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Konishi Y, Minoshima M, Fujihara K, Uchihashi T, Kikuchi K. Elastic Polymer Coated Nanoparticles with Fast Clearance for 19 F MR Imaging. Angew Chem Int Ed Engl 2023; 62:e202308565. [PMID: 37592736 DOI: 10.1002/anie.202308565] [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: 06/17/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023]
Abstract
19 F magnetic resonance imaging (MRI) is a powerful molecular imaging technique that enables high-resolution imaging of deep tissues without background signal interference. However, the use of nanoparticles (NPs) as 19 F MRI probes has been limited by the immediate trapping and accumulation of stiff NPs, typically of around 100 nm in size, in the mononuclear phagocyte system, particularly in the liver. To address this issue, elastic nanomaterials have emerged as promising candidates for improving delivery efficacy in vivo. Nevertheless, the impact of elasticity on NP elimination has remained unclear due to the lack of suitable probes for real-time and long-term monitoring. In this study, we present the development of perfluorocarbon-encapsulated polymer NPs as a novel 19 F MRI contrast agent, with the aim of suppressing long-term accumulation. The polymer NPs have high elasticity and exhibit robust sensitivity in 19 F MRI imaging. Importantly, our 19 F MRI data demonstrate a gradual decline in the signal intensity of the polymer NPs after administration, which contrasts starkly with the behavior observed for stiff silica NPs. This innovative polymer-coated NP system represents a groundbreaking nanomaterial that successfully overcomes the challenges associated with long-term accumulation, while enabling tracking of biodistribution over extended periods.
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Affiliation(s)
- Yuki Konishi
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, 5650871, Suita, Osaka, Japan
| | - Masafumi Minoshima
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, 5650871, Suita, Osaka, Japan
- JST, PRESTO, 2-1, Yamadaoka, 5650871, Suita, Osaka, Japan
| | - Kohei Fujihara
- Department of Physics, Graduate School of Science, Nagoya University, Nagoya, Furocho, Chikusa, 4648602, Nagoya, Japan
| | - Takayuki Uchihashi
- Department of Physics, Graduate School of Science, Nagoya University, Nagoya, Furocho, Chikusa, 4648602, Nagoya, Japan
- Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Higashiyama 5-1, Myodaiji, 4440864, Okazaki, Japan
| | - Kazuya Kikuchi
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, 2-1, Yamadaoka, 5650871, Suita, Osaka, Japan
- Immunology Frontier Research Center (IFReC), Osaka University, 2-1, Yamadaoka, 5650871, Suita, Osaka, Japan
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Harada M, Fujihara K, Osawa T, Yamamoto M, Kaneko M, Ishizawa M, Matsubayashi Y, Yamada T, Yamanaka N, Seida H, Kodama S, Ogawa W, Sone H. Association of treatment-achieved HbA1c with incidence of coronary artery disease and severe eye disease in diabetes patients. Diabetes & Metabolism 2020; 46:331-334. [DOI: 10.1016/j.diabet.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/09/2023]
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Nojima T, Matsubayashi Y, Yoshida A, Suganami H, Abe T, Ishizawa M, Fujihara K, Tanaka S, Kaku K, Sone H. Influence of an SGLT2 inhibitor, tofogliflozin, on the resting heart rate in relation to adipose tissue insulin resistance. Diabet Med 2020; 37:1316-1325. [PMID: 32096571 PMCID: PMC7496771 DOI: 10.1111/dme.14279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/12/2022]
Abstract
AIMS To examine the effects of a sodium-glucose co-transporter 2 (SGLT2) inhibitor, tofogliflozin, on resting heart rate by exploring baseline factors that independently influenced changes in the resting heart rate. METHODS Data on 419 participants in tofogliflozin phase 2/3 trials were analysed. Changes in resting heart rate from baseline to week 24 were analysed using an analysis of covariance (ANCOVA) model with groups (tofogliflozin/placebo) as a fixed effect and baseline values as covariates. The antilipolytic effect was evaluated as adipose tissue insulin resistance (Adipo-IR) and was calculated as the product of fasting insulin and free fatty acid. Multivariate analysis evaluated independent factors for changes in resting heart rate from baseline to week 24. RESULTS Of the participants, 58% were men, and mean age, HbA1c , BMI and resting heart rate were 57.6 years, 65 mmol/mol (8.1%), 25.5 kg/m2 and 66 bpm, respectively. At week 24, adjusted mean difference vs. placebo in the change from baseline was -2.3 bpm [95% confidence interval (CI) -4.6, -0.1] with tofogliflozin. Changes in resting heart rate were positively correlated with changes in Adipo-IR, whereas reductions in HbA1c , body weight and blood pressure were similar independent of changes in resting heart among quartiles of resting heart rate change. On multivariate analysis, higher baseline resting heart rates and Adipo-IR values were significantly associated with greater reductions in resting heart rate. CONCLUSIONS Tofogliflozin corrected resting heart rate levels in accordance with baseline levels. Correction of high resting heart rates may be attributed to improved adipose tissue insulin resistance, leading to correction of hyperinsulinaemia.
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Affiliation(s)
- T. Nojima
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
- Clinical Data Science DepartmentKowa Co., Ltd.TokyoJapan
| | - Y. Matsubayashi
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - A. Yoshida
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
- Kowa Co., Ltd.TokyoJapan
| | - H. Suganami
- Clinical Data Science DepartmentKowa Co., Ltd.TokyoJapan
| | - T. Abe
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - M. Ishizawa
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - K. Fujihara
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - S. Tanaka
- Department of Clinical BiostatisticsGraduate School of MedicineKyoto UniversityKyotoJapan
| | - K. Kaku
- Kawasaki Medical SchoolOkayamaJapan
| | - H. Sone
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
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Yamamura T, Kleiter I, Fujihara K, Palace J, Greenberg J, Zakrzewska-Pniewska B, Patti F, Tsai C, Saiz A, Haramura M, Terada Y, Kawata Y, De Seze J. Efficacy of satralizumab in subgroups of patients in SAkuraSky: A phase III double-blind, placebo-controlled, add-on study in patients with neuromyelitis optica spectrum disorder (NMOSD). J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kodama S, Fujihara K, Horikawa C, Harada M, Ishiguro H, Kaneko M, Furukawa K, Matsubayashi Y, Matsunaga S, Shimano H, Tanaka S, Kato K, Sone H. Network meta-analysis of the relative efficacy of bariatric surgeries for diabetes remission. Obes Rev 2018; 19:1621-1629. [PMID: 30270528 DOI: 10.1111/obr.12751] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Received: 04/13/2018] [Revised: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery leads to a higher remission rate for type 2 diabetes mellitus than non-surgical treatment. However, it remains unsolved which surgical procedure is the most efficacious. This network meta-analysis aimed to rank surgical procedures in terms of diabetes remission. METHODS AND FINDINGS We electronically searched for randomized controlled trials in which at least one surgical treatment was included among multiple arms and the diabetes remission rate was included in study outcomes. A random-effects network meta-analysis was performed within a frequentist framework. The hierarchy of treatments was expressed as the surface under the cumulative ranking curve value. Results of the analysis of 25 eligible randomized controlled trials that covered non-surgical treatments and eight surgical procedures (biliopancreatic diversion [BPD], BPD with duodenal switch, Roux-en Y gastric bypass, mini gastric bypass [mini-GBP], laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, greater curvature plication and duodenal-jejunal bypass) showed that BPD and mini-GBP had the highest surface under the cumulative ranking curve values among the eight surgical treatments. CONCLUSION Current network meta-analysis indicated that BPD or mini-GBP achieved higher diabetes remission rates than the other procedures. However, the result needs to be interpreted with caution considering that these procedures were in the minority of bariatric surgeries.
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Affiliation(s)
- S Kodama
- Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - C Horikawa
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Japan
| | - M Harada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - H Ishiguro
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - M Kaneko
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - K Furukawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Y Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - S Matsunaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - H Shimano
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan
| | - S Tanaka
- Department of Clinical Trial, Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan
| | - K Kato
- Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J, Franciotta D, Fujihara K, Jacob A, Kim HJ, Kleiter I, Kümpfel T, Levy M, Palace J, Ruprecht K, Saiz A, Trebst C, Weinshenker BG, Wildemann B. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 2018; 15:134. [PMID: 29724224 PMCID: PMC5932838 DOI: 10.1186/s12974-018-1144-2] [Citation(s) in RCA: 478] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/02/2018] [Indexed: 02/11/2023] Open
Abstract
Over the past few years, new-generation cell-based assays have demonstrated a robust association of autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis and brainstem encephalitis, as well as with acute disseminated encephalomyelitis (ADEM)-like presentations. Most experts now consider MOG-IgG-associated encephalomyelitis (MOG-EM) a disease entity in its own right, immunopathogenetically distinct from both classic multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorders (NMOSD). Owing to a substantial overlap in clinicoradiological presentation, MOG-EM was often unwittingly misdiagnosed as MS in the past. Accordingly, increasing numbers of patients with suspected or established MS are currently being tested for MOG-IgG. However, screening of large unselected cohorts for rare biomarkers can significantly reduce the positive predictive value of a test. To lessen the hazard of overdiagnosing MOG-EM, which may lead to inappropriate treatment, more selective criteria for MOG-IgG testing are urgently needed. In this paper, we propose indications for MOG-IgG testing based on expert consensus. In addition, we give a list of conditions atypical for MOG-EM ("red flags") that should prompt physicians to challenge a positive MOG-IgG test result. Finally, we provide recommendations regarding assay methodology, specimen sampling and data interpretation.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - F Paul
- Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Berlin, Germany
| | - O Aktas
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | - N Asgari
- Department of Neurology, University of Southern Denmark, Odense, Denmark
| | - R C Dale
- Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - J de Seze
- Department of Neurology, Hôpital de Hautepierre, Strasbourg Cedex, France
| | - D Franciotta
- IRCCS, National Neurological Institute C. Mondino, Pavia, Italy
| | - K Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Jacob
- The Walton Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - H J Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - I Kleiter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - M Levy
- Department of Neurology, Johns Hopkins Hospital, Cleveland, USA
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Saiz
- Service of Neurology, Hospital Clinic, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - C Trebst
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | | | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
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Matsubayashi Y, Yoshida A, Suganami H, Ishiguro H, Yamamoto M, Fujihara K, Kodama S, Tanaka S, Kaku K, Sone H. Role of fatty liver in the association between obesity and reduced hepatic insulin clearance. Diabetes Metab 2017; 44:135-142. [PMID: 29395810 DOI: 10.1016/j.diabet.2017.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/13/2017] [Accepted: 12/03/2017] [Indexed: 01/29/2023]
Abstract
AIM Hepatic insulin clearance (HIC) is important in regulating plasma insulin levels. Diminished HIC causes inappropriate hyperinsulinaemia, and both obesity and fatty liver (FL), which are known to decrease HIC, can be found either together in the same patient or on their own. The mechanism by which obesity reduces HIC is presumed to be mediated by FL. However, few reports have examined the role of FL in the relationship between obesity and HIC in type 2 diabetes (T2D) patients. Therefore, our study investigated the association of HIC with clinical factors, including insulin sensitivity indices, focusing on the presence or absence of FL and obesity in T2D patients. METHOD Baseline data from 419 patients with T2D (279 men, 140 women; mean age: 57.6 years; body mass index: 25.5kg/m2) controlled by diet and exercise were analyzed. HIC was calculated from the ratio of fasting c-peptide to fasting insulin levels (HICCIR). Correlation analyses between HICCIR and clinical variables were performed using Pearson's product-moment correlation coefficients and single regression analysis in all participants and in those with obesity and FL either alone or in combination. RESULTS HICCIR was significantly correlated with whole-body insulin sensitivity indices and influenced by FL, but only in the FL group was obesity independently influenced HIC level. HICCIR decreased in those with both FL and obesity compared with those with only one such complication. CONCLUSION HICCIR may be used to evaluate whole-body insulin sensitivity in T2D. Also, compared with obesity, the influence of FL strongly contributed to a reduced HIC. TRIAL REGISTRATION NUMBER These trials were registered by the Japan Pharmaceutical Information Centre clinical trials information (JapicCTI) as 101349 and 101351.
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Affiliation(s)
- Y Matsubayashi
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan
| | - A Yoshida
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan; Medical information and product advancement department, Kowa Pharmaceutical Co. Ltd, Tokyo, Japan
| | - H Suganami
- Clinical data science department, Kowa Co. Ltd, 3-4-10 Nihonbashi-Honcho, Chuo-ku, 103-0023 TokyoJapan
| | - H Ishiguro
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan
| | - M Yamamoto
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan
| | - K Fujihara
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan
| | - S Kodama
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan
| | - S Tanaka
- Department of clinical biostatistics, Graduate School of Medicine, Kyoto university
| | - K Kaku
- Kawasaki Medical School, Yoshida-konoe-cho, Sakyo-ku, 606-8501 KyotoOkayama, Japan
| | - H Sone
- Department of hematology, endocrinology and metabolism, faculty of medicine, Niigata university, Niigata, Japan.
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Abe T, Matsubayashi Y, Yoshida A, Suganami H, Nojima T, Osawa T, Ishizawa M, Yamamoto M, Fujihara K, Tanaka S, Kaku K, Sone H. Predictors of the response of HbA1c and body weight after SGLT2 inhibition. Diabetes Metab 2017; 44:172-174. [PMID: 29128289 DOI: 10.1016/j.diabet.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 02/04/2023]
Affiliation(s)
- T Abe
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Y Matsubayashi
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - A Yoshida
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan; Medical Information and Product Advancement Department, Kowa Pharmaceutical Company Ltd., Tokyo, Japan
| | - H Suganami
- Clinical Data Science Department, Kowa Company Ltd., Tokyo, Japan
| | - T Nojima
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan; Clinical Data Science Department, Kowa Company Ltd., Tokyo, Japan
| | - T Osawa
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - M Ishizawa
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - M Yamamoto
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - K Fujihara
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - S Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - K Kaku
- Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - H Sone
- Department of Haematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan.
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Akaishi T, Nakashima I, Mugikura S, Aoki M, Fujihara K. Brain atrophy in Japanese patients with multiple sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fujihara K. Pathogenesis of NMOSD. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.043] [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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Miyamoto K, Fujihara K, Kira J, Kuriyama N, Matsui M, Tamakoshi A, Kusunoki S. The prevalence and characteristics of neuromyelitis optica in Japan: A nationwide epidemiological study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ogawa R, Nakashima I, Takahashi T, Kaneko K, Akaishi T, Takai Y, Sato D, Nishiyama S, Fujimori J, Misu T, Kuroda H, Ikeda T, Uchibori A, Ohashi T, Fujihara K, Aoki M. Autoimmune encephalitis in patients with anti-myelin oligodendrocyte glycoprotein-antibody. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matsumoto Y, Shakespear N, Tsuchiya M, Kaneko C, Kubo J, Ogawa R, Kaneko K, Takahashi T, Yamamoto T, Fujihara K. Myelin olygodendorocyte glycoprotein-antybody-associated neurologic disease – an adult case series at a Fukushima Hospital. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Matsui M, Uchida N, Kawai U, Kusunoki S, Kuwabara S, Mori M, Shimizu J, Shimizu Y, Sonoo M, Tanaka M, Nakatsuji Y, Niino M, Kawachi I, Nomra K, Fujihara K, Matsuo H, Watanabe O. Useful scales for recognition of severe disease status in patients with multiple sclerosis in Japan. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fujihara K, Matsubayashi Y, Yamamoto M, Osawa T, Ishizawa M, Kaneko M, Matsunaga S, Kato K, Seida H, Yamanaka N, Kodama S, Sone H. Impact of body mass index and metabolic phenotypes on coronary artery disease according to glucose tolerance status. Diabetes Metab 2017; 43:543-546. [PMID: 28918195 DOI: 10.1016/j.diabet.2017.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/27/2017] [Accepted: 08/13/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to examine the impact of obesity, as defined by body mass index (BMI), and a metabolically unhealthy phenotype on the development of coronary artery disease (CAD) according to glucose tolerance status. METHODS . Metabolically unhealthy individuals were defined as those with one or more of the following conditions: hypertension, hypertriglyceridaemia and/or low HDL cholesterol. A Cox proportional hazards regression model identified variables related to CAD incidence. RESULTS The prevalences of obese subjects with normal glucose tolerance, prediabetes and diabetes were 21%, 34% and 53%, whereas those for metabolically unhealthy people were 43%, 60% and 79%, respectively. Multivariate analysis showed that a metabolically unhealthy phenotype increases hazard ratios (HRs) for CAD compared with a metabolically healthy phenotype, regardless of glucose tolerance status (normal glucose tolerance: 1.98, 95% CI: 1.32-2.95; prediabetes: 2.91, 95% CI: 1.85-4.55; diabetes: 1.90, 95% CI: 1.18-3.06). HRs for CAD among metabolically unhealthy non-obese diabetes patients and obese diabetes patients with a metabolically unhealthy status were 6.14 (95% CI: 3.94-9.56) and 7.86 (95% CI: 5.21-11.9), respectively, compared with non-obese subjects with normal glucose tolerance and without a metabolically unhealthy status. CONCLUSION A metabolically unhealthy state can associate with CAD independently of obesity across all glucose tolerance stages. Clinicians may need to consider those with at least one or more conditions indicating a metabolically unhealthy state as being at high risk for CAD regardless of glucose tolerance status.
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Affiliation(s)
- K Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - Y Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - M Yamamoto
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - T Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - M Ishizawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - M Kaneko
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - S Matsunaga
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - K Kato
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - H Seida
- Japan Medical Data Center Co., Ltd., 2-5-5, Shibadaimon, 105-0012 Tokyo, Japan
| | - N Yamanaka
- Japan Medical Data Center Co., Ltd., 2-5-5, Shibadaimon, 105-0012 Tokyo, Japan
| | - S Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan
| | - H Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, 951-8510 Niigata, Japan.
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Fujihara K, Igarashi R, Yamamoto M, Ishizawa M, Matsubayasi Y, Matsunaga S, Kato K, Ito C, Koishi M, Yamanaka N, Kodama S, Sone H. Impact of glucose tolerance status on the development of coronary artery disease among working-age men. Diabetes & Metabolism 2017; 43:261-264. [DOI: 10.1016/j.diabet.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Abstract
We report a case of neuromyelitis optica (NMO) with a large cerebral lesion. The patient had an episode of fever and consciousness disturbance with a tumefactive frontal white matter lesion at age 43, and then repeated bilateral optic neuritis and transverse myelitis until she died at age 63. Histopathological examinations revealed that marked tissue destruction, cavities and inflammatory changes typical of NMO were seen in the cerebrum as well as the optic nerves and spinal cord. This is the first autopsied case of NMO with a tumefactive cerebral lesion that later became cavitary.
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Affiliation(s)
- M Nakamura
- Department of Neurology, Tohoku Welfare Pension Hospital, 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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Nishiyama S, Misu T, Nuriya M, Takano R, Takahashi T, Nakashima I, Yasui M, Itoyama Y, Aoki M, Fujihara K. Complement-dependent and -independent aquaporin 4-antibody-mediated cytotoxicity in human astrocytes: Pathogenetic implications in neuromyelitis optica. Biochem Biophys Rep 2016; 7:45-51. [PMID: 29114578 PMCID: PMC5627508 DOI: 10.1016/j.bbrep.2016.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/25/2016] [Accepted: 05/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is an inflammatory disease caused by the aquaporin (AQP)-4-antibody. Pathological studies on NMO have revealed extensive astrocytic damage, as evidenced by the loss of AQP4 and glial fibrillary acidic protein (GFAP), specifically in perivascular regions with immunoglobulin and complement depositions, although other pathological patterns, such as a loss of AQP4 without astrocyte destruction and clasmatodendrosis, have also been observed. Previous studies have shown that complement-dependent antibody-mediated astrocyte lysis is likely a major pathomechanism in NMO. However, there are also data to suggest antibody-mediated astrocyte dysfunction in the absence of complement. Thus, the importance of complement inhibitory proteins in complement-dependent AQP4-antibody-mediated astrocyte lysis in NMO is unclear. In most of the previous studies, the complement and target cells (astrocytes or AQP4-transfected cells) were derived from different species; however, the complement inhibitory proteins that are expressed on the cell surface cannot protect themselves against complement-dependent cytolysis unless the complements and complement inhibitory proteins are from the same species. To resolve these issues, we studied human astrocytes in primary culture treated with AQP4-antibody in the presence or absence of human complement and examined the effect of complement inhibitory proteins using small interfering RNA (siRNA). Methods Purified IgG (10 mg/mL) was obtained from 5 patients with AQP4-antibody-positive NMO, 3 patients with multiple sclerosis (MS), and 3 healthy controls. Confluent human astrocytes transfected with Venus-M1-AQP4-cDNA were incubated with IgG (5% volume). After washing, we cultured the cells with human complements with or without heat inactivation. We observed time-lapse morphological and immunohistochemical changes using a fluorescence microscope. We also evaluated cytotoxicity using a propidium iodide (PI) kit and the lactate dehydrogenase (LDH) assay. Result AQP4-antibody alone caused clustering and degradation followed by endocytosis of membraneous AQP4, thereby resulting in decreased cellular adherence and the shrinkage of astrocytic processes. However, these changes were partially reversed by the removal of IgG in culture. In contrast, following the application of AQP4-antibody and non-heated human complements, the cell bodies and nuclei started to swell. At 3 h, most of the astrocytes had lost mobility and adherence and were eventually destroyed or had swollen and were then destroyed. In addition, the remaining adherent cells were mostly PI-positive, indicating necrosis. Astrocyte lysis caused by rabbit complement occurred much faster than did cell lysis with human complement. However, the cell lysis was significantly enhanced by the transfection of astrocytes with siRNA against human CD55 and CD59, which are major complement inhibitory proteins on the astrocyte membrane. AQP4-antibody-negative IgG in MS or control did not induce such changes. Conclusion Taken together, these findings suggest that both complement-dependent and complement-independent AQP4-antibody-mediated astrocytopathies may operate in NMO, potentially contributing to diverse pathological patterns. Our results also suggest that the effect of complement inhibitory proteins should be considered when evaluating AQP4-antibody-mediated cytotoxicity in AQP4-expressing cells.
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Affiliation(s)
- S. Nishiyama
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
- Correspondence to: Department of Neurology, Tohoku University Graduate School of Medicine, 1–1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.Department of Neurology, Tohoku University Graduate School of Medicine1–1 Seiryo-machiAoba-kuSendai980-8574Japan
| | - T. Misu
- Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M. Nuriya
- Department of Pharmacology, School of Medicine, Keio University, Tokyo, Japan
| | - R. Takano
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T. Takahashi
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
| | - I. Nakashima
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M. Yasui
- Department of Pharmacology, School of Medicine, Keio University, Tokyo, Japan
| | - Y. Itoyama
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M. Aoki
- Departments of Neurology Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K. Fujihara
- Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Fujihara K. Our current understanding of neuromyelitis optica and its spectrum. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.09.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yokote H, Nose Y, Ishibashi S, Tanaka K, Takahashi T, Fujihara K, Yokota T, Mizusawa H. Spinal cord ring enhancement in patients with neuromyelitis optica. Acta Neurol Scand 2015; 132:37-41. [PMID: 25639599 DOI: 10.1111/ane.12354] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Clinical and pathological significance of gadolinium (Gd)-enhancing pattern on magnetic resonance imaging (MRI), including ring enhancement (RE), is well documented in multiple sclerosis but not in neuromyelitis optica (NMO), especially in the spinal cord. The purpose of this study is to examine the prevalence of spinal cord RE in NMO and to determine the association between clinical characteristics and spinal cord RE. MATERIALS AND METHODS We retrospectively examined Gd-enhanced spinal cord MRI scans, during the acute phase, in patients with anti-aquaporin 4-positive NMO, including NMO spectrum disorder. We then analysed their clinical features and MRI imaging characteristics of spinal cord lesions. RESULTS Of the 30 patients with NMO, we enrolled 12 patients with 16 Gd-enhanced spinal cord MRI scans in this study. Five scans revealed RE (31.2%). Male ratio, as well as myelin basic protein (MBP) levels, in the cerebrospinal fluid (CSF) of patients with RE was significantly higher than those of patients without RE (P = 0.018, P = 0.026, respectively). CONCLUSIONS Spinal cord RE is common in patients with NMO. Higher MBP levels in the CSF of patients with RE can be associated with a higher degree of myelin damage.
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Affiliation(s)
- H. Yokote
- Department of Neurology; Musashino Red Cross Hospital; Musashino Tokyo Japan
- Department of Neurology and Neurological Sciences; Tokyo Medical and Dental University; Bunkyo-ku Tokyo Japan
| | - Y. Nose
- Department of Neurology and Neurological Sciences; Tokyo Medical and Dental University; Bunkyo-ku Tokyo Japan
| | - S. Ishibashi
- Department of Neurology and Neurological Sciences; Tokyo Medical and Dental University; Bunkyo-ku Tokyo Japan
| | - K. Tanaka
- Department of Neurology; Kanazawa Medical University; Kanazawa Tokyo Japan
| | - T. Takahashi
- Department of Multiple sclerosis Therapeutics; Tohoku University Graduate School of Medicine; Sendai Tokyo Japan
| | - K. Fujihara
- Department of Multiple sclerosis Therapeutics; Tohoku University Graduate School of Medicine; Sendai Tokyo Japan
| | - T. Yokota
- Department of Neurology and Neurological Sciences; Tokyo Medical and Dental University; Bunkyo-ku Tokyo Japan
| | - H. Mizusawa
- Department of Neurology and Neurological Sciences; Tokyo Medical and Dental University; Bunkyo-ku Tokyo Japan
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Bennett JL, de Seze J, Lana-Peixoto M, Palace J, Waldman A, Schippling S, Tenembaum S, Banwell B, Greenberg B, Levy M, Fujihara K, Chan KH, Kim HJ, Asgari N, Sato DK, Saiz A, Wuerfel J, Zimmermann H, Green A, Villoslada P, Paul F. Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography. Mult Scler 2015; 21:678-88. [PMID: 25662342 PMCID: PMC4425816 DOI: 10.1177/1352458514567216] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [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: 11/02/2014] [Accepted: 11/27/2014] [Indexed: 01/12/2023]
Abstract
Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients’ RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.
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Affiliation(s)
- J L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - J de Seze
- Neurology Service, University Hospital of Strasbourg, France
| | - M Lana-Peixoto
- CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil
| | - J Palace
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
| | - A Waldman
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - S Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland
| | - S Tenembaum
- Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - B Banwell
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - B Greenberg
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA
| | - M Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA
| | - K Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K H Chan
- University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - H J Kim
- Research Institute and Hospital of National Cancer Center Goyang Republic of Korea
| | - N Asgari
- Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark
| | - D K Sato
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - A Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - J Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany
| | - H Zimmermann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - A Green
- Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA
| | - P Villoslada
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - F Paul
- NeuroCure Clinical Research and Department of Neurology, Charité - Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
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Heianza Y, Kato K, Fujihara K, Tanaka S, Kodama S, Hanyu O, Sato K, Sone H. Role of sleep duration as a risk factor for Type 2 diabetes among adults of different ages in Japan: the Niigata Wellness Study. Diabet Med 2014; 31:1363-7. [PMID: 25124930 DOI: 10.1111/dme.12555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/15/2014] [Accepted: 07/28/2014] [Indexed: 12/13/2022]
Abstract
AIM To compare the role of short sleep duration as a risk factor for diabetes among adults of different ages. METHODS The study enrolled 38987 Japanese individuals without diabetes, and the 8-year risk of developing diabetes attributable to different sleep durations (< 5.5 h, 5.5 to < 6.5 h, 6.5 to < 7.0 h, 7.0-7.5 h, > 7.5-8.0 h, or > 8.0 h) was assessed among individuals aged ≤ 45, 46-59 or ≥ 60 years. RESULTS During the 8-year follow-up period, 2085 individuals developed diabetes. Overall, individuals with a short sleep duration of < 5.5 h or 5.5 to < 6.5 h had, respectively, a 1.53-fold (95% CI 1.19, 1.97) or 1.25-fold (95% CI 1.10, 1.42) increased risk of diabetes as compared with those who had 7.0-7.5 h of sleep. A sleep duration of < 5.5 h or 5.5 to < 6.5 h was predictive of the development of diabetes among individuals aged ≤ 45 years, but not among those aged ≥ 60 years. With increasing age, the effect of short sleep duration on the risk of diabetes was attenuated. CONCLUSIONS Short sleep duration was predictive of diabetes among young or middle-aged Japanese adults but not among elderly individuals after age was considered. Managing habitual short sleep and the possible reasons for having such short sleep duration could be particularly important for young or middle-aged adults in the development of future diabetes.
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Affiliation(s)
- Y Heianza
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Nour M, Coutinho E, Nakashima I, Sousa F, Woodhall M, Revis J, Santos E, George J, Kitley J, Misu T, Silva AM, Vincent A, Palace J, Waters P, Fujihara K, Leite M. PREGNANCY OUTCOME IN AQUAPORIN-4 POSITIVE NEUROMYELITIS OPTICA SPECTRUM DISORDER: A MULTI-CENTER RETROSPECTIVE COHORT STUDY. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Siritho S, Apiwattanakul M, Nakashima I, Takahashi T, Fujihara K, Prayoonwiwat N. Features of anti-aquaporin 4 antibody-seronegative Thai patients with neuromyelitis optica spectrum disorders: a comparison with seropositive cases. J Neurol Sci 2014; 341:17-21. [PMID: 24713508 DOI: 10.1016/j.jns.2014.03.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/07/2014] [Accepted: 03/17/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the unique features of seronegative neuromyelitis optica spectrum disorders (NMOSD) in Thailand. BACKGROUND It remains unknown whether seronegative NMOSD patients possess clinical and paraclinical features that are distinct from those with seropositivity. METHODS In a Thai cohort of idiopathic inflammatory CNS disorders (n=122), 52 patients fulfilled the Wingerchuk 2007 criteria for NMOSD. We determined anti-AQP4 antibody statuses using three different assays (an in-house cell-based assay [CBA], a commercially available CBA and a tissue-based indirect immunofluorescence [IIF] assay). RESULTS Among the NMOSD patients, the percentage of seropositive cases was 54.5% based on the in-house and commercial CBAs and 30.8% based on the IIF assay. Using the in-house CBA, seronegative NMOSD patients exhibited distinct features compared with seropositive patients, such as a lack of female preponderance (F/M=1.2 vs. 6.0), frequent simultaneous bilateral optic involvement (33.3% vs. 0.04%), a lower annual relapse rate (0.4 ± 0.3 vs. 0.7 ± 0.6), fewer spinal cord lesions (1.0 ± 4.3 vs. 1.4 ± 0.6), and lower CSF cell counts (20 ± 72 vs. 80 ± 285). Use of the commercial CBA yielded essentially similar results, but some of these differences were not significant using IIF. CONCLUSIONS Sensitive anti-AQP4 antibody assays reveal features of seronegative NMOSD patients that differ from those of seropositive patients from Thailand.
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Affiliation(s)
- S Siritho
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Bumrungrad International Hospital, Bangkok 10110, Thailand.
| | - M Apiwattanakul
- Department of Neurology, Prasat Neurological Institute, Bangkok 10400, Thailand.
| | - I Nakashima
- Department of Neurology, Tohoku University School of Medicine, Sendai 980-8574, Japan.
| | - T Takahashi
- Department of Neurology, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Neurology, Yonezawa National Hospital, Yonezawa 992-1202, Japan.
| | - K Fujihara
- Department of Neurology, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| | - N Prayoonwiwat
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Kodama S, Horikawa C, Fujihara K, Yoshizawa S, Yachi Y, Tanaka S, Ohara N, Matsunaga S, Yamada T, Hanyu O, Sone H. Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis. Obes Rev 2014; 15:202-14. [PMID: 24165305 DOI: 10.1111/obr.12129] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [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: 07/25/2013] [Revised: 09/07/2013] [Accepted: 09/19/2013] [Indexed: 01/11/2023]
Abstract
This meta-analysis quantified the risk of type 2 diabetes mellitus (T2DM) preceded by body weight (BW) gain in the general population. Systematic literature searches retrieved 15 eligible studies. The BW gain was divided into early weight-gain, which was defined as BW gain from early adulthood (18-24 years of age) to cohort entry (≥25 years of age), and late weight-gain, which was defined as BW gain from cohort entry. The pooled relative risk (RR; 95% confidence interval [CI]) of T2DM for an increment of BW gain standardized into a 5-kg m(-2) increment in the body mass index (BMI) was 3.07 (2.49-2.79) for early weight-gain and 2.12 (1.74-2.58) for late weight-gain. When limiting analysis to studies that concurrently examined T2DM risk for current BMI (defined in both groups as BMI at cohort entry), a larger magnitude of T2DM risk was revealed for early weight-gain compared with current BMI (RR [95% CI], 3.38 [2.20-5.18] vs. 2.39 [1.58-3.62]), while there was little difference between late weight-gain (RR [95% CI], 2.21 [1.91-2.56]) and current BMI (RR [95% CI], 2.47 [1.97-3.30]). The meta-analysis suggested that BW gain was a quantifiable predictor of T2DM, as well as current obesity in adults. Particularly, BW gain in early rather than middle-to-late adulthood played an important role in developing T2DM.
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Affiliation(s)
- S Kodama
- Department of Health Management Center, Mito Kyodo General Hospital, Ibaraki, Japan; Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Blum S, Wilson B, Prain K, Wong R, Gills D, Sato DK, Takahashi T, Fujihara K. Aquaporin-4 antibody-positive cases beyond current diagnostic criteria for NMO spectrum disorders. Neurology 2014; 82:372. [DOI: 10.1212/wnl.0000000000000005] [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: 11/15/2022] Open
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Kremer L, Mealy M, Jacob A, Nakashima I, Cabre P, Bigi S, Paul F, Jarius S, Aktas O, Elsone L, Mutch K, Levy M, Takai Y, Collongues N, Banwell B, Fujihara K, de Seze J. Brainstem manifestations in neuromyelitis optica: a multicenter study of 258 patients. Mult Scler 2013; 20:843-7. [PMID: 24099751 DOI: 10.1177/1352458513507822] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/13/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a severe autoimmune disease of the central nervous system characterized by spinal cord and optic nerve involvement. Brainstem manifestations have recently been described. OBJECTIVE To evaluate the time of occurrence, the frequency and the characteristics of brainstem symptoms in a cohort of patients with NMO according to the ethnic background and the serologic status for anti-aquaporin-4 antibodies (AQP4-abs). METHODS We performed a multicenter study of 258 patients with NMO according to the 2006 Wingerchuk criteria and we evaluated prospectively the frequency, the date of onset and the duration of various brainstem signs in this population. RESULTS Brainstem signs were observed in 81 patients (31.4%). The most frequently observed signs were vomiting (33.1%), hiccups (22.3%), oculomotor dysfunction (19.8%), pruritus (12.4%), followed by hearing loss (2.5%), facial palsy (2.5%), vertigo or vestibular ataxia (1.7%), trigeminal neuralgia (2.5%) and other cranial nerve signs (3.3%). They were inaugural in 44 patients (54.3%). The prevalence was higher in the non-Caucasian population (36.6%) than in the Caucasian population (26%) (p<0.05) and was higher in AQP4-ab-seropositive patients (32.7%) than in seronegative patients (26%) (not significant). CONCLUSIONS This study confirms the high frequency of brainstem symptoms in NMO with a majority of vomiting and hiccups. The prevalence of these manifestations was higher in the non Caucasian population.
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Affiliation(s)
- L Kremer
- Department of Neurology, University Hospital of Strasbourg, France
| | - M Mealy
- Department of Neurology, John Hopkins University, USA
| | - A Jacob
- The Walton Centre for Neurology and Neurosurgery, UK
| | - I Nakashima
- Department of Neurology, Tohoku University, Japan
| | - P Cabre
- Department of Neurology, Centre Hospitalier La Meynard, France
| | - S Bigi
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - F Paul
- Department of Neurology and NeuroCure Clinical Research Center, Charité University Medicine, Germany
| | - S Jarius
- Department of Neurology, University of Heidelberg, Germany
| | - O Aktas
- Department of Neurology, Heinrich-Heine University, Germany
| | - L Elsone
- The Walton Centre for Neurology and Neurosurgery, UK
| | - K Mutch
- The Walton Centre for Neurology and Neurosurgery, UK
| | - M Levy
- Department of Neurology, John Hopkins University, USA
| | - Y Takai
- Department of Neurology, Tohoku University, Japan
| | - N Collongues
- Department of Neurology, University Hospital of Strasbourg, France
| | - B Banwell
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - K Fujihara
- Department of Neurology, Tohoku University, Japan
| | - J de Seze
- Department of Neurology, University Hospital of Strasbourg, France
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Carroll WM, Saida T, Kim HJ, Kira J, Kermode AG, Tsai CP, Fujihara K, Kusunoki S, Tanaka M, Kim KK, Bates D. A guide to facilitate the early treatment of patients with idiopathic demyelinating disease (multiple sclerosis and neuromyelitis optica). Mult Scler 2013; 19:1371-80. [PMID: 23325588 DOI: 10.1177/1352458512471092] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Definite diagnosis of inflammatory demyelinating disease (multiple sclerosis (MS) and neuromyelitis optica (NMO)) may require time, but early treatment offers the opportunity to maximize patient outcomes. The purpose of this report is to provide guidance to facilitate early treatment decisions for patients with inflammatory demyelinating disease, before definitive diagnosis. Neurology experts reviewed the existing literature and clinical evidence. A treatment decision pathway was developed, defining patients for whom first-line MS disease-modifying therapies (a) are unlikely to be effective, (b) may be effective but require careful monitoring and (c) are likely to provide benefit. This algorithm seeks to ensure that patients, particularly those in Asia, receive appropriate treatment early in inflammatory demyelinating disease.
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Takai Y, Misu T, Nakashima I, Takahashi T, Itoyama Y, Fujihara K, Aoki M. Two cases of lumbosacral myeloradiculitis with anti-aquaporin-4 antibody. Neurology 2012; 79:1826-8. [DOI: 10.1212/wnl.0b013e3182703ff7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Heianza Y, Arase Y, Fujihara K, Tsuji H, Saito K, Hsieh SD, Kodama S, Shimano H, Yamada N, Hara S, Sone H. High normal HbA(1c) levels were associated with impaired insulin secretion without escalating insulin resistance in Japanese individuals: the Toranomon Hospital Health Management Center Study 8 (TOPICS 8). Diabet Med 2012; 29:1285-90. [PMID: 22486679 DOI: 10.1111/j.1464-5491.2012.03667.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We aimed to characterize the association of insulin resistance, impaired insulin secretion and β-cell dysfunction in relation to HbA(1c) levels in a non-diabetic range in Japanese individuals without clinically diagnosed diabetes. METHODS This cross-sectional study included 1444 individuals without a history of outpatient treatment of diabetes or use of insulin or oral hypoglycaemic agents. The homeostasis model assessment of insulin resistance and beta-cell function, insulinogenic index, Matsuda index and disposition index were calculated using data from 75-g oral glucose tolerance tests and compared across quintile (Q) categories of HbA(1c) levels. RESULTS Fasting plasma glucose and 30-min and 60-min plasma glucose (PG) levels were significantly higher when HbA(1c) exceeded 36 mmol/mol (5.4%). A HbA(1c) concentration of 36-37 mmol/mol (5.4-5.5%) (Q3) was significantly associated with a 15% lower homeostasis model assessment of β-cell function value and 31% lower insulinogenic index value compared with HbA(1c) ≤ 32 mmol/mol (≤ 5.1%) (Q1) (P <0.01). Further, a HbA(1c) concentration of 38-40 mmol/mol (5.6-5.8%) (Q4) was associated with 17% (P <0.01) and 24% (P <0.05) reductions in those indexes, respectively. However, the homeostasis model assessment of insulin resistance was not significantly elevated and the Matsuda index was not significantly lower unless HbA(1c) exceeded 41 mmol/mol (5.9%). Individuals with HbA(1c) ≥ 41 mmol/mol (≥ 5.9%) (Q5) had a 69% lower disposition index than those with a HbA(1c) concentration of ≤ 32 mmol/mol (≤ 5.1%) (Q1). CONCLUSIONS Elevated HbA(1c) levels ≥ 41 mmol/mol (≥ 5.9%) were associated with substantial reductions in insulin secretion, insulin sensitivity and β-cell dysfunction in Japanese individuals not treated for diabetes. High normal HbA(1c) levels of 36-40 mmol/mol (5.4-5.8%) were also associated with impaired insulin secretion without marked insulin resistance in Japanese individuals.
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Affiliation(s)
- Y Heianza
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan
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Heianza Y, Arase Y, Fujihara K, Tsuji H, Saito K, Hsieh SD, Kodama S, Shimano H, Yamada N, Hara S, Sone H. Screening for pre-diabetes to predict future diabetes using various cut-off points for HbA(1c) and impaired fasting glucose: the Toranomon Hospital Health Management Center Study 4 (TOPICS 4). Diabet Med 2012; 29:e279-85. [PMID: 22510023 DOI: 10.1111/j.1464-5491.2012.03686.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM To evaluate various screening criteria for pre-diabetes to identify which combination of impaired fasting glucose and elevated HbA(1c) values performs most effectively in predicting future diabetes in a large cohort of Japanese individuals. METHODS The study included 4670 men and 1571 women without diabetes (diabetes: fasting plasma glucose ≥ 7.0 mmol/l, HbA(1c) ≥ 48 mmol/mol (≥ 6.5%), or self-reported clinician-diagnosed diabetes). Pre-diabetes was diagnosed by a combination of impaired fasting glucose (fasting plasma glucose 5.6-6.9 mmol/l or 6.1-6.9 mmol/l) and elevated HbA(1c) [39-46 mmol/mol (5.7-6.4%) or 42-46 mmol/mol (6.0-6.4%)]. RESULTS During a 5-year follow-up, 338 incident cases of diabetes occurred. The combination of HbA(1c) 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l yielded the highest sensitivity (86%) and generated a large population-attributable per cent risk (78%) for predicting development of diabetes. Among individuals classified as having pre-diabetes by any of the four combined criteria, 20.5-32.0% reverted to the normoglycaemic state as having neither elevated HbA(1c) nor impaired fasting glucose at the last follow-up examination. At 5.6 years after the baseline examination, however, pre-diabetic individuals who fulfilled both HbA(1c) 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l had a 100% cumulative risk of developing diabetes. CONCLUSIONS The combination of HbA(1c) 39-46 mmol/mol (5.7-6.4%) and fasting plasma glucose 5.6-6.9 mmol/l would have the best performance in reducing the likelihood of missing future cases of diabetes. Identifying pre-diabetic individuals who strictly fulfil HbA(1c) 42-46 mmol/mol (6.0-6.4%) and fasting plasma glucose 6.1-6.9 mmol/l would predict definite progression to diabetes.
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Affiliation(s)
- Y Heianza
- Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan
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Fujihara K, Saito A, Heianza Y, Gibo H, Suzuki H, Shimano H, Saito K, Kodama S, Yamada N, Sone H. Impact of psychological stress caused by the Great East Japan Earthquake on glycemic control in patients with diabetes. Exp Clin Endocrinol Diabetes 2012; 120:560-3. [PMID: 22851189 DOI: 10.1055/s-0032-1314873] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [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: 10/27/2022]
Abstract
We examined the relationship between psychological stress and the worsening of glycemic control in diabetic patients at the time of the Great East Japan Earthquake. HbA1c levels in diabetic patients before and after the disaster were evaluated with the General Health Questionnaire (GHQ) and other questions including those on changes in diet, exercise, psychological stress and drug intake in 320 consecutive diabetic patients who had been followed in a diabetes clinic. Logistic regression analysis revealed that the total GHQ scores (odds ratio [OR] 1.03 [95% confidence interval 1.01-1.06]; p<0.01) and interruption of drug intake (OR 4.48 [1.57-12.7]; p=0.01) were independently associated with worsening of glycemic control defined as an increase in the HbA1c level equal to or greater than 0.5%. Among the scores on the GHQ, those for somatic symptoms (OR 1.18 [1.01-1.38]; p=0.03) and sleep disturbances or anxiety (OR 1.26 [1.08-1.46]; p<0.01) were independently associated with glycemic control. These results suggest that psychological stress during a disaster has independent effects on worsening of glycemic control.
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Affiliation(s)
- K Fujihara
- Department of Endocrinology and Metabolism, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan
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Shimizu Y, Ohashi T, Maruyama K, Nakashima I, Yokoyama K, Fujihara K, Uchiyama S. Neuromyelitis Optica Relapse Associated with Pregnancy: Similarities to Multiple Sclerosis (P06.184). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.184] [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: 11/15/2022] Open
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Kuroda H, Fujihara K, Kushimoto S, Aoki M. Stratifying Patients at Risk for Neurologic Sequelae after Carbon Monoxide Poisoning by Monitoring Serum Bilirubin Response (S47.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s47.001] [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: 11/15/2022] Open
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Fronda A, Kuan A, Fritzler M, Fujihara K, Takahashi T, Oger J. NMO-IgG as Measured in Multiple Facilities in Optic Neuritis (ON), Transverse Myelitis (TM) and Combinations Thereof (P02.130). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.130] [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: 11/15/2022] Open
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Nishiyama S, Misu T, Sugeno N, Takahashi T, Nakashima I, Itoyama Y, Aoki M, Fujihara K. The Effect of NMO-IgG and Complement Against Primary Human Astrocytes in Culture (P02.132). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.132] [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: 11/15/2022] Open
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Kim W, Kim SH, Nakashima I, Takai Y, Fujihara K, Leite MI, Kitley J, Palace J, Santos E, Coutinho E, Silva AM, Kim BJ, Kim BJ, Ahn SW, Kim HJ. Influence of pregnancy on neuromyelitis optica spectrum disorder. Neurology 2012; 78:1264-7. [DOI: 10.1212/wnl.0b013e318250d812] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kabasawa C, Shimizu Y, Suzuki S, Masuda M, Nagane Y, Utsugisawa K, Suzuki Y, Utsumi H, Fujihara K, Suzuki N, Uchiyama S. Taste disorders in myasthenia gravis: a multicenter cooperative study. Eur J Neurol 2012; 20:205-7. [DOI: 10.1111/j.1468-1331.2012.03713.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kuroda H, Fujihara K, Takahashi S, Shinozawa Y, Itoyama Y. A case of delayed encephalopathy after carbon monoxide poisoning longitudinally monitored by diffusion tensor imaging. AJNR Am J Neuroradiol 2011; 33:E52-4. [PMID: 21852370 DOI: 10.3174/ajnr.a2600] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A woman with DE after CO poisoning was longitudinally evaluated by DTI, performed during the following periods: at the phase of acute CO poisoning, the lucid interval, neurologic deterioration due to DE, and neurologic recovery. The present case revealed the long-term course of DTI parameters after CO poisoning and the usefulness of DTI for quantifying neurologic damage after CO poisoning.
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Affiliation(s)
- H Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Siritho S, Nakashima I, Takahashi T, Fujihara K, Prayoonwiwat N. AQP4 antibody-positive Thai cases: clinical features and diagnostic problems. Neurology 2011; 77:827-34. [PMID: 21813785 DOI: 10.1212/wnl.0b013e31822c61b1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of aquaporin-4 (AQP4) antibody in Thai patients with idiopathic inflammatory demyelinating CNS diseases (IIDCDs) and to analyze the significance of the autoantibody to distinguish neuromyelitis optica (NMO) and other NMO spectrum disorders (ONMOSDs) from other IIDCDs, especially multiple sclerosis (MS). METHODS We retrospectively evaluated 135 consecutive patients with IIDCDs seen at the MS clinic at Siriraj Hospital, Bangkok, Thailand, and classified them into NMO, ONMOSDs, optic-spinal MS (OSMS), classic MS (CMS), and clinically isolated syndrome (CIS) groups in this order with accepted diagnostic criteria. The patients' coded sera were tested separately for AQP4 antibody. Then the relations between the clinical diagnosis and the AQP4 antibody serologic status were analyzed. RESULTS Among the 135 patients, 53 (39.3%) were AQP4 antibody-positive. Although the AQP4 antibody-positive group had features of NMO, such as female predominance, long cord lesions (>3 vertebral bodies), and CSF pleocytosis, only 18 patients (33% of 54) fully met Wingerchuk 2006 criteria except for AQP4 antibody-seropositive status. We also detected some AQP4 antibody-positive patients in the OSMS (4 of 7), CMS (11 of 46), and CIS (1 of 16) groups. These patients had been misdiagnosed with MS because they often had brain lesions and never underwent spinal cord MRI examination or lacked long cord lesions. CONCLUSIONS AQP4 antibody was highly prevalent (almost 40%) in Thai patients with IIDCDs. Moreover, only one-third of AQP4 antibody-positive patients fully met Wingerchuk 2006 criteria, and many were misdiagnosed with MS. A sensitive AQP4 antibody assay is required in this region because the therapy for NMO is different from that for MS.
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Affiliation(s)
- S Siritho
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Kanamori Y, Nakashima I, Takai Y, Nishiyama S, Kuroda H, Takahashi T, Kanaoka-Suzuki C, Misu T, Fujihara K, Itoyama Y. Pain in neuromyelitis optica and its effect on quality of life: a cross-sectional study. Neurology 2011; 77:652-8. [PMID: 21813781 DOI: 10.1212/wnl.0b013e318229e694] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the features of pain and its impact on the health-related quality of life (HRQOL) in neuromyelitis optica (NMO). METHODS We analyzed 37 patients with NMO or NMO spectrum disorders seen at the Department of Neurology, Tohoku University Hospital, Sendai, Japan, during the period from November 2008 to February 2009. A total of 35 of them were aquaporin-4 antibody-positive. We used Short Form Brief Pain Inventory (BPI) to assess pain and Short Form 36-item (SF-36) health survey to evaluate the HRQOL. Fifty-one patients with multiple sclerosis (MS) were also studied for comparison. RESULTS Pain in NMO (83.8%) was far more common than in MS (47.1%). The Pain Severity Index score in BPI was significantly higher in NMO than in MS, and patients' daily life assessed by BPI was highly interfered by pain in NMO as compared with MS. Pain involving the trunk and both legs was much more frequent in NMO than in MS. SF-36 scores in NMO were lower than MS, especially in bodily pain. CONCLUSION Our study showed that pain in NMO is more frequent and severe than in MS and that pain has a grave impact on NMO patients' daily life and HRQOL. Therapy to relieve pain is expected to improve their HRQOL.
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Affiliation(s)
- Y Kanamori
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
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Pazhani G, Chakraborty S, Fujihara K, Yamasaki S, Ghosh A, Nair G, Ramamurthy T. QRDR mutations, efflux system & antimicrobial resistance genes in enterotoxigenic Escherichia coli isolated from an outbreak of diarrhoea in Ahmedabad, India. Indian J Med Res 2011; 134:214-23. [PMID: 21911975 PMCID: PMC3181023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Diverse mechanisms have been identified in enteric bacteria for their adaptation and survival against multiple classes of antimicrobial agents. Resistance of bacteria to the most effective fluoroquinolones have increasingly been reported in many countries. We have identified that most of the enterotoxigenic Escherichia coli (ETEC) were resistant to several antimicrobials in a diarrhoea outbreak at Ahmedabad during 2000. The present study was done to identify several genes responsible for antimicrobial resistance and mobile genetic elements in the ETEC strains. METHODS Seventeen ETEC strains isolated from diarrhoeal patients were included in this study. The antimicrobial resistance was confirmed by conventional disc diffusion method. PCR and DNA sequencing were performed for the identification of mutation in the quinolone resistance-determining regions (QRDRs). Efflux pump was tested by inhibiting the proton-motive force. DNA hybridization assay was made for the detection of integrase genes and the resistance gene cassettes were identified by direct sequencing of the PCR amplicons. RESULTS Majority of the ETEC had GyrA mutations at codons 83 and 87 and in ParC at codon 80. Six strains had an additional mutation in ParC at codon 108 and two had at position 84. Plasmid-borne qnr gene alleles that encode quinolone resistance were not detected but the newly described aac(6')-Ib-cr gene encoding a fluoroquinolne-modifying enzyme was detected in 64.7 per cent of the ETEC. Class 1 (intI1) and class 2 (intI2) integrons were detected in six (35.3%) and three (17.6%) strains, respectively. Four strains (23.5%) had both the classes of integrons. Sequence analysis revealed presence of dfrA17, aadA1, aadA5 in class 1, and dfrA1, sat1, aadA1 in class 2 integrons. In addition, the other resistance genes such as tet gene alleles (94.1%), catAI (70.6%), strA (58.8%), bla TEM-1 (35.2%), and aphA1-Ia (29.4%) were detected in most of the strains. INTERPRETATION & CONCLUSIONS Innate gene mutations and acquisition of multidrug resistance genes through mobile genetic elements might have contributed to the emergence of multidrug resistance (MDR) in ETEC. This study reinforces the necessity of utilizing molecular techniques in the epidemiological studies to understand the nature of resistance responsible for antimicrobial resistance in different species of pathogenic bacteria.
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Affiliation(s)
- G.P. Pazhani
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India
| | - S. Chakraborty
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India
| | - K. Fujihara
- Graduate School of Agriculture & Biological Sciences, Osaka Prefecture University, Osaka, Japan
| | - S. Yamasaki
- Graduate School of Agriculture & Biological Sciences, Osaka Prefecture University, Osaka, Japan
| | - A. Ghosh
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India
| | - G.B. Nair
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India
| | - T. Ramamurthy
- National Institute of Cholera & Enteric Diseases (ICMR), Kolkata, India,Reprint requests: Dr T. Ramamurthy, National Institute of Cholera & Enteric Diseases, P-33, C.I.T. Road, Scheme XM, Beliaghata, Kolkata 700 010, India e-mail:
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