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Ueshima T, Endo K, Nishimura H, Sawaji Y, Suzuki H, Aihara T, Murata K, Konishi T, Kusakabe T, Yamauchi H, Matsubayashi J, Yamamoto K. Magnetic resonance imaging findings in patients with dropped head syndrome. J Orthop Sci 2024:S0949-2658(24)00062-9. [PMID: 38705766 DOI: 10.1016/j.jos.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 03/04/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Dropped head syndrome (DHS) is difficult to diagnose only by clinical examination. Although characteristic images on X-rays of DHS have been studied, changes in soft tissue of the disease have remained largely unknown. Magnetic resonance imaging (MRI) is useful for evaluating soft tissue, and we therefore performed this study with the purpose of investigating the characteristic signal changes of DHS on MRI by a comparison with those of cervical spondylosis. METHODS The study involved 35 patients diagnosed with DHS within 6 months after the onset and 32 patients with cervical spondylosis as control. The signal changes in cervical extensor muscles, interspinous tissue, anterior longitudinal ligament (ALL) and Modic change on MRI were analyzed. RESULTS Signal changes of cervical extensor muscles were 51.4% in DHS and 6.3% in the control group, those of interspinous tissue were 85.7% and 18.8%, and those of ALL were 80.0% and 21.9%, respectively, suggesting that the frequency of signal changes of cervical extensor muscles, interspinous tissue and ALL was significantly higher in the DHS group (p < 0.05). The presence of Modic change of acute phase (Modic type I) was also significantly higher in the DHS group than in the control group (p < 0.001). CONCLUSION MRI findings of DHS within 6 months after the onset presented the characteristic signal changes in cervical extensor muscles, interspinous tissue, ALL and Modic change. Evaluation of MRI signal changes is useful for an objective evaluation of DHS.
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Affiliation(s)
- Tomoyuki Ueshima
- Department of Orthopedic Surgery, Tokyo Medical University, Japan.
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | | | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | | | - Takuya Kusakabe
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | - Hideya Yamauchi
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Japan
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Endo K, Nishimura H, Sawaji Y, Aihara T, Suzuki H, Konishi T, Nagayama K, Yamamoto K. Contrast-enhanced Magnetic Resonance Imaging in Patients With Dropped Head Syndrome. Spine (Phila Pa 1976) 2024; 49:385-389. [PMID: 37791664 DOI: 10.1097/brs.0000000000004841] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
STUDY DESIGN This is a retrospective study of a consecutive case series of dropped head syndrome (DHS). OBJECTIVE To identify the characteristic features of contrast-enhanced magnetic resonance imaging (MRI) in DHS patients. SUMMARY OF BACKGROUND DATA Isolated neck extensor myopathy DHS is thought to be caused by severe cervical extensor muscle weakness from age-related loss of elasticity. However, the MRI findings of the cervical extensor muscles in DHS patients have not yet been characterized. MATERIALS AND METHODS The subjects were 34 patients with isolated neck extensor myopathy DHS who underwent contrast-enhanced MRI within seven months after onset and 32 patients with age-matched cervical spondylosis or cervical soft-tissue tumor as controls. The presence of enhanced findings in the cervical extensor muscles, the involved cervical levels, and the characteristically enhanced shape of those muscles were evaluated using contrast-enhanced MRI. RESULTS In the DHS group, the contrast-enhanced MRI showed pronounced enhancement at splenius capitis in 34 cases, rhomboid in 23 cases, semispinalis cervicis in seven cases, and levator scapulae in three cases. In the non-DHS group, none of those extensor muscles were enhanced. The enhanced pattern was butterfly shaped in 29 cases (85.3%) and linear in five cases (14.7%). All were located at the spinous process attachment at C6 or C7 in the DHS group. In the non-DHS group, seven cases presented an enhanced image of the spinous process, with C5-6 in one case, C6 in five cases, and C7 in one case. CONCLUSIONS In DHS, contrast-enhanced MRI showed intramuscular enhancement of the cervical extensor muscles, which was not present in non-DHS cases. The enhanced muscles included the splenius capitis muscle in all cases. These findings may be useful for developing a strategy for DHS treatment.
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Affiliation(s)
- Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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3
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Takenaka S, Sato T, Kazui S, Yasui Y, Saiin K, Naito S, Takahashi Y, Mizuguchi Y, Tada A, Kobayashi Y, Omote K, Konishi T, Kamiya K, Ooka T, Nagai T, Wakasa S, Anzai T. Clinical Utility of Near-Infrared Spectroscopy Intravascular Ultrasound in the Assessment of Rapidly Progressive Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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4
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Sato T, Takenaka S, Kazui S, Yasui Y, Saiin K, Naito S, Takahashi Y, Mizuguchi Y, Tada A, Kobayashi Y, Omote K, Konishi T, Kamiya K, Ooka T, Nagai T, Wakasa S, Anzai T. Clinical Implications of Hemodynamic Assessment in Small Body Surface Area Patients with Left Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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5
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Nishimura H, Endo K, Sawaji Y, Suzuki H, Aihara T, Murata K, Konishi T, Yamauchi H, Ueshima T, Yamamoto K. Global Sagittal Spinal Compensation for Dropped Head Alignment. Spine (Phila Pa 1976) 2023; 48:421-427. [PMID: 36728796 DOI: 10.1097/brs.0000000000004562] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a retrospective radiographic study of a consecutive series of cases in patients with dropped head syndrome (DHS) at a single tertiary referral center. OBJECTIVE The aim was to clarify the compensation among parameters of spinal sagittal alignment in patients with DHS. SUMMARY OF BACKGROUND DATA The treatment strategy for DHS should vary according to the types of global sagittal spinal alignment. However, theoretical evidence in consideration of spinal sagittal compensation against the dropped head condition is lacking. MATERIALS AND METHODS One hundred sixteen patients diagnosed with isolated neck extensor myopathy were enrolled. Radiographic measurements were made, including parameters of spinal sagittal alignment. The patients were divided into three groups according to sagittal spinal balance: C7SVA (sagittal vertical axis) ≥ +50 mm (P-DHS; positive imbalanced DHS), -50 mm ≤C7SVA <+50 mm (B-DHS; balanced DHS), and C7SVA <-50 mm (N-DHS; negative imbalanced DHS). Correlations among the various spinal parameters were analyzed. RESULTS Among all types of DHS, there was no correlation between C2-C7 angle (C2-C7A) and T1 slope. In B-DHS, other correlations among the adjacent spinal segments were maintained. In N-DHS, there was no correlation between C2-C7A and TK, and in P-DHS, there was also no correlation between TK and lumbar lordosis. CONCLUSIONS The loss of compensation at the cervicothoracic junction was observed in all DHS types. B-DHS showed decompensation only at the cervicothoracic junction. N-DHS presented additional decompensation of the thoracic spine, and P-DHS showed decompensation between the thoracic and lumbar spine. Evaluation of global sagittal spinal balance is important for determining global spinal compensation associated with DHS and when considering treatment strategy.
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Affiliation(s)
- Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Tanabe K, Uehara S, Katsumura S, Konishi T, Noro A. The controlling nutritional status (CONUT) score may predict the development of febrile urinary tract infection after ureterorenoscopic lithotripsy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01250-2] [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: 02/12/2023]
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Ogawa H, Konishi T, Najima Y, Kito S, Ohashi K, Doki N, Murofushi K. Phase I Dose Escalation Trial of 3-Day Total Marrow and Lymphoid Irradiation for Leukemia as Part of Myeloablative Conditioning in Unrelated Bone Marrow Transplantation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1463] [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: 10/31/2022]
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Takenaka S, Sato T, Nagai T, Omote K, Kamiya K, Konishi T, Kobayashi Y, Tada A, Mizuguchi Y, Takahashi Y, Naito S, Saiin K, Ishizaka S, Wakasa S, Anzai T. Impact of right ventricular reserve on exercise capacity and quality of life in patients with left ventricular assist device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1011] [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
Right heart failure following left ventricular assist device (LVAD) implantation is a major complication which significantly impairs functional capacity and quality of life (QoL). Right ventricular (RV) reserve function may limit exercise capacity and QoL in LVAD patients; however, most patients show normal RV haemodynamics at rest.
Purpose
The aim of this study was to investigate whether RV reserve assessed by the changes of RV function during exercise is correlated with exercise capacity and QoL in patients with LVAD.
Methods
We prospectively examined 20 consecutive LVAD patients who were admitted to our university hospital between June 2020 and November 2021 after excluding those who were unable to perform exercise (n=8). All patients underwent invasive exercise right heart catheterisation with simultaneous echocardiography in the supine position. RV stroke work index (RVSWI) was calculated as 0.0136 × stroke volume index × (mean pulmonary artery pressure [mPAP] − right atrial pressure [RAP]) at rest and during exercise. Exercise capacity and QoL were assessed by 6-minute walk distance (6MWD) and peak oxygen consumption (VO2) in cardiopulmonary exercise testing, and the EuroQol visual analogue scale (EQ-VAS), respectively. The patients were divided into two groups according to the median ΔRVSWI (RVSWI change from rest to peak exercise) of 1.45 (interquartile range [IQR] −0.31 to 8.25) g/m2.
Results
Patients were predominantly male (75%) and the median age was 47 (IQR 38–60) years. Patients with lower ΔRVSWI had significantly higher change on RAP (P=0.019), but significantly lower change on mPAP (P<0.001) compared to those with higher ΔRVSWI. There were no significant differences in age, gender, primary aetiology of heart failure, type of LVAD devices, or echocardiographic parameters including tricuspid annular plane systolic excursion, and RVSWI at rest between the groups. ΔRVSWI during exercise were positively correlated with 6MWD (R=0.69, P<0.01) and peak VO2 (R=0.66, P<0.01) (Figure A). In addition, ΔRVSWI during exercise were positively correlated with the EQ-VAS (R=0.48, P=0.031). On the other hand, there was no significant correlation between RVSWI at rest and 6MWD (R=−0.11, P=0.63) and peak VO2 (R=0.13, P=0.95), and the EQ-VAS (R=0.11, P=0.61). During a median follow-up period of 312 (IQR 176–369) days, adverse events occurred in 3 patients (15%), including 1 death and 2 hospitalisations for major bleeding and right heart failure. Kaplan-Meier analysis revealed that the adverse events more frequently occurred in patients with lower ΔRVSWI compared to those with higher ΔRVSWI (Figure B).
Conclusions
ΔRVSWI was positively correlated with 6MWD, peak VO2 and EQ-VAS irrespective of RV function at rest. Our findings suggest that the assessment of RV reserve function using ΔRVSWI would be useful for risk stratification in patients with LVAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Takenaka
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - T Sato
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - T Nagai
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - K Omote
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - K Kamiya
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - T Konishi
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - Y Kobayashi
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - A Tada
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - Y Mizuguchi
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - Y Takahashi
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - S Naito
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - K Saiin
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - S Ishizaka
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - S Wakasa
- Hokkaido University, Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
| | - T Anzai
- Hokkaido University, Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine , Sapporo , Japan
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9
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Endo K, Sawaji Y, Aihara T, Suzuki H, Murata K, Matsuoka Y, Nishimura H, Takamatsu T, Konishi T, Yamamoto K. Eight cases of sudden-onset dropped head syndrome: patient series. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21177. [PMID: 36059718 PMCID: PMC9435544 DOI: 10.3171/case21177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
As the proportion of elderly people continues to increase, the number of patients with dropped head syndrome (DHS) also grows. However, the relationship between onset and clinical course of DHS has hardly been studied, particularly, that of sudden-onset DHS has not been reported and remains unclear.
OBSERVATIONS
Sudden-onset DHS was defined as presenting with chin on chest deformity within 3 days from the time of awareness of cervical weakness. Sixty-six patients with DHS visited our facility. Among them, 8 of the total cases (12.1%) had experienced sudden onset DHS (6 females and 2 males; average age: 71.9 ± 10.9 years). Six of 8 cases showed recovery by conservative treatment, whose first interventions were from 0.1 to 12 months, but 3 experienced recurrence. Diffuse spinal kyphotic-type DHS was seen in 2 cases, and both had recurring horizontal gaze disturbance after initial recovery. Two unimproved cases underwent surgery of combined anterior and posterior cervical fixation, and their first interventions were at 5 and 24 months. After surgery, cervical sagittal alignment was improved, and they could walk maintaining horizontal gaze.
LESSONS
Sudden-onset DHS can be expected to have a better outcome, but recurrence is possible in global imbalanced-type DHS.
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Affiliation(s)
- Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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10
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Endo K, Matsubayashi J, Sawaji Y, Murata K, Konishi T, Nagao T, Yamamoto K. Histopathological characteristics of cervical extensor tissue in patients with dropped head syndrome. Eur J Med Res 2021; 26:135. [PMID: 34836551 PMCID: PMC8620639 DOI: 10.1186/s40001-021-00605-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background To date, the histopathologic characteristics of dropped head syndrome (DHS) have not been reported sufficiently. The present study investigates the histopathology of biopsy specimens from the cervical paravertebral region in patients with DHS. Methods Histopathological parameters were evaluated in biopsy specimens of the cervical paravertebral soft tissue from 15 patients with DHS. Results Among the 15 cases of DHS examined, skeletal muscle was identified in 7 cases, all of which showed necrosis, microvessel proliferation and atrophy. The ligament was identified in 12 cases, 8 of which showed degeneration. The lag time between the onset of symptoms and the performance of a biopsy in all 8 cases, which showed degeneration was over 3 months. Microvessel proliferation in the ligament was observed in 1 of the 4 cases, in which the lag time between the onset of symptoms and the performance of a biopsy was less than 3 months (acute or subacute phase), and in 7 of the 8 cases, in which the lag time between the symptoms and the performance of a biopsy was over 3 months (chronic phase). Chronic inflammation in the ligament was identified in 1 of the 12 cases. Conclusions The identification of necrosis, microvessel proliferation, and atrophy in the skeletal muscle of patients with DHS and the presence of ligament degeneration and microvessel proliferation in the chronic but not acute or subacute phases may suggest that persistent skeletal muscle damage of the cervical paravertebral region causes subsequent ligament damage in patients with DHS.
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Affiliation(s)
- Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Tada A, Nagai T, Omote K, Tsujinaga S, Kamiya K, Konishi T, Sato T, Komoriyama H, Kobayashi Y, Takenaka S, Mizuguchi Y, Yamamoto K, Yoshikawa T, Saito Y, Anzai T. Validation of the HFA-PEFF and the H2FPEF scores for the diagnosis of heart failure with preserved ejection fraction in Japanese patients:a report from the Japanese multicentre registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The standard diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) is based on the following: 1) symptoms of HF, 2) preserved left ventricular (LV) ejection fraction (LVEF, >50%), and 3) presence of LV diastolic dysfunction confirmed by echocardiography or cardiac catheterisation. However, there are limits to the diagnostic accuracy of individual parameters, and what cut-off values should be applied and how they should be combined remain unclear. Diagnostic algorithms for HFpEF such as the HFA-PEFF algorithm and the H2FPEF score have been proposed; however, previous validation studies were conducted in stable chronic HF and did not include an invasive haemodynamic assessment. Thus, the diagnostic accuracy for HFpEF lacked robustness. Moreover, information on their applicability in the Asian population is limited.
Purpose
The aim of this study was to investigate these scores' diagnostic validity for HFpEF in Japanese patients recently hospitalised due to acute decompensated HF.
Methods
We examined patients with HFpEF recently hospitalised with acute decompensated HF whose HFA-PEFF and H2FPEF scores could be calculated at discharge from a nationwide HFpEF-specific multicentre registry (HFpEF group) and control patients who underwent echocardiography to investigate the cause of dyspnoea in our hospital (Non-HFpEF group). We calculated the HFA-PEFF and the H2FPEF scores among the studied population. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were computed to compare the diagnostic accuracy of these scores.
Results
The studied population included 372 consecutive patients (194 HFpEF group and 178 Non-HFpEF group; HFpEF prevalence, 52%). The HFA-PEFF score classified 155 (42%) of all patients into the high likelihood category (5–6 points) and only 19 (5%) into the low likelihood category (0–1 point). A high HFA-PEFF score could diagnose HFpEF with a high specificity of 84% and a positive predictive value (PPV) of 82%, and a low HFA-PEFF score could rule out HFpEF with a high sensitivity of 99% and a negative predictive value (NPV) of 89%. The H2FPEF score classified 86 (23%) of all patients into the high likelihood category (6–9 points) and 84 (23%) into the low likelihood category (0–1 point). HFpEF could be diagnosed with a high H2FPEF score (specificity, 97%; PPV, 94%) or ruled out with a low H2FPEF score (sensitivity, 97%; NPV, 93%). The diagnostic accuracy for the HFA-PEFF and H2FPEF scores was 0.82 (95% confidence interval [CI] 0.78–0.86) and 0.89 (95% CI 0.86–0.93), respectively, by the AUC of the ROC curve (P=0.004) (Figure 1A). In the HFA-PEFF sub-scores, the functional score showed little diagnostic value, while the morphological and biomarker scores showed moderate diagnostic value (Figure 1B).
Conclusions
The H2FPEF score may be more useful than the HFA-PEFF score in diagnosing HFpEF in Japanese patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI) Figure 1
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Affiliation(s)
- A Tada
- Hokkaido University, Sapporo, Japan
| | - T Nagai
- Hokkaido University, Sapporo, Japan
| | - K Omote
- Hokkaido University, Sapporo, Japan
| | | | - K Kamiya
- Hokkaido University, Sapporo, Japan
| | | | - T Sato
- Hokkaido University, Sapporo, Japan
| | | | | | | | | | | | | | - Y Saito
- Nara Medical University, Nara, Japan
| | - T Anzai
- Hokkaido University, Sapporo, Japan
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12
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Takenaka S, Kobayashi Y, Nagai T, Kato Y, Komoriyama H, Nagano N, Kamiya K, Konishi T, Sato T, Omote K, Tada A, Iwano H, Kusano K, Ishibashi-Ueda H, Anzai T. Applicability of the AHA/ACC/HRS guideline for implantable cardioverter defibrillator implantation in Japanese patients with cardiac sarcoidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0689] [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
Sarcoidosis is a systemic granulomatous disease that affects multiple organs. Cardiac involvement is a key determinant of poor clinical outcomes in the patients with sarcoidosis, as it causes congestive heart failure, conduction abnormalities, ventricular tachycardia and fibrillation (VT/VF), and sudden cardiac death (SCD). Although implantable cardioverter defibrillators (ICDs) are used to prevent SCD from VT/VF in patients with cardiac sarcoidosis (CS), the generalizability of the AHA/ACC/HRS guidelines for the Japanese CS patients remains unclear.
Purpose
We aimed to assess, among Japanese patients with CS, the ICD recommendations from the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
Methods
We examined 188 consecutive patients with CS in two tertiary hospitals between 1979 and 2020. The primary outcome was defined as a composite outcome involving SCD or ventricular arrhythmic events. Ventricular arrhythmic events were defined as either emergency treatment for VF or sustained VT, which included appropriate ICD therapy.
Results
During a median follow-up period of 5.68 (IQR: 4.87–6.70) years, the primary outcome occurred in 44 patients (23%), which included 6 cases of SCD and 38 cases of VT/VF. ICD implant was indicated based on left ventricular ejection fraction (LVEF) of ≤35% (class I recommendation) in 62 patients, with an annualized event rate of 3.93%. A LVEF of >35% with a need for a permanent pacemaker (class IIa recommendation) was observed for 53 patients, with an annualized event rate of 2.54%. A LVEF of >35% with late gadolinium enhancement (LGE) during cardiovascular magnetic resonance (class IIa recommendation) was observed for 62 patients, with an annualized event rate of 2.38% (Figure A). Kaplan-Meier analyses revealed that patients with a class I recommendation for ICD implantation had a significant higher incidence of the primary outcome, compared to patients with a class IIa recommendation and patients with no indication for ICD implantation (P=0.03). However, there were no significant differences in the incidence of the primary outcome between patients with a LVEF of >35% and a need for a permanent pacemaker and patients with a class I recommendation (P=0.08) or patients with a LVEF of ≤35% (P=0.31). Moreover, there was no significant difference in the incidence of the primary outcome between patients with a LVEF of >35% and LGE on cardiovascular magnetic resonance and patients with a class I recommendation (P=0.054) or patients with a LVEF of ≤35% (P=0.22) (Figure B).
Conclusions
The American guideline recommendations for ICD implantation might be applicable to Japanese patients with CS. Implantation of an ICD may need to be considered in these patients if they require a permanent pacemaker or have LGE, regardless of LVEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science
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Affiliation(s)
| | | | - T Nagai
- Hokkaido University, Sapporo, Japan
| | - Y Kato
- Hokkaido University, Sapporo, Japan
| | | | - N Nagano
- Sapporo Medical University Hospital, Sapporo, Japan
| | - K Kamiya
- Hokkaido University, Sapporo, Japan
| | | | - T Sato
- Hokkaido University, Sapporo, Japan
| | - K Omote
- Hokkaido University, Sapporo, Japan
| | - A Tada
- Hokkaido University, Sapporo, Japan
| | - H Iwano
- Hokkaido University, Sapporo, Japan
| | - K Kusano
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - H Ishibashi-Ueda
- National Cerebral and Cardiovascular Center Hospital, Osaka, Japan
| | - T Anzai
- Hokkaido University, Sapporo, Japan
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Kobayashi Y, Nagai T, Hirata K, Tsuneta S, Kato Y, Komoriyama H, Kamiya K, Konishi T, Sato T, Omote K, Ohira H, Kudoh K, Konno S, Anzai T. Association of high serum soluble interleukin 2 receptor levels with risk of adverse events in patients with cardiac sarcoidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1797] [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
Sarcoidosis is a systemic granulomatous disease that affects multiple organs. Among these, the presence of cardiac involvement is recognised as a determinant of worse clinical outcomes. Soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis. However, it remains to be seen whether sIL-2R is associated with the severity and activity of disease in patients with cardiac sarcoidosis (CS).
Purpose
The aims of this study were to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity evaluated by 18F-fluorideoxyglucose in positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with CS.
Methods
We examined 101 consecutive patients with CS who were admitted to our University HospitalbetweenMay 2003 and February 2020. Patients who had no data of serum sIL-2R levels before initiation of immunosuppressive therapy (n=18) were excluded. Ultimately, 83 patients were examined in this study. The primary outcome was a composite of advanced atrioventricular block (AVB), ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalisation, and all-cause death. Inflammatory activity in the myocardium and lymph nodes were assessed by18F-FDG PET/CT. We used a published program to analyse the cardiac metabolic activity (CMA), and total lymph node glycolysis (TLyG), which are quantitative measures of FDG volume-intensity.
Results
During a median follow-up period of 2.96 (interquartile range 2.24–4.27) years, the primary outcome occurred in 24 patients (29%), including 1 advanced AVB, 13 VT/VF, 5 hospitalisations for heart failure, and 5 all-cause deaths. Kaplan-Meier analyses showed that the primary outcome occurred more frequently in patients with higher sIL-2R levels (>538 U/mL, the median) than in those with lower sIL-2R levels (Figure). A multivariable Cox regression analysis revealed that a higher sIL-2R level was independently associated with an increased subsequent risk of adverse events (hazard ratio 3.71, 95% confidence interval 1.63–8.44, p=0.002), even after adjustments for age, plasma B-type natriuretic peptide, estimated glomerular filtration rate, left ventricular ejection fraction, and late gadolinium enhancement, which are known to be strong determinants of worse clinical outcomes in patients with CS (Table). Furthermore, sIL-2R levels were significantly correlated with TLyG, the inflammatory activity in lymph nodes (r=0.346, p=0.003) but not with CMA, the inflammatory activity in myocardium (r=0.131, p=0.27).
Conclusions
Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients. These findings suggest the importance of assessing sIL-2R as a surrogate marker for further risk stratification in these patients.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science
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Affiliation(s)
- Y Kobayashi
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Nagai
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Hirata
- Hokkaido University, Department of Diagnostic Imaging, Sapporo, Japan
| | - S Tsuneta
- Hokkaido University, Department of Diagnostic Imaging, Sapporo, Japan
| | - Y Kato
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - H Komoriyama
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Kamiya
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Konishi
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Sato
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Omote
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - H Ohira
- Hokkaido University, Department of Respiratory Medicine, Sapporo, Japan
| | - K Kudoh
- Hokkaido University, Department of Diagnostic Imaging, Sapporo, Japan
| | - S Konno
- Hokkaido University, Department of Respiratory Medicine, Sapporo, Japan
| | - T Anzai
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
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14
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Aihara T, Kojima A, Urushibara M, Endo K, Sawaji Y, Suzuki H, Matsuoka Y, Nishimura H, Murata K, Konishi T, Yamamoto K. In Reply to the Letter to the Editor Regarding "Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up". World Neurosurg 2021; 151:326-328. [PMID: 34243658 DOI: 10.1016/j.wneu.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Takato Aihara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba; Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Atsushi Kojima
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba
| | - Makoto Urushibara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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15
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Murata K, Endo K, Aihara T, Suzuki H, Sawaji Y, Matsuoka Y, Takamatsu T, Konishi T, Yamauchi H, Endo H, Yamamoto K. Use of residual neural network for the detection of ossification of the posterior longitudinal ligament on plain cervical radiography. Eur Spine J 2021; 30:2185-2190. [PMID: 34196802 DOI: 10.1007/s00586-021-06914-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/23/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022]
Abstract
Ossification of the posterior longitudinal ligament (OPLL) causes serious problems, such as myelopathy and acute spinal cord injury. The early and accurate diagnosis of OPLL would hence prevent the miserable prognoses. Plain lateral radiography is an essential method for the evaluation of OPLL. Therefore, minimizing the diagnostic errors of OPLL on radiography is crucial. Image identification based on a residual neural network (RNN) has been recognized to be potentially effective as a diagnostic strategy for orthopedic diseases; however, the accuracy of detecting OPLL using RNN has remained unclear. An RNN was trained with plain lateral cervical radiography images of 2,318 images from 672 patients (535 images from 304 patients with OPLL and 1,773 images from 368 patients of Negative). The accuracy, sensitivity, specificity, false positive rate, and false negative rate of diagnosis of the RNN were calculated. The mean accuracy, sensitivity, specificity, false positive rate, and false negative rate of the model were 98.9%, 97.0%, 99.4%, 2.2%, and 1.0%, respectively. The model achieved an overall area under the curve of 0.99 (95% confidence interval, 0.97-1.00) in which AUC in each fold estimated was 0.99, 0.99, 0.98, 0.98, and 0.99, respectively. An algorithm trained by an RNN could make binary classification of OPLL on cervical lateral X-ray images. RNN may hence be useful as a screening tool to assist physicians in identifying patients with OPLL in future setting. To achieve accurate identification of OPLL patients clinically, RNN has to be trained with other cause of myelopathy.
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16
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Miura M, Maki S, Miura K, Takahashi H, Miyagi M, Inoue G, Murata K, Konishi T, Furuya T, Koda M, Takaso M, Endo K, Ohtori S, Yamazaki M. Automated detection of cervical ossification of the posterior longitudinal ligament in plain lateral radiographs of the cervical spine using a convolutional neural network. Sci Rep 2021; 11:12702. [PMID: 34135404 PMCID: PMC8208978 DOI: 10.1038/s41598-021-92160-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022] Open
Abstract
Cervical ossification of the posterior longitudinal ligament (OPLL) is a contributing factor to spinal cord injury or trauma-induced myelopathy in the elderly. To reduce the incidence of these traumas, it is essential to diagnose OPLL at an early stage and to educate patients how to prevent falls. We thus evaluated the ability of our convolutional neural network (CNN) to differentially diagnose cervical spondylosis and cervical OPLL. We enrolled 250 patients with cervical spondylosis, 250 patients with cervical OPLL, and 180 radiographically normal controls. We evaluated the ability of our CNN model to distinguish cervical spondylosis, cervical OPLL, and controls, and the diagnostic accuracy was compared to that of 5 board-certified spine surgeons. The accuracy, average recall, precision, and F1 score of the CNN for classification of lateral cervical spine radiographs were 0.86, 0.86, 0.87, and 0.87, respectively. The accuracy was higher for CNN compared to any expert spine surgeon, and was statistically equal to 4 of the 5 experts and significantly higher than that of 1 expert. We demonstrated that the performance of the CNN was equal or superior to that of spine surgeons.
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Affiliation(s)
- Masataka Miura
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan.
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, 260-8670, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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17
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Konishi T, Fujiogi M, Michihata N, Tanaka-Mizutani H, Morita K, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Breast cancer surgery in patients with schizophrenia: short-term outcomes from a nationwide cohort. Br J Surg 2021; 108:168-173. [PMID: 33711128 DOI: 10.1093/bjs/znaa070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/04/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Although patients with schizophrenia have a higher risk of developing breast cancer than the general population, studies that have investigated postoperative complications after breast cancer surgery in patients with schizophrenia are scarce. This study examined associations between schizophrenia and short-term outcomes following breast cancer surgery. METHODS Patients who underwent surgery for stage 0-III breast cancer between July 2010 and March 2017 were identified from a Japanese nationwide inpatient database. Multivariable analyses were conducted to compare postoperative complications and hospitalization costs between patients with schizophrenia and those without any psychiatric disorder. Three sensitivity analyses were performed: a 1 : 4 matched-pair cohort analysis with matching for age, institution, and fiscal year at admission; analyses excluding patients with schizophrenia who were not taking antipsychotic medication; and analyses excluding patients with schizophrenia who were admitted to hospital involuntarily. RESULTS The study included 3660 patients with schizophrenia and 350 860 without any psychiatric disorder. Patients with schizophrenia had a higher in-hospital morbidity (odds ratio (OR) 1.37, 95 per cent c.i. 1.21 to 1.55), with more postoperative bleeding (OR 1.34, 1.05 to 1.71) surgical-site infections (OR 1.22, 1.04 to 1.43), and sepsis (OR 1.20, 1.03 to 1.41). The total cost of hospitalization (coefficient €743, 95 per cent c.i. 680 to 806) was higher than that for patients without any psychiatric disorder. All sensitivity analyses showed similar results to the main analyses. CONCLUSION Although causal inferences remain premature, multivariable regression analyses showed that schizophrenia was associated with greater in-hospital morbidity and higher total cost of hospitalization after breast cancer surgery than in the general population.
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Affiliation(s)
- T Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - N Michihata
- Department of Health Services Research, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Tanaka-Mizutani
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - K Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.,Department of Health Services, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - M Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Y Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
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18
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Schaap DP, Boogerd LSF, Konishi T, Cunningham C, Ogura A, Garcia-Aguilar J, Beets GL, Suzuki C, Toda S, Lee IK, Sammour T, Uehara K, Lee P, Tuynman JB, van de Velde CJH, Rutten HJT, Kusters M. Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes. Br J Surg 2021; 108:205-213. [PMID: 33711144 DOI: 10.1093/bjs/znaa009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 05/18/2020] [Revised: 07/06/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. METHODS Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. RESULTS More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. CONCLUSION Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes.Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.
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Affiliation(s)
- D P Schaap
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - L S F Boogerd
- Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - T Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - C Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Ogura
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, USA
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Suzuki
- Department of Radiology, Karolinska Institutet, Stockholm, Sweden
| | - S Toda
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - I K Lee
- Department of Surgery, Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - T Sammour
- Department of Surgery, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - K Uehara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - P Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - J B Tuynman
- Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Maastricht University, GROW, School of Oncology and Developmental Biology, Maastricht, the Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, the Netherlands
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19
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20
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Konishi T, Endo K, Aihara T, Suzuki H, Matsuoka Y, Nishimura H, Takamatsu T, Murata K, Kusakabe T, Maekawa A, Sawaji Y, Yamamoto K. Global sagittal spinal alignment at cervical flexion in patients with dropped head syndrome. J Orthop Surg (Hong Kong) 2021; 28:2309499020948266. [PMID: 32856531 DOI: 10.1177/2309499020948266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Dropped head syndrome (DHS) is characterized by the passively correctable chin-on-chest deformity. The characteristic feature is emphasized in the cervical flexion position. The purpose of this study was to analyze the influence of cervical flexion on sagittal spinal alignment in patients with DHS. METHODS The study included 15 DHS subjects and 55 cervical spondylosis (CS) subjects as the control group. The following parameters were analyzed: cervical sagittal vertical axis (C-SVA), occipitoaxial angle (O-C2A), C2 slope (C2S), C2-C7 angle (C2-C7A), T1 slope (T1S), sagittal vertical axis, T1-T4 angle (T1-T4A), T5-T8 angle (T5-T8A), T9-T12 angle, lumbar lordosis, sacral slope, and pelvic tilt, in cervical flexion and neutral positions. RESULTS The values of C-SVA, O-C2A, C2S, and T1S were significantly different between CS and DHS at cervical neutral and flexion positions. C2-C7A showed significant difference in cervical neutral position, but the difference disappeared in flexion position. T1-T4A did not present a significant difference, but T5-T8A showed a difference in neutral and flexion positions. CONCLUSIONS Malalignment of DHS extended not only to cervical spine but also to cranio-cervical junction and thoracic spine, except T1-T4. It is known that global sagittal spinal alignment is correlated with adjacent parameters, although in DHS the reciprocal change was lost from cranio-cervical junction to the middle part of thoracic spine at cervical flexion.
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Affiliation(s)
- Takamitsu Konishi
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Takuya Kusakabe
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Asato Maekawa
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, 13112Tokyo Medical University, Tokyo, Japan
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21
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Aihara T, Endo K, Suzuki H, Kojima A, Sawaji Y, Urushibara M, Matsuoka Y, Takamatsu T, Murata K, Konishi T, Yamauchi H, Endo H, Yamamoto K. Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up. World Neurosurg 2020; 146:e1219-e1225. [PMID: 33271376 DOI: 10.1016/j.wneu.2020.11.131] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether preoperative presence of degenerative lumbar spondylolisthesis (DS) worsens the minimum 10-year outcome of patients undergoing microendoscopic decompression (MED) for lumbar spinal stenosis (SS). METHODS Eighty patients undergoing MED were classified into 2 groups: DS group (34 SS with DS patients) and SS group (46 SS without DS patients). The degrees of improvement (DOIs) by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and intensities of improvement (IOIs) by Visual Analog Scale (VAS) at 120-159 (mean, 138.4) months after MED of the DS and SS groups were statistically compared. Patients with DS were classified into 2 groups based on the effectiveness by VAS or JOABPEQ: effective group (E group: IOI or DOI ≥20) and ineffective group (I group). All preoperative radiologic measurements were statistically compared between the E and I groups. RESULTS Significant decreases in low back pain, leg pain, and numbness, as measured by VAS, were noted at follow-up in the DS and SS groups. The effectiveness rates of pain-related disorders, lumbar spine dysfunction, and gait disturbance by JOABPEQ were almost equally high in the DS and SS groups. Statistical comparisons of the DOIs in all 5 functional scores and IOIs in low back pain, leg pain, and numbness showed no significant differences between the DS and SS groups. No significant differences were confirmed between the E and I groups concerning preoperative spondylolisthesis and instability. CONCLUSIONS Our study indicated that preoperative DS did not worsen the outcome of patients with SS undergoing MED.
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Affiliation(s)
- Takato Aihara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan; Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Kojima
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Makoto Urushibara
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hideya Yamauchi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroo Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Murata K, Endo K, Aihara T, Suzuki H, Sawaji Y, Matsuoka Y, Nishimura H, Takamatsu T, Konishi T, Maekawa A, Yamauchi H, Kanazawa K, Endo H, Tsuji H, Inoue S, Fukushima N, Kikuchi H, Sato H, Yamamoto K. Artificial intelligence for the detection of vertebral fractures on plain spinal radiography. Sci Rep 2020; 10:20031. [PMID: 33208824 PMCID: PMC7674499 DOI: 10.1038/s41598-020-76866-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 04/22/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022] Open
Abstract
Vertebral fractures (VFs) cause serious problems, such as substantial functional loss and a high mortality rate, and a delayed diagnosis may further worsen the prognosis. Plain thoracolumbar radiography (PTLR) is an essential method for the evaluation of VFs. Therefore, minimizing the diagnostic errors of VFs on PTLR is crucial. Image identification based on a deep convolutional neural network (DCNN) has been recognized to be potentially effective as a diagnostic strategy; however, the accuracy for detecting VFs has not been fully investigated. A DCNN was trained with PTLR images of 300 patients (150 patients with and 150 without VFs). The accuracy, sensitivity, and specificity of diagnosis of the model were calculated and compared with those of orthopedic residents, orthopedic surgeons, and spine surgeons. The DCNN achieved accuracy, sensitivity, and specificity rates of 86.0% [95% confidence interval (CI) 82.0-90.0%], 84.7% (95% CI 78.8-90.5%), and 87.3% (95% CI 81.9-92.7%), respectively. Both the accuracy and sensitivity of the model were suggested to be noninferior to those of orthopedic surgeons. The DCNN can assist clinicians in the early identification of VFs and in managing patients, to prevent further invasive interventions and a decreased quality of life.
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Affiliation(s)
- Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Asato Maekawa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hideya Yamauchi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kei Kanazawa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hiroo Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hanako Tsuji
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Noritoshi Fukushima
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Hiroki Sato
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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23
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Kobayashi Y, Nagai T, Kamiya K, Konishi T, Sato T, Omote K, Kato Y, Komoriyama H, Tsujinaga S, Iwano H, Kusano K, Yasuda S, Ogawa H, Ueda H, Anzai T. Long-term prognostic significance of dispersion of ventricular repolarization in patients with cardiac sarcoidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2145] [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
Although the presence of cardiac involvement is recognised as a determinant of worse clinical outcomes in sarcoidosis patients, the determinants of adverse outcomes in patients with cardiac sarcoidosis (CS) have not been well understood. T-peak to T-end interval (TpTe) on the surface electrocardiogram (ECG) was proposed as a marker of dispersion of ventricular repolarisation. Prolonged TpTe to QT interval ratio (TpTe/QT) represents a period of potential vulnerability to reentrant ventricular arrhythmias. Notably, prolonged TpTe/QT has been associated with increased risk of mortality in hypertrophic cardiomyopathy, congenital long-QT syndrome, and Brugada syndrome. However, its prognostic implication in patients with CS is unclear.
Purpose
We sought to investigate whether TpTe/QT was associated with long-term clinical outcomes in patients with CS.
Methods
A total of 108 consecutive CS patients between August 1986 and March 2019 in two academic hospitals who had ECG data before initiation of immunosuppressive therapy were examined. We excluded patients who received pacemaker (n=15) or cardiac resynchronization therapy (n=3) at the time of ECG. Ultimately, 90 CS patients were included in this study. All standard 12-lead ECGs were recorded at 25 mm/s with an amplification of 10 mm/mV. TpTe was measured from the peak of T wave to the end of T wave which defined as the intersection of the tangent to the down slope of the T wave and the isoelectric line. Lead V5 was selected for the analyses. If V5 is not suitable for analyses, V4 was selected. The primary outcome was the composite of advanced atrioventricular block (AVB), ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalisation and all-cause death.
Results
During a median follow-up period of 4.70 (interquartile range [IQR] 2.06–7.23) years, adverse events occurred in 21 patients (23.3%), including 2 advanced AVB, 12 VT/VF, 4 heart failure hospitalisation and 3 all-cause death. Events group had higher TpTe/QT compared to no events group (0.231 [IQR 0.193–0.261] vs. 0.282 [IQR 0.263–0.304] P<0.001). Kaplan-Meier analyses revealed that the primary outcome, especially VT/VF or sudden cardiac death more frequently occurred in patients with higher TpTe/QT (≥0.242, the median) compared to those with lower TpTe/QT (Figure 1). Multivariable Cox regression analysis showed that higher TpTe/QT was independently associated with increased subsequent risk of adverse events (hazard ratio 1.09, 95% confidence interval [CI] 1.02–1.17, P=0.014) even after adjustment for age, sex and left ventricular ejection fraction. Furthermore, the optimal cut-off value of TpTe/QT for the discriminatory of primary outcome was 0.257, and c-index was 0.77 (95% CI 0.64–0.89).
Conclusions
Higher TpTe/QT was associated with worse long-term clinical outcomes in patients with CS. Our findings indicate the importance of assessing TpTe/QT for risk stratification in patients with CS.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Kobayashi
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Nagai
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Kamiya
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Konishi
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - T Sato
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Omote
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - Y Kato
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - H Komoriyama
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - S Tsujinaga
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - H Iwano
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
| | - K Kusano
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Osaka, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Osaka, Japan
| | - H Ogawa
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiovascular Medicine, Osaka, Japan
| | - H Ueda
- National Cerebral and Cardiovascular Center Hospital, Department of Clinical Pathology, Osaka, Japan
| | - T Anzai
- Hokkaido University, Department of Cardiovascular Medicine, Sapporo, Japan
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24
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Bellato V, Konishi T, Pellino G, An Y, Piciocchi A, Sensi B, Siragusa L, Khanna K, Pirozzi BM, Franceschilli M, Campanelli M, Efetov S, Sica GS. Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic. Br J Surg 2020; 107:e364-e365. [PMID: 32767367 PMCID: PMC7929295 DOI: 10.1002/bjs.11800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- V Bellato
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - T Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Y An
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - B Sensi
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - L Siragusa
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - K Khanna
- Department of Orthopaedic surgery, Rush university medical center, Chicago, IL
| | - B M Pirozzi
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - M Franceschilli
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - M Campanelli
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | - S Efetov
- Department of Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - G S Sica
- Department of Surgery, Minimally Invasive Unit, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
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25
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Konishi T, Endo K, Aihara T, Matsuoka Y, Suzuki H, Takamatsu T, Kusakabe T, Sawaji Y, Nishimura H, Murata K, Yamamoto K. Effect of cervical flexion and extension on thoracic sagittal alignment. J Orthop Surg (Hong Kong) 2020; 27:2309499019876999. [PMID: 31597519 DOI: 10.1177/2309499019876999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The cervical spine has the largest sagittal motion in the whole spine, and cervical alignment affects the thoracic sagittal alignment. However, the effects of cervical flexion and extension on thoracic sagittal alignment have not been investigated in detail. The purpose of this study was to analyze the change of thoracic sagittal alignment following cervical flexion and extension. SUBJECTS AND METHODS A total of 55 consecutive patients (42 men and 13 women; average age 49.1 years) who presented to our department with spinal degenerative disease between January 2016 and September 2017 were enrolled in our study. Subjects with a history of trauma, infection, tumor, inflammatory disease, ossification, or cervical deformities, and those who had undergone spinal surgery were excluded. The following parameters were analyzed: occipito-axial angle (O-C2), C2 slope (C2S), C2-C7 angle, T1 slope (T1S), thoracic kyphosis, T1-T4 angle, T5-T8 angle, T9-T12 angle, lumbar lordosis, sacral slope, pelvic tilt in cervical flexion, neutral, and extension. RESULTS Cervical flexion significantly decreased O-C2, C2-C7 angles and T1S, and increased C2S. Cervical extension conversely changed these parameters. At cervical flexion, the correlation of C2-C7 angle with thoracic parameters was maintained, except for the T1-T4 angle. At cervical extension, the correlation was observed with T1S and T1-T4 angle. CONCLUSION Cervical flexion affects the T1S and T5-T8 angle, but there is no significant change in T1-T4 and T9 and lower spino-pelvic columns. This study suggests that T2-T4 can be considered as a stable distal end when cervical long fixation for corrective surgery is performed.
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Affiliation(s)
- Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takuya Kusakabe
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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26
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Yamaguchi T, Akiyoshi T, Fukunaga Y, Nagayama S, Nagasaki T, Mukai T, Nakanishi R, Konishi T. Robotic extralevator abdominoperineal resection with en bloc multivisceral resection and lateral lymph node dissection for rectal cancer. Tech Coloproctol 2020; 24:1093-1094. [PMID: 32472358 DOI: 10.1007/s10151-020-02256-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 01/31/2023]
Affiliation(s)
- T Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - T Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Y Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - S Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - T Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - T Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - R Nakanishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - T Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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27
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Kusakabe T, Endo K, Aihara T, Suzuki H, Konishi T, Maekawa A, Seki T, Murata K, Takamatsu T, Matsuoka Y, Sawaji Y, Yamamoto K. Differences in cervical sagittal alignment between the standing and sitting positions. J Orthop Sci 2019; 24:1005-1009. [PMID: 31533891 DOI: 10.1016/j.jos.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 04/10/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sagittal spinal alignment has mainly analyzed in the standing position. According to previous studies, there are significant differences in lumbopelvic alignment between the standing and sitting positions and cervical alignment is affected by lumbopelvic alignment. In this study, therefore, we hypothesized that cervical sagittal alignments are different between the standing and sitting positions. METHODS A total of 108 patients with spinal degenerative diseases underwent whole spine radiography. Cervical lordosis (CL), C2-7 SVA, T1S, C7-S1 SVA, TK, LL, SS, PT, and PI were measured in the standing and sitting positions. Patients were classified into 3 groups according to the changes in CL (ΔCL, CL in the sitting position - CL in the standing position); ΔCL < -3° (Decreased group: DG; 28.7%), -3° ≤ ΔCL ≤ 3° (Unchanged group: UG; 41.7%), and ΔCL > 3° (Increased group: IG; 29.6%). RESULTS The parameters of the UG in the standing position were closer to the ideal alignment (SRS-Schwab classification). In the DG, CL, T1S, and C7-S1 SVA in the standing position were significantly higher than in the UG. In the IG, PI-LL in the standing position was significantly higher than in the UG. In the sitting position, pelvis was rotated posteriorly (decrease in SS and increase in PT) and lumbar lordosis was flattened (decrease in LL) in all groups, and C2-7 SVA was significantly higher in the DG than in the UG. CONCLUSIONS CL was different between the standing and sitting positions in 58.3% of individuals. However, patients with good spinal sagittal alignment appeared to not undergo any changes in cervical alignment. Our results suggest the possibility that patients who had a positive imbalance and large PI-LL mismatch in the standing position had decreased CL and increased CL, respectively, when in the sitting position.
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Affiliation(s)
- Takuya Kusakabe
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Asato Maekawa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Seki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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28
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Konishi T. P5366Eicosapentaenoic acid therapy is associated with decreased coronary plaque instability assessed using optical frequency domain imaging. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relationship between eicosapentaenoic acid (EPA) therapy and coronary plaque stability assessed by optical frequency domain imaging (OFDI) has not been thoroughly described.
Hypothesis
EPA therapy is associated with decreased plaque instability in patients undergoing percutaneous coronary intervention (PCI) using OFDI.
Methods
Data on coronary artery plaques from 121 patients presenting with acute coronary syndrome or stable angina who consecutively underwent PCI between October 2015 and July 2018 were retrospectively analyzed. Of these patients, 109 were untreated (no-EPA group), whereas 12 were treated with EPA (EPA group). Each plaque's morphological characteristics were analyzed using OFDI.
Results
We used 1:4 propensity score matching for patients who received or did not receive EPA therapy before PCI. Baseline characteristics were balanced between both groups (age, sex, body mass index, diabetes mellitus, hypertension, dyslipidemia, chronic kidney disease, smoking, previous PCI or coronary artery bypass grafting, previous myocardial infarction, prior statin use, acute coronary syndrome, hemoglobin A1c level, low-density lipoprotein cholesterol concentration, triglyceride concentration, and high-density lipoprotein cholesterol concentration). The EPA group had significantly lower mean lipid index (818±806 vs. 1,574±891) and macrophage grade (13.5±5.9 vs. 19.3±7.4) but higher mean minimum fibrous cap thickness (109.2±55.7 vs. 81.6±36.4 μm) than the no-EPA group (P=0.010, 0.019, and 0.040, respectively). Multiple logistic regression analyses showed that prior EPA use was independently associated with lower lipid index and macrophage grade (P=0.043 and 0.024, respectively).
Conclusion
This OFDI analysis suggests that EPA therapy is associated with decreased plaque instability in patients undergoing PCI.
Acknowledgement/Funding
None
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29
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Nishizaki D, Hida K, Sumii A, Sakai Y, Konishi T, Akagi T, Yamaguchi T, Akiyoshi T, Fukuda M, Yamamoto S, Maruyama S, Okajima M, Miyakura Y, Okamura R, Arizono S, Yamamoto M, Kawada K, Morita S, Watanabe M. Neoadjuvant chemoradiotherapy with/without lateral lymph node dissection for low rectal cancer: Which patients can benefit? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Akiyoshi T, Toda S, Tominaga T, Oba K, Tomizawa K, Hanaoka Y, Nagasaki T, Konishi T, Matoba S, Fukunaga Y, Ueno M, Kuroyanagi H. Prognostic impact of residual lateral lymph node metastasis after neoadjuvant (chemo)radiotherapy in patients with advanced low rectal cancer. BJS Open 2019; 3:822-829. [PMID: 31832589 PMCID: PMC6887909 DOI: 10.1002/bjs5.50194] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 02/10/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
Background There is a lack of large studies focusing on the prognostic significance of lateral lymph node (LLN) metastasis following LLN dissection (LLND) in rectal cancer. The aim of this study was to evaluate the prognostic impact of LLN metastases on survival of patients with advanced low rectal cancer. Methods Consecutive patients with locally advanced, but not metastatic, extraperitoneal rectal cancer treated with neoadjuvant (chemo)radiotherapy plus total mesorectal excision between 2004 and 2015 were included in the study. LLND was performed when pretreatment imaging documented enlarged LLNs (7 mm or greater in size). Localization of nodal metastases and long‐term outcomes were analysed. Kaplan–Meier analysis was used to compare the survival of patients with ypN0 disease with that of patients with mesorectal ypN+/LLN− status and patients with positive LLNs. The Cox proportional hazards model was used to evaluate predictors of disease‐free survival (DFS) and local recurrence. Results A total of 613 patients were included in the study; LLND was performed in 212 patients (34·6 per cent) and 57 (9·3 per cent) had LLN metastasis. Patients with LLN metastasis had improved DFS and local recurrence cumulative incidence rates compared with patients with mesorectal ypN2+/LLN− disease (DFS: P = 0·014; local recurrence: P = 0·006). Although the DFS rate of patients with LLN metastasis was worse than that of patients with ypN0 disease (P < 0·001), the cumulative incidence of local recurrence was similar (P = 0·491). In multivariable analysis, residual LLN metastasis was not an independent predictor of worse DFS or local recurrence. Conclusion LLN metastasis is not an independent predictor of local recurrence or survival. Survival of patients presenting with LLN metastasis after (chemo)radiotherapy was intermediate between that of patients with ypN0 status and those with mesorectal ypN2 positivity.
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Affiliation(s)
- T Akiyoshi
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - S Toda
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - T Tominaga
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - K Oba
- Department of Biostatistics, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - K Tomizawa
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - Y Hanaoka
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - T Nagasaki
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - T Konishi
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - S Matoba
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - Y Fukunaga
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - M Ueno
- Gastroenterological Centre, Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan
| | - H Kuroyanagi
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
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31
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Konishi T, Kodaira S, Itakura Y, Ohsawa D, Homma-Takeda S. IMAGING URANIUM DISTRIBUTION ON RAT KIDNEY SECTIONS THROUGH DETECTION OF ALPHA TRACKS USING CR-39 PLASTIC NUCLEAR TRACK DETECTOR. Radiat Prot Dosimetry 2019; 183:242-246. [PMID: 30521045 DOI: 10.1093/rpd/ncy224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 06/09/2023]
Abstract
Uranium is renowned as a global contaminant, and attracts major concern with regards to the health risks involved because its nephrotoxicity. This paper discusses the development of a simple method to identify accumulated regions or localized sites of uranium within kidneys using the CR-39 plastic nuclear track detector. To demonstrate the proposed method, renal cryo-sections (5 μm-t) from Wistar male rats, subcutaneously administered with uranyl acetate (2 mg/kg), were prepared on day one after administration. Concerned sections were subsequently placed on CR-39, stored for 1.25 years, and then etched in a 7 M NaOH solution at 70°C for 3 h. α-tracks were then detected in the form of etch pits, corresponding to uranium, and also the tissue shape and structure were transferred as a roughness on the surface of CR-39. As observed, the proposed method served to facilitate simultaneous detection and identification of localized regions of uranium accumulation within kidneys.
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Affiliation(s)
- T Konishi
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - S Kodaira
- Department of Radiation Measurement and Dose Assessment, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Y Itakura
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - D Ohsawa
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - S Homma-Takeda
- Department of Basic Medical Sciences for Radiation Damages, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Kobayashi A, Autsavapromporn N, Ahmad TAFT, Oikawa M, Homma-Takeda S, Furusawa Y, Wang J, Konishi T. BYSTANDER WI-38 CELLS MODULATE DNA DOUBLE-STRAND BREAK REPAIR IN MICROBEAM-TARGETED A549 CELLS THROUGH GAP JUNCTION INTERCELLULAR COMMUNICATION. Radiat Prot Dosimetry 2019; 183:142-146. [PMID: 30535060 DOI: 10.1093/rpd/ncy249] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bi-directional signaling involved in radiation-induced bystander effect (RIBE) between irradiated carcinoma cells and their surrounding non-irradiated normal cells is relevant to radiation cancer therapy. Using the SPICE-NIRS microbeam, we delivered 500 protons to A549-GFP lung carcinoma cells, stably expressing H2B-GFP, which were co-cultured with normal WI-38 cells. The level of γ-H2AX, a marker for DNA double-strand breaks (DSB), was subsequently measured up to 24-h post-irradiation in both targeted and bystander cells. As a result, inhibition of gap junction intercellular communication (GJIC) attenuated DSB repair in targeted A549-GFP cells, and suppressed RIBE in bystander WI-38 cells but not in distant A549-GFP cells. This suggests that GJIC plays a two-way role through propagating DNA damage effect between carcinoma to normal cells and reversing the bystander signaling, also called 'rescue effect' from bystander cells to irradiated cells, to enhance the DSB repair in targeted cells.
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Affiliation(s)
- A Kobayashi
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - N Autsavapromporn
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
- Division of Therapeutic Radiology and Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Thailand
| | - T A F Tengku Ahmad
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
- Division of Agrotechnology and Biosciences, Malaysian Nuclear Agency, Bangi, Kajang, Malaysia
| | - M Oikawa
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
| | - S Homma-Takeda
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
| | - Y Furusawa
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
| | - J Wang
- Key Laboratory of Ion Beam Bioengineering, Hefei Institute of Physical Science, Chinese Academy of Sciences and Anhui Province, No. 350 of Shushanhu Road, Hefei, PR China
| | - T Konishi
- SPICE-BIO research core, International Open Laboratory, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba, Japan
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Furusawa Y, Matsumoto Y, Hirayama R, Ohsawa D, Konishi T. DOSE-RATE AND CELL-KILLING SENSITIVITY OF HIGH-LINEAR ENERGY TRANSFER ION BEAM. Radiat Prot Dosimetry 2019; 183:219-222. [PMID: 30566666 DOI: 10.1093/rpd/ncy267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
It is believed that the dose-rate of radiation will have an influence on cell sensitivity. The dose-rate effects on cell survival can be expressed by the change of the β term in the linear quadratic model. The value at a high-dose-rate decreases below 60 Gy/h and reaches zero at 0.2 Gy/h or less for photons. However, the effect for a high-LET ion-beam is not well known. At HIMAC, cells were exposed to 70 keV/μm carbon-ion beams at different dose-rates between 0.5 and 600 Gy/h at room temperature. The β values for all survival curves show no significant differences among the dose-rates tested for HSG, V79 and CHO cells. Changing the ion-beam dose-rate had no effect on cell survival. This suggests that high-LET particle beams, such as galactic cosmic rays, may not exhibit a dose-rate effect on cell survival. Low-dose-rate radiation showed an effect similar to high-dose-rate radiation.
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Affiliation(s)
- Y Furusawa
- Department of Basic Medical Sciences for Radiation Damages, National Institutes of Radiological Sciences, QST (National Institutes for Quantum and Radiological Science and Technology), 4-9-1, Anagawa, Inage-ku, Chiba, Japan
| | - Y Matsumoto
- Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan
| | - R Hirayama
- Department of Basic Medical Sciences for Radiation Damages, National Institutes of Radiological Sciences, QST (National Institutes for Quantum and Radiological Science and Technology), 4-9-1, Anagawa, Inage-ku, Chiba, Japan
| | - D Ohsawa
- Department of Basic Medical Sciences for Radiation Damages, National Institutes of Radiological Sciences, QST (National Institutes for Quantum and Radiological Science and Technology), 4-9-1, Anagawa, Inage-ku, Chiba, Japan
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - T Konishi
- Department of Basic Medical Sciences for Radiation Damages, National Institutes of Radiological Sciences, QST (National Institutes for Quantum and Radiological Science and Technology), 4-9-1, Anagawa, Inage-ku, Chiba, Japan
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Maekawa A, Endo K, Suzuki H, Sawaji Y, Nishimura H, Matsuoka Y, Murata K, Takamatsu T, Seki T, Konishi T, Kusakabe T, Aihara T, Yamamoto K. Impact of pelvic incidence on change in lumbo-pelvic sagittal alignment between sitting and standing positions. Eur Spine J 2019; 28:1914-1919. [PMID: 30859390 DOI: 10.1007/s00586-019-05891-9] [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] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/09/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Lumbo-pelvic sagittal alignment is affected by pelvic incidence (PI), and the PI represents the compensatory capacity of lumbo-pelvic sagittal alignment. The purpose of this study was to analyze changes in lumbo-pelvic sagittal alignment between the standing and sitting positions and to analyze its association with PI. METHODS This study included 253 subjects (160 men and 93 women; age 53.6 ± 7.4 years). The subjects were divided into three groups (younger age group (YG), from 20 to 49 years; middle age group, from 50 to 69 years, and older age group (OG), of 70 years and above). Lumbar lordotic angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and the associations between the changes in LL (∆LL), SS (∆SS), PT (∆PT), and PI were analyzed. RESULTS In the YG, the amount of change in LL, SS, and PT was larger than in the OG. These parameters correlated with age in the standing position but not in the sitting position. On the other hand, in all groups, there were positive correlations between PI and changes between the standing and sitting positions. Multiple logistic regression analysis demonstrated that ∆LL = 3.81 - 0.72 × PT + 0.52 × PI, ∆SS = - 4.50 - 5.3 × PT + 0.34 × PI, and ∆PT = - 9.1 + 3.5 × PT - 0.21 × PI. CONCLUSIONS Change in lumbo-pelvic parameters between the sitting and standing positions correlated with PI. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Asato Maekawa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takeshi Seki
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takuya Kusakabe
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Kozuki R, Shinozaki E, Osumi H, Wakatsuki T, Suenaga M, Ichimura T, Ogura M, Suzuki T, Ota Y, Nakayama I, Takahari D, Chin K, Nagasaki T, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M, Yamaguchi K. A retrospective analysis of the association between perioperative carcinoembryonic antigen level and prognosis in stage III colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy431.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Matsuoka Y, Endo K, Suzuki H, Sawaji Y, Nishimura H, Takamatsu T, Kojima O, Murata K, Seki T, Horie S, Konishi T, Yamamoto K. Postoperative Radiographic Early-Onset Adjacent Segment Degeneration after Single-Level L4-L5 Posterior Lumbar Interbody Fusion in Patients without Preoperative Severe Sagittal Spinal Imbalance. Asian Spine J 2018; 12:743-748. [PMID: 30060385 PMCID: PMC6068422 DOI: 10.31616/asj.2018.12.4.743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/17/2017] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To investigate the relationship between preoperative total spinal sagittal alignment and the early onset of adjacent segment degeneration (ASD) after single-level posterior lumbar interbody fusion (PLIF) in patients with normal sagittal spinal alignment. Overview of Literature Postoperative early-onset ASD is one of the complications after L4–L5 PLIF, a common surgical procedure for lumbar degenerative disease in patents without severe sagittal imbalance. A better understanding of the preoperative characteristics of total spinal sagittal alignment associated with early-onset ASD could help prevent the condition. Methods The study included 70 consecutive patients diagnosed with lumbar degenerative disease who underwent single-level L4–L5 PLIF between 2011 and 2015. They were divided into two groups based on the radiographic progression of L3–L4 degeneration after 1-year follow-up: the ASD and the non-ASD (NASD) group. The following radiographic parameters were preoperatively and postoperatively measured: sagittal vertebral axis (SVA), thoracic kyphosis (TK), lumbar lordosis, pelvic tilt, and pelvic incidence (PI). Results Eight of the 70 patients (11%) experienced ASD after PLIF (three males and five females; age, 64.4±7.7 years). The NASD group comprised 20 males and 42 females (age, 67.7±9.3 years). Six patients of the ASD group showed decreased L3–L4 disc height, one had L3–L4 local kyphosis, and one showed both changes. Preoperative SVA, PI, and TK were significantly smaller in the ASD group than in the NASD group (p <0.05). Conclusions A preoperative small SVA and TK with small PI were the characteristic alignments for the risk of early-onset ASD in patients without preoperative severe sagittal spinal imbalance undergoing L4–L5 single-level PLIF.
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Affiliation(s)
- Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Osamu Kojima
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Seki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shinji Horie
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Konishi T, Watanabe T, Shibahara J, Nagawa H. Surveillance Colonoscopy Should be Conducted in Patients with Colorectal Shistosomiasis Even after Successful Treatment of the Disease. Int J Immunopathol Pharmacol 2018. [DOI: 10.1177/205873920601900127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- T. Konishi
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - T. Watanabe
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - J. Shibahara
- Department of Pathology, University of Tokyo, Tokyo, Japan
| | - H. Nagawa
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
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Matsuoka Y, Endo K, Nishimura H, Suzuki H, Sawaji Y, Takamatsu T, Seki T, Murata K, Konishi T, Yamamoto K. Cervical Kyphotic Deformity after Laminoplasty in Patients with Cervical Ossification of Posterior Longitudinal Ligament with Normal Sagittal Spinal Alignment. Spine Surg Relat Res 2018; 2:210-214. [PMID: 31440670 PMCID: PMC6698525 DOI: 10.22603/ssrr.2017-0078] [Citation(s) in RCA: 5] [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: 10/26/2017] [Accepted: 12/03/2017] [Indexed: 11/23/2022] Open
Abstract
Background Preoperative cervico-thoracic kyphosis and cervical regional positive imbalance are the risk factors for postoperative cervical kyphosis after expansive laminoplasty (ELAP). However, the relationship between preoperative global sagittal spinal alignment and postoperative cervical kyphosis in patients with cervical ossification of the posterior longitudinal ligament (OPLL) is unclear. The purpose of this study was to investigate the relationship between the onset of postoperative cervical kyphosis after ELAP and the preoperative global spinal sagittal alignment in patients with OPLL with normal sagittal spinal alignment. Methods Sixty-nine consecutive patients without preoperative cervical kyphosis who underwent ELAP for OPLL and cervical spondylotic myelopathy (CSM) were enrolled. The global sagittal alignment radiography preoperatively and 1 year postoperatively were examined. The subjects were divided into a postoperative cervical lordosis group (LG) or a kyphosis group (KG) at 1 year postoperatively. The preoperative global sagittal spinal alignment between LG and KG in CSM and OPLL was compared. Results The occurrence of cervical kyphosis after ELAP was 7 of 27 cases (25.9%) in OPLL and 13 of 42 cases (31.0%) in CSM. In patients with CSM in the KG, C7 the sagittal vertical axis (SVA) was smaller than in the LG. In patients with cervical OPLL in the KG, C2-C7 angle, C2-C7 SVA, and thoracic kyphosis (TK) were smaller than those in the LG. In OPLL, the age of the KG was younger than that of LG; however, this was not a significant difference in CSM. Conclusion In patients with cervical OPLL without preoperative global spinal sagittal imbalance, preoperative small C2-C7 angle, C2-C7 SVA, TK, and younger age were typical characteristics of postoperative cervical kyphosis after ELAP.
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Affiliation(s)
- Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Seki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Suzuki H, Endo K, Sawaji Y, Matsuoka Y, Nishimura H, Takamatsu T, Murata K, Seki T, Konishi T, Aihara T, Yamamoto K. Radiographic Assessment of Spinopelvic Sagittal Alignment from Sitting to Standing Position. Spine Surg Relat Res 2018; 2:290-293. [PMID: 31435536 PMCID: PMC6690107 DOI: 10.22603/ssrr.2017-0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/20/2017] [Accepted: 12/21/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Most people in modern societies spend the majority of their time sitting. However, sagittal spinal alignment is usually analyzed in the standing position. For understanding the symptoms associated with postural changes, this alignment is better to be analyzed in various positions. The purpose of this study was to investigate lumbo-pelvic relationships between standing up and sitting (sit-to-stand) motion. Methods The study subjects were 25 healthy young adult volunteers without any spinal symptoms. The following parameters were measured, namely, intervertebral range of motion (IV ROM), lumbar lordotic angle (L1L5), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI), on lateral whole-spine radiographs while sitting upright, sitting anterior flexed (anteflexed), standing anteflexed, and standing upright. Results The measurements of spinopelvic parameters during sit-to-stand motion (sitting upright, sitting anteflexed, standing anteflexed, standing upright, respectively) were as follows: L1L5 (7.9, −4.4, 3.1, 31.9) and PT (31.5, 26.5, 11.9, 7.7). Regarding IV ROM, the lumbar segmental ROM after seat-off was wider than before seat-off (sitting anteflexed). In particular, the L4-L5 segments had a wide ROM from standing anteflexed to standing upright. Conclusions The pelvis was retroverted in the sitting upright position and gradually anteverted during sit-to-stand motion. Lumbar lordosis decreased in the sitting upright position, temporarily decreased further (sitting anteflexed), and then increased in the standing position (standing anteflexed and standing upright). The mechanical loads on lumbosacral segments were greater after seat-off due to the reverse movement between upper lumbar and pelvic segments.
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Affiliation(s)
- Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenji Endo
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasunobu Sawaji
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taichiro Takamatsu
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuma Murata
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Seki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takamitsu Konishi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takato Aihara
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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Imai N, Shota I, Horiuchi K, Tasaki A, Yagi N, Konishi T, Serizawa M, Kobari M. Comparison of resting-state functional connectivity between women with chronic migraine and those with episodic migraine. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shinozaki E, Sakata S, Konishi T, Osumi H, Ueno M, Yamaguchi K, Takeuchi K. Array based profiling of emerging molecules in colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.096] [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: 11/15/2022] Open
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Takagane A, Mohri Y, Konishi T, Fukushima R, Noie T, Sueyoshi S, Omura K, Ono S, Kusunoki M, Mochizuki H, Sumiyama Y. Randomized clinical trial of 24 versus 72 h antimicrobial prophylaxis in patients undergoing open total gastrectomy for gastric cancer. Br J Surg 2017; 104:e158-e164. [PMID: 28121044 DOI: 10.1002/bjs.10439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/08/2016] [Accepted: 10/31/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy. METHODS An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of β-lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection. RESULTS A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (8·8 per cent) in the 24-h prophylaxis group and 26 (11·0 per cent) in the 72-h group (absolute difference -2·2 (90 per cent c.i. -6·8 to 2·4) per cent; P < 0·001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group. CONCLUSION Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).
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Affiliation(s)
- A Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Y Mohri
- Department of Gastrointestinal and Paediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - T Konishi
- Division of Medical Nutrition, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan
| | - R Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - T Noie
- Department of Surgery, NTT Medical Centre, Tokyo, Japan
| | - S Sueyoshi
- Department of Surgery, Omuta City Hospital, Omuta, Japan
| | - K Omura
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - S Ono
- Division of Critical Care Medicine, Tokyo Medical University Hachioji Medical Centre, Tokyo, Japan
| | - M Kusunoki
- Department of Gastrointestinal and Paediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - H Mochizuki
- Department of Surgery, National Defence Medical College, Tokorozawa, Japan
| | - Y Sumiyama
- Department of Surgery, Toho University Medical Centre, Ohashi Hospital, Tokyo, Japan
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Konishi T, Clarke E, Burrows CW, Bomphrey JJ, Murray R, Bell GR. Spatial regularity of InAs-GaAs quantum dots: quantifying the dependence of lateral ordering on growth rate. Sci Rep 2017; 7:42606. [PMID: 28211899 PMCID: PMC5304192 DOI: 10.1038/srep42606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/04/2016] [Accepted: 01/11/2017] [Indexed: 11/21/2022] Open
Abstract
The lateral ordering of arrays of self-assembled InAs-GaAs quantum dots (QDs) has been quantified as a function of growth rate, using the Hopkins-Skellam index (HSI). Coherent QD arrays have a spatial distribution which is neither random nor ordered, but intermediate. The lateral ordering improves as the growth rate is increased and can be explained by more spatially regular nucleation as the QD density increases. By contrast, large and irregular 3D islands are distributed randomly on the surface. This is consistent with a random selection of the mature QDs relaxing by dislocation nucleation at a later stage in the growth, independently of each QD’s surroundings. In addition we explore the statistical variability of the HSI as a function of the number N of spatial points analysed, and we recommend N > 103 to reliably distinguish random from ordered arrays.
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Affiliation(s)
- T Konishi
- Centre for Collaborative Research, National Institute of Technology, Anan College, Anan, Tokushima, Japan
| | - E Clarke
- EPSRC National Centre for III-V Technologies, Department of Electronic and Electrical Engineering, University of Sheffield, Mappin Street, Sheffield, S1 3JD, United Kingdom
| | - C W Burrows
- Department of Physics, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - J J Bomphrey
- Department of Chemistry, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - R Murray
- Department of Physics, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom
| | - G R Bell
- Department of Physics, University of Warwick, Coventry, CV4 7AL, United Kingdom
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Ikeda A, Konishi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Akiyoshi T, Yamaguchi T. Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection. Br J Surg 2016; 103:1608-1615. [DOI: 10.1002/bjs.10281] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
The use of oral prophylactic antibiotics for the prevention of surgical-site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer is controversial. The aim of this RCT was to evaluate whether intravenous perioperative antibiotics are inferior to combined preoperative oral and perioperative intravenous antibiotics in this setting.
Methods
Patients undergoing elective laparoscopic colorectal resection in a single cancer centre were assigned randomly to combined preoperative oral antibiotics (metronidazole and kanamycin) and perioperative intravenous antibiotics (cefmetazole) (oral/IV group) or to perioperative intravenous antibiotics (cefmetazole) alone (IV-only group). Patients were stratified for the analyses based on type of operation (colonic surgery, anterior resection or abdominoperineal resection), preoperative use of mechanical bowel preparation, preoperative chemoradiotherapy and the presence of diabetes mellitus. The primary endpoint was the overall rate of SSI. Secondary endpoints were the rates of incisional site infection, organ/space infection, anastomotic leakage, intra-abdominal abscess, adverse events and postoperative complications.
Results
Of 540 patients offered participation in the trial in 2013–2014, 515 agreed to take part and were randomized. Some 256 patients in the IV-only group and 255 in the oral/IV group completed the treatment per protocol. The overall rate of SSI was 7·8 per cent (20 of 256) in the IV-only group and 7·8 per cent (20 of 255) in the oral/IV group, confirming that perioperative administration of intravenous antibiotics alone was not inferior to the combined regimen (P = 0·017). There were no differences in rates of incisional site infection (5·5 versus 5·9 per cent respectively), organ/space infection (2·3 versus 2·0 per cent) or other secondary endpoints between the two groups.
Conclusion
Intravenous perioperative antimicrobial prophylaxis alone is not inferior to combined preoperative oral and intravenous perioperative prophylaxis with regard to SSI in patients with colorectal cancer undergoing elective laparoscopic resection. Registration number: UMIN000019339 (http://www.umin.ac.jp/ctr/).
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Affiliation(s)
- A Ikeda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - T Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - M Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Y Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - S Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Y Fujimoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - T Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - T Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
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Akiyoshi T, Nagata J, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M. Laparoscopic salvage lateral pelvic lymph node dissection for locally recurrent rectal cancer. Colorectal Dis 2015; 17:O213-6. [PMID: 26277783 DOI: 10.1111/codi.13088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 02/02/2015] [Accepted: 05/22/2015] [Indexed: 12/13/2022]
Abstract
AIM The lateral pelvic lymph nodes are one of the major sites and sources of local recurrence (LR) after surgery for rectal cancer. Salvage lateral pelvic lymph node dissection (LPLD) is potentially curative, but the value of laparoscopic surgery in such cases is unknown. Our aim was to report the technical details of laparoscopic salvage LPLD for LR at these nodes after rectal cancer surgery. METHOD The study was based on nine patients who underwent laparoscopic salvage LPLD for LR at the lateral pelvic lymph nodes after surgery for rectal cancer. The safety and feasibility of this procedure were determined. RESULTS The median operation time was 381 min and the median estimated blood loss was 130 ml. There were no conversions. Adjacent structures removed en bloc were the pelvic plexus in four patients, the internal iliac artery in seven patients and the seminal vesicle in one patient. The median number of metastatic lymph nodes was 1 (range 1-11). CONCLUSION Our novel technique of laparoscopic salvage LPLD for LR at the lateral pelvic lymph nodes is safe and feasible.
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Affiliation(s)
- T Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - J Nagata
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Ng C, Kong E, Konishi T, Kobayashi A, Suya N, Cheng S, Yu K. Low-dose neutron dose response of zebrafish embryos obtained from the Neutron exposure Accelerator System for Biological Effect Experiments (NASBEE) facility. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Somasundaram A, Rajarajan A, Vigneshwaran P, Vengadeshprabhu K, Meilei H, Suzuki K, Watanabe K, Konishi T. Dietary Petitvert supplementation protects against acute colitis induced by dextran sulphate sodium in mice. PharmaNutrition 2014. [DOI: 10.1016/j.phanu.2013.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- S Kono
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - H Takashima
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - D Suzuki
- Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - T Terada
- Laboratory of Human Brain Imaging Research, Molecular Imaging Frontier Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - T Konishi
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - H Miyajima
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Yurikusa T, Yokota T, Kubo T, Sawamura M, Tachibana H, Konishi T, Zenda S, Taguri M, Sato M, Ota Y. Medical Staff Training Program for Assessment of Chemoradiotherapy-Induced Oral Mucositis in Head and Neck Cancer. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.38] [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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Choi VWY, Ng CYP, Kobayashi A, Konishi T, Suya N, Ishikawa T, Cheng SH, Yu KN. Bystander effect between zebrafish embryos in vivo induced by high-dose X-rays. Environ Sci Technol 2013; 47:6368-6376. [PMID: 23668636 DOI: 10.1021/es401171h] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We employed embryos of the zebrafish, Danio rerio, for our studies on the in vivo bystander effect between embryos irradiated with high-dose X-rays and naive unirradiated embryos. The effects on the naive whole embryos were studied through quantification of apoptotic signals at 25 h post fertilization (hpf) through the terminal dUTP transferase-mediated nick end-labeling (TUNEL) assay followed by counting the stained cells under a microscope. We report data showing that embryos at 5 hpf subjected to a 4-Gy X-ray irradiation could release a stress signal into the medium, which could induce a bystander effect in partnered naive embryos sharing the same medium. We further demonstrated that this bystander effect (induced through partnering) could be successfully suppressed through the addition of the nitric oxide (NO) scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (cPTIO) into the medium but not through the addition of the CO liberator tricarbonylchloro(glycinato)ruthenium(II) (CORM-3). This shows that NO was involved in the bystander response between zebrafish embryos induced through X-ray irradiation. We also report data showing that the bystander effect could be successfully induced in naive embryos by introducing them into the irradiated embryo conditioned medium (IECM) alone, i.e., without partnering with the irradiated embryos. The IECM was harvested from the medium that had conditioned the zebrafish embryos irradiated at 5 hpf with 4-Gy X-ray until the irradiated embryos developed into 29 hpf. NO released from the irradiated embryos was unlikely to be involved in the bystander effect induced through the IECM because of the short life of NO. We further revealed that this bystander effect (induced through IECM) was rapidly abolished through diluting the IECM by a factor of 2× or greater, which agreed with the proposal that the bystander effect was an on/off response with a threshold.
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Affiliation(s)
- V W Y Choi
- Department of Physics and Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, Hong Kong
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