1
|
Takahashi T, Maruno K, Hazama T, Yamada Y, Nakashima M, Kikkawa K, Tamaki M, Ito N. A case of successful treatment of Fournier's gangrene through conservative management and elective debridement. IJU Case Rep 2024; 7:217-220. [PMID: 38686076 PMCID: PMC11056266 DOI: 10.1002/iju5.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Fournier's gangrene refers to a necrotizing fasciitis that mainly affects the perineal region and a condition that requires immediate debridement. This case involved elective debridement of Fournier's gangrene after the general condition was improved through antibiotic treatment instead of requesting an emergency debridement. Case presentation The patient was an 85-year-old man with a performance status of 4 admitted to a nursing home. He was transferred by ambulance with a fever. Blood tests showed a markedly elevated inflammatory response, and computed tomography revealed widespread aerodermectasia around the right testis to the lower abdomen. The patient was diagnosed with Fournier's gangrene. However, his family declined emergency surgical debridement. The patient's general condition was improved with antibiotics, and debridement was eventually performed. After 52 days of hospitalization, the patient was transferred to another hospital. Conclusion This study describes the successful treatment of Fournier's gangrene through conservative treatment followed by elective debridement.
Collapse
Affiliation(s)
- Toshifumi Takahashi
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kouhei Maruno
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Tatsuya Hazama
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yuya Yamada
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masakazu Nakashima
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kazuro Kikkawa
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masahiro Tamaki
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Noriyuki Ito
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| |
Collapse
|
2
|
Kikkawa K, Maruno K, Hazama T, Takahashi T, Yamada Y, Nakashima M, Tamaki M, Ito N. Robotic-assisted partial nephrectomy for a neuroendocrine tumor in a horseshoe kidney: a case report. J Surg Case Rep 2024; 2024:rjae292. [PMID: 38711819 PMCID: PMC11070646 DOI: 10.1093/jscr/rjae292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
Neuroendocrine tumors of the kidney are exceedingly rare. We report the first case of robotic-assisted partial nephrectomy for such tumors in horseshoe kidneys. A 65-year-old woman was incidentally found to have a 27 mm renal mass in the isthmus of her horseshoe kidney during computed tomography. Based on contrast-enhanced computed tomography results, we initially suspected renal cell carcinoma originating from the horseshoe kidney. Subsequently, robotic-assisted partial nephrectomy with isthmus transection was performed. Intraoperatively, we adjusted the port position for camera insertion and the patient's positioning to facilitate better visualization for dorsal isthmus and vessel dissection. Pathological examination and immunohistochemical analysis revealed a well-differentiated neuroendocrine tumor. Therefore, robotic-assisted partial nephrectomy is a safe and effective approach for managing neuroendocrine tumors in the isthmus of horseshoe kidneys. Given the nonspecific clinical presentation of renal neuroendocrine tumors and their rarity, the optimal management of these tumors remains controversial.
Collapse
Affiliation(s)
- Kazuro Kikkawa
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Kouhei Maruno
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Tatsuya Hazama
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Toshifumi Takahashi
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Yuya Yamada
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Masakazu Nakashima
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Masahiro Tamaki
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| |
Collapse
|
3
|
Niki K, Asano R, Sakanoue R, Hasegawa A, Yamada Y, Hagiwara M, Mimura K. Photoemission Orbital Tomography Using a Robust Sparse PhaseLift. J Phys Chem A 2024; 128:2672-2679. [PMID: 38530789 DOI: 10.1021/acs.jpca.3c06506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Photoemission orbital tomography (POT) from photoelectron momentum maps (PMMs) is a powerful technique that visualizes the shape of the molecular orbitals (MOs) of molecular films. For further utilization of POT, a simple and low-cost method of POT is highly required. Here, we propose a new POT method based on the PhaseLift algorithm (PhaseLift POT). This method utilizes a lifting procedure to convert the PMM, which is a second-order polynomial of MO coefficients, into a first-order polynomial of the lifted MO coefficients and further relaxes the equality constraint for a given PMM. We also established a method to improve the accuracy of phase retrieval from the noisy PMM data by using sparsity for MO coefficients (sparse PhaseLift POT). These methods make it possible to reconstruct the three-dimensional MOs, including phases of the wave function, directly from a single experimental PMM. This method can also precisely determine the adsorption-induced molecular deformations with an accuracy of 0.05 [Å]. Furthermore, the robust sparse PhaseLift POT is robust against unavoidable noise in the experimental PMMs due to the relaxation of the matching condition for a given PMM. Therefore, this will be an innovative tool for POT, especially for analyzing the dynamics of the molecules during the chemical reaction and excitation processes.
Collapse
Affiliation(s)
- K Niki
- Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - R Asano
- Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - R Sakanoue
- Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - A Hasegawa
- Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - Y Yamada
- Faculty of Pure and Applied Science, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan
| | - M Hagiwara
- Graduate School of Science, Chiba University, Chiba 263-8522, Japan
| | - K Mimura
- Graduate School of Information Sciences, Hiroshima City University, Hiroshima 731-3194, Japan
- School of Computing, Tokyo Institute of Technology, Yokohama, Kanagawa 226-0026, Japan
| |
Collapse
|
4
|
Katsuki M, Matsumori Y, Ichihara T, Yamada Y, Kawamura S, Kashiwagi K, Koh A, Goto T, Kaneko K, Wada N, Yamagishi F. Treatment Patterns for and Characteristics of Headache in Children and Adolescents Aged 6-17 Years in Japan: A Retrospective Cross-Sectional and Longitudinal Analysis of Health Insurance Claims Data. Life (Basel) 2024; 14:96. [PMID: 38255711 PMCID: PMC10820976 DOI: 10.3390/life14010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To investigate the prescription patterns for patients aged 6-17 years with headaches in the REZULT database. METHODS We cross-sectionally investigated (Study 1) the pattern of prescription and the proportion of triptan overprescription (≥30 tablets/90 d of triptans) among patients diagnosed with headaches in 2020. Next, we longitudinally studied patients (Study 2) for more than two years from the initial headache diagnosis (July 2010 to April 2022). The number of prescribed tablets was counted every 90 days. RESULTS In Study 1, headache diagnoses were assigned to 62,568 of 543,628 (11.51%) patients, and 1524 of 62,568 (2.44%) patients received acute medication. Single nonsteroidal anti-inflammatory drugs and triptans were prescribed to 620/624 (99.36%) and 5/624 (0.80%) of patients aged 6-11 years, respectively, and 827/900 (91.89%) and 91/900 (10.11%) of patients aged 12-17 years, respectively. Triptan overprescription was observed in 11/96 (11.46%) patients, and 5/11 (45.45%) of those patients received prophylactic medication. In Study 2, 80,756/845,470 (9.55%) patients aged 6-17 years were diagnosed with headaches that persisted for at least two years. Over two years, 44/80,756 (0.05%) patients were overprescribed triptans, and 3408/80,756 (4.22%) patients were prescribed prophylaxis on at least one occasion. CONCLUSIONS Based on real-world data, the appropriate use of prophylactic treatment is still problematic. Overprescription of triptans was observed, although the number of patients was small.
Collapse
Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | | | - Taisuke Ichihara
- Japan System Techniques Co., Ltd. (JAST), Minato-ku 108-8288, Japan
| | - Yuya Yamada
- Japan System Techniques Co., Ltd. (JAST), Minato-ku 108-8288, Japan
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Kenta Kashiwagi
- Department of Neurology, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Kazuma Kaneko
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Department of Neurology, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa 392-0027, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa 392-0027, Japan
| | - Fuminori Yamagishi
- Department of Surgery, Itoigawa General Hospital, Itoigawa 941-0006, Japan
| |
Collapse
|
5
|
Katsuki M, Matsumori Y, Ichihara T, Yamada Y, Kawamura S, Kashiwagi K, Koh A, Goto T, Kaneko K, Wada N, Yamagishi F. Treatment patterns and characteristics of headache in patients in Japan: A retrospective cross-sectional and longitudinal analysis of health insurance claims data. Cephalalgia 2024; 44:3331024231226177. [PMID: 38194504 DOI: 10.1177/03331024231226177] [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] [Indexed: 01/11/2024]
Abstract
BACKGROUND The present study aimed to investigate prescription patterns for patients aged over 17 years with headaches in the REZULT database. METHODS We conducted a cross-sectional study (Study 1) of the proportion of over-prescription of acute medications (≥30 tablets/90 days for triptans, combination non-steroidal anti-inflammatory drugs (NSAIDs) and multiple types; ≥45 tablets/90 days for single NSAIDs) among patients with headache diagnosed in 2020. We longitudinally studied (Study 2) patients for >2 years from initial headache diagnosis (July 2010 to April 2022). The number of prescribed tablets was counted every 90 days. RESULTS In Study 1, headache was diagnosed in 200,055 of 3,638,125 (5.5%) patients: 13,651/200,055 (6.8%) received acute medication. Single NSAIDs were prescribed to 12,297/13,651 (90.1%) patients and triptans to 1710/13,651 (12.5%). Over-prescription was found in 2262/13,651 (16.6%) patients and 1200/13,651 (8.8%) patients received prophylactic medication. In Study 2, 408,183/6,840,618 (6.0%) patients were first diagnosed with headaches, which persisted for ≥2 years. Over time, the proportion of patients over-prescribed acute medications increased. Over 2 years, 37,617/408,183 (9.2%) patients were over-prescribed acute medications and 29,313/408,183 (7.2%) patients were prescribed prophylaxis at least once. CONCLUSIONS According to real-world data, prophylaxis remains poorly prescribed, and both acute and prophylactic treatment rates for headaches have increased over time.
Collapse
Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | | | - Taisuke Ichihara
- Japan System Techniques Co., Ltd (JAST), Minato-ku, Tokyo, Japan
| | - Yuya Yamada
- Japan System Techniques Co., Ltd (JAST), Minato-ku, Tokyo, Japan
| | - Shin Kawamura
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Kenta Kashiwagi
- Department of Neurology, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Akihito Koh
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Kazuma Kaneko
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Department of Neurology, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
- Headache Outpatient, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Fuminori Yamagishi
- Department of Surgery, Itoigawa General Hospital, Itoigawa, Niigata, Japan
| |
Collapse
|
6
|
Takahashi T, Maruno K, Hazama T, Ota H, Yamada Y, Nakashima M, Kikkawa K, Tamaki M, Ito N. A case of one-stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury associated with infected urinoma. IJU Case Rep 2023; 6:406-409. [PMID: 37928275 PMCID: PMC10622193 DOI: 10.1002/iju5.12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Iatrogenic ureteral injury is a rare but often encountered complication of abdominal and gynecological surgery. This is a case of iatrogenic ureteral injury with infected urinoma treated with one-stage laparoscopic drainage and ureterocystoneostomy. Case presentation An 80-year-old man with rectal cancer had robot-assisted low anterior rectum resection and left lateral lymph node dissection after colostomy and preoperative chemoradiotherapy. On the 14th postoperative day, he had a fever, and a noncontrast-enhanced computed tomography scan revealed a low-density polycystic area in the left pelvic cavity. Retrograde pyelography revealed contrast medium leaking from the left lower ureter, preventing ureteral stent placement. We identified it as a delayed ureteral injury with infected urinoma and performed laparoscopic one-stage drainage and ureterocystoneostomy. Conclusion This study reported a case of one-stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury with infected urinoma.
Collapse
Affiliation(s)
- Toshifumi Takahashi
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kouhei Maruno
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Tatsuya Hazama
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Hideto Ota
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yuya Yamada
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masakazu Nakashima
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Kazuro Kikkawa
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Masahiro Tamaki
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Noriyuki Ito
- Department of UrologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| |
Collapse
|
7
|
Eichholz J, Gaeta B, Walch H, Boe L, Kratochvil L, Del Balzo LA, Yamada Y, Yu Y, Zinovoy M, Gomez DR, Imber BS, Isbell J, Li BT, Murciano-Goroff Y, Arbour K, Schultz N, Lebow ES, Pike LRG. The Impact of Co-Alterations on Outcomes after Local Therapy for Patients with KRAS-Mutant Lung Adenocarcinoma Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e101-e102. [PMID: 37784628 DOI: 10.1016/j.ijrobp.2023.06.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases are common in NSCLC with up to 25% of patients having brain metastases (BMs) at the time of diagnosis and 30% developing BMs during their disease course. KRAS is an oncogenic driver in approximately 25% of lung adenocarcinomas. Genomic alterations co-occurring with KRAS are associated with distinct biological landscapes which may influence prognosis. Herein, we sought to identify correlations between genomic profiles, intracranial progression free survival (iPFS), and overall survival (OS). MATERIALS/METHODS We retrospectively reviewed 156 patients with KRAS-mutant lung adenocarcinoma BM who underwent SRS for their BMs at MSKCC from 2010-2022. Each patient had at least one tumor sample profiled with MSK-IMPACT, a custom FDA-cleared next-generation sequencing. Mutations, copy number alterations, and fusions were filtered for driver alterations using OncoKB. Survival outcomes were calculated from date of MRI indicating metastatic brain disease. RESULTS Of the 156 patients, 80 patients presented with BMs at diagnosis whereas 76 developed BMs during their disease course, with a median 2 lines of therapy prior to BM diagnosis. The most common KRAS mutation was G12C (n = 64; 41%), G12V (n = 26, 17%), G12D (n = 17; 11%), and G12A (n = 11; 7%). The most frequently co-altered genes were TP53 (n = 71, 46%), STK11 (n = 51, 33%), CDKN2A (n = 27, 17%), KEAP1 (n = 17, 11%), and SMARCA4 (n = 10, 6%). The presence of a KEAP1 co-occurring alteration was associated with inferior iPFS (HR 1.95, 95% CI 1.05 - 3.59, p = 0.035) and the presence of SMARCA4 was also associated with inferior iPFS (HR 2.28, 95% CI 1.05 - 4.95, p = 0.038). The presence of an STK11 mutation was associated with worse OS (HR 1.57, 95% 1.01 - 2.43, p = 0.045). In a multi-variate clinico-genomic model, KEAP1 and STK11 co-occurring alterations remained significantly associated with iPFS. Patients with KEAP1-altered tumors had an increased incidence of intracranial regional progression. The 24-month cumulative incidence of regional progression amongst KEAP1-altered tumors was 57% (95% CI, 29%-77%) compared with 37% (95% CI, 29%-46%) among KEAP1-wildtype tumors (P = 0.041). Patients with CDKN2A-altered tumors had an increased incidence of leptomeningeal disease (LMD) as a form of intracranial progression. The 24-month cumulative incidence of LMD amongst CDKN2A-altered tumors was 11% (95% CI, 2.7%-27%) compared with 4.1% (95% CI, 1.5%-8.8%) among CDKN2A-wildtype tumors (P = 0.023). CONCLUSION In our cohort of molecularly profiled KRAS-mutant lung adenocarcinoma BM patients treated with SRS, we found that co-occurring KEAP1 and STK11 were significantly associated with worse iPFS. We also observed that CDKN2A co-altered tumors had an increased incidence of LMD. These findings have implications for future efforts to personalize brain metastasis management based on comprehensive genomic profiling.
Collapse
Affiliation(s)
- J Eichholz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Gaeta
- Weill Cornell Medical School, New York, NY
| | - H Walch
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Boe
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Kratochvil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Y Yamada
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Isbell
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - K Arbour
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Schultz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - E S Lebow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L R G Pike
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
8
|
Dee EC, Freret ME, Brennan VS, Yamada Y, Gomez DR, McBride S, Xu AJ, Yerramilli D. Inpatient Simulation Resource Utilization for Inpatient Radiation Oncology Consults. Int J Radiat Oncol Biol Phys 2023; 117:e98. [PMID: 37786227 DOI: 10.1016/j.ijrobp.2023.06.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Previous data have shown that inpatient radiation oncology consult services result in high-value care, with decreased length of stay, adoption and delivery of shorter fractionation schedules, and lower hospital costs. As such, institutions are increasingly creating inpatient radiation oncology services, although little is known about the allocation of limited resources for patients who may have limited prognosis, complex simulation requirements, and may have difficulty tolerating treatment. Thus, we sought to examine the utilization of simulation appointments for inpatient emergencies. MATERIALS/METHODS At our institution, inpatient consults are placed to a specialized inpatient palliative radiation oncology service, consisting of radiation oncologists specialized in metastatic and palliative RT, dedicated advanced practitioners, and nurses who specifically assess patients for medical appropriateness prior to simulation, including changes in disposition, medical stability, and adequate premedication. Electronic health record data was used to explore utilization trends of a single-institution inpatient radiation oncology consult service in 2020. Data regarding the nature and timing of consults, subsequent simulations and treatments, and patient outcomes including 14-day mortality and 30-day mortality from radiation (RT) start were assessed. Descriptive statistics are presented. RESULTS From 1/1/2020-12/31/2020, 1557 consults were placed. These consults led to 220 (14.1%) inpatient simulations. Of these planned simulations, 210 (95.5%) simulations occurred (of which 10 [4.8%] were rescheduled and eventually completed) and 179 (85.2%) completed treatment. Of 169 with mortality data available, 16 (9.5%) died within 14 days of RT start, and 41 (24.5%) died within 30 days of RT start. Of those with scheduling data (N = 193), 122 were same-day simulations (63.2%), and 507 (93.8%) occurred within 7 days or fewer. CONCLUSION Of 1557 inpatient consultations in one year, with appropriate metastatic and palliative experience, only a minority of consultations required inpatient simulation (14.1%). With appropriate nursing assessment, over 95% were able to complete simulation, with nearly two-thirds completing simulation on the same day, and nearly all patients completing simulation within a week of consultation. Most of these patients completed treatment and survived 30 days from treatment start. Thus, with highly specialized radiation oncologist clinical judgment in conjunction with appropriate nursing assessment prior to simulation scheduling, patients booked for simulation represent high-value utilization of resources.
Collapse
Affiliation(s)
- E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M E Freret
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - V S Brennan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Yamada
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S McBride
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A J Xu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
9
|
Lin H, Yu F, Gorovets D, Kabarriti R, Alektiar KM, Ohri N, Hasan S, Tsai P, Shim A, Kang M, Barker CA, Wolden SL, Hajj C, Mehta KJ, Lee NY, Chhabra AM, Shepherd AF, Choi IJ, Yamada Y, Simone CB. Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy (SBRT): A Robust Single Institution Experience. Int J Radiat Oncol Biol Phys 2023; 117:e686-e687. [PMID: 37786018 DOI: 10.1016/j.ijrobp.2023.06.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To describe the feasibility of treating a complex and diverse group of patients using pencil beam scanning (PBS) proton stereotactic body radiation therapy (SBRT: 5 or fewer fractions, with a fraction size of at least 5 Gy). MATERIALS/METHODS Our center treats on average 105-120 PBS proton treatments daily, of which 9.5% of treatment courses are proton SBRT. Statistics of disease sites, treatment planning parameters (target volume, prescriptions, number of fields, SFO vs. MFO), and treatment efficiencies (scheduled time slots, actual treatment time) are presented for 305 consecutive SBRT patients receiving 1507 fractions in the past three years. Thermoplastic masks or Vacuum-lock bags are used to immobilize SBRT patients and index the patients' treatment position. Imaging guidance of orthogonal kV images and volumetric cone-beam CT is routinely used for patient setup. RESULTS SBRT patients are grouped based on the target locations: pelvis (31%), liver (17%), thoracic (13%), spine (8%), abdominal (8%), brain (7%), non-spine bone (7%), ocular (6%), and head and neck (2%). Only 112 patients (37%) were receiving their 1st RT course, whereas 113 (37%) had one prior in-field RT course, and 80 (26%) had multiple prior in-field RT courses. The median [IQR] target volume was 65.4 [29.3, 168] cc (range: 0.3-2475 cc). 72% of cases were planned with SFO and 28% with MFO. On average, 3.76 fields (range: 2 to 12) were planned for each treatment. 44% of the treatments were planned with three or fewer fields, and 10% received more than five fields, most of which involved repainting for moving targets. Over 97% of treatments were delivered in 5 fractions, with ∼3% delivered in 3 fractions. The median [IQR] prescription per treatment was 8 [7, 10] Gy (range: 5-18 Gy per treatment). 85% (84%) of the SBRT treatments were scheduled (delivered) in a 45-minute or shorter slot, and 6% (7%) of treatments were scheduled (delivered) in over a one-hour slot, most commonly for multiple isocenter treatments. 93% of treatments were delivered within 15 minutes of the planned treatment time or shorter. Deep-inspiration breath-hold (DIBH) was applied to 45% of liver SBRT cases, with the remaining 55% planned on 4D CT with (14%) or without (86%) abdominal compression. DIBH was applied in 13% of lung SBRT cases. The application of other motion mitigation approaches, such as volumetric repainting, was determined by the target motion amplitude and whether the patient could tolerate DIBH. CONCLUSION In the most diverse and largest proton SBRT experience delivered in the world over the past 3 years, over 300 patients were treated, demonstrating the feasibility and efficiency of delivering proton SBRT in a very busy center. The planning and treatment parameter statistics reported serve as a helpful reference for the proton community.
Collapse
Affiliation(s)
- H Lin
- New York Proton Center, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| | - F Yu
- New York Proton Center, New York, NY
| | - D Gorovets
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Kabarriti
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - K M Alektiar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Ohri
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - S Hasan
- New York Proton Center, New York, NY; Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - P Tsai
- New York Proton Center, New York, NY
| | - A Shim
- New York Proton Center, New York, NY
| | - M Kang
- New York Proton Center, New York, NY
| | - C A Barker
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - S L Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Hajj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - K J Mehta
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - N Y Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A M Chhabra
- New York Proton Center, New York, NY; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - A F Shepherd
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - I J Choi
- New York Proton Center, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Yamada
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - C B Simone
- New York Proton Center, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
10
|
Abeloos CH, Gorovets D, Lewis A, Ji W, Lozano A, Tung CC, Yu F, Hanlon A, Lin H, Kha A, Yamada Y, Kabarriti R, Lazarev S, Hasan S, Chhabra AM, Simone CB, Choi IJ. Prospective Evaluation of Patient-Reported Outcomes of Invisible Ink Tattoos for the Delivery of External Beam Radiation Therapy: The PREFER Trial. Int J Radiat Oncol Biol Phys 2023; 117:e234. [PMID: 37784934 DOI: 10.1016/j.ijrobp.2023.06.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Invisible ink tattoos allow for setup accuracy while avoiding the cosmetic permanence of visible ink tattoos. The goal of this trial was to evaluate patient-reported preference for the use of invisible ink tattoos in a radiation oncology clinic. MATERIALS/METHODS In an IRB-approved, prospective, feasibility trial, patients at a single institution receiving pencil beam scanning proton therapy to the thorax, abdomen, or pelvis underwent invisible ink tattoo-based treatment setup. Patient preference surveys comparing visible and invisible ink tattoos were completed prior to simulation (17 questions), immediately following simulation (5 questions), and at the end of treatment (18 questions), with preference scored on a 5-point Likert scale from strongly disagree to strongly agree, and cosmesis scored on a 4-point Likert scale of excellent-good-fair-poor. Differences in distributions were examined using Wilcoxon rank-sum tests, Fisher's exact tests, or chi-square tests, where statistical significance was considered at p<0.05. RESULTS Of 107 patients screened, 102 were enrolled and 94 completed all surveys. Mean age was 55.0 years, and 58.5% were female. Most patients were white (79.1%) and non-Hispanic (92.6%). Patients most commonly had breast (34.0%), prostate (16.0%), and lung (9.6%) cancer. An average of 5 (range 3-8) invisible ink tattoos were placed per patient. Overall, 75.5% of patients reported that they would prefer to receive invisible tattoos vs. visible tattoos, and 88.3% rated the overall cosmetic outcome of invisible ink tattoo marks as excellent or good. Compared to males, females were more willing to travel farther from their home in order to avoid receiving visible tattoos (45.4% vs. 23.1%, p = 0.035) and would pay additional money to avoid receiving visible tattoos (34.5% vs. 5.1%, p = 0.002). Patients who had previously received any tattoo (cosmetic or visible RT tattoos) were more satisfied with the appearance of their invisible ink tattoos compared to those who had never previously received tattoos (82.9% vs. 61.5%, p = 0.022). Patients receiving definitive intent RT were more satisfied with the appearance of the tattoos compared to those receiving palliative intent RT (67.1% vs. 38.9%, p = 0.011). Patients with at least a college education were less satisfied with the appearance of tattoos compared to those without a college education (67.0% vs. 95.0% p = 0.018). CONCLUSION These findings demonstrate stronger avoidance of visible tattoos and patient preference for invisible tattoos. The standard incorporation of invisible ink tattoos for patient setup should be strongly considered.
Collapse
Affiliation(s)
| | - D Gorovets
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Lewis
- Rutgers Robert Wood Johnson, Newark, NJ
| | - W Ji
- Virginia Tech, Roanoke, VA
| | | | - C C Tung
- New York Proton Center, New York, NY
| | - F Yu
- New York Proton Center, New York, NY
| | | | - H Lin
- New York Proton Center, New York, NY
| | - A Kha
- New York Proton Center, New York, NY
| | - Y Yamada
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Kabarriti
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - S Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Hasan
- New York Proton Center, New York, NY
| | | | - C B Simone
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Proton Center, New York, NY
| | - I J Choi
- Memorial Sloan Kettering Cancer Center, New York, NY; New York Proton Center, New York, NY
| |
Collapse
|
11
|
Yamada Y, Ishikawa Y, Sagawa K. Intra-abdominal haemorrhaging after cardiac catheterisation: the importance of recognising vascular anomalies in heterotaxy syndrome. Cardiol Young 2023; 33:1465-1467. [PMID: 36647709 DOI: 10.1017/s1047951122004279] [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: 01/18/2023]
Abstract
A 2-month-old boy with a single ventricle underwent cardiac catheterisation. Inferior vena cava angiography at the end of the examination revealed local stenosis, flexion, and connection to the right hepatic vein. Six hours after catheterisation, he went into haemorrhagic shock. CT revealed contrast extravasation into the liver with ascites. A precise diagnosis of vascular anomalies is mandatory, especially in patients with heterotaxy syndrome.
Collapse
Affiliation(s)
- Yuya Yamada
- Department of Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuichi Ishikawa
- Department of Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Koichi Sagawa
- Department of Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| |
Collapse
|
12
|
Takahashi T, Sumi T, Michimata H, Nagayama D, Koshino Y, Watanabe H, Yamada Y, Chiba H. Fatal diffuse alveolar hemorrhage caused by acute COVID-19 infection in an unvaccinated patient. QJM 2023; 116:521-522. [PMID: 36727497 DOI: 10.1093/qjmed/hcad018] [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: 01/24/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
- T Takahashi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan and Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - T Sumi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan and Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Michimata
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan and Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - D Nagayama
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan and Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Y Koshino
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan and Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Watanabe
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - Y Yamada
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - H Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
13
|
Morimura Y, Tanaka S, Matsubara K, Tanaka S, Kanou T, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Shintani Y, Sugimoto S, Toyooka S, Date H. Indication and Long-Term Outcome of Pediatric Lung Transplantation in Japan; A Multicenter, Retrospective Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
14
|
Yamada Y, Tanaka S, Yutaka Y, Hamaji M, Nakajima D, Ohsumi A, Date H. CD26/Dipeptidyl Peptidase-4 Inhibitors as Prophylaxis of Chronic Lung Allograft Dysfunction after Lung Transplantation, a Clinicopathological Evaluation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
15
|
Mineura K, Tanaka S, Goda Y, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Menju T, Date H. The Effect of CTLA-4-Ig on the Progression of Fibrosis from Acute Cellular Rejection in a Murine Model of Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
16
|
Uehashi Y, Izawa S, Yamada Y, Miwa Y, Inuzuka T, Kubota Y, Hiramoto M, Funabiki K. Synthesis of Highly Photostable Benzoindolenine‐Based Squaraine Dyes by using Aromatic Fluorine Atoms. ChemistrySelect 2023. [DOI: 10.1002/slct.202300309] [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: 03/30/2023]
|
17
|
Sumi T, Takahashi T, Michimata H, Nagayama D, Koshino Y, Watanabe H, Yamada Y, Kodama K, Nishikiori H, Chiba H. Exacerbation of hypersensitivity pneumonitis induced by COVID-19. QJM 2023; 116:235-236. [PMID: 36752528 DOI: 10.1093/qjmed/hcad021] [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: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- T Sumi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan and Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - T Takahashi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan and Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - H Michimata
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan and Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - D Nagayama
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan and Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - Y Koshino
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan and Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - H Watanabe
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - Y Yamada
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan
| | - K Kodama
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Nishikiori
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
18
|
Kashiwagi-Takayama R, Kozawa J, Hosokawa Y, Kato S, Kawata S, Ozawa H, Mineo R, Ishibashi C, Baden MY, Iwamoto R, Saisho K, Fujita Y, Tamba S, Sugiyama T, Nishizawa H, Maeda N, Yamamoto K, Higashi M, Yamada Y, Sakata Y, Matsuzawa Y, Shimomura I. Myocardial fat accumulation is associated with cardiac dysfunction in patients with type 2 diabetes, especially in elderly or female patients: a retrospective observational study. Cardiovasc Diabetol 2023; 22:48. [PMID: 36882731 PMCID: PMC9993532 DOI: 10.1186/s12933-023-01782-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Ectopic fat is fat that accumulates in or around specific organs or compartments of the body including myocardium. The clinical features of type 2 diabetes patients with high fat accumulation in the myocardium remain unknown. Moreover, little is known about the influence of myocardial fat accumulation in type 2 diabetes on coronary artery disease and cardiac dysfunction. We aimed to clarify the clinical features, including cardiac functions, of type 2 diabetes patients with myocardial fat accumulation. METHODS We retrospectively enrolled type 2 diabetes patients who underwent ECG-gated coronary computed tomography angiography (CCTA) and abdominal computed tomography (CT) scan examinations within 1 year of CCTA from January 2000 to March 2021. High fat accumulation in the myocardium was defined as the low mean myocardial CT value of three regions of interest, and the associations between CT values and clinical characteristics or cardiac functions were assessed. RESULTS In total, 124 patients were enrolled (72 males and 52 females). The mean age was 66.6 years, the mean BMI was 26.2 kg/m2, the mean ejection fraction (EF) was 67.6%, and the mean myocardial CT value was 47.7 Hounsfield unit. A significant positive correlation was found between myocardial CT value and EF (r = 0.3644, p = 0.0004). The multiple regression analyses also showed that myocardial CT value was independently associated with EF (estimate, 0.304; 95% confidence interval (CI) 0.092 to 0.517; p = 0.0056). Myocardial CT value showed significant negative correlations with BMI, visceral fat area and subcutaneous fat area (r = - 0.1923, - 0.2654, and -0.3569, respectively, p < 0.05). In patients who were ≥ 65 years or female, myocardial CT value showed significant positive correlations with not only EF (r = 0.3542 and 0.4085, respectively, p < 0.01) but also early lateral annular tissue Doppler velocity (Lat e') (r = 0.5148 and 0.5361, respectively, p < 0.05). The multiple regression analyses showed that myocardial CT value was independently associated with EF and Lat e' in these subgroups (p < 0.05). CONCLUSIONS Patients with type 2 diabetes, especially in elderly or female patients, who had more myocardial fat had more severe left ventricular systolic and diastolic dysfunctions. Reducing myocardial fat accumulation may be a therapeutic target for type 2 diabetes patients.
Collapse
Affiliation(s)
- Risa Kashiwagi-Takayama
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Junji Kozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan. .,Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Yoshiya Hosokawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sarasa Kato
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Satoshi Kawata
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Harutoshi Ozawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Lifestyle Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryohei Mineo
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Chisaki Ishibashi
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Megu Y Baden
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Lifestyle Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryuya Iwamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Kenji Saisho
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yukari Fujita
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Sachiko Tamba
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Takuya Sugiyama
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Norikazu Maeda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Koji Yamamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yuya Yamada
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yasushi Sakata
- Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuji Matsuzawa
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
19
|
Takahashi T, Hazama T, Ota H, Yamada Y, Nakashima M, Tamaki M, Ito N. Bladder paraganglioma: A case of acute respiratory distress syndrome triggered by large bladder tumor transurethral resection with mild symptoms and atypical imaging. IJU Case Rep 2023; 6:177-180. [PMID: 37144079 PMCID: PMC10151201 DOI: 10.1002/iju5.12580] [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: 12/06/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Bladder paraganglioma is exceedingly rare, accounting for <0.05% of bladder tumors. This is a case of paraganglioma with no symptom other than palpitations during urination, with atypical imaging, resulting in acute respiratory distress syndrome after transurethral resection of the bladder tumor. Case presentation A 46-year-old man underwent transurethral resection of the bladder tumor for a bladder tumor 61 × 52 mm in size on contrast-enhanced computed tomography. The patient only had micturition attacks and was suspected to have urothelial carcinoma on magnetic resonance imaging. The patient had acute respiratory distress syndrome after the operation which improved conservatively. The 123Iodine metaiodobenzylguanidine scintigraphy, urinalysis, and pathological examination revealed bladder paraganglioma. Robot-assisted radical cystectomy and ileal neobladder reconstruction were performed. Conclusion This study reported bladder paraganglioma with no symptoms other than micturition attacks in which acute respiratory distress syndrome occurred after transurethral resection of the bladder tumor.
Collapse
Affiliation(s)
- Toshifumi Takahashi
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Tatsuya Hazama
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Hideto Ota
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yuya Yamada
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Masakazu Nakashima
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Masahiro Tamaki
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Noriyuki Ito
- Department of Urology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| |
Collapse
|
20
|
Sakamoto S, Baba H, Xue Z, Yamada Y, Rii J, Fujimoto A, Takeuchi N, Sazuka T, Imamura Y, Akakura K, Ichikawa T. The location of tumor volume over 2.8cc predict the prognosis among Japanese localized prostate cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
21
|
Yamada Y, Ichii T, Utsunomiya T, Kimura K, Kobayashi K, Yamada H, Sugimura H. Fundamental and higher eigenmodes of qPlus sensors with a long probe for vertical-lateral bimodal atomic force microscopy. Nanoscale Adv 2023; 5:840-850. [PMID: 36756504 PMCID: PMC9890686 DOI: 10.1039/d2na00686c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/26/2022] [Indexed: 06/18/2023]
Abstract
The detection of vertical and lateral forces at the nanoscale by atomic force microscopy (AFM) reveals various mechanical properties on surfaces. The qPlus sensor is a widely used force sensor, which is built from a quartz tuning fork (QTF) and a sharpened metal probe, capable of high-resolution imaging in viscous liquids such as lubricant oils. Although a simultaneous detection technique of vertical and lateral forces by using a qPlus sensor is required in the field of nanotribology, it has still been difficult because the torsional oscillations of QTFs cannot be detected. In this paper, we propose a method to simultaneously detect vertical and lateral force components by using a qPlus sensor with a long probe. The first three eigenmodes of the qPlus sensor with a long probe are theoretically studied by solving a set of equations of motion for the QTF prong and probe. The calculation results were in good agreement with the experimental results. It was found that the tip oscillates laterally in the second and third modes. Finally, we performed friction anisotropy measurements on a polymer film by using a bimodal AFM utilizing the qPlus sensor with a long probe to confirm the lateral force detection.
Collapse
Affiliation(s)
- Yuya Yamada
- Department of Materials Science and Engineering, Kyoto University Yoshida Honmachi, Sakyo Kyoto 606-8501 Japan
| | - Takashi Ichii
- Department of Materials Science and Engineering, Kyoto University Yoshida Honmachi, Sakyo Kyoto 606-8501 Japan
| | - Toru Utsunomiya
- Department of Materials Science and Engineering, Kyoto University Yoshida Honmachi, Sakyo Kyoto 606-8501 Japan
| | - Kuniko Kimura
- Department of Electronic Science and Engineering, Kyoto University Katsura, Nishikyo Kyoto 615-8510 Japan
| | - Kei Kobayashi
- Department of Electronic Science and Engineering, Kyoto University Katsura, Nishikyo Kyoto 615-8510 Japan
| | - Hirofumi Yamada
- Department of Electronic Science and Engineering, Kyoto University Katsura, Nishikyo Kyoto 615-8510 Japan
| | - Hiroyuki Sugimura
- Department of Materials Science and Engineering, Kyoto University Yoshida Honmachi, Sakyo Kyoto 606-8501 Japan
| |
Collapse
|
22
|
Ishikawa Y, Urabe H, Yamada Y, Yamamura K, Tao K, Suzuki S, Muraji S, Kuraoka A, Sagawa K. Normal Ventricular and Regional Blood Flow Volumes and Native T1 Values in Healthy Japanese Children Obtained from Comprehensive Cardiovascular Magnetic Resonance Imaging. Int Heart J 2023; 64:663-671. [PMID: 37518347 DOI: 10.1536/ihj.23-022] [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: 08/01/2023]
Abstract
Age-related mean and reference ranges for ventricular volumes and mass, regional blood flow measurements, and T1 values using cardiovascular magnetic resonance (CMR) imaging are yet to be established for the pediatric population. Especially in infants and toddlers, no consistent flow volume sets or T1 values have been reported. The purpose of this study was to determine the relevant normal values.Twenty-three children (aged 0.1-15.3 years) without cardiovascular diseases were included. Comprehensive CMR imaging including cine, 2-dimensional phase-contrast, and native T1 mapping, were performed. Ventricular volumes and masses, 11 sets of regional blood flow volumes, and myocardial and liver T1 values were measured. All intraclass correlation coefficient values were > 0.94, except for the right ventricular mass (0.744), myocardial (0.868) and liver T1 values (0.895), reflecting good to excellent agreement between rates.Regression analysis showed an exponential relationship between body surface area (BSA) and ventricular volumes, mass, and regional blood flow volumes (normal value = a*BSAb). Left ventricular myocardial T1 values were regressed on linear regression with age (normal value = -7.39*age + 1091), and hepatic T1 values were regressed on a quadratic function of age (normal value = 0.923*age2 -18.012*age + 613).Comparison of the 2 different methods for the same physical quantities by Bland-Altman plot showed no difference except that the right ventricular stroke volume was 1.5 mL larger than the main pulmonary trunk flow volume.This study provides the normal values for comprehensive CMR imaging in Japanese children.
Collapse
Affiliation(s)
| | - Hiroaki Urabe
- Department of Radiology, Fukuoka Children's Hospital
| | - Yuya Yamada
- Department of Cardiology, Fukuoka Children's Hospital
| | - Kenichiro Yamamura
- Department of Cardiovascular Intensive Care, Fukuoka Children's Hospital
| | - Katsuo Tao
- Department of Cardiology, Fukuoka Children's Hospital
| | - Sayo Suzuki
- Department of Cardiology, Fukuoka Children's Hospital
| | - Shota Muraji
- Department of Cardiology, Fukuoka Children's Hospital
| | - Ayako Kuraoka
- Department of Cardiology, Fukuoka Children's Hospital
| | - Koichi Sagawa
- Department of Cardiology, Fukuoka Children's Hospital
| |
Collapse
|
23
|
Yamada K, Iwata K, Yoshimura Y, Ota H, Oki Y, Mitani Y, Oki Y, Yamada Y, Yamamoto A, Ono K, Honda A, Kitai T, Tachikawa R, Kohara N, Tomii K, Ishikawa A. Predicting the Readmission and Mortality in Older Patients Hospitalized with Pneumonia with Preadmission Frailty. J Frailty Aging 2023; 12:208-213. [PMID: 37493381 DOI: 10.14283/jfa.2022.36] [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: 07/27/2023]
Abstract
BACKGROUND In older people, frailty has been recognized as an important prognostic factor. However, only a few studies have focused on multidimensional frailty as a predictor of mortality and readmission among inpatients with pneumonia. OBJECTIVE The present study aimed to assess the association between preadmission frailty and clinical outcomes after the hospitalization of older patients with pneumonia. DESIGN Single-center, retrospective case-control study. SETTING Acute phase hospital at Kobe, Japan. PARTICIPANTS The present study included 654 consecutive older inpatients with pneumonia. MEASUREMENTS Frailty status before admission was assessed using total Kihon Checklist (KCL) score, which has been used as a self-administered questionnaire to assess comprehensive frailty, including physical, social, and cognitive status. The primary outcome was a composited 6-month mortality and readmission after discharge. RESULTS In total, 330 patients were analyzed (median age: 79 years, male: 70.4%, median total KCL score: 10 points), of which 68 were readmitted and 10 died within 6 months. After multivariate analysis, total KCL score was associated with a composited 6-month mortality and readmission (adjusted hazard ratio, 1.07; 95% confidence interval, 1.02-1.12; p = 0.006). The cutoff value for total KCL score determined by receiver operating characteristic curve analysis was 15 points (area under the curve = 0.610). The group with a total KCL score ≥ 15 points had significantly higher readmission or mortality rates than the groups with a total KCL score < 15 points (p < 0.001). CONCLUSIONS Preadmission frailty status in older patients with pneumonia was an independent risk factor for readmission and survival after hospitalization.
Collapse
Affiliation(s)
- K Yamada
- Kentaro Iwata, PT, MSc, Department of Rehabilitation, Kobe City Medical Center General Hospital, 2-1-1, Minatojimaminami, Chuo, Kobe 650-0047 Hyogo, Japan. Tel.: +81 78 302,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Watanabe D, Yoshida T, Nanri H, Watanabe Y, Itoi A, Goto C, Ishikawa-Takata K, Yamada Y, Fujita H, Miyachi M, Kimura M. Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study. J Nutr Health Aging 2023; 27:1228-1237. [PMID: 38151874 DOI: 10.1007/s12603-023-2041-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Although better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS We used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study. MESUREMENTS Dietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. RESULTS During the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54-1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52-1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. CONCLUSIONS Our findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.
Collapse
Affiliation(s)
- D Watanabe
- Daiki Watanabe, RD, PhD, Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama 359-1192, Japan. Tel.: +81-4-2947-6936. E-mail:
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Tengah Z, Abd Rahman NH, Yamada Y, Abd Rashid NE, Pasya I, Aris MA, Dinh NQ. Design of Bifurcated Beam using Convex Bent Array Feed for Satellite Mobile Earth Station Application. RADIOENGINEERING 2022; 31:541-552. [DOI: 10.13164/re.2022.0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
26
|
Otaki M, Higashino Y, Yamada Y. Experimental validation of determinants of UV sensitivity using synthetic DNA. Journal of Photochemistry and Photobiology 2022. [DOI: 10.1016/j.jpap.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
27
|
Moore A, Zhang Z, Schmitt A, Higginson D, Mueller B, Zinovoy M, Gelblum D, Yerramilli D, Xu A, Brennan V, Guttmann D, Grossman C, Dover L, Shaverdian N, Pike L, Cuaron J, Lis E, Barzilai O, Bilsky M, Yamada Y. 40 Gray in 5 Fractions for Salvage Re-Irradiation of Spine Lesions Previously Treated with Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1667] [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]
|
28
|
Michimata H, Sumi T, Keira Y, Nagayama D, Koshino Y, Watanabe H, Yamada Y, Chiba H. Intravascular large B-cell lymphoma with hot lung sign diagnosed by transbronchial lung cryobiopsy. QJM 2022; 115:677-678. [PMID: 35876561 DOI: 10.1093/qjmed/hcac169] [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: 07/04/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - T Sumi
- Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Y Keira
- Department of Surgical Pathology, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | | | - Y Koshino
- Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, 060-8556, Japan
| | | | - Y Yamada
- Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-cho, Hakodate-shi, Hokkaido 040-8611, Japan
| | - H Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, South 1, West 17, Chuo-ku, Sapporo, 060-8556, Japan.
| |
Collapse
|
29
|
Kawaguchi Y, Kita R, Kimura T, Goto R, Takayama T, Izumi N, Kudo M, Kaneko S, Yamanaka N, Inomata M, Shimada M, Baba H, Koike K, Omata M, Makuuchi M, Matsuyama Y, Yamada Y, Kokudo N, Hasegawa K. 723P Medical expenditures and treatment efficacy of patients who had initial hepatocellular carcinoma and underwent surgery or radiofrequency ablation: Accompanying research of the SURF trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
30
|
Sugiyama T, Yamada Y, Ito Y, Mineo R, Iwamoto R, Tamba S, Fujimoto T, Yamamoto K, Matsuzawa Y. Increase in glycemic set point, alongside a decrease in waist circumference, in the non-diabetic population during the Japanese National Intervention Program for metabolic syndrome: A single-center, large-scale, matched-pair analysis. PLoS One 2022; 17:e0268450. [PMID: 35947600 PMCID: PMC9365144 DOI: 10.1371/journal.pone.0268450] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background In 2008, the Japanese government implemented a National Intervention Program for metabolic syndrome. Low-risk individuals were not direct targets of this intervention. Nevertheless, they were indirectly enlightened by this massive campaign. Documentation of the metabolic shifts in low-risk individuals following the program launch may inform public health policy regarding approaches to metabolic risks in the general population. Methods We conducted a cross-sectional analysis of data from non-diabetic participants who underwent general health check-ups at the Physical Check-up Center of Sumitomo Hospital. Participants during 2007–2008 were pair-matched with those during 2015–2016 with respect to sex, age, smoking status, hemoglobin level, and red blood cell (RBC) count. Each participant was included only once in the study. Results Totals of 3,140 men and 2,048 women were pair-matched. The non-diabetic participants showed lower waist circumference, blood pressure, heart rate, and serum lipid concentrations during the second study period. In contrast, the entire distributions of fasting plasma glucose (FPG) concentration in both sexes and glycated hemoglobin (HbA1c) in women were shifted upwards. In men, Δ FPG was +1.6 mg/dL (P < 0.001) and Δ HbA1c was ±0% (P = 0.6). In women, Δ FPG was +3.0 mg/dL (P < 0.001), and Δ HbA1c was +0.1% (P < 0.001). Δ Homeostasis model assessment of β-cell function was −6.6 in men (P < 0.001) and −10.3 in women (P < 0.001). The homeostasis model assessment of insulin resistance did not change significantly. Conclusions The “glycemic set point” has increased in non-diabetic people in Japan during recent years. Lifestyle or environmental changes may have caused this metabolic shift through obesity-independent pathways, possibly through effects on pancreatic β-cell function. The underlying mechanism awaits further investigation.
Collapse
Affiliation(s)
- Takuya Sugiyama
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
- * E-mail:
| | - Yuya Yamada
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yoshito Ito
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryohei Mineo
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Ryuya Iwamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Sachiko Tamba
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | | | - Koji Yamamoto
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| | - Yuji Matsuzawa
- Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan
| |
Collapse
|
31
|
Yamada Y, Nakamizo S, Endo Y, Usui S, Uza N, Kabashima K. Subcutaneous metastasis at the totally implantable venous access port site in a patient with pancreatic cancer. J Eur Acad Dermatol Venereol 2022; 36:e572-e573. [PMID: 35279882 DOI: 10.1111/jdv.18067] [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] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Y Yamada
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| | - S Nakamizo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| | - Y Endo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| | - S Usui
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| | - N Uza
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| | - K Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo, Japan
| |
Collapse
|
32
|
Yamada Y, Yasuda K, Hata Y, Nishida N, Hirono K. A Novel NKX2-5 Variant in a Child with Left Ventricular Noncompaction, Atrial Septal Defect, Atrioventricular Conduction Disorder, and Syncope. J Clin Med 2022; 11:jcm11113171. [PMID: 35683556 PMCID: PMC9181799 DOI: 10.3390/jcm11113171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
The NKX2-5 gene encodes a transcription factor and is actively involved in heart formation and development. A pediatric case with its variant and left ventricular noncompaction (LVNC) has not been reported. A 12-year-old girl with a history of a surgery for atrial septal detect was referred because of syncope during exercise. The electrocardiogram showed atrioventricular block, and the echocardiogram revealed prominent trabeculations in the left ventricular wall, suggesting LVNC. A novel heterozygous variant in the NKX2-5 gene (NM_004387.1: c.255_256delCT, p.Phe86fs) was identified. NKX2-5 variants should be considered in cases with LVNC, congenital heart disease, arrhythmia, and syncope to prevent sudden cardiac death.
Collapse
Affiliation(s)
- Yuya Yamada
- Department of Cardiology, Aichi Children’s Health and Medical Center, Obu 474-8710, Japan; (Y.Y.); (K.Y.)
| | - Kazushi Yasuda
- Department of Cardiology, Aichi Children’s Health and Medical Center, Obu 474-8710, Japan; (Y.Y.); (K.Y.)
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (Y.H.); (N.N.)
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (Y.H.); (N.N.)
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
- Correspondence: ; Tel.: +81-76-434-7313
| |
Collapse
|
33
|
Anno S, Okano T, Mandai K, Orita K, Yamada Y, Mamoto K, Iida T, Tada M, Inui K, Koike T, Nakamura H. POS0681 DRUG RETENTION RATE AND EFFECTIVENESS OF JAK INHIBITOR IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRecently, the disease activity of rheumatoid arthritis (RA) was improved due to the ‘treat-to-target’ strategy. However, some patients remain various symptoms despite recommended treatment was performed. Then, the term of ‘difficult-to-treat RA (D2TRA)’ is widely recognized. Janus kinase inhibitor (JAKi) might be effective for D2TRA patients, because JAKi can simultaneously block the function of multiple cytokines.ObjectivesThe aim of this study was to evaluate drug retention rate and effectiveness of JAKi in patients with D2TRA.MethodsThis study included 220 RA patients (tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14, filgotinib 2) treated with JAKi. Sixty-two patients were treated as first line bDMARDs/JAKi (1st group), 57 patients were treated as second line bDMARDs/ JAKi (2nd group), 101 patients were treated as third and more bDMARDs/ JAKi. In these 101 patients, 25 patients did not met D2TRA criteria (non-D2TRA group) and 76 patients met D2TRA criteria (D2TRA group). Drug retention rate and effectiveness of JAKi were evaluated during 24 weeks in each group.ResultsUsage rate of methotrexate was lower and dosage of glucocorticoid was higher in D2TRA group than in other groups (Table 1). Drug retention rate at 24 weeks was 87.1% (54/62) in 1st group, 80.1% (46/57) in 2nd group, 88% (22/25) in non-D2TRA group, 61.8% (47/76) in D2TRA group. Drug retention rate was lower in D2TRA group compared to 1st group, 2nd group and non-DT2RA group (p<0.01, p=0.03, p=0.01). DAS28-CRP was 4.4, 4.0, 3.9, 4.4 at baseline, 3.0, 3.0, 3.3, 3.5 at 4 weeks, 2.5, 2.9, 2.7, 3.3 at 12 weeks, 2.5, 3.0, 2.9, 3.2 at 24 weeks in 1st group, 2nd group, non-D2TRA group and D2TRA group, respectively. Improvement ratio of DAS28-CRP was 32.9, 27.6, 20.4, 19.3 % at 4 weeks, 40.8, 26.5, 28.1, 19.5 % at 12 weeks, 40.8, 24.6, 18.7, 24.7 % at 24 weeks. DAS28-CRP was improved in all groups. Altough 1st group showed higher improvement ratio of DAS28-CRP at 24 weeks compared to 2nd group, non-DT2RA group and D2TRA group (p<0.01, p<0.01, p<0.01), there was no differences between DT2RA group and 2nd group or non-D2TRA group (p=0.95, p=0.48). SDAI was 22.9, 19.9, 18.3, 23.9 at baseline, 11.8, 11.9, 13.3, 14.4 at 4 weeks, 7.9, 11.3, 8.4, 13.3 at 12 weeks, 8.5, 11.5, 9.7, 12.6 at 24 weeks. CDAI was 21.3, 18.8, 17.6, 21.8 at baseline, 11.3, 11.2, 12.5, 13.9 at 4 weeks, 7.5, 10.9, 8.0, 12.3 at 12 weeks, 8.1, 10.7, 8.6, 12.1 at 24 weeks. HAQ was 1.15, 0.99, 0.89, 1.39 at baseline, 0.84, 0.76, 0.93, 1.22 at 4 weeks, 0.79, 0.84, 0.77, 1.17 at 12 weeks, 0.76, 0.79, 0.76, 1.14 at 24 weeks. Improvement rate of HAQ at 24 weeks were 44.3%, 23.9%, 21.2%, 8.1%.Table 1.Baseline characteristics of RA patients1st group (n=62)2nd group (n=57)non-D2TRA group (n=25)D2TRA group (n=76)Age (years)64.9 ± 14.866.1 ± 11.564.6 ± 16.163.0 ± 15.0Female (%)75.879.096.080.3Disease durations (years)10.4 ± 11.717.6 ± 17.622.6 ± 22.416.3 ± 15.7RF (IU/ml)296.3 ± 1153.8314.9 ± 1037.7262.4 ± 375.9305.9 ± 819.6RF positive ratio (%)81.878.479.275.7Anti CCP antibody (U/ml)221.8 ± 327.2157.8 ± 258.795.9 ± 101.6191.8 ± 250.6Anti CCP antibody positive ratio (%)79.679.672.283.3CRP (U/ml)1.5 ± 2.11.1 ± 2.01.6 ± 1.61.8 ± 2.9MMP-3 (ng/ml)185.7 ± 167.6146.7 ± 122.1190.1 ± 152.6268.0 ± 451.2DAS28-CRP4.3 ± 1.24.1 ± 1.33.9 ± 1.44.4 ± 1.3SDAI21.8 ± 12.221.7 ± 13.118.4 ± 13.023.9 ± 12.8CDAI20.3 ± 11.320.7 ± 12.717.6 ± 12.822.1 ± 12.2HAQ1.1 ± 0.81.2 ± 1.00.9 ± 0.81.4 ± 1.1MTX use (%)69.463.25647.4MTX (mg/day)10.7 ± 3.410.4 ± 3.58.8 ± 3.59.0 ± 4.3Glucocorticoid use (%)29.136.81646.1Glucocorticoid dose (mg/day)3.3 ± 2.13.0 ± 1.53.5 ± 1.95.1 ± 2.8ConclusionDrug retention rate of JAKi in treatment of D2TRA group were lower than that of 1st group, 2nd group, and non-D2TRA group. Clinical efficacy of JAKi in D2TRA group were not significantly different to 2nd group and non-D2TRA group. However, HAQ improvement was weak in D2TRA group.Disclosure of InterestsNone declared
Collapse
|
34
|
Tabata K, Nishie A, Shimomura Y, Isoda T, Kitamura Y, Nakata K, Yamada Y, Oda Y, Ishigami K, Baba S. Prediction of pathological response to preoperative chemotherapy for pancreatic ductal adenocarcinoma using 2-[ 18F]-fluoro-2-deoxy-d-glucose positron-emission tomography. Clin Radiol 2022; 77:436-442. [PMID: 35410786 DOI: 10.1016/j.crad.2022.03.001] [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: 11/05/2021] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
Abstract
AIM To determine whether the pathological response to preoperative chemotherapy for pancreatic ductal adenocarcinoma (PDAC) can be predicted using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (F-18 FDG-PET). MATERIALS AND METHODS Twenty-eight patients with PDAC who underwent only neoadjuvant chemotherapy (NAC) before surgery were enrolled in the study. All patients had F-18 FDG-PET examinations before NAC. The resected specimen was pathologically evaluated according to the Classification of Pancreatic Carcinoma (7th edn). Patients were categorised into a non-response group and a response group based on the pathological findings. The non-response group (Grades 1a and 1b) showed ≤50% necrosis in the specimen, while the specimens of the response group (Grades 2-3) showed >50% necrosis. The maximum standardised uptake values (SUVmax) of the tumours on F-18 FDG-PET were measured. The mean values of SUVmax were compared between the two groups. The diagnostic performance of SUVmax in distinguishing the two groups was also evaluated using receiver operating characteristic analysis. RESULTS The mean SUVmax of the response group was higher than that of the non-response group (9.00 ± 1.78 versus 4.26 ± 2.35; p<0.001). The optimal cut-off value of SUVmax was 9.28 for distinguishing the two groups. The sensitivity, specificity, and accuracy for the prediction in the response group were 80%, 95.7%, and 92.9%, respectively. CONCLUSIONS SUVmax on F-18 FDG-PET may be useful as a biomarker to predict the pathological response to NAC in patients with PDAC.
Collapse
Affiliation(s)
- K Tabata
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - A Nishie
- Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan; Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207, Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Y Shimomura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - T Isoda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - Y Kitamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - K Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - Y Yamada
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - Y Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - K Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| | - S Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka, 812-8582, Japan
| |
Collapse
|
35
|
Okano T, Mamoto K, Yamada Y, Mandai K, Anno S, Tada M, Inui K, Koike T, Nakamura H. AB0188 ULTRASONOGRAPHIC RESIDUAL INTRA-ARTICULAR SYNOVITIS IS MORE SEVERE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH PREDNISOLONE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe treatment option including biological DMARDs (BIO) and JAK inhibitor (JAK) was expanded, and the number of patients reached to the treatment target are increasing in rheumatoid arthritis (RA). On the other hand, it is also true that some patients are still using prednisolone (PSL). Recently, ultrasound has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA. It is known that residual synovitis was found in ultrasound even in patients with clinical remission.ObjectivesWe investigated the differences of ultrasonographic intra-articular synovitis findings between treatment drugs in patients with RA.MethodsFrom January 2017 to August 2020, 750 RA patients who underwent ultrasound examination were included. A US examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). The gray scale and power Doppler findings were assessed by the semi-quantitative method (0-3). All patients were divided into with or without BIO / JAK, methotrexate (MTX) and PSL. Then, patients were matched using the propensity score adjusted for gender, age, RA disease duration, disease activity, CRP value, and MMP-3 value. The total gray scale and power Doppler score (GSUS / PDUS) were compared between treatment drugs of RA by using propensity score matching methods.ResultsThe average age of 750 RA patients were 64.5 years and an average disease duration of RA was 13.9 years and females were 581 (77.5%). There were 517 patients (68.9%) treated with BIO/JAK and 233 patients treated without BIO/JAK. The 205 patients in each group were matched. GSUS were 10.6±11.1 vs 9.2±10.4 (p=0.218) and PDUS 7.4±9.2 vs 6.5±9.0 (p=0.328). Ultrasound residual synovitis was not different between with or without BIO/JAK in matched patients. There were 525 patients (70.0%) treated MTX, the average MTX dose was 9.3 mg, and 225 patients treated without MTX. The 203 patients with or without MTX in each group were matched. GSUS were 9.7±10.6 vs 11.4±12.0 (p=0.119) and PDUS 6.6±8.8 vs 8.1±10.1 (p=0.117). Ultrasound residual synovitis was not different between with or without MTX in matched patients. There were 111 patients (14.8%) treated PSL, the average dose was 4.0mg, and 639 patients treated without PSL. The 105 patients with or without PSL in each group were matched. GSUS were 15.7±13.9 vs 11.6±10.6 (p=0.018) and PDUS 11.5±11.4 vs 8.1±9.6 (p=0.021). Ultrasound residual synovitis was more severe treated with PSL than without PSL in matched patients.ConclusionIn a comparison between RA patients matched backgrounds such as disease activity, there was no difference in ultrasound residual synovitis between patients with or without BIO/JAK and MTX. However, there was significant difference in patients with or without PSL. This suggests that PSL use suppresses clinical symptoms but does not improve synovitis. Thus, it should be noted that joint destruction may progress in patients treating with PSL.References[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.[2]Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford). 2014;53:2110-8.AcknowledgementsWe wish to thank Atsuko Kamiyama, Tomoko Nishimura for clinical assistant, Setsuko Takeda, Emi Yamashita, Yuko Yoshida, Emi Ohtani, Yuka Domae, Asami Yagami, Shingo Washida for their special efforts as a sonographer and collecting data.Disclosure of InterestsTadashi Okano Speakers bureau: Asahi Kasei, Astellas, Abbvie, Amgen, Ayumi, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi Tanabe, Novartis, Ono, Pfizer, Sanofi, Takeda, UCB, Grant/research support from: Asahi Kasei, Abbvie, Chugai, Eisai, Mitsubishi Tanabe, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Masahiro Tada: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Tatsuya Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Hiroaki Nakamura: None declared
Collapse
|
36
|
Yamada Y, Okano T, Mamoto K, Inui K, Mandai K, Koike T, Nakamura H. AB0340 SHORTENING THE DOSING INTERVAL OR DOSE ESCALATION OF BIOLOGICAL DMARDs SUPPRESSED RESIDUAL ULTRASOUND SYNOVITIS AND JOINT DESTRUCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS -STARBOARD STUDY-. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn patients with rheumatoid arthritis (RA) who have residual synovitis even after using biological disease modified anti-rheumatic drug (bDMARDs), joint destruction may progress1,. The enhanced treatment such as shortening the dosing interval or dose escalation of bDMARDs are recommended for these patients, if allowed in package inserts 2, 3.ObjectivesWe investigated the effects of enhanced treatment in RA patients with residual synovitis under treatment with standard dose of bDMARDs.MethodsForty RA patients treated with standard dose of infliximab, tocilizumab or golimumab were included in this study. Ultrasound (US) examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three parts of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). Residual synovitis was defined as Power Doppler score (PD) ≥2. In patients with residual synovitis, we recommended enhanced treatment. The patients were divided into 3 groups, PD≥2/ET+ group (patients agreed enhanced treatment), PD≥2/ET- group (patients rejected enhanced treatment), and PD<2 group. We assessed ultrasound (PD score), laboratory data (CRP, MMP-3), disease activity (Simplified Disease Activity Index; SDAI), physical function (Health Assessment Questionnaire; HAQ), and joint destruction (modified Total Sharp Score; mTSS) at baseline and 1-year follow-up.ResultsThere were 9 patients in PD≥2/ET+ group and 31 patients in PD<2 group. PD≥2/ET+ group had significantly higher SDAI (p=0.027), MMP-3 (p=0.005), and PD (p<0.001) at baseline compared with PD<2 group, but their MMP-3 (p=0.019) and PD (p=0.042) were significantly decreased over 1 year. PD≥2/ET+ group had joint destruction before ET (p=0.022), but it was suppressed after ET and there was no significance in change in mTSS compared with PD<2 group (p>0.99) (Figure 1).Figure 1.Disease activity, ultrasound assessment and radiographic change from baseline (BL) to 1-year follow-up in RA patients with residual synovitis who had enhanced treatment (PD≥2/ET+) and those without active synovitis (PD<2).*Each parameter at BL and 1-year was statistically analyzed by Wilcoxin signed rank test only in PD≥2/ET+ group.**Difference in two groups at BL was statistically analyzed by Student t test or Mann-Whitney U test.SDAI: simplified disease activity index, HAQ: health assessment questionnaire, PD: Power Doppler, MMP-3: matrix metalloproteinase 3, mTSS: modified Total Sharp Score.ConclusionIn RA patients with the residual synovitis under treatment with standard dose of bDMARDs, enhanced treatment decreased the synovitis and suppressed the joint destruction.References[1]Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford). 2014 Nov;53(11):2110-8.[2]Ogata A, Tanaka Y, Ishii T, Kaneko M, Miwa H, Ohsawa S; SHINOBI study group. A randomized, double-blind, parallel-group, phase III study of shortening the dosing interval of subcutaneous tocilizumab monotherapy in patients with rheumatoid arthritis and an inadequate response to subcutaneous tocilizumab every other week: Results of the 12-week double-blind period. Mod Rheumatol. 2018 Jan;28(1):76-84.[3]Takeuchi T, Miyasaka N, Tatsuki Y, Yano T, Yoshinari T, Abe T, Koike T. Baseline tumour necrosis factor alpha levels predict the necessity for dose escalation of infliximab therapy in patients with rheumatoid arthritis. Ann Rheum Dis. 2011 Jul;70(7):1208-15.Disclosure of InterestsNone declared
Collapse
|
37
|
Tada M, Yamada Y, Mandai K, Matsumoto Y, Hidaka N. AB1096 THE INFLUENCE OF THE BEHAVIORAL RESTRICTION OF COVID-19 PANDEMIC FOR THE FRAILTY OF PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWe previously reported the prevalence of frailty and relation of disease activity at patients with rheumatoid arthritis (RA)1. The behavioral restriction of COVID-19 pandemic influenced for the lifestyle of people included patients with RA.ObjectivesThe relationship between the behavioral restriction of COVID-19 pandemic and frailty was investigated.MethodsWe used the date from prospective observational study (CHIKARA study: UMIN000023744). 70 from 100 patients with RA were followed-up and evaluated the frailty and subcategories (social, physical, mental, nutrition, and cognitive) by frailty checklist. The prevalence of frailty and the change of exercise and daily life activities by visual analog scale were investigated at pre- and post-behavioral restriction. The correlation of frailty and change of amount of exercise and daily life activity examined by univariate analysis.ResultsMean age was 69.7 years (women n=57, men n=13). The prevalence of frailty at post-behavioral restriction increased compared that at pre-behavioral restriction (post:35.8% vs pre:30.0%). Especially, cognitive and total score at post-behavioral restriction increased significantly. The rate of decrease of exercise by <25%, 26~50%, and 51%< were 70%, 21%, and 9%, respectively (mean:20% decrease). Whereas, the rate of decrease of daily life activities by <25%, 26~50%, and 51%< were 37%, 27%, and 36%, respectively (mean:44% decrease). The change of exercise was significantly negatively correlated with the change of nutrition (R=-0.245, P=0.041) at Table 1. There was no correlation between the change of daily life activities and subcategories.Table 1.Univariate analysis of the changes in daily living activities or exercise and those in frailty and subcategoriesChange of daily living activitiesChange of exerciseR valueP valueR valueP valueΔ Social0.0990.417-0.0060.962Δ Physical0.1820.130-0.0050.965Δ Mental-0.2000.097-0.2340.051Δ Nutrition-0.2040.091-0.2450.041Δ Cognitive-0.0870.476-0.0340.778Δ Total-0.0910.454-0.1780.140Δ, change from pre- to post-behavioral restriction.Analyzed by Spearman’s rank correlation coefficientConclusionThe exercise slightly decreased and the daily life activities decreased almost 50% by the behavioral restriction of COVID-19 pandemic. The prevalence of frailty increased 5.8%, and cognitive and total score were significantly high at post-behavioral restriction of COVID-19 pandemic. The decrease of exercise correlated with the worse of nutrition.References[1]Tada M, Yamada Y, Mandai K, Hidaka N. Correlation between frailty and disease activity in patients with rheumatoid arthritis: Data from the CHIKARA study. Geriatr Gerontol Int 2019; 19:1220-5.Disclosure of InterestsNone declared
Collapse
|
38
|
Anno S, Okano T, Mandai K, Orita K, Yamada Y, Mamoto K, Iida T, Tada M, Inui K, Koike T, Nakamura H. POS0290 THE EFFECTS OF TREATMENT RESPONSE AND RISK FACTOR TO INHIBIT THE CLINICAL RESPONSE IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS TREATED WITH IL-6 RECEPTOR INHIBITOR, ABATACEPT AND JAK INHIBITOR. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRecently, the disease activity of rheumatoid arthritis (RA) was improved due to the ‘treat-to-target’ strategy. However, some patients remain various symptoms despite recommended treatment was performed. Then, the term of ‘difficult-to-treat RA (D2TRA)’ is widely recognized. It is unknown how the difference of type of biological disease-modifying anti rheumatic dugs (bDMARDs)/Janus kinase inhibitor (JAKi) will affect clinical efficacy in patients with D2TRA. Moreover, the risk factor to inhibit the clinical response in patients with D2TRA is unknown.ObjectivesThe aim of this study was to evaluate the treatment response in patients with D2TRA who were treated with interleukin 6 receptor inhibitor (IL-6Ri), abatacept and JAKi.MethodsThis study used the multicenter database included 673 RA patients treated with bDMARDs/JAKi (tocilizumab 240, sarilumab 67, abatacept 146, tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14, filgotinib 2). Two hundred forty-two patients were treated as first line bDMARDs/JAKi (IL-6Ri 117, abatacept 63, JAKi 62), 211 patients were treated as second line bDMARDs/JAKi (IL-6Ri 117, abatacept 37, JAKi 57), 220 patients were treated as third and more bDMARDs/JAKi. In these 220 patients, 82 patients did not meet D2TRA criteria (IL-6Ri 42, abatacept 15, JAKi 25) and 138 patients met D2TRA criteria (IL-6Ri 31, abatacept 31, JAKi 76). In all patients, we analyzed 138 patients with D2TRA (113 female, mean age was 63.1 ± 13.7 years). Drug retention rate and effectiveness of bDMARDs/JAKi in patients with D2TRA were evaluated for 24 weeks. Multivariate linear regression analysis was performed to clarify the risk factors to inhibit the clinical response.ResultsDrug retention rate of patients with D2TRA at 24 weeks was 67.7% in IL-6Ri group, 74.2% in abatacept group, 61.8% in JAKi group. Drug retention rate in patients with D2TRA was not different between groups (IL-6Ri vs abatacept: p=0.86, IL-6Ri vs JAKi group: p=0.39, abatacept vs JAKi group: p=0.33). DAS28-CRP at 4, 12, 24 weeks decreased in all group (Figure 1). Abatacept showed lower improvement ratio of DAS28-CRP at 24 weeks compared to IL-6Ri group (IL-6Ri vs abatacept: p<0.01, IL-6Ri vs JAKi: p=0.1, abatacept vs JAKi: p=0.07). Good responder (defined as decrease in DAS28-CRP score > 1.2 with a score < 3.2) was 52.4% patients in IL-6Ri, 17.4% patients in abatacept, 29.8% patients in JAKi. SDAI and CDAI at 4, 12, 24 weeks decreased in all group (Figure 1). There were no diferences between the groups in improvement ratio of SDAI (IL-6Ri vs abatacept: p=0.11, IL-6Ri vs JAKi: p=0.81, abatacept vs JAKi: p=0.08) and CDAI (IL-6Ri vs abatacept: p=0.31, IL-6Ri vs JAKi: p=0.82, abatacept vs JAKi: p=0.13) at 24 weeks. HAQ was 1.42, 1.15, 1.39 at baseline, 1.27, 1.07, 1.22 at 4 weeks, 1.17, 1.07, 1.17 at 12 weeks, 1.26, 1.06, 1.14 at 24 weeks in IL-6Ri group, abatacept and JAKi, respectively. Multivariate linear regression analysis revealed that high HAQ (β=0.28, p=0.02) and high dosage of glucocorticoid (β=0.67, p<0.01) inhibited the improvement of DAS28-CRP. Type of bDMARDs/JAKi (β=-0.09, p=0.36) did not affect the DAS28-CRP improvement for 24 weeks.Table 1.Multivariate linear regression analysis of risk factor to inhibit the clinical response in patients with D2TRA.β95% CIpAge (years)-0.037-0.025, 0.0170.74male-0.047-0.788, 0.4860.64Disease durations (years)-0.048-0.028, 0.0170.63RF (IU/ml)-0.082-0.0004, 0.00020.41Anti CCP antibody (U/ml)0.111-0.0005, 0.0020.26DAS28-CRP-0.063-0.265, 0.1420.55HAQ0.2790.059, 0.7170.02MTX (mg/day)0.136-0.018, 0.0810.21Glucocorticoid dose (mg/day)0.6690.174, 0.324< 0.01Type of bDMARDs/JAKi-0.088-0.415, 0.1510.36ConclusionDrug retention rate and clinical efficacy of D2TRA patients were not different among IL-6Ri, abatacept and JAKi. DT2RA patient with functional disorder and high dosage of glucocorticoid were risk factor to inhibit the clinical response.Disclosure of InterestsNone declared
Collapse
|
39
|
Tada M, Yamada Y, Mandai K, Matsumoto Y, Hidaka N. OP0133 THE DECREASE OF MUSCLE MASS BY THE BEHAVIORAL RESTRICTION OF COVID-19 PANDEMIC IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWe previously reported the prevalence of sarcopenia and body compositions at patients with rheumatoid arthritis (RA)1. The behavioral restriction of COVID-19 pandemic influenced for the lifestyle of people included patients with RA.ObjectivesThe change of exercise and daily life activity of patients with RA were investigated and body composition and muscle function were compared pre- and post-behavioral restriction.MethodsWe used the date from prospective observational study (CHIKARA study: UMIN000023744). 70 from 100 patients with RA were followed-up and evaluated the change of exercise and daily life activity by visual analog scale. They were measured the muscle mass, fat mass, basal metabolic rate by body composition analyzer and grip strength as muscle function. The relationship between the change of exercise and daily life activity and body composition was investigated by univariate analysis.ResultsMean age was 69.7 years (women n=57, men n=13). The rate of decrease of exercise by <25%, 26~50%, and 51%< were 70%, 21%, and 9%, respectively (mean:20% decrease). Whereas, the rate of decrease of daily life activities by <25%, 26~50%, and 51%< were 37%, 27%, and 36%, respectively (mean:44% decrease). Muscle mass at post-behavioral restriction decrease significantly compared that at pre-behavioral restriction activities (34.0kg vs 34.7kg, P<0.001). Fat mass at post-behavioral restriction increase significantly compared that at pre-behavioral restriction (16.2kg vs 15.5kg, P=0.014). Grip strength at post-behavioral restriction decrease significantly compared that at pre-behavioral restriction (16.2kg vs 17.2kg, P=0.026). The change of exercise was significantly positively correlated with the change of muscle mass and basal metabolic rate (R=0.273, P=0.021 and R=0.256, P=0.033, relatively) at Table 1. Whereas, the change of daily living activities was not significantly correlated with the change of muscle mass and muscle function.Table 1.Univariate analysis of the changes in daily living activities or exercise and those in body composition or muscle functionChange of daily living activitiesChange of exerciseR valueP valueR valueP valueΔ Weight (kg)-0.1230.311-0.1310.279Δ BMI (kg/m2)-0.1080.397-0.1130.345Δ Muscle mass (kg)0.1400.3110.2730.021Δ Fat mass (kg)-0.0610.614-0.0750.539Δ Fat percentage (%)-0.0030.982-0.0180.884Δ Basal metabolic rate (kcal)0.2010.0950.2560.033Δ Grip strength (kg)0.1170.3360.0370.762Δ Walk speed (m/s)0.1690.1610.1390.250Δ, change from pre- to post-behavioral restriction; BMI, body mass indexAnalyzed by Spearman’s rank correlation coefficientConclusionMuscle mass and grip strength decrease and fat mass increase in patients with RA by the behavioral restriction of COVID-19 pandemic. Muscle mass and basal metabolic rate decrease in patients without exercise habits. Maintenance of muscle mass might be important during the COVID-19 pandemic.References[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis 21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).Disclosure of InterestsNone declared
Collapse
|
40
|
Okano T, Koike T, Inui K, Tada M, Mamoto K, Yamada Y, Orita K, Mandai K, Anno S, Iida T, Nakamura H. AB0405 JAK INHIBITORS IMPROVE PATIENT-REPORTED OUTCOMES SUCH AS PAIN AND HAQ EARLIER THAN ANTI-IL-6 INHIBITORS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundClinical feature of Janus kinase (JAK) inhibitor is recognized as not only suppress inflammation but also improve patient-reported outcomes (PRO) such as pain and health assessment questioner (HAQ) in patients with rheumatoid arthritis (RA). This representative clinical feature was known as a results of phase 3 trial compared to TNF inhibitor. One of the mechanisms of JAK in RA is to suppresses interleikin-6 (IL-6). However, the effect for PRO in JAK inhibitor compared to IL-6 inhibitor have not been known.ObjectivesWe investigated the effect for patient-reported outcomes such as pain and HAQ in patients with RA treated with JAK inhibitor compared to IL-6 inhibitor.MethodsThis study was analysed a multicenter database included RA patients treated with biological disease-modifying anti rheumatic dugs (bDMARDs) and JAK inhibitors. In 307 patients treated with IL-6 inhibitor (tocilizumab 240 and sarilumab 67) and 220 patients with JAK inhibitor (tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14 and filgotinib 2), 155 patients were treated as first-line bDMARDs/JAK inhibitor (IL-6R inhibitor 104 and JAK inhibitor 51). In this first-line patients, patients treated with IL-6R inhibitor and JAK inhibitor were matched using the propensity score adjusted for gender, age, RA disease duration, baseline charactristics of disease activity, CRP level, and MMP-3 level. The beaseline data and the change of clinical and laboratory data at 4, 12 and 24 weeks were compared between IL-6 inhibitor and JAK inhibitor.ResultsThirty-six patients in each group were matched and analyzed. The average age was 62.4 and 62.6 years and the average disease duration of RA was 13.2 and 10.1 years in IL-6 inhibitor and JAK inhibitor. The baseline characteristics were not significantly different in both groups. At week 4, tender joint count (TJC) was significantly improved in JAK inhibitor than IL-6 (IL-6: -1.86 vs JAK: -4.12, p= 0.036) and HAQ was significantly improved in JAK inhibitor than IL-6 (IL-6: -0.04 vs JAK: -0.27, p= 0.041). Moreover, Clinical Disease Activity Index (CDAI) was also improved in JAK inhibitor than IL-6 (IL-6: -6.6 vs JAK: -10.9, p= 0.026) at week 4. However, pain VAS and patient global VAS were not significantly different in each group in week4. TJC, HAQ and CDAI was not different in both groups at week 12 and week 24. On the other hand, ESR was significantly decreased in IL-6 inhibitor than JAK inhibitor at week 4, 12 and 24 (IL-6: -26.6 vs JAK: -14.1, p=0.018 at week 4, IL-6: -32.7 vs JAK: -16.5 p=0.004 at week 12, IL-6: -31.3vs JAK: -17.7 p=0.014 at week 24).ConclusionIn a comparison between IL-6 inhibitor and JAK inhibitor as a first-line molecular-targeted drug matched baseline charactristics of disease activity, TJC and HAQ was improved in JAK inhibitor earlier than IL-6 inhibitors. JAK inhibitor suppress multi cytokine that might be the reason why JAK inhibitor improve pain. Improvement of patient reported outcome in JAK inhibitor was found also in comparison with IL-6 inhibitor.References[1]Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med. 2017;376:652-62.[2]Fleischmann R, Pangan AL, Song IH, et al. Upadacitinib Versus Placebo or Adalimumab in Patients with Rheumatoid Arthritis and an Inadequate Response to Methotrexate: Results of a Phase III, Double-Blind, Randomized Controlled Trial. Arthritis Rheumatol. 2019;71:1788-1800.AcknowledgementsWe wish to thank Atsuko Kamiyama and Tomoko Nishimura for clinical assistant, and all member of Team RA.Disclosure of InterestsTadashi Okano Speakers bureau: Asahi Kasei, Astellas, Abbvie, Amgen, Ayumi, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi Tanabe, Novartis, Ono, Pfizer, Sanofi, Takeda, UCB, Grant/research support from: Asahi Kasei, Abbvie, Chugai, Eisai, Mitsubishi Tanabe, Tatsuya Koike Speakers bureau: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd., Masahiro Tada: None declared, Kenji Mamoto: None declared, Yutaro Yamada: None declared, kazuki Orita: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Takahiro Iida: None declared, Hiroaki Nakamura: None declared
Collapse
|
41
|
Yamada Y, Tada M, Mandai K, Hidaka N, Nakamura H. AB0262 PATIENTS WITH RHEUMATOID ARTHRITIS WHO DEVELOP SARCOPENIA FALL FREQUENTLY: 5-YEAR DATA FROM THE CHIKARA STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with rheumatoid arthritis (RA) are likely to have sarcopenia due to decreased muscle mass and physical function. Some patients develop sarcopenia even if disease activity is well-controlled. We previously reported that 13.2% of RA patients without sarcopenia at baseline developed sarcopenia over a year1.ObjectivesThe aim was to longitudinally investigate sarcopenia status and the characteristics of RA patients using data from the prospective, observational CHIKARA study.MethodsBody composition, laboratory data, disease activity, physical function (HAQ), treatment, and history of falls and fractures were investigated in 100 RA patients who participated in the CHIKARA study at baseline and at 5 years. They were divided into 4 groups depending on their sarcopenia status: no sarcopenia developed (N group; sarcopenia absent at baseline and 5 years); sarcopenia developed (S group; sarcopenia absent at baseline, but present at 5 years); cured (C group; sarcopenia present at baseline, but absent at 5 years); and persistent (P group; sarcopenia present at baseline and at 5 years).ResultsSeventy RA patients completed the survey. There were no differences among the 4 groups in disease activity, physical function, and treatment. The N group, accounting for 67.1% of all patients, was young and had high body mass index, muscle mass, fat mass, estimated bone mass, and body metabolic rate at baseline. On the other hand, the S group, accounting for 4.3% of all patients, fell significantly more frequently (p=0.035), 3.3 times during 5 years. The P group, accounting for 18.6% of all patients, had significantly higher MMP-3 at baseline (p=0.006). The C group accounted for 10.0% of all patients (Table 1).Table 1.Characteristics of 77 RA patients by sarcopenia status at baseline and at 5-year follow-upno development (n=47)development (n=3)cured (n=7)persisted (n=13)p valueage, years63 (57.5, 70)76 (74.5, 81)66 (54, 70)73 (65, 82)0.006disease duration, years6.5 (1.1, 10.7)15.2 (14.9, 20.7)11.4 (7.2, 14.8)3.5 (1.1, 6.5)0.021MTX dose, mg/day8.1 ± 3.76.0 ± 2.07.4 ± 3.86.2 ± 4.80.406biologics use, %36.266.728.623.10.513GC use, %23.4028.615.40.701average GC dose, mg/day3.5 ± 1.103.7 ± 1.86.3 ± 1.80.833CRP, mg/dl0.1 (0.04, 0.18)0.04 (0.04, 0.23)0.2 (0.12, 0.47)0.19 (0.08,0.82)0.22MMP-3, ng/ml62.2 (50.3, 98.6)58.9 (47.8, 71.3)74.9 (58.3,147.2)160 (90.8,262)0.006DAS28ESR3.34 ± 0.914.11 ± 0.723.36 ± 1.383.79 ± 1.200.355mHAQ0.25 (0, 0.5)0.63 (0.56, 1.25)0.87 (0.25, 1.0)0.25 (0.13, 0.75)0.132BMI, kg/m223.22 ± 3.5121.4 ± 2.2518.69 ± 2.0819.56 ± 2.39<0.001SMI, kg/m26.73 ± 0.76.1 ± 0.25.51 ± 0.145.79 ± 0.6<0.001fat percentage, %30.39 ± 8.7730.03 ± 9.1225.04 ± 6.2323.75 ± 6.560.051estimated bone mass, kg2.2 (2, 2.4)1.9 (1.75, 1.95)1.6 (1.55, 1.9)1.9 (1.7, 2.2)0.001BMR, kcal1101 (1051, 1198)986 (934, 1010)896 (872, 994)978 (902,1107)<0.001ΔDAS28ESR-0.15 ± 0.84-0.43 ± 1.730.04 ± 0.89-0.59 ± 1.330.445ΔSMI, kg/m2-0.06 ± 0.34-0.38 ± 0.570.25 ± 0.220.08 ± 0.420.038fall, times1.63.331.290.380.045Data are shown as mean ± standard deviation (SD) or median (25th, 75th percentile).GC: glucocorticoids, MMP-3: matrix metalloproteinase 3, DAS: disease activity score, HAQ: health assessment questionnaire, BMI: body mass index, SMI: skeletal muscle mass index, BMR: body metabolization rate, Δ:change during 5 years.ConclusionOverall, 4.3% of RA patients developed sarcopenia and fell frequently during 5-year follow-up. Patients who develop sarcopenia require special care because they are at high risk of falls.References[1]Y Yamada, M Tada, K Mandai et al. Glucocorticoid use is an independent risk factor for developing sarcopenia in patients with rheumatoid arthritis: from the CHIKARA study. Clin Rheumatol 2020 Jun;39(6):1757-1764.Disclosure of InterestsNone declared
Collapse
|
42
|
Tada M, Okano T, Mamoto K, Yamada Y, Orita K, Mandai K, Anno S, Iida T, Inui K, Koike T. AB0387 THE RELATIONSHIP BETWEEN JAK INHIBITORS AND CREATINE KINASE ELEVATION IN PATIENTS WITH RHEUMATOID ARTHRITIS: A REAL-WORLD CLINICAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSome cases of creatine kinase (CK) elevation caused by Janus kinase (JAK) inhibitor treatment for rheumatoid arthritis (RA) have been reported in clinical trials1. However, the frequency and patients’ background characteristics in clinical practice are unknown.ObjectivesThe correlation between JAK inhibitor treatment for RA and changes in CK levels in clinical practice were investigated using a multicenter database.MethodsThe multicenter database of JAK inhibitors was used, and 103 (tofacitinib 46, baricitinib 44, upadacitinib 11, peficitinib 1, filgotinib 1) of 265 RA patients were followed up at 24 weeks, and their CK levels were evaluated. The time-dependent change of CK was evaluated by sex and analyzed by the Wilcoxon signed-rank test. The percentage abnormal from the standard titer was calculated. The factors related to an elevated CK at 24 weeks were investigated using patients’ background characteristics at the time of starting JAK inhibitors by univariate analysis.ResultsWomen accounted for 85.4% of the patients, the median age was 68 years, disease duration was 15 years, and the mean DAS28ESR was 5.00. The CK levels of both men and women were significantly elevated at 4 weeks and maintained until 24 weeks (men, women: 63, 62 (0 weeks), 101, 95 (4 weeks), 119, 96 (12 weeks), 155, 99 (24 weeks), U/L, P<0.001) (Figure 1). The percentage abnormal was also significantly increased at 4 weeks and maintained until 24 weeks (5.8% (0 weeks), 20.7% (4 weeks), 26.3% (12 weeks), 24.3% (24 weeks), P=0.002). The factors significantly positively related to elevated CK levels at 24 weeks were male, CK, creatinine, and lactate dehydrogenase (LDH), and stage, class, modified health assessment questionnaire, estimated glomerular filtration rate (eGFR), and glucocorticoid use were significantly negatively correlated (Table 1). There were no significant differences in CK elevation among the agents.Table 1.Characteristics at the time of starting JAK inhibitors related to elevated creatine kinase levels at 24 weeksUnivariateData at stating JAK inhibitorsR valueP valueCreatine kinase0.653<0.001Gender, men0.2470.012Steinbrocker stage-0.2150.039Steinbrocker class-0.2770.008modified health assessment questionnaire-0.2680.008Creatinine0.2890.003eGFR-0.2310.019LDH0.2010.041Glucocorticoid use-0.4090.008Analyzed by Spearman rank correlation coefficientFigure 1.Time-dependent changes of CK in all RA patientsConclusionCK was significantly elevated at 4 weeks and maintained until 24 weeks. However, no patients complained of muscle pain and stopped JAK inhibitors. Patients with high CK, low eGFR, high LDH, or maintained activities of daily living at the time of starting JAK inhibitors tended to have high CK levels at 24 weeks.References[1]Fleischmann, R. et al. Upadacitinib Versus Placebo or Adalimumab in Patients With Rheumatoid Arthritis and an Inadequate Response to Methotrexate: Results of a Phase III, Double-Blind, Randomized Controlled Trial. Arthritis & rheumatology (Hoboken, N.J.) 71, 1788-1800, doi:10.1002/art.41032 (2019).Disclosure of InterestsNone declared
Collapse
|
43
|
Anno S, Iida T, Yamada Y, Okano T, Sugioka Y, Inui K, Wakitani S, Nakamura H. POS1146 ROMOSOZUMAB INCREASE BONE MINERAL DENSITY AT LUMBAR AND FEMORAL IRRESPECTIVE OF PREOSTEOPOROSIS TREATMENT, HISTORY OF FRAGILITY FRACTURE AND COMBINATION OF VITAMIN D. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundRomosozumab, a monoclonal antibody that binds sclerostin, increases bone formation and decreases bone resorption. Romosozumab has an excellent therapeutic effect on patients with osteoporosis. However, there are few reports investigated the efficacy and the effect of various factors relative to osteoporosis in real-world.ObjectivesWe evaluated bone mineral density (BMD) and bone metabolism marker (BMM) change in osteoporosis patients treated with romosozumab, and assessed the effect of various factors, such as preosteoporosis treatment, history of fragility fracture and combination of vitamin D.MethodsThis study included 141 osteoporosis patients (132 female, mean age: 78.8 ± 7.5 years, mean hight: 151.1 ± 7.5 cm, mean weight: 50.9 ± 8.9 kg) treated with romosozumab. BMD measurements using dual energy X-ray absorptiometry (DXA) and BMM measurements using N-terminal propeptide of type 1 collagen (P1NP) were evaluated at 0, 4, 6, and 12 months after treatment. DXA were performed at the lumbar spine (n=92), at proximal femoral and femoral neck (n=92), and at distal third radius (n=49). We evaluated the influence of preosteoporosis treatment, history of fragility fracture and combination of vitamin D for BMD change.ResultsBMD at lumbar spine (5.2%: p<0.01, 9.2%: p<0.01, 10.8%: p<0.01), proximal femoral (1.3%: p=0.02, 2.8%: p<0.01, 4.5%: p<0.01) and femoral neck (2.0%: p=0.03, 2.7%: p=0.06, 5.0%: p=0.01) were significantly increased at 4, 8, 12 months after treatment. BMD at distal third radius (-1.5%: p<0.01, -0.8%: p=0.17, -1.0%: p=0.13) were not increased at 4, 8, 12 months after treatment. P1NP chane were 63% (p<0.01), 6.4% (p=0.55), -2.3% (p=0.2) at 4, 8, 12 months after treatment. There were no significant differences in 1 year improvement ratio of BMD at lumbar spine, proximal femoral and femoral neck between 38 patients with pretreatment of osteoporosis and 54 patients without pretreatment of osteoporpsis (13.5 vs 9.5%: p=0.1, 4.9 vs 4.4%: p=0.7, 6.1 vs 4.6%: p=0.67), between 33 patients with a history of fragility fracture and 59 patients without a history of fragility fracture (7.3 vs 11.7%: p=0.42, 0.8 vs 5.5%: p=0.08, -0.7 vs 6.6%: p=0.14), between 50 patients with romosozumab alone and 42 patients with romosozumab plus vitamin D (11.3 vs 10.0%: p=0.93, 4.1 vs 5.3%: p=0.59, 6.8 vs 2.3%: p=0.47). There were no significant differences in 1 year improvement ratio of BMD at distal third radius between 33 patients with pretreatment of osteoporosis and 16 patients without pretreatment of osteoporpsis (-1.1 vs -0.9%: p=0.63), between 31 patients with a history of fragility fracture and 18 patients without a history of fragility fracture (-1.5 vs -0.5%: p=0.3).ConclusionRomosozumab improved BMD at lumbar and femoral independently regardless of preosteoporosis treatment, history of fragility fracture and combination of vitamin D.References[1]Felicia Cosman et al. Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med 2016; 375:1532-1543, DOI: 10.1056/NEJMoa1607948Disclosure of InterestsNone declared
Collapse
|
44
|
Kimura M, Yoshimura I, Yanagida K, Yoshida T, Hagiwara K, Kaneko T, Yamada Y, Nakagawa T. Evaluation of ejaculation function using a simple questionnaire. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.448] [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]
|
45
|
Quzwain K, Yamada Y, Kamardin K, Abd Rahman NH, Ismail A. New Reflector Shaping Methods for Dual-Reflector Antenna. RADIOENGINEERING 2022; 31:39-53. [DOI: 10.13164/re.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
46
|
Ikeda M, Nakajima D, Oshima A, Oshima Y, Kayawake H, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Hamaji M, Date H. The Effects of Early Postoperative Nutrition Support on Enhanced Recovery After Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1087] [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] Open
|
47
|
Kayawake H, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Nagao M, Date H. Cytomegalovirus Infection After Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1553] [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] Open
|
48
|
Ikeda R, Ichihara Y, Yamada Y, Saito S, Nishinaka T, Shinkawa T, Niinami H. Optimization of Left Ventricle Size After VAD Implantation Prevents Incidence of Cerebral Infarction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1163] [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] Open
|
49
|
Morimura Y, Tanaka S, Kayawake H, Yamada Y, Yutaka Y, Ohsumi A, Nakajima D, Hamaji M, Date H. Use of Basiliximab in Recipients Who Required Dose Reduction or Discontinuation of Calcineurin Inhibitors Early After Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
50
|
Yamada Y, Bohnenberger H, Kriegsmann M, Kriegsmann K, Schölch S, Ströbel P, Marx A. 174P Pulmonary tuft cell-like cancers across different histotypes share molecular features with potentially druggable vulnerabilities. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|