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Kanno J, Miura A, Kawashima S, Shima H, Suzuki D, Kamimura M, Fujiwara I, Kamimura M, Uematsu M, Kudo M, Kikuchi A. A case of 49,XXXYY followed-up from infancy to adulthood with review of literature. Endocr J 2024:EJ24-0015. [PMID: 38684424 DOI: 10.1507/endocrj.ej24-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
49,XXXYY is an extremely rare sex chromosomal aneuploidy (SCA), with only seven cases reported worldwide to date. Among these cases, only three have been documented into adulthood. Moreover, no cases of 49,XXXYY have been reported in Japan. This SCA has been identified in two scenarios: in vitro fertilization and abortion. Similar to 47,XXY, this aneuploidy is a type of Klinefelter syndrome. Aneuploidy of the X chromosome can lead to various progressive complications due to excess X chromosomes. Herein, we present the case of a Japanese man with 49,XXXYY. He exhibited developmental delays and external genitalia abnormalities since early infancy but was not closely monitored for these symptoms until the age of 3 years old. At that time, a chromosome test revealed his karyotype to be 49,XXXYY. Subsequent examinations were conducted due to various symptoms, including delayed motor development, intellectual disability, facial dysmorphisms, forearm deformities, hip dysplasia, cryptorchidism, micropenis, primary hypogonadism, and essential tremor. Since reaching puberty, he has undergone testosterone replacement therapy for primary hypogonadism, experiencing no complications related to androgen deficiency to date. He has maintained normal lipid and glucose metabolism, as well as bone density, for a prolonged period. There are no other reports on the long-term effects of testosterone treatment for the SCA. Appropriate testosterone replacement therapy is recommended for individuals with 49,XXXYY to prevent complications. This report will contribute to an enhanced understanding of the 49,XXXYY phenotype, aiding in the diagnosis, treatment, and genetic counseling of future cases.
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Affiliation(s)
- Junko Kanno
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
- Department of Pediatrics, Tome City Maiya Hospital, Tome 987-0500, Japan
| | - Akinobu Miura
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Sayaka Kawashima
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Hirohito Shima
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Dai Suzuki
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Miki Kamimura
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
- Department of Pediatrics, National Hospital Organization Sendai Medical Center, Sendai 983-0045, Japan
| | - Ikuma Fujiwara
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
- Department of Pediatrics, Sendai City Hospital, Sendai 982-8502, Japan
| | - Masayuki Kamimura
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Masataka Kudo
- Department of Nephrology and Endocrinology, Osaki Citizen Hospital, Osaki 989-6136, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
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Sugeno N, Hasegawa T, Haginoya K, Kubota T, Ikeda K, Nakamura T, Ishiyama S, Sato K, Yoshida S, Koshimizu E, Uematsu M, Miyatake S, Matsumoto N, Aoki M. Detection of Modified Histones from Oral Mucosa of a Patient with DYT- KMT2B Dystonia. Mol Syndromol 2023; 14:461-468. [PMID: 38108041 PMCID: PMC10722472 DOI: 10.1159/000530625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/07/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction DYT-KMT2B is a rare childhood-onset, hereditary movement disorder typically characterized by lower-limb dystonia and subsequently spreads into the craniocervical and laryngeal muscles. Recently, KMT2B-encoding lysine (K)-specific histone methyltransferase 2B was identified as the causative gene for DYT-KMT2B, also known as DYT28. In addition to the fact that many physicians do not have sufficient experience or knowledge of hereditary dystonia, the clinical features of DYT-KMT2B overlap with those of other hereditary dystonia, and limited clinical biomarkers make the diagnosis difficult. Methods Histone proteins were purified from the oral mucosa of patients with de novo KMT2B mutation causing premature stop codon, and then trimethylated fourth lysine residue of histone H3 (H3K4me3) which was catalyzed by KMT2B was analyzed by immunoblotting with specific antibody. We further analyzed the significance of H3K4me3 in patients with DYT-KMT2B using publicly available datasets. Results H3K4me3 histone mark was markedly lower in the patient than in the control group. Additionally, a reanalysis of publicly available datasets concerning DNA methylation also demonstrated that KMT2B remained inactive in DYT-KMT2B. Discussion Although only one case was studied due to the rarity of the disease, the reduction of H3K4me3 in the patient's biological sample supports the dysfunction of KMT2B in DYT-KMT2B. Together with informatics approaches, our results suggest that KMT2B haploinsufficiency contributes to the DYT-KMT2B pathogenic process.
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Affiliation(s)
- Naoto Sugeno
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
- Department of Pediatric Neurology, Miyagi Children’s Hospital, Sendai, Japan
| | - Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaaki Nakamura
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Ishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shun Yoshida
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eriko Koshimizu
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- Department of Clinical Genetics, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Uneoka S, Kobayashi T, Numata-Uematsu Y, Oikawa Y, Katata Y, Okubo Y, Abe Y, Kikuchi A, Takayama J, Tamiya G, Kure S, Saito K, Uematsu M. A Case Series of Patients With MYBPC1 Gene Variants Featuring Undulating Tongue Movements as Myogenic Tremor. Pediatr Neurol 2023; 146:16-20. [PMID: 37392669 DOI: 10.1016/j.pediatrneurol.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/18/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
Myosin-binding protein C1 (MYBPC1) encodes myosin-binding protein C, slow type (sMyBP-C), an accessory protein that regulates actomyosin cross-linking, stabilizes thick filaments, and modulates contractility in muscle sarcomeres and has recently been linked to myopathy with tremor. The clinical features of MYBPC1 mutations manifesting in early childhood bear some similarities to those of spinal muscular atrophy (SMA), such as hypotonia, involuntary movement of the tongue and limbs, and delayed motor development. The development of novel therapies for SMA has necessitated the importance of differentiating SMA from other diseases in the early infancy period. We report the characteristic tongue movements of MYBPC1 mutations, along with other clinical findings, such as positive deep tendon reflexes and normal peripheral nerve conduction velocity testing, which could help in considering other diseases as differential diagnoses.
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Affiliation(s)
- Saki Uneoka
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | | | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Katata
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Takayama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan; Department of AI and Innovative Medicine, Tohoku University School of Medicine, Sendai, Japan; Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Gen Tamiya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan; Department of AI and Innovative Medicine, Tohoku University School of Medicine, Sendai, Japan; Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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Numata-Uematsu Y, Uematsu M. WE-198. The onset of interictal spike related ripples facilitates detection of the epileptogenic zone. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.242] [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: 11/03/2022]
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Uematsu M, Goto Y, Torasawa M, Matsumoto Y, Masuda K, Shinno Y, Okuma Y, Yoshida T, Horinouchi H, Yamamoto N, Ohe Y. EP07.03-004 Efficacy of Thoracic Radiotherapy for Local Progression in Advanced Thymic Carcinoma. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saijo N, Abe Y, Oikawa Y, Okubo Y, Endo W, Numata-Uematsu Y, Takahashi T, Uematsu M. Successful treatment with dimethyl fumarate in a child with relapsing-remitting multiple sclerosis. Brain Dev 2022; 44:353-356. [PMID: 35058083 DOI: 10.1016/j.braindev.2021.12.010] [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: 08/12/2021] [Revised: 12/09/2021] [Accepted: 12/30/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Early disease control with disease-modifying drugs is important for improving the prognosis of multiple sclerosis (MS) in children. Dimethyl fumarate (DMF) is an oral disease-modifying drug for MS in adults with relatively stable disease; however, its use in young children has not been heavily documented in the current literature. We report the case of a pediatric patient with relapsing-remitting MS who was treated with DMF. CASE REPORT A 3-year-old boy with a history of common cold symptoms developed unsteadiness and somnolence. Magnetic resonance imaging revealed multiple white matter lesions. Symptoms were recurrent, and DMF was prescribed at 6 years of age due to a relapse episode with oculomotor disability and facial paralysis. However, disease progression continued, and new lesions were noted at age 7; thus, the dose of DMF was increased to 240 mg/day. No relapse has been observed for over three years; sequelae or severe side effects were absent. CONCLUSIONS DMF may be a useful oral disease-modifying drug for preventing recurrence in young children with MS.
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Affiliation(s)
- Naoya Saijo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | | | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization National Yonezawa Hospital, Yonezawa, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
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Ukishiro K, Osawa SI, Iwasaki M, Kakisaka Y, Jin K, Uematsu M, Yamamoto T, Tominaga T, Nakasato N. Age-Related Recovery of Daily Living Activity After 1-Stage Complete Corpus Callosotomy: A Retrospective Analysis of 41 Cases. Neurosurgery 2022; 90:547-551. [PMID: 35129138 DOI: 10.1227/neu.0000000000001871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. OBJECTIVE To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. METHODS This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. RESULTS Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P < .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (>80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (<50%) seizure reduction in 20. CONCLUSION Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.
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Affiliation(s)
- Kazushi Ukishiro
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kirikae H, Uematsu M, Numata-Uematsu Y, Saijo N, Katata Y, Oikawa Y, Kikuchi A, Yanagi K, Kaname T, Haginoya K, Kure S. Two types of early epileptic encephalopathy in a Pitt-Hopkins syndrome patient with a novel TCF4 mutation. Brain Dev 2022; 44:148-152. [PMID: 34579981 DOI: 10.1016/j.braindev.2021.09.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pitt-Hopkins syndrome (PTHS) is a neurodevelopmental disorder caused by mutations in TCF4. Seizures have been found to vary among patients with PTHS. We report the case of a PTHS patient with a novel missense mutation in the gene TCF4, presenting with two types of early epileptic encephalopathy. CASE REPORT The patient was a Japanese boy. His first seizure was reported at 17 days of age, with twitching of the left eyelid and tonic-clonic seizures on either side of his body. An ictal electroencephalogram (EEG) showed epileptic discharges arising independently from both hemispheres, occasionally resembling migrating partial seizures of infancy (MPSI) that migrated from one side to the other. Brain magnetic resonance imaging revealed agenesis of the corpus callosum. His facial characteristics included a distinctive upper lip and thickened helices. His seizures were refractory, and psychomotor development was severely delayed. At the age of 10 months, he developed West syndrome with spasms and hypsarrhythmia. After being prescribed topiramate (TPM), his seizures and EEG abnormalities dramatically improved. Also, psychomotor development progressed. Whole-exome sequencing revealed a novel de novo missense mutation in exon 18 (NM_001083962.2:c.1718A > T, p.(Asn573Ile)), corresponding to the basic region of the basic helix-loop-helix domain, which may be a causative gene for epileptic encephalopathy. CONCLUSIONS To our knowledge, this is the first report of a patient with PTHS treated with TPM, who presented with both MPSI as well as West syndrome. This may help provide new insights regarding the phenotypes caused by mutations in TCF4.
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Affiliation(s)
- Hinako Kirikae
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
| | | | - Naoya Saijo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Katata
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Kumiko Yanagi
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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Katata Y, Uneoka S, Saijyo N, Aihara Y, Miyazoe T, Koyamaishi S, Oikawa Y, Ito Y, Abe Y, Numata-Uematsu Y, Takayama J, Kikuchi A, Tamiya G, Uematsu M, Kure S. The longest reported sibling survivors of a severe form of congenital myasthenic syndrome with the ALG14 pathogenic variant. Am J Med Genet A 2021; 188:1293-1298. [PMID: 34971077 DOI: 10.1002/ajmg.a.62629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Abstract
Congenital myasthenic syndromes (CMS) is a group of diseases that causes abnormalities at the neuromuscular junction owing to genetic anomalies. The pathogenic variant in ALG14 results in a severe pathological form of CMS causing end-plate acetylcholine receptor deficiency. Here, we report the cases of two siblings with CMS associated with a novel variant in ALG14. Immediately after birth, they showed hypotonia and multiple joint contractures with low Apgar scores. Ptosis, low-set ears, and high-arched palate were noted. Deep tendon reflexes were symmetrical. They showed worsening swallowing and respiratory problems; hence, nasal feeding and tracheotomy were performed. Cranial magnetic resonance imaging scans revealed delayed myelination and cerebral atrophy. Exome sequencing indicated that the siblings had novel compound heterozygous missense variants, c.590T>G (p.Val197Gly) and c.433G>A (p.Gly145Arg), in exon 4 of ALG14. Repetitive nerve stimulation test showed an abnormal decrease in compound muscle action potential. After treatment with pyridostigmine, the time off the respirator increased. Their epileptic seizures were well controlled by anti-epileptic drugs. Their clinical course is stable even now at the ages of 5 and 2 years, making them the longest reported survivors of a severe form of CMS with the ALG14 variant thus far.
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Affiliation(s)
- Yu Katata
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Saki Uneoka
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Naoya Saijyo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Aihara
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Takamitsu Miyazoe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Shun Koyamaishi
- Department of Pediatrics, Hachinohe City Hospital, Hachinohe, Japan
| | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yuya Ito
- Department of Pediatrics, Hachinohe City Hospital, Hachinohe, Japan.,Department of Neonatology, Aomori Prefectural Central Hospital, Hachinohe, Japan
| | - Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.,Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Japan
| | | | - Jun Takayama
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Gen Tamiya
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.,Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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10
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Numata-Uematsu Y, Uematsu M, Sakuraba R, Iwasaki M, Osawa S, Jin K, Nakasato N, Kure S. The Onset of Interictal Spike-Related Ripples Facilitates Detection of the Epileptogenic Zone. Front Neurol 2021; 12:724417. [PMID: 34803874 PMCID: PMC8599368 DOI: 10.3389/fneur.2021.724417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Accurate estimation of the epileptogenic zone (EZ) is essential for favorable outcomes in epilepsy surgery. Conventional ictal electrocorticography (ECoG) onset is generally used to detect the EZ but is insufficient in achieving seizure-free outcomes. By contrast, high-frequency oscillations (HFOs) could be useful markers of the EZ. Hence, we aimed to detect the EZ using interictal spikes and investigated whether the onset area of interictal spike-related HFOs was within the EZ. Methods: The EZ is considered to be included in the resection area among patients with seizure-free outcomes after surgery. Using a complex demodulation technique, we developed a method to determine the onset channels of interictal spike-related ripples (HFOs of 80-200 Hz) and investigated whether they are within the resection area. Results: We retrospectively examined 12 serial patients who achieved seizure-free status after focal resection surgery. Using the method that we developed, we determined the onset channels of interictal spike-related ripples and found that for all 12 patients, they were among the resection channels. The onset frequencies of ripples were in the range of 80-150 Hz. However, the ictal onset channels (evaluated based on ictal ECoG patterns) and ripple onset channels coincided in only 3 of 12 patients. Conclusions: Determining the onset area of interictal spike-related ripples could facilitate EZ estimation. This simple method that utilizes interictal ECoG may aid in preoperative evaluation and improve epilepsy surgery outcomes.
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Affiliation(s)
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Rie Sakuraba
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan.,Department of Neurosurgery, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan
| | - Shinichiro Osawa
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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11
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Kuroda K, Moriya K, Nakano T, Saito R, Sato D, Katayama S, Niizuma H, Watanuki M, Uematsu M, Sasahara Y, Kure S. A pediatric case of osteosarcoma and tuberous sclerosis complex with a novel germline mutation in the TSC2 gene and a somatic mutation in the TP53 gene. Pediatr Blood Cancer 2021; 68:e28960. [PMID: 33694273 DOI: 10.1002/pbc.28960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Kaoru Kuroda
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kunihiko Moriya
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Nakano
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoko Saito
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daichi Sato
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Saori Katayama
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidetaka Niizuma
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Munenori Watanuki
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
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12
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Umeda T, Minemura H, Tanino Y, Hirai K, Koizumi T, Nikaido T, Sato Y, Togawa R, Kawamata T, Watanabe N, Tomita H, Rikimaru M, Morimoto J, Suzuki Y, Uematsu M, Fukuhara N, Fukuhara A, Saito J, Kanazawa K, Shibata Y. P44.02 Mild Interstitial Pneumonia as a Risk Factor for Chemotherapy-Induced Acute Exacerbation of Interstitial Pneumonia in Patients with Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Abe Y, Aihara Y, Endo W, Hasegawa H, Ichida K, Uematsu M, Kure S. The effect of dietary protein restriction in a case of molybdenum cofactor deficiency with MOCS1 mutation. Mol Genet Metab Rep 2021; 26:100716. [PMID: 33552910 PMCID: PMC7859290 DOI: 10.1016/j.ymgmr.2021.100716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
Molybdenum cofactor deficiency (MoCD) is an autosomal recessive inborn error of metabolism that results from mutations in genes involved in molybdenum cofactor (Moco) biosynthesis. MoCD is characterized clinically by intractable seizures and severe, rapidly progressing neurodegeneration leading to death in early childhood in the majority of known cases. We report on a patient with an unusual late disease onset and mild phenotype, characterized by delayed development and a decline triggered by a febrile illness and a subsequent dystonic movement disorder. Magnetic resonance imaging showed abnormal signal intensities of the bilateral basal ganglia. Blood and urine chemistry tests demonstrated remarkably low serum and urinary uric acid levels. A urine sulfite test was positive. Specific diagnostic workup showed elevated levels of xanthine and hypoxanthine in serum with increased urinary sulfocysteine (SSC) levels. Genetic analysis revealed a homozygous missense mutation at c.1510C > T (p.504R > W) in exon 10 of the MOCS1 in isoform 7 (rs1387934803). At age 1 year 4 months, the patient was placed on a low protein diet to reduce cysteine load and accumulation of sulfite and SCC in tissues. At 3 months after introduction of protein restriction, the urine sulfite test became negative and the urine SCC level was decreased. After starting the protein restriction diet, dystonic movement improved, and the patient's course progressed without regression and seizures. Electroencephalogram findings were remarkably improved. This finding demonstrates that the dietary protein restriction suppresses disease progression in mild cases of MoCD and suggests the effectiveness of dietary therapy in MoCD.
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Affiliation(s)
- Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Aihara
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Wakaba Endo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroshi Hasegawa
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan
| | - Kimiyoshi Ichida
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan.,Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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14
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Kosugi S, Ueda Y, Abe H, Mishima T, Shinouchi K, Ozaki T, Takayasu K, Iida Y, Ohashi T, Toriyama C, Nakamura M, Date M, Uematsu M, Koretsune Y. Angioscopic evaluation of vascular healing at 1 and 12 months after drug-coated stent implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Polymer- and carrier-free Biolimus-A9-coated stent (DCS) is expected better vascular healing compared with conventional durable polymer drug-eluting stents (DES). Moreover, DCS had been demonstrated in clinical trials to allow one-month short dual antiplatelet therapy, which might achieve sufficient healing at only 1 month after implantation. However, the process of vascular healing after DCS implantation has not been elucidated by angioscopic observation.
Purpose
To evaluate the process of vascular healing at 1 month and 12 months after DCS implantation.
Methods
This study included 57 patients treated with DCS or durable polymer everolimus-eluting stents (EES) in our hospital from April 2017 to April 2019. Firstly, the angioscopic findings of DCS at 1 month (n=16) and 12 months (n=14) after implantation were respectively compared with EES at 12 months after implantation (EES-12, n=35) as a standard healing status of DES. Secondary, angioscopic findings of DCS at 1 month and 12 months after implantation were compared among the serially observed eight patients. Neointimal coverage (NIC) grade, yellow colour grade, and the presence of thrombus were evaluated. NIC grade was classified as grade 0 (no neointimal coverage), grade 1 (struts were bulged into lumen but covered), grade 2 (struts were embedded in the neointima but visible), or grade 3 (struts were fully embedded and invisible). Yellow colour grade was classified as grade 0 (white), grade 1 (light yellow), grade 2 (yellow), or grade 3 (intensive yellow).
Results
At 1 month after DCS implantation, dominant NIC grade was lower (0.3±0.5 vs. 1.5±0.7, p<0.001) and the frequency of thrombus was higher (38% vs. 6%, p=0.008) than EES-12. On the other hands, at 12 months after DCS implantation, dominant NIC grade was higher (2.1±0.6 vs. 1.5±0.7, p=0.013) and the frequency of thrombus was not different (7% vs. 6%, p=1.000) in comparison with EES-12. By serial observation of DCS, dominant NIC grade was higher at 12 months than at 1 month (2.3±0.5 vs. 0.4±0.5, p<0.001), while yellow colour grade (1.0±0.5 vs. 1.5±1.2, p=0.227) and the frequency of thrombus adhesion (0% vs. 38%, p=0.200) were not different.
Conclusion
Compared with EES-12, vascular healing of DCS was inferior at 1 month but superior at 12 months.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Kosugi
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Ueda
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - H Abe
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - T Mishima
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - K Shinouchi
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - T Ozaki
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - K Takayasu
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Iida
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - T Ohashi
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - C Toriyama
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Nakamura
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Date
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Uematsu
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Koretsune
- National Hospital Organization Osaka National Hospital, Cardiovascular Division, Osaka, Japan
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15
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Uematsu M, Numata-Uematsu Y, Aihara Y, Kobayashi T, Fujikawa M, Togashi N, Shiihara T, Ohashi K, Hattori A, Saitoh S, Kure S. Behavioral problems and family distress in tuberous sclerosis complex. Epilepsy Behav 2020; 111:107321. [PMID: 32698109 DOI: 10.1016/j.yebeh.2020.107321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) have a large impact on patients and their families. Improving intellectual ability outcomes using preventive vigabatrin (VGB) treatment has recently been reported. AIM The aim of this study was to investigate the severity of behavioral problems and degree of distress among families of patients with TSC with and without a history of VGB treatment. METHOD The study enrolled 21 children and adolescents who were patients with TSC from four hospitals: 14 in the VGB group and 7 in the no-VGB group. To evaluate patients' psychiatric and neurological symptoms, we used the TAND Checklist, Aberrant Behavior Checklist (ABC), Social Communication Questionnaire (SCQ), and Social Responsive Scale-2nd edition (SRS-2). RESULTS All VGB-group patients were administered VGB after the onset of epileptic seizures. No obvious differences were observed between the VGB and no-VGB groups in behavioral problem scores on the TAND Checklist, or on the ABC, SCQ, and SRS-2 total scores. Behavioral problem scores were lower in patients with normal intelligence than in those with mild intellectual disability (ID; P = 0.042). Degrees of family distress assessed with the TAND Checklist were not correlated with the intelligence quotient/developmental quotient (IQ/DQ) or seizure frequency but were correlated with the total SRS-2 scores (P = 0.022). For several patients, there were large discrepancies between familial and physician ratings of the TAND impact score. CONCLUSION Children and adolescents with TSC may present with significant behavioral difficulties and family distress, regardless of whether they were treated with VGB or not after the onset of seizures. Difficulties in social communication may have the strongest "TAND impact" on families.
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Affiliation(s)
- Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, 980-8574, Japan.
| | | | - Yu Aihara
- Department of Pediatrics, Tohoku University School of Medicine, 980-8574, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics, Tohoku University School of Medicine, 980-8574, Japan
| | - Mayu Fujikawa
- Department of Neuropsychiatry, Keio University School of Medicine, 160-8582, Japan; Department of Epileptology, Tohoku University School of Medicine, 980-8574, Japan
| | - Noriko Togashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, 989-3126, Japan
| | - Takashi Shiihara
- Department of Neurology, Gunma Children's Medical Center, 377-8577, Japan
| | - Kei Ohashi
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, 467-8602, Japan
| | - Ayako Hattori
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, 467-8602, Japan
| | - Shinji Saitoh
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, 467-8602, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, 980-8574, Japan
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16
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Toriyama C, Abe H, Nishida H, Nakamura M, Ohashi T, Iida Y, Kosugi S, Ozaki T, Shinouchi K, Mishima T, Date M, Ueda Y, Uematsu M, Koretsune Y. P92 A novel method of correcting the left ventricular stroke volume by Doppler echocardiography: comparison with multidetector computed tomography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although transthoracic Doppler echocardiography is widely used for estimating left ventricular stroke volume (SV), accelerated blood flow in the left ventricular (LV) outflow tract may lead to overestimation. SV can be calculated accurately from left ventricular end-systolic and end-diastolic volume determined by multi-detector computed tomography (MDCT). However, radiation exposure as well as the use of contrast medium hampers its routine use.
Purpose
The purpose of this study was to examine whether the correction of SV measured by pulsed wave Doppler echocardiography (SVdop) can accurately predicts SV obtained by MDCT (SVct).
Methods: We enrolled consecutive 61 patients who underwent both MDCT and transthoracic echocardiography. Patients with moderate or severe valvular diseases and valve replacement surgery were excluded. Correction of SV was explored with SVct as a reference.
Results: Univariate analysis showed that SVdop (r = 0.42, P = 0.0007) and patient age (r=-0.50, P < 0.0001) were significantly correlated with SVct. On the other hand, left ventricular ejection fraction calculated by Teicholz method (EFteich) (r = 0.19, P = 0.14), systolic blood pressure (r = 0.07, P = NS), and LV mass index (r=-0.02, P = NS) were not correlated with SVct. Multivariate analysis showed that SVdop, patient age and EFteich were the independent predictive factors for SVct (R2 = 0.49, P < 0.0001). Based on these correlations, we postulated SV as: corrected SV = SVdop × 0.40 + EFteich × 0.46 – age × 0.67 + 44.77. As expected, the correlation between corrected SV and SVct significantly improved (r = 0.70, P < 0.0001). Bland-Altman plot analysis showed that corrected SV significantly reduced the variation between SVdop and SVct, and diminished the overestimation of SVdop (Figure).
Conclusion: The new correction formula of SVdop may correct the overestimation of SV obtained by pulsed wave Doppler echocardiography, although the formula remains to be validated in a separate cohort of patients.
Abstract P92 Figure
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Affiliation(s)
| | - H Abe
- Osaka National Hospital, Osaka, Japan
| | - H Nishida
- Osaka National Hospital, Osaka, Japan
| | | | - T Ohashi
- Osaka National Hospital, Osaka, Japan
| | - Y Iida
- Osaka National Hospital, Osaka, Japan
| | - S Kosugi
- Osaka National Hospital, Osaka, Japan
| | - T Ozaki
- Osaka National Hospital, Osaka, Japan
| | | | - T Mishima
- Osaka National Hospital, Osaka, Japan
| | - M Date
- Osaka National Hospital, Osaka, Japan
| | - Y Ueda
- Osaka National Hospital, Osaka, Japan
| | - M Uematsu
- Osaka National Hospital, Osaka, Japan
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17
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Hasegawa S, Kumada S, Tanuma N, Tsuji-Hosokawa A, Kashimada A, Mizuno T, Moriyama K, Sugawara Y, Shirai I, Miyata Y, Nishida H, Mashimo H, Hasegawa T, Hosokawa T, Hisakawa H, Uematsu M, Fujine A, Miyata R, Sakuma H, Kashimada K, Imai K, Morio T, Hayashi M, Mizutani S, Takagi M. Long-Term Evaluation of Low-Dose Betamethasone for Ataxia Telangiectasia. Pediatr Neurol 2019; 100:60-66. [PMID: 31272782 DOI: 10.1016/j.pediatrneurol.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/07/2018] [Revised: 03/15/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ataxia telangiectasia is an autosomal recessive disorder characterized by cerebellar ataxia, telangiectases, immune defects, and a predisposition to malignancy. Quality of life is severely impaired by neurological symptoms. However, curative options for the neurological symptoms are limited. Recent studies have demonstrated short-term improvement in neurological symptoms with betamethasone therapy. However, the long-term and adverse effects of betamethasone are unclear. The aim of this study was to evaluate the long-term effects, benefits, and adverse effects of low-dose betamethasone in ataxia telangiectasia. METHODS Six patients with ataxia telangiectasia received betamethasone at 0.02 mg/kg/day for two years. After cessation of betamethasone, the patients were observed for two additional years. Neurological assessments were performed, and adverse effects were monitored every three months throughout the four-year study period. RESULTS Transient improvement of neurological symptom was observed in five of the six patients. However, after two years betamethasone treatment, only one of the six patients showed a slight improvement in the neurological score, one patient showed no change, and the neurological scores of the remaining four patients deteriorated. After the cessation of betamethasone treatment, neurological symptoms worsened in all patients. As an adverse effect of betamethasone, transient adrenal dysfunction was observed in all cases. CONCLUSIONS Although these findings are in agreement with previous studies suggesting that short-term betamethasone treatment transiently benefits patients with ataxia telangiectasia, the long-term benefits and risks should be carefully considered.
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Affiliation(s)
- Setsuko Hasegawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Naoyuki Tanuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Atsumi Tsuji-Hosokawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoko Mizuno
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kengo Moriyama
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuji Sugawara
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; Department of Pediatrics, Soka Municipal Hospital, Soka, Japan
| | - Ikuko Shirai
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yohane Miyata
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hiroya Nishida
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hideaki Mashimo
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | | | | | | | | | - Akio Fujine
- Department of Pediatrics, Fukui Prefectural Hospital, Fukui, Japan
| | - Rie Miyata
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Pediatrics, Tokyo Kita Medical Center, Tokyo, Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohsuke Imai
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masaharu Hayashi
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuki Mizutani
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masatoshi Takagi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
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18
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Deyama J, Nakamura T, Ono S, Kobayashi A, Horikoshi T, Yoshizaki T, Watanabe Y, Uematsu M, Kobayashi T, Fujioka D, Saito Y, Nakamura K, Kawabata K, Obata J, Kugiyama K. P6415Combined assessment of contrast-enhanced ultrasound of carotid plaque and carotid intima-media thickness improves the prediction of future coronary events in patients with coronary artery disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study examined whether combined ultrasound assessment of plaque size and intraplaque neovascularization in the carotid artery had an additive effect for predicting coronary events in patients with coronary artery disease (CAD).
Methods
CEUS of the carotid plaques using perfluorobutane microbubbles as an ultrasound contrast agent and Ultrasound assessment of carotid plaque maximum intima-media thickness (max IMT) was performed in 221 patients with CAD and carotid plaque IMT over 2mm. Intraplaque neovascularization was identified on the basis of microbubbles within the carotid plaque and graded as: G0, not visible; G1, moderate; or G2, extensive microbubbles. All study patients were followed up prospectively for 5 years or until the occurrence of a cardio-vascular event.
Result
During the follow-up period, 53 coronary events (9 cardiac deaths, 44 ACSs) were occurred. Multivariate Cox hazards analysis showed that max IMT and CEUS grade were independent predictors of coronary events (HR 1.59, 95% CI 1.15–2.21 p=0.005 and HR 2.26, 95% CI 1.52–3.36 p<0.01) that were independent of age, gender, diabetes and LDL-C levels. C-statistics for logistic models predicting future coronary events using conventional risk factors with or without the addition of max IMT alone, CEUS grade alone, and both max IMT and CEUS grade in combination (area under the ROC curve; 0.55,0.61,0.69 and 0.71, respectively). The addition of the plaque enhanced intensity to traditional risk factors resulted in net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.42, p=0.002; and IDI 0.04, p=0.002).
CEUS grade and ROC curve for 3models
Conclusions
Combined ultrasound assessment of carotid plaque IMT and intraplaque neovascularization has an additive value on the prediction of coronary events.
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Affiliation(s)
- J Deyama
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - T Nakamura
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - S Ono
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - A Kobayashi
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - T Horikoshi
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - T Yoshizaki
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - Y Watanabe
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - M Uematsu
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - T Kobayashi
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - D Fujioka
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - Y Saito
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - K Nakamura
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - K Kawabata
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - J Obata
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
| | - K Kugiyama
- University of Yamanashi, Internal Medicine II, Yamanashi, Japan
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19
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Matsusaki N, Sotomi Y, Kobayashi T, Hayashi T, Takeda Y, Yasumura Y, Yamada T, Uematsu M, Tamaki S, Abe H, Hikoso S, Nakatani D, Hirayama A, Higuchi Y, Sakata Y. P4512Impact of pulmonary artery catheter on all-cause death of patients with acute heart failure with preserved ejection fraction: Short-term results from the PURSUIT-HFpEF registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Appropriate pulmonary artery catheter (PAC) use may effectively decrease mortality in acute heart failure patients. The concept that the pulmonary artery catheter (PAC) is a valuable tool for hemodynamic monitoring when used in appropriately selected patients and by physicians trained well to interpret and apply the data correctly provided has not been evaluated adequately yet in acute heart failure patients with preserved ejection fraction (HFpEF).
Methods
The PERSUIT-HFpEF Registry is a prospective, observational, multicenter cohort study on prognosis of HFpEF in Japan. Patients hospitalized for heart failure (diagnosed by using Framingham criteria) who met both of the following criteria were enrolled: 1) a left ventricular ejection fraction of 50% or more as measured at the local site by echocardiography; 2) an elevated level of N terminal pro brain natriuretic peptide (NT proBNP) (400 pg per milliliter or more) or brain natriuretic peptide (BNP) (100 pg per milliliter or more). In the present study, we evaluated the impact of PAC on all-cause death of the patients with HFpEF. PAC use was left at the discretion of attending physicians.
Results
The PERSUIT-HFpEF Registry enrolled 486 patients (81±9 years, 259 females, mean follow-up duration 198±195 days). Of these, data of PAC usage was available in 434 patients. Patients were further stratified according to use of a PAC: PAC 153 patients vs. non-PAC 281 patients. Length of hospitalization was numerically shorter in the PAC group than in the non-PAC group [20.3±14.7 vs. 22.5±17.4 days, p=0.182]. Kaplan-Meier estimated 1-year all-cause death rate was significantly lower in the PAC group than in the non-PAC group (9.5% vs. 19.1%, p=0.019). PAC use was associated with significant risk reduction of all-cause death [hazard ratio (HR) 0.425, 95% confidence interval (CI), 0.203–0.890, p=0.023] in the crude analysis. The significant risk reduction still existed after multivariate adjustment including potential confounders [HR 0.427, 95% CI, 0.185–0.984, p=0.046]
Kaplan Meier analysis
Conclusions
In the real-world Asian registry data, PAC use was associated with the improved all-cause death rate, suggesting that the PAC might be a useful guidance tool for treatment of the patients with HFpEF.
Acknowledgement/Funding
Roche diagnostics FUJIFILM Toyama Chemical
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Affiliation(s)
| | - Y Sotomi
- Osaka Police Hospital, Osaka, Japan
| | | | | | - Y Takeda
- Osaka Police Hospital, Osaka, Japan
| | - Y Yasumura
- Amagasaki Chuo Hospital, Amagasaki, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - M Uematsu
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - H Abe
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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20
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Hoshida S, Watanabe T, Shinoda Y, Minamisaka T, Fukuoka H, Inui H, Ueno K, Yasumura Y, Yamada T, Uematsu M, Tamaki S, Higuchi Y, Abe H, Hikoso S, Sakata Y. P321A single factor related to left atrial pressure overload is useful for prognosis in elderly patients with heart failure with preserved ejection fraction: PURSUIT HFpEF study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
E/e' and the ratio of diastolic elastance (Ed)/arterial elastance (Ea) = (E/e')/(0.9 × systolic blood pressure), indices of left atrial (LA) pressure overload, are elevated in elderly women with heart failure with preserved ejection fraction (HFpEF). The severity of diastolic dysfunction is assessed by a combination of several indices of LA volume and pressure overload. However, which overload is more important as a single factor for the prognosis of these patients remains undefined.
Methods
We enrolled patients with HFpEF showing sinus rhythm (n=145; left ventricular ejection fraction >50%; men/women, 56/89; mean age, 80.5 years). Blood examination and transthoracic echocardiography were performed before discharge. All-cause mortality and admission for cardiac events were evaluated after more than 1 year (mean, 370 days).
Results
The all-cause mortality rate was 11% (16/145). There were significant differences in age (p=0.005), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level (p<0.001), LA volume index (p=0.018), E/e' (p=0.022), and Ed/Ea (p=0.016) between patients with and without all-cause mortality. When cutoff points for mortality by receiver operating characteristic curve analysis were examined, the area under the curve in LA volume index (0.564) was slightly smaller than that in age (0.734), NT-proBNP level (0.732), E/e' (0.695), and Ed/Ea (0.709). Kaplan-Meier survival analysis clearly showed that age >85 years (p<0.001), NT-proBNP level >888 pg/mL (p=0.003), E/e' >14.4 (p=0.020), and Ed/Ea >0.153 (p<0.001) were determinant factors for mortality. Cox hazard ratios were also significant in these indices (p=0.002, p=0.012, p=0.028, and p=0.001, respectively). In the case of all-cause mortality or admission for cardiac events, the results were nearly similar as those in the case of all-cause mortality. Ed/Ea exhibited a larger Cox hazard ratio for prognosis than E/e' in the multivariate analysis.
Conclusions
LA pressure overload compared to volume overload was a useful marker for prognosis in elderly patients with HFpEF. As a single index for LA pressure overload in noninvasive echocardiographic findings, Ed/Ea may be more suitable than E/e'.
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Affiliation(s)
| | | | | | | | | | - H Inui
- Yao Municipal Hospital, Yao, Japan
| | - K Ueno
- Yao Municipal Hospital, Yao, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - M Uematsu
- Osaka National Hospital, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | | | - H Abe
- Osaka National Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
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21
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Tamaki S, Yamada T, Morita T, Furukawa Y, Fukunami M, Yasumura Y, Abe H, Uematsu M, Higuchi Y, Hikoso S, Nakatani D, Sakata Y. P786Plasma volume status is associated with the change in nutritional status during hospitalization in acute decompensated heart failure patients with preserved left ventricular ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Plasma volume (PV) expansion has an essential role in heart failure (HF). PV can be estimated by a simple formula using hematocrit and body weight, and PV status (PVS) provides prognostic information in patients (pts) with chronic HF. Nutritional status (NS) based on the prognostic nutritional index (PNI) and NS change during hospitalization have been shown to predict prognosis in pts admitted with acute decompensated HF (ADHF).
Purpose
We sought to assess the hypothesis that PVS is associated with NS change during hospitalization in pts with HF with preserved LVEF (HFpEF) who are admitted with ADHF.
Methods
We prospectively studied 411 pts who were admitted for ADHF with LVEF ≥50% and survived to discharge. Body weight measurement and venous blood sampling were performed on admission and at discharge. PVS was defined as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The pts were divided into 3 groups by PNI: normal (>38), moderate malnutrition (35–38), and severe malnutrition (<35). During admission, pts who remained in the moderate or severe malnutrition group or whose NS worsened were defined as no improvement in NS. Follow-up data was obtained in 203 cases. They were followed for up to 18 months, and the incidence of all-cause death was evaluated.
Results
On admission, PVS in the moderate (n=71, 13.3±13.9%) or severe malnutrition group (n=69, 14.8±10.8%) was significantly higher than in the normal PNI group (n=271, 5.4±10.8%, p<0.001). During hospitalization, 123 pts had no NS improvement. Admission PVS was significantly higher in pts with no NS improvement than in pts with improved NS (13.9±11.2% vs 5.9±12.8%, p<0.0001). In multivariate logistic regression analysis, admission PVS was independently associated with no NS improvement during hospitalization (OR 1.06, 95% CI 1.03–1.08, p<0.0001). Receiver operating characteristics curve analysis revealed that the optimal cut-off value of admission PVS for predicting no NS improvement was 9.4% (sensitivity: 72%, specificity: 63%). The area under the curve for predicting no NS improvement using admission PVS was significantly greater than for other independent factors (Figure 1A). During the follow-up period (median 12.4 months), 68 of 203 patients had all-cause death. Kaplan-Meier analysis showed that the patients with no NS improvement had a significantly higher risk of all-cause death (Figure 1B).
Figure 1
Conclusions
In this multicenter study, admission PVS was shown to be associated with poor improvement in NS during hospitalization in HFpEF pts admitted for ADHF.
Acknowledgement/Funding
Roche diagnostics, FUJIFILM Toyama Chemical
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Affiliation(s)
- S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - H Abe
- Osaka National Hospital, Osaka, Japan
| | - M Uematsu
- Osaka National Hospital, Osaka, Japan
| | | | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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22
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Masuda M, Kanda T, Asai M, Mano T, Yamada T, Yasumura Y, Uematsu M, Hikoso S, Nakatani D, Tamaki S, Higuchi Y, Nakagawa Y, Fuji H, Abe H, Sakata Y. P6356Comparisons of clinical outcomes in patients with heart failure with preserved ejection fraction with and without atrial fibrillation: results from a multicenter PURSUIT-HFpEF registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction.
Objective
This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF).
Methods
PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded.
Results
Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups.
Conclusion
In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without.
Acknowledgement/Funding
None
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Affiliation(s)
- M Masuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - T Kanda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - M Asai
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - T Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - M Uematsu
- Osaka National Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Cardiology, Suita, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Cardiology, Suita, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | | | - Y Nakagawa
- Kawanishi city hospital, Kawanishi, Japan
| | - H Fuji
- Kobe ekisaikai hospital, Kobe, Japan
| | - H Abe
- Osaka National Hospital, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Cardiology, Suita, Japan
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23
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Seo M, Yamada T, Tamaki S, Yasumura Y, Uematsu M, Abe H, Higuchi Y, Hikoso S, Nakatani D, Fukunami M, Sakata Y. P1649Prognostic significance of serum cholinesterase in patients with acute decompensated heart failure with preserved ejection fraction: insights from PURSUIT-HFpEF registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Comorbidities strongly influence the prognosis in heart failure with preserved ejection fraction (HFpEF). Malnutrition is one of the most important comorbidities among heart failure patients. Serum cholinesterase (CHE), one of the markers of malnutrition, was reported to be a prognostic factor in patients with chronic heart failure. In addition, we previously reported prognostic significance of CHE from a single center registry data of acute decompensated heart failure (ADHF). The aim of this study is to conduct external validation of the prognostic role of CHE using multi-center HFpEF registry.
Methods and results
Patients data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study. PURSUIT-HFpEF study is a prospective multicenter observational study in which collaborating hospitals in Osaka recorded clinical, echocardiographic, and outcome data of patients with ADHF and preserved ejection fraction. Between June 2016 and January 2018, 381 patients were enrolled and we excluded patients without sufficient laboratory data and in-hospital death. Finally, we analyzed 204 patients with survival discharge. Laboratory data including CHE and echocardiography were obtained just before discharge. The endpoint of this study is the composite of all-cause death and worsening heart failure re-admission (cardiac event). During a follow up period of 0.92±0.37 years, 49 patients had cardiac event. CHE was significantly lower in patients with than without cardiac event (183±67 vs 223±71 U/L, p<0.0001). At multivariate Cox analysis, CHE (p=0.0020) was significantly associated with cardiac event, independently of NT-pro BNP after adjustment of age, sex, eGFR and hemoglobin. ROC curve analysis showed that AUC of CHE for the prediction of cardiac event was 0.706 (95% CI 0.638–0.768). Kaplan-Meier analysis showed that patients with low CHE (<211U/L defined by median) had a significantly greater risk of cardiac event (35% vs 13% p=0.0002).
Figure 1
Conclusion
Serum cholinesterase level is the useful prognostic marker for the prediction of cardiac event in patients with ADHF with preserved ejection fraction.
Acknowledgement/Funding
Roche diagnostics, FUJIFILM Toyama Chemical
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Affiliation(s)
- M Seo
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - S Tamaki
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Cardiology, Amagasaki, Japan
| | - M Uematsu
- Osaka National Hospital, Cardiology, Osaka, Japan
| | - H Abe
- Osaka National Hospital, Cardiology, Osaka, Japan
| | - Y Higuchi
- Osaka Police Hospital, Cardiology, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Cardiology, Osaka, Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine, Cardiology, Osaka, Japan
| | - M Fukunami
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Cardiology, Osaka, Japan
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24
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Asagi S, Jin K, Uematsu M, Miki T, Nakasato N. S4-1. Role of medical technologists in long-term video-EEG monitoring of children. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.06.085] [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: 11/29/2022]
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25
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Sunaga A, Hikoso S, Yamada T, Yasumura Y, Uematsu M, Abe H, Nakagawa Y, Higuchi Y, Fuji H, Mano T, Nakatani D, Mizuno H, Okada K, Kitamura T, Sakata Y. 128Change in geriatric nutritional risk index predicts one-year mortality in patients with heart failure with preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Malnutrition is associated with adverse prognosis in heart failure patients. However, in patients with heart failure with preserved ejection fraction (HFpEF), the effects of change in nutritional status during hospitalization on prognosis is unknown. Geriatric nutritional risk index (GNRI) is a widely used objective index for evaluating nutritional status. Low GNRI (<92) has moderate or severe nutritional risk and high GNRI (≥92) has no or low nutritional risk.
Purpose
The purpose of this study was to clarify the effect of change in GNRI during hospitalization on one-year mortality and the association between the value of GNRI and one-year mortality in patients with HFpEF.
Methods
We prospectively registered patients with HFpEF in PURSUIT-HFpEF registry when they were hospitalized for heart failure in 29 hospitals. Preserved ejection fraction was defined as more than 50% of left ventricular ejection fraction. Of the 486 patients who registered PURSUIT-HFpEF, 228 cases with one-year follow-up data were examined. GNRI was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index/22.
Results
Mean age was 81±10 years and 100 patients (44%) were male. During a median [interquartile range] follow-up period of 374 [342, 400] days, 28 patients (12%) died. Mortality was significantly higher in patients with low GNRI at admission (n=65) than those with high GNRI at admission (n=163) (26% vs. 9%, log-rank P=0.011) and higher in patients with low GNRI at discharge (n=109) than those with high GNRI at discharge (n=119) (22% vs. 6%, log-rank P=0.002). Multivariate analysis with Cox proportional hazard model with patient characteristics at admission revealed that low GNRI at admission was independently associated with mortality (hazard ratio: 0.96, 95% CI: 0.93–0.99, P=0.035) and that with patient characteristics at discharge revealed that low GNRI at discharge was independently associated with mortality (hazard ratio: 0.94, 95% CI: 0.91–0.97, P<0.001). We also compared mortality by dividing patients into 4 group according to whether GNRI was high or low at the time of admission and discharge. Patients with low GNRI at admission and at discharge (n=59) exhibited the highest mortality, on the other hand, patients with high GNRI at admission and low GNRI at discharge (n=50) exhibited higher mortality than those with high GNRI both at admission and at discharge (n=113) (Low and low: 28% vs. High and low: 14% vs. High and high: 6% vs. Low and high: 0%, log-rank P=0.010).
All cause mortality
Conclusion
GNRI at admission or at discharge was independently associated with one-year mortality in patients with HFpEF. Moreover, worsening GNRI during hospitalization is associated with the worse prognosis. It is important to prevent lowering GNRI during treatment of acute decompensated HFpEF.
Acknowledgement/Funding
Roche Diagnostics, FUJIFILM Toyama Chemical
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Affiliation(s)
- A Sunaga
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - S Hikoso
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - T Yamada
- Osaka General Medical Center, Cardiology, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Cardiology, Amagasaki, Japan
| | - M Uematsu
- Osaka National Hospital, Cardiology, Osaka, Japan
| | - H Abe
- Osaka National Hospital, Cardiology, Osaka, Japan
| | - Y Nakagawa
- Kawanishi City Hospital, Cardiology, Kawanishi, Japan
| | - Y Higuchi
- Osaka Police Hospital, Cardiology, Osaka, Japan
| | - H Fuji
- Kobe Ekisaikai Hospital, Cardiology, Kobe, Japan
| | - T Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - D Nakatani
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - H Mizuno
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - K Okada
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - T Kitamura
- Osaka University, Cardiovascular Medicine, Suita, Japan
| | - Y Sakata
- Osaka University, Cardiovascular Medicine, Suita, Japan
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26
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Okuma K, Okamoto H, Iijima K, Nishioka F, Kashihara T, Shima S, Uematsu M, Igaki H, Nakayama Y, Itami J, Murakami N, Nakamura S. EP-1403 Retrospective evaluation of usefulness of MR-guided adaptive radiotherapy of gastric MALT lymphoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Akiyama T, Kubota T, Ozono K, Michigami T, Kobayashi D, Takeyari S, Sugiyama Y, Noda M, Harada D, Namba N, Suzuki A, Utoyama M, Kitanaka S, Uematsu M, Mitani Y, Matsunami K, Takishima S, Ogawa E, Kobayashi K. Pyridoxal 5'-phosphate and related metabolites in hypophosphatasia: Effects of enzyme replacement therapy. Mol Genet Metab 2018; 125:174-180. [PMID: 30049651 DOI: 10.1016/j.ymgme.2018.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/21/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the utility of serum pyridoxal 5'-phosphate (PLP), pyridoxal (PL), and 4-pyridoxic acid (PA) as a diagnostic marker of hypophosphatasia (HPP) and an indicator of the effect of, and patient compliance with, enzyme replacement therapy (ERT), we measured PLP, PL, and PA concentrations in serum samples from HPP patients with and without ERT. METHODS Blood samples were collected from HPP patients and serum was frozen as soon as possible (mostly within one hour). PLP, PL, and PA concentrations were analyzed using high-performance liquid chromatography with fluorescence detection after pre-column derivatization by semicarbazide. We investigated which metabolites are associated with clinical phenotypes and how these metabolites change with ERT. RESULTS Serum samples from 20 HPP patients were analyzed. The PLP-to-PL ratio and PLP concentration were elevated in all HPP patients. They correlated negatively with serum alkaline phosphatase (ALP) activity and showed higher values in more severe phenotypes (perinatal severe and infantile HPP) compared with other phenotypes. PL concentration was reduced only in perinatal severe HPP. ERT reduced the PLP-to-PL ratio to mildly reduced or low-normal levels and the PLP concentration was reduced to normal or mildly elevated levels. Urine phosphoethanolamine (PEA) concentration did not return to normal levels with ERT in most patients. CONCLUSIONS The serum PLP-to-PL ratio is a better indicator of the effect of ERT for HPP than serum PLP and urine PEA concentrations, and a PLP-to-PL ratio of <4.0 is a good indicator of the effect of, and patient compliance with, ERT.
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Affiliation(s)
- Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Daisuke Kobayashi
- Department of Food and Chemical Toxicology, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Shinji Takeyari
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masahiro Noda
- Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Daisuke Harada
- Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization (JCHO), Osaka, Japan
| | - Noriyuki Namba
- Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization (JCHO), Osaka, Japan
| | - Atsushi Suzuki
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Maiko Utoyama
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Sachiko Kitanaka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yusuke Mitani
- Department of Pediatrics, Kanazawa University Hospital, Ishikawa, Japan
| | - Kunihiro Matsunami
- Department of Pediatrics, Gifu Prefectural General Medical Center, Gifu, Japan
| | | | - Erika Ogawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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28
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Yasumura K, Abe H, Iida Y, Kato T, Nakamura M, Toriyama C, Nishida H, Idemoto A, Shinouchi K, Mishima T, Awata M, Date M, Ueda Y, Uematsu M, Koretsune Y. P5682A new prognostic indicator in patients with acute decompensated heart failure including both ambulatory and nutritional statuses. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Yasumura
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - H Abe
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Iida
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - T Kato
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Nakamura
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - C Toriyama
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - H Nishida
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - A Idemoto
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - K Shinouchi
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - T Mishima
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Awata
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Date
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Ueda
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - M Uematsu
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Koretsune
- Osaka National Hospital, Cardiovascular Division, Osaka, Japan
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29
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Suzuki Y, Saito J, Kikuchi M, Uematsu M, Fukuhara A, Sato S, Munakata M. Sputum-to-serum hydrogen sulphide ratio as a novel biomarker of predicting future risks of asthma exacerbation. Clin Exp Allergy 2018; 48:1155-1163. [PMID: 29758106 DOI: 10.1111/cea.13173] [Citation(s) in RCA: 14] [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: 12/04/2017] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased level of hydrogen sulphide (H2 S) in sputum is reported to be a new biomarker of neutrophilic airway inflammation in chronic airway disorders. However, the relationship between H2 S and disease activity remains unclear. OBJECTIVE We investigated whether H2 S levels could vary during different conditions in asthma. METHOD H2 S levels in sputum and serum were measured using a sulphide-sensitive electrode in 47 stable asthmatic subjects (S-BA), 21 uncontrolled asthmatic subjects (UC-BA), 26 asthmatic subjects with acute exacerbation (AE-BA) and 15 healthy subjects. Of these, H2 S levels during stable, as well as exacerbation states, were obtained in 13 asthmatic subjects. RESULTS Sputum H2 S levels were significantly higher in the AE-BA subjects compared to the UC-BA and healthy subjects (P < .05). However, serum H2 S levels in the AE-BA subjects were lower than in the S-BA subjects (P < .001) and similar to those in healthy subjects. Thus, the sputum-to-serum ratio of H2 S (H2 S ratio) in the AE-BA subjects was significantly higher than in the S-BA, UC-BA and healthy subjects (P < .05). Among all subjects, sputum H2 S levels showed a trend to decrease with FEV1 %predicted and significantly positive correlations with sputum neutrophils (%), sputum IL-8 and serum IL-8. A multiple linear regression analysis showed that sputum H2 S was independently associated with increased sputum neutrophils (%) and decreased FEV1 %predicted (P < .05). The cut-off level of H2 S ratio to indicate an exacerbation was ≥0.34 (area under the curve; 0.88, with a sensitivity of 81.8% and specificity of 72.7%, P < .001). Furthermore, half of the asthmatic subjects with H2 S ratios higher than the cut-off level experienced asthma exacerbations over the following 3 months after enrolment. CONCLUSIONS The H2 S ratio may provide useful information on predicting future risks of asthma exacerbation, as well as on obstructive neutrophilic airway inflammation as one of the non-Th2 biomarkers, in asthma.
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Affiliation(s)
- Y Suzuki
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - J Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - M Kikuchi
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - M Uematsu
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - A Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - S Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - M Munakata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
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30
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Nakamura H, Uematsu M, Numata-Uematsu Y, Abe Y, Endo W, Kikuchi A, Takezawa Y, Funayama R, Shirota M, Nakayama K, Niihori T, Aoki Y, Haginoya K, Kure S. Rett-like features and cortical visual impairment in a Japanese patient with HECW2 mutation. Brain Dev 2018; 40:410-414. [PMID: 29395664 DOI: 10.1016/j.braindev.2017.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/28/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
Abstract
Numerous genetic syndromes that include intellectual disability (ID) have been reported. Recently, HECW2 mutations were detected in patients with ID and growth development disorders. Four de novo missense mutations have been reported. Here, we report a Japanese girl with Rett-like symptoms of severe ID, hypotonia, refractory epilepsy, and stereotypical hand movement (hand tapping, flapping, and wringing) after the age of 1 year. Characteristically, she had cortical visual impairment. She had difficulty swallowing since the age of 4 years, and diminished activity was noticeable since the age of 12 years, suggesting neurodevelopmental regression. She has no acquired microcephaly, and brain magnetic resonance imaging showed non-specific mild cerebral and cerebellar atrophy without progression over time. Genetic analyses of MECP2, CDKL5, and FOXG1 were negative. Whole-exome sequencing analysis revealed a known de novo mutation (c.3988C > T) in HECW2. The characteristics of her clinical symptoms are severe cortical visual impairment and Rett-like phenotype such as involuntary movements and regression. This is the first report that patients with HECW2 mutation could show Rett-like feature.
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Affiliation(s)
- Haruhiko Nakamura
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Japan.
| | | | - Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Wakaba Endo
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Yusuke Takezawa
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Ryo Funayama
- Division of Cell Proliferation, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Matsuyuki Shirota
- Division of Interdisciplinary Medical Sciences, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Keiko Nakayama
- Division of Cell Proliferation, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Tetsuya Niihori
- Center for Genomic Medicine, Tohoku University Hospital, Japan
| | - Yoko Aoki
- Center for Genomic Medicine, Tohoku University Hospital, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Japan
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31
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Abstract
We report on a patient with choriocarcinoma in the pineal region who was successfully treated with stereotactic radiation therapy (SRT). The increased level of serum human chorionic gonadotropin (HCG) was lowered during chemotherapy with etoposide, cisplatin, and ifosfamide. However, HCG was not normalized and magnetic resonance images still showed an enhanced tumor mass with gadolinium. The patient underwent SRT of 40 Gy at an 80% isodose line per 10 fractions over'two weeks, followed by conventional craniospinal irradiation of 32.4 Gy. The level of HCG dropped below the detection limit. The patient has been in good condition for more than four years after the completion of treatment, without any signs of recurrence. We propose SRT as a valid treatment option for malignant germ cell tumors in the pineal region.
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Affiliation(s)
- S Kohyama
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
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32
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Hama Y, Uematsu M, Ichikura T, Tamura E, Aida S, Kohno M, Kusano S. A Case of Primary Small Cell Carcinoma of the Cervical Esophagus with Long-term Survival following Concurrent Chemoradiotherapy: Case Report and Review of the Literature. Tumori 2018; 85:284-7. [PMID: 10587033 DOI: 10.1177/030089169908500414] [Citation(s) in RCA: 5] [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] [Indexed: 11/16/2022]
Abstract
The authors describe a case of small cell carcinoma of the esophagus that was treated by concurrent chemoradiotherapy. Both the esophageal tumor and the regional lymph node metastases disappeared after this treatment. The patient is alive and disease free after more than five years. Primary small cell carcinoma of the esophagus is a rare and aggressive neoplasm with a very poor prognosis, and the treatment modality is controversial. This case illustrates the possibility of treating this tumor type with concurrent chemoradiotherapy.
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Affiliation(s)
- Y Hama
- Department of Radiology, National Defense Medical College, Tokorozawa, Japan
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33
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Sato M, Uematsu M, Hama Y, Kondo M, Kutsuki S, Shigematsu N, Ando Y, Kusano S, Kubo A. Low-Dose Induction Radiotherapy for Stomach Conservation in Patients with Massive Gastric Lymphoma. Tumori 2018; 86:286-8. [PMID: 11016705 DOI: 10.1177/030089160008600405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low-dose induction radiotherapy was performed in 4 patients with massive gastric lymphoma in order to treat the disease without gastrectomy. Following the radiotherapy, gastric lesions had shrunk considerably without any complications. Standard chemotherapy and/or radiotherapy could then be performed safely, and stomach conservation could be achieved in all 4 patients.
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Affiliation(s)
- M Sato
- Radiation Oncology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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34
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Irikura N, Uematsu M, Kitahara G, Osawa T, Sasaki Y. Association of interservice interval with conception rate in Japanese Black cattle. Reprod Domest Anim 2018; 53:1020-1023. [PMID: 29663567 DOI: 10.1111/rda.13191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
This study aimed to clarify the association of interservice interval (ISI) with conception rate (CR) and to evaluate factors affecting ISI in Japanese Black cattle. Data used in this study covered 32,639 artificial insemination (AI) records on 972 farms. The mean ± SEM of ISI and CR was 57.0 ± 0.3 days and 44.6 ± 0.3%, respectively. The relative frequency of ISI differed significantly between parity groups (p < .05). For parity 0, the proportion of ISI at an 18- to 24-day interval was 43.6%, whereas the proportions in the other parity groups ranged from 27.2% to 29.1%. The CR was associated significantly with ISI, parity and AI number (p < .05), but not with season. Cows reinseminated at an 18- to 24-day interval had the highest CR (46.8%; p < .05). Cows reinseminated at a 39- to 45-day interval had a similar CR to those reinseminated at 25- 38-day and 46- to 59-day intervals. Cows reinseminated at 11-17, 60-66 and 67 days or longer intervals had the lowest CR (p < .05). Thus, cows returning to oestrus in a normal cycle tended to have a higher probability of conceiving compared with those that returned to oestrus after a normal cycle for any degree of parity and at any number of AI.
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Affiliation(s)
- N Irikura
- Faculty of Agriculture, Department of Animal and Grassland Sciences, University of Miyazaki, Miyazaki, Japan
| | - M Uematsu
- Miyazaki Agricultural Mutual Aid Association, Miyazaki, Japan
| | - G Kitahara
- Faculty of Agriculture, Department of Veterinary Sciences, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - T Osawa
- Faculty of Agriculture, Department of Veterinary Sciences, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - Y Sasaki
- Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan.,Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan
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35
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Numata‐Uematsu Y, Yokoyama H, Sato H, Endo W, Uematsu M, Nara C, Kure S. Attachment Disorder and Early Media Exposure: Neurobehavioral symptoms mimicking autism spectrum disorder. J Med Invest 2018; 65:280-282. [DOI: 10.2152/jmi.65.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Hiroyuki Yokoyama
- Department of Fukushima medical Center for Children and Women, Fukushima Medical University
| | - Hiroki Sato
- Department of Pediatrics, Tohoku University School of Medicine
| | - Wakaba Endo
- Department of Pediatrics, Tohoku University School of Medicine
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine
| | - Chieko Nara
- Department of Pediatrics, Tohoku University School of Medicine
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine
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36
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Sato R, Arai-Ichinoi N, Kikuchi A, Matsuhashi T, Numata-Uematsu Y, Uematsu M, Fujii Y, Murayama K, Ohtake A, Abe T, Kure S. Novel biallelic mutations in the PNPT1
gene encoding a mitochondrial-RNA-import protein PNPase cause delayed myelination. Clin Genet 2017; 93:242-247. [DOI: 10.1111/cge.13068] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/19/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022]
Affiliation(s)
- R. Sato
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - N. Arai-Ichinoi
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - A. Kikuchi
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - T. Matsuhashi
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - Y. Numata-Uematsu
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - M. Uematsu
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
| | - Y. Fujii
- Department of Pediatrics; Hiroshima University Hospital; Hiroshima Japan
| | - K. Murayama
- Department of Metabolism; Chiba Children's Hospital; Chiba Japan
| | - A. Ohtake
- Department of Pediatrics; Saitama Medical University; Saitama Japan
| | - T. Abe
- Department of Nephrology, Endocrinology, and Vascular Medicine; Tohoku University School of Medicine; Miyagi Japan
| | - S. Kure
- Department of Pediatrics; Tohoku University School of Medicine; Miyagi Japan
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37
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Irikura N, Uematsu M, Kitahara G, Osawa T, Sasaki Y. Effects of service number on conception rate in Japanese Black cattle. Reprod Domest Anim 2017; 53:34-39. [PMID: 28801993 DOI: 10.1111/rda.13049] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Abstract
The conception rate (CR) of Japanese Black cattle has been decreasing since 1990. The objectives of this study were to compare CR by artificial insemination (AI) number, and to assess the interaction between AI number and possible factors related to CR in Japanese Black cattle. Records of 11,182 AI records for 6,741 heifers and 61,302 AI records for 13,139 cows on 977 farms were analysed. The average CR of heifers was 47.0%, and CR at the first, second and third AI was higher than at the fourth or subsequent AI (p < 0.05). The average CR of cows was 47.8%, and their CR at first and second AI was higher than the fourth or subsequent AI (p < 0.05). Data analysis with CR as the dependent variable revealed significant interactions of AI number with interval from calving to first AI and AI season. Cows first serviced at ≤48 days post-partum had lower CR than those at ≥90 days at first AI (p < 0.05), but the interval from calving to first AI did not affect CR at second AI. Cows serviced in the autumn had a higher CR at first AI than those serviced in the spring and winter (p < 0.05); however, there was no seasonal difference in CR at the second AI. In summary, CR began to decrease from the fourth AI in heifers and the third AI in cows. The AI season and the interval from calving to first AI significantly affected CR only at the first AI.
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Affiliation(s)
- N Irikura
- Department of Animal and Grassland Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - M Uematsu
- Miyazaki Agricultural Mutual Aid Association, Miyazaki, Japan
| | - G Kitahara
- Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - T Osawa
- Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan.,Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan
| | - Y Sasaki
- Center for Animal Disease Control, University of Miyazaki, Miyazaki, Japan.,Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan
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38
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Kanda T, Fujita M, Iida O, Masuda M, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Sunaga A, Uematsu M, Mano T. P3367A novel index of left ventricular stiffness predicting clinical outcome in patients with heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3367] [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: 11/12/2022] Open
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39
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Shinouchi K, Iida Y, Toriyama C, Nishida H, Yasumura K, Yorifuji H, Kato T, Idemoto A, Mishima T, Yokoi K, Abe H, Date M, Ueda Y, Uematsu M, Koretsune Y. P2737Impact of preexisting chronic total occlusions of the coronary artery on the outcome of out-of-hospital sudden cardiac arrest patients with acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2737] [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: 11/14/2022] Open
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40
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Affiliation(s)
- M. Salvatores
- Commissariat à I’Energie Atomique, Nuclear Reactor Directorate, CE Cadarache 13108 St-Paul-lez-Durance, France
| | - I. Slessarev
- Commissariat à I’Energie Atomique, Nuclear Reactor Directorate, CE Cadarache 13108 St-Paul-lez-Durance, France
| | - M. Uematsu
- Commissariat à I’Energie Atomique, Nuclear Reactor Directorate, CE Cadarache 13108 St-Paul-lez-Durance, France
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41
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Affiliation(s)
- M. Salvatores
- Commissariat à I’Energie Atomique, Centre d’Etudes Nucléaires Cadarache Nuclear Reactor Directorate, 13108 St. Paul-lez-Durance, France
| | - I. Slessarev
- Commissariat à I’Energie Atomique, Centre d’Etudes Nucléaires Cadarache Nuclear Reactor Directorate, 13108 St. Paul-lez-Durance, France
| | - M. Uematsu
- Commissariat à I’Energie Atomique, Centre d’Etudes Nucléaires Cadarache Nuclear Reactor Directorate, 13108 St. Paul-lez-Durance, France
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42
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Oikawa Y, Okubo Y, Numata-Uematsu Y, Aihara Y, Kitamura T, Takayanagi M, Takahashi Y, Kure S, Uematsu M. Initial vasodilatation in a child with reversible cerebral vasoconstriction syndrome. J Clin Neurosci 2017; 39:108-110. [PMID: 28209305 DOI: 10.1016/j.jocn.2017.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
We describe the case of a 10-year-old boy who developed reversible cerebral vasoconstriction syndrome (RCVS) after cerebellitis. He received intravenous immunoglobulin and methylprednisolone to treat the cerebellitis. However, he then presented with a sudden severe headache, vomiting, and generalized tonic-clonic seizure. Brain magnetic resonance angiography (MRA) initially revealed diffuse cerebral vasodilatations, and diffuse multifocal segmental vasoconstrictions developed several days later. His clinical symptoms gradually resolved after several days, in the absence of any specific therapy. MRA performed 46days after symptom onset showed that the multifocal segmental vasoconstrictions had resolved, suggesting a diagnosis of RCVS. The imaging features of RCVS include multifocal segmental vasoconstriction. However, our case suggests that diffuse cerebral vasodilatation may in fact be evident during the early stage of disease.
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Affiliation(s)
- Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | | | - Yu Aihara
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | - Taro Kitamura
- Division of Pediatrics, Sendai City Hospital, Sendai, Japan
| | | | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Shizuoka, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
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43
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Shi RM, Kobayashi T, Kikuchi A, Sato R, Uematsu M, An K, Kure S. Phenytoin-responsive epileptic encephalopathy with a tandem duplication involving FGF12. Neurol Genet 2017; 3:e133. [PMID: 28144627 PMCID: PMC5260483 DOI: 10.1212/nxg.0000000000000133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/20/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Rui-Ming Shi
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Ryo Sato
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Kumiko An
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics (R.-M.S.), the First Affiliated Hospital of Xi'an Jiaotong University, China; Division of Genomic Medicine Support and Genetic Counseling (T.K.), Department of Education and Training, Tohoku Medical Megabank Organization (ToMMo), Tohoku University; Department of Pediatrics (R.-M.S., T.K., A.K., R.S., M.U., S.K.), Tohoku University School of Medicine; and Department of Clinical Laboratory (K.A.), Tohoku University Hospital, Sendai, Japan
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Kanda T, Borizanova A, Borizanova A, Zayat R, Bianco F, Hajdu M, Cherata DA, Ariani R, Sanchez J, Surkova E, Kalcik M, Demkina AE, Di Meglio M, Luszczak JM, Filipiak D, Sanz Sanchez J, Kolesnyk MY, Cersit S, Chokesuwattanaskul R, De Lepper AGW, Hubert A, Tavares Da Silva M, Svetlin Nedkov Tsonev ST, Ahmed A, Fujita M, Iida O, Masuda M, Okamoto S, Ishihara T, Nanto K, Uematsu M, Kinova E, Goudev A, Kinova E, Goudev A, Aljalloud A, Musetti G, Kang HJ, Jansen-Park SH, Goetzenich A, Autschbach R, Hatam N, Cicchitti V, Bucciarelli V, Di Girolamo E, Tonti G, De Caterina R, Gallina S, Vertes V, Meiszterics ZS, Szabados S, Simor T, Faludi R, Muraru D, Palermo C, Romeo G, Aruta P, Binotto G, Semenzato G, Carstea D, Iliceto S, Badano LP, Soesanto AM, Ruiz M, Mesa D, Delgado M, Gutierrez G, Aristizabal CH, Fernandez J, Ferreiro C, Duran E, Anguita M, Castillo JC, Pan M, Arizon JM, Suarez De Lezo J, Bidviene J, Brunello G, Veronesi F, Cavalli G, Sokalskis V, Aruta P, Badano LP, Muraru D, Yesin M, Bayam E, Gunduz S, Gursoy MO, Karakoyun S, Astarcioglu MA, Cersit S, Candan O, Ozkan M, Krylova NS, Poteshkina NG, Kovalevskaya EA, Hashieva FM, Venner C, Huttin O, Guillaumot A, Chaouat A, Chabot F, Juilliere Y, Selton-Suty C, Williams CA, Stuart AG, Pieles GE, Kasprzak JD, Lipiec P, Osa Saez A, Arnau Vives MA, Buendia Fuentes F, Ferre Valverdu M, Quesada Carmona A, Serrano Martinez F, Montero Argudo A, Martinez Dolz L, Rueda Soriano J, Nikitjuk OV, Dzyak GV, Gunduz S, Tabakci M, Gursoy O, Karakoyun S, Bayam E, Kalcik M, Yesin M, Ozkan M, Satitthummanid S, Boonyaratavej S, Herold IHF, Saporito S, Bouwman RA, Mischi M, Korsten HHM, Reesink KD, Houthuizen P, Galli E, Bouzille G, Samset E, Donal E, Pestana G, De Sousa C, Pinto R, Ribeiro V, Vasconcelos M, Almeida PB, Macedo F, Maciel MJ, Manov E, Runev N, Shabani R, Gartcheva M, Donova T, Petrov I, Al-Mallah M. HIT Poster session 1P161E/e'*SV is a better predictor of outcome than E/e' in patients with heart failure with preserved left ventricular ejection fractionP162Subclinical left atrial and left ventricular structural and functional abnormalities in postmenopausal women with abdominal obesityP163Central obesity and hypertension: double burden to the left atrium of postmenopausal womenP164Comparison between 3-D blood pressure pulse analyser and pulsed-wave doppler echocardiography derived hemodynamic parameters in cardiac surgery patients - a pilot studyP165Paced-induced heart electrical activation modifies the orientation of left ventricular flow momentum: novel insights from echocardiographic particle image velocimetryP166Correlations between echocardiographic and CMR-derived parameters of right ventricular size and function in patients with COPDP167Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular myocardial function in patients with cancer therapy-related left ventricular dysfunctionP168Effect of atrial fibrillation to pulmonary hypertension and right ventricular function in patient with severe mitral stenosisP169Evolution of etiologic spectrum and clinical features of mitral regurgitation since 2007 until 2015P170Tricuspid annulus area correlates more with right atrial than right ventricular volumes in patients with different mechanisms of functional tricuspid regurgitation: a 3D echocardiography studyP171The effect of hemolysis on serum lipid levels in patients suffering from severe paravalvular leakageP172Right ventricular dysfunction in patients with hypertrophic cardiomyopathyP173Interest of variations of echocardiographic parameters after initiation of specific therapy in the risk stratification of patients with pulmonary hypertensionP174Comparison of left and right atrial size and function in elite adolescent male football playersP175Do pocket-size imaging devices allow for reliable bedside vascular screening?P176Evolution of tricuspid regurgitation after pulmonary valve replacement for pulmonary regurgitation in repaired tetralogy of fallotP177Effect of perindopril/amlodipine combination on post-exercise E/e' in patients with arterial hypertensionP178Relationship between pulmonary venous flow and prosthetic mitral valve thrombosis P179Mitral valve parameters derived from 3-dimensional transesophageal echocardiography dataset: correlation between qlab and tomtec softwareP180Non-invasive pulmonary transit time: a new parameter for global cardiac performanceP181Assessment of the positive work and mechanical dispersion: new methods to quantify left ventricular function in aortic stenosisP182Atrial function in Takotsubo cardiomyopathy: deformation analysisP183Cardiac syndrome X- proven left ventricular perfusion and kinetic abnormalities by SPECT-CT and pharmacological dobutamine stress testP184Impact of frailty assessment on myocardial perfusion imaging results: a prospective cohort study. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew235] [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: 11/14/2022] Open
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Suzuki-Muromoto, S, Uematsu M, Sato H, Numata-Uematsu Y, Nakayama T, Kiluchi A, Kobayashi T, Hino-Fukuyo N, Kure S. [Efficacy of vigabatrin therapy for tuberous sclerosis with infantile spasms]. No To Hattatsu 2016; 48:413-419. [PMID: 30010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To evaluate the effects and tolerability of vigabatrin (VGB) in children with tuberous sclerosis (TS) with infantile spasms or tonic seizures. Methods: We examined the impact of VGB on a series of 17 children with TS visiting Tohoku University Hospital in Japan during April 2010 and May 2015. To minimize potential adverse effects, VGB was given to the patients for limited 6 months with titration from 30 mg/kg/day as an initial dose. Results: Main seizure types were classified into spasms (n=10) or tonic seizures (n=7). Seizure reduction was positively associated with seizure type of infantile spasms, lower maximum dosage, younger age on VGB administration, and earlier VGB treatment after the diagnosis. Seizure type of infantile spasm was an independent favorable predictor and also associated with long-term seizure reduction. Major adverse events included psychiatric symptoms (n=7) and electroretinogram (ERG) abnormalities (n=2). All symptoms were recovered by reducing the dosage of VGB. Conclusion: VGB is effective and well tolerated as first-line treatment for TS children with infantile spasms. Our “low dosage and limited period” protocol is efficient for improving seizure control as well as minimizing the potential risks of VGB.
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Uematsu M, Haginoya K, Kikuchi A, Hino-Fukuyo N, Ishii K, Shiihara T, Kato M, Kamei A, Kure S. Asymptomatic congenital cytomegalovirus infection with neurological sequelae: A retrospective study using umbilical cord. Brain Dev 2016; 38:819-26. [PMID: 27068877 DOI: 10.1016/j.braindev.2016.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/11/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection causes various neurological sequelae. However, most infected infants are asymptomatic at birth, and retrospective diagnosis is difficult beyond the neonatal period. OBJECTIVE This study aimed to investigate the aspects of neurological sequelae associated with asymptomatic congenital CMV infection. METHODS We retrospectively analyzed 182 patients who were suspected of having asymptomatic congenital CMV infection with neurological symptoms in Japan. Congenital CMV infection was diagnosed by quantitative polymerase chain reaction amplification of CMV from dried umbilical cord DNA. RESULTS Fifty-nine patients (32.4%) who tested positive for CMV were confirmed as having congenital CMV infection. Among 54 congenital CMV patients, major neurological symptoms included intellectual disability (n=51, 94.4%), hearing impairment (n=36, 66.7%) and cerebral palsy (n=21, 38.9%), while microcephaly (n=16, 29.6%) and epilepsy (n=14, 25.9%) were less common. In a brain magnetic resonance imaging (MRI) study, cortical dysplasia was observed in 27 CMV-positive patients (50.0%), and all patients (100%) had cerebral white matter (WM) abnormality. Intracranial calcification was detected by CT in 16 (48.5%) of 33 CMV-positive patients. Cerebral palsy, cortical dysplasia and a WM abnormality with a diffuse pattern were associated with marked intellectual disability. CONCLUSIONS Brain MRI investigations are important for making a diagnosis and formulating an intellectual prognosis. Analysis of umbilical cord tissue represents a unique and useful way to retrospectively diagnose congenital CMV infection.
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Affiliation(s)
- Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Japan.
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Naomi Hino-Fukuyo
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Keiko Ishii
- Department of Medical Microbiology, Mycology and Immunology, Tohoku University School of Medicine, Japan
| | | | - Mitsuhiro Kato
- Department of Pediatrics, Yamagata University Faculty of Medicine, Japan
| | - Atsushi Kamei
- Department of Pediatrics, Iwate Medical University, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Japan
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Anzai M, Arai-Ichinoi N, Takezawa Y, Endo W, Inui T, Sato R, Kikuchi A, Uematsu M, Kure S, Haginoya K. Patchy white matter hyperintensity in ring chromosome 18 syndrome. Pediatr Int 2016; 58:919-22. [PMID: 27577543 DOI: 10.1111/ped.13043] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/12/2016] [Indexed: 11/27/2022]
Abstract
Ring chromosome 18 syndrome is a chromosomal abnormality in which partial deletions occur at both ends of chromosome 18, that is, distally on the short and long arms. Previously reported brain magnetic resonance imaging (MRI) abnormalities include diffuse hyperintensity in the white matter, which has been regarded as hypomyelination because the gene for myelin basic protein production is located on the long arm of chromosome 18. We report the case of a 14-year-old boy with ring chromosome 18 syndrome, whose MRI showed patchy asymmetrical T2 and fluid-attenuated inversion-recovery hyperintensities in the deep white matter as well as diffuse hypomyelination. These patchy lesions may indicate demyelination or gliosis rather than hypomyelination. This result differs from previous reports.
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Affiliation(s)
- Mai Anzai
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Tohoku University School of Medicine, Sendai, Japan.
| | | | - Yusuke Takezawa
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Tohoku University School of Medicine, Sendai, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Tohoku University School of Medicine, Sendai, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Tohoku University School of Medicine, Sendai, Japan
| | - Ryo Sato
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Tohoku University School of Medicine, Sendai, Japan
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Shiihara T, Watanabe M, Moriyama K, Maruyama Y, Kikuchi A, Arai-Ichinoi N, Uematsu M, Sameshima K. Mucolipidosis IV: A milder form with novel mutations and serial MRI findings. Brain Dev 2016; 38:763-7. [PMID: 26926398 DOI: 10.1016/j.braindev.2016.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/21/2015] [Revised: 01/21/2016] [Accepted: 02/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mucolipidosis IV (MLIV; OMIM #252650) is an autosomal recessive lysosomal storage disorder, frequently observed in the Ashkenazi Jewish population. MLIV typically results in intellectual disability, corneal opacities, and delayed motor milestones during infancy, with a relatively static course. To date, reports of MLIV in other ethnic groups have been sparse. PATIENT The present study is a case report of a 9-year-old Japanese boy, diagnosed via whole-exome sequencing, with compound heterozygous mutations of MCOLN1 (OMIM(*)605248): c.410T>C (p.Leu137Pro) and c.802_803delAG (p.Ser268Trpfs*17). Although his clinical course was mild (due to a lack of corneal clouding), other relevant features were present. These included strabismus, white matter signal abnormalities, and a hypoplastic corpus callosum at 2years of age. After a molecular diagnosis, a markedly elevated serum gastrin level (which is also common in MLIV) was confirmed. DISCUSSION The present results suggest that MLIV could be added as a differential diagnosis for white matter disorders, regardless of ethnicity. Beyond neurological or ophthalmologic findings, serum gastrin could be a useful diagnostic marker for MLIV.
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Affiliation(s)
- Takashi Shiihara
- Department of Neurology, Gunma Children's Medical Center, Gunma 377-8577, Japan.
| | - Mio Watanabe
- Department of Neurology, Gunma Children's Medical Center, Gunma 377-8577, Japan
| | - Kengo Moriyama
- Department of Neurology, Gunma Children's Medical Center, Gunma 377-8577, Japan
| | - Yasuhiro Maruyama
- Department of Ophthalmology, Kiryu Kosei General Hospital, Gunma 376-0034, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Natsuko Arai-Ichinoi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Kiyoko Sameshima
- Division of Medical Genetics, Gunma Children's Medical Center, Gunma 377-8577, Japan
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Sato Y, Numata-Uematsu Y, Uematsu M, Kikuchi A, Nakayama T, Kakisaka Y, Kobayashi T, Hino-Fukuyo N, Suzuki H, Takahashi Y, Saito Y, Tanuma N, Hayashi M, Iwasaki M, Haginoya K, Kure S. Acute encephalitis with refractory, repetitive partial seizures: Pathological findings and a new therapeutic approach using tacrolimus. Brain Dev 2016; 38:772-6. [PMID: 26906012 DOI: 10.1016/j.braindev.2016.02.006] [Citation(s) in RCA: 17] [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: 12/08/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by prolonged severe seizures and a high-grade fever. We experienced a boy with severe AERRPS with frequent partial seizures that exhibited right-side predominance. The patient required the continuous intravenous administration of many antiepileptic drugs and respirator management for several months. Methylprednisolone pulse therapy and intravenous immunoglobulin administration were only temporarily effective. The MRI and EEG showed the abnormality in the left occipital lobe. Although occipital lobectomy was performed, his seizures continued. His cerebrospinal fluid exhibited elevated protein and proinflammatory cytokine levels, and was positive for anti-glutamate receptor ε2 antibodies. Pathological examination showed infiltration of many neutrophilic leukocytes, T cells, and microglia in the area exhibiting severe spongiosis. We thought that the exaggerated microglia and T-cell responses were related to the pathogenesis of the patient's seizures, and we therefore initiated treatment with tacrolimus. As a result, many of the daily seizure clusters were ameliorated, and the patient was discharged. We attempted to discontinue the tacrolimus twice, but the patient's seizure clusters recurred each time. This is the first case report of the pathological findings of AERRPS and showing an effective therapeutic approach using tacrolimus. Tacrolimus may be an effective immunosuppressant, especially for patients with severe AERRPS.
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Affiliation(s)
- Yuko Sato
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | | | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Tojo Nakayama
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yosuke Kakisaka
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Naomi Hino-Fukuyo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Hiroyoshi Suzuki
- Department of Clinical Pathology and Laboratory, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Yoshiaki Saito
- Division of Child Neurology, Department of Brain and Neurosciances, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Naoyuki Tanuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masaharu Hayashi
- Department of Pediatrics, Tokyo Metropolitan Fuchu Medical Center for the Disabled, Tokyo, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuhiro Haginoya
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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Shiraki T, Iida O, Takahara M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Fujita M, Uematsu M. The Geriatric Nutritional Risk Index is Independently Associated with Prognosis in Patients with Critical Limb Ischemia Following Endovascular Therapy. Eur J Vasc Endovasc Surg 2016; 52:218-24. [DOI: 10.1016/j.ejvs.2016.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/19/2016] [Indexed: 12/22/2022]
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