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Fujimoto K, Akamatsu Y, Nishikawa Y, Ogasawara K. Intraoperative application of indocyanine green and temporary venous occlusion test to assess collateral flow during microvascular decompression for venous-related trigeminal neuralgia: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE2469. [PMID: 38588600 PMCID: PMC11007271 DOI: 10.3171/case2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND In microvascular decompression (MVD) for vein-related trigeminal neuralgia (TN), determining whether transection of the offending vein is safe can be challenging. Here, the authors present a case of vein-related TN successfully treated by sacrificing the offending vein on the basis of findings from indocyanine green (ICG) video angiography and a temporary venous occlusion test to assess the collateral flow of the offending vessel. OBSERVATIONS A 43-year-old man presented with TN, which had failed to respond to previous medical therapy. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed that the transverse or superior petrosal vein was the offending vein. The patient underwent MVD. Because the transposition of the offending vein was anatomically challenging, a temporary vein occlusion test was performed using ICG video angiography. During and after temporary occlusion, bidirectional flow in the offending vein was observed, suggesting collateral flow even after vein occlusion. On the basis of these findings, the offending vein was transected, resulting in relief from pain without any complications. Postoperative MRI revealed no new lesions in the brainstem or the cerebellar hemisphere. The patient has been free from neuralgia for 6 months. LESSONS The temporary vein occlusion test under ICG video angiography was useful for evaluating collateral flow in the offending vein in TN.
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Fujiwara K, Kondo T, Fujimoto K, Yumita S, Ogawa K, Ishino T, Nakagawa M, Iwanaga T, Tsuchiya S, Koroki K, Kanzaki H, Inoue M, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Ogasawara S, Nakamoto S, Chiba T, Koizumi J, Kato J, Kato N. Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma. J Gastroenterol 2024:10.1007/s00535-024-02097-9. [PMID: 38583112 DOI: 10.1007/s00535-024-02097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND During systemic therapy, the management of portal hypertension (PH)-related complications is vital. This study aimed to clarify factors associated with the incidence and exacerbation of PH-related complications, including the usefulness of contrast-enhanced computed tomography (CECT) in the management of PH-related complications during systemic therapy. METHODS A total of 669 patients who received systemic therapy as first-line treatment (443 patients for sorafenib, 131 for lenvatinib, and 90 for atezolizumab/bevacizumab [ATZ/BEV]) were enrolled in this retrospective study. Additionally, the lower esophageal intramural vessel diameters (EIV) on CECT and endoscopic findings in 358 patients were compared. RESULTS The cutoff values of the EIV diameter on CECT were 3.1 mm for small, 5.1 mm for medium, and 7.6 mm for large varices, demonstrating high concordance with the endoscopic findings. esophageal varices (EV) bleeding predictors include EIV ≥ 3.1 mm and portal vein tumor thrombosis (PVTT). In patients without EV before systemic therapy, factors associated with EV exacerbation after 3 months were EIV ≥ 1.9 mm and ATZ/BEV use. Predictors of hepatic encephalopathy (HE) include the ammonia level or portosystemic shunt diameter ≥ 6.8 mm. The incidence of HE within 2 weeks was significantly higher (18%) in patients with an ammonia level ≥ 73 μmol/L and a portosystemic shunt ≥ 6.8 mm. The exacerbating factors for ascites after 3 months were PVTT and low albumin levels. CONCLUSIONS Careful management is warranted for patients with risk factors for exacerbation of PH-related complications; moreover, the effective use of CECT is clinically important.
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Affiliation(s)
- Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- Ultrasound Center, Chiba University Hospital, Chiba, Japan.
| | - Kentaro Fujimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Tsuchiya
- Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masanori Inoue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
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Fujimoto K, Kondo T, Unozawa H, Koizumi J, Kato N. First Experience With the Utility of ReMAP (Repeatable Microcatheter Access Port) in Portal Vein Stenting. Cureus 2024; 16:e58530. [PMID: 38770468 PMCID: PMC11103942 DOI: 10.7759/cureus.58530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Portal vein stenting is a treatment option for portal hypertension caused by extrahepatic portal vein obstruction or stenosis. However, limited pathways to approach the portal vein are available, hindering re-intervention in the portal vein. Portal vein puncture through the transjugular intrahepatic portosystemic shunt route is less invasive and considered suitable for portal vein stenting. Furthermore, transjugular intrahepatic portosystemic shunting facilitates repeat approaches to the portal vein. However, a transjugular intrahepatic portosystemic shunt stent is not recommended unless necessary because of adverse events, and cannot be retrieved, once placed. Herein, we report on a novel approach using the repeatable microcatheter access port: ReMAP™ (Toray, Tokyo, Japan), a central vein port into which a 2.9 Fr catheter can be inserted. We used it for a repeat approach to the portal vein with only one puncture and without placing a transjugular intrahepatic portosystemic shunt stent.
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Affiliation(s)
| | | | | | | | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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Fujimoto K, Omondi BA, Kawano S, Hidaka Y, Ishida K, Okabe H, Hara K. Ionized acrylamide-based copolymer / terpolymer hydrogels for recovery of positive and negative heavy metal ions. PLoS One 2024; 19:e0298047. [PMID: 38427672 PMCID: PMC10906855 DOI: 10.1371/journal.pone.0298047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024] Open
Abstract
In this study, we explored the effective capture of both cations and anions onto a single adsorbent. Acrylamide (AAm) served as the polymer backbone, onto which co-monomers sodium p-styrenesulfonate (SS) and N,N-dimethylaminopropyl acrylamide (DMAPAA) were grafted, creating ionized polymer hydrogel adsorbents. These adsorbents were engineered for the synergistic separation and recovery of heavy metal cations and anions from concentrated solutions, focusing specifically on industrially significant ions such as Ni2+-, Cu2+, Zn2+ and (Cr2O7)2-. The adsorption and desorption behaviors of the AAm terpolymer hydrogels were investigated across various pH solutions, considering the competition and concentrations of these specific metal ions. Moreover, the study delved into the effects of the internal pH environment within the hydrogel adsorbents, determining its impact on the type of metal adsorbed and the adsorption capacity. Our findings indicated that the adsorption of cations was enhanced with a higher proportion of SS relative to DMAPAA in the hydrogel. In contrast, significant anion capture occurred when the concentration of DMAPAA exceeded that of SS. However, equal ratios of SS and DMAPAA led to a noticeable reduction in the adsorption of both types of substrates, attributed to the counteractive nature of these co-monomers. To enhance the adsorption efficiency, it may be necessary to consider methods for micro-scale separation of the two types of monomers. Additionally, the adsorption capacity was observed to be directly proportional to the swelling capacity of the hydrogels. For complete desorption and separation of the cations and anions from the adsorbent, the application of concentrated NaOH solutions followed by HNO3 was found to be essential. Given the varying concentrations of cation and anion pollutants, often present in heavy metal factory effluents, it is crucial to fine-tune the ratios of DMAPAA and SS during the synthesis process. This adjustment ensures optimized efficiency in the decontamination and recovery of these significant heavy metal ions.
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Affiliation(s)
- Kentaro Fujimoto
- Department of Applied Quantum Physics and Nuclear Engineering, Graduate School of Engineering, Kyushu University, Fukuoka, Japan
| | - Brian Adala Omondi
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
| | - Shinya Kawano
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
| | - Yoshiki Hidaka
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
| | - Kenji Ishida
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
| | - Hirotaka Okabe
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
| | - Kazuhiro Hara
- Department of Applied Quantum Physics and Nuclear Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan
- Center for Research and Education of Environmental Technology, Kyushu University, Fukuoka, Japan
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Fujiwara S, Ogasawara K, Chida K, Ogasawara Y, Nomura JI, Oshida S, Fujimoto K, Tsutsui S, Setta K, Yoshioka Y. Feasibility of Diffusion-weighted Imaging (DWI) for Assessing Cerebrospinal Fluid Dynamics: DWI-fluidography in the Brains of Healthy Subjects. Magn Reson Med Sci 2024:mp.2022-0152. [PMID: 38355106 DOI: 10.2463/mrms.mp.2022-0152] [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: 02/16/2024] Open
Abstract
PURPOSE The present study aimed to investigate whether diffusion-weighted imaging (DWI) can qualify and quantify cerebrospinal fluid (CSF) dynamics in the brains of healthy subjects. For this purpose, we developed new DWI-based fluidography and compared the CSF dynamics seen on the fluidography with two apparent diffusion coefficients obtained with different DWI signal models at anatomical spaces filled by CSF. METHODS DWI with multiple b values was performed for 10 subjects using a 7T MRI scanner. DWI-fluidography based on the DWI signal variations in different motion probing gradient directions was developed for visualizing the CSF dynamics voxel-by-voxel. DWI signals were measured using an ROI in the representative CSF-filled anatomical spaces in the brain. For the multiple DWI signals, the mono-exponential and kurtosis models were fitted and two kinds of apparent diffusion coefficients (ADCC and ADCK) were estimated in each space using the Gaussian and non-Gaussian diffusion models, respectively. RESULTS DWI-fluidography could qualitatively represent the features of CSF dynamics in each anatomical space. ADCs indicated that the motions at the foramen of Monro, the cistern of the velum interpositum, the quadrigeminal cistern, the Sylvian cisterns, and the fourth ventricle were more drastic than those at the subarachnoid space and anterior horns of the lateral ventricle. Those results seen in ADCs were identical to the findings on DWI-fluidography. CONCLUSION DWI-fluidography based on the features of DWI signals could show differences of CSF dynamics among anatomical spaces.
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Affiliation(s)
- Shunrou Fujiwara
- Division of Molecular and Cellular Pharmacology, Department of Pathophysiology and Pharmacology, School of Pharmaceutical Science, Iwate Medical University, Yahaba, Iwate, Japan
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Kohei Chida
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Yasushi Ogasawara
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Jun-Ichi Nomura
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Sotaro Oshida
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Shota Tsutsui
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Kengo Setta
- Department of Neurosurgery, Iwate Medical University Hospital, Yahaba, Iwate, Japan
| | - Yoshichika Yoshioka
- Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Iwate, Japan
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Kanzaki H, Ogasawara S, Okubo T, Itokawa N, Yoshino R, Fujimoto K, Kogure T, Yumita S, Ishino T, Ogawa K, Iwanaga T, Nakagawa M, Fujiwara K, Kojima R, Koroki K, Inoue M, Kobayashi K, Kanogawa N, Kiyono S, Nakamura M, Kondo T, Nakagawa R, Nakamoto S, Muroyama R, Itobayashi E, Atsukawa M, Kato J, Kato N. Cabozantinib for Advanced Hepatocellular Carcinoma in the Latest Real-World Practice: A Multicenter Retrospective Analysis. Drugs Real World Outcomes 2023; 10:513-520. [PMID: 37466822 PMCID: PMC10730490 DOI: 10.1007/s40801-023-00379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cabozantinib was found to be effective as a second- or third-line treatment after sorafenib in patients with advanced hepatocellular carcinoma (HCC) in the phase 3 CELESTIAL trial. So far, as immunotherapy has substituted molecular target agents as the primary systemic therapy for advanced HCC, cabozantinib is extensively used in the latest real-world clinical practice in a greatly different position than that shown by the CELESTIAL trial. In the current analysis, we examined the safety and effectiveness of cabozantinib administration in real-life settings for patients with advanced HCC. METHODS We retrospectively obtained data from patients with advanced HCC who received cabozantinib in three institutions in Japan between 14 September 2018 and 30 November 2021. RESULTS During the study period, 23 patients with advanced HCC received cabozantinib. Our cohort included 21.7% of patients with Child-Pugh class B, and 52.2% of patients in fourth line or later. The median progression-free survival of patients given cabozantinib was 3.7 months. Regarding patients with Child-Pugh class B or administration in fourth line or later, the discontinuation rate due to adverse events in patients who initialized at 40 or 20 mg was lower than those who initialized at 60 mg (42.9% versus 75.0%). Patients who were able to continue treatment with cabozantinib for more than 3 months were more likely to undergo dose reduction than those who did not (85.7% versus 25.0%). CONCLUSIONS Cabozantinib has recently been administered to a diverse range of patients, including those who were not enrolled in the CELESTIAL trial. Deliberate dose reduction could potentially offer clinical benefits to patients with impaired liver function. Furthermore, managing adverse events by reducing the dose could play a crucial role in extending the duration of treatment with cabozantinib. The preprint version of this work is available on https://www.researchsquare.com/article/rs-2655181/v1 .
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Affiliation(s)
- Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
| | - Tomomi Okubo
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Norio Itokawa
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Ryohei Yoshino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kentaro Fujimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Tadayoshi Kogure
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ryuta Kojima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Masanori Inoue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ryo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Ryosuke Muroyama
- Department of Molecular Virology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ei Itobayashi
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Masanori Atsukawa
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
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Fujiwara K, Kondo T, Fujimoto K, Fujie M, Kanogawa N, Ogasawara S, Kato N. Use of disposable endoscope for variceal sclerotherapy. Endoscopy 2023; 55:E1248-E1249. [PMID: 38101451 PMCID: PMC10723940 DOI: 10.1055/a-2215-1100] [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] [Indexed: 12/17/2023]
Affiliation(s)
- Kisako Fujiwara
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Fujimoto
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mai Fujie
- Department of Clinical Engineering Center, Chiba University Hospital, Chiba, Japan
| | - Naoya Kanogawa
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Fujimoto K, Chida K, Yoshida J, Kojima D, Yoshida K, Misaki T, Konno H, Ogasawara K. A case of intracerebral hemorrhage due to cerebral hyperperfusion after stenting for acute cervical carotid artery dissection. Radiol Case Rep 2023; 18:3856-3860. [PMID: 37670927 PMCID: PMC10475400 DOI: 10.1016/j.radcr.2023.08.004] [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: 07/11/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Urgent carotid artery stenting (CAS) is effective for treatment-resistant cervical internal carotid artery dissection (CICAD). We experienced a 37-year-old woman who presented with sudden onset of cervical pain, blurred vision in the right eye, and numbness in the left upper and lower extremities. Due to neurological deterioration resulting from hemodynamic impairment, urgent CAS was performed under general anesthesia. Brain perfusion single-photon emission computed tomography performed immediately after CAS showed increased blood flow in the right hemisphere despite no evidence of hemorrhage or ischemic lesion on brain computed tomography (CT). Systolic blood pressure was therefore strictly controlled below 110 mm Hg perioperatively. However, the day after CAS, a follow-up CT showed intracerebral hemorrhage in the right temporal lobe. Urgent CAS in patients with progressive deterioration of hemodynamic impairment caused by CICAD may induce intracerebral hemorrhage due to cerebral hyperperfusion. Care should be taken to recognize and manage this phenomenon during the perioperative period.
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Affiliation(s)
- Kentaro Fujimoto
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
- Department of Neurosurgery, Iwate Medical University, Yahaba, Iwate, Japan
| | - Kohei Chida
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
- Department of Neurosurgery, Iwate Medical University, Yahaba, Iwate, Japan
| | - Jun Yoshida
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
| | - Daigo Kojima
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
| | - Koji Yoshida
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
| | - Toshinari Misaki
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
| | - Hiromu Konno
- Department of Neurosurgery, Hachinohe Red-Cross Hospital, Hachinohe, Aomori, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Yahaba, Iwate, Japan
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Tanaka H, Karita M, Ueda K, Ono T, Manabe Y, Kajima M, Fujimoto K, Yuasa Y, Shiinoki T. Difference in Radiosensitivity Depending on the Presence and Absence of EGFR Mutations: Clinical and In Vitro Analyses. Int J Radiat Oncol Biol Phys 2023; 117:e63. [PMID: 37785880 DOI: 10.1016/j.ijrobp.2023.06.785] [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) For stage IV non-small cell lung cancer (NSCLC), the treatment drug is selected based on the gene mutation status. However, the dose or field of radiation therapy is not change based on the genetic status. We evaluated both clinical and in vitro data, showing that the presence or absence of epidermal growth factor receptor (EGFR) mutations affects radiosensitivity in patients with brain metastases (BM) from NSCLC. MATERIALS/METHODS Patients with BM from NSCLC who received whole brain radiotherapy (WBRT) were enrolled in this study. Patient characteristics are shown in the Table. EGFR mutations were observed in 13 (31.0%) patients. The prescribed dose was 30 Gy in 10 fractions (85.7%). The A549, VMRC-LCD, NCI-H1975, and HCC4006 cell lines were used for the in vitro study. EGFR mutation was negative in A549 and VMRC-LCD and positive in NCI-H1975 (exon21) and HCC4006 (exon19). After irradiation of these cell lines with 0, 2, 4, and 8 Gy, a colony formation assay was performed. DNA double-strand breaks (DSBs) were assessed 30 min and 24 h after 4 Gy irradiation using γH2AX. RESULTS The median follow-up period was 4 months (range, 1-35). Intracranial recurrence was observed in 14 (33.3%) patients during the follow-up period. Thirty-nine (92.9%) patients died during the follow-up period. Patients with EGFR mutation-positive tumors had significantly better intracranial control rates than those with EGFR mutation-negative tumors (p = 0.0213). A similar tendency was observed in the analysis conducted, except for the cases in which tyrosine kinase inhibitor (TKI) was administered after WBRT. In the EGFR mutation-positive group, no significant difference was observed between patients who received TKI after WBRT and those who did not (p = 0.527). In the colony formation assay, EGFR mutation-positive cell lines showed a significantly lower number of colonies formed after irradiation with 2 and 4 Gy than mutation-negative cell lines (p = 0.00018 and 0.0000291, respectively). EGFR mutation-positive cell lines had significantly more DNA-DSBs remaining 24 h after irradiation than mutation-negative cell lines (p = 0.0000000312). CONCLUSION Our data suggest that patients with EGFR mutation-positive NSCLC are more radiosensitive than those with negative EGFR mutations.
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Affiliation(s)
- H Tanaka
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - M Karita
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - K Ueda
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - T Ono
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - Y Manabe
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - M Kajima
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - K Fujimoto
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - Y Yuasa
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - T Shiinoki
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
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10
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Tanaka H, Ueda K, Karita M, Ono T, Kajima M, Manabe Y, Sera T, Fujimoto K, Yuasa Y, Shiinoki T. Deep-Inspiration Breath-Hold Stereotactic Body Radiation Therapy by Combining Spirometer-Guided Breath-Hold and a Real-Time Tumor Tracking System: A Novel Approach. Int J Radiat Oncol Biol Phys 2023; 117:e63-e64. [PMID: 37785881 DOI: 10.1016/j.ijrobp.2023.06.786] [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) There are several methods used against respiratory motion (RM). Expiratory breath-hold (BH) is considered more stable and reproducible than inspiratory BH; therefore, BH with spirometry is often used for expiration. The real-time tumor tracking radiotherapy (RTRT) system is a highly effective method for reducing the margin of RM. This system ambushes and irradiates tumors during the expiratory phase when tumors move slowly. Although these methods usually involve expiration, it is advantageous to expand the lungs with inspiration to reduce the risk of adverse events. Here, we developed a new approach of performing stereotactic body radiation therapy (SBRT) under deep-inspiration BH (DIBH) by combining these two methods. MATERIALS/METHODS Lung tumors with respiratory motion ≥ 1 cm were included. Three or four fiducial markers were placed near the tumor via bronchoscopy. DIBH CT (CT-IN) was performed under the guidance of spirometer. The PTV was obtained by adding a 5-mm margin to the GTV delineated on CT-IN. The prescribed dose was 42 Gy in four fractions for the D95 of the PTV. An error of 2.0 mm around the planned position of the fiducial marker on CT-IN was permitted along each orthogonal axis as a gating box. In preparation for cases in which the reproducibility of DIBH is low and treatment cannot be performed, light expiration BH CT (CT-EX) was also performed, and a radiotherapy plan was prepared for the conventional RTRT system so that it could be switched at any time. Lung volumes and doses (mean dose, V20 Gy, V10 Gy, and V5 Gy) on CT-EX and CT-IN were compared. RESULTS Five patients underwent SBRT with DIBH, and all completed the planned irradiation course. The median treatment time per fraction was 27.86 min (range, 25.5-40.6). Four tumors were located in the left lower lobe and one in the right lower lobe. The median volume of PTV was 12.4 (range, 5.2-26.2) mL. The lung volumes and doses on CT-EX and CT-IN are shown in the Table. The lung volume on CT-IN was 1.6 times larger than that on CT-EX. The PTV-to-lung ratio on CT-IN was significantly lower than that on CT-EX. V20 Gy and V10 Gy on CT-IN were significantly lower than those on CT-EX. CONCLUSION SBRT with DIBH was achieved by combining the spirometer and RTRT system. This can help to eliminate concerns about reproducibility and high-speed tumor movement during inspiration, which are weaknesses of spirometer-guided breath-hold and the RTRT system, respectively, while ensuring the accuracy of the RTRT system. DIBH SBRT is a promising method that can reduce lung dose.
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Affiliation(s)
- H Tanaka
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - K Ueda
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - M Karita
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - T Ono
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - M Kajima
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - Y Manabe
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - T Sera
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - K Fujimoto
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - Y Yuasa
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
| | - T Shiinoki
- Yamaguchi University Graduate School of Medicine, Department of Radiation Oncology, Ube, Japan
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11
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Fujiwara K, Kondo T, Fujimoto K, Koizumi J, Kato N. Percutaneous Transhepatic Direct Portosystemic Shunt for a Patient With Budd-Chiari Syndrome Using a Balloon as a Target in a Stenotic Inferior Vena Cava. Cureus 2023; 15:e44967. [PMID: 37822436 PMCID: PMC10562881 DOI: 10.7759/cureus.44967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/13/2023] Open
Abstract
Budd-Chiari syndrome (BCS) patients with portal hypertension are often treated with a direct intrahepatic portosystemic shunt (DIPS) or transjugular intrahepatic portosystemic shunt (TIPS) and angioplasty. DIPS can be problematic, however, due to the technical difficulty of the procedure. To address this problem, we describe a method using the balloon used for inferior vena cava (IVC) dilatation as a puncture target to safely perform DIPS in a BCS patient with complete hepatic vein occlusion and stenosis of the IVC. To perform balloon dilation, the puncture is made through the internal jugular vein, and the guidewire is advanced to the IVC with stenosis. After dilatation of the IVC, the direct left lateral subdistrict branch of the portal vein is percutaneously punctured directly from the cardiac fossa (targeting the inflated balloon in the IVC), and the IVC puncture is done through the portal vein. After creating a pull-through route, a stent is placed between the left portal vein and the IVC. The procedure is completed without any complications. This technique has the potential to form the basis of a safe and reliable DIPS procedure.
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Affiliation(s)
| | | | | | | | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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12
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Kondo T, Fujimoto K, Fujiwara K, Yumita S, Ishino T, Ogawa K, Nakagawa M, Iwanaga T, Koroki K, Kanzaki H, Inoue M, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Ogasawara S, Nakamoto S, Chiba T, Kato J, Fujiwara K, Kato N. Potential of circulating receptor-interacting protein kinase 3 levels as a marker of acute liver injury. Sci Rep 2023; 13:14043. [PMID: 37640752 PMCID: PMC10462689 DOI: 10.1038/s41598-023-41425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/26/2023] [Indexed: 08/31/2023] Open
Abstract
The pathogenesis of acute liver failure (ALF) involves cell death. Necroptosis is a newly suggested programmed cell death, and receptor-interacting protein kinase 3 (RIPK3) has been reported as a marker for necroptosis. However, there are few reports on necroptosis in ALF. Therefore, we evaluated the role of cell death markers such as cytokeratin (CK) 18, cleaved CK (cCK) 18, and RIPK3 in ALF, as well as cytokines and hepatocyte growth factor (HGF). Seventy-one hospitalized patients with acute liver injury (38 nonsevere hepatitis [non-SH]/22 severe hepatitis [SH]/11 ALF) were studied. No significant difference was found for cytokines, but a substantial increase in HGF levels was found following the severity of hepatitis. The non-SH group had lower levels of CK18 and cCK18 than the SH/ALF group. RIPK3 was significantly lower in the non-SH/SH group than in the ALF group. HGF, RIPK3, and albumin levels were found to be important predictive variables. The present study suggests that cCK18, CK18, and RIPK3 are associated with the severity of hepatitis. RIPK3 and other markers related cell death may be useful for understanding the pathogenesis of ALF and as a prognostic marker of acute liver injury.
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Affiliation(s)
- Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- Ultrasound Center, Chiba University Hospital, Chiba, Japan.
| | - Kentaro Fujimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masanori Inoue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keiichi Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
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13
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Oshida S, Saura H, Akamatsu Y, Yanagihara W, Fujimoto K, Nagasawa K, Takahashi K, Ogasawara K. Delayed blink R1 latency in a patient with trigeminal neuralgia due to a contralateral vestibular schwannoma: An illustrative case. Surg Neurol Int 2023; 14:284. [PMID: 37680908 PMCID: PMC10481850 DOI: 10.25259/sni_422_2023] [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: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Background Although the blink reflex (BR) is effective in objectively evaluating trigeminal neuropathy, few studies have demonstrated its effect on trigeminal neuralgia (TN). The authors report a patient with TN due to contralateral vestibular schwannoma (VS) functionally diagnosed by delayed R1 latency of the BR. Case Description A 36-year-old man presented with left-sided deafness and paroxysmal facial pain in the right V1-3 area. Magnetic resonance imaging (MRI) showed a solid cystic mass compressing the right pons and left brainstem at the left cerebellopontine angle. Although preoperative BR evoked by right supraorbital nerve stimulation-induced delayed ipsilateral R1 latency and normal ipsilateral and contralateral R2 responses, the BR latency evoked by left supraorbital nerve stimulation was normal, indicating deficits in the principal nucleus of the trigeminal nerve in the right pons. The symptoms of TN disappeared after the removal of the VS. Postoperative MRI showed subtotal removal of the tumor and sufficient decompression of the pons and cerebellopontine cistern. The R1 latency returned to normal 50 days after surgery. Conclusion The perioperative BR test was not only useful for objective evaluation of the localization of trigeminal neuropathy but also correlated with the symptoms of TN.
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Affiliation(s)
- Sotaro Oshida
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Hiroaki Saura
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | | | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
| | - Kazuki Nagasawa
- Central Clinical Laboratory, Iwate Medical University, Yahaba, Japan
| | - Kodai Takahashi
- Central Clinical Laboratory, Iwate Medical University, Yahaba, Japan
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14
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Kondo T, Fujiwara K, Nakagawa M, Fujimoto K, Yumita S, Ishino T, Ogawa K, Iwanaga T, Koroki K, Kanzaki H, Inoue M, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Ogasawara S, Nakamoto S, Chiba T, Kato J, Kato N. Estimation of the effect of atezolizumab plus bevacizumab on pulmonary arterial hypertension using computed tomography in HCC patients. Sci Rep 2023; 13:11524. [PMID: 37460776 DOI: 10.1038/s41598-023-38377-2] [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: 03/24/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
The effect of the combination of atezolizumab and bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC) on pulmonary arterial hypertension (PAH) is unknown. Estimation of PAH by using computed tomography (CT) has recently been proposed. Thus, we aimed to estimate the effect of Atez/Bev on PAH using CT. Altogether, 113 patients who received Atez/Bev for HCC were enrolled. Probable PAH was defined as the diameter of the main pulmonary artery (mPA-D) ≥ 33 mm, whereas suspicious PAH was defined as mPA-D ≥ 29 mm or mPA-D/the diameter of the ascending aorta (aAo-D) ≥ 1.0. Before treatment, probable/suspicious PAH were diagnosed in 7 (6.7%)/22 (21.0%) patients, respectively. mPA-D and mPA-D/aAo-D significantly increased after induction of Atez/Bev. The increment of mPA-D was correlated with the occurrence of post-treatment respiratory/heart failure. In analysis of 55 patients who underwent CT at 3 months after the last dose of Atez/Bev, mPA-D and mPA-D/aAo-D significantly decreased. However, in the group with continuous treatment of other molecular-targeted drugs after Atez/Bev, mPA-D and mPA-D/aAo-D showed no significant change. In conclusion, PAH may not be a rare complication in patients with HCC and should be managed carefully because of the possible negative effect of Atez/Bev on PAH.
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Affiliation(s)
- Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- Ultrasound Center, Chiba University Hospital, Chiba, Japan.
| | - Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kentaro Fujimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masanori Inoue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
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15
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Matsumoto Y, Akamatsu Y, Kojima D, Fujimoto K, Sato S, Yanagihara W, Kashimura H, Kubo Y, Ogasawara K. Endovascular treatment of anastomotic duplicated middle cerebral artery aneurysm: Report of two cases. Interdisciplinary Neurosurgery 2023. [DOI: 10.1016/j.inat.2023.101750] [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: 02/22/2023] Open
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16
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Morizawa Y, Satoh H, Arai M, Iwasa S, Sato A, Fujimoto K. Association Between Nonadherence and Transient Hyperuricemia in Pediatric Kidney Transplantation. Transplant Proc 2023; 55:129-133. [PMID: 36581508 DOI: 10.1016/j.transproceed.2022.09.033] [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: 05/13/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nonadherence among pediatric transplant recipients is a significant problem that reduces graft survival and leads to poor kidney graft outcomes. It is, however, extremely difficult to detect during a regular follow-up. This study, therefore, aimed to investigate the risk factors involved in nonadherence, focusing on unexplained transient hyperuricemia in pediatric kidney transplant (KTx) recipients at a single pediatric center. METHODS This retrospective study included 167 patients who underwent KTx at our pediatric center. A Cox proportional hazards analysis was performed to evaluate the risk of nonadherence using the following factors: age, sex, body mass index SD score, transient hyperuricemia, hypertension, and follow-up period. RESULTS Nonadherence was identified in 19 patients (11%), with the average (SD) age and post-KTx duration at diagnosis being 17.21 (4.73) years and 79.21 (38.77) months, respectively. Thirty-four patients (20%) were diagnosed with transient hyperuricemia at a median of 14 months after KTx. On multivariate Cox regression analysis, transient hyperuricemia was the only independent risk factor for nonadherence after KTx. CONCLUSIONS Transient hyperuricemia was identified as one of the risk factors for nonadherence after KTx; therefore, careful monitoring for transient hyperuricemia may allow early detection of nonadherence.
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Affiliation(s)
- Y Morizawa
- Department of Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Urology, Nara Medical University, Kashihara, Nara, Japan.
| | - H Satoh
- Department of Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - M Arai
- Department of Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - S Iwasa
- Department of Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - A Sato
- Department of Urology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - K Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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17
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Miyagishima D, Inoue M, Kinjo K, Fujimoto K, Suzuki H, Sugimura K, Kubota M, Nakagawa A, Kikuchi Y, Shinozaki M, Fujimoto H. Bowel Obstruction due to Shiitake Mushrooms: Diagnostic Features on Computed Tomography. Intern Med 2022; 61:3349-3354. [PMID: 35466167 PMCID: PMC9751717 DOI: 10.2169/internalmedicine.9181-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Shiitake mushrooms are edible mushrooms popular in East Asian cuisine. We herein report a 69-year-old man with abdominal distension and vomiting after ingesting several pieces of sautéed Shiitake mushrooms. Abdominal computed tomography (CT) revealed ring-shaped and crescent-shaped low-density objects (-100 to -300 Hounsfield units) in the ileum. Based on the specific shapes and CT numbers of the foreign bodies, he was diagnosed with small bowel obstruction due to Shiitake mushrooms. After conservative treatment, he passed four pieces of Shiitake mushrooms. Despite the rarity, the condition can be diagnosed before exploratory surgery by careful and detailed interpretation of CT findings.
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Affiliation(s)
- Daisuke Miyagishima
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaori Kinjo
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kentaro Fujimoto
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Hiromasa Suzuki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaoru Sugimura
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Michio Kubota
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Akihiko Nakagawa
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Yasuharu Kikuchi
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masami Shinozaki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Hajime Fujimoto
- Comprehensive Radiology Center, Chiba University Hospital, Japan
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Kajima M, Ono T, Manabe Y, Fujimoto K, Shiinoki T, Tanaka H. Prognostic Role of Systemic Inflammation Response Index for Cervical Cancer Patients Treated with Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee JL, Keam B, Kanesvaran R, Yamamoto Y, Su WP, Chiang PH, Lin CC, Sassa N, Nishimura K, Fujimoto K, Chang PH, Kim M, Fukasawa S, Yokoyama M, Enokida H, Xu J, Homet Moreno B, Imai K, Nishiyama H, Rha S. 136MO Efficacy and safety of pembrolizumab (pembro) monotherapy in East Asian patients (pts) with urothelial carcinoma (UC) in KEYNOTE-045 or KEYNOTE-052. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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20
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Kojima D, Akamatsu Y, Fujimoto K, Oikawa K, Kashimura H, Kubo Y, Ogasawara K. Utility of manual venous compression during transvenous Onyx injection for a scalp arteriovenous fistula: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22317. [PMID: 36317235 PMCID: PMC9624155 DOI: 10.3171/case22317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND When performing transvenous liquid embolization for scalp arteriovenous fistulas, multiple networks of venous drainage could limit effective retrograde penetration of embolic agents into feeding arteries, resulting in incomplete obliteration. A salvage technique to achieve effective Onyx penetration with manual venous compression during transvenous embolization is demonstrated. OBSERVATIONS A 43-year-old man presented with a progressively enlarging mass on his left temporal scalp that was first noticed approximately 20 years earlier. External carotid artery injection showed two scalp arteriovenous fistulas (AVFs). The patient received endovascular embolization. After successful transarterial obliteration of one AVF, transvenous Onyx embolization was performed for another AVF located in the subcutaneous layer. To avoid unnecessary Onyx migration into multiple venous networks, several coils were put in a venous pouch as a scaffold for the Onyx, and feeding arteries were temporarily occluded. Despite these adjunctive techniques, the Onyx migrated into multiple veins and even toward the orbit without complete fistula obliteration. Thereafter, Onyx was injected under manual compression of venous outlets from the pouch, resulting in complete obliteration. LESSONS Manual compression of venous outlets can be used as a salvage procedure during transvenous Onyx embolization for a scalp AVF. A surgeon’s radiation exposure can be reduced by step-by-step adjunctive procedures.
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Affiliation(s)
- Daigo Kojima
- 1Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yosuke Akamatsu
- 1Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and.,2Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Kentaro Fujimoto
- 1Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and.,2Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Kohki Oikawa
- 2Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Hiroshi Kashimura
- 1Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yoshitaka Kubo
- 2Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Kuniaki Ogasawara
- 2Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
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21
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Yanagihara W, Akamatsu Y, Shibanai K, Fujimoto K, Kojima D, Kashimura H, Kubo Y, Ogasawara K. Cerebral protection during retrograde brachiocephalic artery stenting using a single filter and increased subclavian steal phenomenon: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22194. [PMID: 35855349 PMCID: PMC9257397 DOI: 10.3171/case22194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/25/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cerebral protection during brachiocephalic artery (BCA) stenting is important. However, the maneuver is sometimes challenging because both the internal carotid artery (ICA) and vertebral artery (VA) should be protected. Herein, the authors present an alternative cerebral protection technique involving filter protection for the ICA and hemodynamic protection for the VA during retrograde BCA stenting. OBSERVATIONS A 64-year-old man with a thoracic aortic aneurysm presented with cold sensation and numbness in his right arm due to BCA stenosis. Endovascular stenting under cerebral protection was planned. Cerebral protection was attempted through the brachial access. Despite the successful placement of the filter in the ICA, selective catheterization of the VA failed. Furthermore, repeated transfemoral catheterization of the BCA was unsuccessful. Concerning a thoracic aortic aneurysm injury, the authors performed retrograde BCA stenting using a transbrachial approach. Hemodynamic protection of the VA was provided by increasing the subclavian steal phenomenon that resulted in successful recanalization of the BCA. LESSONS Retrograde BCA stenting performed while protecting the ICA with a filter and the right VA by increasing the subclavian steal phenomenon was successful. This simple technique is feasible, especially in patients with steno-occlusive lesions of the BCA concurrent with the dominant vertebra/vertebral collateral pathway.
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Affiliation(s)
- Wataru Yanagihara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Kazuo Shibanai
- Department of Neurosurgery, Kitakami Saiseikai Hospital, Kitakami, Iwate, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Daigo Kojima
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Hiroshi Kashimura
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan; and
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan
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22
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Fujimoto K, Fujii K, Kanamori T, Murai K, Tomura T, Tsutsumi R, Teramoto T, Nonaka Y, Sakaue H, Matsuo Y, Murayama N. Randomized, double-blind, crossover, placebo-controlled clinical trial to evaluate the effects of chicken hot water extract on insulin secretion. Eur Rev Med Pharmacol Sci 2022; 26:2422-2430. [PMID: 35442497 DOI: 10.26355/eurrev_202204_28476] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Essence of chicken (EOC), a hot water extract of chicken, is widely consumed in Southeast Asia as a beverage. EOC has an inhibitory effect on the elevation of blood glucose levels and a secretagogue effect on insulin. However, the mechanism by which EOC promotes insulin secretion is unknown. We aimed to verify the postprandial hyperglycemic inhibitory effect and the insulin secretory effect of EOC in healthy adults under appropriate placebo settings. In addition, we aimed to understand the mechanism underlying the insulin secretory effect of EOC. PATIENTS AND METHODS Thirty-four healthy Japanese adults were fed 68 mL of EOC or control food, followed by 200 g of cooked rice. Blood glucose and plasma insulin levels were measured at 30, 45, 60, 90, and 120 min after the participants ate cooked rice. The trial had a randomized, double-blind, crossover, placebo-controlled design. RESULTS The ingestion of EOC induced an increase in the maximum blood concentration (Cmax) of insulin and shortened the time required to reach the maximum blood concentration following rice consumption. Ingestion of the test beverage resulted in a significantly higher insulinogenic index than that obtained after ingestion of the control beverage. No side effects were observed in this study. Mechanistic experiments revealed that EOC stimulated significant (p < 0.05) secretion of GLP-1 from NCI-H716 human intestinal L cells at 0.1, 1, and 10 mg/mL. CONCLUSIONS Consuming EOC when eating rice supports pancreatic function. Daily consumption of EOC could elevate the early-phase insulin response; therefore, it could prevent diabetes in Asians with low insulin secretion.
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Affiliation(s)
- K Fujimoto
- Research Institute, Suntory Global Innovation Center Limited, Kyoto, Japan.
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Kojima D, Fujimoto K, Kashimura H, Akamatsu Y. Successful Leptomeningeal Enhancement in a Patient with Tandem Occlusion of a Carotid and Middle Cerebral Artery Following Carotid Artery Stenting for Contralateral Carotid Artery Stenosis. J Neuroendovasc Ther 2021; 16:381-386. [PMID: 37502347 PMCID: PMC10370919 DOI: 10.5797/jnet.cr.2021-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/01/2021] [Indexed: 07/29/2023]
Abstract
Objective Although the presence of leptomeningeal anastomosis is known as a predictor of favorable outcome in patients with acute large vessel occlusion, the efficacy of enhancing leptomeningeal collateral flow has rarely been demonstrated. Case Presentation A 73-year-old man previously diagnosed with asymptomatic bilateral carotid stenosis was admitted to our emergency department 2 hours after the onset of fluctuating symptoms, including aphasia, left conjugate deviation, and right hemiparesis. CT demonstrated no hemorrhagic lesion. Considering the history of the patient, emergent angiography was performed and demonstrated tandem occlusion of the left cervical internal carotid artery (ICA) with left common carotid injection, leptomeningeal flow compensating for distal territory of occluded segment of left middle cerebral artery (MCA) via the left anterior cerebral artery through severe cervical ICA stenosis with right common carotid injection, and the proximal segment of the left MCA through the posterior communicating artery and occlusion of the M2 segment with left vertebral injection. Given the results of angiography and fluctuating symptoms, hemodynamic insufficiency was considered the underlying stroke mechanism for this case. Although recanalization of tandem lesions was initially considered, the risk of distal clot migration was a concern, so the patient underwent right carotid artery stenting (CAS) to enhance leptomeningeal collateral flow. This resulted in immediate resolution of symptoms after right CAS. Conclusion Stenting for carotid artery stenosis contralateral to tandem occlusive lesion may offer an effective alternative when both Willisian and leptomeningeal collaterals are robust.
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Affiliation(s)
- Daigo Kojima
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Hiroshi Kashimura
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
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Tanaka H, Ono T, Takano H, Manabe Y, Kajima M, Fujimoto K, Yuasa Y, Shiinoki T, Yamaji Y, Matsunaga K, Matsuo M. Monocyte-to-Lymphocyte Ratio is a Significant Prognostic Factor for Patients With Non-Small Cell Lung Cancer Who Treated By Stereotactic Body Radiation Therapy: A Multi Institutional Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Terashima T, Higashibeppu Y, Yamashita T, Sakata Y, Azuma M, Fujimoto K, Munakata H, Ishii M, Kaneko S. 954P Comparison of medical costs and outcome between hepatectomy and radiofrequency ablation for hepatocellular carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Makarov SN, Wartman WA, Noetscher GM, Fujimoto K, Zaidi T, Burnham EH, Daneshzand M, Nummenmaa A. Degree of improving TMS focality through a geometrically stable solution of an inverse TMS problem. Neuroimage 2021; 241:118437. [PMID: 34332043 PMCID: PMC8561647 DOI: 10.1016/j.neuroimage.2021.118437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 10/31/2022] Open
Abstract
The Transcranial Magnetic Stimulation (TMS) inverse problem (TMS-IP) investigated in this study aims to focus the TMS induced electric field close to a specified target point defined on the gray matter interface in the M1HAND area while otherwise minimizing it. The goal of the study is to numerically evaluate the degree of improvement of the TMS-IP solutions relative to the well-known sulcus-aligned mapping (a projection approach with the 90∘ local sulcal angle). In total, 1536 individual TMS-IP solutions have been analyzed for multiple target points and multiple subjects using the boundary element fast multipole method (BEM-FMM) as the forward solver. Our results show that the optimal TMS inverse-problem solutions improve the focality - reduce the size of the field "hot spot" and its deviation from the target - by approximately 21-33% on average for all considered subjects, all observation points, two distinct coil types, two segmentation types, two intracortical observation surfaces under study, and three tested values of the field threshold. The inverse-problem solutions with the maximized focality simultaneously improve the TMS mapping resolution (differentiation between neighbor targets separated by approximately 10 mm) although this improvement is quite modest. Coil position/orientation and conductivity uncertainties have been included into consideration as the corresponding de-focalization factors. The present results will change when the levels of uncertainties change. Our results also indicate that the accuracy of the head segmentation critically influences the expected TMS-IP performance.
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Affiliation(s)
- S N Makarov
- Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115 USA.
| | - W A Wartman
- Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - G M Noetscher
- Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - K Fujimoto
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD 20993 USA
| | - T Zaidi
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD 20993 USA
| | - E H Burnham
- Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - M Daneshzand
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - A Nummenmaa
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115 USA
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27
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Kaga T, Noda Y, Fujimoto K, Suto T, Kawai N, Miyoshi T, Hyodo F, Matsuo M. Deep-learning-based image reconstruction in dynamic contrast-enhanced abdominal CT: image quality and lesion detection among reconstruction strength levels. Clin Radiol 2021; 76:710.e15-710.e24. [PMID: 33879322 DOI: 10.1016/j.crad.2021.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the use of deep-learning-based image reconstruction (DLIR) algorithms in dynamic contrast-enhanced computed tomography (CT) of the abdomen, and to compare the image quality and lesion conspicuity among the reconstruction strength levels. MATERIALS AND METHODS This prospective study included 59 patients with 373 hepatic lesions who underwent dynamic contrast-enhanced CT of the abdomen. All images were reconstructed using four reconstruction algorithms, including 40% adaptive statistical iterative reconstruction-Veo (ASiR-V) and DLIR at low, medium, and high-strength levels (DLIR-L, DLIR-M, and DLIR-H, respectively). The signal-to-noise ratio (SNR) of the abdominal aorta, portal vein, liver, pancreas, and spleen and the lesion-to-liver contrast-to-noise ratio (CNR) were calculated and compared among the four reconstruction algorithms. The diagnostic acceptability was qualitatively assessed and compared among the four reconstruction algorithms and the conspicuity of hepatic lesions was compared between <5 and ≥5 mm lesions. RESULTS The SNR of each anatomical structure (p<0.0001) and CNR (p<0.0001) were significantly higher in DLIR-H than the other reconstruction algorithms. Diagnostic acceptability was significantly better in DLIR-M than the other reconstruction algorithms (p<0.0001). The conspicuity of hepatic lesions was highest when using 40% ASiR-V and tended to lessen as the reconstruction strength level was getting higher in DLIR, especially in <5 mm lesions; however, all hepatic lesions could be detected. CONCLUSIONS DLIR improved the SNR, CNR, and image quality compared with 40% ASiR-V, while making it possible to decrease lesion conspicuity using higher reconstruction strength.
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Affiliation(s)
- T Kaga
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Y Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - K Fujimoto
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - T Suto
- Department of Radiology, Gifu Municipal Hospital, Gifu, Japan
| | - N Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - T Miyoshi
- Department of Radiology Services, Gifu University Hospital, Gifu, Japan
| | - F Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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Suzuki T, Akamatsu Y, Fujimoto K, Yoshida J. Occlusion of ruptured dissecting distal anterior inferior cerebellar artery aneurysm following pharmacological blood pressure control: A case report. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100876] [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
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29
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Tanaka N, Nakai Y, Asakawa I, Miyake M, Anai S, Hasegawa M, Fujimoto K. The oncologic outcomes of low-dose-rate brachytherapy for prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33523-0] [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: 10/23/2022] Open
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30
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Miyake M, Marugami N, Hori S, Nishimura N, Owari T, Itami Y, Nakai Y, Tanaka N, Fujimoto K. Dynamic contrast-enhanced magnetic resonance imaging can improve diagnostic accuracy of detecting bladder carcinoma in situ in combination with photodynamic diagnosis? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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31
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Miyake M, Marugami N, Fujiwara Y, Komura K, Inamoto T, Azuma H, Matsumoto H, Matsuyama H, Nishimura N, Hori S, Owari T, Itami Y, Nakai Y, Fujimoto K. Down-grading of ipsilateral hydronephrosis by neoadjuvant chemotherapy is associated with better oncological outcomes after radical nephroureterectomy in patients with ureteral cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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32
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Fujimoto K, Uwano I, Sasaki M, Oshida S, Tsutsui S, Yanagihara W, Fujiwara S, Kobayashi M, Kubo Y, Yoshida K, Terasaki K, Ogasawara K. Acetazolamide-Loaded Dynamic 7T MR Quantitative Susceptibility Mapping in Major Cerebral Artery Steno-Occlusive Disease: Comparison with PET. AJNR Am J Neuroradiol 2020; 41:785-791. [PMID: 32299799 DOI: 10.3174/ajnr.a6508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dynamic changes in cerebrovascular reactivity after acetazolamide administration vary markedly among patients with major cerebral arterial steno-occlusive disease. MR quantitative susceptibility mapping can dynamically quantify the cerebral magnetic susceptibility. The purpose of this study was to determine whether dynamic changes in susceptibility after administration of acetazolamide on 7T quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in the cerebral hemispheres with major cerebral arterial steno-occlusive disease. MATERIALS AND METHODS Sixty-five patients underwent 7T MR imaging at baseline and at 5, 10, 15, and 20 minutes after acetazolamide administration. Differences between the susceptibility of venous structures and surrounding brain tissue were calculated in the quantitative susceptibility mapping images. Susceptibility differences at 5, 10, 15, and 20 minutes after acetazolamide administration relative to baseline were calculated in 97 cerebral hemispheres with major cerebral arterial steno-occlusive disease. CBV and the cerebral metabolic rate of oxygen were also calculated using 15O-gas PET in the resting state. RESULTS Dynamic changes of susceptibility after acetazolamide administration were classified into 3 patterns: abnormally increasing 5 or 10 minutes after acetazolamide administration; abnormally decreasing within 20 minutes after acetazolamide administration; and remaining unchanged after acetazolamide administration. CBV was significantly greater in the first pattern than in the latter 2. The cerebral metabolic rate of oxygen differed significantly in descending order from the first to middle to last pattern. CONCLUSIONS Dynamic changes of susceptibility after acetazolamide administration on 7T MR quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in major cerebral arterial steno-occlusive disease.
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Affiliation(s)
- K Fujimoto
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - I Uwano
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., M.S.)
| | - M Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (I.U., M.S.)
| | - S Oshida
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - S Tsutsui
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - W Yanagihara
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - S Fujiwara
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - M Kobayashi
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - Y Kubo
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - K Yoshida
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.)
| | - K Terasaki
- Cyclotron Research Center (K.T.), Iwate Medical University School of Medicine, Morioka, Japan
| | - K Ogasawara
- From the Department of Neurosurgery (K.F., S.O., S.T., W.Y., S.F., M.K., Y.K., K.Y., K.O.),
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Fukui Y, Yamamoto K, Yamamoto T, Fujimoto K. Tuning of particle indentation by surface modification of polymer particles and substrates. Colloids Surf A Physicochem Eng Asp 2020. [DOI: 10.1016/j.colsurfa.2019.124380] [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: 10/25/2022]
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34
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Sato R, Sakamoto K, Yamashita T, Nagamatsu S, Motozato K, Sueta D, Oshima S, Nakako K, Fujimoto K, Shimomura H, Tsunoda R, Hokimoto S, Kaikita K, Tsujita K. 3285Impact of intravascular ultrasound-guided percutaneous coronary intervention in patients with diabetes mellitus and chronic kidney disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several studies have shown favorable results using IVUS-guided PCI. Nevertheless, patient background in which use of IVUS is effective is not well elucidated. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) tend to have complex coronary artery lesions. We sought to assess the impact of IVUS guidance on clinical outcomes in these patients.
Methods
Kumamoto Intervention Conference Study is a multicenter registry which has enrolled consecutive patients who underwent PCI in 16 centers in Japan. Between August 2008 and March 2014, 11,195 consecutive patients were enrolled in this registry. To elucidate the efficacy of IVUS usage in DM and CKD patients, 10,822 consecutive subjects with 1-year follow-up data were analyzed. In this patient population, 69.2% (n=7,493) of patients were treated with IVUS-guided PCI. Patients were divided into 4 groups: the No Risk Group, the DM only Group, the CKD only Group, and the DM+CKD Group.
Results
Maximum stent diameter, post dilatation rate, usage of distal protection device, and rotational atherectomy rate were significantly higher in the IVUS-guided PCI patients in all 4 groups. 1-year MACE (cardiovascular death, non-fatal myocardial infarction, and MI with stent thrombosis) was significantly lower in the IVUS-guided PCI patients than angiography-guided PCI patients in each subset, except for the No Risk Group. In contrast to angiography-guided PCI patients, there were no significant differences among the 4 groups as regards 1-year MACE in the IVUS-guided PCI patients except for the DM+CKD Group. In multiple regression analysis, IVUS usage was an independent negative predictor for 1-year MACE in the DM only Group (HR=0.374, 95% CI 0.194–0.719, p=0.003) and in the CKD only Group (HR=0.604, 95% CI 0.379–0.962, p=0.010). When the No Risk Group was used as a reference, the HR has increased according to increased risk factors in the angiography-guided PCI patients, but such tendency was not necessarily observed in the IVUS-guided PCI patients (Table).
Risk Stratification of DM and CKD Variable IVUS-Guided PCI Angiography-Guided PCI HR 95% CI P HR 95% CI P The No Risk Group Reference – – Reference – – vs. the DM only Group 0.627 0.321–1.227 0.173 2.036 1.090–3.804 0.026 vs. the CKD only Group 1.334 0.795–2.237 0.275 2.730 1.541–4.836 0.001 vs. the DM+CKD Group 2.114 1.287–3.474 0.014 2.225 1.160–4.266 0.016
Conclusion
The efficacy of IVUS usage as regards 1-year MACE was confirmed in DM and CKD patients, but not observed in patients without them or in the combination of DM and CKD patients.
Acknowledgement/Funding
None
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Affiliation(s)
- R Sato
- Kumamoto University, Kumamoto, Japan
| | | | | | | | | | - D Sueta
- Kumamoto University, Kumamoto, Japan
| | - S Oshima
- Kumamoto Central Hospital, Department of Cardiology, Kumamoto, Japan
| | - K Nakako
- Saiseikai Kumamoto Hospital, Department of Cardiology, Kumamoto, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Department of Cardiology, Kumamoto, Japan
| | - H Shimomura
- Tokusyukai Hospital, Department of Cardiology, Fukuoka, Japan
| | - R Tsunoda
- Kumamoto Red Cross Hospital, Department of cardiology, Kumamoto, Japan
| | | | - K Kaikita
- Kumamoto University, Kumamoto, Japan
| | - K Tsujita
- Kumamoto University, Kumamoto, Japan
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35
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Motozato K, Sakamoto K, Nakao K, Fujimoto K, Miyao Y, Shimomura H, Tsunoda R, Sato R, Nagamatsu S, Yamashita T, Kaikita K, Tsujita K. P5480Impact of Silent Myocardial Ischemia on One Year Mortality after Successful Coronary Intervention: Data from Japanese Multicenter (KICS) Registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Under the awareness of appropriate use criteria, the significance of PCI for the patients with silent myocardial ischemia (SMI) decreases. On the other hand, the prognoses of SMI patients have been reported to be equivalent to those of symptomatic effort angina pectoris (EAP) patients. We aimed to clarify the prognosis of SMI after PCI and elucidate the factors influencing the mortality.
Methods
The Kumamoto Intervention Conference Study is multicenter registry enrolling consecutive patients undergoing PCI in 16 centers in Japan. Overall, 17,688 consecutive patients were enrolled during April 2008 to March 2017. To compare the clinical events between SMI and EAP, 8,278 subjects, excluding acute coronary syndrome, post successful PCI were enrolled with 1-year follow-up data.
Results
In this study, 2,071 patients were classified as SMI and 6,207 patients were EAP. Male, lower body mass index (BMI), diabetes, chronic kidney disease (CKD), smoking habits, prior myocardial infarction (MI), composite of cerebrovascular disease and composite of peripheral arterial disease were all significantly higher in the SMI group. Although nonfatal MI and stent thrombosisduring 12-monthswere comparable between the 2 groups, all-cause mortality and cardiac death during 12-months were significantly higher in the SMI group than in the EAP group (3.9% vs 1.8%, p<0.001, 1.4% vs 0.5%, p<0.001, respectively). On the other hand, Repeat Revascularization rate during 12-months was significantly lower in the SMI group than in the EAP group (15.7% vs 19.5%, p<0.001).Kaplan-Meier analysis for cardiac death showed a significant difference between the 2 groups (Figure). In a multiple logistic regression analysis, in addition to lower BMI and CKD, SMI was an independent predictor for cardiac death. Even after adjustment by propensity-score matching with predictive factors for cardiac event, SMI showed a higher cardiac death rate compared with EAP (1.4% vs 0.5%, p=0.004), and it remained as a significant predictor.
Conclusion
In this study, SMI itself was associated with higher mortality after PCI. Strict follow-up and assessment of residual ischemia should be necessary for SMI patients.
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Affiliation(s)
- K Motozato
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Sakamoto
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | - Y Miyao
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | | | - R Tsunoda
- Kumamoto Red Cross Hospital, Kumamoto, Japan
| | - R Sato
- Kumamoto University Hospital, Kumamoto, Japan
| | - S Nagamatsu
- Kumamoto University Hospital, Kumamoto, Japan
| | - T Yamashita
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Kaikita
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Tsujita
- Kumamoto University Hospital, Kumamoto, Japan
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36
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Soeda T, Ishihara M, Fujino F, Ogawa H, Nakao K, Yasuda S, Noguchi T, Ozaki Y, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Hirohata A, Saito Y. P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated.
Objective
To study the characteristics and prognosis in octogenarians who presented cTn positive AMI.
Methods and results
The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure).
Conclusions
J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn.
Acknowledgement/Funding
None
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Affiliation(s)
- T Soeda
- Nara Medical University, Cardiovascular medicine, Kashihara, Japan
| | - M Ishihara
- Hyogo College of Medicine, Division of Coronary Artery Disease, Nishinomiya, Japan
| | - F Fujino
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Ozaki
- Fujita Health University, Cardiology, Toyoake, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | - Y Nakama
- Hiroshima City Hospital, Hiroshima, Japan
| | - T Morita
- Osaka General Medical Center, Osaka, Japan
| | | | - A Hirohata
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Y Saito
- Nara Medical University, Cardiovascular medicine, Kashihara, Japan
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Yamashita T, Sakamoto K, Tsujita K, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Okura H, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. P3392Potential of imaging-guided PCI for event suppression in Japanese acute myocardial infarction patients: J-MINUET substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) has been widely used in clinical settings. Although favorable results of imaging-guided percutaneous coronary intervention (PCI) compared with angio-guided PCI were observed in several studies, impacts of institutional-based usage frequency, about imaging-guided PCI, have not been well elucidated.
Methods
To elucidate the impact of imaging-guided PCI and the effects of frequency of its usage, we analyzed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48 hours of onset from July 2012 to March 2014. Clinical follow-up data was obtained for 3 years. In this sub-study, a total of 2,788 patients who underwent urgent PCI having detailed procedural information were enrolled. We analyzed the differences of utilization rates of imaging-guided PCI among the participating institutions and the impacts for the clinical events. The participating institutions were divided into 3 groups by the frequency of IVUS usage: low frequency institutions: under 50%; moderate frequency institutions: 50% to 90%; and, high frequency institutions: over 90%.
Results
In this cohort registry, patients were enrolled from 28 institutions. The utilization rate of coronary imaging varied widely depending on each institution from 15.4% to 100% (mean 85.7%±24.3, median 97.4%). When the institutions were divided into 3 groups by the frequency of intravascular imaging usage, four low frequency institutions enrolled 295 patients, five moderate frequency institutions enrolled 624 patients, and 19 high frequency institutions enrolled 1,491 patients. Although the incidence of MACE (death, MI, stroke, cardiac failure, or revascularization for unstable angina) decreased stepwise (33.2%, 23.7%, and 19.7%) (gray bar in the Figure), the event rates of the imaging-guided PCI cases among the 3 groups were comparable (21.6%, 21.9%, and 19.6%) (white bar in the Figure). On the other hand, a gradual event reduction between the 3 groups was observed in the angio-guided PCI cases (black bar in the Figure). In comparison of MACE rate between imaging-guided and angio-guided PCI, there were statistically significant differences in the low frequency and moderate frequency institutions (p=0.001 and p=0.012, respectively). In contrast, comparable event rates were observed in the high frequency institutions (p=0.441).
MACE rate by imaging usage frequency
Conclusions
In Japanese ACS patients treated with imaging-guided PCI, better suppression of clinical events during 3-year was found in the institutions with the more frequent use of intravascular imaging, mainly due to stepwise event suppression in the cases of angio-guided PCI. On the other hand, the clinical benefit of coronary imaging was obtained independently of the frequency of use and its experience.
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Affiliation(s)
- T Yamashita
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Sakamoto
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Tsujita
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Ozaki
- Fujita Health University, Toyoake, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - J Ako
- Kitasato University, tokyo, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - S Suwa
- Juntendo University, Tokyo, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | - H Okura
- Gifu Universiry, Gifu, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
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Sakama M, Fujimoto K, Inoue K, Fukushi M, Imajyo Y, Fukuhara T, Matsuura M, Yajima T, Endo M, Fujisawa M, Matsumoto-Kawaguchi E. FEASIBILITY STUDY ON THE FUSION OF PHITS SIMULATIONS AND THE DLNN ALGORITHM FOR A NEW QUANTITATIVE METHOD OF IN-SITU MULTIPLE-CHANNEL DEPTH DISTRIBUTION SPECTROMETRY. Radiat Prot Dosimetry 2019; 184:328-333. [PMID: 31038704 DOI: 10.1093/rpd/ncz093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We have recently have developed an in-situ multiple-channel depth distribution spectrometer (DDS) that can easily acquire on-site measurements of the depth distribution of specific radioactivities of Cs-134 and Cs-137 underground. Despite considerable improvements in the hardware developed for this device, the quantitative method for determining of radioactivities with this DDS device cannot yet achieve satisfactory performance for practical use. For example, this method cannot discriminate each γ-ray spectra of Cs-134 and Cs-137 acquired by the 20 thallium-doped caesium iodine CsI(Tl) scintillation crystal detectors of the DDS device from corresponding depth levels of underground soil. Therefore, we have applied deep learning neural network (DLNN) as a novel radiation measurement technique to discriminate the spectra and to determine the specific radioactivities of Cs-134 and Cs-137. We have developed model soil layers on a virtual space in Monte-Carlo based PHITS simulations and transported γ-ray radiation generated from a particular single soil layer or multiple layers as radiation sources; next, we performed PHITS calculations of those specific radioactivity measurements for each soil layer using DDS device based on machine learning via the DLNN algorithm. In this study, we obtained informative results regarding the feasibility of the proposal innovative radiation measurement method for further practical use in on-site applications.
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Affiliation(s)
- M Sakama
- Department of Radiation Science and Technology, Division of Radiological Sciences, Institute of Biomedical Sciences, Tokushima University, Kuramoto-cho Tokushima, Japan
| | - K Fujimoto
- Faculty of Engineering and Design, Kagawa University, Hayashi-cho 2217-20, Takamatsu City, Kagawa, Japan
| | - K Inoue
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashi-Ogu 7-2-10, Arakawa City, Tokyo, Japan
| | - M Fukushi
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashi-Ogu 7-2-10, Arakawa City, Tokyo, Japan
| | - Y Imajyo
- Advanced Fusion Technology (AFT), Co., Ltd., Sotokanda 5-6-3, Chiyoda-ku, Tokyo, Japan
| | - T Fukuhara
- Advanced Fusion Technology (AFT), Co., Ltd., Sotokanda 5-6-3, Chiyoda-ku, Tokyo, Japan
| | - M Matsuura
- CLEAR-PULSE, Co., Ltd., Chuo 6-25-17, Ota-ku, Tokyo, Japan
| | - T Yajima
- Advanced Fusion Technology (AFT), Co., Ltd., Sotokanda 5-6-3, Chiyoda-ku, Tokyo, Japan
| | - M Endo
- Advanced Fusion Technology (AFT), Co., Ltd., Sotokanda 5-6-3, Chiyoda-ku, Tokyo, Japan
| | - M Fujisawa
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Higashi-Ogu 7-2-10, Arakawa City, Tokyo, Japan
| | - E Matsumoto-Kawaguchi
- Department of Radiation Science and Technology, Division of Radiological Sciences, Institute of Biomedical Sciences, Tokushima University, Kuramoto-cho Tokushima, Japan
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Motozato K, Sakamoto K, Tsujita K, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. P1954Prognostic value of the CHADS2 score for adverse cardiovascular events in acute myocardial infarction patients without atrial fibrillation: J-MINUET Substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The CHADS2score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS2 score in predicting cardiovascular events in Japanese acute myocardial infarction (AMI) patients without atrial fibrillation.
Methods
To elucidate the prognostic value of CHADS2score in AMI patients, we analysed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48-hours of onset from July 2012 to March 2014. We calculated the CHADS2 scores for 3,044 patients without clinical evidence of atrial fibrillation. The presence of heart failure was substituted by Killip classification>2 on admission. Clinical follow-up data was obtained for 3 years. In addition to the in-hospital mortality,we evaluated cardiovascular events, defined as all cause deathor non-fatal MI during 3-year follow up periods.
Results
In this study, enrolled patients were classified into low- (point 0–1), intermediate- (point 2–3), and high-score (point 4–6) groups by calculating CHADS2 score. Overall patients with low, intermediate and high score were divided into 1,395, 1,393 and 256 patients, respectively. In-hospital mortality among low, intermediate, and high score groups were 2.8%, 7.4% and 14.8%, respectively (P<0.001). The incidence of cardiovascular eventsamong low, intermediate, and high score groups were 7.8%, 16.3%, 29.3%, respectively (P<0.001). Kaplan-Meier analysis showed a significant difference between the groups (Figure). The event rates were significantly higher in both high score and intermediate score group than in low score group (P<0.001). Multivariate Cox hazard analysis identified CHADS2 score (per 1 point) as an independent predictor of cardiovascular events in addition to chronic kidney disease and lower body mass index. (hazard ratio, 1.344; 95% CI, 1.239–1.459; P<0.001). Among the factors constituting CHADS2 score, heart failure and age were identified as independent predictors for in-hospital mortality. With respect to the cardiovascular event during 3 years, heart failure, age, and previous stroke were revealed as significant independent predictors.
Conclusion
This large cohort study indicated that the CHADS2 score is useful for the prediction of in-hospital mortality and the cardiovascular events during 3-year follow up in Japanese AMI patients without atrial fibrillation.
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Affiliation(s)
- K Motozato
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Sakamoto
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Tsujita
- Kumamoto University Hospital, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Y Ozaki
- Fujita Health University Hospital, Toyoake, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - J Ako
- Kitasato University, Sagamihara, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Kumamoto, Japan
| | - Y Nakama
- Hiroshima City Hospital, Hiroshima, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
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Hashimoto T, Ako J, Nakao K, Ozaki Y, Kimura K, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Ogawa H, Ishihara M. P3406Validation of atherothrombotic risk score for secondary prevention in patients with acute myocardial infarction: the J-MINUET study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score are contemporary secondary prevention risk scoring systems. However, these scoring systems have not been validated in other populations.
Purpose
The aim of this study was to validate of the TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score in patients in the early phase of acute myocardial infarction (AMI).
Methods
The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective multicenter registry conducted in 28 Japanese medical institutions. We enrolled 3,283 consecutive patients with AMI who were admitted to participating institutions within 48 hours of symptom onset between July 2012 and May 2014. Among them, 3,070 patients were included in this study after excluding 213 patients who died in the hospital. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI and non-fatal stroke. The patients were stratified by the TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score.
Results
At the 3-year follow-up, the primary endpoint had occurred in 337 patients (11.0%). All-cause death, non-fatal MI and non-fatal stroke had occurred in 177 (5.8%), 80 (2.6%) and 80 (2.6%) patients, respectively. TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score showed a graded association with the composite of all-cause death, non-fatal MI and non-fatal stroke at 3 years in the J-MINUET population (Figure).
Validation of atherothrombotic risk
Conclusions
TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score were shown to be applicable to the patients in the early phase of AMI.
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Affiliation(s)
- T Hashimoto
- Kitasato University School of Medicine, Department of Cardiovascular medicine, Sagamihara, Japan
| | - J Ako
- Kitasato University School of Medicine, Department of Cardiovascular medicine, Sagamihara, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital Cardiovascular Center, Division of Cardiology, Kumamoto, Japan
| | - Y Ozaki
- Fujita Health University, Department of Cardiology, Toyoake, Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiovascular Center, Yokohama, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Department of Cardiology, Izunokuni, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Department of Cardiology, Kumamoto, Japan
| | - Y Nakama
- Hiroshima City Hiroshima Citizens Hospital, Department of Cardiology, Hiroshima, Japan
| | - T Morita
- Osaka General Medical Center, Division of Cardiology, Osaka, Japan
| | - W Shimizu
- Nippon Medical School, Department of Cardiovascular Medicine, Tokyo, Japan
| | - Y Saito
- Nara Medical University, Department of Cardiovascular Medicine, Kashihara, Japan
| | - A Hirohata
- The Sakakibara Heart Institute of Okayama, Department of Cardiovascular Medicine, Okayama, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - M Ishihara
- Hyogo College of Medicine, Division of Cardiovascular Medicine, Hyogo, Japan
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Kanda K, Fujimoto K, Mochizuki R, Ishida K, Lee B. Development and validation of the comprehensive assessment scale for chemotherapy-induced peripheral neuropathy in survivors of cancer. BMC Cancer 2019; 19:904. [PMID: 31506070 PMCID: PMC6734590 DOI: 10.1186/s12885-019-6113-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background Appropriate assessment is essential for the management of chemotherapy-induced peripheral neuropathy (CIPN), an intractable symptom that cannot yet be palliated, which is high on the list of causes of distress for cancer patients. However, objective assessment by medical staff makes it easy to underestimate the symptoms and effects of CIPN in cancer survivors. As a result, divergence from subjective evaluation of cancer survivors is a significant problem. Therefore, there is an urgent need to develop a subjective scale with high accuracy and applicability that reflects the experiences of cancer patients. We developed a comprehensive assessment scale for CIPN in cancer survivors, named the Comprehensive Assessment Scale for Chemotherapy-Induced Peripheral Neuropathy in Survivors of Cancer (CAS-CIPN), and demonstrated its reliability and validity. Methods We developed a questionnaire based on qualitative studies of peripheral neuropathy in Japanese cancer patients and literature review. Twelve cancer experts confirmed the content validity of the questionnaire. A draft version comprising 40 items was finalized by a pilot test on 100 subjects. The participants in the present study were 327 Japanese cancer survivors. Construct validity was determined by factor analysis, and internal validity by confirmation factor analysis and Cronbach’s α. Results Factor analysis showed that the structure consisted of 15 items in four dimensions: “Threatened interference in daily life by negative feelings”, “Impaired hand fine motor skills”, “Confidence in choice of treatment/management,” and “Dysesthesia of the palms and soles.” The CAS-CIPN internal consistency reliability was 0.826, and the reliability coefficient calculated using the Spearman-Brown formula [q = 2r/(1 + r)] was 0.713, confirming high internal consistency and stability. Scores on this scale were strongly correlated with Gynecologic Oncology Group-Neurotoxicity scores (r = 0.714, p < 0.01), confirming its criterion-related validity. Conclusions The CAS-CIPN is an assessment tool with high reliability and validity for the comprehensive evaluation of CIPN in cancer survivors. The CAS-CIPN is simple to use, and can be used by medical professionals for appropriate situational assessment and intervention.
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Affiliation(s)
- K Kanda
- Department of Nursing, Takasaki University of Health and Welfare, 501 Nakaoruimachi, Takasakishi, Gunma, 370-0033, Japan.
| | - K Fujimoto
- Department of Nursing, Takasaki University of Health and Welfare, 501 Nakaoruimachi, Takasakishi, Gunma, 370-0033, Japan
| | - R Mochizuki
- The Jikei University School of Medicine, School of Nursing, 8-3-1, Kokuryocho, Chofu, Tokyo, 182-8570, Japan
| | - K Ishida
- Niigata College of Nursing, 240 Shinnancho, Joetsu, Nigata, 943-0147, Japan
| | - B Lee
- Department of Occupation, Gunma University Graduate School of Health Sciences, 3-39-22, Showamachi, Maebashi, Gunma, 371-8514, Japan
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Fujimoto K, Kubo Y, Koji T, Yoshida J, Yoshida K, Ishigaki D, Sasou M, Yoshida Y, Ogasawara K. [A Case of Ipsilateral Superficial Temporal Artery-Interposed Graft Using Contralateral Superficial Temporal Artery-Ipsilateral Middle Cerebral Artery Bypass and Trapping for a Traumatic Middle Cerebral Artery Aneurysm Formed after Repeated Craniotomies]. No Shinkei Geka 2019; 47:683-687. [PMID: 31235672 DOI: 10.11477/mf.1436204004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ohwada G, Minakuchi S, Sato Y, Kondo H, Nomura T, Tsuboi A, Hong G, Itoh Y, Kawai Y, Kimoto S, Gunji A, Suzuki A, Suzuki T, Kimoto K, Hoshi N, Saita M, Yoneyama Y, Sato Y, Morokuma M, Okazaki J, Maeda T, Nakai K, Ichikawa T, Nagao K, Fujimoto K, Murata H, Kurogi T, Yoshida K, Nishimura M, Nishi Y, Murakami M, Hosoi T, Hamada T. Subjective Evaluation of Denture Adhesives: A Multicenter Randomized Controlled Trial. JDR Clin Trans Res 2019; 5:50-61. [PMID: 30975019 DOI: 10.1177/2380084419837607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Many reports show that denture adhesives improve the retention and stability of dentures. However, few randomized controlled trials have examined the effects of denture adhesives. OBJECTIVE This 10-center randomized controlled trial with parallel groups involving 200 edentulous patients wearing complete dentures aimed to evaluate the effects of short-term use of cream and powder denture adhesives. METHODS Patients were allocated into 2 cream- and powder-type adhesive groups and 1 control group. Intervention groups were treated with the 2 adhesives (1 each), and the control group received saline solution. Adhesive or control was applied to the denture-mucosal surface for 4 d, and data at baseline and after day 4 of intervention (i.e., 8 meals) were obtained. Patient satisfaction was evaluated with a 100-mm visual analog scale. Oral health-related quality of life was measured with the Japanese version of the Oral Health Impact Profile for Edentulous Patients. Perceived chewing ability was evaluated by a questionnaire regarding ease of chewing and swallowing food. Between-group comparisons were performed with Kruskal-Wallis tests with the Mann-Whitney U test adjusted by Bonferroni correction. Within-group comparisons of pre- and postintervention measurements were performed with the Wilcoxon signed-rank test. Intention-to-treat analysis was also performed. RESULTS Between-group comparisons showed no significant differences for general satisfaction or Oral Health Impact Profile for Edentulous Patients. However, significant differences in satisfaction with various denture functions with cream- and powder-type adhesives were seen in pre- and postintervention comparisons (P < 0.05). Significant differences were also observed for perceived chewing ability of hard foods (P < 0.05). CONCLUSION These results suggest that although denture adhesives do not invariably improve denture function, they do affect subjective evaluations and possibly chewing of hard foods. Therefore, the effects of denture adhesive use are insufficient to resolve any fundamental dissatisfaction with dentures ( ClinicalTrials.gov NCT01712802 ). KNOWLEDGE TRANSFER STATEMENT The results of this study suggest that denture adhesives should be applied under certain conditions; however, an appropriate diagnosis is important before application. These practice-based data provide information to establish evidence-based guidelines for applying denture adhesives.
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Affiliation(s)
- G Ohwada
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Minakuchi
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Sato
- The Japan Denture Care Society.,Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Kondo
- The Japan Denture Care Society.,Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - T Nomura
- The Japan Denture Care Society.,Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - A Tsuboi
- The Japan Denture Care Society.,Division of Community Oral Health Science, Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - G Hong
- The Japan Denture Care Society.,Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Y Itoh
- The Japan Denture Care Society.,Division of Aging and Geriatric Dentistry, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Y Kawai
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - S Kimoto
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - A Gunji
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dentistry, Nihon University, Matsudo, Japan
| | - A Suzuki
- The Japan Denture Care Society.,Department of Removable Prosthodontics, Graduate School of Dentistry, Nihon University, Matsudo, Japan
| | - T Suzuki
- The Japan Denture Care Society.,Section of Oral Prosthetic Engineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kimoto
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - N Hoshi
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - M Saita
- The Japan Denture Care Society.,Division of Prosthodontics and Oral Rehabilitation, Department of Oral Function and Restoration, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Y Yoneyama
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - Y Sato
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - M Morokuma
- The Japan Denture Care Society.,Department of Removable Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - J Okazaki
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - T Maeda
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - K Nakai
- The Japan Denture Care Society.,Department of Removable Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - T Ichikawa
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - K Nagao
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - K Fujimoto
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Graduate School of Biomedical Sciences, Tokushima University, Tokushima City, Japan
| | - H Murata
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - T Kurogi
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - K Yoshida
- The Japan Denture Care Society.,Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Japan
| | - M Nishimura
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutic, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
| | - Y Nishi
- The Japan Denture Care Society.,Department of Oral and Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Course for Advanced Therapeutic, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Japan
| | - M Murakami
- The Japan Denture Care Society.,Denture Prosthodontic Restoration, Advanced Dentistry Center, Kagoshima University Medical and Dental Hospital, Kagoshima City, Japan
| | - T Hosoi
- The Japan Denture Care Society.,School of Dental Medicine, Tsurumi University, Yokohama, Japan
| | - T Hamada
- The Japan Denture Care Society.,Hiroshima University, Hiroshima City, Japan
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Shiinoki T, Yuasa Y, Fujimoto K. PO-0921 Assessment of CT-based imaging biomarker of COPD in IGRT planning for lung cancer patient. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nakao KK, Kido A, Imai T, Abiko K, Fujimoto K, Horie A, Minamiguchi S, Tanaka S, Mandai M, Togashi K. Frequency and risk factors of thoracic metastases and optimisation of the use of cross-sectional chest imaging in follow-up patients with cervical cancer. Clin Radiol 2019; 74:326.e1-326.e8. [PMID: 30771995 DOI: 10.1016/j.crad.2018.11.014] [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: 08/16/2018] [Accepted: 11/16/2018] [Indexed: 11/28/2022]
Abstract
AIM To optimise cross-sectional chest imaging usage by identifying frequency and risk factors associated with thoracic metastases in cervical cancer patients after initial definitive treatment. MATERIALS AND METHODS This study, conducted during 2004-2015, examined 361 consecutive patients with histopathologically proven cervical carcinoma with at least 1 year of follow-up. Electronic medical records and all available imaging modes were used to record and assess patient and tumour characteristics and timing of thoracic metastases. Associations with these characteristics and thoracic metastases were assessed using univariate and multivariable Cox proportional hazards modelling. RESULTS Of the 361 patients, 31 developed thoracic metastases. Multivariate regression results showed that adeno/adenosquamous carcinomas (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.06 to 5.72), other histology (HR, 5.61; 95% CI, 1.81 to 17.42), high International Federation of Gynaecology and Obstetrics (FIGO) stage (HR, 2.84; 95% CI, 1.09 to 7.37), and presence of initial intra-abdominal lymph node metastases (HR, 2.46; 95% CI, 1.02 to 5.90) were associated significantly and independently with thoracic metastases. The second analysis among the subgroup of surgical treatment identified intermediate-high risk classification of recurrence (HR, 5.12; 95% CI, 1.14 to 22.94), high FIGO stage (HR, 2.73; 95% CI, 1.05 to 7.13), and other histology (HR, 11.51; 95% CI, 3.66 to 36.19) as independent predictors of thoracic metastases. Two of the 361 and 2/313 patients with thoracic metastases who did not correspond to the conditions above were in the respective evaluation groups. CONCLUSION Assessment of negative prognostic factors for thoracic metastases might contribute to reduced need for chest cross-sectional chest computed tomography examinations.
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Affiliation(s)
- K K Nakao
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - A Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - T Imai
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - K Abiko
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - K Fujimoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - A Horie
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - M Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - K Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Nakai Y, Tanaka N, Asakawa I, Miyake M, Anai S, Morizawa Y, Owari T, Fujii T, Hasegawa M, Fujimoto K. Assessment of the Prostate-Specific Antigen Bounce in Patients Treated with 12⁵I-Brachytherapy for Prostate Cancer and Its Correlation with Testosterone. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Morita K, Fujii T, Shimada K, Itami H, Hatakeyama K, Miyake M, Fujimoto K, Ohbayashi C. NACC1 as a target of microRNA-331-3p regulates cell proliferation in urothelial carcinoma cells. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy304.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ito T, Matsui F, Fujimoto K, Matsuyama S, Yazawa K, Matsumoto F, Shimada K. Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease. J Pediatr Urol 2018; 14:402-406. [PMID: 30219308 DOI: 10.1016/j.jpurol.2018.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. OBJECTIVE The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. MATERIALS AND METHODS Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. RESULTS All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1-20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. DISCUSSION This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. CONCLUSION Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD.
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Affiliation(s)
- T Ito
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - F Matsui
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan.
| | - K Fujimoto
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - S Matsuyama
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - K Yazawa
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - F Matsumoto
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - K Shimada
- Department of Urology, Osaka Women's and Children's Hospital, Osaka, Japan
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Chiba T, Setta K, Shimada Y, Yoshida J, Fujimoto K, Tsutsui S, Yoshida K, Kobayashi M, Kubo Y, Fujiwara S, Terasaki K, Ogasawara K. Comparison of Effects between Clopidogrel and Cilostazol on Cerebral Perfusion in Nonsurgical Adult Patients with Symptomatically Ischemic Moyamoya Disease: Subanalysis of a Prospective Cohort. J Stroke Cerebrovasc Dis 2018; 27:3373-3379. [PMID: 30174225 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/11/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Adult patients with symptomatically ischemic moyamoya disease (MMD) initially undergo medical treatment alone including antiplatelet drugs when symptomatic cerebral hemispheres do not exhibit hemodynamic compromise. The purpose of the present study subanalyzing the same patient cohort used in a previous study was to determine which antiplatelet drug, clopidogrel or cilostazol, provides better improvement of cerebral perfusion in such patients. METHODS All patients without cerebral misery perfusion on 15O gas positron emission tomography (PET) did not undergo revascularization surgery and were treated with medication alone, including antiplatelet therapy. Patients ≥50years and <50years initially received clopidogrel and cilostazol, respectively. When a patient suffered side effects of an antiplatelet drug, they were switched to the other antiplatelet drug. Cerebral blood flow (CBF) in the symptomatic hemisphere was measured at inclusion and at 2years after inclusion using 15O gas PET. RESULTS Of 68 patients, 31 and 38 were treated with clopidogrel and cilostazol, respectively, for 2years after inclusion. For patients treated with clopidogrel, CBF did not differ between first and second PET. For patients treated with cilostazol, CBF was significantly greater in the second PET than in the first PET. On multivariate analysis, cilostazol administration was an independent predictor of CBF improvement in the symptomatic hemisphere (95% confidence interval, 1.34-139.20; P =.0271). CONCLUSIONS Cilostazol improves cerebral perfusion better than clopidogrel in adult patients with symptomatically ischemic MMD not accompanied by misery perfusion.
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Affiliation(s)
- Takayuki Chiba
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kengo Setta
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yasuyoshi Shimada
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Jun Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kentaro Fujimoto
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Shouta Tsutsui
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Masakazu Kobayashi
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kazunori Terasaki
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan; Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
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Sakamoto K, Tsujita K, Kaikita K, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Suwa S, Fujimoto K, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. 5072Obesity paradox outcomes after acute myocardial infarction in Japanese is due to optimal medical therapy in overweight patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Sakamoto
- Kumamoto University Hospital, Department of Cardiovascular Medicine, Kumamoto, Japan
| | - K Tsujita
- Kumamoto University Hospital, Department of Cardiovascular Medicine, Kumamoto, Japan
| | - K Kaikita
- Kumamoto University Hospital, Department of Cardiovascular Medicine, Kumamoto, Japan
| | - K Nakao
- Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan
| | - Y Ozaki
- Fujita Health University, Department of Cardiology, Toyoake, Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiovascular Center, Yokohama, Japan
| | - J Ako
- Kitasato University, Department of Cardiovascular Medicine, Sagamihara, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Suita, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Suita, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Department of Cardiology, Izunokuni, Japan
| | - K Fujimoto
- National Hospital Organization Kumamaoto Medical Center, Department of Cardiology, Kumamoto, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Suita, Japan
| | - Y Miyamoto
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Suita, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Suita, Japan
| | - M Ishihara
- Hyogo College of Medicine, Division of Coronary Artery Disease, Nishinomiya, Japan
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