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Yu HA, Baik C, Kim DW, Johnson ML, Hayashi H, Nishio M, Yang JCH, Su WC, Gold KA, Koczywas M, Smit EF, Steuer CE, Felip E, Murakami H, Kim SW, Su X, Sato S, Fan PD, Fujimura M, Tanaka Y, Patel P, Sternberg DW, Sellami D, Jänne PA. Translational insights and overall survival in the U31402-A-U102 study of patritumab deruxtecan (HER3-DXd) in EGFR-mutated NSCLC. Ann Oncol 2024; 35:437-447. [PMID: 38369013 DOI: 10.1016/j.annonc.2024.02.003] [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: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 3 (HER3) is broadly expressed in non-small-cell lung cancer (NSCLC) and is the target of patritumab deruxtecan (HER3-DXd), an antibody-drug conjugate consisting of a HER3 antibody attached to a topoisomerase I inhibitor payload via a tetrapeptide-based cleavable linker. U31402-A-U102 is an ongoing phase I study of HER3-DXd in patients with advanced NSCLC. Patients with epidermal growth factor receptor (EGFR)-mutated NSCLC that progressed after EGFR tyrosine kinase inhibitor (TKI) and platinum-based chemotherapy (PBC) who received HER3-DXd 5.6 mg/kg intravenously once every 3 weeks had a confirmed objective response rate (cORR) of 39%. We present median overall survival (OS) with extended follow-up in a larger population of patients with EGFR-mutated NSCLC and an exploratory analysis in those with acquired genomic alterations potentially associated with resistance to HER3-DXd. PATIENTS AND METHODS Safety was assessed in patients with EGFR-mutated NSCLC previously treated with EGFR TKI who received HER3-DXd 5.6 mg/kg; efficacy was assessed in those who also had prior PBC. RESULTS In the safety population (N = 102), median treatment duration was 5.5 (range 0.7-27.5) months. Grade ≥3 adverse events occurred in 76.5% of patients; the overall safety profile was consistent with previous reports. In 78/102 patients who had prior third-generation EGFR TKI and PBC, cORR by blinded independent central review (as per RECIST v1.1) was 41.0% [95% confidence interval (CI) 30.0% to 52.7%], median progression-free survival was 6.4 (95% CI 4.4-10.8) months, and median OS was 16.2 (95% CI 11.2-21.9) months. Patients had diverse mechanisms of EGFR TKI resistance at baseline. At tumor progression, acquired mutations in ERBB3 and TOP1 that might confer resistance to HER3-DXd were identified. CONCLUSIONS In patients with EGFR-mutated NSCLC after EGFR TKI and PBC, HER3-DXd treatment was associated with a clinically meaningful OS. The tumor biomarker characterization comprised the first description of potential mechanisms of resistance to HER3-DXd therapy.
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MESH Headings
- Humans
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- ErbB Receptors/genetics
- ErbB Receptors/antagonists & inhibitors
- Female
- Receptor, ErbB-3/genetics
- Receptor, ErbB-3/antagonists & inhibitors
- Middle Aged
- Male
- Aged
- Mutation
- Adult
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Aged, 80 and over
- Camptothecin/analogs & derivatives
- Camptothecin/therapeutic use
- Camptothecin/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Broadly Neutralizing Antibodies
- Immunoconjugates/therapeutic use
- Immunoconjugates/adverse effects
- Immunoconjugates/administration & dosage
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Affiliation(s)
- H A Yu
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York.
| | - C Baik
- University of Washington/Seattle Cancer Care Alliance, Seattle, USA
| | - D-W Kim
- Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - M L Johnson
- Sarah Cannon Research Institute at Tennessee Oncology, Nashville, USA
| | | | - M Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - J C-H Yang
- National Taiwan University Hospital, Taipei City
| | - W-C Su
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - K A Gold
- Moores Cancer Center at UC San Diego Health, San Diego
| | | | - E F Smit
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C E Steuer
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - E Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - S-W Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - X Su
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - S Sato
- Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - P-D Fan
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | | | - Y Tanaka
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - P Patel
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | | | - D Sellami
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
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Nishida T, Kusuda S, Mori R, Toyoshima K, Mitsuhashi H, Sasaki H, Yonemoto N, Kono Y, Uchiyama A, Fujimura M. Impact of comprehensive quality improvement program on outcomes in very-low-birth-weight infants: A cluster-randomized controlled trial in Japan. Early Hum Dev 2024; 190:105947. [PMID: 38295559 DOI: 10.1016/j.earlhumdev.2024.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Differences in outcomes among neonatal intensive care units (NICUs) in Japan have been noted, prompting the need for quality improvement. AIM To assess a comprehensive quality improvement program on outcomes in very-low-birth-weight (VLBW) infants. STUDY DESIGN A cluster-randomized clinical trial. SUBJECTS Forty hospitals and VLBW infants born in 2012-2014 and admitted to those hospitals were study subjects. OUTCOME MEASURES The intervention group (IG) received a comprehensive quality improvement program involving clinical practice guidelines, educational outreach visits, workshops, opinion leader training, audits, and feedback. The control group (CG) was provided only with the guidelines. The primary outcome was survival without neurological impairment at three years of age. RESULTS IG consisted of 19 hospitals and 1735 infants, while CG included 21 hospitals and 1700 infants. There were no significant differences in gestational weeks, 29.1(26.9-31.3) vs. 29.1(26.7-31.1) or birth weights (g), 1054(789-1298) vs. 1084(810-1309) between the two groups. Both groups showed survival rates without neurological impairment of 67.2 % (1166) and 66.9 % (1137), respectively, without a significant difference. There was no significant difference in mortalities at NICU discharge between the groups, with rates of 4.0 % (70) and 4.2 % (72) respectively. Several clinically relevant improvements were observed in IG, including reduced rates of sepsis, adrenal insufficiency, transfusion for anemia, and a shorter interval to achieve full enteral feeding. However, these did not lead to improvements in the primary outcome. CONCLUSION The comprehensive quality improvement program to Japanese NICUs did not result in a significant improvement in survival without neurological impairment in VLBW infants.
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Affiliation(s)
- Toshihiko Nishida
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Pediatrics, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan; Neonatal Research Network of Japan, 3-7-1 Nishishinjuku, Shinjuku, Tokyo, Japan.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan; Graduate School of Medicine, Kyoto University, Yoshidakonoecho, Sakyoku, Kyoto, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Hospital, 2-138-4 Mutsugawa, Minami, Kanagawa, Japan
| | - Hideko Mitsuhashi
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan
| | - Hatoko Sasaki
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan; Shizuoka Graduate University of Public Health, 4-27-2 Kita Ando, Aoi, Shizuoka, Japan
| | - Naohiro Yonemoto
- Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Atsushi Uchiyama
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Pediatrics, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, Japan
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Hirata K, Nishikawa M, Nozaki M, Kitajima H, Yanagihara I, Wada K, Fujimura M. Urine Desmosine as a Novel Biomarker for Bronchopulmonary Dysplasia and Postprematurity Respiratory Disease in Extremely Preterm or Low Birth Weight Infants. Am J Perinatol 2022. [PMID: 36384237 DOI: 10.1055/a-1979-8501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether elevated urine desmosine levels at 3 weeks of age were associated with severe radiological findings, bronchopulmonary dysplasia (BPD), and post-prematurity respiratory disease (PRD) in extremely preterm (EP) or extremely low birth weight (ELBW) infants. STUDY DESIGN This study recruited 37 EP (22-27 completed weeks) or ELBW (<1,000 g) infants. Urine was collected between 21 and 28 postnatal days, and desmosine was measured using an enzyme-linked immunosorbent assay kit; the urine creatinine level was also measured. Bubbly/cystic lungs were characterized by emphysematous chest X-rays on postnatal day 28. Furthermore, provision of supplemental oxygen or positive-pressure respiratory support at 40 weeks' postmenstrual age defined BPD, and increased medical utilization at 18 months of corrected age defined PRD. The desmosine/creatinine threshold was determined by receiver operating characteristic analysis. The adjusted risk and 95% confidence interval (CI) for elevated urine desmosine/creatinine levels were estimated by logistic regression analysis. RESULTS Elevated urine desmosine/creatinine levels higher than the threshold were significantly associated with bubbly/cystic lungs (8/13 [61.5%] vs. 2/24 [8.3%], p = 0.001), BPD (10/13 [76.9%] vs. 8/24 [33.3%], p = 0.02), and PRD (6/13 [46.2%] vs. 2/24 [8.3%], p = 0.01). After adjusting for gestational age, birth weight, and sex, the urine desmosine/creatinine levels were significantly higher in those who were highly at risk of bubbly/cystic lungs (odds ratio [OR], 13.2; 95% CI, 1.67-105) and PRD (OR, 13.8; 95% CI, 1.31-144). CONCLUSION Elevated urine desmosine/creatinine levels on the third postnatal week were associated with bubbly/cystic lungs on day 28 and PRD at 18 months of corrected age in EP or ELBW infants. KEY POINTS · Urine desmosine was prospectively measured in 3-week-old EP/ELBW infants.. · Elevated urine desmosine levels were associated with emphysematous radiological findings on day 28, PRD at 18 months of corrected age.. · Urine desmosine may be a promising biomarker indicating lung damage in EP/ELBW infants..
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Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masatoshi Nozaki
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Kitajima H, Fujimura M, Takeuchi M, Kawamoto Y, Sumi K, Matsunami K, Shiraishi J, Hirano S, Nakura Y, Yanagihara I. Intrauterine Ureaplasma is associated with small airway obstruction in extremely preterm infants. Pediatr Pulmonol 2022; 57:2763-2773. [PMID: 35931924 DOI: 10.1002/ppul.26098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The long-term follow-up of lung function (LF) in extremely preterm (EP) infants with bronchopulmonary dysplasia (BPD) has shown a worldwide increase in small airway obstructions (SAO). OBJECTIVES We investigated the relationships between intrauterine Ureplasma infection in EP infants and bubbly/cystic lung, BPD, and SAO at school age. METHODS Placental pathology, placental Ureaplasma DNA (pU-DNA), and cord blood immunoglobulin M (IgM) (C-IgM) were investigated in 360 EP infants born from 1981 to 2004. Maternal amniotic inflammatory response (M-AIR) scores and hemosiderin deposition (HD) were estimated in the chorioamnion. The study subjects were divided into groups based on their M-AIR scores. Their LF at school age was compared with those of 33 healthy siblings. FINDINGS pU-DNA and C-IgM were significantly related to SAO at school age (p < 0.012). M-AIR score 3 and pU-DNA >1000 units had an odds ratio (OR) of 35 (95% confidence interval: 10-172) and 18 (5.6-67) for bubbly/cystic lung, and 11 (3.1 - 43) and 31 (4.5-349) for severe BPD, and 5.3 (2.1-11) and 12 (2.4-74) for SAO, respectively. The ORs of surfactant treatment, BPD grade III, O2 at 40 weeks, HD, and C-IgM >30 mg/dl for SAO were 0.21 (0.075-0.58), 5.3 (2.1-15), 2.5 (1.4-4.6), 3.6 (1.5-9.1) and 2.5 (1.0-5.2). 84% (90/107) SAO infants showed no or mild BPD in infancy, and 61% of infants had no severe CAM. CONCLUSION Our long-term cohort study of LF in EP infants revealed that intrauterine Ureaplasma was associated with bubbly/cystic lung, severe BPD, and SAO at school age.
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Affiliation(s)
- Hiroyuki Kitajima
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan.,Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Makoto Takeuchi
- Department of Laboratory Medicine and Pathology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yutaka Kawamoto
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kiyoaki Sumi
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Katsura Matsunami
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yukiko Nakura
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
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Kono Y, Yonemoto N, Nakanishi H, Hosono S, Hirano S, Kusuda S, Fujimura M. A Retrospective Cohort Study on Mortality and Neurodevelopmental Outcomes of Preterm Very Low Birth Weight Infants Born to Mothers with Hypertensive Disorders of Pregnancy. Am J Perinatol 2022; 39:1465-1477. [PMID: 33535243 DOI: 10.1055/s-0041-1722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We examined the effects of maternal hypertensive disorders of pregnancy (HDP) on the mortality and neurodevelopmental outcomes in preterm very low birth weight (VLBW) infants (BW ≤1,500 g) based on their intrauterine growth status and gestational age (GA). STUDY DESIGN We included singleton VLBW infants born at <32 weeks' gestation registered in the Neonatal Research Network Japan database. The composite outcomes including death, cerebral palsy (CP), and developmental delay (DD) at 3 years of age were retrospectively compared among three groups: appropriate for GA (AGA) infants of mothers with and without HDP (H-AGA and N-AGA) and small for GA (SGA) infants of mothers with HDP (H-SGA). The adjusted odds ratios (AOR) and 95% confidence intervals (CI) stratified by the groups of every two gestational weeks were calculated after adjusting for the center, year of birth, sex, maternal age, maternal diabetes, antenatal steroid use, clinical chorioamnionitis, premature rupture of membranes, non-life-threatening congenital anomalies, and GA. RESULTS Of 19,323 eligible infants, outcomes were evaluated in 10,192 infants: 683 were H-AGA, 1,719 were H-SGA, and 7,790 were N-AGA. Between H-AGA and N-AGA, no significant difference was observed in the risk for death, CP, or DD in any GA groups. H-AGA had a lower risk for death, CP, or DD than H-SGA in the 24 to 25 weeks group (AOR: 0.434, 95% CI: 0.202-0.930). The odds for death, CP, or DD of H-SGA against N-AGA were found to be higher in the 24 to 25 weeks (AOR: 2.558, 95% CI: 1.558-3.272) and 26 to 27 weeks (AOR: 1.898, 95% CI: 1.427-2.526) groups, but lower in the 30 to 31 weeks group (AOR: 0.518, 95% CI: 0.335-0.800). CONCLUSION There was a lack of follow-up data; however, the outcomes of liveborn preterm VLBW infants of mothers with HDP depended on their intrauterine growth status and GA at birth. KEY POINTS · The effects of HDP on preterm low birth weight infants need to be further examined.. · The outcomes were not different between AGA infants with and without maternal HDP.. · The outcomes of SGA infants with maternal HDP were dependent on their GA..
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Naohiro Yonemoto
- Department of Psychoneuropharmacology, National institute of Mental Health, National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | - Hidehiko Nakanishi
- Division of Neonatal Intensive Care Medicine, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shigeharu Hosono
- Department of Perinatal and Neonatal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Mitaka, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Fujimura M. Effects of an enzyme agent containing mutanase and dextranase for treatment of biofilms in bacteria- and yeast-infected canine otitis externa. Pol J Vet Sci 2022; 25:383-389. [PMID: 36156100 DOI: 10.24425/pjvs.2022.142021] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate in detail both the in vivo and in vitro efficacy of the enzyme agents, ZYMOX® Plus Otic (ZYMOX-P), in the treatment of canine otitis externa (OE). Eight dogs with a diagnosis of non-seasonal severe chronic OE were recruited for the study. ZYMOX-P was administered for 2-4 weeks. The Otitis Index Score (OTIS3) and bacteria or yeast colony growth were measured. Also, minimum biofilm (BF) formation inhibition concentration (MBIC) and BF bactericidal concentration (BBC) were measured in vitro. OTIS3 showed a statistically significant reduction after treatment (88.2%, p⟨0.001; pre-treatment = 11.0 ± 0.9; post-treatment = 1.3 ± 0.4, mean ± SEM). The individual OTIS scores, erythema, edema, erosions/ ulcerations, exudate and pruritus showed significant reduction (85.7%, 95.7%, 83.3%, 80.0%, and 89.3%, respectively). Microscopic examination revealed the presence of BF exopolysaccharide in all 8 ear samples when stained with alcian blue. Seven of the 8 dogs (87.5%) showed a reduction in colony growth. ZYMOX-P was effective at 34-fold and 16-fold dilutions on MBIC and BBC, respectively. These findings indicate that ZYMOX-P has efficacy against BF-related infection and is beneficial when used for the management of canine OE.
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Affiliation(s)
- M Fujimura
- Fujimura Animal Allergy Hospital, Aomatanihigashi 5-10-26, Minou-city, Osaka 562-0022, Japan
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Hirata K, Kimura T, Hirano S, Wada K, Kusuda S, Fujimura M. Outcomes of outborn very-low-birth-weight infants in Japan. Arch Dis Child Fetal Neonatal Ed 2021; 106:131-136. [PMID: 32788390 DOI: 10.1136/archdischild-2019-318594] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain. OBJECTIVE To compare morbidity and mortality between outborn and inborn VLBWIs. DESIGN Observational cohort study using inverse-probability-of-treatment weighting. SETTING Neonatal Research Network of Japan. PATIENTS Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016. METHODS Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality. RESULTS The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4-31.0) weeks and 1128 (862-1351) g for outborns and 28.7 (26.3-30.9) weeks and 1042 (758-1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality. CONCLUSION Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
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Affiliation(s)
- Katsuya Hirata
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takeshi Kimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinya Hirano
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuko Wada
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | | | - Masanori Fujimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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8
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Tamai K, Nishihara M, Hirata K, Shiraishi J, Hirano S, Fujimura M, Yano S, Kanazawa T, Kitajima H. Physical fitness of non-disabled school-aged children born with extremely low birth weights. Early Hum Dev 2019; 128:6-11. [PMID: 30392918 DOI: 10.1016/j.earlhumdev.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/20/2018] [Revised: 10/06/2018] [Accepted: 10/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The assessment of long-term outcomes in survivors born with extremely low birth weights (ELBWs) has become increasingly important. However, little has been reported on the physical fitness of non-disabled school-aged children born with ELBWs. AIMS To assess the physical fitness of non-disabled school-aged children born with ELBWs. STUDY DESIGN Retrospective cohort study. SUBJECTS We analyzed 169 ELBW infants without cerebral palsy or intellectual disability (based on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) Full Scale intelligence quotient (IQ) test < 70). OUTCOME MEASURES Physical fitness was assessed using the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, and softball throw tests. T-scores were calculated using national survey data. RESULTS The T-scores for the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, softball throw tests, and the overall T-score were 43.7 ± 7.5, 44.2 ± 10.5, 46.0 ± 9.7, 40.9 ± 8.0, 40.0 ± 9.8, 42.4 ± 8.1, and 42.9 ± 5.5, respectively. After adjusting for other age-related factors, the height (SD score), WISC-III Performance IQ score, and percent predicted forced vital capacity (FVC) independently predicted the overall T-scores. Their standardized partial regression coefficients (β) were 0.334 (p = 0.009), 0.190 (p = 0.022), and 0.187 (p = 0.032), respectively. CONCLUSIONS Our cohort's physical fitness at approximately 8 years of age was significantly impaired compared to average Japanese children of the same age. Height, FVC, and Performance IQ independently predicted physical fitness, with height being the strongest predictor.
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Affiliation(s)
- Kei Tamai
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan; Department of Neonatology, Okayama Medical Center, National Hospital Organization, 1711-1 Tamasu, Kita-ku, Okayama, Okayama 701-1192, Japan.
| | - Masahiro Nishihara
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Katsuya Hirata
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Jun Shiraishi
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
| | - Suguru Yano
- Department of Education, Faculty of Health and Physical Education, Wakayama University, 930 Sakaedani, Wakayama, Wakayama 640-8510, Japan.
| | - Tadahiro Kanazawa
- Department of Comparative and Developmental Psychology, Faculty of Human Sciences, Osaka University, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
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9
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Amao Y, Fujimura M, Miyazaki M, Tadokoro A, Nakamura M, Shuto N. A visible-light driven electrochemical biofuel cell with the function of CO2conversion to formic acid: coupled thylakoid from microalgae and biocatalyst immobilized electrodes. NEW J CHEM 2018. [DOI: 10.1039/c8nj01118d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A new visible-light driven electrochemical biofuel cell consisting of the thylakoid membrane of microalgae immobilized on a TiO2layer electrode as a photoanode, a formate dehydrogenase/viologen co-immobilized electrode as a cathode, and a CO2-saturated buffer solution as the redox electrolyte, was developed.
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Affiliation(s)
- Y. Amao
- Advanced Research Institute for Natural Science and Technology
- Osaka City University
- Osaka 558-8585
- Japan
- Research Center for Artificial Photosynthesis
| | - M. Fujimura
- Advanced Research Institute for Natural Science and Technology
- Osaka City University
- Osaka 558-8585
- Japan
- Precursory Research for Embryonic Science and Technology (PRESTO)
| | - M. Miyazaki
- Advanced Research Institute for Natural Science and Technology
- Osaka City University
- Osaka 558-8585
- Japan
- Precursory Research for Embryonic Science and Technology (PRESTO)
| | - A. Tadokoro
- Precursory Research for Embryonic Science and Technology (PRESTO)
- Japan Science and Technology Agency
- Saitama 332-0012
- Japan
- Department of Applied Chemistry
| | - M. Nakamura
- Precursory Research for Embryonic Science and Technology (PRESTO)
- Japan Science and Technology Agency
- Saitama 332-0012
- Japan
- Department of Applied Chemistry
| | - N. Shuto
- Precursory Research for Embryonic Science and Technology (PRESTO)
- Japan Science and Technology Agency
- Saitama 332-0012
- Japan
- Department of Applied Chemistry
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10
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Kono Y, Yonemoto N, Nakanishi H, Kusuda S, Fujimura M. Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks' gestation: a retrospective observational study in tertiary centres in Japan. BMJ Paediatr Open 2018; 2:e000211. [PMID: 29637189 PMCID: PMC5843009 DOI: 10.1136/bmjpo-2017-000211] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate changes in the outcomes of infants born at <25 weeks' gestation in the past decade. DESIGN Retrospective observational study. SETTINGS A multicentre database of the Neonatal Research Network, Japan. PATIENTS A total of 3318 infants born at 22-24 weeks' gestation between periods 1 (2003-2007) and 2 (2008-2012) from 52 tertiary centres. MAIN OUTCOME MEASURES We compared death and neurodevelopmental impairments (NDIs) at 3 years of age, including cerebral palsy (CP), visual impairments (VIs), hearing impairments (HIs) and the developmental quotient (DQ) of the Kyoto Scale of Psychological Development test <70, between two periods using multivariate logistic regression analyses adjusted for the centre, gender, multiple gestation, maternal age, caesarean delivery, antenatal steroid use, pregnancy-related hypertension, clinical chorioamnionitis, congenital anomalies and birth weight. RESULTS A total of 496/1479 infants (34%) in period 1 and 467/1839 (25%) in period 2 died by 3 years of age (adjusted OR 0.70, 95% CIs 0.59 to 0.83). Follow-up data were collected from 631 infants (64% of survivors) in period 1 and 832 (61% of survivors) in period 2. The proportions of CP with Gross Motor Function Classification System ≥2, VI and HI in the infants evaluated were lower, while that of DQ <70 was higher in period 2 than in period 1. Using multiple imputations to account for missing data, death or NDI decreased from 54% in period 1 to 47% in period 2 (0.83, 0.71 to 0.97). Significant decreases were observed in death or CP (0.65, 0.55 to 0.76), death or VI (0.59, 0.50 to 0.69) and death or HI (0.69, 0.58 to 0.81), but not in death or DQ <70 (0.91, 0.78 to 1.06). CONCLUSION Along with improved survival, CP, VI and HI, but not cognitive impairments decreased in infants born at <25 weeks' gestation between the two periods examined in the last decade. Further strategies are needed to reduce cognitive impairments in these infants.
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Hidehiko Nakanishi
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masanori Fujimura
- Osaka Women's and Children's Hospital, Neonatology, Izumi, Osaka, Japan
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11
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Sunadome H, Matsumoto H, Petrova G, Kanemitsu Y, Tohda Y, Horiguchi T, Kita H, Kuwabara K, Tomii K, Otsuka K, Fujimura M, Ohkura N, Tomita K, Yokoyama A, Ohnishi H, Nakano Y, Oguma T, Hozawa S, Nagasaki T, Ito I, Oguma T, Inoue H, Tajiri T, Iwata T, Izuhara Y, Ono J, Ohta S, Hirota T, Tamari M, Yokoyama T, Niimi A, Izuhara K, Mishima M. Cover Image. Clin Exp Allergy 2017. [DOI: 10.1111/cea.12985] [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: 11/28/2022]
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12
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Hirata K, Nishihara M, Kimura T, Shiraishi J, Hirano S, Kitajima H, Fujimura M. Longitudinal impairment of lung function in school-age children with extremely low birth weights. Pediatr Pulmonol 2017; 52:779-786. [PMID: 28125159 DOI: 10.1002/ppul.23669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/03/2016] [Accepted: 12/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess lung function and long-term respiratory outcomes in extremely low birth weight (ELBW) survivors. WORKING HYPOTHESIS ELBW, especially with respiratory complications in the neonatal period, affects lung function at a later age. STUDY DESIGN Longitudinal retrospective study. PATIENT-SUBJECT SELECTION Lung function was evaluated in 89 ELBW survivors (at ages 8 and 12) with or without a history of bronchopulmonary dysplasia (BPD) or a bubbly/cystic lung appearance in the neonatal period. METHODOLOGY FVC, FEV1 , FEF50 , and FEF75 were measured using spirometry. Two-way repeated-measures ANOVA was used to compare lung function and deterioration time course from 8 to 12 years of age. RESULTS Lung function variables were significantly and positively correlated between 8 and 12 years: %FVC (R2 = 0.558), %FEV1 (R2 = 0.539), %FEF50 (R2 = 0.412), and %FEF75 (R2 = 0.429). Lung function values were lower than Japanese reference values, especially in children with a history of severe BPD or a bubbly/cystic appearance. %FEV1 and FEV1 /FVC ratio worsened from 8 to 12 years of age: 83.0 ± 17.0% versus 76.6 ± 17.8% (mean difference, 95%CI: -6.43, -9.10 to -3.75) and 84.0 ± 10.1% versus 78.2 ± 13.4% (mean difference, 95%CI: -5.82, -8.56 to -3.08), regardless of whether or not there was a history of neonatal respiratory disease. CONCLUSIONS In ELBW survivors, the obstructive pattern of lung function impairment deteriorated from 8 to 12 years of age, independent of the presence of severe BPD or bubbly/cystic appearance in the neonatal period.
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Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masahiro Nishihara
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Takeshi Kimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Jun Shiraishi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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13
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Sunadome H, Matsumoto H, Petrova G, Kanemitsu Y, Tohda Y, Horiguchi T, Kita H, Kuwabara K, Tomii K, Otsuka K, Fujimura M, Ohkura N, Tomita K, Yokoyama A, Ohnishi H, Nakano Y, Oguma T, Hozawa S, Nagasaki T, Ito I, Oguma T, Inoue H, Tajiri T, Iwata T, Izuhara Y, Ono J, Ohta S, Hirota T, Tamari M, Yokoyama T, Niimi A, Izuhara K, Mishima M. IL4Rα and ADAM33 as genetic markers in asthma exacerbations and type-2 inflammatory endotype. Clin Exp Allergy 2017; 47:998-1006. [PMID: 28326636 DOI: 10.1111/cea.12927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Genetic markers of susceptibility to asthma exacerbations in adults remain unclear. OBJECTIVE To identify genetic markers of asthma exacerbations, particularly in patients with type-2 inflammatory endotype. METHODS In this observational study of patients enrolled in the Kinki Hokuriku Airway disease Conference multicenter study, frequency of exacerbations requiring systemic corticosteroids during 2 years after enrolment and associated risk factors was determined. For genetic marker analysis, interleukin-4 receptor α (IL4RA) rs8832 and a disintegrin and metalloprotease 33 (ADAM33) S_2 (rs528557), T_1 (rs2280091), T_2 (rs2280090), and V_4 (rs2787094) variants were included. Elevated serum periostin levels at enrolment (≥95 ng/mL, defined as type-2 inflammatory endotype) were considered in the analysis. RESULTS Among 217 patients who were successfully followed up for 2 years after enrolment, 60 patients showed at least one asthma exacerbation during the 2 years. Airflow limitation (%FEV1 <80%) and recent exacerbations but not genetic variants were identified as risk markers of exacerbations. A total of 27 patients showed type-2 inflammatory endotype (serum periostin ≥95 ng/mL at enrolment) and subsequent exacerbations; risk factors in these patients were airflow limitation (odds ratio, 6.51; 95% confidence interval (CI): 2.37-18.6; P=.0003), GG genotype of IL4RA rs8832 (odds ratio, 4.01; 95% CI: 1.47-11.0; P=.007), and A allele of ADAM33 T_2 (odds ratio, 2.81; 95% CI: 1.05-7.67; P=.04) by multivariate analysis. In addition, GG genotype of IL4RA rs8832 was associated with type-2 endotype, whereas A allele of ADAM33 T_2 was associated with mixed type of eosinophilic/type-2 and neutrophilic inflammations. CONCLUSIONS AND CLINICAL RELEVANCE IL4RA and ADAM33 variants may be risk markers of asthma exacerbations in type-2 inflammatory endotype. Precise endotyping may facilitate the identification of genetic risk markers of asthma exacerbations.
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Affiliation(s)
- H Sunadome
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan
| | - H Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan
| | - G Petrova
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Kanemitsu
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan
| | - Y Tohda
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kinki University, Sayama, Japan
| | - T Horiguchi
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Internal Medicine, Fujita Health University Second Educational Hospital, Nagoya, Japan
| | - H Kita
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - K Kuwabara
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Internal Medicine, Fujita Health University Second Educational Hospital, Nagoya, Japan
| | - K Tomii
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Otsuka
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Fujimura
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - N Ohkura
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - K Tomita
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kinki University, Sayama, Japan
| | - A Yokoyama
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Hematology and Respiratory Medicine, Kochi University, Kochi, Japan
| | - H Ohnishi
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Department of Hematology and Respiratory Medicine, Kochi University, Kochi, Japan
| | - Y Nakano
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - T Oguma
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - S Hozawa
- Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Hiroshima Allergy and Respiratory Clinic, Hiroshima, Japan
| | - T Nagasaki
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - I Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Inoue
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Tajiri
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Iwata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Izuhara
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - J Ono
- Shino-Test Corporation, Sagamihara, Japan
| | - S Ohta
- Department of Laboratory Medicine, Saga Medical School, Saga, Japan
| | - T Hirota
- Laboratory for Respiratory and Allergic Diseases, Core for Genomic Medicine, Center for Integrative Medical Sciences, Institute of Physical and Chemical Research (RIKEN), Yokohama, Japan
| | - M Tamari
- Laboratory for Respiratory and Allergic Diseases, Core for Genomic Medicine, Center for Integrative Medical Sciences, Institute of Physical and Chemical Research (RIKEN), Yokohama, Japan
| | - T Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako, Japan
| | - A Niimi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan.,Division of Respiratory Medicine, Department of Medical Oncology and Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan
| | - K Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - M Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kinki Hokuriku Airway disease Conference (KiHAC), Sayama, Japan
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14
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Hirata K, Sumi K, Nakayama M, Fujimura M, Kitajima H. Early-onset chronic obstructive pulmonary disease in Wilson-Mikity syndrome with preterm birth. Pediatr Int 2017; 59:364-365. [PMID: 28317304 DOI: 10.1111/ped.13205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/24/2016] [Accepted: 11/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Kiyoaki Sumi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Masahiro Nakayama
- Department of Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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15
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Nakamura T, Yonemoto N, Nakayama M, Hirano S, Aotani H, Kusuda S, Fujimura M, Tamura M. Early inhaled steroid use in extremely low birthweight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2016; 101:F552-F556. [PMID: 27059072 DOI: 10.1136/archdischild-2015-309943] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 10/14/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We hypothesised that a prophylactic inhaled steroid would prevent the progression of bronchopulmonary dysplasia (BPD) in extremely low birthweight infants (ELBWIs). DESIGN This study was a multicentre, randomised, double-blinded, placebo-controlled trial. SETTING This investigation was conducted in 12 level III neonatal intensive care units (NICUs). PATIENTS A total of 211 ELBWIs requiring ventilator support were enrolled. INTERVENTION Starting within 24 h of birth and continuing until 6 weeks of age or extubation, two doses of 50 μg fluticasone propionate (FP) or placebo were administered every 24 h. MAIN OUTCOME MEASUREMENT The primary outcome measure used to indicate the morbidity of severe BPD incidence was death or oxygen dependence at discharge from the NICU. The secondary measures were neurodevelopmental impairments (NDIs) at 18 months of postmenstrual age and 3 years of age. We performed subgroup analyses based on gestational week (GW) and the presence of chorioamnionitis (CAM). RESULTS Infants were randomised into the FP (n=107) or placebo (n=104) groups. No significant differences were detected between the FP and placebo groups with respect to either the frequency of death or the oxygen dependence at discharge or NDIs. In subgroup analyses, the frequencies of death and oxygen dependence at discharge were significantly decreased in the FP group for infants born at 24-26 GWs and for infants with CAM, regardless of the GW at birth. CONCLUSIONS Inhaled steroids have no effect on the prevention of severe BPD or long-term NDI but might decrease the severity of BPD for ELBWIs with a risk factor. TRIAL REGISTRATION NUMBER UMIN-CTR C000000405.
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Affiliation(s)
- Tomohiko Nakamura
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan.,Division of Neonatology, Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masahiro Nakayama
- Department of Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hirofumi Aotani
- Department of Pediatrics, Kyoto Kizukawa Hospital, Kyoto, Japan
| | - Satoshi Kusuda
- Department of Neonatal Medicine, Maternal and Perinatal Center, Tokyo Women's Medical Center, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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16
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Fujimura M, Nakatsuji Y, Ishimaru H. Cyclosporin A Treatment in Intrinsic Canine Atopic Dermatitis (Atopic-like Dermatitis): Open Trial Study. Pol J Vet Sci 2016; 19:567-572. [DOI: 10.1515/pjvs-2016-0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In this study, dogs were separated into two groups and treated with immunosuppressant (Cyclosporin A: CsA). The first group was the canine atopic dermatitis (CAD) group, which is similar to extrinsic atopic dermatitis (AD) in humans (treated with a CsA dose of 2.5-5.5 mg/kg, n=8), and the second group was the canine atopic-like dermatitis (ALD) group, which is similar to intrinsic AD in humans (treated with a CsA dose of 2.5-6.5 mg/kg, n=14). The canine atopic dermatitis extent and severity index (CADESI)-4 was evaluated before treatment (PRE) and after treatment (POST) to assess the effectiveness of CsA for the two groups. In the CAD group, CADESI-4 showed no change (PRE:79±29, POST:77±28) and out of the eight dogs, no dogs showed complete remission, three dogs showed partial remission, and five dogs showed no effect. Whereas in the ALD group, CADESI-4 showed a significant reduction (PRE: 61±42, POST: 32±25, p<0.01) and out of the 14 dogs, 11 dogs showed complete remission, two dogs showed partial remission, and one dog showed no effect. The results indicate that the immunosuppressant showed effectiveness for the dogs diagnosed with ALD. One dog had to be treated for a year and eight months, which was the longest period in the study, this dog presented with hyperplasia of the lymphoidgland and mammary tumor.
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17
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Omodaka S, Endo H, Niizuma K, Fujimura M, Inoue T, Sato K, Sugiyama SI, Tominaga T. Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging. AJNR Am J Neuroradiol 2016; 37:1262-6. [PMID: 26939634 DOI: 10.3174/ajnr.a4722] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/03/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. MATERIALS AND METHODS We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. RESULTS The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). CONCLUSIONS Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.
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Affiliation(s)
- S Omodaka
- From the Departments of Neurosurgery (S.O., H.E.)
| | - H Endo
- From the Departments of Neurosurgery (S.O., H.E.)
| | - K Niizuma
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Fujimura
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Inoue
- Department of Neurosurgery (T.I.), Sendai Medical Center, Sendai, Japan
| | - K Sato
- Neuroendovascular Therapy (K.S.)
| | - S-I Sugiyama
- Neuroanesthesia (S.-i.S.), Kohnan Hospital, Sendai, Japan
| | - T Tominaga
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
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Namba F, Fujimura M, Tamura M. Bubbly and cystic appearance in chronic lung disease: Is this diagnosed as Wilson-Mikity syndrome? Pediatr Int 2016; 58:251-3. [PMID: 26717558 DOI: 10.1111/ped.12901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/24/2015] [Indexed: 11/29/2022]
Abstract
Wilson-Mikity syndrome (WMS) was first reported in 1960 by Wilson and Mikity. They described preterm infants who developed areas of cystic emphysema in the first month of life with subsequent progression to chronic lung disease (CLD) of infancy, although these infants did not exhibit early respiratory distress, such as respiratory distress syndrome (RDS). This condition was widely accepted over the next 20 years, but WMS is now rarely mentioned and is commonly considered an anachronism. In Japan, CLD is classified into six types according to the presence of RDS and/or intrauterine inflammation and appearance on chest X-ray. One type of CLD (type III, which accounts for 13.5% of all CLD) is defined as history of intrauterine inflammation and the typical bubbly and cystic appearance on chest X-ray described in the original report of WMS. There is insufficient evidence to determine whether WMS exists or whether WMS is relatively common only in Japan and not in other countries. It is important, however, to distinguish this type of CLD from other types because the strategy for the prevention or treatment of CLD should be different according to its origin, cause, and risk factors.
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Affiliation(s)
- Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Abstract
Abstract
Twenty dogs with canine atopic dermatitis (CAD) were treated with rush sublingual immunotherapy (SLIT), with a 48 hour build-up phase and 6 months maintenance phase (treated by antigen once every 3-4 weeks). The canine atopic dermatitis extent and severity index (CADESI)-4 was evaluated before treatment (baseline) and after 6 months. An open, non-controlled, non-randomized pilot trial was conducted to assess the effectiveness and safety of rush SLIT for environmental allergen extracts (Dematophagoides pteronyssinus and D.farinae mix and other). Three dogs dropped out and 17 dogs finished the trial. CADESI-4 at baseline was 60.6±27.1 (range 17-107, n=17). After 6 months of SLIT treatment, CADESI-4 was 37.4±36.0 (range 5-152, n=17) (p <0.01), which was a 38.3% reduction. A significant improvement, defined as a CADESI-4 reduction of > 30%, was observed in 13 out of 17 dogs (76%). A moderate improvement, defined as a CADESI-4 reduction of ≦30%, was observed in 2 dogs (12%). In the other 2 dogs (12%), CADESI-4 worsened or showed no change. However, no severe adverse effects were observed during the trial.
Therefore, rush SLIT against environmental allergen extract for CAD showed effectiveness and safety as evidenced by the reduction of CADESI-4 after 6 months SLIT without severe adverse effects.
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Morisaki N, Belfort MB, McCormick MC, Mori R, Noma H, Kusuda S, Fujimura M. Correction: Brief Parenteral Nutrition Accelerates Weight Gain, Head Growth Even in Healthy VLBWs. PLoS One 2015; 10:e0143984. [PMID: 26606139 PMCID: PMC4659585 DOI: 10.1371/journal.pone.0143984] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Maruyama H, Yonemoto N, Kono Y, Kusuda S, Fujimura M. Weight Growth Velocity and Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants. PLoS One 2015; 10:e0139014. [PMID: 26402326 PMCID: PMC4581837 DOI: 10.1371/journal.pone.0139014] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction This study aimed to assess whether weight growth velocity (WGV) predicts neurodevelopmental outcomes in extremely low birth weight infants (ELBWIs). Methods Subjects were infants who weighed 501–1000 g at birth and were included in the cohort of the Neonatal Research Network of Japan (2003–2007). Patel’s exponential model (EM) method was used to calculate WGV between birth and discharge. Assessment of predictions of death or neurodevelopmental impairment (NDI) was performed at 3 years of age based on the WGV score, which was categorized by per one increase in WGV. Multivariate logistic regression analysis was used to calculate adjusted odds ratios and their 95% confidence intervals (95%CI). Results In the 2961 ELBWIs assessed, the median WGV was 10.5 g/kg/day (interquartile, 9.4–11.9). With the categorical approach, the adjusted odds ratios for death or NDI with WGV scores of 6 and 7 were 2.41 (95%CI, 1.60–3.62) and 1.81 (95%CI, 1.18–2.75), respectively, relative to the reference WGV score of 10. WGV scores ≥8 did not predict death or NDI. Conclusions WGV scores <8 were significant predictors suggesting that values of WGV during hospitalization in a NICU are associated with neurodevelopmental outcomes. Further investigations is necessary to determine whether additional nutritional support may improve low WGV in ELBWIs.
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Affiliation(s)
- Hidehiko Maruyama
- Department of Pediatrics, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- * E-mail:
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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Isayama T, Mirea L, Mori R, Kusuda S, Fujimura M, Lee SK, Shah PS. Patent ductus arteriosus management and outcomes in Japan and Canada: comparison of proactive and selective approaches. Am J Perinatol 2015; 32:1087-94. [PMID: 25825965 DOI: 10.1055/s-0035-1548727] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to compare patent ductus arteriosus (PDA) management strategies and outcomes between the Neonatal Research Network of Japan (NRNJ) with proactive functional echocardiography and the Canadian Neonatal Network (CNN) with selective conventional echocardiography practice. STUDY DESIGN Retrospective analyses examined very low-birth-weight infants admitted to the NRNJ or CNN in 2006 to 2008. Multivariable logistic regression analyses compared a composite outcome indicating a mortality or major morbidity (severe intraventricular hemorrhage, periventricular leukomalacia, severe retinopathy of prematurity, bronchopulmonary dysplasia, or necrotizing enterocolitis) between networks, according to PDA diagnosis and treatment, and tested the association between PDA treatment and the composite outcome within networks. RESULTS PDA treatment (NRNJ:CNN) with conservative management (8%:16%), indomethacin only (77%:59%), ligation only (1%:13%), or indomethacin and ligation (14%:13%) varied significantly between networks. The composite outcome was lower in NRNJ versus CNN only among infants with PDA (odds ratio: 0.70; 95% confidence interval: 0.62-0.80). Surgical ligation was associated with higher composite outcome only in CNN (odds ratio: 1.79; 95% confidence interval: 1.40-2.28). CONCLUSION Lower composite mortality/morbidity outcome in Japan versus Canada only among infants with PDA, and association of surgical ligation with higher mortality/morbidity only in Canada, suggest differential PDA management and ligation processes contribute to outcome variation.
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Affiliation(s)
- Tetsuya Isayama
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lucia Mirea
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Shoo K Lee
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Hirata K, Nishihara M, Shiraishi J, Hirano S, Matsunami K, Sumi K, Wada N, Kawamoto Y, Nishikawa M, Nakayama M, Kanazawa T, Kitajima H, Fujimura M. Perinatal factors associated with long-term respiratory sequelae in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2015; 100:F314-9. [PMID: 25783193 DOI: 10.1136/archdischild-2014-306931] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 02/19/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess lung function at 8 years old in extremely low birthweight (ELBW) survivors and to identify perinatal determinants associated with impaired lung function. DESIGN Retrospective cohort study. SETTING Level III neonatal intensive care unit. PATIENTS ELBW survivors born in 1990-2004 with available spirometry at 8 years old were studied. Children were excluded if they had a Wechsler Intelligence Scale for Children Third Edition full IQ <70. MAIN OUTCOME MEASURES Multivariate logistic regression analysis was used to identify perinatal determinants associated with airway obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <80%) at school age and the predictive power of potential determinants. Potential risk factors and predictors assessed in this study were gestational age, birth weight, small for gestational age, sex, chorioamnionitis, premature rupture of membranes, antenatal steroids, surfactant administration, respiratory distress syndrome, postnatal steroids, severe bronchopulmonary dysplasia and bubbly/cystic appearances of the lungs by X-ray during the neonatal period. RESULTS Of 656 ELBW survivors, 301 (45.9%) had attended a school-age follow-up at 8 years old. A total of 201 eligible children completed the lung function test. Bubbly/cystic appearance of the lungs (OR 4.84, 95% CI 1.26 to 18.70) was associated with a low FEV1/FVC ratio. Children with bubbly/cystic appearance had characteristics of immaturity and intrauterine inflammation. CONCLUSIONS Within a cohort of ELBW infants, a bubbly/cystic appearance of the lungs in the neonatal period was the strongest determinant of a low FEV1/FVC ratio at school age.
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Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masahiro Nishihara
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Jun Shiraishi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Katsura Matsunami
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Kiyoaki Sumi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Norihisa Wada
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Yutaka Kawamoto
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masahiro Nakayama
- Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Tadahiro Kanazawa
- Department of Comparative and Developmental Psychology, Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Hayashi K, Kai A, Ishikawa H, Murabayashi N, Ikeda T, Kono Y, Kusuda S, Fujimura M. Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis. Arch Gynecol Obstet 2015; 292:1239-46. [PMID: 25990481 DOI: 10.1007/s00404-015-3762-6] [Citation(s) in RCA: 15] [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: 10/21/2014] [Accepted: 05/13/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA). METHODS We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis. RESULTS In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quotient <70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was associated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was associated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)]. CONCLUSION AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.
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Affiliation(s)
- Ken Miyazaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Madoka Furuhashi
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Kaoru Ishikawa
- Department of Endowed Chair for Regeneration of Medicine in Kuwana District, Suzuka University of Medical Science, Mie, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazutoshi Hayashi
- Department of Obstetrics and Gynecology, Kochi Health Sciences Center, Kochi, Japan
| | - Akihiro Kai
- Department of Neonatology, Aizenbashi Hospital, Osaka, Japan
| | - Hiroshi Ishikawa
- Department of Obstetrics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nao Murabayashi
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Medical Center and Research Institute for maternal and Child Health, Osaka, Japan
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Isayama T, Ye XY, Tokumasu H, Chiba H, Mitsuhashi H, Shahrook S, Kusuda S, Fujimura M, Toyoshima K, Mori R. The effect of professional-led guideline workshops on clinical practice for the management of patent ductus arteriosus in preterm neonates in Japan: a controlled before-and-after study. Implement Sci 2015; 10:67. [PMID: 25952042 PMCID: PMC4438511 DOI: 10.1186/s13012-015-0258-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 04/29/2015] [Indexed: 11/25/2022] Open
Abstract
Background Clinical guidelines assist physicians to make decisions about suitable healthcare. We conducted a controlled before-and-after study to investigate the impact of professional-led guideline workshops for patent ductus arteriosus (PDA) management on physicians’ clinical practices, discharge mortality, and associated morbid conditions among preterm neonates. Methods We recruited physicians practicing at two neonatal intensive care units (NICUs) in Japan and used the data of all neonates weighing less than or equal to 1,500 g admitted to 90 NICUs (2 intervention NICUs and 88 control NICUs) in the Neonatal Research Network of Japan from April 2008 to March 2010. We held 1-day workshops for physicians on PDA clinical practice guidelines at the two intervention NICUs. Physicians’ skills assessed by confidence rating (CR) scores and the Sheffield Peer Review Assessment Tool (SPRAT) were compared between pre- and post-workshop month at the intervention NICUs using Wilcoxon signed-rank tests. Neonatal discharge mortality and morbidity were compared between pre- and post-workshop year at both the intervention and control NICUs using multivariable regression analyses adjusting for potential confounders. Results Fifteen physicians were included in the study. Physicians’ CR scores (2.14 vs. 2.47, p = 0.02) and SPRAT (4.14 vs. 4.50, p = 0.05) in PDA management improved after the workshops. The analyses of neonatal outcomes included 294 and 6,234 neonates in the intervention and control NICUs, respectively. Neonates’ discharge mortality declined sharply at the intervention NICUs (from 15/146 to 5/148, relative risk reduction −0.67; adjusted odds ratio 0.30, 95% confidence interval 0.10 to 0.89) during the post-workshop period. The mortality reduction was much greater than that in the control NICUs (from 207/3,322 to 147/2,912, relative risk reduction −0.19; adjusted odds ratio 0.75, 95% confidence interval 0.59 to 0.95), although the difference between the intervention and control NICUs were not statistically significant. Conclusions Overall, physicians’ confidence in PDA management improved after attending guideline workshops. Face-to-face workshops by guideline developers can be a useful strategy to improve physicians’ PDA management skills and, thereby, might reduce PDA-associated mortality in preterm neonates. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0258-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tetsuya Isayama
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Xiang Y Ye
- Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Hironobu Tokumasu
- Department of Consultation, Kurashiki Clinical Research Institute, Kurashiki, Okayama, Japan.
| | - Hiroo Chiba
- Division of Pediatrics, Sendai City Hospital, Sendai, Miyagi, Japan.
| | - Hideko Mitsuhashi
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
| | - Sadequa Shahrook
- Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
| | - Masanori Fujimura
- Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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Kitajima H, Kanazawa T, Mori R, Hirano S, Ogihara T, Fujimura M. Long-term alpha-tocopherol supplements may improve mental development in extremely low birthweight infants. Acta Paediatr 2015; 104:e82-9. [PMID: 25382182 DOI: 10.1111/apa.12854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 09/10/2014] [Accepted: 11/04/2014] [Indexed: 01/21/2023]
Abstract
AIM Methods to improve the mental development of extremely low birthweight (ELBW) children are currently lacking. We assessed the effects of long-term supplementation of alpha-tocopherol on the neurological development of 259 school-aged ELBW children. METHODS Extremely low birthweight participants were divided into three groups: group A with no alpha-tocopherol supplementation (n = 121); group B with the supplementation for <6 months (n = 104) and group C with the supplementation for more than 6 months (n = 34). We analysed the participants' data at birth and between the ages of one-and-a-half to 8 years and evaluated potential factors associated with intellectual disabilities. RESULTS Children from group C had the best outcome. The groups' mean gestational weeks and mean ventilator days were as follows: 27.5 weeks, 16.1 days (group A); 25.7 weeks, 41.7 days (group B); and 25.1 weeks, 75.5 days (group C). Multivariate regression analysis revealed that the odds ratios for impaired mental development at 8 years were 1.5 in group B and 0.19 (p = 0.017) in group C, compared with 1.0 in group A. The association between the duration of alpha-tocopherol administration and performance intelligence quotient (IQ) was dose dependent (p = 0.03). CONCLUSION Long-term supplementation of alpha-tocopherol appeared to improve mental development, in particular, performance IQ, in school-aged ELBW children.
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Affiliation(s)
- Hiroyuki Kitajima
- Department of Neonatal Medicine; Osaka Medical Center and Research Institute for Maternal and Child Health; Izumi Japan
| | - Tadahiro Kanazawa
- Department of Comparative and Developmental Psychology; School of Human Science Osaka University; Suita Japan
| | - Rintaro Mori
- Department of Health Policy; National Center for Child Health and Development; Tokyo Japan
| | - Shinya Hirano
- Department of Neonatal Medicine; Osaka Medical Center and Research Institute for Maternal and Child Health; Izumi Japan
| | - Tohru Ogihara
- Department of Pediatrics; Osaka Medical College; Takatsuki Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine; Osaka Medical Center and Research Institute for Maternal and Child Health; Izumi Japan
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Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Hayashi K, Kai A, Ishikawa H, Murabayashi N, Ikeda T, Kono Y, Kusuda S, Fujimura M. Impact of chorioamnionitis on short- and long-term outcomes in very low birth weight preterm infants: the Neonatal Research Network Japan. J Matern Fetal Neonatal Med 2015; 29:331-7. [PMID: 25567563 DOI: 10.3109/14767058.2014.1000852] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the short- and long-term outcomes among very low birth weight (VLBW) preterm infants after histologic chorioamnionitis (HCA). METHODS We performed a retrospective analysis of 5849 single infants (birth weight <1500 g) born at a gestational age between 22 + 0 and 33 + 6 weeks. Clinical data were obtained from the Neonatal Research Network Japan between 2003 and 2007. Multivariable logistic regression analyses were performed to assess the effect of HCA on short- and long-term outcome. RESULTS According to logistic regression analysis, HCA was associated with lower incidence of respiratory distress syndrome (odds ratio [OR] = 0.54; p < 0.001), increased chronic lung disease (OR = 1.68; p < 0.001) and sepsis (OR = 1.71; p < 0.001) and as a short-term outcomes. There was no significant association with intraventricular hemorrhage (OR = 1.11; p = 0.33), periventricular leukomalacia (OR = 1.07; p = .070) and death before discharge (OR = 0.97; p = 0.084). HCA was associated with increased home oxygen therapy (OR = 3.09; p < 0.001), but not with cerebral palsy (CP; OR = 0.91; p = 0.63), develop quotient < 70 (OR = 1.27; p = 0.17), visual impairment (OR = 1.08; p = 0.77), severe hearing impairment (OR = 1.28; p = 0.62) and death (OR = 0.98; p = 0.91) before three years of age. CONCLUSIONS In this retrospective population-based study in Japan, HCA was not a risk factor for death, neurodevelopmental impairment and CP in VLBW three-year-old preterm infants.
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Affiliation(s)
- Ken Miyazaki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan
| | - Madoka Furuhashi
- a Department of Obstetrics and Gynecology , Japanese Red Cross Nagoya Daiichi Hospital , Nagoya , Japan
| | - Kaoru Ishikawa
- b Department of Endowed Chair for Regeneration of Medicine in Kuwana District , Suzuka University of Medical Science , Suzuka , Japan
| | - Koji Tamakoshi
- c Department of Nursing , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazutoshi Hayashi
- d Department of Obstetrics and Gynecology , Kochi Health Sciences Center , Kochi , Japan
| | - Akihiko Kai
- e Department of Neonatology , Aizenbashi Hospital , Osaka , Japan
| | - Hiroshi Ishikawa
- f Department of Obstetrics , Kanagawa Children's Medical Center , Yokohama , Japan
| | - Nao Murabayashi
- g Department of Obstetrics and Gynecology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Tomoaki Ikeda
- g Department of Obstetrics and Gynecology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Yumi Kono
- h Department of Pediatrics , Jichi Medical University , Shimotsuke , Japan
| | - Satoshi Kusuda
- i Department of Neonatology , Maternal and Perinatal Center, Tokyo Women's Medical University , Tokyo , Japan , and
| | - Masanori Fujimura
- j Department of Neonatology , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan
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Ishikawa H, Miyazaki K, Ikeda T, Murabayashi N, Hayashi K, Kai A, Ishikawa K, Miyamoto Y, Nishimura K, Kono Y, Kusuda S, Fujimura M. The Effects of Antenatal Corticosteroids on Short- and Long-Term Outcomes in Small-for-Gestational-Age Infants. Int J Med Sci 2015; 12:295-300. [PMID: 25897289 PMCID: PMC4402431 DOI: 10.7150/ijms.11523] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/25/2015] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the effect of antenatal corticosteroids (ANS) on short- and long-term outcomes in small-for-gestational age (SGA) infants. METHODS A retrospective database analysis was performed. A total of 1,931 single infants (birth weight <1,500 g) born at a gestational age between 22 weeks and 33 weeks 6 days who were determined to be SGA registered in the Neonatal Research Network Database in Japan between 2003 and 2007 were evaluated for short-term outcome and long-term outcome. RESULTS ANS was administered to a total of 719 infants (37%) in the short-term outcome evaluation group and 344 infants (36%) in the long-term outcome evaluation group. There were no significant differences between the ANS group and the no-ANS group for primary short-term outcome (adjusted odds ratio (OR) 0.73; 95% confidence interval (CI) 0.45-1.20; P-value 0.22) or primary long-term outcome (adjusted OR 0.69; 95% CI 0.40-1.17; P-value 0.17). CONCLUSIONS Our results show that ANS does not affect short- or long-term outcome in SGA infants when the birth weight is less than 1500 g. This study strongly suggests that administration of ANS resulted in few benefits for preterm FGR fetuses.
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Affiliation(s)
- Hiroshi Ishikawa
- 1. Department of Obstetrics and Gynecology, Kanagawa Children's Medical Center
| | - Ken Miyazaki
- 2. Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital
| | - Tomoaki Ikeda
- 3. Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine
| | - Nao Murabayashi
- 3. Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine
| | - Kazutoshi Hayashi
- 4. Department of Obstetrics and Gynecology, Kochi Health Sciences Center
| | - Akihiko Kai
- 5. Department of Pediatrics, Aizenbashi Hospital
| | - Kaoru Ishikawa
- 6. Endowed Chair for Regeneration of Medicine in Kuwana District, Suzuka university of medical science
| | - Yoshihiro Miyamoto
- 7. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- 7. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Yumi Kono
- 8. Department of Pediatrics, Jichi Medical University
| | - Satoshi Kusuda
- 9. Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University
| | - Masanori Fujimura
- 10. Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Director of the Neonatal Research Network of Japan
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Izuhara Y, Matsumoto H, Kanemitsu Y, Izuhara K, Tohda Y, Horiguchi T, Kita H, Kuwabara K, Tomii K, Otsuka K, Fujimura M, Ohkura N, Tomita K, Yokoyama A, Ohnishi H, Nakano Y, Oguma T, Hozawa S, Nagasaki T, Ito I, Oguma T, Inoue H, Tajiri T, Iwata T, Ono J, Ohta S, Tamari M, Hirota T, Yokoyama T, Niimi A, Mishima M. GLCCI1 variant accelerates pulmonary function decline in patients with asthma receiving inhaled corticosteroids. Allergy 2014; 69:668-73. [PMID: 24673601 DOI: 10.1111/all.12400] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND In steroid-naive patients with asthma, several gene variants are associated with a short-term response to inhaled corticosteroid (ICS) treatment; this has mostly been observed in Caucasians. However, not many studies have been conducted for other ethnicities. Here, we aimed to determine the relationship between the annual decline in forced expiratory flow volume in one second (FEV1 ) and the variant of the glucocorticoid-induced transcript 1 gene (GLCCI1) in Japanese patients with asthma receiving long-term ICS treatment, taking into account the effect of high serum periostin levels, a known association factor of pulmonary function decline and a marker of refractory eosinophilic/Th2 inflammation. METHODS In this study, 224 patients with asthma receiving ICS treatment for at least 4 years were enrolled. The effects of single-nucleotide polymorphisms (SNPs) in GLCCI1, stress-induced phosphoprotein 1 (STIP1), and T gene on the decline in FEV1 of 30 ml/year or greater were determined. RESULTS Besides the known contributing factors, that is, the most intensive treatment step, ex-smoking, and high serum periostin levels (≥95 ng/ml), the GG genotype of GLCCI1 rs37973, and not other SNPs, was independently associated with a decline in FEV1 of 30 ml/year or greater. When patients were stratified according to their serum periostin levels, the GG genotype of rs37973 was significantly associated with blood eosinophilia (≥250/μl) in the high serum periostin group. CONCLUSIONS A GLCCI1 variant is a risk factor of pulmonary function decline in Japanese patients with asthma receiving long-term ICS treatment. Thus, GLCCI1 may be associated with response to ICS across ethnicities.
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Shah PS, Lee SK, Lui K, Sjörs G, Mori R, Reichman B, Håkansson S, Feliciano LS, Modi N, Adams M, Darlow B, Fujimura M, Kusuda S, Haslam R, Mirea L. The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care. BMC Pediatr 2014; 14:110. [PMID: 24758585 PMCID: PMC4021416 DOI: 10.1186/1471-2431-14-110] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants. METHODS/DESIGN Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods. DISCUSSION The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.
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Affiliation(s)
- Prakesh S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Shoo K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
| | - Kei Lui
- Australia and New Zealand Neonatal Network, Royal Hospital for Women, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Gunnar Sjörs
- Swedish Neonatal Quality Register, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Rintaro Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Brian Reichman
- Israeli Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer 52621, Israel
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics, Umea University Hospital, SE-901 85 Umeå, Sweden
| | - Laura San Feliciano
- Spanish Neonatal Network, Unidad Neonatal Barakaldo, Plaza de cruces s/n, 5ª Planta, Unidad Neonatal, Barakaldo 48903, (Bizkaia), Spain
| | - Neena Modi
- UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London SW10 9NH, UK
| | - Mark Adams
- Swiss Neonatal Network, Division of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland
| | - Brian Darlow
- Australia and New Zealand Neonatal Network, University of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand
| | - Masanori Fujimura
- Neonatal Research Network Japan, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ross Haslam
- Australia and New Zealand Neonatal Network, Women’s and Children’s Hospital, Adelaide, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lucia Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada
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Sasaki Y, Ikeda T, Nishimura K, Katsuragi S, Sengoku K, Kusuda S, Fujimura M. Association of antenatal corticosteroids and the mode of delivery with the mortality and morbidity of infants weighing less than 1,500g at birth in Japan. Neonatology 2014; 106:81-6. [PMID: 24819396 DOI: 10.1159/000358189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to re-evaluate the effectiveness of antenatal corticosteroids (ACS) and to analyze the association between ACS and the mode of delivery in the context of perinatal morbidity and mortality in very-low-birth-weight (VLBW) infants. STUDY DESIGN This retrospective cohort study involved 15,765 VLBW infants born between 2003 and 2008 at less than 34 weeks of gestation and weighing less than 1,500 g at birth. Data were obtained from the Japanese neonatal research network database. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of ACS and mode of delivery on the risk of infant mortality and morbidity. RESULTS Administration of ACS was associated with decreases in mortality rate, intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP), and was not associated with the incidence of respiratory distress syndrome (RDS), periventricular leukomalacia or necrotizing enterocolitis (NEC). When the administration of ACS was analyzed in the context of different modes of delivery, the incidence of IVH and ROP tended to decrease with cesarean section deliveries, whereas the incidence of RDS tended to decrease and the incidence of NEC tended to increase for infants delivered vaginally. The incidence of chronic lung disease tended to increase in association with both delivery methods. CONCLUSIONS This large cohort study reconfirms that ACS treatment is associated with decreases in infant mortality and severe morbidity. Furthermore, the delivery method may be associated with severe morbidity in VLBW infants exposed to ACS.
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Miyazaki K, Furuhashi M, Ishikawa K, Tamakoshi K, Ikeda T, Kusuda S, Fujimura M. The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis. Arch Gynecol Obstet 2013; 289:1185-90. [PMID: 24305749 DOI: 10.1007/s00404-013-3106-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effectiveness of antenatal corticosteroids (AC) therapy on outcomes of very low birthweight infants with histologic chorioamnionitis. METHODS We performed a retrospective analysis of 10,935 single infants born at a gestational age between 22 + 0 and 33 + 6 weeks and birth weight <1,500 g. Clinical data were obtained from the Neonatal Research Network that included the tertiary neonatal intensive care units throughout Japan between 2003 and 2008. RESULTS Data of 7,896 infants were available for the period 2003-2008 and were included in the analysis. According to logistic regression analysis, AC were significantly associated with reduced mortality [odds ratio (OR) = 0.50; p < 0.001], lower incidence of respiratory distress syndrome (OR = 0.72; p < 0.001), neonatal seizure (OR = 0.65; p = 0.003) and intraventricular hemorrhage (OR = 0.68; p = 0.001) in cases after histologic chorioamnionitis compared with the cases had no AC therapy (n = 3,271 vs. 4,625). Antenatal corticosteroids were significantly associated with reduced mortality [odds ratio (OR) = 0.60; p < 0.001] among the cases without histologic chorioamnionitis. CONCLUSION In the retrospective population-based study in Japan, AC exposure was significantly associated with a lower rate of death and neurological morbidity in cases with histologic chorioamnionitis. These outcome data in Japan will be important for further improvement of antenatal practice and care.
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Affiliation(s)
- Ken Miyazaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan,
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Kusuda S, Fujimura M, Uchiyama A, Nakanishi H, Totsu S. Identification of practices and morbidities affecting the mortality of very low birth weight infants using a multilevel logistic analysis: clinical trial or standardisation? BMJ Open 2013; 3:e003317. [PMID: 23970432 PMCID: PMC3753512 DOI: 10.1136/bmjopen-2013-003317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine the feasibility of clinical trials of newly developed treatments or standardisation of existing practices to further improve outcomes among very low birth weight (VLBW) infants, a nationwide database was analysed with a two-dimensional approach using two multivariate logistic models. DESIGN Retrospective observational analysis. SETTING Level III perinatal centres in Japan. PARTICIPANTS 15 920 VLBW infants admitted at 38 participating centres from 2003 through 2010. OUTCOME MEASURES Clinical information for the infants was collected until discharge from the centres. A multivariate logistic model identified practices and morbidities associated with mortality. Then, those which were significantly associated with mortality were analysed using a multilevel logistic model. The residues calculated by the multilevel analysis were used as an indicator of centre variation. RESULTS Among practices, antenatal steroids and intubation at birth showed relatively high centre variations (0.9 and 0.8) and favourable ORs (0.7 and 0.5) for mortality, while caesarean section showed a low centre variation (0.4) and a favourable OR (0.8). Sepsis and air leak showed high centre variations (0.4 and 0.4) and high ORs (3.8 and 3.4) among morbidities. Pulmonary haemorrhage, persistent pulmonary hypertension of the newborn, and intraventricular haemorrhage showed moderate variations (0.2, 0.3 and 0.2, respectively) and high ORs (5.6, 4.1 and 2.9, respectively). In contrast, necrotising enterocolitis showed the lowest variation (0.1) and a high OR (4.9). CONCLUSIONS The two-dimensional approach has clearly demonstrated the importance of clinical trial or standardisation. The practices and morbidities with low centre variations and high ORs for mortality must be improved through clinical trials of newly introduced techniques, while standardisation must be considered for practices and morbidities with a high centre variation. TRIAL REGISTRATION The database was registered as UMIN000006961.
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Affiliation(s)
- Satoshi Kusuda
- Department of Neonatal Medicine, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Atsushi Uchiyama
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Hidehiko Nakanishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Satsuki Totsu
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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Abstract
OBJECTIVE To provide instructive information on death and neurodevelopmental outcomes of infants born at 22 and 23 weeks' gestational age. METHODS The study cohort consisted of 1057 infants born at 22 to 25 weeks in the Neonatal Research Network, Japan. Neurodevelopmental impairment (NDI) at 36 to 42 months' chronological age was defined as any of the following: cerebral palsy, hearing impairment, visual impairment, and a developmental quotient <70. A systematic review was performed by using databases of publications of cohort studies with neonatal and neurodevelopmental outcomes at 22 and 23 weeks. RESULTS Numbers and incidences (%) of infants with death or NDI were 60 (80%) at 22 weeks and 156 (64%) at 23 weeks. In logistic regression analysis, gestational ages of 22 weeks (odds ratio [OR]: 5.40; 95% confidence interval [CI]: 2.48-11.76) and 23 weeks (OR: 2.14; 95% CI: 1.38-3.32) were associated with increased risk of death or NDI compared with 24 weeks, but a gestational age of 25 weeks (OR: 0.65; 95% CI: 0.45-0.95) was associated with decreased risk of death or NDI. In the systematic review, the medians (range) of the incidence of death or NDI in 8 cohorts were 99% (90%-100%) at 22 weeks and 98% (67%-100%) at 23 weeks. CONCLUSIONS Infants born at 22 and 23 weeks' gestation were at higher risk of death or NDI than infants at born at 24 weeks. However, outcomes were improved compared with those in previous studies. There is a need for additional discussions on interventions for infants born at 22 or 23 weeks' gestation.
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Affiliation(s)
- Nozomi Ishii
- Department of Pediatrics, Aiiku Hospital, Minato, Tokyo, Japan
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Wariki WMV, Mori R, Boo NY, Cheah IGS, Fujimura M, Lee J, Wong KY. Risk factors associated with outcomes of very low birthweight infants in four Asian countries. J Paediatr Child Health 2013; 49:E23-7. [PMID: 23282105 DOI: 10.1111/jpc.12054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2012] [Indexed: 11/30/2022]
Abstract
AIM The study aims to determine the risk factors associated with mortality and necrotising enterocolitis (NEC) among very low birthweight infants in 95 neonatal intensive care units in the Asian Network on Maternal and Newborn Health. METHODS This is a cross-sectional study using an international collaborative database of 17,595 very low birthweight infants admitted within 28 days of birth between 2003 and 2006 in four Asian countries. Information on the mortality and morbidity of neonates admitted to the neonatal intensive care units was recorded. Factors associated with the death and diseases of infants were estimated using multilevel multivariate logistic regression. Random effects were included to account for the clustering of the observations. RESULTS Overall discharge mortality was 15% and it was significantly different by countries and units. The mortality rate was found to be significantly higher in neonates with pulmonary haemorrhage (odds ratio 1.83, 95% confidence interval 1.63-2.04) and air leak syndrome (odds ratio 1.51, 95% confidence interval 1.30-1.72). The incidence of NEC was 4.3% and was strongly associated with other morbidities. Multivariate logistic regression showed that patent ductus arteriosus was the most significant risk factor associated with NEC. CONCLUSIONS Our analysis has highlighted the great potential that multi-country, collaborative datasets have in terms of epidemiologic research when it comes to identifying issues in perinatal health that are common throughout Asia, and in relation to particular issues pertaining to specific countries and neonatal units. Establishing collaborative networks, conducting analyses of common datasets and further epidemiologic research are now essential measures to improve newborn health in Asia.
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Bando T, Kasahara K, Shibata K, Numata Y, Heki U, Shirasaki H, Iwasa K, Fujimura M, Matsuda T. Cytotoxicity of a novel indoloquinone eo9 in hypoxic non-small-cell lung-cancer cell-lines. Int J Oncol 2012; 7:789-93. [PMID: 21552905 DOI: 10.3892/ijo.7.4.789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
3-Hydroxymethyl-5-aziridinyl-1-methyl-[1H-indole-4,7-dione]-prop-beta-en -alpha-ol (EO9) is a bioreductive anticancer agent active for non-small cell lung cancer (NSCLC) and structurally related to mitomycin C (MMC). DT-diaphorase (DTD) is regarded as a two electron reductase that plays an important role in the biotransformation of MMC to antitumor metabolites. To evaluate the role of DTD as a bioactivator of EO9 in NSCLC cell lines under oxic and hypoxic conditions, we examined the inhibitory effect of dicumarol which was regarded as a selective inhibitor of DTD on the sensitivity to EO9 in vitro. In this study, we used an MMC-resistant NSCLC cell line (PC-9/MC4) which was established from a PC-9 cell line as a parent cell line by continuous exposure to MMC in our laboratory. We reported previously that the subline PC-9/MC4 was 6.7-fold more resistant to MMC than PC-9 with decreased DTD activity. The IC50 value of PC-9 against EO9 was significantly increased by co-incubation with dicumarol under oxic conditions. EO9 was more cytotoxic against PC-9/MC4 than against PC-9 cells and the enhancement was impaired by tempol under hypoxic conditions. These findings suggest a suppressive role of DTD against one-electron reduction pathway in the bioactivation of EO9 under hypoxic conditions and EO9 may be more active against oxygen-deficient solid tumors especially in MMC-resistant NSCLC cells with low levels of DTD activity.
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Bando T, Kasahara K, Shibata K, Nakatsumi Y, Fujimura M, Matsuda T. Role of dt-diaphorase as a determinant of sensitivity to mitomycin analogs in nonsmall cell lung-cancer cell-lines. Int J Oncol 2012; 5:819-25. [PMID: 21559647 DOI: 10.3892/ijo.5.4.819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
DT-diaphorase (DT-D) is regarded as a two-electron reductase that plays an important role in the biotransformation of mitomycin C (MMC) to antitumor metabolites, which is enhanced under hypoxic conditions. To evaluate the role of DT-D as a bioactivator of MMC and its analogue, KW-2149, in non-small cell lung cancer (NSCLC) cell lines under an aerobic or hypoxic condition, we examined the inhibitory effect of dicumarol which was regarded as an inhibitor of DT-D on the sensitivity to these anticancer agents in vitro. In this study, we used an MMC-resistant NSCLC cell line (PC-9/MC4) which was established in our laboratory from a PC-9 cell line as a parent cell line by continuous exposure to MMC. The subline PC-9/MC4 was 6.7-fold more resistant to MMC than PC-9, the parent cell line, under aerobic conditions, and 5.2-fold more resistant even under hypoxic conditions. PC-9/MC4 cell lines did not show collateral resistance to KW-2149, a newly developed MMC analogue. The IC50 value of PC-9 against MMC significantly decreased by co-incubation with dicumarol under aerobic, but not under hypoxic conditions. KW-2149 was cytotoxic to PC-9/MC4 as well as PC-9 cells, and the sensitivity to KW-2149 was not altered by coincubation with dicumarol or exposure to hypoxia. There were no significant differences in intracellular uptake of MMC and the activities of cytosolic detoxification enzymes, GST and GSH, between PC-9 and PC-9/MC4 cell lines under aerobic conditions. These findings suggest a partial role of DT-D in bioactivation of MMC, but not of KW-2149, under aerobic conditions. However, the detailed mechanisms of drug resistance to MMC under hypoxic conditions are still not clear.
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Bando T, Fujimura M, Kasahara K, Shibata K, Shirasaki H, Heki U, Iwasa K, Ueda A, Tomikawa S, Matsuda T. Stimulation of beta-adrenoceptor enhances sensitivity to cisplatin in non-small cell lung cancer cell lines. Int J Oncol 2012; 10:1197-201. [PMID: 21533504 DOI: 10.3892/ijo.10.6.1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cisplatin is a key drug in chemotherapy for lung cancer. It has been reported that intracellular accumulation of cisplatin is an important step as a determinant for resistance to cisplatin, which may be modulated by Na+, K+-ATPase activity. And it has been reported that beta-adrenoceptor agonists modulate the Na+, K+-ATPase in some organs. In this study, the effects of a beta-adrenoceptor agonist and an antagonist on membrane Na+, K+-ATPase activity were evaluated using human non-small cell (NSCLC) lung cancer cell lines. In the NSCLC cell lines, sensitivity to cisplatin was improved by treatment with isoproterenol. Na+, K+-ATPase was activated and intracellular accumulation of cisplatin increased with the treatment. But the antagonist, propranolol, did not modulate sensitivity to cisplatin or Na+, K+-ATPase activity. These results suggest that beta-adrenoceptors may be one of the determinant for sensitivity to cisplatin in NSCLC, but endogenous catecholamine dose not play a role in the intracellular accumulation of cisplatin in these cell lines. Exogenous beta-adrenoceptor agonists may improve the antitumor effect of chemotherapy involving cisplatin.
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Isayama T, Lee SK, Mori R, Kusuda S, Fujimura M, Ye XY, Shah PS. Comparison of mortality and morbidity of very low birth weight infants between Canada and Japan. Pediatrics 2012; 130:e957-65. [PMID: 22966031 DOI: 10.1542/peds.2012-0336] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [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: 01/19/2023] Open
Abstract
OBJECTIVE To compare neonatal outcomes of very low birth weight (VLBW) infants admitted to NICUs participating in the Canadian Neonatal Network and the Neonatal Research Network of Japan. METHODS Secondary analyses of VLBW infants in both national databases between 2006 and 2008 were conducted. The primary outcome was a composite of mortality or any major morbidity defined as severe neurologic injury, bronchopulmonary dysplasia, necrotizing enterocolitis, or severe retinopathy of prematurity at discharge. Secondary outcomes included individual components of primary outcome and late-onset sepsis. Logistic regression adjusting for confounders was performed. RESULTS A total of 5341 infants from the Canadian Neonatal Network and 9812 infants from the Neonatal Research Network of Japan were compared. There were higher rates of maternal hypertension, diabetes mellitus, outborn, prenatal steroid use, and multiples in Canada, whereas cesarean deliveries were higher in Japan. Composite primary outcome was better in Japan in comparison with Canada (adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.79-0.96). The odds of mortality (AOR 0.40, 95% CI 0.34-0.47), severe neurologic injury (AOR 0.57, 95% CI 0.49-0.66), necrotizing enterocolitis (AOR 0.23, 95% CI 0.19-0.29), and late-onset sepsis (AOR 0.22, 95% CI 0.19-0.25) were lower in Japan; however, the odds of bronchopulmonary dysplasia (AOR 1.24, 95% CI 1.10-1.42) and severe retinopathy of prematurity (AOR 1.98, 95%CI 1.69-2.33) were higher in Japan. CONCLUSIONS Composite outcome of mortality or major morbidity was significantly lower in Japan than Canada for VLBW infants. However, there were significant differences in various individual outcomes identifying areas for improvement for both networks.
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Affiliation(s)
- Tetsuya Isayama
- Department of Paediatrics,University of Toronto, Toronto, Canada
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Ikeda H, Kasahara K, Koba H, Kurokawa K, Nishikawa S, Sakai A, Tanbo Y, Araya T, Sone T, Fukuoka J, Fujimura M, Nakao S. Prognostic Impact of C-MET/phospho-MET and Topoisomerase I in Small-Cell Lung Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Maruyama H, Kitajima H, Yonemoto N, Fujimura M. Frequent use of fresh frozen plasma is a risk factor for venous thrombosis in extremely low birth weight infants: a matched case-control study. Acta Med Okayama 2012; 66:61-6. [PMID: 22358140 DOI: 10.18926/amo/48082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneously inserted central catheters (PICCs) are often used in neonatal medicine. Venous thrombosis (VT) is one of the complications associated with PICC use. According to some reports, fresh frozen plasma (FFP) may be a risk factor for VT. The purpose of this study was to determine whether FFP use is associated with VT in extremely low birth weight infants (ELBWIs). We performed a matched case-control study on risk factors for VT in ELBWIs born over a period of 5 years in the neonatal intensive care unit of a tertiary hospital. Controls were infants from the unit matched for gestational age and birth weight. We performed univariate analyses and created receiver operating characteristic (ROC) curves for the cut-off values of continuous parameters such as FFP. We also conducted multivariate conditional logistic regression analysis and calculated adjusted odds ratios and their 95% confidence intervals. Thirteen VT cases and 34 matched controls were examined. Using an ROC curve, FFP by day 5 > 50 mL/kg was selected as the cut-off value. In multivariate conditional logistic regression analysis, FFP by day 5 > 50 mL/kg exhibited an adjusted odds ratio of 5.88 (95% confidence interval: 1.12-41.81, p = 0.036). FFP by day 5 > 50 mL/kg may be a risk factor for VT in ELBWIs.
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Abstract
BACKGROUND The aim of this study was to describe and compare neurodevelopmental outcomes with birthweight (BW) groups at 250-g intervals of very-low-birthweight (VLBW) infants at 3 years of age in a multicenter cohort in Japan. METHODS A total of 3104 VLBW infants born in 2003 and 2004 registered in a NICU-network database were followed in the study. Neurodevelopmental impairment (NDI) was defined as any of the following impairments: cerebral palsy, unilateral or bilateral blindness, severe hearing impairment, or developmental delay; a developmental quotient (DQ) <70 measured using the Kyoto Scale of Psychological Development test or judged by physicians in infants without the test. RESULTS A total of 257 infants died and follow-up data were obtained from 1826 infants. Of the 1826 infants, 155 (8.5%) had cerebral palsy, 25 (1.4%) had visual impairment, and 12 (0.7%) had hearing impairment. Of the 1197 infants in whom DQ was measured, 184 (15.4%) had DQ < 70. The proportion of NDI in the evaluated infants was 19.2% (n= 350), ranging from 11.9% (BW 1251-1500 g) to 42.0% (BW ≤ 500 g). Odds ratios (95%CI) of NDI or death against the group BW 1251-1500 g were 20.62 (13.29-31.97) in BW ≤ 500 g, 7.25 (5.45-9.64) in BW 501-750 g, 2.85 (2.12-3.82) in BW 751-1000 g and 1.18 (0.85-1.64) in BW 1001-1250 g. CONCLUSION The increasing proportion of NDI or death, an indicator of adverse outcome, was associated with decrement in the BW of the groups. Although we have to consider a bias due to loss of follow-up data, the incidence of NDI was similar to previous overseas cohort studies despite the higher survival proportion in our study.
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Abstract
BACKGROUND The aim of the present study was to explore the relationships among neonatal morbidity, interventions and death or adverse neurodevelopmental outcomes in very low-birthweight (VLBW) infants. METHODS Subjects were infants with birthweight ≤ 1500 g who were cared for in the tertiary neonatal intensive care units in Japan. Multiple logistic regression analysis was performed to examine the odds ratios (OR) and 95% confidence intervals (CI) of neonatal factors for death or cerebral palsy (CP) and death or developmental delay (developmental quotient <70 or delay judged by physicians) at 3 years of age after adjusting for biological and prenatal variables. RESULTS Of the 3104 subjects, 257 died and 1826 were evaluated at 3 years of age. Cystic periventricular leukomalacia (PVL; OR, 23.9; 95%CI: 11.0-51.7), gastrointestinal perforation (OR, 8.5; 95%CI: 2.8-25.4), intraventricular hemorrhage (IVH) grade 3 or 4 (OR, 3.1; 95%CI: 1.3-7.2) and sepsis (OR, 2.6; 95%CI: 1.4-4.8) were neonatal factors significantly associated with an increased risk of death or CP. Significant correlates with death or developmental delay were cystic PVL (OR, 7.9; 95%CI: 3.7-16.8), gastrointestinal perforation (OR, 6.3; 95%CI: 1.9-20.8), sepsis (OR, 2.8; 95%CI: 1.6-4.8), IVH grade 3 or 4 (OR, 2.6; 95%CI: 1.2-5.7), chronic lung disease at 36 weeks of corrected gestational age (OR, 1.6; 95%CI: 1.1-2.4) and treatment for retinopathy of prematurity (ROP; OR, 1.5; 95%CI: 1.0-2.3). CONCLUSION Cystic PVL, gastrointestinal perforation, IVH and sepsis correlated with both death or CP and death or developmental delay in VLBW infants. Chronic lung disease at 36 weeks and treatment for ROP were associated with death or developmental delay, but not with death or CP.
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Affiliation(s)
- Yumi Kono
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan.
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Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, Nara K, Kitajima H, Fujimura M, Kuwae Y, Nakayama M. Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int 2011; 53:887-91. [PMID: 21486380 DOI: 10.1111/j.1442-200x.2011.03381.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 11/29/2022]
Abstract
BACKGROUND A nationwide survey on neonatal surgery conducted by the Japanese Society of Pediatric Surgeons has demonstrated that the mortality of neonatal intestinal perforation has risen over the past 15 years. The incidence of intestinal perforation in extremely low-birthweight (ELBW) neonates has been increasing as more ELBW neonates survive and as the live-birth rate of ELBW has increased. In contrast to necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP), the pathogenesis of meconium-related ileus, defined as functional bowel obstruction characterized by delayed meconium excretion and microcolon, remains unclarified. METHODS The histology of 13 ELBW neonates with intestinal perforation secondary to meconium-related ileus was reviewed, and the radiology of 33 cases of meconium-related ileus diagnosed on contrast enema was reviewed. Specimens obtained from 16 ELBW neonates without gastrointestinal disease served as age-matched controls for histological assessment. RESULTS The size of the ganglion cell nucleus in meconium-related ileus and in control subjects was 47.3 ± 22.0 µm(2) and 37.8 ± 11.6 µm(2), respectively, which was not significantly different. In all cases of meconium-related ileus, contrast enema demonstrated a microcolon or small-sized colon, with a gradual caliber change in the ileum and filling defects due to meconium in the ileum or colon, showing not-identical locations of caliber changes and filling defects. CONCLUSION Morphological immaturity of ganglia was not suggested to be the pathogenesis of meconium-related ileus. Impaction of inspissated meconium is not the cause of obstruction, but the result of excessive water absorption in the hypoperistaltic bowel before birth, although the underlying mechanism responsible for the fetal hypoperistalsis remains unclear.
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Affiliation(s)
- Akio Kubota
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
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Mori R, Kusuda S, Fujimura M. Antenatal corticosteroids promote survival of extremely preterm infants born at 22 to 23 weeks of gestation. J Pediatr 2011; 159:110-114.e1. [PMID: 21334006 DOI: 10.1016/j.jpeds.2010.12.039] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 11/17/2010] [Accepted: 12/22/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of antenatal corticosteroid (ACS) to improve neonatal outcomes for infants born at <24 weeks of gestation. STUDY DESIGN We performed a retrospective analysis of 11,607 infants born at 22 to 33 weeks of gestation between 2003 and 2007 from the Neonatal Research Network of Japan. We evaluated the gestational age effects of ACS administered to mothers with threatened preterm birth on several factors related to neonatal morbidity and mortality. RESULTS By logistic regression analysis, ACS exposure decreased respiratory distress syndrome and severe intraventricular hemorrhage in infants born between 24 and 29 weeks of gestation. Cox regression analysis revealed that ACS exposure was associated with a significant decrease in mortality of preterm infants born at 22 or 23 weeks of gestation (adjusted hazard ratio, 0.72; 95% CI, 0.53 to 0.97; P=.03). This effect was also observed at 24 to 25 and 26 to 27 weeks of gestation and in the overall study population. CONCLUSIONS ACS exposure improved survival of extremely preterm infants. ACS treatment should be considered for threatened preterm birth at 22 to 23 weeks of gestation.
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Affiliation(s)
- Rintaro Mori
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Ogawa H, Fujimura M. Allergic Fungal Cough (AFC): A More Severe Type of Fungus-Associated Chronic Cough (FACC). Pulm Pharmacol Ther 2011. [DOI: 10.1016/j.pupt.2011.04.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sone T, Kasahara K, Sakai A, Ikeda H, Kurokawa K, Fujimura M. Analysis of c-Met gene amplification in Japanese patients with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18021] [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: 11/20/2022] Open
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Uehara R, Miura F, Itabashi K, Fujimura M, Nakamura Y. Distribution of birth weight for gestational age in Japanese infants delivered by cesarean section. J Epidemiol 2011; 21:217-22. [PMID: 21478642 PMCID: PMC3899412 DOI: 10.2188/jea.je20100123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neonatal anthropometric charts of the distribution of measurements, mainly birth weight, taken at different gestational ages are widely used by obstetricians and pediatricians. However, the relationship between delivery mode and neonatal anthropometric data has not been investigated in Japan or other countries. METHODS The subjects were selected from the registration database of the Japan Society of Obstetrics and Gynecology (2003-2005). Tenth centile, median, and 90th centile of birth weight by sex, birth order, and delivery mode were observed by gestational age from 22 to 42 weeks among eligible singleton births. RESULTS After excluding 248 outliers and 5243 births that did not satisfy the inclusion criteria, 144,980 births were included in the analysis. The distribution of 10th centile curves was skewed toward lower birth weights during the preterm period among both first live births and second and later live births delivered by cesarean section. More than 40% of both male and female live births were delivered by cesarean section at 37 weeks or earlier. CONCLUSIONS The large proportion of cesarean sections influenced the skewness of the birth weight distribution in the preterm period.
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Affiliation(s)
- Ritei Uehara
- Department of Public Health, Jichi Medical University, Tochigi, Japan.
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