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Akita S, Fujibayashi K, Ueno EI, Wakasa M, Kawai Y, Kajinami K. Thrombotic Microangiopathy after a 15-year Treatment with Interferon Beta-1b in a Patient with Multiple Sclerosis: A Case Report and Review of Literature. Intern Med 2024; 63:1113-1117. [PMID: 37661454 DOI: 10.2169/internalmedicine.1846-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
A 54-year-old woman with multiple sclerosis treated with interferon-β (IFN-β)-1b for 15 years presented with sustained hypertension (240/124 mmHg) and retinal bleeding. She had proteinuria, anemia, thrombocytopenia, elevated serum creatinine levels, and haptoglobin depletion. Intravenous nicardipine stabilized her blood pressure, but her renal function and platelet count deteriorated. The initial disintegrin-like metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13) activity was 28% of normal without its inhibitor. The subsequent peripheral appearance of schistocytes suggested thrombotic microangiopathy (TMA). After IFN-β-1b cessation, the platelet count increased, and the blood pressure stabilized. The ADAMTS13 activity normalized, although the creatinine level did not. TMA may develop after the long-term use of IFN-β without adverse events.
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Affiliation(s)
- Satori Akita
- Department of Cardiology, Kanazawa Medical University, Japan
| | | | - Ei-Ichi Ueno
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Minoru Wakasa
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Japan
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Kawai Y, Yamamoto K, Miyazaki K, Asai H, Fukushima H. Machine learning-based analysis of regional differences in out-of-hospital cardiopulmonary arrest outcomes and resuscitation interventions in Japan. Sci Rep 2023; 13:15884. [PMID: 37741881 PMCID: PMC10518013 DOI: 10.1038/s41598-023-43210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/21/2023] [Indexed: 09/25/2023] Open
Abstract
Refining out-of-hospital cardiopulmonary arrest (OHCA) resuscitation protocols for local emergency practices is vital. The lack of comprehensive evaluation methods for individualized protocols impedes targeted improvements. Thus, we employed machine learning to assess emergency medical service (EMS) records for examining regional disparities in time reduction strategies. In this retrospective study, we examined Japanese EMS records and neurological outcomes from 2015 to 2020 using nationwide data. We included patients aged ≥ 18 years with cardiogenic OHCA and visualized EMS activity time variations across prefectures. A five-layer neural network generated a neurological outcome predictive model that was trained on 80% of the data and tested on the remaining 20%. We evaluated interventions associated with changes in prognosis by simulating these changes after adjusting for time factors, including EMS contact to hospital arrival and initial defibrillation or drug administration. The study encompassed 460,540 patients, with the model's area under the curve and accuracy being 0.96 and 0.95, respectively. Reducing transport time and defibrillation improved outcomes universally, while combining transport time and drug administration showed varied efficacy. In conclusion, the association of emergency activity time with neurological outcomes varied across Japanese prefectures, suggesting the need to set targets for reducing activity time in localized emergency protocols.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Koji Yamamoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Keita Miyazaki
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Kawai Y, Yamamoto K, Miyazaki K, Asai H, Fukushima H. Explainable Prediction Model of the Need for Emergency Hemostasis Using Field Information During Physician-Staffed Helicopter Emergency Medical Service Interventions: A Single-Center, Retrospective, Observational Pilot Study. Air Med J 2023; 42:336-342. [PMID: 37716804 DOI: 10.1016/j.amj.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE Early recognition of hemostasis is important to prevent trauma-related deaths. We conducted a pilot study of a predictive model of hemostatic need using factors that can be collected during helicopter emergency medical service (HEMS) interventions until transport hospital selection using cases from our institution. METHODS This single-center, retrospective, observational pilot study included 251 trauma patients aged ≥ 18 years treated with HEMS between April 2017 and March 2022, in Nara Medical University. Cardiac arrest and pre-HEMS treatment patients were excluded. Emergency hemostatic surgery prediction models were constructed using the light gradient boosting machine cross-validation method using objective data that could be collected before hospital determination. The accuracy of this model was compared with that of the ground emergency medical service-based model, and factors influencing outcome were visualized using Shapley additive explanations. RESULTS The predictive accuracy of the model with HEMS intervention factors was an area under the receiver operating characteristic curve of 0.80, superior to the 0.73 accuracy area under the receiver operating characteristic curve for ground emergency medical services constructed with contact information. Clinically important factors, such as shock index, blood pressure changes, and ultrasound findings, had a significant impact on outcomes, with nonmonotonic effects observed across factors. CONCLUSION This pilot study suggests that predictive models of emergency hemostasis can be built using limited prehospital information. To validate this model, a larger, multicenter study is recommended.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan.
| | - Koji Yamamoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Keita Miyazaki
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
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Kawai Y, Kogeichi Y, Yamamoto K, Miyazaki K, Asai H, Fukushima H. Explainable artificial intelligence-based prediction of poor neurological outcome from head computed tomography in the immediate post-resuscitation phase. Sci Rep 2023; 13:5759. [PMID: 37031248 PMCID: PMC10082754 DOI: 10.1038/s41598-023-32899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/04/2023] [Indexed: 04/10/2023] Open
Abstract
Predicting poor neurological outcomes after resuscitation is important for planning treatment strategies. We constructed an explainable artificial intelligence-based prognostic model using head computed tomography (CT) scans taken immediately within 3 h of resuscitation from cardiac arrest and compared its predictive accuracy with that of previous methods using gray-to-white matter ratio (GWR). We included 321 consecutive patients admitted to our institution after resuscitation for out-of-hospital cardiopulmonary arrest with circulation resumption over 6 years. A machine learning model using head CT images with transfer learning was used to predict the neurological outcomes at 1 month. These predictions were compared with the predictions of GWR for multiple regions of interest in head CT using receiver operating characteristic (ROC)-area under curve (AUC) and precision recall (PR)-AUC. The regions of focus were visualized using a heatmap. Both methods had similar ROC-AUCs, but the machine learning model had a higher PR-AUC (0.73 vs. 0.58). The machine learning-focused area of interest for classification was the boundary between gray and white matter, which overlapped with the area of focus when diagnosing hypoxic- ischemic brain injury. The machine learning model for predicting poor outcomes had superior accuracy to conventional methods and could help optimize treatment.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yohei Kogeichi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Koji Yamamoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keita Miyazaki
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Fujihara J, Takinami Y, Kimura-Kataoka K, Kawai Y, Takeshita H. Cell-free DNA Release in the Plasma of Patients with Cardiac Disease is Associated with Cell Death Processes. Indian J Clin Biochem 2023; 38:67-72. [PMID: 36684502 PMCID: PMC9852365 DOI: 10.1007/s12291-022-01034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/04/2022] [Indexed: 01/25/2023]
Abstract
Cell-free DNA (cfDNA) is released into the plasma of patients with cardiac disease. Here, the source and mechanism of plasma cfDNA release in patients with myocardial infarction (MI) and other cardiac diseases (n = 59) were investigated. Plasma levels of various markers including M30 (apoptosis), M65 (apoptosis and necrosis), cyclophilin A (CyPA) (necrosis), and myeloperoxidase (MPO) (neutrophil activation) were assayed. The plasma cfDNA concentrations in MI and other cardiac diseases were significantly higher than that in the healthy control subjects. Significant differences were not observed among the cardiac disease patients (MI and other cardiac diseases) and healthy control subjects in M30, M65, and CyPA levels. In contrast,the MPO levels were significantly elevated in cardiac disease patients when compared to control groups, and MPO levels in MI patients were significantly higher than other cardiac diseases patients. These results suggest that cfDNA is mainly released by neutrophils via NETosis in addition to apoptosis except for epithelial apoptosis in patients with cardiac disease and the degree is greater in MI patients. The results from this study provide basic information for diagnosis marker of MI.
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Affiliation(s)
- Junko Fujihara
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, 693-8501 Izumo, Shimane, Japan
| | - Yoshikazu Takinami
- Department of Emergency Medicine, Fukui Kosei Hospital, 201 Shimorokujyo, 918-8537 Fukui, Fukui Japan
| | - Kaori Kimura-Kataoka
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, 693-8501 Izumo, Shimane, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, 920-0293 Uchinada, Kanazawa, Ishikawa Japan
| | - Haruo Takeshita
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, 693-8501 Izumo, Shimane, Japan
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Yasuda Y, Aoki H, Fujita W, Fujibayashi K, Wakasa M, Kawai Y, Nakanishi H, Saito K, Takeuchi M, Kajinami K. Glyceraldehyde-derived advanced glycation end-products are associated with left ventricular ejection fraction and brain natriuretic peptide in patients with diabetic adverse cardiac remodeling. SCAND CARDIOVASC J 2022; 56:208-216. [PMID: 35792728 DOI: 10.1080/14017431.2022.2095013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Glyceraldehyde-derived advanced glycation end-products (Glycer-AGEs) have a strong binding affinity for their cognate receptor and elicit oxidative stress and inflammation. However, it remains unknown whether the levels of Glycer-AGEs correlate with the severity of cardiac function and heart failure in patients with diabetic adverse cardiac remodeling (DbCR). Fourteen heart failure patients with type 2 diabetes mellitus (DM) without other cardiac disorders (DbCR group) were enrolled. Another 14 patients with idiopathic dilated cardiomyopathy (DCM) without DM were served as a control (DCM group). All patients were assessed for serum Glycer-AGEs, nitrotyrosine (NT), and tumor necrosis factor alpha (TNFα) and for plasma brain natriuretic peptide (BNP). The left ventricular ejection fraction (LVEF) was evaluated by echocardiography. Results: The mean serum levels of Glycer-AGEs, NT, and TNFα in the DbCR group were significantly higher than those in the DCM group (for Glycer-AGEs, p = .0073; for NT, p = .005; for TNFα, p < .0001, respectively). In the patients with DbCR, the levels of serum Glycer-AGEs and TNFα were closely associated with LVEF and BNP values. Conclusions: Both Glycer-AGEs and TNFα showed close associations with LVEF and the levels of BNP in patients with DbCR. Glycer-AGEs and TNFα may play a pathological role in the development of DbCR.
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Affiliation(s)
- Yuushi Yasuda
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Hirofumi Aoki
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Wataru Fujita
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | | | - Minoru Wakasa
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Nakanishi
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuyuki Saito
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Masayoshi Takeuchi
- Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
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Oda M, Fujibayashi K, Wakasa M, Takano S, Fujita W, Kitayama M, Nakanishi H, Saito K, Kawai Y, Kajinami K. Increased plasma glutamate in non-smokers with vasospastic angina pectoris is associated with plasma cystine and antioxidant capacity. SCAND CARDIOVASC J 2022; 56:180-186. [PMID: 35695518 DOI: 10.1080/14017431.2022.2085884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Endothelial dysfunction caused by oxidative stress plays an important role in the development of vasospastic angina pectoris (VSAP). Glutamate causes endothelial dysfunction by generating oxidative stress, and it inhibits cystine import into endothelial cells via the cystine/glutamate antiporter (XC-), which leads to depletion of antioxidant glutathione. However, whether glutamate and cystine are implicated in the pathogenesis of VSAP remains unclear. We investigated plasma glutamate and cystine levels, oxidative stress markers and antioxidant capacity in non-smoker patients with VSAP to determine whether glutamate and cystine are associated with the development of VSAP. We assessed 49 non-smokers assigned to groups with (n = 27) and without (n = 22) VSAP, and also measured plasma glutamate, cystine, nitrotyrosine, reactive oxygen metabolites and biological antioxidant potential. Results. Plasma glutamate and cystine values were significantly higher in the group with, than without VSAP (59.8 ± 25.7 vs. 43.5 ± 18.7 µmol/L, p = .016 and 35.3 ± 14.2 vs. 25.2 ± 9.1 µmol/L, p = .0056, respectively). Plasma glutamate and cystine values were significantly and positively associated (r = 0.32, p = .027). Levels of the oxidative stress markers nitrotyrosine and reactive oxygen metabolites, and biological antioxidant potential of as a measure of antioxidant capacity, did not significantly differ between the two groups. However, glutamate and biological antioxidant potential values were significantly and negatively associated (r = -0.3, p = .036). Conclusion. Plasma glutamate levels were increased in patients with VSAP who did not smoke, and they were positively associated with plasma cystine and negatively associated with the biological antioxidant potential levels.
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Affiliation(s)
- Minako Oda
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | | | - Minoru Wakasa
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Shintaro Takano
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Wataru Fujita
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | | | - Hiroaki Nakanishi
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuyuki Saito
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
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Sawaguchi J, Saeki Y, Oda M, Takamura TA, Fujibayashi K, Wakasa M, Akao H, Kitayama M, Kawai Y, Kajinami K. The circulating furin-cleaved/mature PCSK9 ratio has a potential prognostic significance in statin-naïve patients with acute ST elevation myocardial infarction. Atheroscler Plus 2022; 50:50-56. [PMID: 36643795 PMCID: PMC9833232 DOI: 10.1016/j.athplu.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
Background and aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) circulates as mature and furin-cleaved forms, but their biological functions are uncertain. We investigated whether their levels associate with prognosis in patients with acute ST elevation myocardial infarction (STEMI). Methods We enrolled 160 statin-naïve patients with acute STEMI and followed for 3 years. PCSK9 subtype levels were determined by an enzyme-linked immunosorbent assay before and at five timepoints up to 48 h after emergent coronary intervention. The occurrence of coronary and cardiac events was compared between subjects stratified by the PCSK9 level. Results One hundred and twenty-six patients completed 3 years of follow-up. In the acute phase, both PCSK9 subtype levels decreased, and thereafter increased from 6 to 48 h (mature: from 198 ± 67 to 334 ± 116 ng/mL, furin-cleaved: from 20 ± 7 to 39 ± 16 ng/mL, both p < 0.01). Major cardiac events occurred in 46 patients. The furin-cleaved/mature PCSK9 ratio at 48 h after coronary intervention predicted the likelihood of experiencing of events; patients in the third tertile had lower event-free survival than those in the first and second tetiles in Kaplan-Meier analysis (p = 0.004). Multivariate Cox regression analysis revealed that this ratio had a greater impact (HR: 1.92; 95% CI: 1.06-3.45, p = 0.03) on events than other known atherosclerosis risk factors. Conclusions The furin-cleaved/mature PCSK9 ratio was associated with 3-year cardiovascular events in statin-naïve patients with acute STEMI, suggesting a potential link between furin cleavage process of PCSK9 and its effect on prognosis. (249 words).
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Affiliation(s)
- Jun Sawaguchi
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Yasuhiko Saeki
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Minako Oda
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | | | | | - Minoru Wakasa
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Hironobu Akao
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Michihiko Kitayama
- Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Kouji Kajinami
- Department of Cardiology, 1-1 Daigaku, Uchinada, 920-0293, Japan,Corresponding author. Department of Cardiology, Kanazawa Medical University , 1-1 Daigaku, Uchinada 920-0293, Japan.
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Ito S, Asai H, Kawai Y, Suto S, Ohta S, Fukushima H. Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study. BMC Emerg Med 2022; 22:160. [PMID: 36109716 PMCID: PMC9479253 DOI: 10.1186/s12873-022-00718-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The outcome of road traffic injury (RTI) is determined by duration of prehospital time, patient’s demographics, and the type of injury and its mechanism. During the emergency medical service (EMS) prehospital time interval, on-scene time should be minimized for early treatment. This study aimed to examine the factors influencing on-scene EMS time among RTI patients.
Methods
We evaluated 19,141 cases of traffic trauma recorded between April 2014 and March 2020 in the EMS database of the Nara Wide Area Fire Department and the prehospital database of the emergency Medical Alliance for Total Coordination of Healthcare (e-MATCH). To examine the association of the number of EMS phone calls until hospital acceptance, age ≥65 years, high-risk injury, vital signs, holiday, and nighttime (0:00–8:00) with on-scene time, a generalized linear mixed model with random effects for four study regions was conducted.
Results
EMS phone calls were the biggest factor, accounting for 5.69 minutes per call, and high-risk injury accounted for an additional 2.78 minutes. Holiday, nighttime, and age ≥65 years were also associated with increased on-scene time, but there were no significant vital sign variables for on-scene time, except for the level of consciousness. Regional differences were also noted based on random effects, with a maximum difference of 2 minutes among regions.
Conclusions
The number of EMS phone calls until hospital acceptance was the most significant influencing factor in reducing on-scene time, and high-risk injury accounted for up to an additional 2.78 minutes. Considering these factors, including regional differences, can help improve the regional EMS policies and outcomes of RTI patients.
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Kawai Y, Takano K, Miyazaki K, Yamamoto K, Tada Y, Asai H, Maegawa N, Urisono Y, Saeki K, Fukushima H. Association of multiple rib fractures with the frequency of pneumonia in the post-resuscitation period. Resusc Plus 2022; 11:100267. [PMID: 35812719 PMCID: PMC9256829 DOI: 10.1016/j.resplu.2022.100267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Successful cardiopulmonary resuscitation is associated with a high incidence of chest wall injuries. However, few studies have examined chest wall injury as a risk factor for respiratory complications after cardiopulmonary resuscitation. Therefore, herein, we investigated the association of multiple rib fractures on the incidence of post-resuscitation pneumonia. Methods This single-centre retrospective cohort study enrolled adult, nontraumatic, out-of-hospital cardiac arrest patients who maintained circulation for more than 48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission. The association with newly developed pneumonia within 7 days of hospitalisation was analysed using a Fine-Gray proportional hazards regression model adjusted for the propensity score of multiple rib fractures estimated from age, sex, presence of witnessed status, bystander CPR, initial rhythm, and total CPR time and for previously reported risk factors for pneumonia (therapeutic hypothermia and prophylactic antibiotics). Results Overall, 683 patients with out-of-hospital cardiac arrest were treated; 87 eligible cases were enrolled for analysis. Thirty-two (36.8%) patients had multiple rib fractures identified on computed tomography, and 35 (40.2%) patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia, consistently both with and without adjustment for background factors (unadjusted hazard ratio 4.63, 95% confidence interval: 2.35–9.13, p < 0.001; adjusted hazard ratio 4.03, 95% confidence interval: 2.08–7.82, p < 0.001). Conclusions Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.
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Takamura TA, Kawai Y, Akita S, Oda M, Akao H, Nakagawa T, Takama S, Tsuchiya T, Kitayama M, Kajinami K. Response to pre-dilatation with POBA can predict target lesion revascularization after DCB angioplasty for de novo small coronary artery lesions. J Int Med Res 2022; 50:3000605221113779. [PMID: 35929357 PMCID: PMC9358574 DOI: 10.1177/03000605221113779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To assess the determinants of target lesion revascularization (TLR) after drug-coated balloon (DCB) angioplasty for de novo small coronary artery lesions. Methods This retrospective study enrolled consecutive lesions from patients that were in a stable condition and had undergone successful DCB treatment for de novo small coronary artery lesions. The study endpoint was TLR and major adverse cardiac events at 12 months. Results A total of 68 patients with 83 lesions were enrolled in the study. Of these, 11 (13.3%) lesions required TLR. Mean ± SD pre-dilatation balloon diameters were similar in the non-TLR (2.33 ± 0.72 mm) and TLR (2.18 ± 0.36 mm) groups. A comparison of the two groups showed that post/pre-lumen area ratio during pre-dilatation (%) by plain old balloon angioplasty (POBA) was significantly and negatively associated with TLR and the optimal cut-off point was 170%. Cox proportional hazard and multivariate regression analyses showed that post/pre-lumen area ratio was the only independent predictor of TLR (hazard ratio 0.9318; 95% confidence interval 0.9001, 0.9645). Conclusion Greater pre-dilatation using POBA, assessed as the post/pre-lumen area ratio, may be independently associated with a lower 12-month TLR rate in patients undergoing DCB angioplasty for de novo small coronary lesions.
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Affiliation(s)
- Taka-Aki Takamura
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
| | - Satori Akita
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
| | - Minako Oda
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
| | - Hironobu Akao
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
| | - Tohru Nakagawa
- Division of Medical Engineering, Kanazawa Medical University, Uchinada, Japan
| | - Shunsuke Takama
- Division of Medical Engineering, Kanazawa Medical University, Uchinada, Japan
| | - Taketsugu Tsuchiya
- Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University, Uchinada, Japan
| | - Michihiko Kitayama
- Transcatheter Cardiovascular Therapeutics, Kanazawa Medical University, Uchinada, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Uchinada, Japan
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Kawai Y, Yamamoto K, Miyazaki K, Takano K, Asai H, Nakano K, Fukushima H. Comparison of Changes in Vital Signs During Ground and Helicopter Emergency Medical Services and Hospital Interventions. Air Med J 2022; 41:391-395. [PMID: 35750447 DOI: 10.1016/j.amj.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Few studies have evaluated the effects of helicopter emergency medical services (HEMS) alone. This single-center study compared the changes in vital signs during ground emergency medical services (GEMS), HEMS, and hospital interventions to assess the impact of HEMS interventions. METHODS This retrospective observational study included 168 trauma patients older than 18 years of age who received HEMS. Patients with cardiac arrest or those who received medical attention before HEMS were excluded. We assessed 3 intervention phases (GEMS, HEMS, and hospital). The changes in heart rate, systolic blood pressure, respiratory rate, and shock index in response to interventions were calculated and divided by the intervention time, and the changes observed during the interventions were compared. RESULTS No changes in vital signs were observed when receiving GEMS. Systolic blood pressure increased and shock index decreased after HEMS, whereas systolic blood pressure decreased and shock index increased during hospital interventions. Heart rate showed no significant change (P = .12), and respiratory rate showed very little change. Systolic blood pressure increased significantly during HEMS compared with the pre- and postintervention periods. CONCLUSION Changes in vital signs differed according to the intervention. Systolic blood pressure increased during HEMS but not with GEMS or hospital interventions.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan.
| | - Koji Yamamoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Keita Miyazaki
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Keisuke Takano
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Kenichi Nakano
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
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Furutani S, Furutani N, Kawai Y, Nakayama A, Nagai H. Rapid DNA Sequencing Technology Based on the Sanger Method for Bacterial Identification. Sensors (Basel) 2022; 22:2130. [PMID: 35336302 PMCID: PMC8955868 DOI: 10.3390/s22062130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Antimicrobial resistance, a global health concern, has been increasing due to inappropriate use of antibacterial agents. To facilitate early treatment of sepsis, rapid bacterial identification is imperative to determine appropriate antibacterial agent for better therapeutic outcomes. In this study, we developed a rapid PCR method, rapid cycle sequencing, and microchip electrophoresis, which are the three elemental technologies for DNA sequencing based on the Sanger sequencing method, for bacterial identification. We achieved PCR amplification within 13 min and cycle sequencing within 14 min using a rapid thermal cycle system applying microfluidic technology. Furthermore, DNA analysis was completed in 14 min by constructing an algorithm for analyzing and performing microchip electrophoresis. Thus, the three elemental Sanger-based DNA sequencing steps were accomplished within 41 min. Development of a rapid purification process subsequent to PCR and cycle sequence using a microchip would help realize the identification of causative bacterial agents within one hour, and facilitate early treatment of sepsis.
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Affiliation(s)
- Shunsuke Furutani
- Advanced Photonics and Biosensing Open Innovation Laboratory (Photo-BIO OIL), National Institute of Advanced Industrial Science and Technology (AIST), 2-1 Yamadaoka, Suita 565-0871, Osaka, Japan; (S.F.); (N.F.)
| | - Nozomi Furutani
- Advanced Photonics and Biosensing Open Innovation Laboratory (Photo-BIO OIL), National Institute of Advanced Industrial Science and Technology (AIST), 2-1 Yamadaoka, Suita 565-0871, Osaka, Japan; (S.F.); (N.F.)
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo, Kashihara 634-8522, Nara, Japan;
| | - Akifumi Nakayama
- Department of Medical Technology, School of Health Sciences, Gifu University of Medical Science, 795-1 Ichihiraga, Seki 501-3892, Gifu, Japan;
| | - Hidenori Nagai
- Advanced Photonics and Biosensing Open Innovation Laboratory (Photo-BIO OIL), National Institute of Advanced Industrial Science and Technology (AIST), 2-1 Yamadaoka, Suita 565-0871, Osaka, Japan; (S.F.); (N.F.)
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14
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Kawai Y, Fukushima H, Asai H, Takano K, Okuda A, Tada Y, Maegawa N, Bolstad F. Significance of initial hemoglobin levels in severe trauma patients without prehospital fluid administration: a single-center study in Japan. Trauma Surg Acute Care Open 2021; 6:e000831. [PMID: 35036573 PMCID: PMC8720982 DOI: 10.1136/tsaco-2021-000831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives Hemoglobin (Hb) levels have been considered to remain stable in the early stages of bleeding due to trauma. However, several studies have reported that rapid compensatory fluid shifts cause Hb dilution earlier than previously thought. These reports are from Western countries where it is standard protocol to administer fluids during an emergency, making it almost impossible to eliminate the effect of prehospital intravenous fluid administration on Hb levels. This study aimed to determine the relationship between Hb levels and severity of injury on arrival at the hospital in severe trauma patients without prehospital intravenous fluid administration. Methods This single-center observational retrospective study included patients with Abbreviated Injury Scale scores of 3 or above between 2008 and 2014. In Japan, prehospital life-saving technicians were not allowed to administer intravenous fluids until 2014. We investigated whether the difference between the measured blood Hb level at arrival and the corresponding standard blood Hb level for each age group and sex reported in the national survey was associated with the severity of injury and the need for hemostasis. Results In total, 250 patients were included in this study (median age, 46 years; male patients, 183). The median time from injury to arrival at the hospital was 45 min, and there was no statistical correlation with the initial Hb level on arrival (ρ=0.092, p=0.14). When the study subjects were stratified into four groups according to the initial Hb levels, lower Hb levels correlated with higher rates of requirement for hemostatic interventions (p=0.02) and mortality (p=0.02). In addition, lower Hb levels were associated with the need for hemostasis. Conclusion In severe trauma patients without prehospital intravenous fluid administration, decreased Hb levels on arrival may be associated with the severity of trauma and with the need for hemostasis. Level of evidence Level IV.
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Affiliation(s)
- Yasuyuki Kawai
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hidetada Fukushima
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hideki Asai
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Keisuke Takano
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Akinori Okuda
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Tada
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Naoki Maegawa
- Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara, Japan
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Kubo K, Kawai Y. Zeolite Improves High-Fat Diet-Induced Hyperglycemia, Hyperlipidemia and Obesity in Mice. J Nutr Sci Vitaminol (Tokyo) 2021; 67:283-291. [PMID: 34719613 DOI: 10.3177/jnsv.67.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Zeolite, an abundant mineral in the Earth's crust, is utilized in a wide range of fields because of its well-known adsorption properties. Its application as a functional food ingredient resembling dietary fiber is expected, but it has not yet been investigated in the context of prevention of lifestyle-related diseases. The present study was designed to evaluate the availability and safety of a natural zeolite preparation for this purpose. Acute oral toxicity testing showed that the lowest lethal dose of zeolite was more than 2,000 mg/kg body weight for both male and female mice. In a prolonged feeding test for 18 wk using model mice with high-fat-induced obesity and type 2 diabetes mellitus, intake of a 10% zeolite-containing diet suppressed body weight gain, as well as liver and visceral fat weights, without any changes in food and energy intake. Moreover, plasma lipid (triacylglycerol, total cholesterol and high-density-lipoprotein cholesterol) levels and fasting blood glucose levels decreased in parallel with zeolite intake. No changes in the glycated hemoglobin level were found. However, in an oral glucose tolerance test at week 12, increased postprandial blood glucose levels were suppressed in accordance with zeolite intake, and then insulin secretion was also decreased. On the other hand, a decrease of plasma amylase activity and increases in total bilirubin and urea nitrogen suggested the need for further investigation of safety.
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Affiliation(s)
- Kazuhiro Kubo
- Department of Home Economics, Faculty of Education, Gifu University
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16
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Kuroda K, Tsuji M, Saito E, Kawamura K, Ono T, Tokioka K, Kawai Y. Hyperacute postprocedural high platelet reactivity: a novel predictor for in-hospital adverse events in acute coronary syndrome with prasugrel loading. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Postprocedural High platelet reactivity (HPR) seems to associate long term adverse cardiovascular events, mainly intrastent thrombosis. However, the relationship between hyper-acute postprocedural HPR with prasugrel loading and clinical outcomes in acute coronary syndrome (ACS) is still unclear. Moreover, factors contributing HPR in ACS with prasugrel loading are also unknown.
Purpose
This study aimed to assess the impact of hyper-acute postprocedural HPR with prasugrel loading on clinical outcomes in ACS during hospitalization, as well as to define appropriate cut-off values and identify contributing factors of HPR.
Methods
We performed a single-centre, retrospective observational study that enrolled 207 patients who underwent emergent PCI for ACS with prasugrel loading. The P2Y12reaction unit (PRU) value was measured immediately after PCI with the VerifyNow System. The primary endpoint was major adverse cardiac events (MACE, defined as the composite of death, myocardial infarction, stroke, heart failure, ventricular arrhythmia needing defibrillation).
Results
Mean patient age (standard deviation) was 70.5 (±13.0) years, 78.7% were male, and average time from prasugrel intake to PRU calculation was 98.3 (±49.1) min. During a mean hospital stay of 15.9 (±9.3) days, there were 34 in-hospital MACE (16.4%) and 10 deaths (4.8%). Thrombosis events, didn't stand out and mechanical complications, such as cardiac rupture and cardiac tamponade occupies most of cardiovascular death which occurred before 10 days on admission. PRU was significantly higher in MACE group than Non-MACE group (279±65 vs 227±72, p<0.001 respectively). The ROC curve analysis of PRU for discriminating significant in-hospital MACE showed the cut off value of 293 (sensitivity:52.9%, specificity:83.2% [AUC=0.709, p<0.0001]). 47patients (29.4%) were thus categorized as HPR (PRU>293) immediately after emergent PCI. Kaplan-Meyer curve showed MACE events occurred in HPR group than non-HPR group (38.2% vs 10.0%, p<0.001). Multiple cox analysis demonstrated that HPR was independent predictors of MACE in patients with ACS underwent PCI (OR 5.416, 95% CI 2.157–13.598, p<0.0001). Multiple logistic regression model showed female sex, low haemoglobin value, and large mean platelet volume were independent predictors of HPR.
Conclusion
PRU was significantly higher in MACE group, and appropriate cut-off value of HPR in this study was 293. HPR was independent predictor of MACE during hospitalization, however thrombosis event was not significant. Evidence of clinical impact with postprocedural HPR within 120 minutes after prasugrel loading is scarce. This study shows post-procedural HPR, even without sufficient time after prasugrel intake, can be a useful predictive marker of adverse events during hospitalization.
Funding Acknowledgement
Type of funding sources: None. PRU between Non-MACE and MACE groupKaplan-Meyer curve
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Affiliation(s)
- K Kuroda
- Okayama City Hospital, Okayama, Japan
| | - M Tsuji
- Okayama City Hospital, Okayama, Japan
| | - E Saito
- Okayama City Hospital, Okayama, Japan
| | | | - T Ono
- Okayama City Hospital, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Okayama, Japan
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17
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Ono T, Miyoshi T, Ueki Y, Kuroda K, Saito E, Tsuji M, Kawamura K, Tokioka K, Ohe T, Kawai Y. Cardio-ankle vascular index is useful screening method to detect obstructive coronary artery disease in asymptomatic diabetes patients with subclinical atherosclerosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients with diabetes mellitus are at very high risk for obstructive coronary artery disease; however, invasive coronary angiography is not allowed to apply in all patients. Cardio-ankle vascular index (CAVI), a marker of arterial stiffness has been reported to reflect atherosclerotic burden.
Purpose
To assess the diagnostic performance of CAVI vs. coronary calcium score for detecting obstructive coronary artery disease determined by Coronary CT angiography (CCTA) in asymptomatic diabetes patients.
Methods
During May 2015 to December 2019, 816 patients with diabetes mellitus were evaluated. First, intima-media thickness of carotid artery was measured in all subjects. Then, patients with intima-media thickness over 11mm underwent CAVI. Finally, 209 patients who have one or more cardiovascular risk factors other than diabetes mellitus were enrolled (68±11 years, 68% men). Patients were excluded if they had a disorder of the kidney, a prior history of coronary artery revascularization, atrial fibrillation, LV ejection fraction <50%, ABI <0.9 or allergy to contrast. Diagnostic performance of CAVI was evaluated with coronary stenosis >50% by CCTA.
Results
CAVI, Agatston score, and intima-media thickness of carotid artery were 9.2±1.3, 396±621 and 2.0±0.7mm, respectively. CAVI was significantly correlated with age (r=0.530, p<0.001), coronary artery calcification (r=0.182, p=0.008), and intima-media thickness of carotid artery (r=0.195, p=0.005). Among them, 108 patients (48%) had coronary stenosis. CAVI, Agatston score and intima-media thickness of carotid artery in patients with coronary stenosis were higher than that without coronary stenosis, respectively (9.8±1.1 vs 8.5±1.0, p<0.001, 526±676 vs. 255±525, p=0.001, 2.2±0.7 vs. 1.8±0.6, p<0.001). The ROC curve analysis of CAVI for discriminating coronary stenosis showed that the sensitivity 75.0% and specificity 77.2% at the cut off value of 9.23 (AUC=0.812, p<0.001). Contrastingly, diagnostic performance of coronary calcium score and intima-media thickness of carotid artery were less than CAVI (sensitivity: 91.7%, specificity: 56.4%, AUC=0.753, p<0.05 vs. CAVI, sensitivity: 68.5%, specificity: 59.4%, AUC=0.663, p<0.05 vs. CAVI). Multivariate logistic analysis demonstrated that CAVI was significantly associated with coronary stenosis (OR=4.133, p<0.001) after adjustment of conventional risk factors, although coronary calcium score was not correlated with coronary stenosis.
Conclusion
CAVI could be informative to select patients having obstructive coronary artery disease in asymptomatic diabetes patients with thick intima-media thickness.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Ono
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Miyoshi
- Okayama University, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Ueki
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Kuroda
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - E Saito
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - M Tsuji
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Kawamura
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Ohe
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
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18
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Tsuji M, Kuroda K, Saito E, Kawamura K, Ono T, Tokioka K, Ohe T, Kawai Y. Impact of high platelet reactivity on left ventricular remodeling in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Previous studies demonstrated that high platelet reactivity (HPR) predicts future cardiovascular death and coronary events in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). However, few studies have focused on the impact of HPR on left ventricular remodeling (LVR) and each echocardiographic parameter.
Purpose
The purpose of this study was to investigate the impact of HPR in ACS patients on LVR and changes in echocardiographic volume indexes and LV ejection fraction.
Methods
This is a retrospective cohort study of prospectively collected data in a single center that enrolled patients who underwent emergency PCI for ACS including STEMI and NSTEMI with prasugrel loading. The primary outcome of the study was LVR associated with HPR. Secondary endpoints were changes in indexed LVESV, LVEDV, LVEF, E/e' and LAVI between baseline and follow-up. The P2Y12 reaction unit (PRU) value in response to prasugrel was assessed by the VerifyNow P2Y12 assay. Blood samples were collected once per procedure immediately after PCI. LVR index was calculated as the relative change in LVEDV observed at follow-up compared with baseline. LVR was defined as a relative increase in LVEDV ≥20%, measured at follow-up visit compared with the baseline value before discharge.
Results
A total of 196 ACS patients who underwent emergency PCI between January 2016 and July 2020 were enrolled in the study. The mean age of the study population was 69.9 years, and 76.0% were male. On echocardiography at follow up visit of mean duration of 7.0±4.0 months, LVR was found in 38 patients (19.4%). The optimal cutoff for PRU associated with increased LVR assessed by receiver-operating characteristic curve analysis was 245.5 (AUC: 0.656; 95% CI: 0.564 to 0.749; p=0.003). On the basis of this cutoff, HPR was found in 82 patients (42.1%) and the prevalence of LVR was significantly higher in the HPR group compared to the non-HPR group (30.5% vs. 11.4%; p=0.001). Multiple Cox regression analysis showed that HPR was an independent predictor of LVR (OR 4.22, 95% CI 1.83–9.71, p=0.001). In addition, Δ% EDV and Δ% ESV increased in the HPR group, and decreased in the non-HPR group with significant differences (5.8±32.6% vs. −8.0±26.2% in Δ% EDV; p=0.002, 2.0±37.5% vs. −13.3±33.0% in Δ% ESV; p=0.004, respectively). Δ%EF, Δ%E/e', Δ%LAVI were numerically improved in the non-HPR group compared with the HPR group, but this difference did not reach statistical significance.
Conclusion
In patients with ACS, HPR defined as PRU ≥246 immediately after emergency PCI was an independent predictor of LVR in the chronic phase.
Funding Acknowledgement
Type of funding sources: None. Predictors of the presence of LVRChanges (Δ%) of LVEDV and LVESV
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Affiliation(s)
- M Tsuji
- Okayama City Hospital, Okayama, Japan
| | - K Kuroda
- Okayama City Hospital, Okayama, Japan
| | - E Saito
- Okayama City Hospital, Okayama, Japan
| | | | - T Ono
- Okayama City Hospital, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Okayama, Japan
| | - T Ohe
- Okayama City Hospital, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Okayama, Japan
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Kawai Y, Konishi H, Miyazaki K, Kogeichi Y, Takano K, Okuda A, Maegawa N, Urisono Y, Fukushima H. A new quantitative assessment method for predicting pneumonia caused by chest wall injury. J Trauma Acute Care Surg 2021; 91:521-526. [PMID: 34137745 DOI: 10.1097/ta.0000000000003314] [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: 11/26/2022]
Abstract
BACKGROUND The severity of rib fractures has been previously evaluated by combining categorical data, but these methods have only low predictive capability for respiratory complications and mortality. This study aimed to establish a more accurate method for predicting the development of pneumonia, a frequent complication in chest injuries, using anatomical relationships. METHODS We analyzed three-dimensional reconstructed images of 644 consecutive trauma patients who underwent whole-body computed tomography (CT) in our institution within a 36-month study period from April 2017. The anatomical relationship between the right and left thoracic volumes of non-rib fracture patients was used to estimate thoracic volume changes on the injured side in unilateral rib fracture patients. The predictive capability of changes in thoracic volume for the development of pneumonia was evaluated according to the area under the receiver operating characteristic curve and compared with that of previous chest wall severity evaluation methods. RESULTS Of the 644 patients, 133 and 478 patients had unilateral rib fractures and non-rib fractures, respectively. The amount of change in thoracic volume due to unilateral rib fractures was significantly greater in pneumonia patients (400 mL vs. 160 mL, p < 0.01). The area under the receiver operating characteristic curve for the development of pneumonia was 0.83, which tended to be higher than that of the previous severity scoring methods. CONCLUSION The amount of change in chest volume, which can be estimated using CT images, has better predictive capability for pneumonia than previous severity assessment methods based on categorical data. The amount of change in chest volume measured using whole-body CT can be used to rapidly determine the optimal treatment for severe chest wall injuries. LEVEL OF EVIDENCE Prognostic study, level IV.
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Affiliation(s)
- Yasuyuki Kawai
- From the Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara City, Nara, Japan
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20
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Fujihara J, Takinami Y, Kawai Y, Kimura-Kataoka K, Takeshita H. Comparison of serum cell-free DNA between postmortem and living samples. Clin Chim Acta 2021; 519:255-259. [PMID: 34015305 DOI: 10.1016/j.cca.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Cell-free DNA (cfDNA) originates from apoptotic and/or necrotic cells. Few reports are available that examine cfDNA from postmortem samples. Therefore, this study investigated differences between postmortem and biogenic subjects in concentration and fragment distribution of serum cfDNA. We also clarified features of serum cfDNA in postmortem subjects. The results revealed that postmortem subjects had significantly higher cfDNA concentrations than healthy controls and patients with cardiac disease. Serum cfDNA concentrations increased slightly with postmortem interval in subjects who died of asphyxia, and they were slightly higher in subjects who died from internal vs. external causes. Microchip electrophoresis of serum cfDNA revealed a fragment larger than 10,000 bp in only two postmortem subjects; we speculate that the fragment may have originated from necrotic cells. A relatively high concentration of one 150-200 bp fragment was characteristic of postmortem samples. This fragment may have been derived from apoptosis or other processes. We also observed ladder fragments in some subjects who died from external causes. Although additional research is needed for verification, serum cfDNA concentrations and fragment patterns possibly be used as a tool to estimate postmortem intervals and cause of death.
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Affiliation(s)
- Junko Fujihara
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan.
| | - Yoshikazu Takinami
- Department of Emergency Medicine, Fukui Kosei Hospital, 201 Shimorokujyo, Fukui, Fukui 918-8537, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan
| | - Kaori Kimura-Kataoka
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan
| | - Haruo Takeshita
- Department of Legal Medicine, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501, Japan
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21
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Mizutani Y, Okuda A, Maegawa N, Tada Y, Takano K, Asai H, Watanabe T, Kawai Y, Shigematsu H, Urisono Y, Fukushima H, Okuchi K, Tanaka Y. Esophageal incarceration associated with cervical vertebral fracture in a patient with diffuse idiopathic skeletal hyperostosis. J Orthop Sci 2021; 26:182-185. [PMID: 29935973 DOI: 10.1016/j.jos.2018.05.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/07/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Yasushi Mizutani
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan; Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yusuke Tada
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Keisuke Takano
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Tomoo Watanabe
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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Watanabe T, Matsumoto Y, Amamizu H, Morosawa S, Ohyama K, Sugisawa J, Tsuchiya S, Sato K, Shindo T, Nishimiya K, Watanabe-Asaka T, Hayashi M, Kawai Y, Shimokawa H. A novel therapeutic approach for coronary inflammation and lymphatic vessels using non-invasive low-intensity pulsed ultrasound in a porcine model with DES-induced coronary hyperconstricting responses. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The coronary adventitia harbors lymphatic vessels (LVs). We previously demonstrated that coronary adventitial inflammation and LV dysfunction play important roles in the pathogenesis of coronary artery spasm, including drug-eluting stent (DES)-induced coronary hyperconstricting responses, in pigs and humans. However, a direct therapeutic approach to the coronary adventitia remains to be developed.
Purpose
In this study, we aimed to examine whether our novel and non-invasive therapy with low-intensity pulsed ultrasound (LIPUS) ameliorates DES-induced coronary hyperconstricting responses, and if so, what mechanisms are involved.
Methods
An everolimus-eluting stent (EES) was implanted into the left anterior descending (LAD) coronary artery in normal male pigs. They were randomly assigned to the LIPUS or the sham therapy groups. After EES implantation, in the LIPUS group, LIPUS (32 cycles, 193 mW/cm2) was applied to the heart at 3 different levels (proximal and distal stent edges and middle portion of the stent) through X-ray fluoroscopy for 20 min at each level for every other day for 2 weeks (6 days in total) (Fig. 1A, B). The sham therapy group was treated in the same manner but without LIPUS. At 4 weeks after the procedure, we performed coronary angiography to examine coronary vasoconstricting responses to intracoronary serotonin in vivo. Finally, stented coronary vessels were harvested for immunohistochemistry of vasa vasorum (vWF), LVs (LYVE-1), vascular inflammation (CD68-positive macrophages and IL-1β expression), vascular endothelial growth factor A (VEGF-A, angiogenesis marker), VEGF-C and VEGF receptor 3 (VEGFR3, lymphangiogenesis markers).
Results
Coronary vasoconstricting responses to intracoronary serotonin at the DES edges in the LAD were significantly enhanced in the sham group but were significantly suppressed in the LIPUS group, while those responses were comparable at the non-DES implanted left circumflex (LCx) coronary artery between the 2 groups (Fig. 1C, D). In addition, in vivo lymph transport speed was significantly faster in the LIPUS group than in the sham group (Fig. 1E–G). In histological analysis, the number of LVs was significantly increased in the LIPUS group compared with the sham group, whereas those of CD68 and IL-1β expressions were significantly reduced in the LIPUS group compared with the sham group. In contrast, the density of vasa vasorum was comparable between the 2 groups. Mechanistically, the extents of VEGF-C and VEGFR3 expressions were increased in the LIPUS group, whereas that of VEGF-A was comparable between the 2 groups (Fig. 1G–K). Importantly, there were significant correlations among the LV-related changes and enhanced coronary vasoconstricting responses.
Conclusion
These results provide the first evidence that the LIPUS therapy ameliorates DES-induced coronary hyperconstricting responses in pigs in vivo through structural and functional alterations of LVs (Fig. 1L).
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Watanabe
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Amamizu
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Morosawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Nishimiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Watanabe-Asaka
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - M Hayashi
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - Y Kawai
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Ono T, Miyoshi T, Ohno Y, Ueki Y, Kuroda K, Kawamura K, Tokioka K, Ohe T, Kawai Y. Cardio-ankle vascular index as an arterial stiffness marker improves on cardiovascular events by adding to framingham risk score. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The cardio-ankle vascular index (CAVI) is a non-invasive measurement that evaluates arterial stiffness using the analysis of oscillometric waveform during cuff-Inflation. Several studies reported that CAVI is associated with cardiovascular risk factors, while the clinical prognostic value of CAVI as a surrogate marker of atherosclerosis has not been fully elucidated. Meanwhile, the Framingham risk score (FRS) is an established marker of cardiovascular outcomes.
Purpose
To investigate whether adding CAVI to Framingham risk score improves the prediction of cardiovascular events.
Methods
This prospective observational study included consecutive 422 patients with cardiovascular risk factors but without known coronary artery disease (69±8 years, 63% men). CAVI was measured by the oscillometric method with VaSera vascular screening system. Patients with atrial fibrillation, left ventricular ejection fraction <50%, both ABI<0.9, severe valvular diseases, or hemodialysis were excluded. Primacy outcomes were cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure and revascularization.
Results
During a median follow-up of 3.1 years, cardiovascular events occurred in 12.8% (3.3%, 15.7%, and 19.1% in the low, intermediate and high-risk group of stratification by FRS, respectively). The ROC curve analysis for discriminating cardiovascular events showed that the AUC of CAVI added to Framingham risk score was the highest compared to Framingham risk score and CAVI alone (CAVI added to Framingham risk score: AUC 66.9, 95% CI 59.6–74.2, Framingham risk score alone: AUC 61.5, 95% CI 53.8–69.1, CAVI alone: AUC 62.3, 95% CI 54.1–70.6). The logistic regression analysis demonstrated that CAVI and Framingham risk score were independent predictors of cardiovascular events (CAVI: OR 1.381, 95% CI 1.164–1.597, p=0.004, Framingham risk score: OR 1.135, 95% CI 1.044–1.225, p=0.007). Next, when logistic regression analysis was performed simultaneously on Framingham risk factor and CAVI, CAVI was an independent predictor of cardiovascular events (OR 1.347, 95% CI 1.124–1.569, p=0.009). Furthermore, in the likelihood ratio test, CAVI added to Framingham risk score significantly improved the cardiovascular event prediction ability than Framingham risk factor alone. Next, when patients with intermediate risk (n=217) were divided into two groups based on CAVI of 9.0, the Kaplan-Meier estimate showed that events occurred more frequently in higher CAVI group (9.3% and 29.1%, log-rank, P=0.009) and the C-statistic was 0.662. Multiple Cox analysis showed that, in the intermediate risk group, CAVI was an independent predictor of primary outcomes (HR 1.387 per 1 index, 95% CI 1.081–1.779, p=0.010).
Conclusion
The measurement of CAVI could be a useful predictor for cardiovascular events. In addition, the combination of CAVI and Framingham risk score could improve the predictability compared to the Framingham risk score alone.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Ono
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Miyoshi
- Okayama University, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Ohno
- Kawasaki University of Medical Welfare, Department of Medical Technology, Kurashiki, Japan
| | - Y Ueki
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Kuroda
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Kawamura
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Ohe
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
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24
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Ueno EI, Fujibayashi K, Sawaguchi J, Yasuda Y, Takano S, Fujioka N, Kawai Y, Fujita H, Tanaka Y, Kajinami K. Monitoring the roles of prothrombin activation fragment 1 and 2 (F1 + 2) in patients with atrial fibrillation receiving rivaroxaban and apixaban. J Thromb Thrombolysis 2020; 50:371-379. [PMID: 32166540 DOI: 10.1007/s11239-020-02079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Factor Xa (FXa) inhibitors are recommended for use in fixed doses without laboratory monitoring. However, prior studies reported the importance of establishing biomarkers representing anticoagulation intensity related to bleeding or thrombotic events. To test the hypothesis that prothrombin activation fragment 1 and 2 (F1 + 2), a non-specific marker of thrombin generation, could be altered during FXa inhibitor treatment in patients with atrial fibrillation. We conducted the study in two different clinical settings. First, the interrelations among biomarkers representing coagulation/fibrinolysis were investigated in 80 patients in an outpatient clinic. Second, these biomarkers were evaluated in 75 patients who underwent radiofrequency catheter ablation. Plasma concentration of FXa inhibitors was evaluated using an anti-FXa chromogenic assay (C-Xa). In the outpatient study, only F1 + 2 exhibited a significant and negative association with C-Xa (rS = - 0.315, p = 0.026), and 37% of the variance could be explained by C-Xa levels. F1 + 2 levels above the reference range (> 229 pmol/L) could be considered as a cut-off to identify poor patient compliance or under-dosing. In the peri-ablation study, increased F1 + 2 levels were associated with decline of C-Xa levels after periprocedural discontinuation of FXa inhibitors, which was greater in the rivaroxaban group than in the apixaban group. F1 + 2 showed modest and inverse association with plasma concentration of rivaroxaban and apixaban in patients with atrial fibrillation. Larger study to test the hypothesis that continued thrombin generation despite anticoagulation is associated with a heightened risk of clinical events is required.
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Affiliation(s)
- Ei-Ichi Ueno
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Kosuke Fujibayashi
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan.
| | - Jun Sawaguchi
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Yushi Yasuda
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Shintaro Takano
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Nakaba Fujioka
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Harumi Fujita
- Central Clinical Laboratoy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Yoshi Tanaka
- Central Clinical Laboratoy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, 920-0293, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Japan
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25
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Wakasa M, Kawai Y, Kajinami K. P104 Prognostic value of Circulating Amino Acids (AAs) in Patients with Idiopathic Dilated Cardiomyopathy (DCM). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.048] [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
Backgrounds Circulating levels of some amino acids are significantly decreased in heart failure patients. However, relationship between their levels and cardiac function remains unclear. We therefore examined association between amino acid levels and cardiac function as prognostic predictor in DCM patients.
Methods
Consecutive 59 patients with DCM (M/F: 46/13, mean age: 59 years) were enrolled. We measured 25 kinds of plasma AA concentration, derivative of reactive oxygen metabolites (d-ROMs) as marker of oxidative stress, and washout rate of Tc-99m Sestamibi (WOR) as function of mitochondria and LVEF as LV function parameters. The occurrence of rehospitalization for cardiac events or cardiac death were followed during mean 1101 days (13-2626).
Results
Histidine, arginine and Fischer ratio (FR) showed a significant positive association with LVEF (p < 0.05). Threonine and asparagine showed a significant negative association with WOR (P < 0.05). Histidine and arginine showed a significant negative association with levels of d-ROMs (p < 0.05).Rehospitalization for cardiac events and cardiac death were recorded in 16 patients (27%) and 6 patients (10%), respectively. Kaplan-Meier curves analysis showed similar trend of rehospitalization in subjects with lower FR and those with higher values. However, cardiac death in subjects with lower FR was observed more frequently as compared to those with higher values (22.2% vs 5.3% p < 0.05).
ConclusionsThe plasma FR could be a novel prognostic biomarker in DCM patients.
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Affiliation(s)
- M Wakasa
- Kanazawa Medical University, Ishikawa, Japan
| | - Y Kawai
- Kanazawa Medical University, Ishikawa, Japan
| | - K Kajinami
- Kanazawa Medical University, Ishikawa, Japan
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26
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Fujibayashi K, Saeki Y, Sawaguchi J, Yasuda Y, Ueno E, Takano S, Fujioka N, Kawai Y, Kajinami K. A case of cardiac resynchronization therapy in a patient with coronary sinus ostial atresia and persistent left superior vena cava. J Cardiol Cases 2019; 21:101-103. [PMID: 32153683 PMCID: PMC7054661 DOI: 10.1016/j.jccase.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 12/28/2022] Open
Abstract
Coronary sinus ostial atresia is rare and usually not clinically relevant, but it should be noted in cases of cardiac resynchronization therapy. A rare case of successful left ventricular lead implantation for cardiac resynchronization therapy via the left superior vena cava in a patient with coronary sinus ostial atresia is reported. The persistent left superior vena cava associated with these cases tends to be smaller than usual in its diameter and difficult to identify, since the direction of venous drainage is reversed. Therefore, in the present case, it was useful to use a small-diameter, soft inner catheter as a guiding catheter to perform selective imaging and avoid vascular injury. In addition, it appeared to be important to plan the surgical strategy using prior imaging information, since it would be difficult to obtain the backup needed for lead insertion. 〈 Learning objective: Cardiac resynchronization therapy via the left superior vena cava with coronary sinus ostial atresia is generally possible without problems if prior imaging information is available, such as three-dimensional computed tomography and the venous phase of coronary angiography. It is important to determine whether there is a persistent left superior vena cava before the procedure. Thromboprophylaxis remains controversial in this situation.〉
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Affiliation(s)
- Kosuke Fujibayashi
- Corresponding author at: Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
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27
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Baba K, Tanaka H, Fujita Y, Nakamura A, Kikuchi E, Kawai Y, Harada T, Watanabe N, Yokouchi H, Usui K, Saito R, Watanabe H, Masuda T, Fukuhara T, Kudo K, Honda R, Oizimi S, Maemondo M, Inoue A, Morikawa N. A randomized, phase II study comparing irinotecan versus amrubicin as maintenance therapy after first-line induction therapy for extensive disease small cell lung cancer (HOT1401/NJLCG1401). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.046] [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: 11/13/2022] Open
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28
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Fujibayashi K, Oda M, Wakasa M, Takano S, Kuzume Y, Saeki Y, Sawaguchi J, Fujita W, Saito R, Kawai Y, Kajinami K. P3648Plasma glutamate are increased in non-smoker patients with vasospastic angina pectoris and associated with plasma cystine and antioxidant capacity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Endothelial dysfunction of the coronary arteries caused by oxidative stress plays an important role in the pathogenesis of vasospastic angina pectoris (VSAP). Glutamate, a non-essential amino acid, exerts endothelial dysfunction by oxidative stress production through N-methyl-D-aspartate receptor activation. Besides oxidative stress, decrease of antioxidant may be responsible for endothelial dysfunction. Glutathione (GSH), an important antioxidant, is synthesized from imported cystine through the cystine/glutamate antiporter system (XC-) in association with the export of glutamate. Glutamate also competitively inhibits cystine import into the endothelial cells through the XC-leading to GSH depletion. Thus the extracellular glutamate and cystine are crucial for the intracellular redox status. However, it remains unclear whether glutamate and/or cystine are implicated in the pathogenesis of VSAP. As smoking induces powerful oxidant stresses in the whole body, we investigated plasma glutamate, cystine, oxidative stress markers and antioxidant capacity in non-smoker patients with VSAP.
Methods and results
Sixty-two consecutive non-smoker patients suspected having VSAP were performed coronary angiograms (CAG). Forty-nine patients who did not show any significant coronary stenosis (<50%) were performed the intracoronary acetylcholine provocation test. Patients were categorized into the VSAP-positive group (n=27) and the VSAP-negative group (n=22) on the basis of test results. Blood samples were collected from the femoral sheath before the CAG. Plasma glutamate, cystine, nitrotyrosine (NT), reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) were measured. The levels of plasma glutamate and cystine in the VSAP-positive group were significantly higher than those in the VSAP-negative group (59.8±25.7 vs 43.5±18.7 nmol/L, p=0.0054, and 35.3±14.2 nmol/L vs 25.2±9.1 nmol/L, p=0.0018, respectively). The levels of plasma glutamate showed significant and positive association with the levels of plasma cystine (r=0.40, p=0.005). There were no significant differences in the levels of NT and d-ROMs as oxidative stress markers, and BAP as an antioxidant capacity between the two groups, respectively. However, the levels of plasma glutamate showed significant and negative association with BAP values (r=−0.3, p=0.038).
Conclusions
Plasma levels of glutamate were increased in non-smoker patients with VSAP and positively associated with plasma cystine levels and negatively associated with antioxidant capacity, suggesting that plasma glutamate modulate plasma cystine levels and antioxidant capacity through the XC- inhibition, and could be a novel risk factor of VSAP.
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Affiliation(s)
| | - M Oda
- Kanazawa Medical University, Uchinada, Japan
| | - M Wakasa
- Kanazawa Medical University, Uchinada, Japan
| | - S Takano
- Kanazawa Medical University, Uchinada, Japan
| | - Y Kuzume
- Kanazawa Medical University, Uchinada, Japan
| | - Y Saeki
- Kanazawa Medical University, Uchinada, Japan
| | - J Sawaguchi
- Kanazawa Medical University, Uchinada, Japan
| | - W Fujita
- Kanazawa Medical University, Uchinada, Japan
| | - R Saito
- Kanazawa Medical University, Uchinada, Japan
| | - Y Kawai
- Kanazawa Medical University, Uchinada, Japan
| | - K Kajinami
- Kanazawa Medical University, Uchinada, Japan
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29
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Ejiri K, Miyoshi T, Kihara H, Hata Y, Nagano T, Takaishi A, Toda H, Namba S, Nakamura Y, Akagi S, Sakuragi S, Minagawa T, Kawai Y, Nakamura K, Ito H. 1407Drug effect of luseogliflozin and voglibose on heart failure with preserved ejection fraction in diabetic patients: a multicenter randomized-controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent randomized, placebo-controlled trial in patients with type 2 diabetes demonstrated that the sodium-glucose cotransporter 2 inhibitors reduced mortality, cardiovascular events and hospitalization for heart failure. However, those trials were not specialized design to investigate the effect of sodium-glucose cotransporter 2 inhibitors in patients with heart failure, in particular with heart failure with preserved ejection fraction.
Purpose
The aim of this study was to evaluate the drug efficacy of luseogliflozin, a sodium-glucose cotransporter 2 inhibitor, compared with voglibose, an alpha-glucosidase inhibitor, using brain natriuretic peptide (BNP) in type 2 diabetes patients with heart failure with preserved ejection fraction.
Methods
This study was a prospective, multicenter, open-label, randomized-controlled trial, comparing luseogliflozin 2.5 mg once daily or voglibose 0.2 mg three times daily in patients with type 2 diabetes suffering from heart failure with preserved ejection fraction (left ventricular ejection fraction >45% and BNP ≥35 pg/ml2) in a 1:1 randomization fashion. Randomization was undertaken using a computer-generated random sequence web response system. The primary outcome was the difference from baseline in BNP after 12 weeks of treatment between two drugs. The key secondary outcomes were the change from baseline in left ventricular ejection fraction and E/e' in echocardiographic parameters, body weight, glycohemoglobin level after 12 weeks of treatment. The safety outcomes included the incidence of major adverse cardiovascular events, hypoglycemic adverse events, and urinary tract infection.
Results
Between December 2015 and September 2018, 173 patients from 16 hospitals and clinics have been included in this study. Of those, 83 patients were assigned to receive luseogliflozin and 82 to receive voglibose. There was no significant difference in the reduction in the BNP concentration after 12 weeks from baseline between the two groups; the ratio of the average values at week 12 to the baseline value was 0.91 in the luseoglifllzin group as compared with 0.98 in the voglibose group (percent change, −9.0% vs. −1.9%, ratio of change with luseogliflozin vs. voglibose, 0.93; 95% confidence interval, 0.78 to 1.10; p=0.26). The key secondary outcomes including left ventricular ejection fraction, E/e', body weight, glycohemoglobin level and the safety outcomes did not differ significantly between the two groups.
Conclusions
In type 2 diabetes patients with heart failure with preserved ejection fraction, the administration of luseogliflozin did not lead to a significant reduction in the BNP concentration than that of voglibose. Left ventricular ejection fraction, E/e', body weight and glycohemoglobin level after 12 weeks of treatment, comparing with at baseline did not differ significantly between the two groups. (UMIN Clinical Trial Registry number, UMINehz748.005618395)
Acknowledgement/Funding
Novartis
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Affiliation(s)
- K Ejiri
- Okayama University, Cardiovascular Medicine, Okayama, Japan
| | - T Miyoshi
- Okayama University, Cardiovascular Medicine, Okayama, Japan
| | - H Kihara
- Kihara Cardiovascular Clinic, Internal Medicine, Asahikawa, Japan
| | - Y Hata
- Minamino Cardiovascular Hospital, Cardiology, Hachioji, Japan
| | - T Nagano
- Iwasa Hospital, Internal Medicine, Gifu, Japan
| | - A Takaishi
- Mitoyo General Hospital, Cardiology, Kanonji, Japan
| | - H Toda
- Okayama East Neurosurgery Hospital, Internal Medicine, Okayama, Japan
| | - S Namba
- Okayama Rosai Hospital, Cardiology, Okayama, Japan
| | - Y Nakamura
- Specified Clinic of Soyokaze Cardiovascular Medicine and Diabetes Care, Cardiovascular Medicine, Matsuyama, Japan
| | - S Akagi
- Akaiwa Medical Association Hospital, Internal Medicine, Akaiwa, Japan
| | - S Sakuragi
- Iwakuni Clinical Center, Cardiovascular Medicine, Iwakuni, Japan
| | - T Minagawa
- Minagawa Cardiovascular Clinic, Internal Medicine, Gifu, Japan
| | - Y Kawai
- Okayama City Hospital, Cardiovascular Medicine, Okayama, Japan
| | - K Nakamura
- Okayama University, Cardiovascular Medicine, Okayama, Japan
| | - H Ito
- Okayama University, Cardiovascular Medicine, Okayama, Japan
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30
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Kuroda K, Gentaro S, Kawamura K, Ono T, Tokioka K, Kawai Y, Tohru O. P4634Acute-phase high platelet reactivity with prasugrel loading is correlated with clinical outcomes during hospitalization in acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Although high platelet reactivity (HPR) seems to be associated with adverse cardiovascular events after percutaneous coronary intervention (PCI), the relationship between post-procedure HPR with prasugrel loading and clinical outcomes in acute coronary syndrome (ACS) is still unclear. Moreover, factors contributing to HPR in ACS with prasugrel loading are also unknown.
Purpose
This study aimed to assess the impact of post-procedure HPR with prasugrel loading on clinical outcomes in ACS during hospitalization, as well as to define appropriate cut-off values and identify factors contributing to HPR.
Methods
We performed a single-centre, retrospective observational study that enrolled 132 patients who underwent emergent PCI for ACS with prasugrel loading. The P2Y12 reaction unit (PRU) value was measured immediately after PCI with the VerifyNowR System. The primary endpoint was major adverse cardiac events (MACE, defined as the composite of death, myocardial infarction, stroke, heart failure, ventricular arrhythmia needing defibrillation).
Results
Mean patient age (standard deviation) was 70.7 (±12.5) years, 76% were male, and average time from prasugrel intake to PRU calculation was 101 (±48.8) min. During a mean hospital stay of 15.4 (±8.0) days, there were 22 (16%) MACE events and 6 (4%) deaths. The post-procedure PRU value was 241±66. HPR was significantly higher in MACE group than non-MACE group [287 (±55) vs 232 (±64), p<0.001]. The ROC curve analysis of PRU for discriminating significant in-hospital MACE showed a cut off value of 293 (sensitivity: 64%, specificity: 84% [AUC=0.764, p<0.0001]). Thus, 33 patients (25%) were found to have HPR (PRU>293) immediately after emergent PCI. Kaplan-Meier curve analysis showed MACE events occurred more frequently in the HPR group than in the non-HPR group (42% vs 8%, log rank p<0.001). Multiple Cox regression analysis showed that peak creatine phosphokinase >3,000 U/L and HPR were independent predictors of MACE in patients with ACS who underwent PCI (OR 4.96, 95% CI 1.86–13.26, p=0.001, and OR 7.52, 95% CI 2.73–20.7, p<0.0001, respectively). HPR was significantly correlated with age, female sex, and reference lumen short diameter (pre-dilation) used in PCI.
Conclusion
HPR was significantly associated with adverse event during hospitalization in ACS patients. Female patients with large culprit lesion diameter were more likely to have HPR. Appropriate cut-off value of HPR in this study was 293. HPR in early-phase of ACS with prasugrel loading is a useful predictor of adverse events during hospitalization.
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Affiliation(s)
- K Kuroda
- Okayama City Hospital, Okayama, Japan
| | - S Gentaro
- Okayama City Hospital, Okayama, Japan
| | | | - T Ono
- Okayama City Hospital, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Okayama, Japan
| | - O Tohru
- Okayama City Hospital, Okayama, Japan
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31
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Ohhara Y, Kojima T, Honjo O, Yamada N, Sato T, Kunisaki M, Takamura K, Takashina T, Sukoh N, Tanaka H, Kawai Y, Fujita Y, Sugaya F, Hommura F, Harada T, Ryoichi H, Kinoshita I, Amano T, Oizumi S, Akita H. Prognostic factors for non-small cell lung cancer patients with driver mutation negative and brain metastases (HOT 1701). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.101] [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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32
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Ueki M, Kimura-Kataoka K, Fujihara J, Iida R, Kawai Y, Kusaka A, Sasaki T, Takeshita H, Yasuda T. Evaluation of the functional effects of genetic variants‒missense and nonsense SNPs, indels and copy number variations‒in the gene encoding human deoxyribonuclease I potentially implicated in autoimmunity. Sci Rep 2019; 9:13660. [PMID: 31541133 PMCID: PMC6754452 DOI: 10.1038/s41598-019-49935-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/29/2019] [Indexed: 01/31/2023] Open
Abstract
Genetic variants, such as single nucleotide polymorphisms (SNPs), in the deoxyribonuclease I (DNase I) gene which remarkably reduce or abolish the activity are assumed to be substantially responsible for the genetic backgrounds determining susceptibility to autoimmune dysfunction. Here, we evaluated many genetic variants, including missense and nonsense SNPs, and indel (inframe) variants in the gene, potentially implicated in autoimmune diseases as functional variants resulting in altered activity levels. Eighteen missense and 7 nonsense SNPs, and 9 indel (inframe) variants were found to result in loss of function and disappearance of DNase I activity. Furthermore, considering the positions in the DNase I protein corresponding to the various nonsense SNPs, all of the other nonsense SNPs and frameshift variants registered in the Ensembl database (https://asia.ensembl.org) appear likely to exert a pathogenetic effect through loss of the activity. Accordingly, a total of 60 genetic variants in the DNase 1 gene (DNASE1) inducing abolishment or marked reduction of the DNase I activity could be identified as genetic risk factors for autoimmunity, irrespective of how sparsely they were distributed in the population. It was noteworthy that SNP p.Gln244Arg, reportedly associated with autoimmunity and reducing the activity to about half of that of the wild type, and SNP p.Arg107Gly, abolishing the activity completely, were distributed worldwide and in African populations at the polymorphic level, respectively. On the other hand, with regard to copy number variations in DNASE1 where loss of copy leads to a reduction of the in vivo enzyme activity, only 2 diploid copy numbers were distributed in Japanese and German populations, demonstrating no loss of copy. These exhaustive data for genetic variants in DNASE1 resulting in loss or marked reduction of the DNase I activity are highly informative when considering genetic predisposition leading to autoimmune dysfunction.
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Affiliation(s)
- Misuzu Ueki
- Department of Medical Genetics and Biochemistry, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Kaori Kimura-Kataoka
- Department of Legal Medicine, Shimane University School of Medicine, Enya, Izumo, Japan
| | - Junko Fujihara
- Department of Legal Medicine, Shimane University School of Medicine, Enya, Izumo, Japan
| | - Reiko Iida
- Department of Life Sciences, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Akari Kusaka
- Department of Legal Medicine, Shimane University School of Medicine, Enya, Izumo, Japan
| | - Takamitsu Sasaki
- Department of Legal Medicine, Shimane University School of Medicine, Enya, Izumo, Japan
| | - Haruo Takeshita
- Department of Legal Medicine, Shimane University School of Medicine, Enya, Izumo, Japan.
| | - Toshihiro Yasuda
- Department of Medical Genetics and Biochemistry, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
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33
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Okuda K, Watanabe N, Hashimoto M, Doai M, Kawai Y, Takahashi T, Arikawa T, Ooiso K, Sunatani Y, Iwabuchi K, Kajinami K, Matoba M. Preliminary quantitative evaluation of radiation-induced DNA damage in peripheral blood lymphocytes after cardiac dual-isotope imaging. Appl Radiat Isot 2019; 154:108890. [PMID: 31525597 DOI: 10.1016/j.apradiso.2019.108890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/20/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022]
Abstract
DNA double-strand breaks (DSBs) of peripheral blood lymphocyte were prospectively assessed in 9 patients who were injected with 201Tl-chloride and 123I-beta-methyl-p-iodophenyl-pentadecanoic acid in dual-isotope imaging. Phosphorylated H2AX (γH2AX) was used as a biomarker for detecting DSBs, and the mean number of γH2AX foci per cell was measured microscopically. Mean γH2AX foci before administration of radiopharmaceuticals and at 3, 6, and 24 h following administration were 0.22 ± 0.34, 0.10 ± 0.14, 0.59 ± 0.46, and 0.52 ± 0.40, respectively (p = n.s. for all combinations).
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Affiliation(s)
- Koichi Okuda
- Department of Physics, Kanazawa Medical University, Ishikawa, 920-0293, Japan.
| | - Naoto Watanabe
- Department of Radiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Mitsumasa Hashimoto
- Department of Physics, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Mariko Doai
- Department of Radiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Tomoko Takahashi
- Department of Radiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Tomohiro Arikawa
- Department of Biology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Kazumasa Ooiso
- Department of Radiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Yumi Sunatani
- Department of Biochemistry I, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Kuniyoshi Iwabuchi
- Department of Biochemistry I, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Koji Kajinami
- Department of Cardiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Ishikawa, 920-0293, Japan
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34
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Ohwada G, Minakuchi S, Sato Y, Kondo H, Nomura T, Tsuboi A, Hong G, Itoh Y, Kawai Y, Kimoto S, Gunji A, Suzuki A, Suzuki T, Kimoto K, Hoshi N, Saita M, Yoneyama Y, Sato Y, Morokuma M, Okazaki J, Maeda T, Nakai K, Ichikawa T, Nagao K, Fujimoto K, Murata H, Kurogi T, Yoshida K, Nishimura M, Nishi Y, Murakami M, Hosoi T, Hamada T. Subjective Evaluation of Denture Adhesives: A Multicenter Randomized Controlled Trial. JDR Clin Trans Res 2019; 5:50-61. [PMID: 30975019 DOI: 10.1177/2380084419837607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Many reports show that denture adhesives improve the retention and stability of dentures. However, few randomized controlled trials have examined the effects of denture adhesives. OBJECTIVE This 10-center randomized controlled trial with parallel groups involving 200 edentulous patients wearing complete dentures aimed to evaluate the effects of short-term use of cream and powder denture adhesives. METHODS Patients were allocated into 2 cream- and powder-type adhesive groups and 1 control group. Intervention groups were treated with the 2 adhesives (1 each), and the control group received saline solution. Adhesive or control was applied to the denture-mucosal surface for 4 d, and data at baseline and after day 4 of intervention (i.e., 8 meals) were obtained. Patient satisfaction was evaluated with a 100-mm visual analog scale. Oral health-related quality of life was measured with the Japanese version of the Oral Health Impact Profile for Edentulous Patients. Perceived chewing ability was evaluated by a questionnaire regarding ease of chewing and swallowing food. Between-group comparisons were performed with Kruskal-Wallis tests with the Mann-Whitney U test adjusted by Bonferroni correction. Within-group comparisons of pre- and postintervention measurements were performed with the Wilcoxon signed-rank test. Intention-to-treat analysis was also performed. RESULTS Between-group comparisons showed no significant differences for general satisfaction or Oral Health Impact Profile for Edentulous Patients. However, significant differences in satisfaction with various denture functions with cream- and powder-type adhesives were seen in pre- and postintervention comparisons (P < 0.05). Significant differences were also observed for perceived chewing ability of hard foods (P < 0.05). CONCLUSION These results suggest that although denture adhesives do not invariably improve denture function, they do affect subjective evaluations and possibly chewing of hard foods. Therefore, the effects of denture adhesive use are insufficient to resolve any fundamental dissatisfaction with dentures ( ClinicalTrials.gov NCT01712802 ). KNOWLEDGE TRANSFER STATEMENT The results of this study suggest that denture adhesives should be applied under certain conditions; however, an appropriate diagnosis is important before application. These practice-based data provide information to establish evidence-based guidelines for applying denture adhesives.
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Affiliation(s)
- G Ohwada
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Minakuchi
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Sato
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Kondo
- The Japan Denture Care Society.,Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - T Nomura
- The Japan Denture Care Society.,Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - A Tsuboi
- The Japan Denture Care Society.,Division of Community Oral Health Science, Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - G Hong
- The Japan Denture Care Society.,Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Y Itoh
- The Japan Denture Care Society.,Division of Aging and Geriatric Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Y Kawai
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - S Kimoto
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - A Gunji
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - A Suzuki
- The Japan Denture Care Society.,Department of Removable Prosthodontics, Graduate School of Dentistry, Nihon University, Matsudo, Japan
| | - T Suzuki
- The Japan Denture Care Society.,Section of Oral Prosthetic Engineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kimoto
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - N Hoshi
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - M Saita
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Y Yoneyama
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Y Sato
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - M Morokuma
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - J Okazaki
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - T Maeda
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - K Nakai
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - T Ichikawa
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - K Nagao
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - K Fujimoto
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - H Murata
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - T Kurogi
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - K Yoshida
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - M Nishimura
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutic, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
| | - Y Nishi
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutic, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
| | - M Murakami
- The Japan Denture Care Society.,Denture Prosthodontic Restoration, Advanced Dentistry Center, Kagoshima University Medical and Dental Hospital, Kagoshima City, Japan
| | - T Hosoi
- The Japan Denture Care Society.,School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - T Hamada
- The Japan Denture Care Society.,Hiroshima University, Hiroshima City, Japan
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Okuda A, Maegawa N, Matsumori H, Kura T, Mizutani Y, Shigematsu H, Iwata E, Tanaka M, Masuda K, Yamamoto Y, Tada Y, Kogeichi Y, Takano K, Asai H, Kawai Y, Urisono Y, Kawamura K, Fukushima H, Tanaka Y. Minimally invasive spinopelvic "crab-shaped fixation" for unstable pelvic ring fractures: technical note and 16 case series. J Orthop Surg Res 2019; 14:51. [PMID: 30767783 PMCID: PMC6376779 DOI: 10.1186/s13018-019-1093-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes. Methods Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed. Results The average surgical time was 158 min (range, 117–230 min), with an intraoperative bleeding volume of 299 ml (range, 80–480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4–9.0 mm), to < 10 cm. Correction was retained in all cases. Conclusions Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.
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Affiliation(s)
- Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Naoki Maegawa
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan. .,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Hiroaki Matsumori
- Department of Orthopedic Surgery, Kashiba Asahigaoka Hospital, Kashiba, Nara, Japan
| | - Tomohiko Kura
- Department of Orthopedic Surgery, Kura Hospital, Ikoma, Nara, Japan
| | - Yasushi Mizutani
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan.,Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Eiichiro Iwata
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Keisuke Masuda
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Tada
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yohei Kogeichi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Keisuke Takano
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Kenji Kawamura
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
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Goda T, Kinoshita I, Oizumi S, Nakano K, Harada T, Kawai Y, Sakakibara-Konishi J, Yokouchi H, Morikawa N, Yamada N, Yamazaki S, Sugawara S, Asahina H, Amano T, Hatanaka Y, Matsuno Y, Nishihara H, Isobe H, Nishimura M, Dosaka-Akita H. A prospective observational study of HER2 alterations in NSCLCs: HOT1303-A. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.111] [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: 11/13/2022] Open
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Watanabe T, Kawai Y, Iwamura A, Maegawa N, Fukushima H, Okuchi K. Outcomes after Traumatic Brain Injury with Concomitant Severe Extracranial Injuries. Neurol Med Chir (Tokyo) 2018; 58:393-399. [PMID: 30101808 PMCID: PMC6156128 DOI: 10.2176/nmc.oa.2018-0116] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. Patients with TBI frequently sustain concomitant injuries in extracranial regions. The effect of severe extracranial injury (SEI) on the outcome of TBI is controversial. For 8 years, we retrospectively enrolled 485 patients with the blunt head injury with head abbreviated injury scale (AIS) ≧ 3. SEI was defined as AIS ≧ 3 injuries in the face, chest, abdomen, and pelvis/extremities. Vital signs and coagulation parameter values were also extracted from the database. Total patients were dichotomized into isolated TBI (n = 343) and TBI associated with SEI (n = 142). The differences in severity and outcome between these two groups were analyzed. To assess the relation between outcome and any variables showing significant differences in univariate analysis, we included the parameters in univariable and multivariable logistic regression analyses. Mortality was 17.8% in the isolated TBI group and 21.8% in TBI with SEI group (P = 0.38), but the Glasgow Outcome Scale (GOS) in the TBI with SEI group was unfavorable compared to the isolated TBI group (P = 0.002). Patients with SBP ≦ 90 mmHg were frequent in the TBI with SEI group. Adjusting for age, GCS, and length of hospital stay, SEI was a strong prognostic factor for mortality with adjusted ORs of 2.30. Hypotension and coagulopathy caused by SEI are considerable factors underlying the secondary insults to TBI. It is important to manage not only the brain but the whole body in the treatment of TBI patients with SEI.
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Affiliation(s)
- Tomoo Watanabe
- Department of Emergency and Critical Care, Nara Medical University
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care, Nara Medical University
| | - Asami Iwamura
- Department of Emergency and Critical Care, Nara Medical University
| | - Naoki Maegawa
- Department of Emergency and Critical Care, Nara Medical University
| | | | - Kazuo Okuchi
- Department of Emergency and Critical Care, Nara Medical University
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38
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Amamizu H, Matsumoto Y, Morosawa S, Ohyama K, Uzuka H, Hirano M, Sugisawa J, Tsuchiya S, Nishimiya K, Hayashi M, Kawai Y, Shimokawa H. 2435Important roles of cardiac lymphatic vessels in the regulation of coronary vasomotion after DES implantation in pigs in vivo. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- H Amamizu
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - S Morosawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - H Uzuka
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - M Hirano
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - K Nishimiya
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - M Hayashi
- Tohoku Pharmaceutical University Hospital, Physiology, Sendai, Japan
| | - Y Kawai
- Tohoku Pharmaceutical University Hospital, Physiology, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
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Ono T, Miyoshi T, Ohno Y, Kuroda K, Shokoku G, Yamamoto K, Tokioka K, Kawai Y, Ito H, Ohe T. P4786Incremental prognostic value of cardio-ankle vascular index as an arterial stiffness marker in patients with intermediate risk for cardiovascular disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4786] [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: 11/14/2022] Open
Affiliation(s)
- T Ono
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Miyoshi
- Okayama University, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Ohno
- Okayama University, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Kuroda
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - G Shokoku
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Yamamoto
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - K Tokioka
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - Y Kawai
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
| | - H Ito
- Okayama University, Department of Cardiovascular Medicine, Okayama, Japan
| | - T Ohe
- Okayama City Hospital, Department of Cardiovascular Medicine, Okayama, Japan
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40
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Ogawa T, Kimoto S, Nakashima Y, Furuse N, Ono M, Furokawa S, Okubo M, Yamaguchi H, Kawai Y. Differences in pain thresholds elicited by intraoral electrical stimuli between individuals with and without diabetes mellitus. J Oral Rehabil 2018; 45:235-239. [DOI: 10.1111/joor.12601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- T. Ogawa
- Removable Prosthodontics; Nihon University Graduate School of Dentistry at Matsudo; Matsudo Japan
| | - S. Kimoto
- Department of Removable Prosthodontics; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - Y. Nakashima
- Department of Removable Prosthodontics; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - N. Furuse
- Removable Prosthodontics; Nihon University Graduate School of Dentistry at Matsudo; Matsudo Japan
| | - M. Ono
- Removable Prosthodontics; Nihon University Graduate School of Dentistry at Matsudo; Matsudo Japan
| | - S. Furokawa
- Removable Prosthodontics; Nihon University Graduate School of Dentistry at Matsudo; Matsudo Japan
| | - M. Okubo
- Department of Removable Prosthodontics; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - H. Yamaguchi
- Department of Anesthesiology; Nihon University School of Dentistry at Matsudo; Matsudo Japan
| | - Y. Kawai
- Department of Removable Prosthodontics; Nihon University School of Dentistry at Matsudo; Matsudo Japan
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Kawai Y, Asahina H, Ikezawa Y, Oizumi S, Ogi T, Watanabe M, Amano T, Dosaka-Akita H, Isobe H, Nishimura M. P2.01-005 A Randomized Phase II Trial of Erlotinib vs S-1 in Patients with NSCLC as Third- or Fourth-Line Therapy (HOT1002). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wakasa M, Aoki H, Kawai Y, Kajinami K. Prognostic Value of Circulating Amino Acids (AAS) in Patients With Idiopathic Dilated Cardiomyopathy (DCM). J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.08.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Takamura T, Oda M, Watanabe M, Saito R, Tsuchiya T, Akao H, Kawai Y, Kitayama M, Kajinami K. Circulating MDA-LDL after endovascular therapy (EVT) as novel prognostic marker in peripheral artery disease (PAD) patients. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ono T, Miyoshi T, Ohno Y, Syokoku G, Yamamoto K, Tokioka K, Kawai Y, Ito H. P5453Cardio-ankle vascular index, a novel parameter of subclinical atherosclerosis predicts prognosis in patients at high risk for cardiovascular disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aoki H, Kawai Y, Nakanishi H, Tskeuchi M. P4354Glycer-AGEs is associated with the severity of cardiac function of diabetic cardiomyopathy (DbCM). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Takamura TA, Tsuchiya T, Oda M, Watanabe M, Saito R, Sato-Ishida R, Akao H, Kawai Y, Kitayama M, Kajinami K. Circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL) as a novel predictor of clinical outcome after endovascular therapy in patients with peripheral artery disease (PAD). Atherosclerosis 2017. [PMID: 28651186 DOI: 10.1016/j.atherosclerosis.2017.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Despite advances in the treatment of peripheral artery disease (PAD), cardiovascular events and death rates remain high. This study aimed at identifying markers of outcome in patients with PAD undergoing endovascular therapy (EVT). METHODS Consecutive patients undergoing EVT were recruited. Markers of oxidative stress (malondialdehyde-modified low-density lipoprotein [MDA-LDL]), inflammation (IL-6; high-sensitivity C-reactive protein [hsCRP]) and fibrinolysis (D-dimer) were measured pre-EVT and at post-EVT time-points to 36 h. Clinical follow-up assessed major cardiovascular and/or limb events. RESULTS In the 35 patients enrolled, mean MDA-LDL levels decreased from a baseline level of 106.2 U/L to 72.6 U/L immediately post-EVT (p<0.0001); levels remained significantly reduced at all time-points. IL-6, hsCRP and D-dimer increased and were significantly higher at the 36 h time-point. A significant, negative association was seen between decreased MDA-LDL and pre-EVT hsCRP levels (r = -0.42, p=0.012). Clinical follow-up data were obtained for a mean period of 16 months. MDA-LDL ratios (obtained by comparison of post- and pre-EVT values) allowed assessment of high (≥0.495) and low (<0.495) ratio groups. A significantly higher rate of major adverse events, including limb-related events or death, was seen in the low ratio group (p<0.001). Cox proportional hazard analysis including traditional risk factors indicated that this ratio is a significant predictor of clinical endpoints (HR = 0.4210, p=0.0154). An association with clinical outcome was not observed with the other candidate biomarkers. CONCLUSIONS Assessment of pre- and post-EVT MDA-LDL levels is a promising marker of clinical outcome in patients with PAD.
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Affiliation(s)
- Taka-Aki Takamura
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Taketsugu Tsuchiya
- Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Minako Oda
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Makoto Watanabe
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Ryuhei Saito
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Ryoko Sato-Ishida
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Hironobu Akao
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Michihiko Kitayama
- Trans-catheter Cardiovascular Therapeutics, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada 920-0293, Japan.
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Hori M, Nakayama A, Kitagawa D, Fukushima H, Asai H, Kawai Y, Okuchi K. A case of Vibrio vulnificus infection complicated with fulminant purpura: gene and biotype analysis of the pathogen. JMM Case Rep 2017; 4:e005096. [PMID: 29026623 PMCID: PMC5630965 DOI: 10.1099/jmmcr.0.005096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/28/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction.Vibrio vulnificus (V. vulnificus) causes a severe infection that develops in the compromised host. Its pathophysiology is classified into three types: (1) primary septicaemia, (2) gastrointestinal illness pattern and (3) wound infection pattern. Of these, primary septicaemia is critical. V. vulnificus can be classified into three biotypes and two genotypes and its pathogenicity is type-dependent. Case presentation. A 47-year-old man presented to a local hospital with chief complaints of fever, bilateral lower limb pain and diarrhoea. He had no history of foreign travel or known medical problems. He was in septic shock and developed fulminant purpura within 24 h of the onset. High-dose vasopressor and antibiotic administration failed to alter his status and he died 3 days after the onset of symptoms. V. vulnificus was isolated from blood, skin and nasal discharge cultures. Biotype and gene analysis of the microbe isolated identified it as Biotype 3, mainly reported in Israel in wound infections, and Genotype E, implicating an environmental isolate. These typing analyses indicated that the microbe isolated could be classified as a type with low pathogenicity. Conclusion. This case highlighted that Biotype 3 and Genotype E can also cause primary septicaemia. Although the majority of reports on Biotype 3 have been from the Middle East, this experience with the present case provided evidence that the habitat of Biotype 3 V. vulnificus has been extending to East Asia as well.
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Affiliation(s)
- Masatoshi Hori
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Akifumi Nakayama
- Department of Medical Technology, School of Health Sciences, Gifu University of Medical Science, 795-1 Aza-Nagamine, Ichihiraga, Seki City, Seki, Gifu, Japan
| | - Daisuke Kitagawa
- Department of Central Laboratory Medicine, Nara Prefecture General Medical Center, Hiramatsu, Nara, Nara Prefecture 631-0846, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
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Shido K, Kojima K, Hozawa A, Ogishima S, Minegishi N, Kawai Y, Tamiya G, Tanno K, Yamasaki K, Aiba S, Suzuki Y, Nagasaki M. 503 Genome-wide association study identifies novel susceptibility loci for tanning ability in Japanese population. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fukushima H, Kawai Y, Asai H, Seki T, Norimoto K, Urisono Y, Okuchi K. Performance review of regional emergency medical service pre-arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population-based observational study. Acute Med Surg 2017; 4:293-299. [PMID: 29123877 PMCID: PMC5674464 DOI: 10.1002/ams2.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/01/2017] [Indexed: 12/21/2022] Open
Abstract
Background To investigate variations in emergency medical service (EMS) pre‐arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch‐assisted CPR (DACPR). Methods We carried out an observational study by implementing EMS pre‐arrival CPR reports in three fire agencies. We included adult, non‐traumatic, and non‐EMS witnessed out‐of‐hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good‐quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good‐quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group. Results Of 688 out‐of‐hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good‐quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888). Conclusions Ongoing CPR and good‐quality CPR were not frequent in EMS pre‐arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre‐arrival CPR.
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Affiliation(s)
- Hidetada Fukushima
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Tadahiko Seki
- Department of Emergency Nara Prefectural General Hospital Nara City Nara Japan
| | | | - Yasuyuki Urisono
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
| | - Kazuo Okuchi
- Department of Emergency and Critical Care Medicine Nara Medical University Kashihara City Nara Japan
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Ogata H, Saito M, Tsuneizumi M, Kutomi G, Hosoya K, Kawai Y, Sugizaki K, Katsumata N, Senuma K, Kitabatake T, Suda M, Uomori T, Miura K, Kurata M, Nitta Y, Yonemoto N, Matsuoka J. Abstract P5-11-03: Difference between 1st and 2nd generation serotonin receptor antagonists in triplet antiemetic therapy for highly emetogenic chemotherapy in breast cancer patients – according to recent multi-institutional double-blind randomized clinical research on the AC regimen. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-11-03] [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: 11/16/2022]
Abstract
Abstract
<Background>
The information presented herein extends our recent study of TTT (Trial for Triplet Antiemetic Therapy).
One of our main clinical questions has been whether a 2nd generation serotonin receptor antagonist (5-HT3ra) would be superior to 1st generation 5-HT3ra when administering triplet antiemetic therapy for the prevention of chemotherapy induced nausea & vomiting (CINV), since a prior Japanese trial demonstrated palonosetron to be superior to granisetron for controlling the delayed phase of CINV induced by highly emetogenic chemotherapy (HEC) and to doublet antiemetic therapy including dexamethasone for anthracycline and cyclophosphamide containing regimens (AC).
<Objectives>
In this study, we assessed the efficacies of 1st and 2nd generation 5-HT3ra agents for use as triplet antiemetic therapy for AC, by monitoring CINV, focusing especially daily CR in the delayed phase.
<Material and method>
Between 2012 and 2015, 491 women with breast cancer receiving AC were recruited from 11 institutions in Japan, and randomly assigned to either single-dose palonosetron (0.75mg) or granisetron (40μg/kg) prior to chemotherapy on day 1, both with dexamethasone (9.9 mg intravenously) and aprepitant (125mg orally) on day 1 followed by additional doses (80mg orally) on days 2 and 3. Age, institution and habitual alcohol intake were used as stratification factors. The primary endpoint was a complete response (CR). Statistical analysis was done by Mantel-Haenszel Method. This trial was registered with UMIN000007882.
<Results>
All 491 patients were included in efficacy analyses (ITT): 246 patients in the palonosetron group and 245 in the granisetron group. We previously reported that the difference in CR during the delayed phase, i.e. 24 hours after the administration of AC, did not reach statistical significance (53.8% vs 58.5%) in MASCC 2016. However, daily CR in the palonosetron group was much higher than that in the granisetron group after 48 hours.
<Conclusions>
Palonosetron showed better efficacy in controlling CINV during the late period of the delayed phase, i.e. 48 hours after AC administration, than granisetron as triplet antiemetic therapy for AC.
<Considerations>
The pattern of CINV reportedly shows two peaks including an acute phase caused by serotonin and a delayed phase caused by substance P, though the pattern of CINV with triplet antiemetic therapy administration might be different if the suppression of each of these peaks were to be achieved more efficiently. CINV may not be divided into two phases in the future, or the borderline area between the acute and delayed phases may require revision. The analysis of the late period of the delayed phase was ad hoc in this trial. However, when conducting studies related to CINV, it might be worthwhile to revise the borderline area between the two phases of CINV to facilitate elucidating the mechanisms underlying this potentially debilitating side effect of chemotherapy.
Citation Format: Ogata H, Saito M, Tsuneizumi M, Kutomi G, Hosoya K, Kawai Y, Sugizaki K, Katsumata N, Senuma K, Kitabatake T, Suda M, Uomori T, Miura K, Kurata M, Nitta Y, Yonemoto N, Matsuoka J. Difference between 1st and 2nd generation serotonin receptor antagonists in triplet antiemetic therapy for highly emetogenic chemotherapy in breast cancer patients – according to recent multi-institutional double-blind randomized clinical research on the AC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-03.
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Affiliation(s)
- H Ogata
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Saito
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Tsuneizumi
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - G Kutomi
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Hosoya
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Kawai
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Sugizaki
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Katsumata
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Senuma
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Kitabatake
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Suda
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Uomori
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Miura
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Kurata
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Nitta
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Yonemoto
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
| | - J Matsuoka
- Toho University Ohmori Medical Center, Tokyo, Japan; Juntendo University, Tokyo, Japan; Shizuoka General Hospital, Shizuoka, Japan; Sapporo Medical University, Sapporo, Japan; Tottori University, Yonago, Japan; Tokyo Medical University, Tokyo, Japan; Ohme Municipal General Hospital, Ohme, Japan; Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan; Juntendo University Shizuoka Branch Hospital, Izunagaoka, Japan; Juntendo University Urayasu Hospital, Urayasu, Japan; Juntendo University Nerima Hospital, Tokyo, Japan
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