results
The median follow-up duration was 910 days (interquartile range: 307–1479 days). The proportion of male (78% vs. 78%) and age (71±11 vs. 71±10) were similar between the HUA and the non-HUA groups. The prevalence of hypertension (87% vs. 82%), atrial fibrillation (9% vs. 5%), and history of previous hospitalization for heart failure (15% vs. 6%) and baseline creatinine value (1.8±2.3 vs. 1.5±2.0 mg/dL) were significantly higher in the HUA group. In contrast, the prevalence of diabetes (43% vs. 48%) was significantly lower in the HUA group. The incidence of MACE was significantly higher in the HUA group than in the non-HUA group (13.1% vs. 6.4%, log rank P<0.001). Multivariate Cox regression analyses revealed that hyperuricemia was significantly associated with MACE (hazard ratio 1.50, 95% confidence interval 1.22–1.84, P<0.001) after controlling for other cardiovascular risk factors.
Conclusion
The real-world database CLIDAS revealed that hyperuricemia was significantly associated with the increase of MACE in patients with CCS after PCI. This result sheds light on the significant role of urate in prediction of prognosis, suggesting the possibility of new therapeutic approaches using urate-lowering drugs or SGLT2 inhibitors for the CCS patients.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa Co., Ltd
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Affiliation(s)
- N Akashi
- Jichi Medical University Saitama Medical Center , Saitama , Japan
| | - H Fujita
- Jichi Medical University Saitama Medical Center , Saitama , Japan
| | - T Matoba
- Kyushu University Graduate School of Medical Sciences, Cardiovascular Medicine , Fukuoka , Japan
| | - T Kohro
- Jichi Medical University, Clinical Informatics , Tochigi , Japan
| | - T Kabutoya
- Jichi Medical University, Cardiovascular Medicine , Tochigi , Japan
| | - Y Imai
- Jichi Medical University, Clinical Pharmacology , Tochigi , Japan
| | - K Kario
- Jichi Medical University, Cardiovascular Medicine , Tochigi , Japan
| | - A Kiyosue
- University of Tokyo Hospital, Cardiovascular Medicine , Tokyo , Japan
| | - M Nakayama
- Tohoku University Graduate School of Medicine, Medical Informatics , Sendai , Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Open Innovation Center , Osaka , Japan
| | - T Nakamura
- Kumamoto University Hospital, Medical Informatics , Kumamoto , Japan
| | - K Tsujita
- Kumamoto University Hospital, Cardiovascular Medicine , Kumamoto , Japan
| | | | - H Sato
- Precision , Tokyo , Japan
| | - R Nagai
- Jichi Medical University , Tochigi , Japan
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19
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Okutani Y, Fujita H, Harada H, Kataoka M, Murotani Y, Shimizu Y. Hip Function Was Not Associated with the Incidence of Preoperative Deep Vein Thrombosis in Patients Undergoing Primary Total Hip Arthroplasty. Acta Med Okayama 2022; 76:577-584. [PMID: 36352805 DOI: 10.18926/amo/64039] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The prevalence of preoperative deep vein thrombosis (DVT) has been reported to be relatively high in patients undergoing total hip arthroplasty. We investigated the prevalence of DVT, the association between hip function and preoperative DVT, and the effect of a history of surgery in patients who underwent primary total hip arthroplasty. We retrospectively analyzed the cases of the patients who underwent primary total hip arthroplasty between April 2013 and February 2020 at our institution. We evaluated the prevalence of preoperative DVT based on the results of the patients' ultrasound screening. We performed univariate and multivariate analyses to investigate the association between the incidence of DVT and patient factors including age, sex, hip function, medical histories, and American Society of Anesthesiologists Physical Status classification. We analyzed 451 patients (494 hips). The prevalence of DVT was 14.2% (64 patients). The multivariate analysis demonstrated that increased age was an independent significant risk factor for DVT. The prevalence of preoperative DVT was relatively high among patients who underwent primary total hip arthroplasty. Preoperative DVT tended to be more prevalent in older patients. Hip function was not associated with the incidence of DVT.
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Affiliation(s)
- Yuki Okutani
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital
| | | | - Hideto Harada
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital
| | | | - Yoshiki Murotani
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Kyoto City Hospital
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20
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Yokoi M, Ito T, Fujita H, Kitada S, Goto T, Seo Y. Cardiac Magnetic Resonance Assessment of Acute Myocardial Infarction Involving the Right Ventricle. Circ J 2022; 86:2044. [PMID: 36171083 DOI: 10.1253/circj.cj-22-0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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21
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Oshita Y, Takeuchi N, Teramoto A, Kondo M, Imaizumi K, Saito K, Fujita H. [Prognosis Prediction of Lung Cancer Patients Using CT Images: Feature Extraction by Convolutional Neural Network and Prediction by Machine Learning]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:829-837. [PMID: 35811128 DOI: 10.6009/jjrt.2022-1224] [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] [Indexed: 06/15/2023]
Abstract
PURPOSE Lung cancer accounts for the largest number of deaths among malignant tumors. Recently, more and more patients are concerned about their own life expectancy. CT examination is essential for the diagnosis of lung cancer. However, it is difficult to accurately predict the prognosis using CT images. In this study, we developed a method to predict the prognosis of lung cancer patients from CT images using a convolutional neural network (CNN) and a machine learning method. METHODS In this study, the CT images of 173 lung cancer patients were collected. First, we selected the slice with the largest tumor size in each case and extracted features using a CNN. Next, we performed feature selection using information gain and predicted alive or death by classifiers. An artificial neural network or Naïve Bayes was used as a classifier and alive and death were predicted at one-year intervals from one year to five years later. RESULTS We evaluated the prediction accuracy via the three-fold cross-validation method and found that the prediction accuracies were around 80% for all periods from 1 to 5 years. In the evaluation of the survival curve, the shape of the curve was close to the actual curve. CONCLUSION These results indicate that feature extraction by a CNN and classification by the machine learning method may be effective in predicting the prognosis of lung cancer patients using CT images.
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Affiliation(s)
- Yuki Oshita
- Graduate School of Health Sciences, Fujita Health University
| | - Nonoko Takeuchi
- Graduate School of Health Sciences, Fujita Health University (Current address: FUJIFILM Medical Corporation)
| | - Atsushi Teramoto
- Intelligent Information Engineering Field, Research Promotion Unit, School of Medical Sciences, Fujita Health University
| | | | | | - Kuniaki Saito
- Advanced Diagnostic System Development Field, Research Promotion Unit, School of Medical Sciences, Fujita Health University
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22
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Toda R, Teramoto A, Kondo M, Imaizumi K, Saito K, Fujita H. Lung cancer CT image generation from a free-form sketch using style-based pix2pix for data augmentation. Sci Rep 2022; 12:12867. [PMID: 35896575 PMCID: PMC9329467 DOI: 10.1038/s41598-022-16861-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Artificial intelligence (AI) applications in medical imaging continue facing the difficulty in collecting and using large datasets. One method proposed for solving this problem is data augmentation using fictitious images generated by generative adversarial networks (GANs). However, applying a GAN as a data augmentation technique has not been explored, owing to the quality and diversity of the generated images. To promote such applications by generating diverse images, this study aims to generate free-form lesion images from tumor sketches using a pix2pix-based model, which is an image-to-image translation model derived from GAN. As pix2pix, which assumes one-to-one image generation, is unsuitable for data augmentation, we propose StylePix2pix, which is independently improved to allow one-to-many image generation. The proposed model introduces a mapping network and style blocks from StyleGAN. Image generation results based on 20 tumor sketches created by a physician demonstrated that the proposed method can reproduce tumors with complex shapes. Additionally, the one-to-many image generation of StylePix2pix suggests effectiveness in data-augmentation applications.
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Affiliation(s)
- Ryo Toda
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan.,Graduate School of Informatics, Nagoya University, Aichi, Japan
| | - Atsushi Teramoto
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan.
| | - Masashi Kondo
- School of Medicine, Fujita Health University, Aichi, Japan
| | | | - Kuniaki Saito
- Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
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23
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Ertunc N, Phitak T, Wu D, Fujita H, Hane M, Sato C, Kitajima K. Sulfation of sialic acid is ubiquitous and essential for vertebrate development. Sci Rep 2022; 12:12496. [PMID: 35864127 PMCID: PMC9304399 DOI: 10.1038/s41598-022-15143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
Glycosylation of proteins and lipids occurs in vertebrates, usually terminating with sialylation, which regulates the physicochemical and biological properties of these glycoconjugates. Although less commonly known, sialic acid residues also undergo various modifications, such as acetylation, methylation, and sulfation. However, except for acetylation, the enzymes or functions of the other modification processes are unknown. To the best of our knowledge, this study is the first to demonstrate the ubiquitous occurrence of sulfated sialic acids and two genes encoding the sialate: O-sulfotransferases 1 and 2 in vertebrates. These two enzymes showed about 50% amino acid sequence identity, and appeared to be complementary to each other in acceptor substrate preferences. Gene targeting experiments showed that the deficiency of these genes was lethal for medaka fish during young fry development and accompanied by different phenotypes. Thus, the sulfation of sialic acids is essential for the vertebrate development.
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Affiliation(s)
- Nursah Ertunc
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan.,Molecular Cell Biology, Faculty of Medical Technology, Graduate School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Thanyaluck Phitak
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan.,Biochemistry Department, Faculty of Medicine, Chiangmai University, Chiangmai, 50200, Thailand
| | - Di Wu
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan.,Institute for Glyco-Core Research (iGCORE), Nagoya University, Nagoya, 464-8601, Japan
| | - Hiroshi Fujita
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan
| | - Masaya Hane
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan.,Institute for Glyco-Core Research (iGCORE), Nagoya University, Nagoya, 464-8601, Japan
| | - Chihiro Sato
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan.,Institute for Glyco-Core Research (iGCORE), Nagoya University, Nagoya, 464-8601, Japan
| | - Ken Kitajima
- Bioscience and Biotechnology Center, and Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya, 464-8601, Japan. .,Institute for Glyco-Core Research (iGCORE), Nagoya University, Nagoya, 464-8601, Japan.
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24
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Hara H, Fujita H, Okutani Y, Kataoka M, Harada H, Murotani Y. The influence of anterior and posterior knot placement on hip function after total hip arthroplasty using a modified Dall's approach: a prospective non-randomised comparative study. Hip Int 2022; 32:443-451. [PMID: 33297766 DOI: 10.1177/1120700020977789] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The direct lateral modified Dall's approach for total hip arthroplasty (THA) provides an excellent vision of the hip joint by osteotomising the greater trochanter (GT). A robust method for the reattachment of osteotomised fragments is essential to prevent complications around the GT. Ultra-high molecular weight polyethylene cables are reported to be useful for reattachment; but the optimal suture method of these cables is unknown. The purpose of this study was to investigate the influence of the knot position on hip function after primary THA. METHODS In a prospective non-randomised study 216 primary THA were included, being scheduled for an operation with a modified Dall's approach. They were divided into 2 groups, anterior (A) and posterior (P) according to the knot position for the GT. Hip function was assessed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), pain visual analogue scale (VAS), satisfaction VAS and Merle d'Aubigne-Postel hip score at 3 and 6 months postoperatively. A logistic regression analysis was used to investigate factors influenced by the knot position. RESULTS Patient demographics were comparable between the 2 groups. Differences of the knot position did not affect the radiological failure rate of GT reattachment. Regression analysis showed a significantly positive impact on pain VAS and flexion range at 6 months postoperatively for posterior knot position. CONCLUSIONS For the reattachment of osteotomised fragments, the posterior knot may be superior to the anterior knot.
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Affiliation(s)
- Hiroaki Hara
- Department of Rehabilitation, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Department of Orthopaedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yuki Okutani
- Department of Orthopaedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanao Kataoka
- Department of Orthopaedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hideto Harada
- Department of Orthopaedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yoshiki Murotani
- Department of Orthopaedic Surgery, Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
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25
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Sakatani T, Kasahara T, Irie D, Tsubakimoto Y, Matsuo A, Fujita H, Inoue K. Prognostic value of left ventricular mechanical dyssynchrony induced by exercise stress in patients with normal myocardial perfusion single-photon emission computed tomography. J Nucl Cardiol 2022; 29:1-10. [PMID: 33083982 DOI: 10.1007/s12350-020-02389-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. METHODS We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). RESULTS During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P = .001, PSD: 14 ± 9 vs 10 ± 6, P = .001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P = .026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P = .006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P = .019), but the pharmacological stress bandwidth had no influence on MCEs. CONCLUSIONS LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events.
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Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan.
| | - Takeru Kasahara
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Daisuke Irie
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Yoshinori Tsubakimoto
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
| | - Hiroshi Fujita
- Department of Cardiology, North Medical Center, Kyoto Prefectural University of Medicine, 481 Otokoyama, Yosano-cho, Kyoto, 629-2261, Japan
| | - Keiji Inoue
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan
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26
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Yokoi M, Ito T, Nakayama T, Fujita H, Sugiura T, Seo Y. Effects of hemodialysis and reduced estimated glomerular filtration rate in nonhemodialysis on clinical outcomes after fractional flow reserve-guided deferral of revascularization. Medicine (Baltimore) 2022; 101:e29256. [PMID: 35608428 PMCID: PMC9276252 DOI: 10.1097/md.0000000000029256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/21/2022] [Indexed: 01/04/2023] Open
Abstract
The effect of renal dysfunction on clinical outcomes following fractional flow reserve (FFR)-guided deferral of revascularization remains unelucidated.We retrospectively analyzed 224 patients with atherosclerotic coronary lesions who underwent deferred revascularization based on an FFR of >0.80. The median follow-up interval was 28.1 months. Patients were divided into 2 groups: the hemodialysis (HD) and the non-HD group. The non-HD group was further classified into 2 subgroups according to their estimated glomerular filtration rate (eGFR) level: eGFR <45, equivalent to chronic kidney disease stage 3b-5 and eGFR ≥45. We evaluated major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and any revascularization.MACE occurred in 36 patients (16.1%). The rate of HD was significantly higher in the MACE group (19% vs 6%, P < .01). In non-HD patients, the eGFR was significantly lower in the MACE group (51.2 vs 63.2 mL/min/1.73 m2, P < .01). Overall, univariate Cox regression analysis revealed a significant relationship between HD and MACE (HR 2.91, P = .01), as did the multivariate model (HR 2.90, P = .01). Of the MACE, more deaths occurred in HD patients (15.8% vs 2.9%, P = .03). Among non-HD patients, eGFR <45 (HR 2.70, P = .02), FFR (per 0.01, HR 0.87, P < .01), and low-density lipoprotein cholesterol (per 10 mg/dL, HR 1.17, P = .02) were independent predictors of MACE. Any revascularization was more common in patients with eGFR<45 than in those with eGFR ≥45 (21.4% vs 7.3%, P = .02). Kaplan-Meier estimates revealed that the HD group showed a significantly lower MACE-free survival rate than the nonHD group (log-rank P < .01). In non-HD patients, the eGFR<45 group showed a lower MACE-free survival rate than the eGFR ≥45 group (log-rank P = .01).HD and reduced eGFR in non-HD patients were associated with adverse cardiac events after FFR-guided deferral of revascularization.
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27
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Mizoguchi T, Yokoi M, Shintani Y, Yamamoto J, Mori K, Fujita H, Ito T, Sugiura T, Seo Y. A case of an elderly female who developed subacute pleuropericarditis following BNT162b2 mRNA COVID-19 vaccination. J Cardiol Cases 2022; 26:225-228. [PMID: 35600413 PMCID: PMC9110567 DOI: 10.1016/j.jccase.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/09/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Despite the established safety of BNT162b2 coronavirus disease 2019 (COVID-19) vaccine, some rare but serious complications have been previously reported. Here, we report a rare case of an elderly female who developed subacute pleuropericarditis after the vaccination. An 88-year-old female experienced weight gain and dyspnea three days after the second dose of BNT162b2 vaccination, and one month later, presented to our hospital due to the exacerbation of the symptoms. Computed tomography showed remarkable pericardial and bilateral pleural effusions, and transthoracic echocardiogram visualized collapse signs of right and left atrium which indicates pre-tamponade. Percutaneous drainages of pericardial and pleural effusions stabilized her vital condition and revealed that all of them were exudative, indicating the presence of pleuropericarditis. Finally, we diagnosed this case as COVID-19 vaccine-associated pleuropericarditis because there were no signs of bacterial/viral infection or any other relevant causes except for the vaccination. When the pericardial and pleural effusions are concurrently found after COVID-19 vaccination, vaccine-associated pleuropericarditis should be considered as a differential diagnosis. The aggressive drainage of pericardial and pleural effusions could be helpful not only for diagnosis but also for treatment in the clinical management of COVID-19 vaccine-associated pleuropericarditis. Learning objective Although the safety and efficacy of BNT162b2 have been widely accepted, it is clinically important to know the potential risk of side effects. When the pericardial and pleural effusions are concurrently found after the vaccination, coronavirus disease 2019 vaccine-associated pleuropericarditis should be considered as a differential diagnosis.
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Affiliation(s)
| | - Masashi Yokoi
- Corresponding author at: Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuhocho, Nagoya, Aichi 4678601, Japan.
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28
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Morishita T, Muramatsu C, Seino Y, Takahashi R, Hayashi T, Nishiyama W, Zhou X, Hara T, Katsumata A, Fujita H. Tooth recognition of 32 tooth types by branched single shot multibox detector and integration processing in panoramic radiographs. J Med Imaging (Bellingham) 2022; 9:034503. [PMID: 35756973 DOI: 10.1117/1.jmi.9.3.034503] [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: 08/27/2021] [Accepted: 06/02/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose: The purpose of our study was to analyze dental panoramic radiographs and contribute to dentists' diagnosis by automatically extracting the information necessary for reading them. As the initial step, we detected teeth and classified their tooth types in this study. Approach: We propose single-shot multibox detector (SSD) networks with a side branch for 1-class detection without distinguishing the tooth type and for 16-class detection (i.e., the central incisor, lateral incisor, canine, first premolar, second premolar, first molar, second molar, and third molar, distinguished by the upper and lower jaws). In addition, post-processing was conducted to integrate the results of the two networks and categorize them into 32 classes, differentiating between the left and right teeth. The proposed method was applied to 950 dental panoramic radiographs obtained at multiple facilities, including a university hospital and dental clinics. Results: The recognition performance of the SSD with a side branch was better than that of the original SSD. In addition, the detection rate was improved by the integration process. As a result, the detection rate was 99.03%, the number of false detections was 0.29 per image, and the classification rate was 96.79% for 32 tooth types. Conclusions: We propose a method for tooth recognition using object detection and post-processing. The results show the effectiveness of network branching on the recognition performance and the usefulness of post-processing for neural network output.
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Affiliation(s)
- Takumi Morishita
- Gifu University, Graduate School of Natural Science and Technology, Department of Intelligence Science and Engineering, Gifu, Japan
| | | | - Yuta Seino
- Gifu University, Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu, Japan
| | | | | | - Wataru Nishiyama
- Asahi University, School of Dentistry, Department of Oral Radiology, Mizuho, Japan
| | - Xiangrong Zhou
- Gifu University, Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu, Japan
| | - Takeshi Hara
- Gifu University, Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu, Japan
| | - Akitoshi Katsumata
- Asahi University, School of Dentistry, Department of Oral Radiology, Mizuho, Japan
| | - Hiroshi Fujita
- Gifu University, Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu, Japan
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29
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Tsukamoto T, Teramoto A, Yamada A, Kiriyama Y, Sakurai E, Michiba A, Imaizumi K, Fujita H. Comparison of Fine-Tuned Deep Convolutional Neural Networks for the Automated Classification of Lung Cancer Cytology Images with Integration of Additional Classifiers. Asian Pac J Cancer Prev 2022; 23:1315-1324. [PMID: 35485691 PMCID: PMC9375620 DOI: 10.31557/apjcp.2022.23.4.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE It is essential to accurately diagnose and classify histological subtypes into adenocarcinoma (ADC), squamous cell carcinoma (SCC), and small cell lung carcinoma (SCLC) for the appropriate treatment of lung cancer patients. However, improving the accuracy and stability of diagnosis is challenging, especially for non-small cell carcinomas. The purpose of this study was to compare multiple deep convolutional neural network (DCNN) technique with subsequent additional classifiers in terms of accuracy and characteristics in each histology. METHODS Lung cancer cytological images were classified into ADC, SCC, and SCLC with four fine-tuned DCNN models consisting of AlexNet, GoogLeNet (Inception V3), VGG16 and ResNet50 pretrained by natural images in ImageNet database. For more precise classification, the figures of 3 histological probabilities were further applied to subsequent machine learning classifiers using Naïve Bayes (NB), Support vector machine (SVM), Random forest (RF), and Neural network (NN). RESULTS The classification accuracies of the AlexNet, GoogLeNet, VGG16 and ResNet50 were 74.0%, 66.8%, 76.8% and 74.0%, respectively. Well differentiated typical morphologies were tended to be correctly judged by all four architectures. However, poorly differentiated non-small cell carcinomas lacking typical structures were inclined to be misrecognized in some DCNNs. Regarding the histological types, ADC were best judged by AlexNet and SCC by VGG16. Subsequent machine learning classifiers of NB, SVV, RF, and NN improved overall accuracies to 75.1%, 77.5%, 78.2%, and 78.9%, respectively. CONCLUSION Fine-tuning DCNNs in combination with additional classifiers improved classification of cytological diagnosis of lung cancer, although classification bias could be indicated among DCNN architectures.
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Affiliation(s)
- Tetsuya Tsukamoto
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsushi Teramoto
- Faculty of Radiological Technology, Fujita Health University School of Health Sciences, Toyoake, Japan
| | - Ayumi Yamada
- Faculty of Radiological Technology, Fujita Health University School of Health Sciences, Toyoake, Japan
| | - Yuka Kiriyama
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake, Japan.,Department of Diagnostic Pathology, Narita Memorial Hospital, Toyohashi, Japan
| | - Eiko Sakurai
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ayano Michiba
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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Ito T, Yamaji K, Kohsaka S, Ishii H, Wada H, Amano T, Fujita H, Seo Y, Ikari Y. Effect of Procedural Volume on In-Hospital Outcomes After Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease (from the Japanese National Clinical Data [J-PCI Registry]). Am J Cardiol 2022; 165:12-18. [PMID: 34893300 DOI: 10.1016/j.amjcard.2021.10.042] [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] [Received: 08/21/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
Chronic kidney disease (CKD) increases the risk of death and other poor outcomes in patients with cardiovascular diseases. This study investigated the relation between the institutional CKD percutaneous coronary intervention (PCI) volume and in-hospital clinical outcomes in patients with CKD. Among 1,199,901 patients who underwent PCI in 2014 to 2018 from the Japanese nationwide registry, we analyzed 220,509 patients with CKD. Patients were classified into quartiles (Q) according to the mean annual institutional CKD-PCI volume (Q1 <42 PCIs/year, Q2 <74 PCIs/year, Q3 <124 PCIs/year, Q4 ≥125 PCIs/year). The primary outcome was a composite of in-hospital death and periprocedural complications. The mean age of patients was 73 ± 10 years, and 36% (n = 78,332) were on dialysis. PCI was more likely to be performed with rotational atherectomy devices in high-volume institutions. Contrast volume was lower, the rate of radial access PCI was higher, and door-to-balloon time (for ST-elevation myocardial infarction) was shorter in the highest quartile institutions. Primary outcomes were observed in 6,539 patients (3.0%). The crude rate of the primary outcome was lowest in institutions with the highest PCI volume (Q1 3.4%, Q2 3.0%, Q3 3.0%, Q4 2.4%, p <0.001); higher PCI volume was associated with reduced frequency of the primary outcome (odds ratio [95% confidence interval] relative to Q1:Q2, 0.89 [0.83 to 0.96]; Q3 0.90 [0.84 to 0.97]; and Q4 0.76 [0.84 to 0.97]). In conclusion, the procedural characteristics and outcomes of PCI differed significantly by institutional volume in patients with CKD. When considering revascularization among these patients, institutional CKD-PCI volume needs to be incorporated in decision-making.
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Affiliation(s)
- Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka, Hospital Shizuoka Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
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Kario K, Yokoi Y, Okamura K, Fujihara M, Ogoyama Y, Yamamoto E, Urata H, Cho JM, Kim CJ, Choi SH, Shinohara K, Mukai Y, Ikemoto T, Nakamura M, Seki S, Matoba S, Shibata Y, Sugawara S, Yumoto K, Tamura K, Yoshihara F, Nakamura S, Kang WC, Shibasaki T, Dote K, Yokoi H, Matsuo A, Fujita H, Takahashi T, Kang HJ, Sakata Y, Horie K, Inoue N, Sasaki KI, Ueno T, Tomita H, Morino Y, Nojima Y, Kim CJ, Matsumoto T, Kai H, Nanto S. Catheter-based ultrasound renal denervation in patients with resistant hypertension: the randomized, controlled REQUIRE trial. Hypertens Res 2022; 45:221-231. [PMID: 34654905 PMCID: PMC8766280 DOI: 10.1038/s41440-021-00754-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Renal denervation is a promising new non-pharmacological treatment for resistant hypertension. However, there is a lack of data from Asian patients. The REQUIRE trial investigated the blood pressure-lowering efficacy of renal denervation in treated patients with resistant hypertension from Japan and South Korea. Adults with resistant hypertension (seated office blood pressure ≥150/90 mmHg and 24-hour ambulatory systolic blood pressure ≥140 mmHg) with suitable renal artery anatomy were randomized to ultrasound renal denervation or a sham procedure. The primary endpoint was change from baseline in 24-hour ambulatory systolic blood pressure at 3 months. A total of 143 patients were included (72 renal denervation, 71 sham control). Reduction from baseline in 24-hour ambulatory systolic blood pressure at 3 months was not significantly different between the renal denervation (-6.6 mmHg) and sham control (-6.5 mmHg) groups (difference: -0.1, 95% confidence interval -5.5, 5.3; p = 0.971). Reductions from baseline in home and office systolic blood pressure (differences: -1.8 mmHg [p = 0.488] and -2.0 mmHg [p = 0.511], respectively), and medication load, did not differ significantly between the two groups. The procedure-/device-related major adverse events was not seen. This study did not show a significant difference in ambulatory blood pressure reductions between renal denervation and a sham procedure in treated patients with resistant hypertension. Although blood pressure reduction after renal denervation was similar to other sham-controlled studies, the sham group in this study showed much greater reduction. This unexpected blood pressure reduction in the sham control group highlights study design issues that will be addressed in a new trial. CLINICAL TRIAL REGISTRATION: NCT02918305 ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Keisuke Okamura
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Yukako Ogoyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Hidenori Urata
- Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Jin-Man Cho
- Division of Cardiology, Department of Internal Medicine, KyungHee University Hospital at Gangdong, Seoul, South Korea
| | - Chong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, CHA Gangnam Medical Center, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yasushi Mukai
- Division of Cardiology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Tomokazu Ikemoto
- Division of Cardiology, Kumamoto Red Cross Hospital, Kumamoto, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shuichi Seki
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Shigeo Sugawara
- Department of Cardiology, Nihonkai General Hospital, Yamagata, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Medical Center, Kanagawa, Japan
| | - Fumiki Yoshihara
- Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoko Nakamura
- Department of Nutritional Science for Well-being, Kansai University of Welfare Sciences, Osaka, Japan
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Taro Shibasaki
- Department of Cardiology, Saitama Sekishinkai Hospital, Saitama, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Akiko Matsuo
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Department of Cardiology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Hyun-Jae Kang
- Department of Internal Medicine, Seoul National University Hospital and University College of Medicine, Seoul National University, Seoul, South Korea
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital, Miyagi, Japan
| | - Naoto Inoue
- Cardiovascular Center, Tokyo Kamata Hospital, Tokyo, Japan
| | - Ken-Ichiro Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Takafumi Ueno
- Division of Cardiology, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yuhei Nojima
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center, Fukuoka, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
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Murotani Y, Fujita H, Hara H, Harada H, Kataoka M, Okutani Y. Good result for twelve years after bilateral hip and knee arthroplasties for ankylosis with juvenile idiopathic arthritis: a case report. Nagoya J Med Sci 2022; 84:185-199. [PMID: 35392010 PMCID: PMC8971032 DOI: 10.18999/nagjms.84.1.185] [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] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Abstract
Juvenile idiopathic arthritis (JIA) can lead to joint deformity and bone destruction, which can cause gait disturbances. To the best of our knowledge, there are no case reports with over 10 years of follow-up on quadruple joint arthroplasties (QJA) for bilateral hip and knee ankylosis associated with JIA. We present the case of a 29-year-old woman with JIA. The patient suffered from bilateral ankylosis of the hips and knees and developed a swing gait requiring double crutches. We performed staged QJA with careful attention to postoperative rehabilitation and her physical features, which included excessive pelvic anteversion, poor bone quality, and short statue of bones. Twelve years after surgery, the patient was able to walk without any support and showed good clinical functional scores. In addition, no radiological loosening following QJA was observed. We hereby introduce a surgical strategy for total hip arthroplasty for excessive pelvic anteversion, which involves two methods to calculate pelvic tilt on a pelvic anteroposterior radiograph. These methods were able to approximately predict postoperative pelvic changes.
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Affiliation(s)
- Yoshiki Murotani
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Center for Hip and Knee Arthroplasty, Rakuyo Hospital, Kyoto, Japan
| | - Hiroaki Hara
- Rehabilitation Center, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hideto Harada
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanao Kataoka
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yuki Okutani
- Institute for Joint Replacement, Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
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Nanri H, Watanabe D, Yoshida T, Yoshimura E, Okabe Y, Ono M, Koizumi T, Kobayashi H, Fujita H, Kimura M, Yamada Y. Adequate Protein Intake on Comprehensive Frailty in Older Adults: Kyoto-Kameoka Study. J Nutr Health Aging 2022; 26:161-168. [PMID: 35166309 DOI: 10.1007/s12603-022-1740-9] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Defining an adequate protein intake in older adults remains unresolved. We examined the association between calibrated protein intake and comprehensive frailty by sex in the Kyoto-Kameoka study. DESIGN Cross-sectional study of baseline data. SETTING AND PARTICIPANTS The study included 5679 Japanese participants aged 65 years or older. METHODS Calibration coefficients were estimated from food frequency questionnaires and 7-day dietary records as a reference. Comprehensive frailty was evaluated using the 25-item Kihon Checklist (KCL) and defined as a total KCL score of ≥7points. Sex-specific calibrated protein intakes were presented as % of energy, per kg of actual body weight (BW), and per kg of ideal BW. RESULTS Multiple logistic regression analysis showed that calibrated protein intake is inversely associated with comprehensive frailty. The association between protein intake and comprehensive frailty was also evaluated using curve fitting with non-linear regression, a weak U-shaped association was found in males and an L-shaped association in females. Men had a low prevalence of frailty at a calibrated protein intake of 15-17% energy from protein, 1.2 g/kg actual BW/day, or 1.4 g/kg ideal BW/day, and women had a low prevalence of frailty at 17-21% energy from protein or 1.6 g/kg ideal BW/day, with the prevalence of frailty remaining unchanged at higher protein intakes. Meanwhile, the inverse relationship between protein intake per ABW and frailty showed a gradual decrease at 1.4 g/kg ABW/day for protein in women. CONCLUSIONS AND IMPLICATIONS A non-linear relationship was found between calibrated protein intake and frailty, with a U-shaped association in men and an L-shaped association in women. Adequate protein intake in healthy Japanese older adults was higher than the current recommended daily allowance.
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Affiliation(s)
- H Nanri
- Hinako Nanri, Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan, E-mail:
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Fujita H, Toba T, Miwa K, Suzuki M, Takahashi Y, Toh H, Izawa Y, Kawamori H, Otake H, Fujiwara S, Watanabe Y, Kono A, Hirata KI. The impact of computed tomography-derived aortic atheroma volume on prognosis after transcatheter aortic valve replacement. Int J Cardiol 2021; 344:60-65. [PMID: 34600978 DOI: 10.1016/j.ijcard.2021.09.053] [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: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of the extent of aortic atheroma on patients' prognosis after transcatheter aortic valve replacement (TAVR) has not been completely evaluated. This study aimed to evaluate the prognostic value of the aortic atheroma volume (AAV) derived from computed tomography, and the effect of its differences among the segments of the aorta, in patients undergoing TAVR. METHODS In total, 143 patients with symptomatic severe aortic stenosis who underwent pre-procedural computed tomography before TAVR procedure indication were evaluated. AAV was calculated by measuring the aortic lumen and vessel volume using every 1-mm axial image and was further divided into thoracic (TAAV) and abdominal segments (AbAAV). RESULTS During a median follow-up of 651 days, 24 all-cause and 14 cardiac deaths occurred. In the Kaplan-Meier analysis, the high AAV group had significantly higher all-cause and cardiac mortalities than the low AAV group (p = 0.016 and 0.023, respectively). Regarding segmental AAV, all-cause and cardiac mortalities did not have significant differences between the high and low TAAV groups. Moreover, all-cause and cardiac mortalities were significantly higher in the high AbAAV group than in the low AbAAV group (p = 0.0043 and 0.023, respectively). The multivariable analysis showed that only AbAAV was an independent predictor for all-cause mortality (hazard ratio: 1.06, p = 0.046). CONCLUSION AAV was significantly associated with the mortality after TAVR. The current study suggests the pre-procedural assessment of AAV is valuable in predicting prognosis after TAVR. However, further investigation with a larger sample size is needed to validate our findings.
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Affiliation(s)
- Hiroshi Fujita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Keisuke Miwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate school of Medicine, Kobe, Japan
| | - Atsushi Kono
- Department of Radiology, Kobe University Graduate school of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Takahashi Y, Ota A, Tohyama J, Kirino T, Fujiwara Y, Ikeda C, Tanaka S, Takahashi J, Shinoki T, Shiraga H, Inoue T, Fujita H, Bonno M, Nagao M, Kaneko H. Different pharmacoresistance of focal epileptic spasms, generalized epileptic spasms, and generalized epileptic spasms combined with focal seizures. Epilepsia Open 2021; 7:85-97. [PMID: 34773678 PMCID: PMC8886099 DOI: 10.1002/epi4.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/26/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Among standard treatments for infantile spasms, adrenocorticotropic hormone (ACTH) is reported as the best treatment, but ACTH is ineffective in one‐half of the patients. To establish precision medicine, we examined pharmacoresistance of focal epileptic spasms (ES), generalized ES, and generalized ES combined with focal seizures, diagnosed based on the revised seizure classification of ILAE in 2017. Methods We conducted a retrospective nationwide study in Japan on the long‐term seizure outcome of ES. Long‐term seizure outcome was evaluated by seizure‐free rate, seizure‐free period, and Kaplan‐Meier curve. Seizure‐free was defined as seizure control for longer than 2 months. Results From the medical history of 501 patients, 325 patients had generalized ES only (GES group) at the start of the first treatment, 125 patients had generalized ES after focal seizure onset (FS‐GES group), seven patients had focal ES after focal seizure onset (FS‐FES group), and 24 patients had generalized ES combined with focal seizures after focal seizure onset (FS‐GES + FS group). Seizure‐free period of ES (generalized ES and focal ES) [mean (95% confidence interval)] was 2.7 (0.0‐5.4) months in GES group, 1.1 (0.1‐2.2) months in FS‐GES group, 1.0 (0.2‐1.9) months in FS‐GES + FS group, and 0.1 (−0.2‐0.5) months in FS‐FES group. Seizure‐free rate, seizure‐free period, and Kaplan‐Meier curve of generalized ES were almost the same in GES group and FS‐GES group, with characteristics of superior response to ACTH. Mean seizure‐free period of generalized ES combined with focal seizures was significantly shorter in FS‐GES + FS group than in GES group. Mean seizure‐free period of focal ES in FS‐FES group was extremely short with exceedingly early relapse. Significance Pharmacoresistance was different in generalized ES, focal ES, and generalized ES combined with focal seizures. ES with focal features or with focal seizures may have focal lesions, thus consider surgical options earlier in the course.
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Affiliation(s)
- Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan.,Department of Pediatrics, Gifu University School of Medicine, Gifu, Japan.,School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Akiko Ota
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Jun Tohyama
- NHO Nishiniigata Chuo Hospital, Niigata, Japan
| | - Tomoko Kirino
- Shikoku Medical Center for Children and Adults, NHO, Zentsuji, Japan
| | - Yumi Fujiwara
- Shikoku Medical Center for Children and Adults, NHO, Zentsuji, Japan
| | | | - Shigeki Tanaka
- National Hospital Nagasaki Medical Center, NHO, Omura, Japan
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Okutani Y, Fujita H, Harada H, Kataoka M, Shimizu Y, Murotani Y. Inverted reamer technique for bone grafting of the acetabulum: technical note. J Orthop Surg Res 2021; 16:655. [PMID: 34717711 PMCID: PMC8557518 DOI: 10.1186/s13018-021-02810-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Socket fixation with bone grafting for dysplastic hips is technically demanding, and inadequate coverage of the socket may cause poor results in patients with severely dysplastic hips. An accurate technique to form a bone graft to fit into the defect is necessary. We aim to introduce the simple method of bone grafting, “inverted reamer technique” in cemented total hip arthroplasty (cTHA). Methods After acetabular preparation with a normal acetabular reamer, the bone graft was prepared from the resected femoral head with the inverted reamer. The graft can be press-fit into the defect of the acetabulum with good compatibility through this method. Then, the bone graft was fixed with 1–3 screws and the socket was implanted with bone cement. Results The “inverted reamer technique” can easily and automatically create a well-fit graft. This method is simple and technically less demanding; it can be performed by every surgeon, including trainee and inexperienced surgeons. Conclusion This method can improve the outcome of cTHA for dysplastic hips by preserving bone stock and increasing bone coverage of the socket implanted in the anatomic position.
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Affiliation(s)
- Yuki Okutani
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Center for Hip and Knee Arthroplasty, Department of Orthopaedic Surgery, Kyoto Rakuyo Hospital, Iwakura-Agura-cho 143, Sakyo-ku, Kyoto, 606-0017, Japan.
| | - Hideto Harada
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanao Kataoka
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Yoshiki Murotani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Oba Y, Kohro T, Sato H, Nochioka K, Nakayama M, Fujita H, Mizuno Y, Kiyosue A, Iwanaga Y, Miyamoto Y, Matoba T, Tsutsui H, Nakamura T, Usuku K, Nagai R. The relationships among the pulse rate, use of beta-blockers, and prognosis in patients with ischemic heart disease in a real-world database using a storage system. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The use of β-blockers has the effect of improving the prognosis of patients with ischemic heart disease (IHD). One of the underlying mechanisms is a decrease in the cardiac load due to a reduction in the heart rate.
Purpose
To clarify the relationships among the pulse rate, the use of β-blockers, and the prognosis in patients with IHD in a multicenter study using a storage system.
Methods
The Clinical Deep Data Accumulation System (CLIDAS) collects (1) basic patient information, prescriptions, and laboratory data from electronic medical records from the Standardized Structured Medical Information eXchange (SS-MIX2) standard storage, and (2) the results of physiological tests, cardiac catheterization, and cardiac catheter intervention reports from the SS-MIX2 extended storage. 8540 cases who underwent cardiac catheterization from 6 university hospitals and the national cardiovascular center in Japan were registered (male: 77%, average age: 70.2 years). We evaluated these patients' pulse rate at admission and at the discharge of cardiac catheterization in 6,598 patients. We divided the pulse rates at discharge into quartiles (Q1: <60, Q2: 60–66, Q3: 67–75, Q4: ≥76 bpm), and we analyzed the relationship between the pulse rate and the prognosis by dividing the patients into the stable angina group (n=2,631) and the acute coronary syndrome (ACS) group (n=2,394). Regarding the use of β-blockers, we compared the pulse rates of the patients taking carvedilol (n=1,728) and those taking bisoprolol (n=2,761) at admission and discharge. Major adverse cardiovascular events (MACE) were defined as cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other hospitalized cardiovascular events.
Results
A total of 600 MACEs occurred during an average observation period of 890 days. The incidence of cardiovascular events was significantly higher in the Q4 patients in the stable angina group (hazard ratio 1.79, 95% confidence interval 1.32–2.41, but there was no significant difference among the four pulse rate subgroups in the ACS group. The bisoprolol-treated patients had lower pulse rates at discharge (67.4±12.2 vs. 68.8±11.8 bpm, p<0.001) and a lower percentage of patients in the Q4 group (21.2 vs. 24.9%, p=0.005) compared to the carvedilol-treated patients. The pulse rate at admission was similar in the bisoprolol- and carvedilol-treated patients (74.3±19.3 vs. 73.2±29.5 bpm, p=0.328).
Conclusion
In a real-world database using a storage system, a pulse rate of ≤75 bpm was associated with a good prognosis in patients with ACS. Compared to carvedilol, bisoprolol was associated with a decreased pulse rate at discharge.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Kowa Company, Ltd.
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Affiliation(s)
- Y Oba
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - T Kohro
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
| | - H Sato
- Precision Inc., Tokyo, Japan
| | | | | | - H Fujita
- Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Y Mizuno
- University of Tokyo, Tokyo, Japan
| | | | - Y Iwanaga
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Matoba
- Kyushu University, Fukuoka, Japan
| | | | | | - K Usuku
- Kumamoto University, Kumamoto, Japan
| | - R Nagai
- Jichi Medical University, Department of Internal Medicine, Tochigi, Japan
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Matoba T, Fujita H, Kohro T, Kabutoya T, Kiyosue A, Mizuno Y, Nakayama M, Nochioka K, Miyamoto Y, Iwanaga Y, Tsujita K, Nakamura T, Sato H, Tsutsui H, Nagai R. Clinical Deep Data Accumulation System (CLIDAS) reveals lipid paradox in guideline-defined high risk Japanese patients after PCI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Japanese clinical guidelines recommend a stratification of the risks and LDL-cholesterol (LDL-C) treatment goals for patients with coronary artery disease after percutaneous coronary intervention (PCI), i.e. <100 mg/dL for normal risk patients and <70 mg/dL for high risk patients; however, less is known about the association between baseline LDL-C values and long-term prognosis.
Purpose
To investigate the association between LDL-C goals and baseline LDL-C levels in relation to major adverse cardiovascular events (MACE) among high-risk patients after PCI, using a real-world database.
Methods
We developed the Clinical Deep Data Accumulation System (CLIDAS) that acquires clinical data directly from hospital information system, and implemented the system in 6 university hospitals and the national cardiovascular center in Japan. The CLIDAS database accumulates data regarding patient background, laboratory data, prescriptions, electrocardiogram, echocardiogram, PCI report, and long-term prognosis. We retrospectively analyzed 8540 consecutive patients who underwent PCI during April 2014 and March 2020 in participating hospitals, and classified them into the normal risk group (n=3712, 43%) and the high risk group [n=4828, 57%, with any of acute coronary syndrome (ACS), familial hypercholesterolemia (FH), or diabetes with additional risk factor(s)], for which LDL-C goals are <100 mg/dL and <70 mg/dL, respectively, according to the Japanese Atherosclerosis Society guidelines or the diagnosis and prevention of atherosclerotic cardiovascular diseases. The primary outcome was the time to first occurrence of MACE, a composite of cardiovascular death, stroke, myocardial infarction, and coronary revascularization in associations with baseline LDL-C levels and patient background.
Results
Proportion of male (77% vs. 77%) and age (71±11 vs. 70±11) were similar between 2 groups. The prevalence of ACS at the index PCI (0% vs. 62%), FH (0% vs. 2%), hypertension (61% vs. 86%), diabetes (11% vs. 67%), dyslipidemia (73% vs. 84%), hemodialysis (4% vs. 9%), peripheral artery disease (5% vs. 9%), smoking (16% vs. 30%), and prescription of statins (79% vs. 86%) were significantly higher in the high risk group. Among patients in the high risk group, but not in the normal risk group, baseline LDL-C <70 mg/dL was paradoxically associated with higher risk of MACE (P<0.0001 by Log-rank test) (Figure). The Cox proportional hazard model confirmed that the high risk group (risk ratio 1.54, 95% CI [1.31–1.81]), baseline LDL-C <70mg/dL (risk ratio 1.44, 95% CI [1.18–1.75]), baseline age (risk ratio 1.36, 95% CI [1.28–1.45] per 10 year), and prescription of statins (risk ratio 0.80, 95% CI [0.66–0.96]) were significantly associated with the risk of MACE in this population.
Conclusion
The CLIDAS real-world database revealed that baseline low LDL-C paradoxically associated with an increased risk of MACE among guideline-defined high risk patients after PCI.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jichi Medical University, Tochigi, Japan, and Kowa
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Affiliation(s)
- T Matoba
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - H Fujita
- Jichi Medical University Saitama Medical Center, Cardiology, Saitama, Japan
| | - T Kohro
- Jichi Medical University, Medical Informatics, Tochigi, Japan
| | - T Kabutoya
- Jichi Medical University, Cardiology, Tochigi, Japan
| | - A Kiyosue
- University of Tokyo Hospital, Cardiology, Tokyo, Japan
| | - Y Mizuno
- University of Tokyo Hospital, Cardiology, Tokyo, Japan
| | - M Nakayama
- Tohoku University Graduate School of Medicine, Medical Informatics, Sendai, Japan
| | - K Nochioka
- Tohoku University Graduate School of Medicine, Medical Informatics, Sendai, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Cerebral and Cardiovascular Disease Information, Osaka, Japan
| | - Y Iwanaga
- National Cerebral and Cardiovascular Center Hospital, Cerebral and Cardiovascular Disease Information, Osaka, Japan
| | - K Tsujita
- Kumamoto University Hospital, Cardiovascular Center, Kumamoto, Japan
| | - T Nakamura
- Kumamoto University Hospital, Medical Informatics, Kumamoto, Japan
| | | | - H Tsutsui
- Kyushu University, Cardiovascular Medicine, Fukuoka, Japan
| | - R Nagai
- Jichi Medical University, Tochigi, Japan
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Suzuki M, Toba T, Izawa Y, Fujita H, Miwa K, Takahashi Y, Toh H, Kawamori H, Otake H, Tanaka H, Fujiwara S, Watanabe Y, Kono AK, Okada K, Hirata KI. Prognostic Impact of Myocardial Extracellular Volume Fraction Assessment Using Dual-Energy Computed Tomography in Patients Treated With Aortic Valve Replacement for Severe Aortic Stenosis. J Am Heart Assoc 2021; 10:e020655. [PMID: 34482711 PMCID: PMC8649554 DOI: 10.1161/jaha.120.020655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial extracellular volume fraction (ECV), measured by cardiac magnetic resonance imaging, is a useful prognostic marker for patients who have undergone aortic valve replacement (AVR) for aortic stenosis. However, the prognostic significance of ECV measurements based on computed tomography (CT) is unclear. This study evaluated the association between ECV measured with dual-energy CT and clinical outcomes in patients with aortic stenosis who underwent transcatheter or surgical AVR. Methods and Results We retrospectively enrolled 95 consecutive patients (age, 84.0±5.0 years; 75% women) with severe aortic stenosis who underwent preprocedural CT for transcatheter AVR planning. ECV was measured using iodine density images obtained by delayed enhancement dual-energy CT. The primary end point was a composite outcome of all-cause death and hospitalization for heart failure after AVR. The mean ECV measured with CT was 28.1±3.8%. During a median follow-up of 2.6 years, 22 composite outcomes were observed, including 15 all-cause deaths and 11 hospitalizations for heart failure. In Kaplan-Meier analysis, the high ECV group (≥27.8% [median value]) had significantly higher rates of composite outcomes than the low ECV group (<27.8%) (log-rank test, P=0.012). ECV was the only independent predictor of adverse outcomes on multivariable Cox regression analysis (hazards ratio, 1.25; 95% CI, 1.10‒1.41; P<0.001). Conclusions Myocardial ECV measured with dual-energy CT in patients who underwent aortic valve intervention was an independent predictor of adverse outcomes after AVR.
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Affiliation(s)
- Masataka Suzuki
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Hiroshi Fujita
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Keisuke Miwa
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Hiroyuki Toh
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
| | - Yoshiaki Watanabe
- Department of Radiology Kobe University Graduate School of Medicine Japan
| | - Atsushi K Kono
- Department of Radiology Kobe University Graduate School of Medicine Japan
| | - Kenji Okada
- Division of Cardiovascular Surgery Department of Surgery Kobe University Graduate School of Medicine Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine Department of Internal Medicine Kobe University Graduate School of Medicine Japan
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Banno T, Wakami K, Kikuchi S, Fujita H, Goto T, Fukuta H, Seo Y, Ohte N. Non-Invasive Estimation of Left Ventricular Filling Pressure Based on Left Atrial Area Strain Measured With Transthoracic 3-Dimensional Speckle Tracking Echocardiography in Patients With Coronary Artery Disease. Circ Rep 2021; 3:520-529. [PMID: 34568631 PMCID: PMC8423614 DOI: 10.1253/circrep.cr-21-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background:
Chronic elevation of left ventricular (LV) diastolic pressure (DP) or chronic elevation of left atrial (LA) pressure, which is required to maintain LV filling, may determine LA wall deformation. We investigated this issue using transthoracic 3-dimensional speckle tracking echocardiography (3D-STE). Methods and Results:
We retrospectively enrolled 75 consecutive patients with sinus rhythm and suspected stable coronary artery disease who underwent diagnostic cardiac catheterization and 3D-STE on the same day. We computed the global LA wall area change ratio, termed the global LA area strain (GLAS), during both the reservoir phase (GLAS-r) and contraction phase (GLAS-ct). The LVDP at end-diastole (LVEDP) and mean LVDP (mLVDP) were measured with a catheter-tipped micromanometer in each patient. GLAS-r and GLAS-ct were significantly correlated with both mLVDP (r=−0.70 [P<0.001] and r=0.71 [P<0.001], respectively) and LVEDP (r=−0.63 [P<0.001] and r=0.65 [P<0.001], respectively). In receiver operating characteristic curve analysis, the optimal cut-off values for diagnosing elevated LVEDP (≥16 mmHg) were 75.7% (sensitivity 83.3%, specificity 77.8%) for GLAS-r and −43.1% (sensitivity 90.0%, specificity 80.0%) for GLAS-ct. Similarly, for diagnosing elevated mLVDP (≥12 mmHg), the cut-off values were 63.6% (sensitivity 88.9%, specificity 80.3%) for GLAS-r and −26.2% (sensitivity 66.7%, specificity 97.0%) for GLAS-ct. Conclusions:
We showed that 3D-STE-derived GLAS values could be used to non-invasively diagnose elevated LV filling pressure.
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Affiliation(s)
- Tomoyuki Banno
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Hidekatsu Fukuta
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan
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Shiono Y, Matsuo H, Fujita H, Tanaka N, Ogasawara Y, Kawamura I, Katayama Y, Matsuo A, Kawase Y, Kakuta T, Takashima H, Yokoi H, Ohira H, Suwa S, Oguri M, Yamamoto F, Kubo T, Akasaka T, Shiono Y, Katayama Y, Hironori K, Kubo T, Akasaka T, Tanaka N, Yamashita J, Fujita H, Matsuo A, Matsuo H, Kawase Y, Kawamura I, Kakuta T, Hoshino M, Sugano T, Takashima H, Amano T, Yokoi H, Yamamoto Y, Nozaki Y, Machida M, Kobori M, Kikuchi T, Ohira H, Yoshino H, Ishiguro H, Wakabayashi Y, Kondo T, Terai H, Suwa T, Kimura T, Kawajiri T, Hirohata A, Uemura S, Neishi Y, Sakamoto T, Yamada M, Okeie K, Hishikari K, Oguri M, Uetani T, Saegusa T, Yamamoto F, Yamada M. Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis. JACC: Asia 2021; 1:230-241. [PMID: 36338166 PMCID: PMC9627917 DOI: 10.1016/j.jacasi.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 01/10/2023]
Abstract
Background In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure–derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated. Objectives The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory–based environment. Methods In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease. Results Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUCdiastolic FFR: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUCFFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113). Conclusions Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906)
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Toh H, Mori S, Izawa Y, Fujita H, Miwa K, Suzuki M, Takahashi Y, Toba T, Watanabe Y, Kono AK, Tretter JT, Hirata KI. Prevalence and extent of mitral annular disjunction in structurally normal hearts: comprehensive 3D analysis using cardiac computed tomography. Eur Heart J Cardiovasc Imaging 2021; 22:614-622. [PMID: 33713105 DOI: 10.1093/ehjci/jeab022] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 01/26/2023] Open
Abstract
AIMS Mitral annular disjunction is fibrous separation between the attachment of the posterior mitral leaflet and the basal left ventricular myocardium initially described in dissected hearts. Currently, it is commonly evaluated by echocardiography, and potential relationships with mitral valve prolapse and ventricular arrhythmia have been suggested. However, controversy remains as its prevalence and extent have not been fully elucidated in normal living subjects. METHODS AND RESULTS Systolic datasets of cardiac computed tomography obtained from 98 patients (mean age, 69.1 ± 12.6 years; 81% men) with structurally normal hearts were assessed retrospectively. Circumferential extent of both mitral leaflets and disjunction was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral valvar orifice. Distribution angle within the circumference of the mitral valvar attachment and maximal height of disjunction were quantified. In total, 96.0% of patients demonstrated disjunction. Average distribution angles of the anterior and posterior mitral leaflets were 91.3 ± 9.4° and 269.8 ± 9.7°, respectively. Average distribution angle of the disjunction was 105.1 ± 49.2°, corresponding to 39.0 ± 18.2% of the entire posterior mitral valvar attachment. Median value of the maximal height of disjunction was 3.0 (1.5-7.0) mm. Distribution prevalence map of the disjunction revealed characteristic double peaks, with frequent sites of the disjunction located at the anterior to antero-lateral and inferior to infero-septal regions. CONCLUSION Mitral annular disjunction is a rather common finding in the normal adult heart with bimodal distribution predominantly observed involving the P1 and P3 scallops of the posterior mitral leaflet.
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Affiliation(s)
- Hiroyuki Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Suite #46-119C, 650 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Fujita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Miwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Takahashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Fujita H, Yokoi M, Ito T, Nakayama T, Shintani Y, Sugiura T, Seo Y, Ohte N. Unusual interventional treatment of spontaneous coronary artery dissection without stent implantation: a case series. Eur Heart J Case Rep 2021; 5:ytab306. [PMID: 34377927 PMCID: PMC8350351 DOI: 10.1093/ehjcr/ytab306] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/30/2020] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon (CB) angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after CB angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after CB angioplasty. Case summary Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with CB angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by CB angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy. Discussion Cutting balloon angioplasty may be a possible method to treat SCAD.
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Affiliation(s)
- Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yasuhiro Shintani
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Nishio M, Fujimoto K, Matsuo H, Muramatsu C, Sakamoto R, Fujita H. Lung Cancer Segmentation With Transfer Learning: Usefulness of a Pretrained Model Constructed From an Artificial Dataset Generated Using a Generative Adversarial Network. Front Artif Intell 2021; 4:694815. [PMID: 34337394 PMCID: PMC8322116 DOI: 10.3389/frai.2021.694815] [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] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: The purpose of this study was to develop and evaluate lung cancer segmentation with a pretrained model and transfer learning. The pretrained model was constructed from an artificial dataset generated using a generative adversarial network (GAN). Materials and Methods: Three public datasets containing images of lung nodules/lung cancers were used: LUNA16 dataset, Decathlon lung dataset, and NSCLC radiogenomics. The LUNA16 dataset was used to generate an artificial dataset for lung cancer segmentation with the help of the GAN and 3D graph cut. Pretrained models were then constructed from the artificial dataset. Subsequently, the main segmentation model was constructed from the pretrained models and the Decathlon lung dataset. Finally, the NSCLC radiogenomics dataset was used to evaluate the main segmentation model. The Dice similarity coefficient (DSC) was used as a metric to evaluate the segmentation performance. Results: The mean DSC for the NSCLC radiogenomics dataset improved overall when using the pretrained models. At maximum, the mean DSC was 0.09 higher with the pretrained model than that without it. Conclusion: The proposed method comprising an artificial dataset and a pretrained model can improve lung cancer segmentation as confirmed in terms of the DSC metric. Moreover, the construction of the artificial dataset for the segmentation using the GAN and 3D graph cut was found to be feasible.
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Affiliation(s)
- Mizuho Nishio
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Radiology, Kobe University Hospital, Kobe, Japan
| | - Koji Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Real World Data Research and Development, Kyoto University Graduate School of Medicine, Hikone, Japan
| | | | | | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Fujita
- Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University, Gifu, Japan
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45
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Niwa Y, Hayama K, Izaki S, Koga H, Ishii N, Terui T, Fujita H. Mucosa-predominant pemphigus vulgaris with anti-desmocollin 2 and 3 antibody positivity and ocular symptoms. Clin Exp Dermatol 2021; 46:1590-1592. [PMID: 34056753 DOI: 10.1111/ced.14771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Y Niwa
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - K Hayama
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - S Izaki
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - H Koga
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - N Ishii
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - T Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - H Fujita
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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46
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Sasaki F, Kanmura S, Oda K, Maeda H, Kabayama M, Iwaya H, Komaki Y, Arima S, Tanoue S, Hashimoto S, Fujita H, Ido A. Acetaldehyde breath test as a cancer risk marker in patients with esophageal and hypopharyngeal squamous cell carcinoma. PLoS One 2021; 16:e0251457. [PMID: 34010294 PMCID: PMC8133406 DOI: 10.1371/journal.pone.0251457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Patients with inactive acetaldehyde dehydrogenase 2 (ALDH2) are at high risk for esophageal squamous cell carcinoma (ESCC) and hypopharyngeal squamous cell carcinoma (HPSCC). The acetaldehyde breath test (ABT) may demonstrate ALDH2 gene polymorphisms. We evaluated the usefulness of the ABT in patients with ESCC and HPSCC. The squamous cell carcinoma (SCC) group consisted of 100 patients who were treated with endoscopic submucosal dissection (ESD) for ESCC or HPSCC, and the control group (HC) consisted of 275 healthy subjects. The SCC group comprised the “single subgroup” (n = 63), in which a single lesion was initially treated with ESD, and the “multiple subgroup” (n = 31), in which multiple lesions were initially treated with ESD. First, we compared the groups’ risk factors for carcinogenesis and measured the acetaldehyde-to-ethanol (A/E) ratio. Then we tested the groups’ differences in the abovementioned carcinogenic risk factors. We found that the proportion of individuals in the SCC group with inactive ALDH2 (A/E ratio ≥ 23.3) was significantly higher than that in the HC group (p = 0.035), as was the A/E ratio (p < 0.001). Also, the proportion of individuals with inactive ALDH2 in the multiple subgroup was significantly higher than that in single subgroup (p = 0.015), as was the A/E ratio (p = 0.008). In conclusion, ABT may be a potential screening tool for detecting people at risk of ESCC and HPSCC. In addition, it could be a useful tool in detecting patients at risk of multiple or double carcinomas among patients with ESCC and HPSCC. Trial registration: Trial Registration number: UMIN000040615 [https://rctportal.niph.go.jp/en/detail?trial_id=UMIN000040615], Data of Registration: 01 46 June 2020, retrospectively registered.
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Affiliation(s)
- Fumisato Sasaki
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- * E-mail:
| | - Shuji Kanmura
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kohei Oda
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hidehito Maeda
- Department of Gastroenterology and Hepatology, Izumi General Medical Center, Izumi city, Kagoshima, Japan
| | - Masayuki Kabayama
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiromichi Iwaya
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuga Komaki
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shiho Arima
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shiroh Tanoue
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shinichi Hashimoto
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Fujita
- Department of Gastroenterology and Hepatology, Izumi General Medical Center, Izumi city, Kagoshima, Japan
| | - Akio Ido
- Department of Human and Environmental Sciences, Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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47
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Hayakawa T, Teramoto A, Kiriyama Y, Tsukamoto T, Yamada A, Saito K, Fujita H. Development of Pathological Diagnosis Support System Using Micro-computed Tomography. Acta Histochem Cytochem 2021; 54:49-56. [PMID: 34012176 PMCID: PMC8116619 DOI: 10.1267/ahc.20-00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/03/2021] [Indexed: 11/22/2022] Open
Abstract
In pathological diagnosis, the cutting position of pathological materials is subjectively determined by pathologists. This leads to a low cutting accuracy, which in turn may lead to incorrect diagnoses. In this study, we developed a system that supports the determination of the cutting position by visualizing and analyzing the internal structure of pathological material using micro-computed tomography (CT) before cutting. This system consists of a dedicated micro-CT and cutting support software. The micro-CT system has a fixture for fixing the target, enabling the scanning of easily deformable pathological materials. In the cutting support software, a function that interactively selects the extraction plane while displaying the volume rendering image and outputs a pseudo-histological image was implemented. Our results confirmed that the pseudo-histological image showed the fine structure inside the organ and that the latter image was highly consistent with the pathological image.
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Affiliation(s)
| | | | | | | | - Ayumi Yamada
- Graduate School of Health Sciences, Fujita Health University
| | - Kuniaki Saito
- Graduate School of Health Sciences, Fujita Health University
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48
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Ishida T, Morisawa S, Iizuka M, Fujita H, Jobu K, Morita Y, Miyamura M. Juzentaihoto extract suppresses adipocyte hypertrophy and improves hyperglycemia in KKAy mice. Pharmazie 2021; 75:191-194. [PMID: 32393426 DOI: 10.1691/ph.2020.9950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Juzentaihoto is a herbal medicine with reported anti-inflammatory effects, and it is predicted to improve inflammation and insulin sensitivity within obesity. In the present study, juzentaihoto hot water extract (JTT) was administered to obese type 2 diabetic model mice (KKAy) for 56 days. In addition, the effects of JTT on the adipose tissue, glucose metabolism, and blood lipids were evaluated for examining its impact on insulin sensitivity and obesity. As a result of JTT administration, KKAy mice exhibited suppressed adipocyte hypertrophy, decreased the mRNA levels of tumor necrosis factor α, and increased the mRNA levels of adiponectin in epididymal fat tissue. In addition, fasting blood glucose levels, blood triglyceride, and total cholesterol decreased. In summary, these data indicated that JTT administration suppressed the production of inflammatory cytokines and increased adiponectin levels in the adipose tissue. Therefore, with improved insulin sensitivity, blood glucose, and lipid decreased.
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Affiliation(s)
- T Ishida
- Department of Pharmacy, Kochi Medical School Hospital, Kohasu Kochi, Japan; Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan;,
| | - S Morisawa
- Department of Pharmacy, Kochi Medical School Hospital, Kohasu Kochi, Japan; Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
| | - M Iizuka
- Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
| | - H Fujita
- Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
| | - K Jobu
- Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
| | - Y Morita
- Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
| | - M Miyamura
- Department of Pharmacy, Kochi Medical School Hospital, Kohasu Kochi, Japan; Department of Biomedical Science, Kochi Medical Graduate School, Kohasu Kochi, Japan
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49
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Kobayashi Y, Tohyama J, Takahashi Y, Goto T, Haginoya K, Inoue T, Kubota M, Fujita H, Honda R, Ito M, Kishimoto K, Nakamura K, Sakai Y, Takanashi JI, Tanaka M, Tanda K, Tominaga K, Yoshioka S, Kato M, Nakashima M, Saitsu H, Matsumoto N. Clinical manifestations and epilepsy treatment in Japanese patients with pathogenic CDKL5 variants. Brain Dev 2021; 43:505-514. [PMID: 33436160 DOI: 10.1016/j.braindev.2020.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/24/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients with pathogenic cyclin-dependent kinase-like-5 gene (CDKL5) variants are designated CDKL5 deficiency disorder (CDD). This study aimed to delineate the clinical characteristics of Japanese patients with CDD and elucidate possible appropriate treatments. METHODS We recruited patients with pathogenic or likely pathogenic CDKL5 variants from a cohort of approximately 1,100 Japanese patients with developmental and epileptic encephalopathies, who underwent genetic analysis. We retrospectively reviewed clinical, electroencephalogram, neuroimaging, and genetic information. RESULTS We identified 29 patients (21 females, eight males). All patients showed severe developmental delay, especially in males. Involuntary movements were observed in 15 patients. No antiepileptic drugs (AEDs) achieved seizure freedom by monotherapy. AEDs achieving ≥ 50% reduction in seizure frequency were sodium valproate in two patients, vigabatrin in one, and lamotrigine in one. Seizure aggravation was observed during the use of lamotrigine, potassium bromide, and levetiracetam. Adrenocorticotrophic hormone (ACTH) was the most effective treatment. The ketogenic diet (KD), corpus callosotomy and vagus nerve stimulation did not improve seizure frequency in most patients, but KD was remarkably effective in one. The degree of brain atrophy on magnetic resonance imaging (MRI) reflected disease severity. Compared with females, males had lower levels of attained motor development and more severe cerebral atrophy on MRI. CONCLUSION Our patients showed more severe global developmental delay than those in previous studies and had intractable epilepsy, likely because previous studies had lower numbers of males. Further studies are needed to investigate appropriate therapy for CDD, such as AED polytherapy or combination treatment involving ACTH, KD, and AEDs.
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Affiliation(s)
- Yu Kobayashi
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan.
| | - Jun Tohyama
- Department of Child Neurology, NHO Nishiniigata Chuo Hospital, Niigata, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Tomohide Goto
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Takeshi Inoue
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Fujita
- Department of Pediatrics, NHO Aomori Hospital, Aomori, Japan
| | - Ryoko Honda
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Masahiro Ito
- Department of Pediatrics, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Kanako Kishimoto
- Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization (JCHO), Osaka, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Manabu Tanaka
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Koichi Tanda
- Department of Pediatrics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Tominaga
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mitsuko Nakashima
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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50
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Nishiyama M, Ishibashi K, Ariji Y, Fukuda M, Nishiyama W, Umemura M, Katsumata A, Fujita H, Ariji E. Performance of deep learning models constructed using panoramic radiographs from two hospitals to diagnose fractures of the mandibular condyle. Dentomaxillofac Radiol 2021; 50:20200611. [PMID: 33769840 DOI: 10.1259/dmfr.20200611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The present study aimed to verify the classification performance of deep learning (DL) models for diagnosing fractures of the mandibular condyle on panoramic radiographs using data sets from two hospitals and to compare their internal and external validities. METHODS Panoramic radiographs of 100 condyles with and without fractures were collected from two hospitals and a fivefold cross-validation method was employed to construct and evaluate the DL models. The internal and external validities of classification performance were evaluated as accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS For internal validity, high classification performance was obtained, with AUC values of >0.85. Conversely, external validity for the data sets from the two hospitals exhibited low performance. Using combined data sets from both hospitals, the DL model exhibited high performance, which was slightly superior or equal to that of the internal validity but without a statistically significant difference. CONCLUSION The constructed DL model can be clinically employed for diagnosing fractures of the mandibular condyle using panoramic radiographs. However, the domain shift phenomenon should be considered when generalizing DL systems.
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Affiliation(s)
- Masako Nishiyama
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Kenichiro Ishibashi
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Motoki Fukuda
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Wataru Nishiyama
- Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| | - Masahiro Umemura
- Department of Oral and Maxillofacial Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Akitoshi Katsumata
- Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| | - Hiroshi Fujita
- Department of Electrical, Electronic and Computer Engineering, Gifu University, Gifu, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
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