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Kawasaki T, Nakamura T, Ohtake M, Akimoto T, Manaka H, Hamada K, Sakata K, Iwashita M, Takeuchi I, Yamamoto T. Clinical characteristics of aneurysmal subarachnoid haemorrhage complicated by Takotsubo cardiomyopathy resulting in good neurological outcome. Br J Neurosurg 2024:1-8. [PMID: 38571386 DOI: 10.1080/02688697.2024.2334432] [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: 09/05/2022] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is a well-known complication of subarachnoid haemorrhage (SAH), often accompanied by neurogenic myocardial dysfunction. Although TC has been reported to be associated with higher morbidity and mortality among patients with aneurysmal SAH (aSAH), some patients have been reported to recover, the profiles and follow-up outcomes of these survivors remain unclear. MATERIALS AND METHODS To characterize the profiles of patients with aSAH complicated by TC who experienced favourable outcomes using long-term follow-up data, a consecutive series of patients with aSAH were enrolled and TC diagnosis was based on the revised version of the Mayo Clinic criteria. Clinical outcomes were assessed at 6 months according to modified Rankin Scale scores. RESULTS Among 165 consecutive patients with aSAH, 15 cases were complicated by TC, corresponding to an occurrence rate of 9.0%. Five patients with aSAH complicated by TC (33.3%) experienced a favourable outcome, and the mean value of systolic blood pressure on arrival was significantly lower than in those who experienced an unfavourable outcome (p = 0.032). CONCLUSION According to analysis, it is possible cardiac dysfunction with decreased cerebral perfusion pressure and catecholamine toxicity transiently worsens conscious disturbance in aSAH complicated by TC. Therefore, it is important to carefully screen patients with aSAH to identify those complicated by TC, and for close collaboration of the multidisciplinary team to design appropriate treatment strategies.
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Affiliation(s)
- Takafumi Kawasaki
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ohtake
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Hamada
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Suzuki R, Akimoto T, Miyake S, Iida Y, Shimohigoshi W, Nakai Y, Shimizu N, Sakata K, Yamamoto T. Embolic Material Migration as the Predominant Contributing Factor to Prognostic Deterioration Following Combined Tumor Resection and Preoperative Embolization. Cureus 2024; 16:e57315. [PMID: 38690474 PMCID: PMC11060013 DOI: 10.7759/cureus.57315] [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] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Preoperative embolization can potentially facilitate surgical resection of challenging tumors in the intracranial and facial regions; however, its clinical efficacy remains controversial, mainly due to potential morbidity risks. We explored negative factors of the combined treatment of preoperative embolization and tumor resection that affect neurological prognosis. Method This retrospective study used clinical data from 132 consecutive tumors that underwent combined treatment at multiple facilities between January 2016 and May 2021. Basic patient information, tumor characteristics, and treatment details were assessed to identify predictors of deterioration as measured using the modified Rankin scale (mRS) score at three months post-treatment. Results Among the 126 eligible combined treatments, a deterioration in the postoperative mRS score was observed in 19/126 (15.1%). Complications related to embolization and tumor resection occurred in 8/126 (6.3%) and 19/125 (15.2%) of procedures, respectively. Multivariate analyses indicated significant associations between migration of embolic material (adjusted odds ratio 13.80; 95% confidence interval 1.25-152.52; p=0.03), elevated intraoperative blood loss (p=0.04), and deterioration of postoperative mRS score. Embolic material migration was identified as the primary prognostic factor for the deterioration of score. An analysis of 192 procedures, excluding those that exclusively used coils, identified embolization targeting the accessory meningeal artery (p=0.046) and the third segment of the internal maxillary artery (p=0.03) as a risk factor for embolic material migration. Conclusions Embolic material migration is the predominant factor associated with declining neurological outcome that persists into the chronic phase after combined treatment. Given that preoperative embolization is a supplementary treatment option, a thorough understanding of vascular anatomy and striving safe procedure are critical.
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Affiliation(s)
- Ryosuke Suzuki
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, JPN
| | - Yu Iida
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Wataru Shimohigoshi
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
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Okune S, Hayakawa M, Hino T, Hiramine T, Akimoto T, Sato M, Ito Y, Marushima A, Takada T, Ishikawa E, Tamaoka A, Matsumaru Y. Transient Hemichorea-hemiballism Induced by a Combination of Postprandial Hypotension and Severe Stenosis of the Innominate Artery Concomitant with Left Carotid Occlusion. Intern Med 2024; 63:577-582. [PMID: 37407451 PMCID: PMC10937142 DOI: 10.2169/internalmedicine.0633-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
Hemichorea-hemiballism (HCHB) due to transient ischemic attacks (TIAs) is rare. An 83-year-old woman had repeated episodes of right-sided HCHB for 3 months. Magnetic resonance (MR) angiography demonstrated occlusion of the left carotid and middle cerebral arteries and severe stenosis of the innominate artery, and 24-hour ambulatory blood pressure monitoring showed a blood pressure decrease of >20 mmHg after each meal. We speculated that HCHB developed as TIAs due to hemodynamic failure in the left cerebral hemisphere, caused by a combination of severe stenosis of the innominate artery concomitant with occlusion of the left carotid and middle cerebral arteries as well as postprandial hypotension.
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Affiliation(s)
- Sho Okune
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
| | - Tenyu Hino
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Takato Hiramine
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
| | - Taisuke Akimoto
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masayuki Sato
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | | | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
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Shizawa K, Ohtake M, Akimoto T, Kawasaki T, Seki S, Imanishi Y, Yasuda M, Kawasaki T, Sakata K, Takeuchi I, Yamamoto T. The Examination of Prognostic Factors and Treatment Strategies for Traumatic Cerebrospinal Fluid Leakage. Cureus 2024; 16:e52874. [PMID: 38406021 PMCID: PMC10890926 DOI: 10.7759/cureus.52874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction This study aimed to determine the optimal timing for surgical intervention and the prognostic factors of cerebrospinal fluid (CSF) leakage. Methods We identified 25 patients with probable CSF leaks from 472 consecutive patients with head trauma. In addition to baseline characteristics and findings on admission, injury severity score (ISS), abbreviated injury score (AIS), and other factors related to CSF leakage were considered. We analyzed the prognostic factors after setting the primary endpoint as the modified Rankin Scale (mRS) at the time of discharge to determine the appropriate timing for surgical intervention. Results Univariate analysis revealed significantly poorer prognoses for elderly patients (p<0.001) and cases with low Glasgow Coma Scale (GCS) levels (p=0.039) and high D-dimer levels (p=0.028), which was consistent with findings from the analyses of all patients with head trauma. We found that multiple traumas (AIS≥3 at two or more sites, p=0.047) and high lactate levels (p=0.043) were poor prognostic factors specific to CSF leakage cases, while a longer time to CSF leakage cessation was also associated with a poorer prognosis (median, six days versus 13 days, p=0.014). An evaluation of the time to closure found that spontaneous cessation occurred within 14 days in most cases. Conclusions Conservative medical treatment is the first choice for most cases of traumatic CSF leakage. Surgical intervention should be considered if leakage does not cease after 14 days post injury. Furthermore, severe multiple injuries and high lactate levels were poor prognostic factors specific to patients with CSF leakage.
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Affiliation(s)
- Kaoru Shizawa
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Makoto Ohtake
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, JPN
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Takafumi Kawasaki
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Shunsuke Seki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, JPN
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, JPN
| | - Yuya Imanishi
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Masaki Yasuda
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
| | - Takashi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, JPN
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, JPN
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Kojima T, Nakamura T, Saito J, Hidaka Y, Akimoto T, Inoue H, Chick CN, Usuki T, Kaneko M, Miyagi E, Ishikawa Y, Yokoyama U. Hydrostatic pressure under hypoxia facilitates fabrication of tissue-engineered vascular grafts derived from human vascular smooth muscle cells in vitro. Acta Biomater 2023; 171:209-222. [PMID: 37793599 DOI: 10.1016/j.actbio.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Biologically compatible vascular grafts are urgently required. The scaffoldless multi-layered vascular wall is considered to offer theoretical advantages, such as facilitating cells to form cell-cell and cell-matrix junctions and natural extracellular matrix networks. Simple methods are desired for fabricating physiological scaffoldless tissue-engineered vascular grafts. Here, we showed that periodic hydrostatic pressurization under hypoxia (HP/HYP) facilitated the fabrication of multi-layered tunica media entirely from human vascular smooth muscle cells. Compared with normoxic atmospheric pressure, HP/HYP increased expression of N-myc downstream-regulated 1 (NDRG1) and the collagen-cross-linking enzyme lysyl oxidase in human umbilical artery smooth muscle cells. HP/HYP increased N-cadherin-mediated cell-cell adhesion via NDRG1, cell-matrix interaction (i.e., clustering of integrin α5β1 and fibronectin), and collagen fibrils. We then fabricated vascular grafts using HP/HYP during repeated cell seeding and obtained 10-layered smooth muscle grafts with tensile rupture strength of 0.218-0.396 MPa within 5 weeks. Implanted grafts into the rat aorta were endothelialized after 1 week and patent after 5 months, at which time most implanted cells had been replaced by recipient-derived cells. These results suggest that HP/HYP enables fabrication of scaffoldless human vascular mimetics that have a spatial arrangement of cells and matrices, providing potential clinical applications for cardiovascular diseases. STATEMENT OF SIGNIFICANCE: Tissue-engineered vascular grafts (TEVGs) are theoretically more biocompatible than prosthetic materials in terms of mechanical properties and recipient cell-mediated tissue reconstruction. Although some promising results have been shown, TEVG fabrication processes are complex, and the ideal method is still desired. We focused on the environment in which the vessels develop in utero and found that mechanical loading combined with hypoxia facilitated formation of cell-cell and cell-matrix junctions and natural extracellular matrix networks in vitro, which resulted in the fabrication of multi-layered tunica media entirely from human umbilical artery smooth muscle cells. These scaffoldless TEVGs, produced using a simple process, were implantable and have potential clinical applications for cardiovascular diseases.
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Affiliation(s)
- Tomoyuki Kojima
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan; Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Kanagawa 236-0004, Japan
| | - Takashi Nakamura
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Junichi Saito
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Yuko Hidaka
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Kanagawa 236-0004, Japan
| | - Hana Inoue
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Christian Nanga Chick
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University, Tokyo 102-8554, Japan
| | - Toyonobu Usuki
- Department of Materials and Life Sciences, Faculty of Science and Technology, Sophia University, Tokyo 102-8554, Japan
| | - Makoto Kaneko
- Graduate School of Science and Engineering, Meijo University, Aichi 468-8502, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Kanagawa 236-0004, Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute, Yokohama City University Graduate School of Medicine, Kanagawa 236-0004, Japan
| | - Utako Yokoyama
- Department of Physiology, Tokyo Medical University, Tokyo 160-0023, Japan.
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Iida Y, Suenaga J, Shimizu N, Shizawa K, Suzuki R, Miyake S, Akimoto T, Hori S, Tateishi K, Nakai Y, Yamamoto T. Transvenous embolization for an intraosseous clival arteriovenous fistula via a proper access route guiding a three-dimensional fusion image: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23492. [PMID: 37903421 PMCID: PMC10618065 DOI: 10.3171/case23492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous sinus (CS), are rare. Targeting embolization of an intraosseous clival AVF is challenging because of its complex venous and skull base anatomy; therefore, a therapeutic strategy based on detailed preoperative radiological findings is required to achieve a favorable outcome. Here, the authors report the successful targeted embolization of an intraosseous clival AVF using an ingenious access route. OBSERVATIONS A 74-year-old woman presented with left-sided visual impairment, oculomotor nerve palsy, and right facial pain. A fusion image of three-dimensional rotational angiography and cone-beam computed tomography revealed a left CS dural AVF and a right intraosseous clival AVF. The shunt flow of the clival AVF drained extracranially from the posterior and anterior condylar veins via the intraosseous venous route. Transvenous embolization was performed by devising suboccipital, posterior condylar, and intraosseous access routes. The symptoms resolved after the bilateral AVFs were treated. LESSONS Accurate diagnosis and proper transvenous access based on detailed intraosseous and craniocervical venous information obtained from advanced imaging modalities are key to resolving intraosseous clival AVF.
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Ishikawa S, Miyake S, Akimoto T, Nakai Y, Amano Y, Yamamoto R, Amari K, Yamamoto T, Takeuchi M, Morimoto M, Tsuboi Y, Kaku S, Ayabe J, Akiyama T, Yamamoto D, Ito H, Onodera H, Hagiwara Y, Takaishi S, Hasegawa Y, Ueda T. Increased door-to-puncture time during off-duty hours results in poor treatment outcomes for acute ischemic stroke: A subanalysis of the K-NET registry. Interv Neuroradiol 2023:15910199231205050. [PMID: 37807815 DOI: 10.1177/15910199231205050] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND For patients who undergo endovascular treatment for acute ischemic stroke, the total time for treatment may increase during off-duty hours leading to worse outcomes. The present study compared endovascular treatment outcomes for on-duty and off-duty hours and examined factors that could be responsible for the prolonged treatment of patients in a multicenter registry. METHODS The study group comprised 1571 patients listed in the multicenter stroke registry (K-NET) who had undergone endovascular treatment between January 2018 and June 2020. The modified Rankin Scale (mRS), evaluated at 90 days after stroke onset, was utilized as the primary outcome. Patients were divided into on-duty and off-duty patients based on admission time. Multivariate logistic regression analysis was used to identify the independent factors that increased the time from admission to puncture during the off-duty period. RESULTS The mean mRS score at 90 days after stroke onset was 2.9, similar in both on-duty and off-duty patients, with no significant difference (p = 0.77); however, significant differences were observed in time from door-to-puncture (74.7 vs. 88.8, p < 0.01). Additionally, the mRS score at 90 days worsened significantly for door-to-puncture time >60 min in the off-duty period. Multivariate logistic regression analysis revealed that a low National Institute of Health Stroke Scale (NIHSS) score, high pre-mRS score, posterior circulation, and diabetes were independent indicators of door-to-puncture time >60 min during the off-duty period. CONCLUSION Door-to-puncture time >60 min during off-duty hours was associated with poor outcomes related to low NIHSS, high pre-mRS, posterior circulation, and diabetes.
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Affiliation(s)
- Shun Ishikawa
- Department of Neurosurgery, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Yu Amano
- Department of Neurology, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Ryoo Yamamoto
- Department of Neurology, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Kazumitsu Amari
- Department of Neurosurgery, Yokohama Brain, and Spine Center, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masataka Takeuchi
- Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
| | - Masafumi Morimoto
- Department of Neurosurgery, Yokohamashintoshi Neurosurgical Hospital, Yokohama, Kanagawa, Japan
| | - Yoshifumi Tsuboi
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Shogo Kaku
- Department of Neurosurgery, Neurosurgical East Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Junichi Ayabe
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Takekazu Akiyama
- Department of Neurosurgery, Akiyama Neurosurgical Hospital, Yokohama, Kanagawa, Japan
| | - Daisuke Yamamoto
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hidetaka Onodera
- Department of Neurosurgery, St Marianna University Yokohama Seibu Hospital, Yokohama, Kanagawa, Japan
| | - Yuta Hagiwara
- Department of Neurology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Takaishi
- Department of Strokology and Neurointerventional Therapy, St Marianna University School of Medicine Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Toshihiro Ueda
- Department of Strokology and Neurointerventional Therapy, St Marianna University School of Medicine Toyoko Hospital, Kawasaki, Kanagawa, Japan
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Ozaki S, Akimoto T, Iida Y, Miyake S, Suzuki R, Shimohigoshi W, Hori S, Suenaga J, Shimizu N, Nakai Y, Sakata K, Yamamoto T. Complications and outcomes of carotid artery stenting in high-risk cases. J Stroke Cerebrovasc Dis 2023; 32:107329. [PMID: 37657401 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/21/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES Carotid artery stenting is sometimes adapted for some at-risk cases; however, appropriate treatment timing with stroke onset is controversial. This study aims to identify factors that have an impact on complications and outcomes, especially in patients at high risk. MATERIALS AND METHODS We examined the characteristics of 152 consecutive patients treated by carotid artery stenting between January 2018 and March 2022 and retrospectively analyzed the risk factors for complications and poor outcomes (modified-Rankin-Scale deterioration), such as patient background, carotid artery stenting risks (access route tortuosity, severe calcification, vulnerable plaque, estimated glomerular filtration rate <30 mL/min/1.73 m2, etc.), characteristics of the stenosis, details of treatment, and treatment timing. RESULTS The average North American Symptomatic Carotid Endarterectomy Trial criteria score was 68.3% and the lesion length was 20.5±9.7mm. Among patients, 107 (70.4%) had a carotid artery stenting risk. In high-risk carotid artery stenting cases, symptomatic complications occurred in 32 (30.0%), and the 90-day modified Rankin scale score deteriorated in 15 cases (14.0%). Multivariate analysis showed that cases with triple antithrombotic therapy (p=0.003), stenting within 7 days (p=0.0032), and after 28+ days (p=0.0035) of stroke onset were independently associated factors for complications. CONCLUSIONS This study showed that among risk factors, triple antithrombotic therapy in particular was a risk factor for perioperative complications. Carotid artery stenting for patients with stroke after 28 days of onset affects the prognosis. Therefore, although further study is warranted, waiting more than one month for treatment in patients requiring carotid artery stenting is a potential risk.
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Affiliation(s)
- So Ozaki
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama 2320024, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama 2320024, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan.
| | - Yu Iida
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
| | - Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain and Spine Center, 1-2-1, Takigashira, Isogo, Yokohama, Kanagawa 2350012, Japan
| | - Ryosuke Suzuki
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
| | - Wataru Shimohigoshi
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama 2320024, Japan
| | - Satoshi Hori
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama 2320024, Japan; Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan; Department of Neurosurgery, Yokohama Brain and Spine Center, 1-2-1, Takigashira, Isogo, Yokohama, Kanagawa 2350012, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama 2320024, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama 2360004, Japan
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Tomizawa K, Hojo H, Zhou Y, Oyoshi H, Fujisawa T, Kageyama SI, Nakamura M, Hirata H, Motegi A, Zenda S, Akimoto T. Compensatory Enlargement of the Liver after Proton Beam Therapy for Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e346. [PMID: 37785203 DOI: 10.1016/j.ijrobp.2023.06.2414] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Charged particle therapy (CPT) has been applied as a safe and effective treatment option for hepatocellular carcinoma (HCC). Although most HCC patients have cirrhosis, favorable treatment outcome has been achieved with CPT preserving liver function. After proton beam therapy (PBT) for patients with HCC, the liver volume in the non-irradiated area is often enlarged. Here, we evaluated whether enlargement of the non-irradiated liver affects preserving hepatic function and prognosis in HCC patients treated with PBT. MATERIALS/METHODS Among consecutive patients with HCC treated with PBT between April 2011 and July 2017, we retrospectively identified patients who fulfilled the following criteria: (i) receiving PBT to the right hepatic lobe, (ii) the left lateral segment was not irradiated, (iii) no local treatment was performed for liver within 12 months after PBT, and (iv) the albumin-bilirubin (ALBI) score was evaluable at 12 months after PBT. The left lateral segment was defined as the non-irradiated region and measured by contrast-enhanced CT just before and 3 months after PBT. ALBI scores just before and 12 months after PBT were compared to evaluate changes of hepatic function. Overall survival rate was estimated using the Kaplan-Meier method, and differences in survival between subgroups were examined using the log-rank test. The ALBI scores were compared using the Wilcoxon signed-rank test. RESULTS We identified 40 patients (male/female = 32/8). The median age at the start date of PBT was 72 (range, 54-87) years. The prescribed dose was 66.0-76.0 Gy (relative biological effectiveness) delivered in 10-38 fractions. The median follow-up was 61 (range, 12-126) months. The 5-year overall survival rates were 79.0% (95% CI: 60.4-100.0%) in the larger enlargement group (n = 16, enlarged volume of non-irradiated region 3 months after PBT ≥75 cm3) and 53.7% (95% CI: 36.0-79.9%) in the smaller enlargement group (n = 24, as above, <75 cm3), respectively (p = 0.21). The median ALBI scores just before and 12 months after PBT were -3.14 (95% CI: -3.22- (-2.53)) and -2.74 (95% CI: -3.07- (-2.42)) in the larger enlargement group (p = 0.09), and -2.91 (95% CI: -3.15- (-2.40)) and -2.59 (95% CI: -2.74- (-2.12)) in the smaller enlargement group (p = 0.006), respectively. CONCLUSION Our study suggests that larger enlargement of the non-irradiated liver after PBT is related to well-preserved liver function at 1 year and modestly associated with a favorable prognosis.
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Affiliation(s)
- K Tomizawa
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Hojo
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Y Zhou
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Oyoshi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - T Fujisawa
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S I Kageyama
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - M Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Hirata
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - A Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
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Motegi K, Motegi A, Kano K, Yamashita N, Hirotaki K, Oyoshi H, Ariji T, Tachibana H, Akimoto T. Feasibility Study of Robust Treatment Planning in VMAT for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e699. [PMID: 37786049 DOI: 10.1016/j.ijrobp.2023.06.2183] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In general, patient positional uncertainty is considered by adding a geometrically expanded margin to clinical target volume (CTV) in photon radiation therapy. However, this method may not be suitable because image-guided radiotherapy is available. In intensity modulated proton beam therapy, robust treatment planning is currently common to take patient positional uncertainty into account in optimization rather than in margins. The purpose of this study is to assess the feasibility of clinical implementation of the method in volumetric modulated arc therapy (VMAT) for head and neck cancer. We quantitatively evaluated whether the plans with the robust optimization (Robust plans) can adequately cover CTV against patients' positional uncertainties and body shape change throughout a treatment course. MATERIALS/METHODS Ten head and neck cancer patients were chosen, who were treated with PTV-based VMAT plans in our hospital between 2021.5-2022.4. RayStation V10A (RaySearch Laboratories, Stockholm, Sweden) was used for the robust optimization, which was applied to the CTVs with patient positional uncertainty of 5 mm in the 6-axis direction. Dose prescribed to the high- and low-risk CTVs were to 70 and 56 Gy in 35 fractions, respectively. To create the patients' CT images with residual set-up errors and body shape change at the treatment, pseudo simulation-CT images were created by deformable image registration with CBCT and simulation-CT. Dose distribution at the treatment was re-calculated by applying the plan to the pseudo simulation-CT images. The variation of D98 for the high-risk CTV from the time of treatment planning was evaluated on a weekly basis. For comparison, planning target volume (PTV) -based plans (5 mm margin circumference) were created and a similar evaluation was performed. RESULTS D98 for the high-risk CTV varied between -3∼2% in the robust plan and between -5∼1% in the PTV-based plan during the treatment course. There was no significant difference in the amount of D98 variation between the two plans by t-test, except for one case with hypopharyngeal cancer. In this case, D98 for the high-risk CTV varied within ±1% with the PTV-based plan, whereas the value decreased up to 3% with the robust plan (p < 0.05). This case often had a residual setup error of approximately 5 mm at the sites related to the pitch rotation of head, suggesting that the dose distribution for the robust plan was affected by non-rigid positional errors. Patient weight loss during the treatment period was -3.5±2.4 kg, showing a weak correlation (r = -0.33) with the variation in D98 for the high-risk CTV. CONCLUSION The robust treatment planning exhibits comparable CTV coverage to the conventional PTV-based planning against positional uncertainty and body shape change throughout a treatment period. In order to overcome set-up baseline shift by the non-rigid positional errors, re-planning should be recommended. Further planning studies will be conducted to promote clinical implementation of the method.
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Affiliation(s)
- K Motegi
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - K Kano
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - N Yamashita
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - K Hirotaki
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Oyoshi
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - T Ariji
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Tachibana
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
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Akimoto T, Ohtake M, Miyake S, Suzuki R, Iida Y, Shimohigoshi W, Higashijima T, Nakamura T, Shimizu N, Kawasaki T, Sakata K, Yamamoto T. Preoperative tumor embolization prolongs time to recurrence of meningiomas: a retrospective propensity-matched analysis. J Neurointerv Surg 2023; 15:814-820. [PMID: 35803729 PMCID: PMC10359541 DOI: 10.1136/neurintsurg-2022-019080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Meningiomas are often embolized preoperatively to reduce intraoperative blood loss and facilitate tumor resection. However, the procedure is controversial and its effects have not yet been reported. We evaluated preoperative embolization for meningiomas and its effect on postoperative outcome and recurrence. METHODS We retrospectively reviewed the medical records of 186 patients with WHO grade I meningiomas who underwent surgical treatment at our hospital between January 2010 and December 2020. We used propensity score matching to generate embolization and no-embolization groups (42 patients each) to examine embolization effects. RESULTS Preoperative embolization was performed in 71 patients (38.2%). In the propensity-matched analysis, the embolization group showed favorable recurrence-free survival (RFS) (mean 49.4 vs 24.1 months; Wilcoxon p=0.049). The embolization group had significantly less intraoperative blood loss (178±203 mL vs 221±165 mL; p=0.009) and shorter operation time (5.6±2.0 hours vs 6.8±2.8 hours; p=0.036). There were no significant differences in Simpson grade IV resection (33.3% vs 28.6%; p=0.637) or overall perioperative complications (21.4% vs 11.9%; p=0.241). Tumor embolization prolonged RFS in a subanalysis of cases who experienced recurrence (n=39) among the overall cases before variable control (mean RFS 33.2 vs 16.0 months; log-rank p=0.003). CONCLUSIONS After controlling for variables, preoperative embolization for meningioma did not improve the Simpson grade or patient outcomes. However, it might have effects outside of surgical outcomes by prolonging RFS without increasing complications.
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Affiliation(s)
- Taisuke Akimoto
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Makoto Ohtake
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shigeta Miyake
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Ryosuke Suzuki
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yu Iida
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Wataru Shimohigoshi
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takefumi Higashijima
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Taishi Nakamura
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Nobuyuki Shimizu
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takashi Kawasaki
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Katumi Sakata
- Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Neurosurgery, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Miyake S, Nakai Y, Akimoto T, Ishikawa S, Saruta W, Kuroda H, Shimizu S, Yamamoto T. Combined Endovascular Antegrade and Direct Retrograde Carotid Artery Stenting for Chronic and Long Segment Common Carotid Artery Occlusion: Technical Note and Review of Literature. Neurol Med Chir (Tokyo) 2023; 63:321-326. [PMID: 37019649 PMCID: PMC10406455 DOI: 10.2176/jns-nmc.2022-0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 04/07/2023] Open
Abstract
Common carotid artery (CCA) occlusion (CCAO) is a rare cause of ischemic stroke and bypass surgery is the common treatment approach. However, safer alternatives should be developed to treat CCAO. A 68-year-old male was diagnosed with left-sided CCAO with decreased left visual acuity due to neck radiation therapy for laryngeal cancer. Recanalization therapy using a pull-through technique was initiated because cerebral blood flow progressively decreased during the follow-up period. First, after a short sheath was inserted into the CCA, the occluded CCA was retrogradely penetrated through the sheath. Second, a micro-guidewire was guided to the aorta from the femoral sheath where it was caught using a snare wire guided from the cervical sheath. Subsequently, the micro-guidewire was gently pulled out from the cervical sheath, penetrated the occluded lesion, and was secured to the femoral and cervical sheaths. Finally, the occluded lesion was dilated using a balloon, and the stent was placed. Five days postprocedure, the patient was discharged uneventfully and exhibited improved left visual acuity. In terms of reliable penetration of obstructive lesions and reduction of embolic and hemorrhagic complications, combined endovascular antegrade and direct retrograde carotid artery stenting is a versatile and minimally invasive treatment option for CCAO.
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Affiliation(s)
- Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Taisuke Akimoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Shun Ishikawa
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Wakiko Saruta
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Hiroki Kuroda
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Satoru Shimizu
- Department of Neurosurgery, Yokohama Brain and Spine Center
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
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Ohya A, Ohtake M, Kawamura Y, Akimoto T, Iwashita M, Yamamoto T, Takeuchi I. Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report. Int J Emerg Med 2023; 16:15. [PMID: 36858963 PMCID: PMC9976426 DOI: 10.1186/s12245-023-00490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital. CASE PRESENTATION The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient's symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient's condition. CONCLUSION If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient's condition is critical, and early diagnosis will lead to a favorable outcome for the patient.
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Affiliation(s)
- Aimi Ohya
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ohtake
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan. .,Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yusuke Kawamura
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisuke Akimoto
- grid.413045.70000 0004 0467 212XDepartment of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- grid.268441.d0000 0001 1033 6139Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ichiro Takeuchi
- grid.413045.70000 0004 0467 212XDepartment of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
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14
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Akimoto T, Ohtake M, Kawasaki T, Fushimi S, Shimohigoshi W, Manaka H, Kawasaki T, Sakata K, Takeuchi I, Yamamoto T. Predictors of Outcomes Six Months after Endovascular Coil Embolization of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. J Neuroendovasc Ther 2023; 17:47-55. [PMID: 37502127 PMCID: PMC10370525 DOI: 10.5797/jnet.oa.2022-0043] [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] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/09/2022] [Indexed: 07/29/2023]
Abstract
Objective To identify factors associated with the outcome and prognosis of coil embolization for poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Methods We retrospectively reviewed 118 patients with World Federation of Neurosurgical Societies (WFNS) grade IV or V subarachnoid hemorrhage at our institute between January 2010 and December 2020. Outcomes were assessed using modified Rankin Scale (mRS) scores at discharge and at six months after aSAH onset. In addition, patient background, aneurysm characteristics, and treatment outcome were compared between patients showing favorable (mRS scores: 0-2) and unfavorable (mRS scores: 3-6) outcomes at six months. Factors for change of mRS during follow-up were explored, and cut off values were calculated for age using the receiver operating characteristic analysis. Results Endovascular treatment was performed in 51 of the 118 enrolled patients. Data were analyzed for 43 of these patients who underwent coil embolization of ruptured aneurysms and had complete datasets. The mean age was 61.7 years and 24 (55.8%) patients had WFNS grade V aSAH. Coil embolization-related complications were observed in three patients. There were no treatment-related deaths; however, eight patients (18.6%) died at three months. Multivariate analysis showed that the maximum diameter of the aneurysm (p=0.041) and the postoperative dual antiplatelet therapy (DAPT) (p=0.040) were associated with unfavorable and favorable outcomes, respectively. Older age (p=0.033) was independently associated with mRS score deterioration following discharge. Age 72 years and older was the cut off value for mRS deterioration. Conclusion Aneurysm size and postoperative DAPT might be associated with outcomes at 6 months. Moreover, we identified older age as an independent factor that influences mRS deterioration following discharge; thus, especially in cases of elderly patients over 72 years of age, it is highly likely that long-term care to prevent disuse and regular follow-up on imaging will be necessary.
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Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Makoto Ohtake
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takafumi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shuto Fushimi
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Wataru Shimohigoshi
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takashi Kawasaki
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Ichiro Takeuchi
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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15
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Muacevic A, Adler JR, Akimoto T, Ikeuchi H, Muroya A, Ohata H, Kubota Y, Chiku M, Hamano T, Yamamoto T. Magnetic Resonance Imaging Scan of the Brain After Mild COVID-19 Infection. Cureus 2023; 15:e34229. [PMID: 36852359 PMCID: PMC9963390 DOI: 10.7759/cureus.34229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE There have been several reports of central nervous system impairments associated with severe coronavirus disease 2019 (COVID-19) infection on head magnetic resonance imaging and angiography (MRI/A). However, head MRI/A is rarely performed in mild cases, and there have been few reports on intracranial changes after COVID-19 infection in these cases. Here, we report a comparative examination of the findings seen in common head MRI/A sequences in mild cases of COVID-19. METHODS Of the 15,376 patients who underwent head MRI/A examination called "Brain Dock" between June 2020 and June 2021, 746 patients who received a COVID-19 antibody test were evaluated. Positive and negative patients were comparatively examined for head MRI/A findings such as cerebral white matter lesions, ischemic changes, cerebral microbleeds, cerebral aneurysms, arterial stenosis, sinusitis, and other abnormal findings. RESULTS Overall, 31 (4.2%) patients were COVID-19 positive, and all of them had mild infections not requiring hospitalization. There was no significant difference in patient characteristics and head MRI/A findings between positive and negative patients. All positive patients showed no particular abnormalities in the nasal findings such as olfactory bulb atrophy or thickening of the olfactory mucosa. CONCLUSION Intracranial lesions in mild patients do not show a clear difference from those in negative patients. This indicates that findings seen in common MRI/A sequences of severe patients are not likely in mild patients, supporting that there is relatively no damage to the central nervous system in mild patients.
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Ono R, Sato M, Okune S, Hino T, Akimoto T, Ito Y, Marushima A, Hayakawa M, Ishikawa E, Matsumaru Y. Parent Artery Occlusion for Symptomatic Large Internal Carotid Artery Aneurysm with Primitive Trigeminal Artery Variant: A Case Report. J Neuroendovasc Ther 2022; 17:22-26. [PMID: 37501882 PMCID: PMC10370514 DOI: 10.5797/jnet.cr.2022-0029] [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] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/11/2022] [Indexed: 07/29/2023]
Abstract
Objective To report a case of symptomatic large cerebral aneurysm of the internal carotid artery (ICA), associated with a primitive trigeminal artery variant (PTAv), which was treated with a balloon occlusion test (BOT) to evaluate ischemic tolerance. Case Presentation A 79-year-old woman was diagnosed with a symptomatic large cerebral aneurysm of the ICA bifurcating the PTAv due to diplopia. After confirming the ischemic tolerance of the perfusion area and PTAv by BOT, we performed ICA parent artery occlusion with selective embolization of the PTAv. Postoperative MRI showed no ischemic lesion and the diplopia was resolved. Conclusion ICA parent artery occlusion with PTAv selective embolization after evaluation by BOT is useful in the treatment of large aneurysms.
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Affiliation(s)
- Ryohei Ono
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sho Okune
- Division of Stroke Prevention and Treatment, Faculty of Medicine University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tenyu Hino
- Division of Stroke Prevention and Treatment, Faculty of Medicine University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine University of Tsukuba, Tsukuba, Ibaraki, Japan
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17
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Akimoto T, Yoshikawa H, Fushimi S, Takagi R, Nakamura T, Ohtake M, Kawasaki T, Sakata K, Yamamoto T. Surgical complications and recurrence factors for asymptomatic meningiomas: a single-center retrospective study. Acta Neurochir (Wien) 2022; 165:1345-1353. [PMID: 36394668 DOI: 10.1007/s00701-022-05420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Observation is the first management option in asymptomatic meningiomas, but when an enlargement or mass effect is observed, surgery is indicated. This study is aimed at exploring risk factors for complications and recurrence after surgery for asymptomatic meningioma. We also examined the impact of preoperative tumor embolization, which is considered controversial. METHODS We retrospectively reviewed 109 patients with primary asymptomatic meningiomas surgically treated at our institute between April 2007 and March 2021. Patients who only had headaches as a nonspecific complaint were included in the asymptomatic group. Complications, time to recurrence, and Glasgow Outcome Scale (GOS) score were the endpoints of the study. Risk factors for complications and recurrence were explored. Moreover, the effect of the resection on nonspecific headaches was also explored. RESULTS The permanent postoperative complication rate related to the surgical procedure was 1.8%. Of the total, 107 patients (98.2%) with asymptomatic meningiomas who were surgically treated achieved a GOS score of 5 1 year after the operation. Preoperative headache was present in 31 patients and improved postoperatively in 21 patients. Multivariate analysis using the Cox proportional hazard model showed that preoperative tumor embolization with > 80% resolution of tumor staining (p < 0.001) was negatively related to recurrence, whereas age (p = 0.046) and Simpson grade IV resection (p = 0.041) were positively related to recurrence. CONCLUSION Although surgery for asymptomatic meningiomas can, in many cases, be safe, it is not free of complications Thus, surgical intervention for asymptomatic meningiomas should be considered cautiously. However, more than half the patients with headaches showed improvement. Simpson grade IV resection cases should be assessed for recurrence, and preoperative tumor embolization might be effective in controlling recurrence.
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Oyoshi H, Hirata H, Hirano Y, Zenda S, Fujisawa T, Nakamura M, Hojo H, Motegi A, Kageyama S, Akimoto T. Prognosis after Whole-Brain Radiotherapy for Leptomeningeal Metastasis in Patients with Lung Adenocarcinoma with or without EGFR/ALK Alterations. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.806] [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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19
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Inada M, Nishimura Y, Ishikura S, Ishikawa K, Murakami N, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Minemura T, Shimizu H, Hiraoka M. The Organs-at-Risk Dose Constraints in Head and Neck Intensity Modulated Radiation Therapy Using Data from a Multi-Institutional Clinical Trial (JCOG1015A1). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1346] [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: 10/31/2022]
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20
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Miyake S, Nakai Y, Suenaga J, Akimoto T, Uemura K, Funakoshi K, Yamamoto T. Characteristic of Non–Sinus-Type Parasagittal Dural Arteriovenous Fistulas: Clinical and Cadaveric Experiences. Neurosurgery Open 2022. [DOI: 10.1227/neuopn.0000000000000019] [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: 11/05/2022] Open
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21
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Higashijima T, Akimoto T, Sakata K. Effect of Mahjong on children's intelligence quotient. Front Psychol 2022; 13:934453. [PMID: 36225701 PMCID: PMC9549265 DOI: 10.3389/fpsyg.2022.934453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigated the effect of Mahjong, which is a table game played by three or four players and involves intellectual activity, on the intelligence quotient (IQ) of children. The participants were children between the age of 6 and 15 years, and their IQ was assessed immediately after enrolling in children's Mahjong classes and 1 year after the enrollment using the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV). Twenty children were included in the analysis. Their mean age at the time of the initial evaluation was 9 years and 6 months. In addition, we conducted a 1-year post-examination. The change in the IQ of this group was compared to that of a historical control group with a similar age range and test–retest interval. The mean overall full-scale IQ of the 20 children during the initial and post-1-year examinations was 106.05 and 113.75, respectively, and showed a statistically significant increase (p < 0.01). Based on the subscale index, the verbal comprehension index (VCI) and processing speed index (PSI) scores both showed a statistically significant increase from 100.6 to 106.75 and from 108.05 to 119.05 (p < 0.01), respectively. The PSI of the children included in the analysis showed a statistically significant increase compared to the historical control group. This study suggests that children who participate in Mahjong classes during their childhood have increased PSI scores of WISC-IV.
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22
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Yazawa O, Ito Y, Akimoto T, Sato M, Matsumaru Y, Ishikawa E. Middle meningeal artery embolization for pediatric chronic subdural hematoma under anticoagulant therapy with ventricular assist device: a case report. Childs Nerv Syst 2022; 38:1397-1400. [PMID: 34816298 DOI: 10.1007/s00381-021-05418-y] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Recently, the efficacy of middle meningeal artery (MMA) embolization for chronic subdural hematoma (cSDH) in the elderly has been reported. However, no previous reports of MMA embolization for cSDH in children with ventricular assist devices (VAD) have been published. Here, we report a case of MMA embolization for cSDH in a child with VAD. CASE A 15-month-old female was diagnosed with dilated cardiomyopathy at 7 months old. Soon, a VAD was inserted, and anticoagulant and antiplatelet therapy was started. Bilateral cSDH was observed at 15 months, and, 2 months later, an acute exacerbation of the right cSDH necessitated intracerebral hemorrhage removal. Afterwards, increased intracranial pressure occurred due to a contralateral subdural hematoma but, 4 months after intracerebral hemorrhage removal, CT showed new hemorrhaging in the left cSDH. MMA embolization was then conducted to prevent rebleeding in the hematoma. Selective angiography of the left MMA demonstrated stains of hematoma capsules from the frontal and parietal branches, which were embolized using liquid embolic material. During the procedure, the material migrated into the intracranial vessels via an undetected transdural anastomosis. Postoperatively, no new neurological abnormalities, including hemiparesis, were observed. Two months later, CT showed a decrease in hematoma size. CONCLUSION MMA embolization for cSDH in pediatric patients with VAD may be effective, if vigilance is maintained against transdural anastomoses.
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Affiliation(s)
- Osamu Yazawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Taisuke Akimoto
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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23
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Akimoto T, Ito Y, Akutagawa K, Sato M, Hayakawa M, Marushima A, Takigawa T, Tsuruta W, Kato N, Suzuki K, Uemura K, Yamamoto T, Matsumaru Y. Perioperative and long-term complications following therapeutic internal carotid artery occlusion. Interv Neuroradiol 2022:15910199221095786. [PMID: 35450482 PMCID: PMC10399501 DOI: 10.1177/15910199221095786] [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] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Parent artery occlusion (PAO) is an effective treatment for hemorrhagic diseases associated with the internal carotid artery. There are several reports of long-term cerebral infarction or the formation of de novo cerebral aneurysms following PAO. MATERIALS AND METHODS We retrospectively reviewed these complications in 38 patients who underwent PAO for therapeutic treatment. We investigated perioperative cerebral infarctions, long-term cerebral infarctions, and de novo aneurysms. RESULTS The mean age of the patients was 64.0 years, and 25 patients (65.8%) were female. The causative diseases were unruptured (n = 19; 50.0%) and ruptured (n = 8; 21.1%) aneurysms. PAO was performed after ischemic tolerance was assessed with balloon test occlusion (BTO), and BTO was performed in 34 patients, of whom 25 (73.5%) had ischemic tolerance. Twenty-six patients (68.4%) were treated with PAO alone, eight (23.5%) with low-flow bypass, and six (17.6%) with high-flow bypass. Perioperative complications occurred in five patients (13.2%): two of the 26 patients (7.7%) who underwent scheduled treatment and three of the 12 patients (25.0%) who underwent emergency treatment. One patient (2.6%) had long-term de novo aneurysm, and none developed cerebral infarction. CONCLUSIONS These results showed that the assessment of ischemic tolerance by performing BTO and appropriate revascularization in scheduled treatments are important to reduce perioperative and long-term cerebral infarctions. PAO must be performed with greater caution in emergency treatment.
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Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Department of Neurosurgery, 26437Yokomhama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Kazuki Akutagawa
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Wataro Tsuruta
- Department of Neuroendovascular Therapy, 13600Toranomon Hospital, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center Hospital, Ibaraki, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, 26263Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, 26420Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, 13155Yokomhama City University, Yokohama, Kanagawa, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan.,Division of Stroke Prevention and Treatment, Faculty of Medicine, 13121University of Tsukuba, Ibaraki, Japan
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Akimoto T, Suenaga J, Hayashi T, Hirokawa D, Ito S, Sato H, Yamamoto T. Moyamoya Syndrome in a Patient with Williams Syndrome: A Case Report. Pediatr Neurosurg 2022; 57:365-370. [PMID: 35640559 DOI: 10.1159/000525229] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Moyamoya syndrome associated with Williams syndrome is very rare but has been reported to have severe outcomes. Here, we reported a case of Williams syndrome with moyamoya syndrome that was confirmed by the presence of an RNF213 mutation. CASE PRESENTATION A 6-year-old boy with Williams syndrome presented with right hemiparesis induced by hyperventilation. Magnetic resonance angiography and cerebral angiography showed severe stenosis of the bilateral internal carotid arteries and development of moyamoya vessels. Genetic analysis identified a heterozygous c.14576G>A (p.R4859K) mutation in RNF213. Moyamoya syndrome was diagnosed, and bilateral indirect revascularization surgery was conducted without complications and with a good postoperative course. In moyamoya syndrome associated with Williams syndrome, adequate perioperative management of both the moyamoya arteries and the cardiovascular abnormalities is important to prevent complications. CONCLUSION This was the first report on a case in which moyamoya syndrome associated with Williams syndrome was confirmed by the presence of a heterozygous RNF213 mutation. Similar to the workup of moyamoya disease, confirmation of RNF213 mutation in Williams syndrome may be useful in predicting the development of moyamoya syndrome that can lead to severe complications.
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Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Tomoko Hayashi
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Daisuke Hirokawa
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Susumu Ito
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hironobu Sato
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
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25
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Miyake S, Suzuki R, Akimoto T, Iida Y, Shimohigoshi W, Nakai Y, Manaka H, Shimizu N, Yamamoto T. Renal Dysfunction is the Strongest Prognostic Factor After Carotid Artery Stenting According to Real-World Data. J Stroke Cerebrovasc Dis 2021; 31:106269. [PMID: 34963079 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106269] [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: 10/03/2021] [Revised: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data. METHODS This retrospective multicenter cohort study aimed to identify the prognostic factors after CAS using real-world data from the stroke registry of Yokohama (STrOke Registry of Yokohama; STORY) from January 1, 2018 to May 31, 2021. Patient characteristics, procedural factors, complications, and prognoses were collected using medical records. RESULTS Data from 107 patients were enrolled in this study after excluding those with insufficient data (2 cases). The mean participant age was 74.9±8.2 years, and 66 patients (61.7%) were symptomatic. Symptomatic lesions were a significant prognostic factor in the overall analysis (p=0.003). A multivariate analysis showed that the estimated glomerular filtration rate (eGFR) (odds ratio: 1.11, p=0.003) and staged CAS (odds ratio: 38.9, p=0.04) were independent prognostic factors. The odds ratio and relative risk of mRS deterioration when eGFR was under 49 mL/min/1.73 m2 compared with when eGFR was above 49 mL/min/1.73 m2 were 5.2 and 3.74, respectively. CONCLUSIONS In this real-world multicenter study, we established independent prognostic factors for CAS using high totality data. For patients with symptomatic lesions and low eGFR (≤49 mL/min/1.73 m2), indication for treatment should be considered strictly.
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Affiliation(s)
- Shigeta Miyake
- Department of Neurosurgery, Yokohama Brain and Spine Center, 1-2-1, Takigashira, Isogo, Yokohama, Kanagawa, 2350012, Japan
| | - Ryosuke Suzuki
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 2360004, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 2320024, Japan.
| | - Yu Iida
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 2360004, Japan
| | - Wataru Shimohigoshi
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 2320024, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Yokohama Brain and Spine Center, 1-2-1, Takigashira, Isogo, Yokohama, Kanagawa, 2350012, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 2320024, Japan
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 2360004, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 2360004, Japan
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Fujisawa T, Motegi A, Zenda S, Hojo H, Nakamura M, Hirano Y, Hirata H, Vijay Parshuram R, Matsuura K, Shinozaki T, Hayashi R, Akimoto T. PO-1007 Radiotherapy with delayed accelerated hyperfractionated boost for node negative hypopharynx cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Miyake S, Higurashi T, Jono T, Akimoto T, Ogawa F, Oi Y, Tanaka K, Hara Y, Kobayashi N, Kato H, Yamashiro T, Utsunomiya D, Nakajima A, Yamamoto T, Maeda S, Kaneko T, Takeuchi I. Real-world evaluation of a computed tomography-first triage strategy for suspected Coronavirus disease 2019 in outpatients in Japan: An observational cohort study. Medicine (Baltimore) 2021; 100:e26161. [PMID: 34087874 PMCID: PMC8183760 DOI: 10.1097/md.0000000000026161] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.
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Affiliation(s)
- Shigeta Miyake
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Takuma Higurashi
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology and Hepatology
| | - Takashi Jono
- Team COVID-19, Yokohama City University Hospital
- Department of Neurology and Stroke Medicine
| | - Taisuke Akimoto
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Fumihiro Ogawa
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
| | - Yasufumi Oi
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
| | - Katsushi Tanaka
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Yu Hara
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Nobuaki Kobayashi
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Hideaki Kato
- Team COVID-19, Yokohama City University Hospital
- Infection Prevention and Control Department, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa
| | - Atsushi Nakajima
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology and Hepatology
| | - Tetsuya Yamamoto
- Team COVID-19, Yokohama City University Hospital
- Department of Neurosurgery
| | - Shin Maeda
- Team COVID-19, Yokohama City University Hospital
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Japan
| | - Takeshi Kaneko
- Team COVID-19, Yokohama City University Hospital
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama
| | - Ichiro Takeuchi
- Team COVID-19, Yokohama City University Hospital
- Department of Emergency Medicine
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Hino T, Sato M, Hayakawa M, Marushima A, Ito Y, Akimoto T, Okune S, Hiramine T, Shintoku R, Ishikawa E, Matsumaru Y. A Case of Acute Embolic Occlusion of the Common Carotid Artery in Which a Giant Thrombus Was Retrieved Using the Parallel Stent Retriever Technique. J Neuroendovasc Ther 2021; 16:87-92. [PMID: 37502646 PMCID: PMC10370964 DOI: 10.5797/jnet.cr.2020-0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/14/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of embolic occlusion of the common carotid artery (CCA) in which a giant thrombus was retrieved using the parallel stent retriever technique. Case Presentation An 84-year-old woman without anticoagulant therapy despite a history of cardioembolic stroke presented to our hospital because of left hemiparesis after developing sudden vision loss in her right eye. Emergency angiography revealed a giant thrombus in the right CCA. After arresting flow in the CCA using a balloon-guided catheter (BGC), we deployed two stent retrievers in parallel from the internal carotid artery to the CCA, and slowly retrieved them simultaneously under manual aspiration through the BGC. As a result, complete recanalization was achieved. Conclusion Thrombi causing acute embolic occlusion of the CCA are often too large to be completely retrieved using conventional thrombectomy techniques. The parallel stent retriever technique may be effective in such cases.
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Affiliation(s)
- Tenyu Hino
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Taisuke Akimoto
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sho Okune
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takato Hiramine
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Ryosuke Shintoku
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Miyake S, Suenaga J, Nakamura T, Akimoto T, Suzuki R, Ohtake M, Takase H, Tateishi K, Shimizu N, Murata H, Funakoshi K, Sawamura Y, Yamamoto T. Practical Arachnoid Anatomy for the Technical Consideration of Galen Complex Dissection: Cadaveric and Clinical Evaluation. World Neurosurg 2021; 151:e372-e378. [PMID: 33887497 DOI: 10.1016/j.wneu.2021.04.041] [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: 12/01/2020] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. METHODS The procedure is shown through an illustrative video of surgery and cadaver. Five cadavers were analyzed for their arachnoid structures and the surgical procedures via the OTA, in strict compliance with legal and ethical requirements. RESULTS All cadavers showed a 2-layered arachnoid structure-one belonging to the occipital lobe, and the other to the cerebellum. According to our cadaveric analysis, the arachnoid attachment of the tentorial apex can be peeled bluntly, with an average distance of 10.2 mm. For our clinical presentation, a pineal tumor with hydrocephalus was detected in a 14-year-old boy. While using the OTA and expanding the deep surgical field, we detached the membrane from the tentorial apex and bluntly peeled it to reveal the deep veins. Finally, gross total removal of the tumor was achieved. CONCLUSIONS A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.
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Affiliation(s)
- Shigeta Miyake
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan.
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Ryosuke Suzuki
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Makoto Ohtake
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Hajime Takase
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
| | - Kengo Funakoshi
- Department of Neuroanatomy, Yokohama City University, Yokohama, Japan
| | | | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University, Yokohama, Japan
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Tokumaru S, Ohnishi K, Harada H, Wada H, Nakamura N, Arimura T, Iwata H, Sato Y, Tamamura H, Ogino H, Ogino T, Akimoto T, Okimoto T, Kikuchi Y, Murayama S, Sakurai H. Clinical Outcomes of Proton Beam Therapy for Stage I Lung Cancer in Patients with Interstitial Pneumonia: A Multi-Institutional Retrospective Study in Japan. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Okumura M, Hojo H, Nakamura N, Zenda S, Motegi A, Nakamura M, Hirano Y, Kageyama S, Raturi V, Akimoto T. PO-1261: Radiation pneumonitis after palliative radiotherapy in patients with interstitial lung disease. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01279-2] [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: 10/22/2022]
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32
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Maebayashi T, Mizowaki T, Nakamura K, Nakamura K, Inaba K, Asakura H, Iwata H, Wada H, Itasaka S, Sakaguchi M, Jingu K, Akiba T, Tomita N, Imagumbai T, Shimamoto S, Yamazaki T, Yorozu A, Akimoto T. Outcomes Of Radiation Therapy For Clinically Node-Positive Prostate Cancer: Surveillance Study Of The Japanese Radiation Oncology Study Group (JROSG). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.563] [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: 11/26/2022]
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Kubo Y, Ito K, Sone M, Nagasawa H, Onishi Y, Umakoshi N, Hasegawa T, Akimoto T, Kusumoto M. Diagnostic Value of Model-Based Iterative Reconstruction Combined with a Metal Artifact Reduction Algorithm during CT of the Oral Cavity. AJNR Am J Neuroradiol 2020; 41:2132-2138. [PMID: 32972957 DOI: 10.3174/ajnr.a6767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Metal artifacts reduce the quality of CT images and increase the difficulty of interpretation. This study compared the ability of model-based iterative reconstruction and hybrid iterative reconstruction to improve CT image quality in patients with metallic dental artifacts when both techniques were combined with a metal artifact reduction algorithm. MATERIALS AND METHODS This retrospective clinical study included 40 patients (men, 31; women, 9; mean age, 62.9 ± 12.3 years) with oral and oropharyngeal cancer who had metallic dental fillings or implants and underwent contrast-enhanced ultra-high-resolution CT of the neck. Axial CT images were reconstructed using hybrid iterative reconstruction and model-based iterative reconstruction, and the metal artifact reduction algorithm was applied to all images. Finally, hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithm data were obtained. In the quantitative analysis, SDs were measured in ROIs over the apex of the tongue (metal artifacts) and nuchal muscle (no metal artifacts) and were used to calculate the metal artifact indexes. In a qualitative analysis, 3 radiologists blinded to the patients' conditions assessed the image-quality scores of metal artifact reduction and structural depictions. RESULTS Hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithms yielded significantly different metal artifact indexes of 82.2 and 73.6, respectively (95% CI, 2.6-14.7; P < .01). The latter algorithms resulted in significant reduction in metal artifacts and significantly improved structural depictions(P < .01). CONCLUSIONS Model-based iterative reconstruction + metal artifact reduction algorithms significantly reduced the artifacts and improved the image quality of structural depictions on neck CT images.
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Affiliation(s)
- Y Kubo
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan .,Department of Cancer Medicine (Y.K., T.A.), Jikei University Graduate School of Medicine, Tokyo, Japan
| | - K Ito
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - M Sone
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - H Nagasawa
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - Y Onishi
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - N Umakoshi
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - T Hasegawa
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - T Akimoto
- Department of Cancer Medicine (Y.K., T.A.), Jikei University Graduate School of Medicine, Tokyo, Japan.,Division of Radiation Oncology and Particle Therapy (T.A.), National Cancer Center Hospital East, Kashiwa, Japan
| | - M Kusumoto
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
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Yokota T, Ota Y, Fujii H, Kodaira T, Shimokawa M, Nakashima T, Monden N, Homma A, Ueda S, Akimoto T. 960P A real-world clinical outcomes and prognostic factors in Japanese patients with recurrent or metastatic squamous cell carcinoma of head and neck treated with chemotherapy plus cetuximab: A prospective observation study (JROSG12-2). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1075] [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: 10/23/2022] Open
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Kodaira T, Kagami Y, Shibata T, Shikama N, Nishimura Y, Ishikura S, Nakamura K, Saito Y, Matsumoto Y, Teshima T, Ito Y, Akimoto T, Nakata K, Toshiyasu T, Nakagawa K, Nagata Y, Nishimura T, Uno T, Kataoka M, Yorozu A, Hiraoka M. Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701). Ann Oncol 2019; 29:992-997. [PMID: 29401241 DOI: 10.1093/annonc/mdy036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background We assessed the non-inferiority of accelerated fractionation (AF) (2.4 Gy/fraction) compared with standard fractionation (SF) (2 Gy/fraction) regarding progression-free survival (PFS) in patients with T1-2N0M0 glottic cancer (GC). Patients and methods In this multi-institutional, randomized, phase III trial, patients were enrolled from 32 Japanese institutions. Key inclusion criteria were GC T1-2N0M0, age 20-80, Eastern Cooperative Oncology Group performance status of 0-1, and adequate organ function. Patients were randomly assigned to receive either SF of 66-70 Gy (33-35 fractions), or AF of 60-64.8 Gy (25-27 fractions). The primary end point was the proportion of 3-year PFS. The planned sample size was 360 with a non-inferiority margin of 5%. Results Between 2007 and 2013, 370 patients were randomized (184/186 to SF/AF). Three-year PFS was 79.9% (95% confidence interval [CI] 73.4-85.4) for SF and 81.7% (95% CI 75.4-87.0) for AF (difference 1.8%, 91% CI-5.1% to 8.8%; one-sided P = 0.047 > 0.045). The cumulative incidences of local failure at 3 years for SF/AF were 15.9%/10.3%. No significant difference was observed in 3-year overall survival (OS) between SF and AF. Grade 3 or 4 acute and late toxicities developed in 22 (12.4%)/21 (11.5%) and 2 (1.1%)/1 (0.5%) in the SF/AF arms. Conclusion Although the non-inferiority of AF was not confirmed statistically, the similar efficacy and toxicity of AF compared with SF, as well as the practical convenience of its fewer treatment sessions, suggest the potential of AF as a treatment option for early GC. Clinical trials registration UMIN Clinical Trial Registry, number UMIN000000819.
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Affiliation(s)
- T Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Y Kagami
- Department of Radiation Oncology, Showa University, Tokyo, Japan
| | - T Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - N Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Y Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - K Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Y Saito
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Y Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - T Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Y Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - K Nakata
- Department of Radiology, Sapporo Medical University, Sapporo, Japan
| | - T Toshiyasu
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - K Nakagawa
- Department of Radiology, Tokyo University, Tokyo, Japan
| | - Y Nagata
- Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan
| | - T Nishimura
- Department of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - T Uno
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - M Kataoka
- Department of Radiation Oncology, Shikoku Cancer Center, Matsuyama, Japan
| | - A Yorozu
- Department of Radiology, Tokyo Medical Center, Tokyo, Japan
| | - M Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto, Japan
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Nakamura N, Zenda S, Motegi A, Arahira S, Hayashi R, Tahara M, Oyoshi H, Ariji T, Hojo H, Nakamura M, Parshuram R, Okumura M, Akimoto T. The Interval between Initial Surgery and Regional Recurrence May be a Predictive Factor of Local Recurrence in Patients with Oral Cavity Cancer Who Receive Postoperative Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1598] [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: 11/26/2022]
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Nozaki M, Kagami Y, Takahashi M, Machida R, Shibata T, Ito Y, Nishimura Y, Kawaguchi Y, Saito Y, Nagata Y, Matsumoto Y, Akimoto T, Hoiraoka M. EP-1276 A Comparison of Breast Cosmetic Evaluation Methods in Hypofractionated Whole Breast Irradiation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31696-2] [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: 10/26/2022]
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39
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Kawaguchi Y, Nozaki M, Kagami Y, Shibata T, Nakamura K, Ito Y, Nishimura Y, Saito Y, Nagata Y, Matsumo Y, Akimoto T, Nishimura T, Uno T, Tsujino K, Kataoka M, Kodaira T, Shiraishi K, Inoue K, Isohashi F, Hiraoka M. A Multicenter Single-Arm Confirmatory Trial on Hypofractionated Whole-breast Irradiation after Breast-Conserving Surgery. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1618] [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: 11/25/2022]
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Nishimura Y, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Ishikawa K, Shimizu H, Minemura T, Ishikura S, Shibata T, Nakamura K, Shibata T, Hiraoka M. A Phase II Study of Two-Step Intensity Modulated Radiation Therapy (IMRT) with Chemotherapy for Loco-Regionally Advanced Nasopharyngeal Cancer (NPC) (JCOG1015). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.314] [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: 10/28/2022]
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Akimoto T, Umemura M, Nagasako A, Ohtake M, Fujita T, Yokoyama U, Eguchi H, Yamamoto T, Ishikawa Y. Alternating magnetic field enhances cytotoxicity of Compound C. Cancer Sci 2018; 109:3483-3493. [PMID: 30155931 PMCID: PMC6215876 DOI: 10.1111/cas.13781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 12/22/2022] Open
Abstract
We previously reported the efficacy of anti-cancer therapy with hyperthermia using an alternating magnetic field (AMF) and a magnetic compound. In the course of the study, unexpectedly, we found that an AMF enhances the cytotoxicity of Compound C, an activated protein kinase (AMPK) inhibitor, although this compound is not magnetic. Therefore, we examined the cellular mechanism of AMF-induced cytotoxicity of Compound C in cultured human glioblastoma (GB) cells. An AMF (280 kHz, 250 Arms) for 30 minutes significantly enhanced the cytotoxicity of Compound C and promoted apoptosis towards several human GB cell lines in vitro. The AMF also increased Compound C-induced cell-cycle arrest of GB cells at the G2 phase and, thus, inhibited cell proliferation. The AMF increased Compound C-induced reactive oxygen species production. Furthermore, the AMF decreased ERK phosphorylation in the presence of Compound C and suppressed the protective autophagy induced by this compound. The application of an AMF in cancer chemotherapy may be a simple and promising method, which might reduce the doses of drugs used in future cancer treatment and, therefore, the associated side effects.
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Affiliation(s)
- Taisuke Akimoto
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masanari Umemura
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Akane Nagasako
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Makoto Ohtake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takayuki Fujita
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Utako Yokoyama
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Haruki Eguchi
- Research Laboratory, Corporate Research & Development, IHI Corporation, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Imamura Y, Kiyota N, Akimoto T, Ogawa G, Eba J, Minami S, Hasegawa Y, Iwae S, Monden N, Matsuura K, Fujii H, Onozawa Y, Homma A, Hayashi R, Tahara M. Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: A supplementary analysis of a phase II trial (JCOG0706S1). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.068] [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: 11/14/2022] Open
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Sugi H, Akimoto T, Chaen S. WITHDRAWN: Basic Properties of ATP-Induced Myosin Head Movement in Hydrated Myosin Filaments, Studied Using the Gas Environmental Chamber. Micron 2018; 113:48-60. [PMID: 30008439 DOI: 10.1016/j.micron.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Affiliation(s)
- H Sugi
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan.
| | - T Akimoto
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan
| | - S Chaen
- Department of Integrated Sciences in Physics and Biology, College of Humanities and Sciences, Nihon University, Tokyo, Japan
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Sugi H, Akimoto T, Chaen S. Basic properties of ATP-induced myosin head movement in hydrated myosin filaments, studied using the gas environmental chamber. Micron 2018; 112:15-25. [PMID: 29902615 DOI: 10.1016/j.micron.2018.06.003] [Citation(s) in RCA: 2] [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: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
Although more than 50 years have passed since the monumental discovery of Huxley and Hanson that muscle contraction results from relative sliding between actin and myosin filaments, coupled with ATP hydrolysis, the mechanism underlying the filament sliding still remains to be a mystery. It is generally believed that the myofilament sliding is caused by cyclic attachment-detachment between myosin heads in myosin filaments and myosin-binding sites in actin filaments. Attempts to prove the myosin head movement using techniques of X-ray diffraction and chemical probes attached to myosin heads have failed to obtain clear results because of the asynchronous nature of myosin head movement. Using the gas environmental chamber (EC) attached to an electron microscope, we succeeded in recording myosin head movement in hydrated myosin filaments, coupled with ATP hydrolysis with the following results: (1)In the absence of actin filaments, myosin heads fluctuate around a definite neutral position, so that their time-averaged position remains unchanged; (2) On ATP application, myosin heads bind with ATP to be in the charged-up state, M-ADP-Pi, and perform a recovery stroke in the direction away from the myosin filament central bare zone and stay in the post-recovery stroke position; (3) In the actin-myosin filament mixture, myosin heads form rigor linkages with actin, and bind with applied ATP to be in the charged-up state, M-ADP-Pi, and perform a power stroke in the direction towards the myosin filament bare zone, while releasing ADP and Pi to stay in the post-power stroke position; (4) In both recovery and power strokes, myosin heads in the non charged-up state return to the neutral position. These results indicate that the charged-up myosin heads decide their direction of movement without being guided by actin filaments.
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Affiliation(s)
- H Sugi
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan.
| | - T Akimoto
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan
| | - S Chaen
- Department of Integrated Sciences in Physics and Biology, College of Humanities and Sciences, Nihon University, Tokyo, Japan
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Nakamura M, Onozawa M, Motegi A, Hojo H, Zenda S, Nakamura N, Udagawa H, Kirita K, Matsumoto S, Umemura S, Yoh K, Niho S, Goto K, Akimoto T. P3.14-001 Impact of PCI on Prognosis of LD-SCLC Through Pattern of Brain Metastases as a First Recurrence Site. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ono A, Takahashi T, Niho S, Yoshida T, Akimoto T, Sakamaki K, Seto T, Nishio M, Yamamoto N, Hida T, Okamoto H, Kurata T, Satouchi M, Goto K, Yamanaka T, Ohe Y. MA 17.06 Safety Data from Randomized Phase II Study of CDDP+S-1 vs CDDP+PEM Combined with TRT for Locally Advanced Non-Squamous NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.613] [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: 11/27/2022]
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Ohnishi K, Harada H, Nakamura N, Tokumaru S, Wada H, Arimura T, Iwata H, Sato Y, Sekino Y, Tamamura H, Mizoe J, Ogino T, Ishikawa H, Kikuchi Y, Okimoto T, Murayama S, Akimoto T, Sakurai H. P2.05-005 Proton Beam Therapy for Early Stage Lung Cancer: A Multi-Institutional Retrospective Study in Japan. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.11.032] [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: 11/27/2022]
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Okuda T, Maruyama M, Akimoto T, Ohno Y, Haseba T. S21-3THE ROLE OF CLASS III ALCOHOL DEHYDROGENASE (ADH3) IN ALCOHOL-RELATED DISORDER ON LIVER AND BONE. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx075.81] [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: 11/14/2022] Open
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49
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Nakamura N, Kawamori J, Takahashi O, Shikama N, Sekiguchi K, Takahashi T, Kato S, Ogita M, Haga C, Ito R, Nishimura K, Yamano T, Yoshida K, Motegi A, Akimoto T. Palliative Radiation Therapy for Breast Cancer With Skin Invasion: A Multi-institutional Prospective Observational Study. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1858] [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: 11/24/2022]
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50
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Ishibashi N, Soejima T, Kawaguchi H, Oguchi M, Sasai K, Hasegawa M, Isobe K, Ejima Y, Ito H, Imai M, Kasuya T, Shimoda E, Akimoto T. National Survey of Japan for Myeloablative Total Body Irradiation Prior to Hematopoietic Stem Cell Transplantation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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