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Miyamae T, Manabe Y, Sugihara T, Umezawa N, Yoshifuji H, Tamura N, Abe Y, Furuta S, Kato M, Kumagai T, Nakamura K, Nagafuchi H, Ishizaki J, Nakano N, Atsumi T, Karino K, Amano K, Kurasawa T, Ito S, Yoshimi R, Ogawa N, Banno S, Naniwa T, Ito S, Hara A, Hirahara S, Uchida HA, Onishi Y, Murakawa Y, Komagata Y, Nakaoka Y, Harigai M. POS0794 PREGNANCY AND CHILDBIRTH IN TAKAYASU ARTERITIS IN JAPAN – A NATIONWIDE RETROSPECTIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTakayasu arteritis (TAK), a granulomatous large vessel vasculitis, mainly involves the aorta and its proximal branches and commonly occurs in young females. However, studies of pregnancy in women with TAK are sparse and limited, probably due to the rarity of the disease.ObjectivesThe purpose of this study was to understand the status quo of medical treatments of the primary disease and outcomes of pregnancy in patients with TAK, and birth outcomes of the children in Japan.MethodsPatients with TAK who conceived after the onset of the disease and were managed at medical facilities participating in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS) were retrospectively enrolled in this study. The following information was collected from patients who had a live-born baby: age at diagnosis of TAK, disease classification, age at delivery, treatments before and during pregnancy, complications during pregnancy, birth outcomes of the children, and changes in disease activity during pregnancy and after delivery.ResultsFifty-one cases and 69 pregnancies from 19 ethics committee-approved centers were enrolled during the study period 2019–2021. Of these, 49 cases and 66 pregnancies (95.7%) resulted in delivery and live-born babies. The Numano classification of the 49 cases was as follows: type I, 11; type IIa, 15; type IIb,12; type III, 1; type IV, 1; type V, 9; with type IIa being the most common. The age of diagnosis was 22 years (13–37 years, year of diagnosis 1965–2017), the median age of the delivery of 66 pregnancies was 31 years (year of delivery 1969-2021), and the median duration of illness at delivery was nine years. There were 34 planned pregnancies (51.5%, including four pregnancies by artificial insemination/ovulation induction). Preconception therapy included prednisolone (PSL) in 51 pregnancies (77.3%, median dose 7.5 mg (range 4–30 mg)/day), immunosuppressive drugs in 18 pregnancies (27.3%, azathioprine 8, tacrolimus 7, methotrexate 4, cyclosporin A 1, and colchicine 1), biologics in 12 pregnancies (18.1%, infliximab 6, tocilizumab 5, and adalimumab 1), antihypertensive drugs in 5 pregnancies (7.6%). Surgical treatment had been performed before pregnancy in 6 cases (aortic root replacement 2, subclavian artery dilatation 1, subclavian artery bypass 1, subclavian artery stenting 1, and ascending aorta semicircular artery replacement 1). Medications used during the course of pregnancy included PSL in 48 pregnancies (72.7%, median dose 8 mg (range 4–30 mg)/day, increased in 13 pregnancies, decreased in 1 pregnancy), immunosuppressants in 13 pregnancies (19.7%, azathioprine 6, tacrolimus 6, and cyclosporin A 1), biologics 9 pregnancies (13.6%, infliximab 4, tocilizumab 4, and adalimumab 1). Immunosuppressants and biologics were discontinued in five and four pregnancies after conception. Complications during pregnancy were observed in 20 pregnancies (30.3%), with hypertension being the most common. Complications related to TAK or its treatment were severe infections in two pregnancies and aneurysm enlargement due to increased circulating plasma volume in one pregnancy. Aortic arch replacement was performed after delivery for the latter case. Relapse of TAK was observed in 4 pregnancies (6.1%) during pregnancy and in 8 pregnancies (12.1%) after delivery. One pregnancy resulted in restenosis of subclavian artery for which dilatation procedure was performed prior to the pregnancy. There were 13/66 (19.7%) preterm infants and 17/59 (28.8%) low birth weight infants; all but one had a birth weight of more than 2,000 g and no had serious postnatal abnormalities. Forty-three (82.7%) of the 52 confirmed infants were breastfeed fully or mixed.ConclusionMost of the pregnancies in patients with TAK were successfully delivered while they had low disease activity at a dose of less than 10 mg/day of PSL. Relapse occurred during pregnancy and after delivery in some cases. The babies tended to have low birth weight, but 82.7% of them were breastfed without serious complications.Disclosure of InterestsTakako Miyamae: None declared, Yusuke Manabe: None declared, takahiko sugihara Speakers bureau: TS has received honoraria from Abbvie Japan Co., Ltd., AsahiKASEI Co., Ltd., Astellas Pharma Inc., Ayumi Pharmaceutical, Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi-Tanabe Pharma Co., Ono Pharmaceutical, Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., and UCB Japan Co., Grant/research support from: TS has received research grants from AsahiKASEI Co., Ltd., Daiichi Sankyo., Chugai Pharmaceutical Co., Ltd., and Ono Pharmaceutical., Natsuka Umezawa: None declared, Hajime Yoshifuji Speakers bureau: HY has received lecture fees from Janssen and Chugai., Naoto Tamura: None declared, Yoshiyuki Abe: None declared, Shunsuke Furuta Speakers bureau: Chugai Pharmaceutical Co.,Ltd.DaiichiSankyo Co.,Ltd.Asahi-Kasei Pharma Corporation, Manami Kato: None declared, Takashi Kumagai: None declared, Kaito Nakamura: None declared, Hiroko Nagafuchi: None declared, Jun Ishizaki: None declared, Naoko Nakano: None declared, Tatsuya Atsumi Speakers bureau: Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Pfizer Inc., AbbVie Inc., Eisai Co. Ltd., Daiichi Sankyo Co., Ltd., Bristol-Myers Squibb Co., UCB Japan Co. Ltd., Eli Lilly Japan K.K., Novartis Pharma K.K., Eli Lilly Japan K.K., Kyowa Kirin Co., Ltd.,TAIHO PHARMACEUTICAL CO., LTD., Consultant of: AstraZeneca plc., MEDICAL & BIOLOGICAL LABORATORIES CO., LTD., Pfizer Inc., AbbVie Inc., ONO PHARMACEUTICAL CO. LTD.,Novartis Pharma K.K., Nippon Boehringer Ingelheim Co., Ltd., Grant/research support from: Astellas Pharma Inc., TAIHO PHARMACEUTICAL CO., LTD.AbbVie Inc., Nippon Boehringer Ingelheim Co., Ltd.,Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co. Ltd., Otsuka Pharmaceutical Co., Ltd. and Pfizer Inc. Alexion Inc., TEIJIN PHARMA LIMITED., Kohei Karino: None declared, Koichi Amano Speakers bureau: AbbVie GK, Asahi-Kasei Pharma, Astellas, Chugai Pharmaceutical Co.Ltd., Eisai, Eli Lilly, GlaxoSmithKlein, Janssen Pharma, Pfizer Japan, Grant/research support from: Asahi-Kasei Pharma,Chugai Pharmaceutical Co.Ltd., Takahiko Kurasawa: None declared, Shuichi Ito: None declared, Ryusuke Yoshimi: None declared, Noriyoshi Ogawa: None declared, Shogo Banno: None declared, Taio Naniwa Speakers bureau: Chugai, Tanabe, Abbbvie, Eisai, Grant/research support from: Chugai, Tanabe, Abbbvie, Eisai, Satoshi Ito Speakers bureau: SI has received speaker’s fees from pharmaceutical companies., Akinori Hara: None declared, Shinya Hirahara: None declared, Haruhito A. Uchida: None declared, Yasuhiro Onishi: None declared, Yohko Murakawa Speakers bureau: Astellas, UCB, Chugai, AbbVie, Grant/research support from: Chugai, AbbVie, Yoshinori Komagata: None declared, Yoshikazu Nakaoka: None declared, Masayoshi Harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Kissei Pharmaceutical Co., Ltd., Novartis Japan, Pfizer Japan Inc., Mitsubishi Tanabe Pharma Co., Teijin Pharma Ltd and UCB Japan., Consultant of: MH is a consultant for AbbVie, Boehringer-Ingelheim, Kissei Pharmaceutical Co., Ltd., and Teijin Pharma.
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Sugihara T, Uchida HA, Yoshifuji H, Maejima Y, Naniwa T, Katsumata Y, Okazaki T, Ishizaki J, Murakawa Y, Ogawa N, Dobashi H, Horita T, Tanaka Y, Furuta S, Takeuchi T, Komagata Y, Nakaoka Y, Harigai M. POS0336 PATTERNS OF LARGE-VESSEL LESIONS AND POOR TREATMENT OUTCOMES IN PATIENTS WITH LARGE-VESSEL GIANT CELL ARTERITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant cell arteritis (GCA) is characterized by cranial symptoms and large-vessel lesions (LVL) in the aorta or its branches. We retrospectively analyzed the Japanese patients newly diagnosed as GCA between 2007 and 2014, and subsequently treated with glucocorticoid (GC). The imaging studies revealed that LVLs were observed in approximately half of the GCA patients, and the LVLs were significantly associated with the increased probability of poor treatment outcomes (1).Objectives:The objective of this study is to evaluate whether the distribution of LVLs of GCA was associated with poor treatment response.Methods:In a retrospective, multi-centric, nationwide registry of GCA patients treated with GCs between 2007 and 2014, 68 newly-diagnosed GCA with LVLs by imaging were detected. All investigators were members of Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS). Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 104 weeks) were primarily evaluated. Cumulative rates and median time to the first event were analyzed by the Kaplan-Meier method and the log-rank test. Associated factors with the outcomes were analyzed by using the Cox proportional hazard model.Results:The mean age was 70.5 years, and 70.6% were women. Twenty-seven (39.7%) of the 68 patients were diagnosed as having GCA by both positive temporal artery biopsy and positive imaging, and 41 (60.3%) by positive imaging. Aortic lesions were detected in 72.1% (group 2, n=49) of the 68 GCA patients with LVLs. Patients without aortic lesions were categorized into two phenotypes: large-vessel GCA with subclavian lesions (group 1, n=9) and atypical large-vessel GCA without subclavian lesions (group 3, n=10). Cranial lesions were observed in 66.7%, 55.1%, and 80.0% in the group 1, 2, and 3, respectively. The initial mean dose (SD) of prednisolone was 0.74 (0.26) mg/kg/day, and 20.6 % received methotrexate for remission induction therapy. Baseline dose of GCs and mean time to achievement of low-dose GCs (prednisolone ≤ 5 mg/day) was not significantly different among the three groups.Overall, 35 (51.5%) of the 68 patients had the event of poor treatment outcomes. Eleven patients were not able to achieve clinical remission by week 24. Relapse after achievement of clinical remission was reported in total of 24 patients; 9 between week 0 and 24, 12 between week 24 and 52, 3 between week 52 and 104. The cumulative rate of events of poor treatment outcomes over the two years was 11.1% in patients with group 1, 55.3% in those with group 2, and 88.0% in those with group 3. Mean time to events was significantly different among the three groups. Multivariable analysis showed the risk of poor treatment outcomes was likely to decrease in the group 1 (hazard ratio 0.14 [95% CI 0.02-1.03], p=0.054), while it increased in the group 3 (hazard ratio 2.22 [95% CI 1.06-4.68], p=0.035).Conclusion:The distribution of LVLs were associated with poorer treatment outcomes. A half of the patients with aortic lesions had poor treatment outcomes while subclavian arteritis without aortic lesions had better clinical outcomes. Atypical large vessel-GCA without the aortic and subclavian artery involvement was the worst prognostic phenotype of LV-GCA. Extent of LVLs by imaging should be considered when determining the treatment strategy for GCA.References:[1]Sugihara T, et al. Arthritis Res Ther. 2020;22(1):72Acknowledgements:The authors would like to acknowledge Mitsuaki Isobe (Sakakibara Heart Institute), Yoshihiro Arimura (Kichijoji Asahi Hospital), and all the investigators in the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS). In addition to the authors, the following investigators and institutions participated in this study: Department of Internal Medicine, Juntendo University Koshigaya Hospital (Shigeto Kobayashi); Niigata Rheumatic Center (Satoshi Ito); Niigata Prefectural Shibata Hospital (Noriyuki Homma).Disclosure of Interests:takahiko sugihara Speakers bureau: TS has received honoraria from Abbvie Japan Co., Ltd., AsahiKASEI Co., Ltd., Astellas Pharma Inc., Ayumi Pharmaceutical, Bristol Myers Squibb K.K., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi-Tanabe Pharma Co., Ono Pharmaceutical, Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., and UCB Japan Co. Ltd., Grant/research support from: TS has received research grants from AsahiKASEI Co., Ltd., Daiichi Sankyo., and Ono Pharmaceutical., Haruhito A. Uchida Grant/research support from: HAU belongs to the Department of Chronic KidneyDisease and Cardiovascular Disease which is endowed by Chugai Pharmaceutical, MSD, Boehringer Ingelheim, and Kawanishi Holdings., Hajime Yoshifuji Speakers bureau: HY has received lecture fees from Chugai Pharmaceutical Co., Ltd. and Nihon Medi-Physics Co., Ltd., Yasuhiro Maejima Speakers bureau: YM have received honoraria from Chugai Pharmaceutical Co., Ltd.., Taio Naniwa Speakers bureau: TN has received lecture fees from Chugai Pharmaceutical Co., Ltd.., Grant/research support from: TN has received research grants from Chugai Pharmaceutical Co., Ltd.., Yasuhiro Katsumata Speakers bureau: YK has received honoraria from Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., Sanofi K.K., Pfizer Japan Inc., and Asahi Kasei Pharma Corp., Takahiro Okazaki Grant/research support from: TO has received research grants from Chugai Pharmaceutical Co., Ltd., Eisai Pharmaceutical., and Actelion, Jun Ishizaki: None declared, Yohko Murakawa Speakers bureau: YM has received honoraria from Abbvie, Astellas, Ayumi Pharmaceutical, Bristol Myers Squibb, Chugai Pharmaceutical, Eisai Pharmaceutical, Janssen Pharmaceutical, Kissei Pharmaceutical, Nippon Kayaku, Pfizer Pharmaceutical, Takeda Pharmaceutical, UCB Pharmaceutical, Grant/research support from: YM has received research grant support from Asahi Kasei Pharma, AbbVie Japan, Chugai Pharmaceutical, Daiichi Sankyo, Eisai Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Gilead Sciences Inc, Janssen Pharmaceutical, and Teijin Pharma., Noriyoshi Ogawa: None declared, Hiroaki Dobashi: None declared, Tetsuya Horita: None declared, Yoshiya Tanaka Speakers bureau: YT has received consulting fees, speaking fees, and/or honoraria from Daiichi-Sankyo, Astellas, Pfizer, Mitsubishi-Tanabe, Bristol-Myers, Chugai, YL Biologics, Eli Lilly, Sanofi, Janssen, UCB, Grant/research support from: YT has received research grants from Mitsubishi-Tanabe, Takeda, Bristol-Myers, Chugai, Astellas, Abbvie, MSD, Daiichi-Sankyo, Pfizer, Kyowa- Kirin, Eisai, Ono., Shunsuke Furuta: None declared, Tsutomu Takeuchi Speakers bureau: TT has served on speakers’ fees for AbbVie, Bristol-Myers Squibb, Chugai, Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Teijin, Takeda, and Novartis., Consultant of: TT has received consulting fees from Astra Zeneca, Eli Lilly, Novartis, Mitsubishi Tanabe, AbbVie, Nippon Kayaku, Janssen, Astellas, Taiho, Chugai, Taisho Toyama, GlaxoSmithKline, and UCB., Grant/research support from: TT has received research grants from Astellas, Chugai, Daiichi Sankyo, Takeda, AbbVie, Asahi Kasei, Mitsubishi Tanabe, Pfizer, Eisai, AYUMI, Nippon Kayaku, and Novartis., Yoshinori Komagata Speakers bureau: YK has received speakers’ fees from Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Daiichi Sankyo, AbbVie, Nippon Shinyaku, Towa., Consultant of: YK has received consulting fees from Chugai, Kyowa Hakko Kirin, Asahi Kasei, UCB, Yoshikazu Nakaoka Speakers bureau: YN has received lecture fees from Astellas, Takeda, Daiichi Sankyo, Actelion, and Japan Blood Products Organization (JB)., Consultant of: YN has received consulting fees and/or lecture fees from AbbVie and Chugai, Grant/research support from: YN has received research grants from Chugai and Bayer Yakuhin, Ltd, masayoshi harigai Speakers bureau: MH has received speaker’s fee from AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Consultant of: MH is a consultant for AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: MH has received research grants from AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd.
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Kondo M, Murakawa Y, Honda M, Moriyama M. Remission with tocilizumab in a patient with erosive hand osteoarthritis. Scand J Rheumatol 2021; 50:485-487. [PMID: 33729085 DOI: 10.1080/03009742.2020.1867238] [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: 10/21/2022]
Affiliation(s)
- M Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Y Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Department of General Treatment Center for Intractable Diseases, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - M Honda
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - M Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Ikeda T, Ogawa S, Kitazono T, Nakagawara J, Minematsu K, Miyamoto S, Murakawa Y, Iwashiro S, Hayashi Y, Okayama Y, Sunaya T, Sato S, Yamanaka S. Long-term outcomes of Japan-specific dosage of rivaroxaban in high-risk patients with non-valvular atrial fibrillation: analysis from the XAPASS. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0646] [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
XAPASS is a real-world, prospective, single-arm, observational study conducted as a post-marketing surveillance mandated by the health authority in Japan. Nowadays, direct oral anticoagulant therapy using factor Xa or thrombin inhibitor has been the standard of care for patients with non-valvular atrial fibrillation (NVAF) to prevent ischemic stroke. However, the clinical impact of reduced dosage (approved dose of 15 or 10 mg once daily in Japan is relatively reduced compared to global dosage) factor Xa inhibitor rivaroxaban in high-risk patients remains unclear.
Purpose
The present sub-analysis of XAPASS was carried out to assess long-term safety and effectiveness of reduced-dose rivaroxaban in high-risk NVAF patients for bleeding and thromboembolism.
Methods
All patients with NVAF who were newly started on rivaroxaban were eligible for surveillance. The principal safety outcome was a composite of major and non-major bleeding events, and the primary effectiveness outcome was a composite of ischaemic stroke, haemorrhagic stroke, non-central nervous system systemic embolism (non-CNS SE), and myocardial infarction (MI). In this present sub-analysis, high-risk patients were defined as those who had two of the following three risk factors: elderly (≥75 years old), low body weight (≤50 kg), and renal impairment (CrCl <50 mL/min).
Results
In total, 11,308 patients were enrolled between April 2012 and June 2014 from 1,419 hospitals, and overall data were analysed from 10,664 patients from whom data were collected. Among them, 3,694 patients matched the criteria for the high-risk patients defined in this sub-analysis, and 6,970 patients did not match the criteria (non-high-risk patients). The mean treatment duration was 791±673 days in the high-risk patients and 944±709 days in the non-high-risk patients. Mean patient age was 80.9±5.5 years and 69.0±9.0 years at baseline, respectively. Mean CHADS2 score was 2.8 and 1.8, and CHA2DS2-VASc score was 4.4 and 2.9, respectively. The rates of CHADS2 component comorbidities were lower in the non-high-risk patients except for diabetes mellitus. The incidence rates of any bleeding, major bleeding, and the primary effectiveness outcomes were 4.8, 1.6, and 2.1%/patient-year in the high-risk patients. The incidence rates of these clinical events in the non-high-risk patients were 3.3, 0.9, and 1.0%/patient-year, respectively.
Conclusions
Incidence rates of long-term bleeding and thromboembolism were higher in the high-risk patients than in the non-high-risk patients. However, the rates of these outcomes using the Japan-specific reduced dose were not so high. Furthermore, the balance between safety and effectiveness outcomes was within an acceptable range. The present study provides useful information for physicians to stratify high-risk patients using the reduced dose in daily clinical practice.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer Yakuhin Ltd.
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Affiliation(s)
- T Ikeda
- Toho University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - S Ogawa
- IUHW Mita Hospital, Tokyo, Japan
| | - T Kitazono
- Kyushu University Graduate School of Medical Sciences, Department of Medical and Clinical Science, Fukuoka, Japan
| | - J Nakagawara
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - K Minematsu
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - S Miyamoto
- Kyoto University Graduate School of Medicine, Department of Neurosurgery, Kyoto, Japan
| | - Y Murakawa
- Mizonokuchi Hospital, Teikyo University School of Medicine, The 4th Department of Internal Medicine, Kawasaki, Japan
| | - S Iwashiro
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - Y Hayashi
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - Y Okayama
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - T Sunaya
- Bayer Yakuhin Ltd., Research and Development, Osaka, Japan
| | - S Sato
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - S Yamanaka
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
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Honda M, Moriyama M, Kondo M, Kumakura S, Murakawa Y. Tofacitinib-induced remission in refractory adult-onset Still's disease complicated by macrophage activation syndrome. Scand J Rheumatol 2020; 49:336-338. [PMID: 32329389 DOI: 10.1080/03009742.2020.1729405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Honda
- Department of Rheumatology, Shimane University Faculty of Medicine , Izumo, Japan
| | - M Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine , Izumo, Japan
| | - M Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine , Izumo, Japan
| | - S Kumakura
- Department of Rheumatology, Shimane University Faculty of Medicine , Izumo, Japan.,Department of Medical Education and Research, Shimane University Faculty of Medicine , Izumo, Japan
| | - Y Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine , Izumo, Japan
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Honda M, Moriyama M, Kondo M, Kumakura S, Sumita Y, Murakawa Y. Three cases of autoimmune-associated haemophagocytic syndrome in dermatomyositis with anti-MDA5 autoantibody. Scand J Rheumatol 2019; 49:244-246. [DOI: 10.1080/03009742.2019.1653493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Honda
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - M Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - M Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - S Kumakura
- Department of Medical Education and Research, Shimane University Faculty of Medicine, Izumo, Japan
| | - Y Sumita
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Y Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
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Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Hirao K. P1865Incidence and predictors of invasively-treated pericardial effusion during catheter ablation of atrial fibrillation in Japan. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0615] [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
Purpose and method
Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent catheter ablation for atrial fibrillation (AF) in designated eight months from 2011 to 2017. We assessed the incidence and predictors of pericardial effusion (PE) as an early complication of AF ablation.
Results
More than two hundred EP centers reported the data of 13,233 AF ablation cases (age; 64.2±10.7 years, male; 72.6%, paroxysmal AF; 63.4%). Clinically significant complications occurred in 601 subjects (4.5%). Critical PE occurred in 116 patients (0.8%), while six of them required open-chest surgery. Overall complication rate did not show significant changes. In contrast, incidence of PE declined over time (2012:1.2%, 2017:0.5%, p=0.003). Multiple logistic regression analysis showed that seven factors were related with higher incidence of PE. Among these factors, primary extra-PV ablation and hypertrophic cardiomyopathy (HCM) were more remarkably associated with higher rate of PE (PVI[−] vs. PVI[+]= 9.0% vs. 0.8%, OR 12.3, p<0.001; HCM: [+] vs. [−] = 2.6% vs. 0.8%, OR 3.26, p=0.001). Comorbidity of coronary artery disease (CAD) and use of CARTO system were related with lower PE rate (CAD: [+] vs [−] = 0.2% vs. 0.9%, OR 0.22 [p=0.034], CARTO: [+] vs [−] = 0.7% vs. 1.2%, OR 0.52 [p=0.001]). None of cryobaloon ablation, gender, type of AF, center volume, periprocedural oral anticoagulant, or left atrial diameter was significantly related with the occurrence of PE.
Conclusions
Incidence of critical PE decreased recently. HCM and primary extra-PV ablation were outstanding predictors of critical PE.
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Affiliation(s)
- Y Murakawa
- Teikyo University School of Medicine, Fourth Department of Internal Medicine, Kawasaki, Japan
| | - T Yamane
- Jikei University School of Medicine (Tokyo), Department of Cardiology, Tokyo, Japan
| | - M Goya
- Tokyo Medical and Dental University, Heart Rhythm Center, Tokyo, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Naito
- Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | | | - N Morita
- Tokai University Hachioji Hospital, Division of Cardiology, Hachioji, Japan
| | - A Nogami
- Tsukuba University, Cardiovascular Division, Tsukuba, Japan
| | - M Shoda
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Okumura
- Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan
| | - K Hirao
- Tokyo Medical and Dental University, Heart Rhythm Center, Tokyo, Japan
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Moriyama M, Wada Y, Minamoto T, Kondo M, Honda M, Murakawa Y. Unexpectedly lower proportion of placental transferred tocilizumab relative to whole immunoglobulin G: a case report. Scand J Rheumatol 2019; 49:165-166. [PMID: 31436129 DOI: 10.1080/03009742.2019.1639821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Y Wada
- Internal Medicine III, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - T Minamoto
- Department of Obstetrics, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - M Kondo
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - M Honda
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Y Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Internal Medicine III, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Hirao K. 359Do substrate modification in catheter ablation of atrial fibrillation increase the incidence acute complications: analysis of 10,795 procedures. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Murakawa
- Teikyo University School of Medicine, Fourth Department of Internal Medicine, Kawasaki, Japan
| | - T Yamane
- Jikei University School of Medicine (Tokyo), Tokyo, Japan
| | - M Goya
- Tokyo Medical and Dental University, Tokyo, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Naito
- Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - K Kumagai
- Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - N Morita
- Tokai University Hachioji Hospital, Hachioji, Japan
| | - A Nogami
- Tsukuba University, Tsukuba, Japan
| | - M Shoda
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Hirao
- Tokyo Medical and Dental University, Tokyo, Japan
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Murakawa Y, Yamane T, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Goya M, Hirao K. 1162Predictors of serious complications during and immediately after catheter ablation of atrial fibrillation in 8302 procedures: J-CARAF Study. Europace 2017. [DOI: 10.1093/ehjci/eux153.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Takeuchi T, Kaneko Y, Atsumi T, Tanaka Y, Inoh M, Kobayashi H, Amano K, Miyata M, Murakawa Y, Fujii T, Kawakami A, Yamanaka H, Yamamoto K, Miyasaka N, Mimori T, Tanaka E, Nagasawa H, Yasuoka H, Hirata S. SAT0257 Clinical and Radiographic Effects after 52-Week of Adding Tocilizumab or Switching to Tocilizumab in RA Patients with Inadequate Response to Methotrexate: Results from A Prospective Randomized Controlled Study (Surprise Study): Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Kondo M, Murakawa Y, Matsumura T, Moriyama M, Sumita Y, Harashima N, Harada M. AB0102 Differential Effects of CD4+T Cells and CD8+T Cells on the Induction of Osteoclasts from Human Monocytes. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1416] [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: 11/04/2022]
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13
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Gamoh M, Shimodaira H, Murakawa Y, Kato S, Amagai K, Isoge H, Niitani T, Itoh J, Yoshioka T, Ishioka C. Phase II Trial of mFOLFOX6/CapeOX Plus Bevacizumab with Oxaliplatin in a Stop and Go Fashion in Advanced mCRC. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Murakawa Y, Sakayori M. Thrombosis by Totally Implantable Central Venous Access System in the Upper ARM: 3FR Catheter Cases. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Murakawa Y, Nogami A, Shoda M, Naito S, Kumagai K, Inoue K, Miyauchi Y, Yamane T, Morita N, Okumura K. Oral anticoagulation therapy during catheter ablation for atrial fibrillation: J-CARAF registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Sumita Y, Murakawa Y, Sugiura T, Wada Y, Nagai A, Yamaguchi S. Elevated BAFF levels in the cerebrospinal fluid of patients with neuro-Behçet's disease: BAFF is correlated with progressive dementia and psychosis. Scand J Immunol 2012; 75:633-40. [PMID: 22340436 PMCID: PMC3437506 DOI: 10.1111/j.1365-3083.2012.02694.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuro-Behçet's disease (NBD) is a serious complication of Behçet's disease. Generally, NBD patients with a chronic course are refractory to immunosuppressive treatment, resulting in the deterioration of personality. In this study, levels of B cell-activating factor belonging to the TNF family (BAFF) were measured in the cerebrospinal fluid (CSF) from 18 patients with NBD, 27 patients with epidemic aseptic meningitis (AM), 24 patients with multiple sclerosis (MS) and 34 healthy controls. BAFF levels in patients with NBD were significantly elevated compared with healthy controls, but showed no statistically significant elevation compared with either of the disease controls. In contrast, CSF IL-6 levels were slightly elevated in patients with NBD and significantly elevated in patients with AM and MS compared with healthy controls. Patients with NBD were subdivided into two groups according to their clinical course (eight patients with a slowly progressive course presenting with psychosis and dementia and 10 patients with an acute course including aseptic meningitis, brainstem involvement and myelopathy). BAFF levels were significantly increased in those with a slowly progressive course compared with those with an acute course. CSF BAFF levels did not correlate with serum BAFF levels, CSF cell counts or CSF IL-6 levels in patients with NBD. These data suggested that BAFF was produced within the central nervous system and may be associated with the development of NBD, particularly with a progressive course.
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Affiliation(s)
- Y Sumita
- Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan
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17
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Kato S, Andoh H, Gamoh M, Yamaguchi T, Murakawa Y, Sasaki Y, Takahashi S, Shimodaira H, Yoshioka T, Ishioka C. A randomized pilot study comparing safety and efficacy of irinotecan plus S-1 (IRIS) plus bevacizumab (BV) and modified (m) FOLFIRI plus BV in patients (pts) with metastatic colorectal cancer (mCRC): First report of T-CORE0702. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
496 Background: Sequential combination with irinotecan (CPT-11) and S-1 (IRIS) is active and safe regimen against mCRC (ASCO2008, abstract #4107, T. Yoshioka et al. Br J Cancer 101: 1972-77, 2009). The aim of this prospective randomized pilot study was to compare safety (CTCAE v3.0, primary endpoint) and efficacy (RR and PFS, secondary endpoint) of IRIS with mFOLFIRI when these were used with BV. Methods: Sixty pts with mCRC were randomized to compare 30 pts for IRIS+BV (CPT-11 150 mg/m2 infusion on day 1, S-1 80 mg/m2 orally on day 3-16, q3w) with 30 pts for mFOLFIRI+BV (CPT-11 150mg/m2). 57 pts (IRIS arm 29, mFOLFIRI arm 28) were evaluable. Most of them were treated as first-line therapy. Results: Background of pts was well balanced among two arms. Although G3/4 hematological AEs profiles were similar between two arms, G2-4 neutropenia was significantly lower in IRIS arm than mFOLFIRI arm (56.6%, vs. 88.9%, p=0.01, χ2test). Among G3/4 nonhematological AEs, gastrointestinal toxicities were lower in IRIS arm than mFOLFIRI arm (anorexia: 3.5% vs. 17.9%, nausea: 0% vs. 7.1%, diarrhea: 6.9% vs. 14.3%, stomatitis: 0% vs. 3.6%). By χ2 test, nausea, vomiting and hair loss were significantly lower in IRIS arm than mFOLFIRI arm (p<0.05). GI-perforation, a BV-related severe AE, occurred in 2 pts only from mFOLFIRI arm and one of them was died as TRD. RRs (institutional evaluation) were 58.6% in IRIS (CR 2, PR 15, SD 11, and PD 1) and 55.1% in mFOLFIRI arm (CR 0, PR 16, SD 10, PD 2, and not evaluable 1). Our independent review committee will clarified definite RR and median PFS near future. Conclusions: Our IRIS+BV regimen is well tolerated, effective and appears to be a promising choice for pts with mCRC. [Table: see text]
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Affiliation(s)
- S. Kato
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - H. Andoh
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - M. Gamoh
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - T. Yamaguchi
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - Y. Murakawa
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - Y. Sasaki
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - S. Takahashi
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - H. Shimodaira
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - T. Yoshioka
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
| | - C. Ishioka
- Tohoku University, Sendai, Japan; Nakadori General Hospital, Akita, Japan; South Miyagi Medical Center, Ohgawara-Machi, Japan; Miyagi Cancer Center, Sendai, Japan; Yamagata University, Yamagata, Japan
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Kaji H, Kuroki Y, Murakawa Y, Funakawa I, Funasaka Y, Kanda F, Sugimoto T. Effect of alendronate on bone metabolic indices and bone mineral density in patients treated with high-dose glucocorticoid: a prospective study. Osteoporos Int 2010; 21:1565-71. [PMID: 19921083 DOI: 10.1007/s00198-009-1110-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY This prospective study, in the very early phase after initiation of glucocorticoid (GC) treatment, showed that alendronate was effective in suppressing accelerated bone resorption and subsequent decrease in bone mineral density (BMD) at the lumbar spine of patients with high-dose GC treatment. INTRODUCTION How bisphosphonates affect bone metabolism and BMD of patients with high-dose GC in the early phase, especially within 1 month is unclear. METHODS We examined the prospective effects of daily 5 mg alendronate on bone metabolism and BMD in 20 patients with high-dose GC (at least 40 mg prednisolone/day) and compared them to 34 high-dose GC-treated patients without alendronate. RESULTS Serum levels of calcium decreased at day 28 in the alendronate group. Urinary calcium excretion significantly increased after day 7 in both groups. The increase in serum parathyroid hormone (PTH) level at day 7 in the control group was not observed in the alendronate group, but PTH levels increased at day 28 and month 3 in the alendronate group. As for the bone turnover markers, the serum osteocalcin level decreased in both alendronate and control groups, but serum bone-type alkaline phosphatase levels did not show significant changes. Although the urinary type I collagen cross-linked N-telopeptide (NTX) level showed significant increases on days 7 and 28 in the control group; such early increases in urinary NTX were not observed in the alendronate group. Thereafter, the urinary NTX levels fell slowly in the alendronate group significantly. BMD at the lumbar spine significantly decreased from month 1 in the control group, whereas in the alendronate group, BMD at the lumbar spine maintained almost the same level at all time points observed. CONCLUSION Alendronate was effective in suppressing bone resorption and subsequent BMD decrease at the lumbar spine in patients with high-dose GC treatment.
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Affiliation(s)
- H Kaji
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Hayashi K, Yamamoto M, Murakawa Y, Yamauchi M, Kaji H, Yamaguchi T, Sugimoto T. Bone fragility in male glucocorticoid-induced osteoporosis is not defined by bone mineral density. Osteoporos Int 2009; 20:1889-94. [PMID: 19387764 DOI: 10.1007/s00198-009-0901-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Eighty-seven male Japanese subjects taking prednisolone > or = 5 mg for more than 6 months and 132 age- and body mass index (BMI)-matched control subjects were examined. Multiple regression analysis adjusted for age and BMI showed that spinal bone mineral density (BMD) in the prednisolone group was not associated with prevalent vertebral fractures (VFs). INTRODUCTION Glucocorticoid (GC) treatment is known to increase the risk for bone fractures. However, the association between VFs and BMD in GC-treated male patients remains unclear. METHODS Eighty-seven male subjects taking prednisolone > or = 5 mg for more than 6 months and 132 age- and BMI-matched control subjects were examined using lateral thoracic and lumbar spine radiographs and spine dual energy X-ray absorptiometry. RESULTS The presence of GC use was an independent risk factor for VFs adjusted for age and BMI (odds ratio 10.93, P < 0.001). By receiver operating characteristic analysis, the absolute BMD values for detecting VFs were higher and the sensitivity and specificity were lower in the GC group than in the control group (0.936 vs 0.825 g/cm(2) and 53.5% vs 74.0%, respectively). Multiple regression analysis adjusted for age and BMI showed that spinal BMD in the GC group was not associated with prevalent VFs, even after adding current and past maximum GC doses as independent variables. CONCLUSIONS These results show that lumbar BMD values are not associated with prevalent VFs in GC-treated male patients, suggesting that bone fragility in male GC users is affected by bone quality rather than by BMD.
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Affiliation(s)
- K Hayashi
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1, Enya-cho, Izumo, Shimane, 693-8501, Japan.
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Chowdhury MH, Nagai A, Terashima M, Sheikh A, Murakawa Y, Kobayashi S, Yamaguchi S. Chemokine-like factor expression in the idiopathic inflammatory myopathies. Acta Neurol Scand 2008; 118:106-14. [PMID: 18294340 DOI: 10.1111/j.1600-0404.2007.00990.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We evaluated the expression of chemokine-like factor (CKLF) in biopsied muscle fibers in inflammatory myopathies, non-inflammatory myopathies and neurologically diseased controls. MATERIALS AND METHODS We studied the expression of CKLF in 15 polymyositis (PM), five dermatomyositis (DM), 15 non-inflammatory myopathies and nine neurologically diseased patients by immunohistochemistry. RESULTS Chemokine-like factor was mostly expressed in small diameter muscle fibers surrounded by infiltrated lymphocytes of inflammatory myopathies patients. Parts of them were also positive for the staining of the developmental form of myosin heavy chain, a maker of regenerating muscle fibers. Thrombin immunoreactivity was observed in endomysium in PM and perimysium in DM. In vitro differentiation study showed a constitutive expression of CKLF in myoblasts that was abolished in myotubes during differentiation process and was induced again by thrombin. Thrombin regulates CKLF expression through protease-activated receptor-1 in myotubes. Treatment of a protein kinase C inhibitor partially blocked CKLF expression in myoblasts, while it remarkably inhibited that in myotubes. CONCLUSION Chemokine-like factor expression is differentially regulated in myoblasts and myotubes. Thrombin could be a strong regulator for its expression. As CKLF is immunohistochemically positive in regenerating muscle fibers, we postulate here that CKLF is a useful marker for regenerating muscle fibers in inflammatory myopathies.
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Affiliation(s)
- M H Chowdhury
- Department of Internal Medicine III, Shimane University Faculty of Medicine, Shimane University Hospital, Izumo, Japan
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Sumita Y, Sugiura T, Kawaguchi Y, Baba S, Soejima M, Murakawa Y, Hara M, Kamatani N. Genetic polymorphisms in the surfactant proteins in systemic sclerosis in Japanese: T/T genotype at 1580 C/T (Thr131Ile) in the SP-B gene reduces the risk of interstitial lung disease. Rheumatology (Oxford) 2008; 47:289-91. [PMID: 18263595 DOI: 10.1093/rheumatology/kem355] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the association between single-nucleotide polymorphisms (SNPs) in the pulmonary surfactant protein (SP) genes and the presence or absence of interstitial lung disease (ILD) in SSc patients. METHODS We studied 127 Japanese patients with SSc and 206 normal subjects. Investigated SNPs were C/T within amino acid (aa) 219, Arg219Trp in the SP-A1 gene (rs4253527), C/T within aa 131 (at nucleotide 1580) and Thr131Ile of the SP-B gene (rs1130866). Genotypes were determined by the TaqMan method. RESULTS Genotype frequencies were not different between the SSc patients and normal controls for both loci. The patients were subsequently divided into two groups based on presence or absence of ILD. In the SNP in the SP-B gene, the frequency of the T/T genotype was significantly lower in the patients with ILD than in those without ILD. Limited in the patients who were positive for anti-Scl-70 antibody, the difference in the frequency of the T/T genotype between the ILD-positive and ILD-negative groups became more apparent. On the other hand, in the SNP in the SP-A1 gene, there was no significant skewing for a certain genotype. CONCLUSION In SSc, where massive fibrosis occurs, possession of the T/T genotype in the SP-B gene would reduce the risk of ILD in Japanese.
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Affiliation(s)
- Y Sumita
- Third Department of Internal Medicine, Faculty of Medicine, Shimane University, Shimane, Japan
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Zhang W, Murakawa Y, Wozniak KM, Slusher B, Sima AAF. The preventive and therapeutic effects of GCPII (NAALADase) inhibition on painful and sensory diabetic neuropathy. J Neurol Sci 2006; 247:217-23. [PMID: 16780883 DOI: 10.1016/j.jns.2006.05.052] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [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: 12/30/2005] [Revised: 04/24/2006] [Accepted: 05/08/2006] [Indexed: 02/02/2023]
Abstract
Excitotoxic glutamate release occurs in several neurological disorders. One source is derived from the hydrolysis of the neuropeptide N-acetyl aspartyl glutamate (NAAG) by glutamate carboxypeptidase II (GCPII, also known as NAALADase). Drugs that attenuate glutamate transmission have been shown to relieve neuropathic pain, however side effects have limited their clinical use. It appears that GCPII is exclusively recruited to provide a glutamate source in hyperglutamatergic, excitotoxic conditions and therefore would be devoid of such side effects. Here we report on the therapeutic effects of an orally bio-available GCP II inhibitor on established painful and sensory neuropathy in the spontaneously diabetic BB/Wor rat. It significantly improved hyperalgesia, nerve conduction velocity and underlying myelinated fiber atrophy. The data suggest that GCP II inhibition may provide a meaningful and effective approach to the treatment of painful diabetic neuropathy.
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Affiliation(s)
- W Zhang
- Department of Pathology, Wayne State University, Detroit, MI 48201, USA
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Zhang W, Slusher B, Murakawa Y, Wozniak KM, Tsukamoto T, Jackson PF, Sima AAF. GCPII (NAALADase) Inhibition Prevents Long-Term Diabetic Neuropathy In Type 1 Diabetic BB/WOR Rats. J Peripher Nerv Syst 2002. [DOI: 10.1046/j.1529-8027.2002.02026_24.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kumakura S, Ishikura H, Kondo M, Murakawa Y, Kobayashi S. Hemophagocytosis associated with MPO-ANCA positive vasculitis in systemic sclerosis. Clin Exp Rheumatol 2002; 20:411-4. [PMID: 12102482] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Hemophagocytosis is a histiocytic proliferative condition associated with underlying disorders such as infection, lymphoma and autoimmune disease. We describe here a patient with systemic sclerosis who developed MPO-ANCA positive necrotizing vasculitis and hemophagocytosis concomitantly. Vasculitis supervened on a prior systemic sclerosis, and no causative disorder of hemophagocytosis could be found other than active vasculitis, suggesting that an occurrence of hemophagocytosis is associated with underlying vasculitis. Immunosuppressive therapy resulted in excellent improvement of both the hemophagocytosis and vasculitis. On the other hand, this case shows the elevated serum levels of IL-1beta, IL-6 and M-CSF which may be involved in the pathogenesis of hemophagocytosis. To our knowledge, this is the first demonstration indicating the possibility of vasculitis-associated hemophagocytosis.
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Affiliation(s)
- S Kumakura
- Third Division of Internal Medicine, Shimane Medical University, Izumo, Japan.
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Takeda N, Yokoyama I, Hiroi Y, Sakata M, Harada T, Nakamura F, Murakawa Y, Nagai R. Positron emission tomography predicted recovery of complete A-V nodal dysfunction in a patient with cardiac sarcoidosis. Circulation 2002; 105:1144-5. [PMID: 11877369 DOI: 10.1161/hc0902.103432] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- N Takeda
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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Zhang W, Slusher B, Murakawa Y, Wozniak KM, Tsukamoto T, Jackson PF, Sima AAF. GCPII (NAALADase) inhibition prevents long-term diabetic neuropathy in type 1 diabetic BB/Wor rats. J Neurol Sci 2002; 194:21-8. [PMID: 11809162 DOI: 10.1016/s0022-510x(01)00670-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS/HYPOTHESIS Hyperglutamatergic activity induced by ischemia is believed to underlie neuronal damage in a variety of neurological disorders, including neuropathic pain. Since ischemia is believed to be a prominent mechanism involved in diabetic polyneuropathy (DPN), we investigated the effect of the glutamate carboxypeptidase II (GCPII, EC #3.4-17.21; previously termed NAALADase), an enzyme responsible for the hydrolysis of the neuropeptide NAAG to NAA and glutamate, on the development of DPN in type 1 diabetic BB/Wor rats. METHODS Diabetic animals were treated with 10 mg/kg/day i.p. of the selective GCPII inhibitor GPI-5232 from onset of diabetes for 6 months. Hyperalgesia to thermal stimulation and nerve conduction velocity (NCV) were measured monthly. The effect on structural DPN was assessed by scoring of single, teased myelinated fibers, myelinated fiber morphometry and ultrastructural examination of C-fibers at 6 months. RESULTS GCPII inhibition showed significant but partial effects on hyperalgesia (p<0.001), nerve conduction slowing (p<0.01) axonal and nodal structural changes (p<0.001), small myelinated fiber atrophy, and degenerative changes of C-fibers. CONCLUSIONS GCPII inhibition has beneficial effects on hyperalgesia, nerve function, and structural degenerative changes in DPN, which are likely mediated by inhibition of ischemia-induced glutamate release.
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Affiliation(s)
- W Zhang
- Department of Pathology, Wayne State University, 540 E. Canfield Ave, Detroit, MI 48201, USA
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27
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Hatano S, Yamashita T, Hayami N, Fukui E, Murakawa Y, Omata M, Nakazawa K, Nobuoka S, Miyake F, Murayama M. Time- and subunit-dependent differential mRNA expression of L-type Ca2+ channel during progression of right ventricular hypertrophy. Jpn Heart J 2001; 42:617-25. [PMID: 11804303 DOI: 10.1536/jhj.42.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To clarify the molecular basis for changes in L-type calcium channel (VLCC) density in ventricular hypertrophy, we analyzed the mRNA expression of all the subunits including the main subunit alpha1c and auxiliary subunits (alpha2delta, beta2 and beta3) composing VLCC in rat right ventricular hypertrophy (RVH) induced by monocrotaline injection. To test the hypothesis that the expression of each subunit might change differently during progression of RVH, leading to an altered electrophysiologic outcome for VLCC, we investigated the ratio of the mRNA level of each auxiliary subunit to the main subunit. After monocrotaline injection, alpha1c mRNA showed a transient decrease on the 14th day and thereafter significantly increased to reach approximately 1.8 fold that of the control level on the 21st day. The auxiliary subunit alpha2delta mRNA showed a pattern similar to that of alpha1c. The beta3 mRNA increased rapidly after monocrotaline injection and increased approximately 4.1 fold. On the other hand, beta2 mRNA showed no significant changes. Accordingly, only the mRNA ratio of beta3 to alpha1c showed a significant increase among the auxiliary subunits after the monocrotaline injection. The ratio increased to a maximum of approximately 5.7 fold on the 14th day and thereafter decreased. These results suggest that VLCC density may be modified not only by alpha1c but also by its auxiliary subunit expression in ventricular hypertrophy, and provide a clue for understanding the controversial electrophysiologic results on VLCC density in hypertrophied hearts.
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Affiliation(s)
- S Hatano
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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28
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Abstract
We describe a case of symptomatic pseudo-AV block due to His-bundle parasystole masquerading as exercise-induced 2:1 AV block. Electrophysiologic study revealed the presence of His-bundle parasystole, and the fluctuation of parasystolic cycle length could be explained by the concept of modulated parasystole. Modulated parasystole is a possible explanation for maintenance of stable 2:1 AV conduction at an atrial rate of specific range during exercise.
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Affiliation(s)
- Y Kasaoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan.
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29
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Abstract
In this article we will review the clinical signs and symptoms of diabetic somatic polyneuropathy (DPN), its prevalence and clinical management. Staging and classification of DPN will be exemplified by various staging paradigms of varied sophistication. The results of therapeutic clinical trials will be summarized. The pathogenesis of diabetic neuropathy reviews an extremely complex issue that is still not fully understood. Various recent advances in the understanding of the disease will be discussed, particularly with respect to the differences between neuropathy in the two major types of diabetes. The neuropathology and natural history of diabetic neuropathy will be discussed pointing out the heterogeneities of the disease. Finally, the various prospective therapeutic avenues will be dealt with and discussed.
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Affiliation(s)
- K Sugimoto
- Department of Pathology, Wayne State University, School of Medicine and Detroit Medical Center, Detroit, MI 48201, USA
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30
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Murakawa Y, Kondo M, Kobayashi S. [Polymyositis and dermatomyositis]. Ryoikibetsu Shokogun Shirizu 2001:272-5. [PMID: 11031945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Y Murakawa
- Department of Internal Medicine, Shimane Medical University
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31
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Murakawa Y, Tsutsumi M, Murata N, Sasaki Y, Tsujiuchi T, Mikasa K, Narita N, Konishi Y. [Suppressive efffects of clarithromycin and cyclooxygenase-2 inhibitor, etodolac on N-nitrosobis(2-hydroxypropyl)amine(BHP)- induced experimental lung neoplasm in rats]. Jpn J Antibiot 2001; 54 Suppl A:53-8. [PMID: 11439906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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32
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Aoyama K, Matsubara K, Kondo M, Murakawa Y, Suno M, Yamashita K, Yamaguchi S, Kobayashi S. Nicotinamide-N-methyltransferase is higher in the lumbar cerebrospinal fluid of patients with Parkinson's disease. Neurosci Lett 2001; 298:78-80. [PMID: 11154840 DOI: 10.1016/s0304-3940(00)01723-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) may be initiated or precipitated by endogenous toxins with a structure similar to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in genetically-predisposed individuals. Nicotinamide N-methyltransferase (NNMT) catalyzes N-methylation of nicotinamide and other pyridines to form pyridinium ions. The protein amount of NNMT was measured in the lumbar cerebrospinal fluid of PD patients by immunoblot analysis using anti-human NNMT antibody. In younger (65 years old or younger) PD patients, the relative level of NNMT protein was significantly higher than that in younger controls. The NNMT protein was significantly affected by aging: the amount decreased along with aging in PD patients. These findings suggested that excess NNMT in the central nervous system might be implicated in the PD pathogenesis.
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Affiliation(s)
- K Aoyama
- Department of Internal Medicine III, Shimane Medical University, 693-8501, Izumo, Japan.
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33
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Zhang W, Yorek M, Pierson CR, Murakawa Y, Breidenbach A, Sima AAF. Human C-peptide dose dependently prevents early neuropathy in the BB/Wor-rat. Int J Exp Diabetes Res 2001; 2:187-93. [PMID: 12369706 PMCID: PMC2478548 DOI: 10.1155/edr.2001.187] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to explore the neuroprotective and cross-species activities of C-peptide on type 1 diabetic neuropathy, spontaneously diabetic BB/W-rats were given increasing doses of human recombinant C-peptide (hrC-peptide). Diabetic rats received 10, 100, 500, or 1000 microg of hrC-peptide/kg body weight/day from onset of diabetes. After 2 months of hrC-peptide administration, 100 microg and greater doses completely prevented the nerve conduction defect, which was associated with a significant but incomplete prevention of neural Na+/K+-ATPase activity in diabetic rats with 500 microg or greater C-peptide replacement. Increasing doses of hrC-peptide showed increasing prevention of early structural abnormalities such as paranodal swelling and axonal degeneration and an increasing frequency of regenerating sural nerve fibers. We conclude that hrC-peptide exerts a dose dependent protection on type 1 diabetic neuropathy in rats and that this effect is probably mediated by the partially conserved sequence of the active C-terminal pentapeptide.
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Affiliation(s)
- W. Zhang
- Department of PathologyWayne State University540 E. Canfield AveDetroitMI48201USA
- Morris Hood Jr. Diabetes CenterWayne State UniversityDetroitMIUSA
| | - M. Yorek
- Department of Internal MedicineUniversity of IowaIowaIOUSA
| | - C. R. Pierson
- Department of PathologyWayne State University540 E. Canfield AveDetroitMI48201USA
- Morris Hood Jr. Diabetes CenterWayne State UniversityDetroitMIUSA
| | - Y. Murakawa
- Department of PathologyWayne State University540 E. Canfield AveDetroitMI48201USA
- Morris Hood Jr. Diabetes CenterWayne State UniversityDetroitMIUSA
| | | | - A. A. F. Sima
- Department of PathologyWayne State University540 E. Canfield AveDetroitMI48201USA
- Department of NeurotogyWayne State UniversityDetroitMIUSA
- Morris Hood Jr. Diabetes CenterWayne State UniversityDetroitMIUSA
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34
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Nagai A, Murakawa Y, Terashima M, Shimode K, Umegae N, Takeuchi H, Kobayashi S. Cystatin C and cathepsin B in CSF from patients with inflammatory neurologic diseases. Neurology 2000; 55:1828-32. [PMID: 11134381 DOI: 10.1212/wnl.55.12.1828] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In CSF, proteolytic enzymes are believed to have crucial roles in the initiation and progression of inflammatory neurologic diseases (IND). Cystatin C, a major cysteine protease inhibitor in CSF, is tightly bound to cathepsin B and H. OBJECTIVE To determine if cystatin C is involved in the disease process of IND, the authors measured the cystatin C concentration by ELISA method and cathepsin B and H activities in the CSF of patients with acute IND. METHODS Cystatin C concentration and cathepsin B and H activities were measured in CSF samples taken from patients during the acute phase of their disease. Subjects studied were 8 patients with Guillain-Barré syndrome (GBS), 5 with chronic inflammatory demyelinating polyneuropathy (CIDP), 12 with MS, 16 with aseptic meningitis, 15 with neurodegenerative diseases as disease controls, and 35 healthy controls. RESULTS A significant decrease in CSF cystatin C level was seen in the patients with GBS, CIDP, and MS compared to the control subjects. High cathepsin B activity, but not cathepsin H activity, was also observed in the patients with GBS, CIDP, and MS. CONCLUSION Cystatin C levels in CSF measured by ELISA may help the physician recognize GBS, CIDP, and MS. Decreased levels of cystatin C may be related to the high levels of cathepsin B activity seen in the CSF of patients with GBS, CIDP, and MS.
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Affiliation(s)
- A Nagai
- Departments of Internal Medicine III, Shimane Medical University, Izumo, Japan.
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35
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Takase K, Murakawa Y, Eriguchi S, Fujikawa H. Unique hemagglutination activity of an isolate of Newcastle disease virus. J Vet Med Sci 2000; 62:1325-6. [PMID: 11193352 DOI: 10.1292/jvms.62.1325] [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] [Indexed: 11/22/2022] Open
Abstract
The MET95 strain of a lentogenic Newcastle disease virus (NDV) isolated from a broiler in Japan, showed unique hemagglutination (HA) activity. The MET95 strain failed to show HA when examined by rapid glass plate method although they showed HA titer of 1:1,024 by micro-plate method. This unique HA was also observed after the MET95 strain was passaged ten times in chickens. The failure of HA by rapid glass plate method was not shown in any other NDVs examined.
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Affiliation(s)
- K Takase
- The Chemo-Sero-Therapeutic Research Institute, Kumamoto, Japan
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36
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Takase K, Murakawa Y, Ariyoshi R, Eriguchi S, Sugimura T, Fujikawa H. Serological monitoring on layer farms with specific pathogen-free chickens. J Vet Med Sci 2000; 62:1327-9. [PMID: 11193353 DOI: 10.1292/jvms.62.1327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To monitor the existence of avian pathogens in laying chicken flocks, specific pathogen-free (SPF) chickens were introduced into two layer farms and reared with laying hens for 12 months. SPF chickens were bled several times after their introduction and examined for their sero-conversion to avian pathogens. As a result, antibodies to eight or ten kinds of pathogens were detected in SPF chickens on each farm. Antibodies to infectious bronchitis virus (IBV), avian nephritis virus, Mycoplasma gallisepticum and M. synoviae were detected early within the first month. Antibody titer to IBV suggested that the laying chickens were infected with IBV repeatedly during the experiment on both farms. However, antibodies to infectious bursal disease virus and 6 pathogens were not detected.
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Affiliation(s)
- K Takase
- Department of Veterinary Microbiology, Faculty of Agriculture, Kagoshima University, Japan
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37
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Kumakura S, Kondo M, Tsumura H, Murakawa Y, Ishikura H, Kobayashi S. [Hemophagocytic syndrome]. Nihon Rinsho Meneki Gakkai Kaishi 2000; 23:670-3. [PMID: 11210767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- S Kumakura
- Third Division of Internal Medicine, Shimane Medical University, Japan
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38
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Abstract
BACKGROUND Diabetic neuropathy accompanies both Type 1 and Type 2 diabetes, although it shows in both humans and animal models distinct differences between the two types of diabetes. Progressive paranodal degenerations occurring in Type 1, but not in Type 2, diabetes is believed to account for the more severe functional deficits in Type 1 diabetic rats. This suggests that factors other than hyperglycemia, such as insulin deficiency, may play a pathogenetic role. In this study, we investigated the immunolocalization of the insulin receptor (IR) and the expression of its two alternatively spliced isoforms in adult rat peripheral nerve. METHODS Adult male Wistar rats 6-8 months of age were examined. Both light and ultrastructural immunohistochemistry was employed for localization of IR. The antibody was a mouse monoclonal antibody raised against the beta-subunit of human IR. Reverse transcription polymerase chain reaction (RT-PCR) was used to identify the two IR isoforms in peripheral nerve and seven other organs. Localization of the mRNA message was assessed by in situ hybridization. RESULTS IR was localized to paranodal terminal Schwann cell loops and microvilli and to the paranodal axolemma. Furthermore, IR immunoreactivity was also present in Schmidt-Lantermann incisures. Endoneurial vessels showed IR localization on plasma membranes and in endocytotic vesicles of endothelial cells and pericytes. A high intensity of immunostained IR was found in close proximity to interendothelial tight junctions. Peripheral nerve showed, like the brain, predominantly the high affinity IR lacking exon 11. The mRNA message was localized to Schwann cells, endothelial cells and pericytes. CONCLUSION Peripheral nerve expresses predominantly the high affinity IR, which is localized to strategic structures associated with the blood-nerve barrier and the paranodal ion-channel barrier.
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Affiliation(s)
- K Sugimoto
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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39
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Abstract
In this article we will review the clinical signs and symptoms of diabetic somatic polyneuropathy (DPN), its prevalence and clinical management. Staging and classification of DPN will be exemplified by various staging paradigms of varied sophistication. The results of therapeutic clinical trials will be summarized. The pathogenesis of diabetic neuropathy reviews an extremely complex issue that is still not fully understood. Various recent advances in the understanding of the disease will be discussed, particularly with respect to the differences between neuropathy in the two major types of diabetes. The neuropathology and natural history of diabetic neuropathy will be discussed pointing out the heterogeneities of the disease. Finally, the various prospective therapeutic avenues will be dealt with and discussed.
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Affiliation(s)
- K Sugimoto
- Department of Pathology, Wayne State University, School of Medicine and Detroit Medical Center, Detroit, MI 48201, USA
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40
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Fukui E, Yamashita T, Sezaki K, Ajiki K, Inoue M, Hayami N, Kasaoka Y, Omata M, Murakawa Y, Nagai R. Overdrive suppression of antegrade conduction over the accessory pathway. Jpn Heart J 2000; 41:767-72. [PMID: 11232994 DOI: 10.1536/jhj.41.767] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In a patient with Wolff-Parkinson-White syndrome whose accessory pathway was primarily capable of bidirectional conduction, antegrade conduction over the accessory pathway was transiently inhibited after rapid atrial or ventricular pacing or after spontaneous termination of atrioventricular reentrant tachycardia. Pacing rate and duration of tachycardia were related to the duration of the suppression of preexcitation, while the coupling interval of the first sinus beat to the last driven or tachycardia beat was irrelevant to the phenomenon. Thus, overdrive suppression of conduction may be the most likely mechanism of this phenomenon.
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Affiliation(s)
- E Fukui
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan
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41
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Murakawa Y, Yamashita T, Ajiki K, Suzuki J, Hayami N, Fukui E, Kasaoka Y, Omata M, Nagai R. Is the QT interval an indicator of autonomic state? Jpn Heart J 2000; 41:713-21. [PMID: 11232988 DOI: 10.1536/jhj.41.713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prolonged QT interval is suggested to indicate an increased risk of sudden cardiac death in certain clinical conditions such as diabetes mellitus. We investigated whether the individual QT interval is an indicator of an autonomic state. An ambulatory 24-hour ECG was recorded in 53 subjects from different clinical backgrounds. Power spectral components of heart rate variability (HRV) and the QT interval were regressively obtained at a heart rate of 60, 70, 80, 90, or 100 beats per minutes (bpm). Log values of the high-frequency component of HRV (HF: 0.15-0.50 Hz, a scale of cardiac parasympathetic tone) failed to show a relationship with the QT interval. In contrast, the QT interval at a heart rate of 90 bpm and 100 bpm showed a significant correlation with the log values of the low-frequency component (LF: 0.04-0.15 Hz) and the log[LF/HF], i.e., a putative scale of sympathetic tone (100 bpm: QT vs logLF: r = 0.414, p < 0.005, QT vs log[LF/HF]: 0.416, p < 0.002). Also, attenuated rate-dependent QT shortening was associated with greater logLF and log[LF / HF] values at a heart rate of 80, 90, or 100 bpm. These results suggest that the QT interval at a moderate heart rate (approximately 90-100 / min) and the degree of rate-dependent QT shortening are related to individual sympathetic tone.
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Affiliation(s)
- Y Murakawa
- Department of Cardiovascular Medicine, University of Tokyo, Japan
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42
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Sima A, Sugimoto K, Murakawa Y, W‐X. Z. C‐Peptide Deficiency: An Important Pathogenetic Factor In Type 1 Diabetic Neuropathy. J Peripher Nerv Syst 2000. [DOI: 10.1046/j.1529-8027.2000abstracts-29.x] [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: 11/20/2022]
Affiliation(s)
- Aaf Sima
- Wayne State University, Detroit, Michigan
| | - K Sugimoto
- Wayne State University, Detroit, Michigan
| | - Y Murakawa
- Wayne State University, Detroit, Michigan
| | - Zhang W‐X.
- Wayne State University, Detroit, Michigan
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43
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Abstract
BACKGROUND Diabetic neuropathy accompanies both Type 1 and Type 2 diabetes, although it shows in both humans and animal models distinct differences between the two types of diabetes. Progressive paranodal degenerations occurring in Type 1, but not in Type 2, diabetes is believed to account for the more severe functional deficits in Type 1 diabetic rats. This suggests that factors other than hyperglycemia, such as insulin deficiency, may play a pathogenetic role. In this study, we investigated the immunolocalization of the insulin receptor (IR) and the expression of its two alternatively spliced isoforms in adult rat peripheral nerve. METHODS Adult male Wistar rats 6-8 months of age were examined. Both light and ultrastructural immunohistochemistry was employed for localization of IR. The antibody was a mouse monoclonal antibody raised against the beta-subunit of human IR. Reverse transcription polymerase chain reaction (RT-PCR) was used to identify the two IR isoforms in peripheral nerve and seven other organs. Localization of the mRNA message was assessed by in situ hybridization. RESULTS IR was localized to paranodal terminal Schwann cell loops and microvilli and to the paranodal axolemma. Furthermore, IR immunoreactivity was also present in Schmidt-Lantermann incisures. Endoneurial vessels showed IR localization on plasma membranes and in endocytotic vesicles of endothelial cells and pericytes. A high intensity of immunostained IR was found in close proximity to interendothelial tight junctions. Peripheral nerve showed, like the brain, predominantly the high affinity IR lacking exon 11. The mRNA message was localized to Schwann cells, endothelial cells and pericytes. CONCLUSION Peripheral nerve expresses predominantly the high affinity IR, which is localized to strategic structures associated with the blood-nerve barrier and the paranodal ion-channel barrier.
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Affiliation(s)
- K Sugimoto
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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44
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Kumakura S, Ishikura H, Kondo M, Tsumura H, Murakawa Y, Yamauti Y, Kobayashi S. [Amegakaryocytic thrombocytopenia associated with systemic lupus erythematosus]. Nihon Naika Gakkai Zasshi 2000; 89:1430-2. [PMID: 10934774 DOI: 10.2169/naika.89.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S Kumakura
- Third Division of Internal Medicine, Shimane Medical University, Izumo
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45
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Murakawa Y, Takase K, Sakamoto K, Suesoshi M, Nagatomo H. Characterization of a lentogenic Newcastle disease virus isolated from broiler chickens in Japan. Avian Dis 2000; 44:686-90. [PMID: 11007020] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Newcastle disease virus (NDV), named MET95, was isolated from a non-vaccinated broiler flock in Japan in 1995. The MET95 strain was determined to be a lentogenic NDV. The strain has the properties of eluting rapidly at 4 C and has low thermostability in hemagglutinating activity with chicken erythrocytes. In these studies, no difference could be found between the MET95 strain and the Hitcher B1 vaccine strain. However, the chickens inoculated with the MET95 strain, as well as chickens that they were in contact with, had a much higher hemagglutination-inhibition antibody response than those inoculated with the B1 strain. Accordingly, the MET95 strain is thought to be a promising candidate as a live ND vaccine strain. In Japan, this is the first report on the isolation of lentogenic NDV from chickens since the paper on the Ishii strain isolated in 1966.
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Affiliation(s)
- Y Murakawa
- Department of Veterinary Hygiene, Faculty of Agriculture, Miyazaki University, Gakuen-Kibanadai, Japan
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46
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Yamashita T, Murakawa Y, Hayami N, Fukui EI, Kasaoka Y, Inoue M, Omata M. Short-term effects of rapid pacing on mRNA level of voltage-dependent K(+) channels in rat atrium: electrical remodeling in paroxysmal atrial tachycardia. Circulation 2000; 101:2007-14. [PMID: 10779469 DOI: 10.1161/01.cir.101.16.2007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation causes electrophysiological changes of the atrium, thereby facilitating its maintenance. Although the expression of ion channels is modulated in chronic atrial fibrillation, it is yet unknown whether paroxysmal atrial fibrillation can also lead to electrical remodeling by affecting gene expression. METHODS AND RESULTS To examine the short-term effects of rapid pacing on the mRNA level of voltage-dependent K(+) channels, high-rate atrial pacing was performed in Sprague-Dawley rat hearts. Total RNA was prepared from the atrial appendages from 0 to 8 hours after the onset of pacing, and mRNA levels of Kv1.2, Kv1. 4, Kv1.5, Kv2.1, Kv4.2, Kv4.3, erg, KvLQT1, and minK were determined by RNase protection assay. Among these 9 genes, the mRNA level of the Kv1.5 channel immediately and transiently increased, with bimodal peaks at 0.5 and 2 hours after the onset of pacing. Conversely, the pacing gradually and progressively decreased the mRNA levels of the Kv4.2 and Kv4.3 channels. The increase of Kv1.5 and the decrease of Kv4.2 and Kv4.3 mRNA levels were both rate dependent. In correspondence with the changes in the mRNA level, Kv1. 5 channel protein transiently increased in the membrane fraction of the atrium during a 2- to 8-hour pacing period. Electrophysiological findings that the shortening of the action potential produced by 4-hour pacing was almost abolished by a low concentration of 4-aminopyridine implied that the increased Kv1.5 protein was functioning. CONCLUSIONS Even short-term high-rate atrial excitation could differentially alter the mRNA levels of Kv1.5, Kv4.2, and Kv4.3 in a rate-dependent manner. In particular, increased Kv1.5 gene expression, having a transient nature, implied the possible biochemical electrical remodeling unique to paroxysmal tachycardia.
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Affiliation(s)
- T Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan.
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47
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Suzuki J, Shin WS, Shimamoto R, Yamazaki T, Tsuji T, Murakawa Y, Nakajima T, Toyo-oka T, Nishikawa J, Ohotomo K, Nagai R, Omata M. Clinical implication of left precordial T wave inversions in the presence of complete right bundle branch block. Jpn Heart J 1999; 40:745-53. [PMID: 10737558 DOI: 10.1536/jhj.40.745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study was designed to elucidate whether left precordial negative T waves are electrocardiographic indicators for the diagnosis of hypertrophic cardiomyopathy (HCM) even in the presence of complete right bundle branch block (CRBBB). In 7 consecutive patients with CRBBB accompanied by negative T waves in at least one of the left precordial leads (V4, V5, V6, maximal negativity; 1.06 +/- 0.40 mVol) (left precordial negative T wave group) and in 15 randomly selected CRBBB patients without left precordial T wave inversions (control group), echocardiography was performed to rule out underlying diseases causing left ventricular overload and to identify candidates for magnetic resonance (MR) imaging. None had anginal pain indicating ischemic heart disease. When 2-dimensional echocardiography indicated left ventricular hypertrophy with wall thickness > or = 15 mm, the magnitude and distribution of hypertrophy were scrutinized on contiguous left ventricular MR short-axis images. The diagnostic criterion of HCM was the demonstration of hypertrophy with a wall thickness of 20 mm or more on the left ventricular MR short-axis images. All patients in the left precordial negative T wave group had negative T waves in both I (negativity; 0.27 +/- 0.17 mVol) and aVL (negativity; 0.23 +/- 0.14 mVol), whereas none in the control group did. The diagnostic criterion for HCM was fulfilled in six patients in the left precordial negative T wave group. However there were no patients who fulfilled the criterion in the control group. Negative T waves were recorded in the I (negativity; 0.30 +/- 0.17 mVol), aVL (negativity; 0.25 +/- 0.14 mVol), V4 (negativity; 1.03 +/- 0.46 mVol), V5 (negativity; 0.83 +/- 0.37 mVol) and V6 leads (negativity; 0.31 +/- 0.31 mVol) in all patients with HCM, while they were recorded in only 6% of the patients without HCM. In conclusion, the existence of left precordial negative T waves in the presence of CRBBB strongly indicates HCM.
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Affiliation(s)
- J Suzuki
- Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan
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48
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Yoshioka T, Gamoh M, Shineha R, Ishibashi S, Shibata H, Suzuki T, Murakawa Y, Kato S, Shimodaira H, Kato S, Ishioka C, Kanamaru R. A new combination chemotherapy with cis-diammine-glycolatoplatinum (Nedaplatin) and 5-fluorouracil for advanced esophageal cancers. Intern Med 1999; 38:844-8. [PMID: 10563743 DOI: 10.2169/internalmedicine.38.844] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The efficacy of a new chemotherapeutic combination consisting of Cis-diammineglycolatoplatinum (Nedaplatin), a derivative of cisplatin (CDDP), and 5-fluorouracil (5FU) was evaluated in patients with advanced esophageal carcinomas. METHODS Nedaplatin was administered at a dose of 80 or 100 mg/m2 with 500 ml of saline by slow drip infusion for 120 minutes on day 1. 5FU at a dose of 350 or 500 mg/m2 was mixed with 1,000 ml of saline and administered by continuous infusion for 24 hours on days 1 to 5. PATIENTS OR MATERIALS This combination chemotherapy was tried in 17 patients with metastatic, recurrent, or bulky unresectable esophageal cancers. Of these, 15 evaluable patients received at least two courses of chemotherapy. RESULTS The response rates in assessable and all patients were 60% and 52.9%, respectively. Cases with lymph node and liver metastases, as well as primary lesions, showed excellent response to the therapy with positive response rates of 54.5% (6/11), 100% (5/5) and 58.4% (7/12), respectively. The median response duration was 7 (range 3 to 37+) months for patients who achieved a partial response. Adverse drug reactions were limited to three cases of grade 3 toxicity, including allergy, and decreased hemoglobin and platelets, which were well tolerated by the patients. CONCLUSION The present study thus indicated the combination chemotherapy of Nedaplatin and 5FU to be safe and efficacious for advanced esophageal cancer. Further investigations are clearly warranted.
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Affiliation(s)
- T Yoshioka
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai
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49
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Mori Y, Murakawa Y, Yokoyama J, Tajima N, Ikeda Y, Nobukata H, Ishikawa T, Shibutani Y. Effect of highly purified eicosapentaenoic acid ethyl ester on insulin resistance and hypertension in Dahl salt-sensitive rats. Metabolism 1999; 48:1089-95. [PMID: 10484046 DOI: 10.1016/s0026-0495(99)90120-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated the effect of long-term administration of highly purified eicosapentaenoic acid ethyl ester (EPA-E), an n-3 polyunsaturated fatty acid derived from fish oil, in comparison to lard on the development of hypertension and insulin resistance in Dahl salt-sensitive (Dahl-S) rats fed a high-sucrose diet (HSD), a model of salt-sensitive hypertension. After 16 weeks of treatment, the glucose infusion rate (GIR) during the euglycemic insulin-glucose clamp test significantly increased in the HSD-EPA-E group compared with the HSD-water or -lard control group. The GIR was approximately three times higher in the HSD-EPA-E group versus the HSD-water or -lard control group, and it was about 70% of the rate in the calorically deprived control group fed a low-fat-high-fiber diet (LF-HFD). In addition, EPA-E significantly suppressed the elevation of plasma glucose and insulin levels after oral glucose loading. These results indicate that EPA-E prevents the development of insulin resistance in Dahl-S rats fed a HSD. Fatty acid analysis of phospholipids in skeletal muscle showed a significant increase in C18:2, C20:5, and C22:5 components in the HSD-EPA-E group and, conversely, a significant decrease in C16:0, C20:4, and C22:6. The present results indicate that the beneficial effect of EPA-E on insulin resistance in Dahl-S rats fed a HSD is likely dependent on the modification of phospholipid components in the skeletal muscle membrane. These findings suggest that EPA-E might prevent the development of insulin resistance in dietary obesity. In addition, the HSD-EPA-E group showed a significant increase in the level of uncoupling protein (UCP) in brown adipose tissue as compared with the HSD-water or -lard control group. However, EPA-E had no effect on the development of hypertension and obesity in Dahl-S rats fed the HSD.
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Affiliation(s)
- Y Mori
- Department of Internal Medicine, National East-Utsunomiya Hospital, Tochigi, Japan
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50
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Sugishita Y, Tajima S, Shimizu T, Sugishita K, Harada K, Matsui H, Inoue M, Murakawa Y, Suzuki J, Takenaka K, Omata M, Takahashi T. An adult case with an abnormal right ventricular structure causing intraventricular pressure gradient and a history of aphthous stomatitis and thrombophlebitis. Jpn Heart J 1999; 40:517-25. [PMID: 10611919 DOI: 10.1536/jhj.40.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a 50-year-old man with a right ventricular structure causing an intraventricular pressure gradient. He had been diagnosed as vasculo-Behçet with a history of aphthous stomatitis and thrombophlebitis. He had also been suffering from atrial flutter and mild right-side heart failure. Echocardiography showed that there was an abnormal structure attached to the right ventricular free wall and protruding into the cavity, and that it caused the pressure gradient estimated to be approximately 19 mmHg. Chest X-ray computed tomography demonstrated that the structure was partially calcified. Magnetic resonance imaging depicted the structure separating the right ventricle into two chambers. Angiographic study revealed a markedly enlarged right atrium and a filling defect at the mid-portion of the right ventricle, which divided the right ventricular cavity into two parts. Hemodynamic study showed a slightly elevated right atrial pressure (mean 7 mmHg) and a peak-to-peak intraventricular pressure difference of 18 mmHg in the right ventricle. The diastolic pressure tracing of the right ventricular low pressure chamber showed a 'dip and plateau' pattern. Although the pathological features of the abnormal right ventricular structure in this case were not fully clarified, abnormal muscle bundle and/or endocardial fibrosis, which were reported to be associated with Behçet's disease, may have contributed to its generation.
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Affiliation(s)
- Y Sugishita
- Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan
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