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Ogawa A, Kawamoto H, Hara J, Kikuta A, Ogawa C, Hiraga H, Yoshimura K, Miyairi K, Omori R, Ro T, Kamei Y, Kimura T. Phase 2 study of glucarpidase in patients with delayed methotrexate elimination after high-dose methotrexate therapy. Cancer Chemother Pharmacol 2024:10.1007/s00280-024-04664-6. [PMID: 38478074 DOI: 10.1007/s00280-024-04664-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE High-dose methotrexate therapy (HD-MTX) is a standard treatment for various malignant tumors, but approximately 1-10% of patients experience delayed MTX elimination (DME) that can induce organ damage. Glucarpidase can hydrolyze MTX and thereby lower the level of active MTX in the blood. A multicenter, open-label, phase II investigator-initiated trial (CPG2-PII study) was conducted to evaluate glucarpidase rescue therapy in Japanese patients who showed DME after HD-MTX treatment. To confirm the robustness of this therapy, further corporate-sponsored clinical trial (OP-07-001 study) was conducted. METHODS The primary endpoint in the CPG2-PII study was to evaluate the proportion of patients of the percentage clinical important reduction (CIR) as an indicator of MTX concentration, which can be managed with leucovorin and supportive care. The primary endpoint of the OP-07-001 study was to evaluate the decreasing rate of plasma MTX concentration at 20 min after glucarpidase administration from the baseline for four patients. Glucarpidase was administered at a dose of 50 U/kg for 15 and 4 patients, respectively in the two studies, and safety was analyzed for each of them. RESULTS The rate of CIR was 76.9% (95% confidence interval, 46.2-95.0%) in the CPG2-PII study. The median reduction rate of plasma MTX was 98.83% in the OP-07-001 study. Hypersensitivity, blood bilirubin increased, and headache for each patient were the only study drug-related events. CONCLUSION Glucarpidase showed an effect of reducing plasma MTX concentration in Japanese patients with DME as that observed in a previous US study, confirming its favorable safety and tolerability.
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Affiliation(s)
- Atsushi Ogawa
- Department of Pediatrics, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho Chuo-ku, Niigata, 951-8566, Japan.
| | - Hiroshi Kawamoto
- Department of Pediatric and Allergy, Fujimi Clinic, Tokyo, Japan
| | - Junichi Hara
- Department of Pediatrics Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Hiraga
- Department of Musculoskeletal Oncology, NHO Hokkaido Cancer Center, Sapporo, Japan
| | - Kenichi Yoshimura
- Department of Biostatistics and Data Science, Graduate School of Medical Science Nagoya City University, Nagoya, Japan
| | | | - Reiko Omori
- Ohara Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Tokihiro Ro
- Ohara Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yuna Kamei
- Ohara Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
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2
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Iwakawa S, Azechi T, Saigo O, Imai R, Nakai A, Koshiba S, Saito U, Asakura K, Sato K, Kimura T. Vaccination status, incidence of adverse events, and awareness of COVID-19 vaccine among outpatients undergoing chemotherapy. J Pharm Health Care Sci 2024; 10:15. [PMID: 38439102 PMCID: PMC10913650 DOI: 10.1186/s40780-024-00338-w] [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: 12/07/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Cancer has been identified as a risk factor for severe illness and mortality in coronavirus disease (COVID-19), underscoring the importance of recommending COVID-19 vaccinations to patients with cancer. However, few reports have focused on the vaccination status and the incidence of adverse events among patients with cancer. In this study, we aimed to evaluate the vaccination status, incidence of adverse events, concerns, and anxiety related to COVID-19 vaccination among patients with cancer. In addition, we explored the utilization of information sources by these patients and the ease of use. METHODS A survey was conducted among outpatients undergoing chemotherapy who received medication counseling from a pharmacist at Juntendo University Hospital. Responses were gathered from 60 out of the 143 participants. Of the respondents, 96.7% had received two doses of the COVID-19 vaccine. RESULTS Common adverse events included pain at the injection site, fever, and fatigue, which were experienced by nearly half of the respondents. Approximately 80% expressed some concern regarding vaccination, with predominant concerns about timing in the context of ongoing cancer treatment and surgery. Among the respondents, 41.7% consulted primary care physicians regarding the vaccine, with only one mentioning consultation with hospital pharmacists. Notably, primary care physicians were considered the most approachable and useful healthcare professionals. CONCLUSIONS These results suggest that patients with cancer can safely receive the vaccine, comparable to patients without cancer. However, they still harbor concerns, even when seeking advice from primary care physicians. Few patients consulted pharmacists about vaccination, highlighting an opportunity for pharmacist intervention. Pharmacists fostering trust with patients with cancer is imperative to explore pharmacist intervention methods to promote the continued administration of COVID-19 vaccines and enhance the quality of life for them.
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Affiliation(s)
- Satoshi Iwakawa
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takuya Azechi
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Orie Saigo
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryunosuke Imai
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ayumi Nakai
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shoji Koshiba
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Uki Saito
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kota Asakura
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kuniyoshi Sato
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan
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Maruyama T, Kimura T, Ebihara F, Kasai H, Matsunaga N, Hamada Y. Comparison of the predictive accuracy of the physiologically based pharmacokinetic (PBPK) model and population pharmacokinetic (PPK) model of vancomycin in Japanese patients with MRSA infection. J Infect Chemother 2023; 29:1152-1159. [PMID: 37673298 DOI: 10.1016/j.jiac.2023.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION The latest therapeutic drug monitoring guidelines for vancomycin (VCM) recommend that area under the concentration-time curve is estimated based on model-informed precision dosing and used to evaluate efficacy and safety. Therefore, we predicted VCM concentrations in individual methicillin-resistant Staphylococcus aureus-infected patients using existing a physiologically based pharmacokinetic (PBPK) model and 1- and 2-compartment population pharmacokinetic (PPK) models and confirmed and verified the accuracy of the PBPK model in estimating VCM concentrations with the PPK model. METHODS The subjects of the study are 20 patients, and the predicted concentrations were evaluated by comparing the observed and predicted trough and peak values of VCM concentrations for individual patients. RESULTS The results showed good correlation between the observed and predicted trough and peak concentrations of VCM was observed generally in the PBPK model, R2 values of 0.72, 0.62, and 0.40 with trough values of 0.49, 0.40, and 0.34 with peak values for PBPK model, 1-compartment, and 2-compartment model, respectively. CONCLUSIONS Although the performance of the PBPK model is not as predictive as the PPK model, generally similar predictive trends were obtained, suggesting that it may be a valuable tool for rapid and accurate prediction of AUC for VCM.
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Affiliation(s)
- Takumi Maruyama
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Fumiya Ebihara
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hidefumi Kasai
- Laboratory of Pharmacometrics and Systems Pharmacology Keio Frontier Research and Education Collaboration Square (K-FRECS) at Tonomachi, Keio University Kawasaki, Kanagawa, 210-0821, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Hanai Y, Ueda T, Hamada Y, Oda K, Takahashi Y, Nakajima K, Miyazaki Y, Kiriyama M, Uekusa S, Matsuo K, Matsumoto K, Kimura T, Takesue Y. Optimal timing for therapeutic drug monitoring of voriconazole to prevent adverse effects in Japanese patients. Mycoses 2023; 66:1035-1044. [PMID: 37584173 DOI: 10.1111/myc.13639] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The optimal timing for therapeutic drug monitoring (TDM) of voriconazole in Asians, who have higher rates of poor metabolisers than non-Asians, is unclear. This can cause unexpectedly high concentrations and delays in reaching steady-state levels. OBJECTIVES To determine the appropriate timing of TDM in Japanese patients receiving voriconazole. PATIENTS/METHODS Trough levels (Cmin ) were measured on days 3-5 (recommended timing, RT) and days 6-14 (delayed timing, DT) after starting voriconazole in patients receiving an appropriate dosage. Considering bioavailability, Cmin was only compared in patients receiving oral voriconazole. RESULTS A total of 289 and 186 patients were included in the safety and pharmacokinetic analyses, respectively. There was a significant difference in Cmin measured no later than and after day 5 (3.59 ± 2.12 [RT] vs. 4.77 ± 3.88 μg/mL [DT], p = .023), whereas no significant difference was observed on cutoff day 6 (3.91 ± 2.60 vs. 4.40 ± 3.94 μg/mL, p = .465), suggesting that Cmin close to the steady-state was achieved after day 5. DT causes a delay in achieving the therapeutic range. The hepatotoxicity rates were 21.5% and 36.8% in the RT and DT groups, respectively (p = .004); DT was an independent risk factor for hepatotoxicity. CONCLUSION Although steady-state concentrations may not be achieved by day 5, early dose optimisation using RT can prevent hepatotoxicity in Japanese patients. TDM should be performed on days 3-5 to ensure safety. However, subsequent TDM may be necessary due to a possible further increase in Cmin .
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Affiliation(s)
- Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mone Kiriyama
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
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Oda K, Yamada T, Matsumoto K, Hanai Y, Ueda T, Samura M, Shigemi A, Jono H, Saito H, Kimura T. Model-informed precision dosing of vancomycin for rapid achievement of target area under the concentration-time curve: A simulation study. Clin Transl Sci 2023; 16:2265-2275. [PMID: 37718491 PMCID: PMC10651648 DOI: 10.1111/cts.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
In this study, we aimed to evaluate limited sampling strategies for achieving the therapeutic ranges of the area under the concentration-time curve (AUC) of vancomycin on the first and second day (AUC0-24 , AUC24-48 , respectively) of therapy. A virtual population of 1000 individuals was created using a population pharmacokinetic (PopPK) model, which was validated and incorporated into our model-informed precision dosing tool. The results were evaluated using six additional PopPK models selected based on a study design of prospective or retrospective data collection with sufficient concentrations. Bayesian forecasting was performed to evaluate the probability of achieving the therapeutic range of AUC, defined as a ratio of estimated/reference AUC within 0.8-1.2. The Bayesian posterior probability of achieving the AUC24-48 range increased from 51.3% (a priori probability) to 77.5% after using two-point sampling at the trough and peak on the first day. Sampling on the first day also yielded a higher Bayesian posterior probability (86.1%) of achieving the AUC0-24 range compared to the a priori probability of 60.1%. The Bayesian posterior probability of achieving the AUC at steady-state (AUCSS ) range by sampling on the first or second day decreased with decreased kidney function. We demonstrated that second-day trough and peak sampling provided accurate AUC24-48 , and first-day sampling may assist in rapidly achieving therapeutic AUC24-48 , although the AUCSS should be re-estimated in patients with reduced kidney function owing to its unreliable predictive performance.
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Affiliation(s)
- Kazutaka Oda
- Department of PharmacyKumamoto University HospitalKumamotoJapan
- Department of Infection ControlKumamoto University HospitalKumamotoJapan
| | - Tomoyuki Yamada
- Department of PharmacyOsaka Medical and Pharmaceutical University HospitalOsakaJapan
| | - Kazuaki Matsumoto
- Division of PharmacodynamicsKeio University Faculty of PharmacyTokyoJapan
| | - Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical SciencesToho UniversityChibaJapan
| | - Takashi Ueda
- Department of Infection Control and PreventionHyogo College of MedicineNishinomiyaHyogoJapan
| | - Masaru Samura
- Department of PharmacyYokohama General HospitalYokohamaKanagawaJapan
| | - Akari Shigemi
- Department of PharmacyKagoshima University HospitalKagoshima CityKagoshimaJapan
| | - Hirofumi Jono
- Department of PharmacyKumamoto University HospitalKumamotoJapan
| | - Hideyuki Saito
- Department of PharmacyKumamoto University HospitalKumamotoJapan
| | - Toshimi Kimura
- Department of PharmacyJuntendo University HospitalTokyoJapan
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6
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Doi Y, Nagata Y, Matsumo Y, Numata K, Sasaki R, Yamada T, Igaki H, Imagumbai T, Katoh N, Yoshitake T, Shimizuguchi T, Fujioka D, Inoue M, Koide Y, Kimura T, Ito Y. Multicenter Retrospective Study of Stereotactic Body Radiotherapy for Patients with Previously Untreated Initial Small Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e293. [PMID: 37785079 DOI: 10.1016/j.ijrobp.2023.06.1290] [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) The effectiveness of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) has been shown in many studies and its therapeutic effect is similar to radiofrequency ablation (RFA). However, many of these studies were done in combination with transcatheter chemoembolization (TACE), for recurrent HCC, or on a small scale. To better understand the specific outcomes of SBRT for HCC, we conducted a multicenter retrospective analysis of SBRT for previously untreated initial HCC at Japanese Society of Clinical Oncology (JCOG) member hospitals. MATERIALS/METHODS Patientswho underwent SBRT for HCC at JCOG member hospitals between July 2013 and December 2017 and met the following eligibility criteria were included: (1) initial HCC; (2) ≤ 3 nodules, ≤ 5 cm in diameter; (3) a Child-Pugh (CP) score of A or B; and (4) unsuitability for or refusal of standard treatment, such as surgery, transplantation, RFA and TACE. We evaluated the overall survival (OS), recurrence-free survival (RFS) which was defined as the first instance of intra-hepatic recurrence after SBRT, disease-specific survival (DSS) using Kaplan-Meier analysis. Using Grey's test, patients who died of other diseases were analyzed as competing risks to estimate the cumulative incidence of local recurrence (CLR). Adverse events directly related to SBRT also analyzed using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). RESULTS Seventy-three patients with 79 lesions from 14 hospitals were analyzed. The median age was 77 years (range; 50-89 years), and the median tumor size was 23 mm (range; 6-50 mm). The median radiation dose was 40 Gy (range; 35-60 Gy) in five fractions (range; 4-8). The median follow-up period was 45 months (range; 0-103 months). There were three cases where follow-up was not possible due to unexpected events unrelated to SBRT, while the remaining 70 patients were successfully followed for at least six months. The 2 and 3year OS, RFS, DSS, and CLR rates were 84.3% (95% CI: 75.8-92.8%) and 69.9% (95% CI: 58.7-81%), 67.5% (95% CI: 56.0-79.0%) and 57.9% (95% CI: 45.2-70.5%), 95.1% (95% CI:89.7-100%)/87.6% (95% CI:78.8-96.3%), and 11.4% (95% CI: 5.3-20.0%) and 20.0% (95% CI: 11.2-30.5%), respectively. Four cases (5.5%) of adverse events of grade 3 or higher were reported: one case of grade 3 laboratory toxicities, one case of grade 3 liver failure, one case of grade 3 portal tumor thrombosis, and one case of grade 4 duodenal ulcer. No grade 5 toxicities were observed. CONCLUSION The results of our study demonstrate that SBRT for HCC is highly effective in achieving local control and is safe to administer. In addition, survival outcomes are favorable. SBRT is a promising treatment modality, especially for small HCCs for that is not suitable for standard treatment.
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Affiliation(s)
- Y Doi
- Department of Radiation Oncology, Hiroshima High-precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Y Nagata
- Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan
| | - Y Matsumo
- Department of Radiation oncology, Niigata cancer center hospital, Niigata, Japan
| | - K Numata
- Department of Gastroenterology, Yokohama City University Medical Center, Yokohama, Japan
| | - R Sasaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Yamada
- University of Yamanashi, Chuo, Japan
| | - H Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - T Imagumbai
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - T Yoshitake
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Shimizuguchi
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - D Fujioka
- Department of Radiation Oncology, Tsukuba University Hospital, Ibaraki, Japan
| | - M Inoue
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Koide
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - T Kimura
- Department of Radiation Oncology, Kochi University Hospital, Kochi, Japan
| | - Y Ito
- Department of Radiation Oncology, Showa University Hospital, Tokyo, Japan
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Kubota S, Sasano H, Suzuki M, Fukui Y, Chonan M, Kawakami T, Tabe Y, Miida T, Kimura T, Naito T. Impact of the COVID-19 Pandemic on Initiation of Antibiotic Treatment After Performing a Blood Culture and Intervention by the Antimicrobial Stewardship Team. Int J Gen Med 2023; 16:3713-3719. [PMID: 37641628 PMCID: PMC10460591 DOI: 10.2147/ijgm.s418558] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose Whether the coronavirus disease 2019 (COVID-19) pandemic had any effect on the time between blood culture collection and administration of antibiotics in the outpatient Department of Emergency Medicine in a single university hospital in Japan was investigated, and the intervention carried out by the antimicrobial stewardship team (AST) to promote the appropriate use of antibiotics was examined. Patients and Methods The monthly percentage of patients who visited the outpatient Department of Emergency Medicine between January 2019 and December 2021 and received an intravenous antibiotic within 3 hours of blood culture collection was calculated. The AST calculated a quality indicator (QI) based on the results of the investigation and started QI monitoring and hospital feedback. Results From January 2020 to March 2021 (the third COVID-19 wave), the implementation rate of antibiotic administration within 3 hours after blood culture collection decreased as the COVID-19 pandemic spread, and the implementation rate tended to increase as the number of COVID-19-positive patients decreased. However, when the AST started monitoring and feedback from April 2021, although there was a temporary decline in the early stages of the fifth wave when the scale of infection was large, the implementation rate rose and was maintained by AST intervention. (the fourth and the fifth COVID-19 waves) (P<0.01). Also, the implementation rate was significantly lower during the COVID-19 pandemic than during the non- pandemic (P<0.05). Conclusion The early COVID-19 pandemic may have affected the delay in time from blood culture collection to antibiotic administration. Later, in recurring COVID-19 pandemics, AST intervention eliminated this problem. When a bacterial infection such as sepsis is suspected, delayed treatment can be prevented by promptly collecting a blood culture, irrespective of concerns about COVID-19 infection. Calculating the QI may promote AST activities and the appropriate use of antibiotics.
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Affiliation(s)
- Sanae Kubota
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Sasano
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mai Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yukiko Fukui
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayoshi Chonan
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Takaaki Kawakami
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Yoko Tabe
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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8
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Chan YKS, Affendi YA, Ang PO, Baria-Rodriguez MV, Chen CA, Chui APY, Giyanto, Glue M, Huang H, Kuo CY, Kim SW, Lam VYY, Lane DJW, Lian JS, Lin SMNN, Lunn Z, Nañola CL, Nguyen VL, Park HS, Suharsono, Sutthacheep M, Vo ST, Vibol O, Waheed Z, Yamano H, Yeemin T, Yong E, Kimura T, Tun K, Chou LM, Huang D. Decadal stability in coral cover could mask hidden changes on reefs in the East Asian Seas. Commun Biol 2023; 6:630. [PMID: 37301948 PMCID: PMC10257672 DOI: 10.1038/s42003-023-05000-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Coral reefs in the Central Indo-Pacific region comprise some of the most diverse and yet threatened marine habitats. While reef monitoring has grown throughout the region in recent years, studies of coral reef benthic cover remain limited in spatial and temporal scales. Here, we analysed 24,365 reef surveys performed over 37 years at 1972 sites throughout East Asia by the Global Coral Reef Monitoring Network using Bayesian approaches. Our results show that overall coral cover at surveyed reefs has not declined as suggested in previous studies and compared to reef regions like the Caribbean. Concurrently, macroalgal cover has not increased, with no indications of phase shifts from coral to macroalgal dominance on reefs. Yet, models incorporating socio-economic and environmental variables reveal negative associations of coral cover with coastal urbanisation and sea surface temperature. The diversity of reef assemblages may have mitigated cover declines thus far, but climate change could threaten reef resilience. We recommend prioritisation of regionally coordinated, locally collaborative long-term studies for better contextualisation of monitoring data and analyses, which are essential for achieving reef conservation goals.
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Affiliation(s)
- Y K S Chan
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore.
| | - Y A Affendi
- Institute of Ocean and Earth Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - P O Ang
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - M V Baria-Rodriguez
- Marine Science Institute, University of the Philippines Diliman, Quezon, Philippines
| | - C A Chen
- Biodiversity Research Centre, Academia Sinica, Taipei, Taiwan
| | - A P Y Chui
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Giyanto
- Research Center for Oceanography, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - M Glue
- Fauna & Flora International, Phnom Penh, Cambodia
| | - H Huang
- South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - C-Y Kuo
- Biodiversity Research Centre, Academia Sinica, Taipei, Taiwan
| | - S W Kim
- School of Biological Sciences, The University of Queensland, Brisbane, Australia
| | - V Y Y Lam
- Global Coral Reef Monitoring Network, International Union for the Conservation of Nature, Washington D.C., USA
- Marine Spatial Ecology Lab, School of Biological Sciences, The University of Queensland, Brisbane, Australia
| | - D J W Lane
- Lee Kong Chian Natural History Museum, National University of Singapore, Singapore, Singapore
- Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - J S Lian
- South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - S M N N Lin
- Fauna & Flora International, Yangon, Myanmar
| | - Z Lunn
- Fauna & Flora International, Yangon, Myanmar
| | - C L Nañola
- University of the Philippines Mindanao, Davao, Philippines
| | - V L Nguyen
- Institute of Oceanography, Vietnam Academy of Science and Technology, Nha Trang, Vietnam
| | - H S Park
- Korean Institute of Ocean Science and Technology, Seoul, South Korea
| | - Suharsono
- Research Center for Oceanography, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
| | - M Sutthacheep
- Department of Biological Sciences, Ramkhamhaeng University, Bangkok, Thailand
| | - S T Vo
- Institute of Oceanography, Vietnam Academy of Science and Technology, Nha Trang, Vietnam
| | - O Vibol
- Department of Fisheries Conservation, Ministry of Agriculture, Phnom Penh, Cambodia
| | - Z Waheed
- Borneo Marine Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - H Yamano
- National Institute for Environmental Studies, Tsukaba, Japan
| | - T Yeemin
- Faculty of Science, Ramkhamhaeng University, Bangkok, Thailand
| | - E Yong
- Reef Check Brunei, Bandar Seri Begawan, Brunei Darussalam
| | - T Kimura
- Global Coral Reef Monitoring Network East Asia Region, Tokyo, Japan
- Palau International Coral Reef Center, Koror, Palau
| | - K Tun
- Global Coral Reef Monitoring Network East Asia Region, Tokyo, Japan
- National Biodiversity Centre, National Parks Board, Singapore, Singapore
| | - L M Chou
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
- Tropical Marine Science Institute, National University of Singapore, Singapore, Singapore
| | - D Huang
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
- Lee Kong Chian Natural History Museum, National University of Singapore, Singapore, Singapore
- Tropical Marine Science Institute, National University of Singapore, Singapore, Singapore
- Centre for Nature-based Climate Solutions, National University of Singapore, Singapore, Singapore
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9
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Kimura T, Fukaya Y, Hamada Y, Yoshimura K, Kawamoto H. Pharmacokinetics and Pharmacodynamics of Glucarpidase Rescue Treatment After High-dose Methotrexate Therapy Based on Modeling and Simulation. Anticancer Res 2023; 43:1919-1924. [PMID: 37097666 DOI: 10.21873/anticanres.16351] [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: 02/27/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Model-informed approaches are important in drug development, including for dose optimization and the collection of evidence in support of efficacy. MATERIALS AND METHODS We developed a modified Michaelis-Menten pharmacokinetics/pharmacodynamics model and used it to conduct simulations of glucarpidase at doses between 10 and 80 U/kg rescue treatment after high-dose methotrexate therapy. We carried out a dose-finding modeling and simulation study before a phase II study of glucarpidase. Monte-Carlo simulations were conducted using the deSolve package of R software (version 4.1.2). The proportion of samples in which the plasma methotrexate concentration was less than 0.1 and 1.0 μmol/l at 70 and 120 h after methotrexate treatment was evaluated for each dosage of glucarpidase. RESULTS The proportion of samples in which the plasma methotrexate concentration was less than 0.1 μmol/l at 70 h after methotrexate treatment was 71.8% and 89.6% at 20 and 50 U/kg of glucarpidase, respectively. The proportion of samples in which the plasma methotrexate concentration was less than 0.1 μmol/l at 120 h after methotrexate treatment was 46.4% and 59.0% at 20 and 50 U/kg of glucarpidase, respectively. CONCLUSION We determined a recommended glucarpidase dose of 50 U/kg to be ethically acceptable. A rebound in the serum concentration of methotrexate may be observed in many patients after the administration of glucarpidase, and long-term monitoring (over 144 h) of the serum methotrexate concentration may be needed after the administration of glucarpidase. Its validity was confirmed in the phase II study and glucarpidase was approved for manufacturing in Japan.
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Affiliation(s)
- Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yutaka Fukaya
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan;
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Kawamoto
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
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10
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Samejima J, Okami J, Tanaka Y, Kobayashi S, Kimura T, Mukai M, Nagao T, Matsuoka H, Tsuboi M. 159P Optimization and validation of a circulating microRNA biomarker panel for early detection of lung cancer in a Japanese population. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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11
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Fukaya Y, Kimura T, Hamada Y, Yoshimura K, Hiraga H, Yuza Y, Ogawa A, Hara J, Koh K, Kikuta A, Koga Y, Kawamoto H. Development of a population pharmacokinetics and pharmacodynamics model of glucarpidase rescue treatment after high-dose methotrexate therapy. Front Oncol 2023; 13:1003633. [PMID: 36793598 PMCID: PMC9924065 DOI: 10.3389/fonc.2023.1003633] [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: 07/26/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction Glucarpidase (CPG2) reduces the lethal toxicity of methotrexate (MTX) by rapid degradation. Methods In this study, a CPG2 population pharmacokinetics (popPK) analysis in healthy volunteers (phase 1 study) and a popPK-pharmacodynamics (popPK-PD) analysis in patients (phase 2 study, n = 15) who received 50 U/kg of CPG2 rescue for delayed MTX excretion were conducted. In the phase 2 study, the first CPG2 treatment at a dose of 50 U/kg was intravenously administered for 5 min within 12 h after the first confirmation of delayed MTX excretion. The second dose of CPG2, with a plasma MTX concentration >1 μmol/L, was administered to the patient more than 46 h after the start of CPG2 administration. Results The population mean PK parameters (95% CI) of MTX, obtained from the final model post hoc, were estimated as follows: CLrMTX = 2.424 L/h (95% CI: 1.755-3.093), VcMTX = 12.6 L (95% CI: 10.8-14.3), VpMTX = 2.15 L (95% CI: 1.60-2.70), and α = 8.131 x 105 (4.864 x 105-11.398 x 105). The final model, including covariates, was CLrMTX (L/h): 3.248 x Body Weight/Serum creatinine/60 (CV 33.5%), VcMTX (L): 0.386 x Body Weight/body surface area (CV 29.1%), VpMTX (L):3.052 x Body Weight/60 (CV 90.6%), and α (L/h): 6.545 x 105 (CV 79.8%). Discussion These results suggest that the pre-CPG2 dose and 24 h after CPG2 dosing were the most important sampling points in the Bayesian estimation of plasma MTX concentration prediction at 48 h. These CPG2-MTX popPK analysis and Bayesian estimation of rebound in plasma MTX concentrations are clinically important to estimate >1.0 μmol/L 48 h after the first CPG2 dosing. Clinical trial registration https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=2363, identifier JMA-IIA00078 and https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=2782, identifier JMA-IIA00097.
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Affiliation(s)
- Yutaka Fukaya
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroaki Hiraga
- Department of Musculoskeletal Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Yuki Yuza
- Department of Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Atsushi Ogawa
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Junichi Hara
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical College, Fukushima, Japan
| | - Yuhki Koga
- Department of Perinatal and Pediatric Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroshi Kawamoto
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
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12
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Oda K, Yamada T, Matsumoto K, Hanai Y, Ueda T, Samura M, Shigemi A, Jono H, Saito H, Kimura T. Model-informed precision dosing of teicoplanin for the rapid achievement of the target area under the concentration-time curve: A simulation study. Clin Transl Sci 2023; 16:704-713. [PMID: 36748688 PMCID: PMC10087075 DOI: 10.1111/cts.13484] [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] [Received: 10/25/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
Teicoplanin, a glycopeptide antimicrobial, is recommended for therapeutic drug monitoring, but it remains unclear how to target the area under the concentration-time curve (AUC). This simulation study purposed to demonstrate the potential of the Bayesian forecasting approach for the rapid achievement of the target AUC for teicoplanin. We generated concordant and discordant virtual populations against a Japanese population pharmacokinetic model. The predictive performance of the Bayesian posterior AUC in limited sampling on the first day against the reference AUC was evaluated as an acceptable target AUC ratio within the range of 0.8-1.2. In the concordant population, the probability for the maximum a priori or Bayesian posterior AUC on the first day (AUC0-24 ) was 61.3% or more than 77.0%, respectively. The Bayesian posterior AUC on the second day (AUC24-48 ) was more than 75.1%. In the discordant population, the probability for the maximum a priori or Bayesian posterior AUC0-24 was 15.5% or 11.7-80.7%, respectively. The probability for the maximum a priori or Bayesian posterior AUC24-48 was 23.4%, 30.2-82.1%. The AUC at steady-state (AUCSS ) was correlated with trough concentration at steady-state, with a coefficient of determination of 0.930; the coefficients on days 7 and 4 were 0.442 and 0.125, respectively. In conclusion, this study demonstrated that early sampling could improve the probability of AUC0-24 and AUC24-48 but did not adequately predict AUCSS . Further studies are necessary to apply early sampling-based model-informed precision dosing in the clinical settings.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan.,Department of Infection Control, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Tomoyuki Yamada
- Department of Pharmacy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Minato, Tokyo, Japan
| | - Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Chiba, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masaru Samura
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Kanagawa, Japan
| | - Akari Shigemi
- Department of Pharmacy, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
| | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Hideyuki Saito
- Department of Pharmacy, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan
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13
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Mori K, Schuettfort V, Yanagisawa T, Katayama S, Laukhtina E, Pradere B, Rajwa P, Mostafaei H, Kimura T, Shariat S. Prognostic value of angiogenesis related marker vascular endothelial growth factor and vascular cell adhesion molecule-1 in bladder carcinoma treated with radical cystectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01342-8] [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: 02/12/2023]
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14
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Narita N, Terada N, Nomura K, Sakamoto S, Hatakeyama S, Kato T, Matsui Y, Inokuchi J, Yokomizo A, Tabata K, Shiota M, Kimura T, Kojima T, Inoue T, Mizowaki T, Sugimoto M, Kitamura H, Kamoto T, Nishiyama H, Habuchi T. Survival outcomes in octogenarian patients with de novo metastatic prostate cancer: Propensity score matching and net overall survival analyses. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01223-x] [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: 02/12/2023]
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15
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Yanagiswawa T, Rajwa P, Kawada T, Mori K, Quhal F, Laukhtina E, Von Deimling M, Bianchi A, Majdoub M, Pradere B, Kramer G, Kimura T, Shariat S. Efficacy of systemic treatment in prostate cancer patients with visceral metastasis: A systematic review, meta-analysis, and network meta-analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01234-4] [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: 02/12/2023]
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16
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Koishi N, Sasano H, Yoshizawa T, Shikuri M, Matsumoto H, Suzuki M, Fukui Y, Chonan M, Kimura T, Ichida H, Saiura A, Naito T. Successful Treatment of a Case of Metallo-Beta-Lactamase-Producing Raoultella ornithinolytica Bacteremia by Antimicrobial Stewardship Team Intervention and Therapeutic Drug Monitoring-Based Amikacin Treatment. Case Rep Infect Dis 2023; 2023:5574769. [PMID: 37065978 PMCID: PMC10104729 DOI: 10.1155/2023/5574769] [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] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
An 80-year-old woman underwent pancreatoduodenectomy. Post-operation, she experienced a fever, and a culture of blood revealed metallo-beta-lactamase-producing Raoultella ornithinolytica. For treatments with aminoglycoside antimicrobial agents, a therapeutic drug monitoring-based dosing design can lower the risk of adverse events and enable appropriate treatment. Key Clinical Message. When aminoglycoside antimicrobial agents are administered for MBL-producing bacteremia, prescription suggestions based on TDM by antimicrobial stewardship team can reduce the occurrence of adverse events and enable appropriate treatment.
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Affiliation(s)
- Noriko Koishi
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Sasano
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Mika Shikuri
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | | | - Mai Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yukiko Fukui
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayoshi Chonan
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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17
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Kaneko A, Kanemaru H, Kajihara I, Kuriyama H, Kimura T, Sawamura S, Makino K, Aoi J, Fukushima S, Ihn H. 486 Liquid biopsy-based analysis using cell-free DNA from melanoma patients. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.500] [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: 11/19/2022]
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18
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Sawada Y, Kimura S, Watanabe K, Yamaguchi Y, Arima T, Kimura T. Nonreciprocal Directional Dichroism in Magnetoelectric Spin Glass. Phys Rev Lett 2022; 129:217201. [PMID: 36461975 DOI: 10.1103/physrevlett.129.217201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
Optical absorption spectra in the visible and near-infrared light were measured for magnetoelectric spin glass Ni_{0.4}Mn_{0.6}TiO_{3} under various field-cooled conditions. Despite the absence of long-range magnetic-dipole order, this spin-glass system exhibits nonreciprocal directional dichroism (NDD) at zero external field after a magnetoelectric field-cooled procedure. This result is distinct from previous studies on NDD in systems with magnetic toroidal moments induced either by long-range magnetic-dipole order or by applying crossed electric and magnetic fields. The present Letter conclusively demonstrates that the observed NDD originates from magnetoelectrically induced ferroic order of magnetic toroidal moments without conventional magnetic-dipole order.
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Affiliation(s)
- Y Sawada
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - S Kimura
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - K Watanabe
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - Y Yamaguchi
- Division of Materials Physics, Graduate School of Engineering Science, Osaka University, Toyonaka 560-8531, Japan
| | - T Arima
- Department of Advanced Materials Science, University of Tokyo, Kashiwa 277-8561, Japan
| | - T Kimura
- Department of Advanced Materials Science, University of Tokyo, Kashiwa 277-8561, Japan
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Kondo S, Koyama T, Kawazoe A, Iwasa S, Yonemori K, Shitara K, Nakamura Y, Saori M, Yamamoto N, Sato J, Sahara T, Hayata N, Yamamuro S, Kimura T, Dutta L, Tamai T, Ikeda M. 401P A phase Ib study of E7386, a CREB-binding protein (CBP)/β-catenin interaction inhibitor, in combination with lenvatinib in patients (pts) with advanced solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.432] [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: 12/07/2022] Open
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20
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Mori K, Sasaki H, Urabe F, Honda M, Yanagisawa T, Aoki M, Miki K, Shariat S, Kimura T. Radical prostatectomy versus high-dose-rate brachytherapy and hypo-fractionated external beam radiation combined with long-term androgen deprivation for high-risk prostate cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02507-1] [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: 11/11/2022] Open
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21
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Takesue Y, Hanai Y, Oda K, Hamada Y, Ueda T, Mayumi T, Matsumoto K, Fujii S, Takahashi Y, Miyazaki Y, Kimura T. Clinical Practice Guideline for the Therapeutic Drug Monitoring of Voriconazole in Non-Asian and Asian Adult Patients: Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Clin Ther 2022; 44:1604-1623. [DOI: 10.1016/j.clinthera.2022.10.005] [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] [Received: 07/03/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
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22
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Ebihara F, Maruyama T, Kikuchi K, Kimura T, Hamada Y. Antifungal Stewardship Task Shifting Required of Pharmacists. Med Mycol J 2022; 63:109-117. [DOI: 10.3314/mmj.22.003] [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] [Indexed: 12/05/2022]
Affiliation(s)
- Fumiya Ebihara
- Department of Pharmacy, Tokyo Women's Medical University Hospital
| | - Takumi Maruyama
- Department of Pharmacy, Tokyo Women's Medical University Hospital
| | - Ken Kikuchi
- Department of Pharmacy, Department of Infectious Disease, Tokyo Women's Medical University Hospital
| | | | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital
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23
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Hashimoto K, Miyama H, Seki Y, Ibe S, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K, Takatsuki S. Advantage of POLARx over ARCTIC FRONT ADVANCE PRO during pulmonary vein isolation for paroxysmal atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The electrical pulmonary vein (PV) isolation has been established as a curative therapy for paroxysmal atrial fibrillation (AF). Arctic Front™cryoballoon has been used worldwide for AF cryoablation. Recently, a new cryoballoon, POLARxTM CRYOABLATION system have been introduced, of which material of the balloon is softer and the N2O gas flow rate is higher.
Purpose
The aim was to investigate the procedural parameter and efficacy of POLARx comparing with Arctic Front.
Methods
This retrospective single center study included 101 consecutive patients who underwent paroxysmal AF ablation using cryoballoon at Keio University hospital from April 2021 to March 2022. The procedural data including the cryoballoon temperature and the number and duration of cryoablation were compared between POLARx (POLARx group) and ARCTIC FRONT ADVANCE PRO (AFA group). After the cryoablation, we added the radiofrequency application in order to maximize the isolated area when the voltage was remained inside PV (Figure 1). The necessities of the additional radiofrequency applications were also compared.
Results
In the present study, 64 patients in AFA group and 37 patients in POLARx group were analyzed. POLARx group included younger population and less females (62.8±9.9 vs 67.5±9.4 year of age, P=0.02; 13.5 vs 32.8%, P=0.04). There was no significant difference in comorbidities and examination data such as left atrium diameter or brain natriuretic peptide level. The minimal cryoballoon temperatures reached in POLARx group were lower than AFA group (−59.3±6.2 vs −47.7±7.5°C, P<0.01). No difference was found in the total number and duration of cryoablation and the time to isolate PV (6.1±2.1 vs 5.9±1.6, P=0.69; 790.2±256.1 vs 776.1±235.0 sec, P=0.69; 41.8±21.3 vs 47.1±29.6 sec, P=0.44, respectively). With regard to individual PVs, the total number and duration were tended to be larger at right superior PV in POLARx group (1.9±1.1 vs 1.4±0.7, P=0.01; 231.8±123.8 vs 193.2±83.0 sec, P=0.07), while there was no significant difference at the other PVs. The rate of successful PV isolation by a single cryo-application was not different between AFA and POLARx group (54.3 vs 61.4%, P=0.17). The additional radiofrequency applications were more frequent in AFA group (14.8 vs. 4.9%, P=0.003). There was a significant difference at right inferior PV (32.8 vs 8.1%, P=0.01), while not at left superior PV, left inferior PV and right superior PV (9.4 vs 2.9%, P=0.42; 9.4 vs 5.7%, P=0.71; 7.8 vs 2.7%, P=0.41). Phrenic nerve injury was occurred 1 case in both group and esophageal ulcer was occurred in 1 case in AFA group. No other complication including cardiac tamponade was occurred.
Conclusion
The total number and duration of cryoablation were not significantly different between AFA and POLARx group, except for right superior PV. There was an advantage in largely isolating right inferior PV in POLARx group comparing with AFA group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Hashimoto
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - H Miyama
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Seki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Ibe
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Yamashita
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Fujisawa
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Katsumata
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Kimura
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Takatsuki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
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Tanaka N, Inoue K, Hirao Y, Koyama Y, Okamura A, Iwakura K, Okada M, Tanaka K, Kobori A, Kaitani K, Morimoto T, Morishima I, Kusano K, Kimura T, Shizuta S. Sex differences in terms of recurrent atrial fibrillation after catheter ablation according to the history of heart failure: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There are significant differences in the prevalence and prognosis of cardiovascular diseases between male and female. We previously reported that catheter ablation (CA) of atrial fibrillation (AF) was less effective in female than male, but whether their history of heart failure influence the recurrence after CA of AF remains still unknown.
Purpose
We sought to clarify sex differences in terms of AF recurrence after RFCA of AF according to the history of heart failure.
Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.
Results
Fourteen % of female had a history of heart failure prior to CA, while 12.8% of male had a history of heart failure at baseline (p=0.29). The 3-year cumulative incidence of AF recurrence after a single procedure was 43.3% in female and 39.0% in male (log rank P=0.0046). In patients with the history of heart failure, AF recurrence rates were 42.2% in female and 45.8% in male (log rank P=0.51). On the other hand, in patients without history of heart failure, more females experienced AF recurrence (female vs. male, 43.5% vs. 38.0%, log rank P=0.001).
The rate of AF recurrence after multiple procedures was higher in female (24.2% vs. 19.6%, log rank P<0.0001). AF recurrence rates were similar between sexes in patients with history of heart failure (female vs. male, 26.0% vs. 26.7%, log rank P=0.86), while AF recurrence rates were higher in female without history of heart failure than those in male (females vs. males, 23.9% vs. 18.5%, log rank P<0.0001).
Conclusion
The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the AF recurrence after CA of AF. Females had higher recurrence rates compared with males in patients without history of heart failure, while recurrence rates were similar between sexes in patients with history of heart failure.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Kobori
- Kobe City Medical Center General Hospital , Kobe , Japan
| | - K Kaitani
- Japanese Red Cross Otsu Hospital , Otsu , Japan
| | - T Morimoto
- Hyogo Medical University , Nishinomiya , Japan
| | | | - K Kusano
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine , Kyoto , Japan
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Kawaguchi Y, Kita R, Kimura T, Goto R, Takayama T, Izumi N, Kudo M, Kaneko S, Yamanaka N, Inomata M, Shimada M, Baba H, Koike K, Omata M, Makuuchi M, Matsuyama Y, Yamada Y, Kokudo N, Hasegawa K. 723P Medical expenditures and treatment efficacy of patients who had initial hepatocellular carcinoma and underwent surgery or radiofrequency ablation: Accompanying research of the SURF trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Nagumo Y, Kimura T, Ishikawa H, Sekino Y, Maruo K, Mathis B, Takemura M, Kageyama Y, Ushijima H, Kawai T, Yamashita H, Azuma H, Naiki T, Kobayashi Y, Inokuchi J, Osawa T, Kita Y, Tsuzuki T, Hashimoto K, Nishiyama H. 1740P Bladder preservation therapy in combination with atezolizumab and radiation therapy for invasive bladder cancer (BPT-ART): An open-label, single-arm, multicenter, phase II trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1818] [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: 11/01/2022] Open
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27
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Handa M, Takiuchi T, Kawaguchi S, Komukai S, Kitamura T, Miyake T, Ohara Y, Doshida M, Takeuchi T, Matsubayashi H, Ishikawa T, Kimura T. O-130 Reproductive outcomes of normal ovarian reserve patients after progestin-primed ovarian stimulation with chlormadinone acetate vs GnRH antagonist: A retrospective study with inverse-probability-of-treatment weighting. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.030] [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: 11/14/2022] Open
Abstract
Abstract
Study question
To evaluate the effectiveness of chlormadinone acetate (CMA) for preventing premature LH surge in patients with normal ovarian reserve compared to cetrorelix.
Summary answer
In progestin-primed ovarian stimulation (PPOS) than GnRH antagonist (GnRH-ant), the incidence of premature LH surge was significantly lower, without significant difference in oocyte maturation rate.
What is known already
The GnRH-ant protocol is one of the conventional protocols which has some disadvantages including increased premature LH surge rate and cancelation rate. In recent years, the PPOS protocol has attracted attention as a new ovarian stimulation using progestin as an alternative to GnRH analog for suppressing a premature LH surge, however its efficacy is still controversial. In addition, many studies have investigated the reproductive outcomes of PPOS using medroxy-progesterone acetate or dydrogesterone; however, there are few reports of CMA, an oral progestin, which is inexpensive and widely used in Japan.
Study design, size, duration
This retrospective cohort study was performed in a reproduction center between March 2018 and October 2020 which included 977 Japanese patients with normal ovarian reserve undergoing PPOS with CMA (n = 299), or GnRH antagonist (GnRH-ant) with cetrorelix (n = 608) in their first IVF cycle at the reproduction center. In subgroup analysis, pregnancy outcomes after frozen embryo transfers (FET) between PPOS (n = 284) and GnRH-ant (n = 579) were also compared.
Participants/materials, setting, methods
The inclusion criteria were patients aged < 40 years and AMH ≧ 1.1 ng/mL, who underwent autologous oocyte retrieval in their first IVF cycle with freeze-all strategy. The primary outcome was the incidence of premature LH surge, the secondary outcomes was oocyte maturation rate. To reduce the impact of treatment bias and potential confounding factors, we conducted logistic regression models with inverse-probability-of-treatment weighting (IPTW).
Main results and the role of chance
After IPTW, baseline clinical data were well-balanced between the two groups, including age, AMH, BMI, the duration, type, and cause of infertility, antral follicle count, the history of recurrent spontaneous abortion, and previous IVF attempts. The premature LH surge rate was significantly lower with PPOS (3.1%) compared to GnRH-ant (20.1%) (odds ratio, 0.21; 95% confidence interval, 0.11–0.36). No significant differences were found in total gonadotropin dose (2400IU for PPOS vs 2400IU for GnRH-ant, p = 0.136), the number of oocyte retrieval (n = 15 vs n = 15, p = 0.484), oocyte maturation rate (78.8% vs 77.8%, p = 0.275), fertilization rate (73.0% vs 72.0%, p = 0.412), viable embryo rate per oocyte retrieval (40% vs 40%, p = 0.890), and good quality blastocyst rate (72.0% vs 69.6%, p = 0.092). However, the good quality day-3 embryo rate was significantly lower with PPOS (37.2% vs 49.1%, p < 0.05). There were no differences in the incidence of moderate-to-severe OHSS (0.3% vs 0.7%, p = 0.481). In FET cycles, the pregnancy outcomes, such as implantation rate (43.1 % vs 51.9 %, p = 0.013) and clinical pregnancy rate (46.5% vs 54.7%, p = 0.027) were significantly lower with PPOS, however, no significant differences were found in ongoing pregnancy rate (75.6% vs 80.5%, p = 0.325), and live birth rate (72.4% vs 79.5 %, p = 0.142).
Limitations, reasons for caution
This was a retrospective cohort study conducted in a single center. The participants in this study were limited to Japanese ethnicity. The results need to be validated across different centers and other ethnicities.
Wider implications of the findings
This is the first report assessing the reproductive outcomes on PPOS using CMA, widely used in Japan. The PPOS with CMA significantly suppressed the premature LH surge rate compared to GnRH-ant protocol, without decrease in oocyte maturation rate.
Trial registration number
N/A
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Affiliation(s)
- M Handa
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
| | - T Takiuchi
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
- Osaka university Graduate School of Medicine, Clinical Genomics , Osaka, Japan
| | - S Kawaguchi
- Osaka university Graduate School of Medicine, Division of Biomedical Statistics- Integrated Medicine , Osaka, Japan
| | - S Komukai
- Osaka university Graduate School of Medicine, Division of Biomedical Statistics- Integrated Medicine , Osaka, Japan
| | - T Kitamura
- Osaka university Graduate School of Medicine, Division of Environmental Medicine and Population Services- Social and Environmental Medicine , Osaka, Japan
| | - T Miyake
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
| | - Y Ohara
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
| | - M Doshida
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Takeuchi
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - H Matsubayashi
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Ishikawa
- Reproduction Clinic Osaka, Reproductive Medicine , Osaka, Japan
- Reproduction Clinic Tokyo, Reproductive Medicine , Tokyo, Japan
| | - T Kimura
- Osaka university Graduate School of Medicine, Obstetrics and Gynecology , Osaka, Japan
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Takagi M, Ogawa C, Iehara T, Aoki-Nogami Y, Ishibashi E, Imai M, Kimura T, Nagata M, Yasuhara M, Masutani M, Yoshimura K, Tomizawa D, Ogawa A, Yonemori K, Morishita A, Miyamoto S, Takita J, Kihara T, Nobori K, Hasebe K, Miya F, Ikeda S, Shioda Y, Matsumoto K, Fujimura J, Mizutani S, Morio T, Hosoi H, Koike R. First phase 1 clinical study of olaparib in pediatric patients with refractory solid tumors. Cancer 2022; 128:2949-2957. [PMID: 35593736 DOI: 10.1002/cncr.34270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/03/2022] [Accepted: 04/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The survival of patients with high-risk, refractory, relapsed, or metastatic solid tumors remains dismal. A poly(ADP-ribose) polymerase (PARP) inhibitor could be effective for the treatment of pediatric solid tumors with defective homologous recombination. METHODS This open-label, multicenter phase 1 clinical trial evaluated the safety, tolerability, and efficacy of olaparib, a PARP inhibitor, in pediatric patients with refractory solid tumors to recommend a dose for Phase 2 trials. Olaparib (62.5, 125, and 187.5 mg/m2 twice daily) was administered orally every day (1 cycle = 28 days) using a standard 3 + 3 dose-escalation design. Patients aged 3-18 years with recurrent pediatric solid tumors were eligible. Pharmacokinetic and pharmacodynamic analyses were performed. RESULTS Fifteen patients were enrolled and received olaparib monotherapy, which was well tolerated. The recommended phase 2 dose for daily administration was 187.5 mg/m2 twice daily. Pharmacokinetics were dose proportional. The area under the concentration-time curve from 0 to 12 h and the peak plasma concentration for 187.5 mg/m2 twice daily in children were comparable to previous data obtained in a 200-mg, twice-daily cohort and lower than those in the 300-mg twice-daily cohort in adults. Pharmacodynamic studies demonstrated substantial inhibition of PARP activity. Two partial responses were observed in patients with Wilms tumor and neuroblastoma. CONCLUSIONS This report is the first clinical trial to describe the use of a PARP inhibitor as monotherapy in children. Olaparib was well tolerated, with preliminary antitumor responses observed in DNA damage response-defective pediatric tumors. LAY SUMMARY This Phase 1 trial evaluated the efficacy and safety of olaparib in patients with refractory childhood solid tumors. Olaparib was well tolerated, achieving objective response in 2/15 patients. The DNA damage response was attenuated in nearly one-half of advanced neuroblastoma patients, demonstrating the utility of the PARP inhibitor. The results support further investigation of olaparib as a new treatment for DNA damage-response or repair-defective pediatric cancers.
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Affiliation(s)
- Masatoshi Takagi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Yuki Aoki-Nogami
- Department of Pediatric Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Eri Ishibashi
- University Research Administration Division, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Minoru Imai
- University Research Administration Division, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masashi Nagata
- Department of Pharmacokinetics and Pharmacodynamics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Masato Yasuhara
- Department of Pharmacokinetics and Pharmacodynamics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Mitsuko Masutani
- Department of Molecular and Genomic Biomedicine, Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Ishikawa, Japan.,Future Medical Center, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Daisuke Tomizawa
- National Center for Child Health and Development, Children's Cancer Center, Setagaya-ku, Tokyo, Japan
| | - Atsushi Ogawa
- Pediatrics, Niigata Cancer Center Hospital, Chuo-ku, Niigata, Japan
| | - Kan Yonemori
- Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Aoi Morishita
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Miyamoto
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Junko Takita
- Department of Pediatrics, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Tetsuro Kihara
- University Research Administration Division, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Nobori
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Hasebe
- University Research Administration Division, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Fuyuki Miya
- Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Sadakatsu Ikeda
- Department of Precision Cancer Medicine, Center for Innovative Cancer Treatment, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yoko Shioda
- National Center for Child Health and Development, Children's Cancer Center, Setagaya-ku, Tokyo, Japan
| | - Kimikazu Matsumoto
- National Center for Child Health and Development, Children's Cancer Center, Setagaya-ku, Tokyo, Japan
| | - Junya Fujimura
- Department of Pediatrics and Adolescent Medicine, Juntendo University, School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shuki Mizutani
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Ryuji Koike
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Suetomi T, Ichioka D, Iimura T, Kojo K, Ikeda A, Kimura T, Kawahara T, Hoshi A, Kandori S, Negoro H, Nishiyama H. Characteristics of testicular atrophy during testosterone replacement therapy (TRT). J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ebihara F, Hamada Y, Kato H, Maruyama T, Kimura T. Importance and Reality of TDM for Antibiotics Not Covered by Insurance in Japan. Int J Environ Res Public Health 2022; 19:ijerph19052516. [PMID: 35270215 PMCID: PMC8909063 DOI: 10.3390/ijerph19052516] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 12/10/2022]
Abstract
Under the Japanese health insurance system, medicines undergoing therapeutic drug monitoring (TDM) can be billed for medical fees if they meet the specified requirements. In Japan, TDM of vancomycin, teicoplanin, aminoglycosides, and voriconazole, which are used for the treatment of infectious diseases, is common practice. This means the levels of antibiotics are measured in-house using chromatography or other methods. In some facilities, the blood and/or tissue concentrations of other non-TDM drugs are measured by HPLC and are applied to treatment, which is necessary for personalized medicine. This review describes personalized medicine based on the use of chromatography as a result of the current situation in Japan.
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Affiliation(s)
- Fumiya Ebihara
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
- Correspondence:
| | - Hideo Kato
- Department of Pharmacy, Mie University Hospital, Mie 514-8507, Japan;
| | - Takumi Maruyama
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan; (F.E.); (T.M.); (T.K.)
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Yanagiswawa T, Mori K, Kawada T, Sari Motlagh R, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, König F, Pallauf M, Pradere B, Miki J, Kimura T, Egawa S, Shariat S. Can ablation therapy be an alternative treatment to partial nephrectomy for clinical T1b renal tumors?: A systematic review and meta-analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00300-1] [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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32
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Urabe F, Kimura T, Sasaki H, Iwatani K, Aikawa K, Tashiro K, Tsutsumi Y, Morikawa M, Sato S, Takahashi H, Aoki M, Miki K, Egawa S. Comparison between long-term outcomes of low-dose-rate brachytherapy and radical prostatectomy in patients with intermediate-risk prostate cancer: Propensity match scoring analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01031-4] [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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Yanagiswawa T, Mori K, Kawada T, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, Sari Motlagh R, Frederik K, Pallauf M, Pradere B, Miki J, Kimura T, Egawa S, Shariat S. Prevention and detection of iatrogenic ureteral injury during abdominal or pelvic surgery: A systematic review and meta-analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00268-8] [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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Hanai Y, Takahashi Y, Niwa T, Mayumi T, Hamada Y, Kimura T, Matsumoto K, Fujii S, Takesue Y. Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Antimicrob Chemother 2022; 77:869-879. [PMID: 35022752 PMCID: PMC8969460 DOI: 10.1093/jac/dkab499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Owing to its low risk of adverse effects, teicoplanin has been extensively used in patients with infections caused by MRSA. To promote the better management of patients receiving teicoplanin, we have updated the guidelines for therapeutic drug monitoring (TDM). Methods The guidelines were developed by a committee following the methodology handbook published by the Japanese Medical Information Distribution Service. Nine clinical questions were selected. The committee conducted a systematic review and meta-analysis to establish evidence-based recommendations for the target trough concentration (Cmin). An initial electronic database search returned 515 articles, and 97 articles qualified for a full review. Four and five studies were included for the efficacy evaluation of cut-off Cmin values of 15 and 20 mg/L, respectively. Results Compared with Cmin < 15 mg/L, a target Cmin value of 15–30 mg/L resulted in increased clinical efficacy in patients with non-complicated MRSA infections (OR = 2.68; 95% CI = 1.14–6.32) without an increase in adverse effects. Although there was insufficient evidence, target Cmin values of 20–40 mg/L were suggested in patients with complicated or serious MRSA infections. A 3 day loading regimen followed by maintenance treatment according to renal function was recommended to achieve the target trough concentrations. Because of the prolonged half-life of teicoplanin, measurement of the Cmin value on Day 4 before reaching steady state was recommended. Conclusions The new guideline recommendations indicate the target Cmin value for TDM and the dosage regimen to achieve this concentration and suggest practices for specific subpopulations.
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Affiliation(s)
- Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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Onodera M, Muragaki Y, Fukui A, Nitta M, Saito T, Tsuzuki S, Kooriyama S, Tamura M, Kimura T, Kawamata T. COT-31 Risk Factors for the Development of Skin Rash with Levetiracetam and Lacosamide in Patients with Glioma. Neurooncol Adv 2021. [PMCID: PMC8648194 DOI: 10.1093/noajnl/vdab159.123] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Seizure control of in glioma patients is essential for quality of life. The new generation anti-seizure drug (ASD) is represented by lacosamide (LCM) and levetiracetam (LEV), and is said to have few side effects of eruption. We retrospectively analyzed the incidence of rash and related factors of the ASD, evaluated the safety of patients with glioma, and conducted a comparison with the evaluation of patients with meningioma. Method: We calculated the incidence of rash in patients who underwent glioma resection at our Hospital from January 2017 to December 2019 and were prescribed LEV or LCM, and compared it with the same incidence in meningioma patients. Multivariate logistic regression analysis was used to analyze the risk factors for the ASD-related eruption. Result: The subjects were 353 gliomas and 125 meningiomas who received LEV or LCM.The median ages are 44 ± 14.8 and 58 ± 13.2, respectively, and the male-female ratio is 203/150 and 53/72. There was no difference in the incidence of eruptions between the two groups, LEV and LCM, and the incidence of ASD-related eruptions was 11% (39/353) for gliomas, significantly higher than 1.6% (2/125) for meningiomas (p = 0.006). The incidence of ASD-related eruptions in glioma patients was not significantly different between the LEV group (10% (21/216)) and the LCM group (13% (20/154)) (p = 0.53). In a multivariate analysis of risk factors for eruption, chemoradiotherapy (p = 0.01), history of drug allergy (p = 0.039) was significantly higher. Conclusion: The incidence of LEV and LCM eruptions in glioma patients was higher than that in meningioma patients, and it was speculated that the treatment course specificity was more important than the disease-specific factors. Patients with glioma, especially those who have undergone chemoradiotherapy or have a history of drug allergies, require careful confirmation of the eruption.
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Affiliation(s)
- Mikoto Onodera
- Department of Pharmacy, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Taiichi Saito
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Syunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Syunichi Kooriyama
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
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Imano N, Kimura T, Kawahara D, Kubo K, Takeuchi Y, Saito A, Nishibuchi I, Murakami Y, Nagata Y. Potential Benefits of Volumetric Modulated Arc Therapy to Reduce the Incidence of Grade 2 Radiation Pneumonitis in Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1244] [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: 10/20/2022]
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37
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Shima A, Tanaka H, Okamura T, Nishikawa T, Godai K, Kimura T, Tatsumi Y, Morino A, Kawatsu Y, Miyamatsu N. Providing mammography in workplaces improved screening rates: cluster randomized controlled trial. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.375] [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: 11/14/2022] Open
Abstract
Abstract
Background
Despite sufficient evidence on the importance of breast cancer screening, the screening rate has remained less than 50% in Japan. To promote behavioral change of individuals, it is important to reduce barriers to taking screening. The purpose of this study was to examine the effect of an environmental approach providing opportunities for mammography (MMG) in workplaces.
Methods
Female employees aged 40 years or older were eligible. Supermarket stores were randomly assigned into two groups, the intervention arm (leaflet and MMG) and the control arm (leaflet). From May to July 2018, participants in the intervention arm were given a leaflet informing the subsidies for breast cancer screening and were provided the opportunity to have MMG in their workplace. Participants in the control group were given the same leaflet, but they had to take the screening outside the workplace as usual. The primary outcome was the breast cancer screening rate in 2018, evaluated using self-administered questionnaires. The odds ratio (OR) and 95% confidence intervals (CIs) for the screening rate in the intervention arm compared with the control arm was estimated using multilevel logistic regression.
Results
We analyzed 1624 participants (mean age was 53 years) from 25 supermarket stores (intervention: 578 patients in 8 stores, control: 1046 patients in 17 stores). The screening rate in the intervention arm was 312 (54%) and was 125 (12%) in the control arm. The OR (and 95% CIs) was 7.81 (5.03-12.12) in the final model adjusted store level effects (i.e., stores and screening rate in 2017 at each store) and individual age and current smoking.
Conclusions
In a worksite-based cluster-randomized controlled trial conducted in a Japanese population, an environmental approach providing MMG opportunities in workplaces significantly increased the self-reported breast cancer screening rate within one year. (UMIN000030465)
Key messages
Providing the opportunity of mammography in Japanese supermarket stores improved the breast cancer screening rate. An environmental approach reducing barriers to screening may be more effective than conventional approaches in improving breast cancer screening rate.
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Affiliation(s)
- A Shima
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
- Occupational Health Care Office, Heiwado Co.,Ltd, Shiga, Japan
| | - H Tanaka
- Fujiidera Public Health Center of Osaka Prefecture, Osaka, Japan
| | - T Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - T Nishikawa
- Department of Health and Nutrition, Kyoto Koka Wemen’s University, Kyoto, Japan
| | - K Godai
- Department of Health Promotion Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Kimura
- General Incorporated Foundation Kinki Health Administration, Shiga, Japan
| | - Y Tatsumi
- Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan
| | - A Morino
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
- Occupational Health Care Office, Heiwado Co.,Ltd, Shiga, Japan
| | - Y Kawatsu
- Occupational Health Care Office, Heiwado Co.,Ltd, Shiga, Japan
| | - N Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan
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Seko Y, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Shiba M, Yamamoto E, Yoshikawa Y, Yamashita Y, Kitai T, Kuwahara K, Kimura T. Starting Neurohormonal Antagonists in Patients with Acute Heart Failure with Mid-Range and Preserved Ejection Fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The clinical benefits of neurohormonal antagonist in patients with heart failure (HF) with mid-range and preserved ejection fraction (HFmrEF and HFpEF) were uncertain. This study aimed to evaluate the prognostic effect of starting angiotensin-converting enzyme inhibitors (ACE-I) / angiotensin II receptor blockers (ARB) and β-blocker during HF hospitalization in these patients.
Methods
We analyzed 858 consecutive patients with HFmrEF (EF:40–49%) or HFpEF (EF≥50%), who were hospitalized for acute decompensated HF, were discharged alive, and were not taking ACE-I/ARB or β-blockers at admission. The study population was classified into four groups according to the status of prescription of ACE-I/ARB and β-blocker at discharge: no neurohormonal antagonist (N=342, 39.9%), ACE-I/ARB only (N=128, 14.9%), β-blocker only (N=189, 22.0%), and both ACE-I/ARB and β-blocker (N=199, 23.2%) groups. The primary outcome measure was a composite of all-cause death or HF hospitalization.
Results
The cumulative 1-year incidence of the primary outcome measure was 41.2% in the no neurohormonal antagonist group, 34.0% in the ACE-I/ARB only group, 28.6% in the β-blocker only group, and 16.4% in the both ACE-I/ARB and β-blocker group (P<0.001). Compared with the no neurohormonal antagonist group, the both ACE-I/ARB and β-blocker group were associated with a significantly lower risk for a composite of all-cause death or HF hospitalization (HR: 0.59, 95% CI: 0.38–0.91, P=0.02).
Conclusions
In hospitalized patients with HFmrEF and HFpEF, starting both ACE-I/ARB and β-blocker was associated with a reduced risk of a composite of all-cause death or HF hospitalization compared with not starting ACE-I/ARB or β-blocker.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Seko
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kato
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Morimoto
- Hyogo College of Medicine, Nishinomiya, Japan
| | - H Yaku
- Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Y Inuzuka
- Shiga General Hospital, Moriyama, Japan
| | | | - N Ozasa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Shiba
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - E Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Yoshikawa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Yamashita
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Kuwahara
- Shinshu University School of Medicine, Matsumoto, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishiwaki S, Watanabe S, Yoneda F, Tanaka M, Komasa A, Yoshizawa T, Kojitani H, Shizuta S, Morimoto T, Kimura T. Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Since atrial functional tricuspid regurgitation (AF-TR) is associated with increased heart failure and mortality, the management of AF-TR is clinically important. Atrial fibrillation (AF) plays the main role in AF-TR. However, the effectiveness of catheter ablation (CA) and mechanism of improvement of AF-TR haven't been fully evaluated.
Purpose
We sought to investigate the impact of CA for AF on AF-TR in patients with moderate or more TR.
Methods
We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Japan. The current study population consisted of 102 patients with moderate or greater TR who underwent CA for AF. The echocardiographic parameters were compared between pre-ablation and post-ablation transthoracic echocardiography (TTE), and the recurrence rate of AF/ atrial tachycardia (AT) was measured.
Results
The mean age was 73.2 years, 53% were women. TR severity and TR jet area significantly improved after CA for AF (TR jet area: 5.8 [3.9–7.6] cm2 to 2.0 [1.1–3.0] cm2, p<0.001). In addition, mitral regurgitation (MR) jet area, left atrial (LA) area, mitral valve diameter, right ventricular (RV) end-diastolic area, right atrial (RA) area, tricuspid valve (TV) diameter decreased after CA (p<0.001, <0.001, <0.001, = 0.02, <0.001, and <0.001, respectively). There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE (moderate 28.6%, moderate to severe 37.2%, and severe 31.6%, p=0.72).
Conclusions
TR severity and jet area improved after CA in patients with AF and moderate or more TR. RV size, RA size, TV diameter also decreased after CA, which may be associated with TR improvement. There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Nishiwaki
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - S Watanabe
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - F Yoneda
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - M Tanaka
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - A Komasa
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - T Yoshizawa
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - H Kojitani
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - S Shizuta
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - T Morimoto
- Hyogo College of Medicine, Department of Clinical Epidemiology, Hyogo, Japan
| | - T Kimura
- Kyoto University, Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
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Alderete Martinez J, Shizuta S, Yoneda F, Nishiwaki S, Tanaka M, Komasa A, Kohjitani H, Yoshizawa T, Kimura T. 10-year clinical outcomes after radiofrequency catheter ablation for atrial fibrillation. A single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is becoming a routine procedure to treat patients with drug-refractory symptomatic AF. However, data regarding very long-term clinical outcomes is limited. The aim of the present study was to evaluate the 10-year clinical outcomes of patients who underwent RFCA for paroxysmal and persistent AF.
Methods
We retrospectively enrolled 503 consecutive patients (mean age 66,9±9,51 years; 71,6% male) who underwent RFCA for drug-refractory symptomatic AF between February 2004 and June 2011. Follow-up information was obtained using medical records and/or telephonic interviews with the patient, relatives and/or referring physicians.
Results
Among 503 patients enrolled in this study, 362 had paroxysmal atrial fibrillation (PAF) and 141 had persistent atrial fibrillation (PeAF) (72% and 28%, respectively). Mean follow-up was 8,84±3,05 years. The 10-year event-free rate for recurrent atrial tachyarrhythmia (AT) after the first procedure was 44,5% (49,4% for PAF vs 31,9% for PeAF; p=0,002 by log-rank test) and 81,9% after the last procedure (87,3% for PAF and 67,9% for PeAF; p≤0,001 by log-rank test). AT recurrence was observed most commonly during the first 12 months of the initial procedure (56%), with only 18% of them occurring after 60 months. Multivariate analysis revealed that persistent AF (hazard ratio=1,366; 95% confidence interval 1,058–1,76; p=0,017) and duration of AF >5 years (hazard ratio=1,357; 95% confidence interval 1,064–1,732; p=0,005) were independent risk factors for AT recurrence. Regarding adverse events, there were 24 (4,8%) hospitalizations for acute decompensated heart failure, 20 (4%) ischemic strokes and 14 (2,8%) bleeding complications requiring hospital admissions. Patients taking oral anticoagulation and antiarrhythmic drugs at the end of the study accounted for 32,8% and 16,7% respectively.
Conclusions
RFCA for AF provided favorable results in terms of arrhythmia event-free survival in long-term follow-up with better results in patients with paroxysmal AF. Persistent AF and long-standing AF (beyond 5 years) were associated with AT recurrence. Despite the large number of patients who discontinued oral anticoagulation, thromboembolic adverse events were rare.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Shizuta
- Kyoto University Hospital, Kyoto, Japan
| | - F Yoneda
- Kyoto University Hospital, Kyoto, Japan
| | | | - M Tanaka
- Kyoto University Hospital, Kyoto, Japan
| | - A Komasa
- Kyoto University Hospital, Kyoto, Japan
| | | | | | - T Kimura
- Kyoto University Hospital, Kyoto, Japan
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Kato T, Yaku H, Yamamoto E, Inuzuka Y, Tamaki Y, Ozasa N, Kimura T. Impact of decreased lymphocyte, total cholesterol, and albumin levels at discharge on all-cause death in patients with acute heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lymphocyte, total cholesterol, and albumin levels consist of Controlling Nutritional Status (CONUT) score, which has been reported to prognosticate patients with acute heart failure (AHF). However, the influence of each component of CONUT score on outcomes in patients with AHF was not fully elucidated.
Purpose
We aimed to evaluate the prognostic implication of the decrease in lymphocyte, total cholesterol, and albumin levels in patients with AHF.
Methods
We analyzed 1812 AHF patients in whom data at discharge were available from a multicenter registry. The decrease of lymphocyte (Ly) count was assigned with Ly≥1600/mL (31.0%), 1200≤ Ly <1600 (26.9%), 800≤ Ly <1200 (28.6%), Ly <800 (13.5% of patients). The decrease of total cholesterol (TC) was assigned with TC≥180mg/dL (28.9%), 140≤ TC <180 (42.2%), 100≤ TC <140 (26.7%), TC <100 (2.1% of patients). The decrease of albumin (Alb) was assigned and doubled with Alb≥3.5g/dL (45.7%), 3≤ Alb <3.5 (35.1%), 2.5≤ Alb <3 (15.2%), Alb <2.5 (3.9% of patients). The primary outcome measure was all-cause death after discharge from the index hospitalization. Cumulative incidences were estimated by the Kaplan-Meier method and differences were assessed with the log-rank test. We constructed multivariable Cox proportional hazard models to estimate the risk of the decrease in each value per grade, with the results expressed as the hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
Cumulative one-year incidence of the all-cause death was higher with decreasing Ly, TC, and Alb levels (P<0.0001, P<0.0001, and P=0.02, respectively) (Figure 1). The adjusted hazard ratio for all-case death per grade decrease is most prominent in albumin (HR: 1.36, 95% CI: 1.20–1.54), followed by lymphocyte count (HR: 1,23, 95% CI: 1.10–1.38), whereas it became insignificant in total cholesterol (HR: 1.05, 95% CI: 0.91–1.21).
Conclusions
The prognostic implications after discharge were different in albumin, lymphocyte count, and total cholesterol in patients with AHF.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- T Kato
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Yaku
- Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - E Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Y Inuzuka
- Shiga Medical Center for Adults, Moriyama, Japan
| | | | - N Ozasa
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Yamashita Y, Morimoto T, Kimura T. Autoimmune disorders and venous thromboembolism: a report from the COMMAND VTE Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a major health problem in the world. Several studies reported that autoimmune disorder is one of important risk factors for development of VTE. Furthermore, autoimmune disorder is thought to be a relatively strong risk factor for VTE recurrence, and extended anticoagulation therapy are recommended for prevention of VTE recurrence in patients with autoimmune disorders. However, it remains controversial whether patients with autoimmune disorders have higher risk for clinical events after VTE than those without.
Purpose
We sought to evaluate the clinical characteristics, management strategies, and long-term outcomes of patients with autoimmune disorders after excluding patients with active cancer in a large observational database in Japan.
Methods
The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE. After excluding patients with active cancer, the current study population consisted of 2332 patients, who were divided into 2 groups: patients with autoimmune disorders and those without. We estimated the cumulative incidences of the clinical outcomes. To adjust for the clinically relevant confounders, we used the multivariable Cox proportional hazard model to estimate the hazard ratio (HR) and their 95% confidence interval (CI) for the risk of patients with autoimmune disorders relative to those without for the clinical outcome measures. Furthermore, we added corticosteroids use at discharge to explore the effect of corticosteroids use.
Results
There were 188 patients (8.1%) with autoimmune disorders and 2144 patients (92%) without autoimmune disorders. Patients with autoimmune disorders were more often women (74%), and more often received corticosteroids at discharge (69%). The discontinuation rate of anticoagulation therapy was not significantly different between patients with autoimmune disorders and those without (38.0% vs. 39.7% at 3-year, P=0.35). The cumulative 5-year incidences of recurrent VTE and major bleeding were significantly higher in patients with autoimmune disorders than in those without (recurrent VTE: 14.3% vs. 8.3%, P=0.01; major bleeding: 14.9% vs. 8.8%, P=0.02). Even after adjusting confounders of patient characteristic, the excess risk of patients with autoimmune disorders relative to those without remained significant for recurrent VTE (HR 1.81, 95% CI 1.08–2.88, P=0.03) and major bleeding (HR 1.70, 95% CI 1.05–2.63, P=0.03). However, after adjusting for corticosteroids use at discharge, the excess risk was no longer significant for recurrent VTE (HR 1.42, 95% CI 0.75–2.61, P=0.27) nor major bleeding (HR 1.53, 95% CI 0.84–2.69, P=0.16).
Conclusions
Patients with autoimmune disorders had a higher risk for recurrent VTE and major bleeding than those without, and the excess risk could at least partly be attributable to corticosteroids use.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation
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Affiliation(s)
- Y Yamashita
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Morimoto
- Hyogo Medical University, Department of Clinical Epidemiology, Nishinomiya, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Hara H, Shiomi H, Van Klaveren D, Kent D, Steyerberg EW, Garg S, Onuma Y, Kimura T, Serruys PW. Long-term prediction of mortality and comparative treatment benefit following percutaneous or surgical revascularization. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The SYNTAX score II 2020 (SSII-2020), which was derived and externally validated from randomized trials, was designed to predict death following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease and/or left main disease. We aimed to investigate its value in identifying the safest modality of revascularization in a non-randomized setting.
Methods
Five-year mortality was assessed in 7362 patients with three-vessel disease and/or left main disease enrolled in a Japanese PCI/CABG registry. New-generation drug eluting stents and imaging guidance became the default PCI strategy during enrolment of the last cohort. The discriminative ability of the SSII-2020 for 5-year mortality was assessed using Harrell's C statistic (C-index). Agreement between observed and predicted rates of all-cause mortality following either PCI or CABG and treatment benefit (absolute risk difference) for this outcome were assessed by calibration plots.
Results
The SSII-2020 had helpful discrimination (C-index = 0.72) and good calibration (intercept = −0.11, slope = 0.92) for 5-year mortality. The absolute risk difference in mortality between CABG and PCI (treatment benefit) was well calibrated when the whole population was grouped into quarters according to the predicted absolute risk difference of 5-year mortality. The observed differences in survival in favor of CABG were 4.2% (0.1 to 8.2%, log-rank p=0.05) and 8.5% (3.8 to 13.2%, log-rank p<0.01) in the respective third and fourth quarters. In contrast, the observed differences in survival were not significantly different in either the first (3.0% [−0.8 to 6.8%, log-rank p=0.12]) or the second quarter (1.3% [−2.4 to 5.1%, log-rank p=0.39]).
Conclusions
The SSII-2020 is well able to predict death at 5 years – and the mortality difference between PCI and CABG, and therefore has the potential to support decision making on revascularization in patients with three-vessel disease and/or left main coronary artery disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Hara
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - H Shiomi
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - D Van Klaveren
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - D Kent
- Tufts Medical Center, Inc., Boston, United States of America
| | - E W Steyerberg
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - S Garg
- Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Y Onuma
- National University of Ireland, Galway, Ireland
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - P W Serruys
- National University of Ireland, Galway, Ireland
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Yamashita Y, Amano H, Morimoto T, Kimura T. Risk factors of recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism: from the COMMAND VTE Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Patients with venous thromboembolism (VTE), including pulmonary embolism (PE), have a long-term risk of recurrence, and anticoagulation therapy is recommended for the prevention of recurrence. The latest 2019 European Society of Cardiology (ESC) guideline classified the risks of recurrence into low- (<3%/year), intermediate- (3–8%/year), and high- (>8%/year) risk, and recommended the extended anticoagulation therapy of indefinite duration for high-risk patients as well as intermediate-risk patients. However, extended anticoagulation therapy of indefinite duration for all of intermediate-risk patients have been a matter of active debate. Thus, additional risk assessment of recurrence in intermediate-risk patients might be clinically relevant in defining the optimal duration of anticoagulation therapy. Furthermore, bleeding risk during anticoagulation therapy should also be taken into consideration for optimal duration of anticoagulation therapy. However, there are limited data assessing the risk of recurrence as well as bleeding in patients with intermediate-risk for recurrence based on the classification in the latest 2019 ESC guideline.
Purpose
The current study aimed to identify the risk factors of recurrence as well as major bleeding in patients with intermediate-risk for recurrence, using a large observational database of VTE patients in Japan.
Methods
The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy.
Results
In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37).
Conclusions
Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation
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Affiliation(s)
- Y Yamashita
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Amano
- Kurashiki Central Hospital, Department of Cardiology, Kurashiki, Japan
| | - T Morimoto
- Hyogo Medical University, Department of Clinical Epidemiology, Nishinomiya, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nishimoto Y, Yamashita Y, Morimoto T, Saga S, Sato Y, Kimura T. Risk factors of recurrence in patients with cancer-associated venous thromboembolism: from the COMMAND VTE Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2842] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Cancer is a strong risk factor for the development of venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT). Patients with VTE have a long-term risk of recurrence, which can be prevented by anticoagulation therapy. Prolonged anticoagulation therapy is recommended for patients with cancer-associated VTE, although the risk of recurrence might depend on the individual patient.
Purpose
We aimed to identify the risk factors of recurrence in patients with cancer-associated VTE.
Methods
The COMMAND VTE Registry is a multicenter retrospective registry enrolling 3027 consecutive patients with acute symptomatic VTE among 29 Japanese centers between January 2010 and August 2014. The present study population consisted of 695 cancer-associated VTE patients. The primary outcome measure in the present study was recurrent VTE, which was defined as PE and/or DVT with symptoms accompanied by confirmation of a new thrombus or exacerbation of the thrombus by objective imaging examinations or autopsy. Discontinuation of anticoagulation was defined as a withdrawal of anticoagulation therapy lasting >14 days for any reason. We selected clinically relevant variables and variables with P values <0.1 in a univariate analysis as potential risk factors, and constructed a multivariable Cox proportional hazard model for recurrent VTE incorporating the anticoagulation therapy status as a time-updated covariate.
Results
Among the 695 study patients, recurrent VTE occurred in 78 patients, of whom 54 (69%) occurred within 6 months. The cumulative incidence of recurrent VTE was 7.7% at 3-months, 8.9% at 6-months, 11.8% at 1-year, and 17.7% at 5-years. The cumulative incidence of discontinuation of anticoagulation therapy was 18.0% at 3-months, 29.5% at 6-months, 43.4% at 1-year, and 66.5% at 5-years. The cumulative 5-year incidence of recurrent VTE was most frequent in patients with uterus/ovary cancer (26.0%), followed by those with lung cancer (24.7%). The multivariable Cox proportional hazard model revealed that chronic kidney disease (HR, 2.27; 95% CI, 1.36–3.77, P=0.002), a high D-dimer level at the time of VTE diagnosis (HR, 2.85; 95% CI, 1.71–4.74, P<0.001), advanced cancer (HR, 1.69; 95% CI, 1.05–2.72, P=0.03) and discontinuation of anticoagulation therapy (HR, 2.66; 95% CI, 1.53–4.63, P<0.001) were independently associated with an increased risk of recurrent VTE. No cancer site was independently associated with an increased risk for recurrent VTE when adjusting for the above mentioned risk factors in the multivariable Cox proportional hazard model, although the risk of recurrent VTE numerically differed according to the cancer site.
Conclusions
Among patients with cancer-associated VTE, chronic kidney disease, a high D-dimer level at the time of VTE diagnosis, advanced cancer, and discontinuation of anticoagulation therapy were independent risk factors of recurrence.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation Figure 1Figure 2
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Affiliation(s)
- Y Nishimoto
- Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Y Yamashita
- Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - T Morimoto
- Hyogo College of Medicine, Department of Clinical Epidemiology, Nishinomiya, Japan
| | - S Saga
- Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Y Sato
- Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
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Matsuyama T, Endo H, Yamamoto H, Takemasa I, Uehara K, Hanai T, Miyata H, Kimura T, Hasegawa H, Kakeji Y, Inomata M, Kitagawa Y, Kinugasa Y. Outcomes of robot-assisted versus conventional laparoscopic low anterior resection in patients with rectal cancer: propensity-matched analysis of the National Clinical Database in Japan. BJS Open 2021; 5:6374226. [PMID: 34553225 PMCID: PMC8458638 DOI: 10.1093/bjsopen/zrab083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/14/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Robot-assisted laparoscopic surgery has several advantages over conventional laparoscopy. However, population-based comparative studies for low anterior resection are limited. This article aimed to compare peri-operative results of robot-assisted low anterior resection (RALAR) and laparoscopy. METHODS This retrospective cohort study used data from patients treated with RALAR or conventional laparoscopic low anterior resection (CLLAR) between October 2018 and December 2019, as recorded in the Japanese National Clinical Database, a data set registering clinical information, perioperative outcomes, and mortality. Of note, the registry does not include information on the tumour location (centimetres from the anal verge) and diverting stoma creation. Perioperative outcomes, including rate of conversion to open surgery, were compared between RALAR and CLLAR groups. Confounding factors were adjusted for using propensity score matching. RESULTS Of 21 415 patients treated during the study interval, 20 220 were reviewed. Two homogeneous groups of 2843 patients were created by propensity score matching. The conversion rate to open surgery was significantly lower in the RALAR group than in the CLLAR group (0.7 versus 2.0 per cent; P < 0.001). The RALAR group had a longer operating time (median: 352 versus 283 min; P < 0.001), less intraoperative blood loss (15 versus 20 ml; P < 0.001), a lower in-hospital mortality rate (0.1 versus 0.5 per cent; P = 0.007), and a shorter postoperative hospital stay (median: 13 versus 14 days; P < 0.001) compared with the CLLAR group. The CLLAR group had a lower rate of readmission within 30 days (2.4 versus 3.3 per cent; P = 0.045). CONCLUSION These data highlight the reduced conversion rate, in-hospital mortality rate, intraoperative blood loss, and length of postoperative hospital stay for rectal cancer surgery in patients treated using robot-assisted laparoscopic surgery compared with laparoscopic low anterior resection.
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Affiliation(s)
- T Matsuyama
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - H Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - I Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - K Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Hanai
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - T Kimura
- Project Management Subcommittee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - H Hasegawa
- Project Management Subcommittee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Y Kakeji
- Database Committee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - M Inomata
- Department of Gastroenterological and Paediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Y Kitagawa
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Y Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Shiono Y, Matsuo H, Fujita H, Tanaka N, Ogasawara Y, Kawamura I, Katayama Y, Matsuo A, Kawase Y, Kakuta T, Takashima H, Yokoi H, Ohira H, Suwa S, Oguri M, Yamamoto F, Kubo T, Akasaka T, Shiono Y, Katayama Y, Hironori K, Kubo T, Akasaka T, Tanaka N, Yamashita J, Fujita H, Matsuo A, Matsuo H, Kawase Y, Kawamura I, Kakuta T, Hoshino M, Sugano T, Takashima H, Amano T, Yokoi H, Yamamoto Y, Nozaki Y, Machida M, Kobori M, Kikuchi T, Ohira H, Yoshino H, Ishiguro H, Wakabayashi Y, Kondo T, Terai H, Suwa T, Kimura T, Kawajiri T, Hirohata A, Uemura S, Neishi Y, Sakamoto T, Yamada M, Okeie K, Hishikari K, Oguri M, Uetani T, Saegusa T, Yamamoto F, Yamada M. Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis. JACC: Asia 2021; 1:230-241. [PMID: 36338166 PMCID: PMC9627917 DOI: 10.1016/j.jacasi.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 01/10/2023]
Abstract
Background In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure–derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated. Objectives The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory–based environment. Methods In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease. Results Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUCdiastolic FFR: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUCFFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113). Conclusions Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906)
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48
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Matsubara H, Kimura T, Miyao R, Shin Y, Ikeda N. Relation between ionic surfactant concentration and thickness of foam film stabilized by ionic – nonionic surfactant mixed adsorbed films. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2021.126915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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Fukaya Y, Kimura T, Yoshimura K, Umemura K, Kawamoto H. A Dose-Confirmation Phase 1 Study to Evaluate the Safety and Pharmacology of Glucarpidase in Healthy Volunteers. Clin Pharmacol Drug Dev 2021; 11:364-371. [PMID: 34435467 PMCID: PMC9292509 DOI: 10.1002/cpdd.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 11/14/2022]
Abstract
Glucarpidase rapidly decomposes methotrexate. A phase 1 study of glucarpidase in an open‐label, randomized parallel group was conducted to evaluate the safety, pharmacokinetics, and other pharmacologic effects in Japanese healthy volunteers without methotrexate treatment. A dose of 50 U/kg (n = 8) or 20 U/kg (n = 8) of glucarpidase was administered as an intravenous injection, with 1 repeated dose at 48 hours after the first dose. No dose‐limiting toxicities, no significant clinical examination findings, and no clinically relevant differences between dose levels were observed. The pharmacokinetic parameters at a first dose of 20 or 50 U/kg were similar to those at a second dose and were as follows: half‐life, 7.45 and 7.25 hours; area under the plasma concentration–time curve from time 0 to infinity, 8.25 and 19.05 μg·h/mL; total clearance, 4.85 and 5.47 mL/min; and volume of distribution during the elimination phase, 3.12 and 3.41 L, respectively. The area under the plasma concentration–time curve increased in a generally linear dose‐proportional manner. An ethnicity specificity in the pharmacokinetic profile was not observed in Japanese volunteers. The serum folate concentration decreased after glucarpidase administration in all the volunteers. The production of anti‐glucarpidase antibody was observed in many cases in both cohorts. Although the long‐term effect of anti‐glucarpidase antibody will need to be investigated in the future, the effects produced by the anti‐glucarpidase antibody were not influenced by the pharmacokinetics of glucarpidase within 96 hours after the first dose. The observed safety and tolerability, pharmacokinetics, and pharmacodynamics support the continued evaluation of glucarpidase in the patients with lethal methotrexate toxicities.
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Affiliation(s)
- Yutaka Fukaya
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Umemura
- Department of Pharmacology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Kawamoto
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
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50
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Hashimoto N, Kimura T, Hamada Y, Niwa T, Hanai Y, Chuma M, Fujii S, Matsumoto K, Shigemi A, Kawamura H, Takahashi Y, Takesue Y. Candidates for area under the concentration-time curve (AUC)-guided dosing and risk reduction based on analyses of risk factors associated with nephrotoxicity in vancomycin-treated patients. J Glob Antimicrob Resist 2021; 27:12-19. [PMID: 34371241 DOI: 10.1016/j.jgar.2021.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/03/2021] [Revised: 04/22/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Compared with vancomycin trough concentration (Cmin)-guided dosing, area under the concentration-time curve (AUC)-guided dosing is associated with decreased acute kidney injury (AKI). However, whether Cmin-guided or AUC-guided dosing should be used in patients other than those with serious MRSA infections remains uncertain. The purposes of this multicentre study were to identify risk factors for early- and late-phase vancomycin-induced AKI and to identify candidates for AUC-guided dosing, rather than Cmin-guided dosing, who require a more accurate dose titration to reduce the AKI risk. METHODS A multivariate logistic regression analysis was applied to identify risk factors for AKI. Additionally, the cut‑off day for AKI onset, cut-off Cmin for AKI, safe Cmin for reduced AKI risk and probability of AKI were calculated. RESULTS In total, 8.4% (159/1882) of patients developed AKI. AKI occurred within the first 7 days of therapy (early phase) in the vast majority of patients. Significant risk factors for AKI during the early phase were identified as Cmin > 20 mg/L, ICU stay, concurrent diuretic or piperacillin/tazobactam use, and pre-existing renal dysfunction. A temporarily elevated Cmin (>15-20 mg/L) was not associated with a greater risk of AKI. In patients with risk factors, the cut-off Cmin for AKI and the estimated safe Cmin for reduced AKI risk were 18.8-21.0 mg/L and <11.7-13.5 mg/L, respectively. CONCLUSION Patients with known AKI risk factors require a low target Cmin. The presence of several risk factors for AKI may indicate a need for more accurate dose titration using AUC-guided dosing.
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Affiliation(s)
- Naoto Hashimoto
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan.
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota, Tokyo 143-8541, Japan
| | - Masayuki Chuma
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramotocho, Tokushima, Tokushima 770-8503, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, 291 Minami 1-jo, Nishi 16-chome, Chuo, Sapporo, Hokkaidou 060-8556, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato, Tokyo 105-8512, Japan
| | - Akari Shigemi
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan
| | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
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