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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Hisamatsu T, Miura K, Fujiyoshi A, Kunimura A, Ito T, Miyazawa I, Torii S, Shiino A, Nozaki K, Kanda H, Arima H, Ohkubo T, Ueshima H. Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study. Eur J Neurol 2019; 26:1219-1225. [PMID: 31002446 DOI: 10.1111/ene.13970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/26/2018] [Accepted: 04/15/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle-aged to older cohort with neither apparent stroke nor atrial fibrillation. METHODS We conducted a cross-sectional population-based study of 462 men (mean age, 68.1 years) who underwent 24-h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates. RESULTS A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable-adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06-2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02-2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86-2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression. CONCLUSIONS The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.
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Affiliation(s)
- T Hisamatsu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - K Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - A Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - A Kunimura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - T Ito
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - I Miyazawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - S Torii
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - A Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Japan
| | - K Nozaki
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.,Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - H Kanda
- Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan
| | - H Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - T Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - H Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
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Watanabe S, Nakashima I, Misu T, Miyazawa I, Shiga Y, Fujihara K, Itoyama Y. Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica. Mult Scler 2016; 13:128-32. [PMID: 17294622 DOI: 10.1177/1352458506071174] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system (CNS) with a poor prognosis in terms of the optic-spinal function. Recently, a serum autoantibody (NMO-IgG) binding to the blood–brain barrier region was detected exclusively in patients with NMO and its high risk group. We treated six NMO-IgG-positive patients (all female; age 21–67 years old, median 41; three with optic neuritis and three with myelitis) who were unresponsive to high-dose intravenous methylprednisolone (HIMP), with plasma exchange (PE) (three to five exchanges, 2–3 L each). Three of the patients(one with optic neuritis and two with myelitis) showed definite functional improvement following PE. The clinical improvement started to appear after one or two exchanges, while there was little or no improvement in the other three patients. Such quick clinical responses to PE suggest a pathogenetic role of humoral immune factors in NMO, although delayed responses to the corticosteroid therapy might have contributed to the therapeutic efficacy, in part. Further clinical and in vitro studies are needed to determine whether the removal of NMO-IgG is directly relevant to the therapeutic efficacy. PE may hasten the functional recovery from corticosteroid-resistant relapses in some NMO-IgG-positive patients with NMO.
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Affiliation(s)
- S Watanabe
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai 980-8574, Japan
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Nakamura M, Misu T, Fujihara K, Miyazawa I, Nakashima I, Takahashi T, Watanabe S, Itoyama Y. Occurrence of acute large and edematous callosal lesions in neuromyelitis optica. Mult Scler 2009; 15:695-700. [PMID: 19435750 DOI: 10.1177/1352458509103301] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The corpus callosum is commonly involved in multiple sclerosis (MS), but the characteristics of callosal lesions in neuromyelitis optica (NMO) are unknown.ObjectiveTo reveal the features of callosal lesions in NMO in comparison to MS. METHODS We retrospectively reviewed the medical records and the brain magnetic resonance imaging films of 56 patients with MS and 22 patients with NMO. RESULTS In MS, 36 (64.3%) of 56 patients had callosal lesions, but only four patients had acute lesions. All such acute lesions were small, isolated and non-edematous, and the intensity was homotonic. Chronic lesions were observed in 34 patients with MS, and 32 (94%) of them presented small lesions located at the callosal lower margin ("hemi-oval pattern"). Meanwhile, four (18.2%) patients with NMO had callosal lesions, and three of them had acute lesions. Those acute lesions were multiple, large edematous ones with heterogeneous intensity ("marbled pattern"). In the chronic stage, the lesions shrank or disappeared. CONCLUSIONS Acute large, edematous callosal lesions occasionally occur in NMO. Similar to longitudinally extensive transverse myelitis, such callosal lesions may reflect severe edematous inflammation in NMO, and may provide additional evidence that the pathogenesis in NMO is different from that in MS.
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Affiliation(s)
- M Nakamura
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Takahashi T, Miyazawa I, Misu T, Takano R, Nakashima I, Fujihara K, Tobita M, Itoyama Y. Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: a herald of acute exacerbations. J Neurol Neurosurg Psychiatry 2008; 79:1075-8. [PMID: 18420727 DOI: 10.1136/jnnp.2008.145391] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intractable hiccup and nausea (IHN) are unique symptoms in neuromyelitis optica (NMO). Recent studies have strongly suggested that the pathogenesis of NMO is closely associated with anti-aquaporin-4 (AQP4) antibody. However, clinical implications of IHN and the relationship with anti-AQP4 antibody remain unknown. METHODS The past medical records of 35 patients with seropositivity for anti-AQP4 antibody were reviewed. We also followed the titres of anti-AQP4 antibody in a patient with NMO, who had newly developed IHN. RESULTS Of the 35 patients, 15 patients (43%) had episodes of IHN. There was a total of 35 episodes of IHN in these 15 patients and, of the 35 episodes, hiccup was seen in 23 episodes (66%) and nausea was seen in 28 episodes (80%). The IHN frequently preceded (54%) or accompanied (29%) myelitis or optic neuritis. The IHN was often preceded by an episode of viral infection. The titres of anti-AQP4 antibody were remarkably increased when the intractable hiccup appeared in a case. CONCLUSIONS IHN could be a clinical marker for the early phase of an exacerbation. Careful observation may be needed when INH is seen in patients with NMO, and the early initiation of the treatment could prevent subsequent neurological damage.
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Affiliation(s)
- T Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai 980-8574, Japan.
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Nakamura M, Miyazawa I, Fujihara K, Nakashima I, Misu T, Watanabe S, Takahashi T, Itoyama Y. Preferential spinal central gray matter involvement in neuromyelitis optica. J Neurol 2008; 255:163-70. [DOI: 10.1007/s00415-008-0545-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 12/19/2006] [Accepted: 01/17/2007] [Indexed: 11/30/2022]
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Watanabe S, Misu T, Miyazawa I, Nakashima I, Shiga Y, Fujihara K, Itoyama Y. Low-dose corticosteroids reduce relapses in neuromyelitis optica: a retrospective analysis. Mult Scler 2007; 13:968-74. [PMID: 17623727 DOI: 10.1177/1352458507077189] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuromyelitis optica (NMO) is a relapsing neurologic disease characterized by severe optic neuritis and transverse myelitis. A disease-modifying therapy for NMO has not been established. We retrospectively analysed the effect of low-dose corticosteroid (CS) monotherapy on the annual relapse rate in nine patients with NMO. We divided the clinical course in each patient into two periods; the CS Period in which CS was administered, and the No CS Period in which CS was not administered. Periods related to other immunological therapies, such as high-dose methylprednisolone, immunosuppressants, interferon-beta, and plasma exchange, were excluded. As a result, the annual relapse rate during the CS Periods [median, 0.49 (range, 0—1.31)] was found to be significantly lower than that during the No CS Periods [1.48 (0.65—5.54)]. As for the dose of CS, relapses occurred significantly more frequently with `10 mg/day or less' than with `over 10 mg/day' (odds ratio: 8.75). The results of the present study suggest a beneficial effect of low-dose CS monotherapy in reducing relapses in NMO. Multiple Sclerosis 2007; 13: 968—974. http://msj.sagepub.com
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Affiliation(s)
- S Watanabe
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
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Abstract
The neurofilament heavy chain (NfHSMI35), a biomarker of axonal damage in the CSF, was measured in patients with neuromyelitis optica (NMO) and multiple sclerosis (MS). Significantly high CSF NfHSMI35 levels (>0.73 ng/mL) were found in 6 of 24 (25%) of the patients with NMO but none of the patients with MS (0/24). This finding suggests that axonal damage is more severe in NMO than in MS.
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Affiliation(s)
- I Miyazawa
- Department of Neurology, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Japan
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Abstract
Of 23 neuromyelitis optica (NMO) cases, we found two cases with oligoclonal IgG bands (OBs). Both patients were positive for NMO-IgG. Their common features were long disease duration and co-existing autoimmune diseases (myasthenia gravis and sicca syndrome). Although OBs are mostly negative in NMO, which distinguishes it from multiple sclerosis (MS), they can be positive by long-standing autoimmunity, which may not be directly related to NMO. Multiple Sclerosis 2007; 13: 332-335. http://msj.sagepub.com
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Affiliation(s)
- M Nakamura
- Department of Neurology, Tohoku University School of Medicine, Aoba-ku, Sendai 980-8574, Japan.
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Nakamura M, Nakashima I, Sato S, Miyazawa I, Fujihara K, Itoyama Y. Clinical and laboratory features of neuromyelitis optica with oligoclonal IgG bands. Mult Scler 2007. [DOI: 10.1177/1352458506069483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nakashima I, Fujihara K, Miyazawa I, Misu T, Narikawa K, Nakamura M, Watanabe S, Takahashi T, Nishiyama S, Shiga Y, Sato S, Weinshenker BG, Itoyama Y. Clinical and MRI features of Japanese patients with multiple sclerosis positive for NMO-IgG. J Neurol Neurosurg Psychiatry 2006; 77:1073-5. [PMID: 16505005 PMCID: PMC2077753 DOI: 10.1136/jnnp.2005.080390] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study investigates the relation between the serological status of NMO (neuromyelitis optica)-IgG and the clinical and MRI features in Japanese patients with multiple sclerosis. Serum NMO-IgG was tested in 35 Japanese patients diagnosed with multiple sclerosis, including 19 with the optic-spinal form of multiple sclerosis (OSMS), three with the spinal form of multiple sclerosis (SMS), and 13 with the conventional form of multiple sclerosis (CMS), which affects the brain. NMO-IgG was detected in 14 patients, 12 with OSMS and 2 with CMS. In these patients, longitudinally extensive (> 3 vertebral segments) spinal cord lesions (93% v 57%) and permanent, complete blindness (no perception of light) in at least one eye (50% v 0%) were the noticeable features as compared with NMO-IgG-negative OSMS. The two patients having CMS with NMO-IgG had unusual brain lesions, but in other respects had features suggesting OSMS. NMO-IgG was detected in more than half the number of patients with OSMS and in some patients with CMS. This newly discovered serum autoantibody was markedly associated with longitudinally extensive spinal cord lesions and with complete blindness, suggesting severe optic-spinal disease.
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Affiliation(s)
- I Nakashima
- Department of Neurology, Tohoku University School of Medicine, Sendai 980-8574, Japan.
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Miyazawa I, Fujihara K, Itoyama Y. [Neuromyelitis optica(Devic disease) and optic-spinal form multiple sclerosis]. No To Shinkei 2001; 53:901-10. [PMID: 11725499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- I Miyazawa
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Yakubo S, Ozawa Y, Saito S, Kasamaki Y, Komaki K, Hanakawa K, Sasaki Y, Aruga M, Miyazawa I, Kanda T, Sekiguchi K, Shimabukuro H, Nakamura T, Okumura N. Normal limits of high-resolution signal-averaged ECG parameters of Japanese adult men and women. J Electrocardiol 2000; 33:225-31. [PMID: 10954375 DOI: 10.1054/jelc.2000.7665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
High-resolution signal-averaged electrocardiography (Hi-Res ECG) has been found useful in measuring ventricular late potentials for identifying patients prone to life-threatening ventricular arrhythmias. Several studies have reported cut-off values (normal limits) of Hi-Res ECG parameters, including sex-specific limits, for adult population. However, there are no such studies reporting such limits in the Japanese population. Hi-Res ECGs were recorded from 482 normal healthy patients (204 men; 278 women) with no cardiac disease and normal electrocardiogram. Three Hi-Res ECG parameters filtered QRS duration (FQRSD), low amplitude signal duration under 40 microV of terminal QRS (LASD), and root mean square voltage in the terminal 40 milliseconds (RMSV) were analyzed. FQRSD was longer in men than in women (P < .0001). RMSV was larger in men than in women (P < .0001). There was no significant difference in LASD between men and women. The upper limit (90th percentile) of FQRSD was 116 milliseconds for women. The upper limit of LASD was 42 milliseconds for both men and women. The lower limit (10th percentile) of the RMSV was 14 microV for both men and women. There was no significant difference in the distributions of the Hi-Res ECG parameters between our study and an earlier study on mostly whites from the United States and Europe. The upper limits (90th percentile) of FQRSD and LASD in the Japanese normal patients were nearly the same as for whites. But, the lower limit (10th percentile) of RMSV in our Japanese normals was significantly smaller than that for whites. Therefore, it may be necessary to use race-specific normal limits for late potential analysis. Criteria for abnormal late potentials (defined as abnormal values in at least 2 of the 3 Hi-Res ECG parameters) were met in 18 of 482 (3.7%) normal healthy patients. Further studies are needed to evaluate the role of these criteria in identifying cardiac patients with life-threatening arrhythmias in the Japanese population.
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Affiliation(s)
- S Yakubo
- Second Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
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Miyashita T, Miyazawa I, Kawaguchi T, Kasai T, Yamaura T, Ito T, Takei M, Kiyosawa K. A case of primary cardiac B cell lymphoma associated with ventricular tachycardia, successfully treated with systemic chemotherapy and radiotherapy: a long-term survival case. Jpn Circ J 2000; 64:135-8. [PMID: 10716528 DOI: 10.1253/jcj.64.135] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We experienced a long-term survival case of primary cardiac lymphoma (PCL) demonstrating ventricular tachycardia (VT) as an initial sign, which was related to localized myocardial damage by lymphoma cells. A 70-year-old woman with sustained VT was admitted to the Kofu Municipal Hospital. VT ceased with the administration of disopyramide intravenously. The origin of the VT was the free wall of the right ventricular outflow tract (RVOT) as observed by electrocardiography on admission. A solitary mass in the free wall of the RVOT was found by echocardiography, chest computed tomographic scanning and magnetic resonance imaging. There was no evidence of extracardiac involvement. The patient was histologically diagnosed as PCL by endomyocardial biopsy. Chemotherapy started immediately after the diagnosis and the mass showed a marked reduction in size. After 8 cycles of chemotherapy, radiotherapy was performed. Pericardial thickness in the free wall of the RVOT developed without severe side effects. Complete remission has been maintained for 30 months after the initial diagnosis, and no recurrence and arrhythmias have been detected during the follow-up period. It was demonstrated that rapid diagnosis and chemotherapy followed by radiotherapy for PCL achieved better survival.
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Affiliation(s)
- T Miyashita
- Department of Internal Medicine, Kofu Municipal Hospital, Yamanashi, Japan
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Sato Y, Matsuura S, Kadota K, Miyazawa I. T-cell lymphoma in a savanna monkey (Cercopithecus aethiops) probably related to simian T-cell leukemia virus infection. J Vet Med Sci 1999; 61:49-52. [PMID: 10027164 DOI: 10.1292/jvms.61.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lymphoma was seen in an 11-year-old female savanna monkey (Ceropithecus aethiops). The superficial inguinal and visceral lymph nodes were markedly enlarged, and their architecture was completely effaced by neoplastic cells. The neoplastic cells, which were highly pleomorphic, resembled those in adult T-cell lymphoma-leukemia in humans. Ultrastructurally the neoplastic cells were characterized by nuclear irregularity and clustered dense bodies, and almost all cells showed positivity for CD3. The animal had been reared with her family, and her mother and 2 brothers had antibodies reactive to human T-cell leukemia virus. This virus serologically cross-reacts with simian T-cell leukemia virus, which may be the causative agent of the present neoplasm.
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Affiliation(s)
- Y Sato
- Ueda Livestock Hygiene Service Center, Nagano, Japan
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17
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Suzuki T, Hayashi T, Nonaka Y, Hirano M, Nomura T, Miyazawa I, Ishikawa F, Kakiuchi T. [A case of hemolysis induced by lansoprazole]. Rinsho Ketsueki 1996; 37:1389-94. [PMID: 8997127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hemolytic anemia and possible aplastic crisis with symptoms including jaundice, general fatigue and dark urine developed in a man being treated only by lansoprazole. Five days later, he was treated with antibiotics. The next day, he was admitted to our hospital because of jaundice. On admission, the hemoglobin was 14.0 g/dl, reticulocyte count 8/1000, platelets 79 x 10(9)/l and total bilirubin 12.4 mg/dl (indirect bilirubin 9.5 mg/dl). The above medications were discontinued. The direct Coombs antiglobulin test was positive. Examination of the complement revealed a C3 fiter at the upper limit of normal and an increased C4 and CH50. Three days after admission, he had a severe anemia. The hemoglobin was 3.3 g/DL. We thought it possible that aplastic crisis had followed the hemolytic anemia induced by lansoprazole. He was treated with blood transfusions and corticosteroids. He recovered from anemia within three weeks. Exhaustive studies to identify the cause of the hemolytic anemia were undertaken with negative results. We detected IgG antibody to lansoprazole. We believe that the hemolytic anemia was induced by lansoprazole.
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Affiliation(s)
- T Suzuki
- Department of Internal Medicine, Tokyo Metropolitan Police Hospital
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Maruyama T, Miyazawa I, Oguchi T, Miyashita T, Katagiri Y, Sasaki Y, Kiyosawa K. Association between the extent of sclerotic changes in iliac arteries and long-term prognosis in patients with ischemic heart disease. J Cardiol 1996; 28:33-9. [PMID: 8768504] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peripheral vascular disease is often complicated with ischemic heart disease and is associated with increased cardiac mortality. Latent progression of sclerotic changes in the arteries supplying the lower extremities is often present but undiagnosed. We examined the influence of sclerotic changes of the iliac arteries on the late outcome in 79 patients with ischemic heart disease. Lower abdominal aortography was performed at the time of cardiac catheterization between December 1989 and January 1991. The degree of sclerotic change in the iliac arteries was assessed according to aortography findings such as stenosis, dilatation or bend, with higher scores representing more advanced sclerosis (aortography score). The mean aortography score of all patients was 5.8 +/- 4.6. The patients were followed up for 4.4 +/- 1.2 years to monitor the occurrence of cardiac events (cardiac death, acute myocardial infarction, coronary bypass surgery, or coronary angioplasty for new lesion). The cardiac event-free rate at 5 years was 76.6% in the high score group (32 patients with scores of 6 or more) and 92.9% in the low score group (47 patients with scores of 5 or less). The difference was significant (p = 0.007) by log-rank test. The hazard rate of the aortography score for predicting risk of cardiac event was 1.11 by the Cox proportional hazards model (95% confidence intervals: 1.01-1.23, p = 0.039). When the analysis was adjusted for coronary bypass surgery as primary therapy, the number of diseased coronary arteries, or the presence of peripheral vascular disease, similar results were obtained. In conclusion, more severe sclerotic change in iliac arteries is associated with a higher incidence of cardiac events in patients with ischemic heart disease.
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Affiliation(s)
- T Maruyama
- Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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19
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Munekata R, Miyazawa I, Matsuzaki H, Yoshino K, Hirano M, Mukôyama H, Nariuchi H. [A case of refractory anemia with excess of blasts (RAEB) having weakened expression of B blood group antigen]. Rinsho Ketsueki 1990; 31:1960-4. [PMID: 2079733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 52 year-old male was admitted to our hospital with the complaint of the hypochondrial pain after meal in February 1989. He was diagnosed to be RAEB and to have common bile duct stone. His red blood cells (RBC) could not be agglutinated with anti-A, anti-B, or anti-A, B. The agglutinability of the cells to Ulex europaeus (anti-H) was the same to the normal type B RBC, and his serum contained anti-I, anti-E, and anti-c. In his saliva, both B and H antigens were detected. The glycosyl B transferase in his serum showed similar activity to that of normal individual with type B RBC. When his RBC were treated with normal type B transferase, the cells obtained the reactivity to anti-B but they agglutinated much weaker than the type O cells treated with the enzyme. These results indicated that the low agglutinability of his RBC could not be due to the low transferase activity but the qualitative or quantitative changes of the precursor molecules of the type B substance of the cells.
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Affiliation(s)
- R Munekata
- Central Laboratories, Tokyo Metropolitan Police Hospital
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20
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Minezaki KK, Miyazawa I, Natsume T, Fujita T, Kawada Y, Shiina A, Yaginuma T, Hosoda S, Saito K. Long-term survival of a patient with Lutembacher's syndrome. Jpn Heart J 1988; 29:735-40. [PMID: 3221448 DOI: 10.1536/ihj.29.735] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An elderly woman with Lutembacher's syndrome remained asymptomatic until the age of 55, when she was treated for exertional dyspnea with digitalis and diuretics. She died of gastrointestinal hemorrhage and hepatic failure at the age of 69. The autopsy revealed a large atrial septal defect and mitral stenosis without rheumatic changes. This patient is the oldest reported survivor of Lutembacher's syndrome with nonrheumatic mitral stenosis.
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Affiliation(s)
- K K Minezaki
- Department of Cardiology, Jichi Medical School, Tochigi, Japan
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Kawasaki K, Iino T, Hasegawa H, Miyazawa I, Hosoda S. The function of intimal longitudinal smooth muscles of the human coronary artery. Experientia 1986; 42:1222-4. [PMID: 3780944 DOI: 10.1007/bf01946395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Bundles of smooth muscles in the intimal layer of the human coronary artery contracted in a longitudinal direction on the application of vasoactive substances. The data indicate that the human coronary artery contracts not only transversely but also longitudinally.
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Iino T, Kawasaki K, Nakanishi N, Miyazawa I, Hosoda S. Contractions of postmortem human saphenous veins perfused with pulsatile flow. Heart Vessels 1986; 2:154-60. [PMID: 3491819 DOI: 10.1007/bf02128141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to evaluate the contractions of postmortem human saphenous veins under pulsatile flow conditions as a simulation of coronary-aortic bypass graft (CABG) surgery. Twenty-five cylindrical specimens of veins, obtained from 20 cadavers several hours after death, were mounted in a pulsatile flow system with a pulse rate of 80/min and a mean flow rate of 7 ml/min at various perfusion pressures. Prostaglandin F2 alpha(PGF2 alpha) was then applied to the outer physiological salt solution at a concentration of 3 X 10(-6) mol. Of the 25 veins, 18 (72%) contracted and seven did not. Contractions were observed at a mean perfusion pressure of less than 60 mmHg but not at higher pressures. Three contraction patterns were observed: One caused pressure gradients between the proximal and distal sites of the vein and showed periodic contractions (P); one showed only tonic contractions (T); the other showed pulse pressure increase without developing the pressure gradients (PP). The incidences of P, T, and PP in the 18 instances of contraction were 50%, 33%, and 17%, respectively. Repeated applications of PGF2 alpha to the same vein with the same and/or increased perfusion pressure caused changes of pattern in the direction of P to T, to PP, and to no response, whereas decreasing perfusion pressure caused the patterns to change in the reverse direction. The pressure gradients that developed in veins showing P and T patterns correlated well with the mean perfusion pressure (r = 0.68, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Kawasaki K, Seki K, Miyazawa I, Matsumoto N, Nakanishi N, Iino T, Hosoda S. Effects of diltiazem and nitroglycerin on prostaglandin F2 alpha-induced periodic contractions of isolated human coronary arteries. Jpn Circ J 1985; 49:145-54. [PMID: 3919196 DOI: 10.1253/jcj.49.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study characterizes the inhibiting effect of diltiazem and nitroglycerin on periodic contractions of isolated human coronary arteries. Isometric force of coronary ring segments from sixty-nine cadavers was recorded in a muscle bath. To quantify the experimental results, we used 3 X 10(-6) M prostaglandin F2 alpha to induce the periodic contractions of a certain force. When diltiazem was added during the periodic contractions, the amplitude of oscillations gradually decreased until eventually oscillations ceased completely. The process prior to the cessation of the oscillations was characterized mainly by the inhibition of the contraction phase. The inhibition rate at the time of the complete cessation of oscillations was 49.3 +/- 6.3% at 5 X 10(-7) M. The time required for complete disappearance of oscillations was dependent on the diltiazem concentration. When nitroglycerin was added during periodic contractions, the oscillations did not disappear. Compared to the contraction phase, the relaxation phase was appreciably inhibited. With only 10(-7) M diltiazem, the rate of inhibition of the contraction phase was 22.0 +/- 7.7%, whereas the preliminary treatment with 5 X 10(-8) M nitroglycerin led to a complete cessation of the oscillations, and suppression of the level of the contractions to a significantly greater extent, viz. 58.7 +/- 5.8% (p less than 0.001). Therefore, it is considered more effective in the treatment and prevention of coronary spasm to use diltiazem and nitroglycerin simultaneously rather than individually.
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Kawasaki K, Seki K, Miyazawa I, Matsumoto N, Nakanishi N, Iino T, Saito K, Hosoda S. Role of atherosclerosis in spontaneous periodic contractions of isolated postmortem human coronary arteries. Jpn Circ J 1985; 49:94-100. [PMID: 3968866 DOI: 10.1253/jcj.49.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The role of atherosclerosis in coronary artery spasm was studied by morphometrical examinations of isolated postmortem human coronary arteries that were used for the observation of spontaneous periodic contractions. Isometric tension of coronary ring segments from seventy-six cadavers was recorded in a bath containing physiological saline solution. According to the degree of atherosclerosis, the segments were classified into three groups: minimum intimal lesion (Group I), moderate intimal lesion (Group II) and severe atherosclerotic lesion (Group III). Results were analyzed by a chi-square test. The incidence of the spontaneous periodic contractions was 45% in the proximal portion. Of the segments in which the contractions occurred, 83% were in Group II. There were significant differences in the incidence between Group I and II (33% vs 80%; p less than 0.02) and Group II and III (80% vs 25%; p less than 0.001), respectively. According to the characteristics of the atherosclerosis, there were significant differences in incidence of the contractions between circumferential thickening and eccentric thickening in Group II (63% vs 28%; p less than 0.001). In conclusion, the spontaneous periodic contractions occur most frequently in the segments in which (1) the degree of atherosclerosis is moderate rather than minimum or severe and (2) the characteristics of atherosclerosis is circumferential thickening instead of eccentric thickening.
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