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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Fujita T, Sakai K, Uehara N, Hoshi Y, Mori A, Koyama H, Sato M, Saito K, Osaki Y, Nishio K, Doi K. Genetic variants of cancer‑associated genes analyzed using next‑generation sequencing in small sporadic vestibular schwannomas. Oncol Lett 2023; 25:121. [PMID: 36844630 PMCID: PMC9950330 DOI: 10.3892/ol.2023.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Vestibular schwannoma (VS) is the most common tumor of the cerebellopontine angle. Despite the increasing diagnosis of sporadic VS over the past decade, the use of traditional microsurgeries to treat VS has decreased. This is likely a result of the adoption of serial imaging as the most common initial evaluation and treatment strategy, especially for small-sized VS. However, the pathobiology of VSs remains unclear, and elucidating the genetic information of tumor tissue may reveal novel insights. The present study performed a comprehensive genomic analysis of all exons in the key tumor suppressor and oncogenes from 10 small (<15 mm) sporadic VS samples. The evaluations identified NF2, SYNE1, IRS2, APC, CIC, SDHC, BRAF, NUMA1, EXT2, HRAS, BCL11B, MAGI1, RNF123, NLRP1, ASXL1, ADAMTS20, TAF1L, XPC, DDB2 and ETS1 as mutated genes. The current study could not draw any new conclusions about the relationship between VS-related hearing loss and gene mutations; however, it did reveal that NF2 was the most frequently mutated gene in small sporadic VS.
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Affiliation(s)
- Takeshi Fujita
- Department of Otolaryngology Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan,Correspondence to: Dr Takeshi Fujita, Department of Otolaryngology Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuoku, Kobe, Hyogo 650-0017, Japan, E-mail:
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Natsumi Uehara
- Department of Otolaryngology Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Yujiro Hoshi
- Department of Otorhinolaryngology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
| | - Anjin Mori
- Department of Otorhinolaryngology - Head and Neck Surgery, NTT Medical Center Tokyo, Tokyo 141-8625, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Mitsuo Sato
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Kazuya Saito
- Department of Otorhinolaryngology, Izumi City General Hospital, Izumi, Osaka 594-0073, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
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Otsuka S, Imai R, Kamakura T, Nishimura H, Osaki Y, Furukawa M, Yasui T, Yamashita M, Nakamura M, Iwamoto Y, Kanazu K, Yonei S, Okazaki S, Hirose M. How long do tympanostomy ventilation tubes last in pediatric patients with otitis media with effusion or adhesion? A study using Kaplan-Meier survival analysis. Int J Pediatr Otorhinolaryngol 2022; 159:111210. [PMID: 35724491 DOI: 10.1016/j.ijporl.2022.111210] [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: 12/31/2021] [Revised: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the functional duration and survival rate of tympanostomy ventilation tubes and the complications associated with their use in pediatric patients who underwent tube insertion for otitis media with effusion (OME). Complications were analyzed including recurrence and tympanic membrane perforation after the tube removal or extrusion. METHODS Altogether, 447 ears from 234 pediatric patients younger than 15 years of age were studied retrospectively. All patients had undergone long-term tympanostomy ventilation tube: the Goode T-tube insertion for OME at the Osaka Women's and Children's Hospital, which is the pediatrics specialty hospital between April 2014 and March 2016. They were typically followed up every 3-4 months or more frequently if necessary due to otorrhea or tube infection. Subsequently, the tube duration, survival rates of the tube especially at 22 months after insertion defined as "full-term placement", and the rates of recurrence and perforation were calculated and statistically evaluated. RESULTS Of 447 ears, 335 ears from 184 patients underwent their first tube insertion, and 112 ears from 64 patients underwent their second or subsequent tube insertion within the targeted period. Two hundred ears from 106 patients were associated with a cleft palate. The survival rate at full-term placement was 51.7%. The recurrence rate was 56.3%, and the rate of the tympanic perforation was 8.5%. CONCLUSIONS Approximately half of the tubes survived for 22 months. The perforation rate was relatively low; however, recurrence of OME was seen in more than half the ears.
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Affiliation(s)
- Shintaro Otsuka
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology, Nara City Hospital, 1-50-1 Higashikideracho, Nara, Nara, 630-8305, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Nishimura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masashi Furukawa
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Furukawa ENT Clinic, 5-1 Oharacho, Ashiya, Hyogo, 659-0092, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Yasui ENT Clinic, 1294-1 Minaminakayasumatsu, Izumisano, Osaka, 598-0033, Japan
| | - Maki Yamashita
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Megumi Nakamura
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otorhinolaryngology-Head and Neck Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojimaku, Osaka, 534-0021, Japan
| | - Yoriko Iwamoto
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Kimi Kanazu
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Shinichi Yonei
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan; Department of Otolaryngology-Head and Neck Surgery, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Suzuyo Okazaki
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
| | - Masayuki Hirose
- Department of Otorhinolaryngology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, 594-1101, Japan
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Kobayashi T, Iwamoto S, Sahara T, Hoshi Y, Mori A, Koyama H, Fujita T, Sato MP, Osaki Y, Doi K. Examination of risk factors for postoperative vestibular symptoms in patients with cholesteatoma. Acta Otolaryngol 2022; 142:13-18. [PMID: 34923899 DOI: 10.1080/00016489.2021.2014071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In cholesteatoma, the prognosis of tympanoplasty has been well discussed in terms of hearing outcomes and residual or recurrent lesions. Postoperative dizziness and vertigo are major complications of tympanoplasty; however, few reports are available. AIMS/OBJECTIVES We investigated each condition of cholesteatoma postoperative vestibular risk using the STAM system and staging published by EAONO/JOS, as well as findings on bony destruction. MATERIAL AND METHODS From April 2010 to March 2021, 156 patients (166 ears) with cholesteatoma who underwent primary microscopic tympanoplasty at our hospital were registered. Subjective vestibular symptoms were recorded the day after surgery. RESULTS Postoperative vestibular symptoms were observed in 13.9% of subjects. All of them were stage II and had both attic and mastoid lesions. Attic (p < .05) and mastoid (p < .01) lesions were risk factors. Multivariate analysis showed that significant differences were found in past histories of vestibular symptoms (p < .05) and exposure of the dura mater (p < .01). CONCLUSIONS AND SIGNIFICANCE In the exposed dura group, the length of the prominence of the lateral semicircular canal to the middle cranial fossa dura was significantly shorter than that of the non-exposed group (p < .01). Narrow working space and downward operation may increase vestibular risk.
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Affiliation(s)
- Takaaki Kobayashi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shusuke Iwamoto
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toshihito Sahara
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yujiro Hoshi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Anjin Mori
- NTT Medical Center Tokyo, Department of Otorhinolaryngology Head and Neck Surgery, Tokyo, Japan
| | - Hajime Koyama
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takeshi Fujita
- Department of Otorhinolaryngology Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuo P. Sato
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
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Shimizu K, Imai T, Oya R, Okumura T, Sato T, Osaki Y, Ohta Y, Inohara H. Platform posturography of patients with peripheral vestibular dysfunction in the non-acute phase of vertigo. Auris Nasus Larynx 2020; 48:577-582. [PMID: 33189459 DOI: 10.1016/j.anl.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Posturography (PG) shows various patterns corresponding to a patient's equilibrium condition; however, PG is not useful for the differential diagnosis of peripheral vestibular diseases (PVDs). The aim of this study was to identify parameters of PG that can distinguish between PVDs. METHODS The differences in PG parameters between PVDs were evaluated retrospectively. Two hundred and two patients with Ménière's disease (MD), 154 patients with benign paroxysmal positional vertigo (BPPV), 20 patients with sudden sensorineural hearing loss with vertigo (SSNHLwV), and 31 patients with vestibular neuritis (VN) underwent PG during the non-acute phase of vertigo, from January 2010 to March 2017. RESULTS The velocity of body oscillation of BPPV patients with eyes open and closed were significantly faster than those of MD patients with eyes open (p < 0.001) and closed (p = 0.033). The velocity of body oscillation of VN patients with eyes open was significantly faster than that of MD patients with eyes open (p = 0.0083). There were no significant differences among the other PG parameters between PVDs. Although there were significant differences among the velocity with eyes open and closed between males and females (eye open: p = 0.0009, eye close: p < 0.0001), there was no significant difference in the ratio of males to females among PVDs (p = 0.1834). Therefore, the ratio did not influence the difference in velocity among PVDs. Patient age correlated with the velocity with eyes open (p < 0.001) and with eyes closed (p < 0.001). Post-hoc analysis revealed significant differences in patient age, and comparisons of MD and BPPV, MD and SSNHLwV, BPPV and VN, and VN and SSNHLwV. Therefore, we performed multiple regression analysis to determine whether the significant differences in the velocity of body oscillation among PVDs were caused by the difference in age distribution between PVD groups, rather than by differences in the PVDs themselves. There were correlations between age and the velocity of body oscillation with eyes open (p < 0.001) and with eyes closed (p < 0.001). There also were correlations between MD or VN and the velocity of body oscillation with eyes open (p = 0.0194). CONCLUSION There were significant differences in the velocity of body oscillation with eyes open between MD and VN patients. The difference between MD and VN was significant regardless of the age distribution. To distinguish between MD and VN, the velocity of body oscillation with eyes open is a useful PG index.
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Affiliation(s)
- Kotaro Shimizu
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Takao Imai
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan.
| | - Ryohei Oya
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Tomoko Okumura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
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Shiraishi K, Ohira N, Kobayashi T, Sato M, Osaki Y, Doi K. Comparison of furosemide-loading cervical vestibular-evoked myogenic potentials with magnetic resonance imaging for the evaluation of endolymphatic hydrops. Acta Otolaryngol 2020; 140:723-727. [PMID: 32700983 DOI: 10.1080/00016489.2020.1769863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Furosemide-loading cervical vestibular-evoked myogenic potential (FVEMP), in which vestibular function is improved via diuretics-induced dehydration, can be used to estimate the presence of endolymphatic hydrops, one characteristic of Menière's disease. Inner ear magnetic resonance imaging (MRI) can also reveal endolymphatic hydrops.Aims/Objective: This study aimed to compare and confirm the usefulness of these two examination methods for the diagnosis of Menière's disease. METHODS Twenty patients with definite unilateral Menière's disease were included. All subjects underwent both, FVEMP and inner ear MRI examinations. The results were then compared statistically between the affected and contralateral ears and among the methods. RESULTS FVEMP and inner ear MRI of the cochlea, saccules, and utricles yielded positive results indicative of endolymphatic hydrops in 55.0%, 60.0%, 45.0%, and 45.0% of cases, respectively. The results of FVEMP were more consistent with those of the cochlea (κ = 0.8) than with those of the saccules or utricles by inner ear MRI (κ = 0.6). CONCLUSIONS FVEMP appears to be a good and minimally invasive option for evaluating endolymphatic hydrops. However, the combination of FVEMP and inner ear MRI may yield even more accurate evaluations of endolymphatic hydrops.
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Affiliation(s)
- Ko Shiraishi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Noriko Ohira
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takaaki Kobayashi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Mitsuo Sato
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama, Japan
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Brown R, Imawari M, Izumi N, Osaki Y, Bentley R, Baykal T, Ochiai T, Kano T. Abstract No. 617 Lusutrombopag reliably increases platelets regardless of baseline platelet counts in thrombocytopenic chronic liver disease patients undergoing planned invasive procedures: results of two phase 3 trials. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Brown R, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Peck-Radosavljevic M. Abstract No. 615 Lusutrombopag is a safe and efficacious treatment option for thrombocytopenia in patients with chronic liver disease undergoing planned invasive procedures: integrated analysis of two phase 3 trials. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.676] [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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YAMAKOSHI S, Ito O, Osaki Y, Nakamura T, Kazuhiro T, Kohzuki M. SAT-119 Mechanisms of (Pro)renin Receptor Expression in the Kidney of Dahl Salt-Sensitive Rats by High Salt Intake. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.147] [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: 10/26/2022] Open
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Higashi-Shingai K, Imai T, Okumura T, Uno A, Kitahara T, Horii A, Ohta Y, Osaki Y, Sato T, Okazaki S, Kamakura T, Takimoto Y, Ozono Y, Watanabe Y, Imai R, Hanada Y, Ohata K, Oya R, Inohara H. Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI. Auris Nasus Larynx 2018; 46:335-345. [PMID: 30502065 DOI: 10.1016/j.anl.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (-SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD). METHODS Twenty-one patients with unilateral MD who underwent sac surgery were included in this study. All patients underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI) before and 2 years after sac surgery. We evaluated the difference in vestibular and cochlear endolymphatic hydrops between before and after surgery in both ears and compared these findings with the frequency of vertigo attacks, hearing level, and ECochG findings. RESULTS In affected ears, the presence of vestibular endolymphatic hydrops and the frequency of vertigo attacks significantly decreased after surgery. However, affected ears showed no significant improvement in the presence of cochlear endolymphatic hydrops or the -SP/AP ratio by ECochG; there was also no significant improvement or deterioration in the hearing level. CONCLUSION The present findings suggest that sac surgery reduces vestibular endolymphatic hydrops and prevents aggravation of cochlear endolymphatic hydrops, and these changes lead to a reduction of vertigo attacks and suppress the progression of hearing impairment associated with vertigo attacks.
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Affiliation(s)
| | - Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Arata Horii
- Department of Otorhinolaryngology - Head and Neck Surgery, Niigata University Graduate School of Medicine and Dentistry, Niigata, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kinki University Faculty of Medicine, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Suzuyo Okazaki
- Department of Otolaryngology, Osaka City General Hospital, Osaka, Japan
| | | | | | - Yoshiyuki Ozono
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiyuki Watanabe
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Hanada
- Department of Otolaryngology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazuya Ohata
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryohei Oya
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Jiang X, Imai T, Okumura T, Ohta Y, Osaki Y, Sato T, Inohara H. Three-dimensional analysis of the vestibulo-ocular reflex and the ability to distinguish the direction of centripetal acceleration in humans during eccentric rotation with the right ear facing downwards. Neurosci Res 2018; 144:21-29. [PMID: 30217698 DOI: 10.1016/j.neures.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/25/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022]
Abstract
This study was conducted to evaluate the linear vestibulo-ocular reflex (lVOR) mediated by the saccule, and to investigate the relationship between the lVOR and the ability to distinguish the direction of centripetal acceleration during centric and eccentric rotation. Participants sat on a chair in darkness, with the right ear facing downwards, either directly above the center of rotation, or with their nose out, nose in, right shoulder out, or left shoulder out against the center of rotation (eccentric rotation). Participants were given no information about the chair position, and were rotated sinusoidally at 0.1-0.7 Hz. Three-dimensional eye movements during rotation were analyzed. Participants were asked to describe the position of the chair after rotation. Correctly reporting the five possible chair positions requires recognition of the direction of centripetal acceleration. We analyzed the rate of correct answers to assess participants' ability to identify the direction of centripetal acceleration. lVOR mediated by the saccule was observed only at high rotational frequencies. The rate of correct answers was higher at high rotational frequencies than that at low rotational frequencies. These results indicate that high rotational frequency is important for both lVOR mediated by the saccule and distinguishing the direction of centripetal acceleration.
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Affiliation(s)
- Xiuwen Jiang
- Department of Otorhinolaryngology - Head and Neck Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310016, China
| | - Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yasuhiro Osaki
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Matsui N, Nodera H, Kuzume D, Iwasa N, Unai Y, Sakai W, Miyazaki Y, Yamazaki H, Osaki Y, Mori A, Furukawa T, Tsukamoto-Miyashiro A, Shimatani Y, Yamasaki M, Izumi Y, Kusunoki S, Arisawa K, Kaji R. Guillain−Barré syndrome in a local area in Japan, 2006-2015: an epidemiological and clinical study of 108 patients. Eur J Neurol 2018; 25:718-724. [DOI: 10.1111/ene.13569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- N. Matsui
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - H. Nodera
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - D. Kuzume
- Department of Neurology; Chikamori Hospital; Kochi Japan
| | - N. Iwasa
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Unai
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - W. Sakai
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Miyazaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - H. Yamazaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Osaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - A. Mori
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - T. Furukawa
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - A. Tsukamoto-Miyashiro
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Shimatani
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - M. Yamasaki
- Department of Neurology; Chikamori Hospital; Kochi Japan
| | - Y. Izumi
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - S. Kusunoki
- Department of Neurology; Kindai University; Faculty of Medicine; Osaka Japan
| | - K. Arisawa
- Department of Preventive Medicine; Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - R. Kaji
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
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Morita Y, Osaki Y, Furushima T, Miyamoto Y, Furuta K, Furuya H. Disease progression in Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1650] [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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15
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Hanada K, Matsui N, Nodera H, Kuzume D, Sato K, Iwasa N, Unai Y, Sakai W, Miyazaki Y, Yamazaki H, Osaki Y, Furukawa T, Yamasaki M, Izumi Y, Kusunoki S, Arisawa K, Kaji R. Guillain-Barré syndrome in a local area in Japan, 2006-2015: An epidemiological and clinical study of 108 patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1057] [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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16
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Osaki Y, Nodera H, Yamazaki H, Unai Y, Takamatsu N, Izumi Y, Kaji R. Ulnar nerve demyelination within the forearm segment in diabetic patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Takamatsu N, Sogawa K, Nodera H, Hashiguchi S, Osaki Y, Saito M, Mori A, Izumi Y, Kaji R. Preferential changes of skeletal muscle echogenicity in myotonic dystrophy type 1. Eur J Neurol 2016; 24:366-373. [PMID: 27933692 DOI: 10.1111/ene.13212] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE In myotonic dystrophy type 1 (DM1), weakness of distal limb muscles affects quality of life. Non-invasive evaluation of muscular involvement by muscle sonography could be useful for characterizing muscle-specific involvement. METHODS Sonography of the lower leg and forearm was performed in 19 patients with DM1 and 10 control subjects. The mean echo intensities (EIs) of seven limb muscles were obtained by computer-assisted histogram analysis and compared within DM1 according to the overall clinical severity. RESULTS The EIs of the muscles were significantly higher in DM1 than in the controls (P < 0.01), except for the soleus (P = 0.4). Comparison of adjacent muscles showed the following: (i) greater EIs in flexor digitorum profundus than flexor carpi ulnaris (P < 0.01) and flexor digitorum superficialis (P = 0.02), and (ii) greater EIs in the medial head of the gastrocnemius than the soleus (P < 0.00001). In a subgroup analysis of DM1 according to the modified Rankin Scale (mRS), the more severe subgroup (mRS = 4-5) had lower mean EIs than the less severe subgroup (mRS from 1-3) (P = 0.01) in the flexor digitorum superficialis but not in other muscles. CONCLUSIONS Preferential high echogenicity in the medial gastrocnemius and deep finger flexors is suggestive of DM1. Muscle echogenicity is not generally related to functional dysfunction in DM1.
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Affiliation(s)
- N Takamatsu
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - K Sogawa
- Faculty of Medicine - Student Laboratory, Tokushima University, Tokushima, Japan
| | - H Nodera
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - S Hashiguchi
- Department of Neurology, Tokushima Hospital, Tokushima, Japan
| | - Y Osaki
- Department of Neurology, Tokushima University, Tokushima, Japan.,Department of Neurology, Tokushima Hospital, Tokushima, Japan
| | - M Saito
- Department of Internal Medicine, Tokushima Hospital, Tokushima, Japan
| | - A Mori
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - Y Izumi
- Department of Neurology, Tokushima University, Tokushima, Japan
| | - R Kaji
- Department of Neurology, Tokushima University, Tokushima, Japan
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Abstract
The clinical features of tuberculous otitis media (TOM) have changed. This study was performed to evaluate changing trends in the clinical manifestations of TOM. We reviewed a series of 12 cases of TOM (13 ears) recently treated at Osaka Prefectural Habikino Hospital. The results showed a mean age of 41 years and a male predominance of 1.4 to 1. Central or total perforations of the tympanic membrane were observed in most cases, but none of the patients had multiple perforations. Nine patients (75%) had active pulmonary tuberculosis. Normal lung status or inactive pulmonary tuberculosis was significantly more frequent in the older age group. Diagnosis of primary TOM required more time than that of secondary TOM. Most cases of primary TOM had high infectiousness of the primary lesion. We summarize the clinical features of patients who should be evaluated for TOM.
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Affiliation(s)
- Suetaka Nishiike
- Department of Otolaryngology, Suita Municipal Hospital, Suita, Osaka, Japan
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19
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Nodera H, Takamatsu N, Matsui N, Mori A, Terasawa Y, Shimatani Y, Osaki Y, Maruyama K, Izumi Y, Kaji R. Intramuscular dissociation of echogenicity in the triceps surae characterizes sporadic inclusion body myositis. Eur J Neurol 2015; 23:588-96. [DOI: 10.1111/ene.12899] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- H. Nodera
- Department of Neurology Tokushima University TokushimaJapan
| | - N. Takamatsu
- Department of Neurology Tokushima University TokushimaJapan
- Vihara Hananosato Hospital MiyoshiJapan
| | - N. Matsui
- Department of Neurology Tokushima University TokushimaJapan
| | - A. Mori
- Department of Neurology Tokushima University TokushimaJapan
| | - Y. Terasawa
- Department of Neurology Tokushima University TokushimaJapan
- Department of Neurology Jikei University School of Medicine Tokyo Japan
| | - Y. Shimatani
- Department of Neurology Tokushima University TokushimaJapan
| | - Y. Osaki
- Department of Neurology Tokushima University TokushimaJapan
| | - K. Maruyama
- Department of Neurology Tokushima University TokushimaJapan
| | - Y. Izumi
- Department of Neurology Tokushima University TokushimaJapan
- Vihara Hananosato Hospital MiyoshiJapan
| | - R. Kaji
- Department of Neurology Tokushima University TokushimaJapan
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20
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Abstract
CONCLUSIONS Defibrinogenation therapy rather than corticosteroids therapy should be chosen for patients specifically with profound hearing loss and with initial high fibrinogen. OBJECTIVES Corticosteroids therapy is the standard treatment for sudden sensorineural hearing loss (SSNHL) and prognostic factors by this therapy were reported. Defibrinogenation therapy is one of the treatment options for SSNHL. Aims of this study were to identify prognostic factors and correlative markers with hearing improvement in treating SSNHL by defibrinogenation therapy. METHODS During the early phase of the study, consecutive 61 patients were treated by defibrinogenation therapy with batroxobin (50 units), whereas corticosteroids (500 mg/day of hydrocortisone tapered by 9 days) were used for consecutive 64 patients during the late phase. Blood data that could predict a complete recovery were identified. Coagulation/fibrinolysis markers correlated with hearing improvement by defibrinogenation therapy were investigated. RESULTS Although there were no overall differences in hearing improvement between the two therapies, recovery rate in profound hearing loss patients was better in defibrinogenation therapy. In patients who showed complete recovery, serum fibrinogen level before treatment was significantly higher in the defibrinogenation group than the corticosteroid group. Responses of several fibrinolysis markers to defibrinogenation therapy evaluated by post-/pre-values were negatively correlated with hearing improvement.
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Affiliation(s)
- Ryohei Oya
- a Department of Otorhinolaryngology Head and Neck Surgery , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Arata Horii
- b Department of Otolaryngology Head and Neck Surgery , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Hitoshi Akazawa
- c Department of Otolaryngology , Higashiosaka City General Hospital , Higashiosaka , Japan
| | - Yasuhiro Osaki
- d Department of Otolaryngology , Suita Municipal Hospital , Suita , Japan
| | - Hidenori Inohara
- a Department of Otorhinolaryngology Head and Neck Surgery , Osaka University Graduate School of Medicine , Osaka , Japan
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21
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Abstract
CONCLUSIONS Postural control is dependent on the visual system in normal conditions. Shift from visual to somatosensory dependence in dizzy patients suggests that utilizing the stable visual references is recommended for the rehabilitation of dizzy patients. OBJECTIVES To investigate which of the visual or somatosensory system is mainly used for substitution of the impaired spatial orientation in dizzy patients. METHODS We recruited 189 consecutive patients with or without dizziness and vestibular dysfunction. Dizzy patients were divided into three groups: acute, episodic, and chronic dizziness. Vestibular function was assessed by caloric test, traditional head impulse test, and head shaking nystagmus. Visual or somatosensory dependence of spatial orientation was assessed by posturography on a solid surface or on foam in eyes open or closed condition. The foam ratio (posturography with/without foam) when eyes were closed was indicative of somatosensory dependence of postural control, whereas the Romberg ratio on foam showed visual dependence. (Romberg ratio on foam)/(foam ratio with eyes closed) was calculated and used as an index of the visual/somatosensory dependence of postural control. RESULTS The visual/somatosensory ratio of postural control was significantly lower in dizzy patients as well as patients with vestibular dysfunction, however, no differences were found between acute, episodic, and chronic dizziness.
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Affiliation(s)
- Tomoko Okumura
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine , Suita, Osaka , Japan
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Tsuji M, Mori Y, Kanda H, Ito T, Hidaka T, Kakamu T, Kumagai T, Hayakawa T, Osaki Y, Fukushima T. Determine whether nicotine metabolism can be a key to quitting smoking. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Toyama T, Nakayama H, Takimura T, Yoshimura A, Maesato H, Matsushita S, Osaki Y, Higuchi S. SY17-4 * PREVALENCE OF PATHOLOGICAL GAMBLING IN JAPAN: RESULTS OF NATIONAL SURVEYS OF THE GENERAL ADULT POPULATION IN 2008 AND 2013. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu052.75] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [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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Mihara S, Nakayama H, Sakuma H, Osaki Y, Kaneita Y, Higuchi S. OR13-5 * CHANGES OF INTERNET ADDICTION AMONG THE ADULT POPULATION OF JAPAN IN FIVE YEARS: RESULTS OF TWO MAJOR SURVEYS. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu053.64] [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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Matsushita S, Sakuma H, Takimura T, Kimura M, Osaki Y, Higuchi S. SY05-4 * THE IMPACT OF THE GREAT EAST JAPAN EARTHQUAKE ON ALCOHOL, NICOTINE AND HYPNOTIC ABUSE AND GAMBLING IN DISASTER-STRICKEN AREAS. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu052.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Osaki Y, Kanda H, Higuchi S, Matsumoto H, Yuzuriha T, Horie Y, Kimura M, Yoshimoto H. SY08-1 * OVERLAPPING OF DIFFERENT ADDICTIONS INCLUDING ALCOHOL, TOBACCO, INTERNET AND GAMBLING. Alcohol Alcohol 2014. [DOI: 10.1093/alcalc/agu052.37] [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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Osaki Y, Nodera H, Shimatani Y, Chimeglkham B, Kaji R. P843: Influence of anesthetic agents on sensory nerve excitability testing in mice. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kokunai Y, Nakata T, Furuta M, Sakata S, Kimura H, Aiba T, Yoshinaga M, Osaki Y, Nakamori M, Itoh H, Sato T, Kubota T, Kadota K, Shindo K, Mochizuki H, Shimizu W, Horie M, Okamura Y, Ohno K, Takahashi MP. A Kir3.4 mutation causes Andersen-Tawil syndrome by an inhibitory effect on Kir2.1. Neurology 2014; 82:1058-64. [DOI: 10.1212/wnl.0000000000000239] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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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Uno A, Horii A, Imai T, Osaki Y, Kamakura T, Kitahara T, Takimoto Y, Ohta Y, Morihana T, Nishiike S, Inohara H. [Endolymphatic hydrops detected with inner ear gd contrast-enhanced MRI; comparison between administration routes or with ECochG or glycerol test]. ACTA ACUST UNITED AC 2014; 116:960-8. [PMID: 24044172 DOI: 10.3950/jibiinkoka.116.960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Gadolinium (Gd) contrast-enhanced MRI has recently been introduced to clinical practice to detect endolymphatic hydrops. However, since the image depends on the hardware, pulse sequence or the way of Gd administration, the protocol and the evaluating criteria for hydrops on MRI have not yet been standardized. In this study, we assessed the usefulness of the hydrops detection by MRI following the intratympanic or intravenous Gd administration methods, and compared these findings with the electrocochleography and glycerol test. METHODS MRI was taken in 27 patients with Meniere's disease or delayed endolymphatic hydrops. All patients had frequent episodes of vertigo attacks which were clinically considered as of unilateral ear origin. Two types of Gd administration were used; injection into the tympanic cavity in 17 patients or intravenous injection in 10 patients. Axial 2D-FLAIR images were obtained with a 3.0T MRI unit, 24 and 4 h after intratympanic or intravenous administration, respectively. The endolymphatic space was detected as a low signal intensity area, while the surrounding perilymphatic space showed high intensity with Gd contrast. Those cases in which low signal areas corresponding to the cochlear duct could be clearly noticed, were classified as cochlear hydrops. When the greater part of the vestibule was occupied by a low signal area in more than half of the images, it was classified as vestibular hydrops. RESULTS Endolymphatic hydrops was detected in 88% (15/17 cases) by the intratympanic Gd administration method, and 90% (9/10) by the intravenous method. In the contralateral ears, 20% (2/10) showed hydrops, detected by the intravenous method. ECochG and the glycerol test were difficult when the hearing of the patient was severely impaired. Positive results of EcochG and the glycerol test were obtained only in 15 and 6 cases, respectively. However, as far as the waves could be obtained, ECochG showed a high detection rate of 88% (15/17) in the affected ear. In those cases in which both MRI and EcochG could be obtained, including both ears, the results were matched in 78% (21/27ears). CONCLUSION For the qualitative detection of hydrops, intratympanic and intravenous Gd administration methods were equivalent. Inner ear Gd contrast-enhanced MRI had higher efficacy in the detection of hydrops than the conventional tests.
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Affiliation(s)
- Atsuhiko Uno
- Department of Otolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita
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Uno A, Imai T, Watanabe Y, Tanaka H, Kitahara T, Horii A, Kamakura T, Takimoto Y, Osaki Y, Nishiike S, Inohara H. Changes in endolymphatic hydrops after sac surgery examined by Gd-enhanced MRI. Acta Otolaryngol 2013; 133:924-9. [PMID: 23768010 DOI: 10.3109/00016489.2013.795290] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Endolymphatic hydrops could be a reversible inner ear pathological condition. After sac surgery, hydrops was reduced and symptoms went into remission in some cases, although vertigo suppression was not always a result of the reduced hydrops. OBJECTIVE To examine the changes in endolymphatic hydrops detected by gadolinium (Gd) contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after endolymphatic sac surgery in patients with unilateral Ménière's disease. METHODS Fluid-attenuated inversion recovery MRI was obtained 4 h after intravenous administration or 24 h after intratympanic administration of Gd contrast medium. An enlarged negative stain corresponding to the cochlear duct and endolymphatic space of the vestibule was assessed as hydrops. RESULTS Of seven patients with hydrops confirmed by MRI before surgery, both cochlear and vestibular hydrops became negative in two, cochlear hydrops became negative in one, both hydrops were present, but reduced, in one, and there was no change in three patients. The number of vertigo spells was reduced in all cases at 6-12 months after surgery. As for the three cases of negative hydrops, vertigo was completely suppressed. In two cases in which hearing level improved, hydrops became negative after surgery.
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Affiliation(s)
- Atsuhiko Uno
- Department of Otolaryngology Head & Neck Surgery, Japan.
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Sekikawa A, Fukui H, Zhang X, Maruo T, Tsumura T, Okabe Y, Wakasa T, Osaki Y, Chiba T, Tomita T, Oshima T, Watari J, Miwa H. REG Iα is a biomarker for predicting response to chemotherapy with S-1 plus cisplatin in patients with unresectable stage IV gastric cancer. Br J Cancer 2013; 108:395-401. [PMID: 23322208 PMCID: PMC3566803 DOI: 10.1038/bjc.2012.572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The regenerating gene Iα (REG Iα) is involved in gastric carcinogenesis as an antiapoptotic factor. Therefore, we investigated whether REG Iα confers resistance to chemotherapeutic drugs in gastric cancer (GC) cells and whether REG Iα expression is useful for predicting the response to chemotherapy and outcome in patients with GC. Methods: A total of 70 patients with unresectable stage IV GC received first-line chemotherapy with S-1 and cisplatin (S-1/CDDP). The expression of REG Iα was evaluated immunohistochemically using biopsy samples obtained before chemotherapy, and its relationship to clinicopathological parameters was analysed statistically. The effects of REG Iα gene induction on resistance to 5-FU or CDDP treatment were examined by cell survival assay and flow cytometry. Results: Of the 70 patients with unresectable stage IV GC, 19 (27%) were positive for REG Iα expression. The expression of REG Iα was independently predictive of poorer progression-free and overall survival in such patients (hazard ratio (HR) 2.46; P=0.002 and HR 1.89; P=0.037, respectively). The gene induction of REG Iα conferred resistance to cell death induced by 5-FU or CDDP in GC cells. Conclusion: In patients with stage IV GC, REG Iα, which confers resistance to chemotherapeutic drugs in GC cells, is a potential biomarker for predicting resistance to S-1/CDDP treatment.
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Affiliation(s)
- A Sekikawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
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Sekikawa A, Fukui H, Maruo T, Tsumura T, Okabe Y, Osaki Y, Wakasa T, Tomita T, Oshima T, Watari J, Miwa H. Reg Iα1 is a Biomarker to Predict Poor Response to Chemotherapy with S-1–Cisplatin in Patients with Metastatic Gastric Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32458-3] [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: 11/28/2022] Open
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Eso Y, Marusawa H, Osaki Y. Education and imaging. Hepatobiliary and Pancreatic: Detection of early hepatocellular carcinoma by enhanced magnetic resonance imaging. J Gastroenterol Hepatol 2012; 27:416. [PMID: 22260287 DOI: 10.1111/j.1440-1746.2011.06988.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Y Eso
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract
OBJECTIVES To investigate the prevalence of Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) in a rural Japanese district. METHOD Collaboration with the medical institutions, the long-term care insurance system facilities, and the public health office. RESULTS The crude prevalence rates were 175 per 100,000 (95% CI: 143-206) for PD, 18 (8-28) for progressive supranuclear palsy, 17 (7-26) for multiple system atrophy (MSA), and 9 (2-16) for corticobasal degeneration. The age-adjusted prevalence rates were 109 per 100,000 (88-134), 10 (2-17), 13 (4-21), and 6 (0-12), for each condition. There was a preponderance of women with PD and of men with APS. Nine of the 116 PD patients and 7 of the 29 APS patients were newly diagnosed in this study. CONCLUSIONS There are high prevalence rates for PD and APS and suboptimal recognition of APS. This is the first epidemiological prevalence study of MSA from Japan.
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Affiliation(s)
- Y Osaki
- Department of Geriatrics, Cardiology and Neurology, Kochi Medical School, Nankoku, Japan.
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Osaki Y, Ohida T, Kanda H, Kishimoto T, Tanihata T, Kaneita Y. P1-485 Expanding between-school differences in smoking prevalence of high school students in Japan. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976g.74] [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: 11/03/2022]
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Kishimoto T, Osaki Y, Tahara A, Nagai M, Kawajiri T. SP1-64 A cohort study about the association between metabolic syndrome and FTO genetic polymorphism in a Japanese worker population. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976n.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Horii A, Osaki Y, Kitahara T, Imai T, Uno A, Nishiike S, Fujita N, Inohara H. Endolymphatic hydrops in Meniere's disease detected by MRI after intratympanic administration of gadolinium: comparison with sudden deafness. Acta Otolaryngol 2011; 131:602-9. [PMID: 21344957 DOI: 10.3109/00016489.2010.548403] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The detection rate of endolymphatic hydrops was significantly higher in patients with Meniere's disease compared with those with sudden deafness, indicating that 3 T magnetic resonance imaging (MRI) with intratympanic gadolinium injection was effective in diagnosing endolymphatic hydrops. OBJECTIVES To compare the detection rate of endolymphatic hydrops between patients with Meniere's disease and sudden deafness as controls by 3 T MRI after intratympanic gadolinium injection with conventional pulse sequence such as two-dimensional fluid-attenuated inversion recovery. METHODS Ten patients with unilateral Meniere's disease and eight with sudden deafness underwent inner ear MRI 24 h after intratympanic gadolinium injection. RESULTS The endolymphatic space was detected as a low signal intensity area, while the perilymphatic space showed high intensity by gadolinium enhancement. Due to faint enhancement, images could not be evaluated in 1 of 10 patients with Meniere's disease. However, the other nine patients together with two of the eight with sudden deafness were diagnosed as having hydrops. The difference in detection rates between the two diseases was statistically significant. Two hydrops-positive cases with sudden deafness were considered to be of the secondary type of hydrops, because images were taken after partial recovery from hearing loss several months after the onset of the disease.
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Affiliation(s)
- Arata Horii
- Department of Otolaryngology, Suita Municipal Hospital, Osaka University Graduate School of Medicine, Japan.
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Abstract
Gait dysfunction and falling are major sources of disability for patients with advanced Parkinson's disease (PD). It is presently thought that the fundamental defect is an inability to generate normal stride length. Our data suggest, however, that the basic problem in PD gait is an impaired ability to match step frequency to walking velocity. In this study, foot movements of PD and normal subjects were monitored with an OPTOTRAK motion-detection system while they walked on a treadmill at different velocities. PD subjects were also paced with auditory stimuli at different frequencies. PD gait was characterized by step frequencies that were faster and stride lengths that were shorter than those of normal controls. At low walking velocities, PD stepping had a reduced or absent terminal toe lift, which truncated swing phases, producing shortened steps. Auditory pacing was not able to normalize step frequency at these lower velocities. Peak forward toe velocities increased with walking velocity and PD subjects could initiate appropriate foot dynamics during initial phases of the swing. They could not control the foot appropriately in terminal phases, however. Increased treadmill velocity, which matched the natural PD step frequency, generated a second toe lift, normalizing step size. Levodopa increased the bandwidth of step frequencies, but was not as effective as increases in walking velocity in normalizing gait. We postulate that the inability to control step frequency and adjust swing phase dynamics to slower walking velocities are major causes for the gait impairment in PD.
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Affiliation(s)
- Catherine Cho
- Department of Neurology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1135, New York, NY 10029-6574, USA.
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Ikeda A, Marusawa H, Nakajima J, Osaki Y. Education and Imaging. Hepatobiliary and pancreatic: Delayed ileal perforation following radiofrequency ablation of hepatocellular carcinoma. J Gastroenterol Hepatol 2010; 25:430. [PMID: 20136993 DOI: 10.1111/j.1440-1746.2009.06095.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- A Ikeda
- Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan and
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Kunitoh H, Tamura T, Shibata T, Nakagawa K, Takeda K, Nishiwaki Y, Osaki Y, Noda K, Yokoyama A, Saijo N. A phase-II trial of dose-dense chemotherapy in patients with disseminated thymoma: report of a Japan Clinical Oncology Group trial (JCOG 9605). Br J Cancer 2009; 101:1549-54. [PMID: 19809436 PMCID: PMC2778526 DOI: 10.1038/sj.bjc.6605347] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 09/04/2009] [Accepted: 09/04/2009] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of dose-dense weekly chemotherapy in the treatment of advanced thymoma. METHODS Subjects comprised patients with histologically documented chemotherapy-naïve thymoma with stage-IVa or IVb disease. Thymic carcinoma, carcinoid or lymphoma cases were excluded. Patients received 9 weeks of chemotherapy: cisplatin (25 mg m(-2)) on weeks 1-9; vincristine (1 mg m(-2)) on weeks 1, 2, 4, 6 and 8; and doxorubicin (40 mg m(-2)) and etoposide (80 mg m(-2)) on days 1-3 of weeks 1, 3, 5, 7 and 9. Chemotherapy courses were supported by granulocyte colony-stimulating factor. Post-protocol local therapy was allowed. RESULTS From July 1997 to March 2004, 30 patients were entered. Three were ineligible due to different histology. Chemotherapy-associated toxicity was mainly haematological and was well tolerated, with no deaths due to toxicity, and 87% of patients completed the planned 9-week regimen. Overall response rate was 59%, with 16 of the 27 eligible patients achieving partial response. Median progression-fee survival (PFS) was 0.79 years (95% confidence interval: 0.52-1.40 years), and PFS at 1 and 2 years was 37 and 15%, respectively. Overall survival rates at 2 and 5 years were 89 and 65%, respectively. CONCLUSION In stage-IV thymoma patients, weekly dose-dense chemotherapy offers similar activity to conventional regimens.
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Affiliation(s)
- H Kunitoh
- Department of Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Kishima H, Saitoh Y, Oshino S, Hosomi K, Ali M, Maruo T, Hirata M, Goto T, Yanagisawa T, Sumitani M, Osaki Y, Hatazawa J, Yoshimine T. Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study. Neuroimage 2009; 49:2564-9. [PMID: 19874903 DOI: 10.1016/j.neuroimage.2009.10.054] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/27/2009] [Accepted: 10/19/2009] [Indexed: 12/01/2022] Open
Abstract
Spinal cord stimulation (SCS) is an effective therapy for chronic neuropathic pain. However, the detailed mechanisms underlying its effects are not well understood. Positron emission tomography (PET) with H(2)(15)O was applied to clarify these mechanisms. Nine patients with intractable neuropathic pain in the lower limbs were included in the study. All patients underwent SCS therapy for intractable pain, which was due to failed back surgery syndrome in three patients, complex regional pain syndrome in two, cerebral hemorrhage in two, spinal infarction in one, and spinal cord injury in one. Regional cerebral blood flow (rCBF) was measured by H(2)(15)O PET before and after SCS. The images were analyzed with statistical parametric mapping software (SPM2). SCS reduced pain; visual analog scale values for pain decreased from 76.1+/-25.2 before SCS to 40.6+/-4.5 after SCS (mean+/-SE). Significant rCBF increases were identified after SCS in the thalamus contralateral to the painful limb and in the bilateral parietal association area. The anterior cingulate cortex (ACC) and prefrontal areas were also activated after SCS. These results suggest that SCS modulates supraspinal neuronal activities. The contralateral thalamus and parietal association area would regulate the pain threshold. The ACC and prefrontal areas would control the emotional aspects of intractable pain, resulting in the reduction of neuropathic pain after SCS.
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Affiliation(s)
- Haruhiko Kishima
- Department of Neurosurgery, Osaka University, Graduated school of Medicine, Suita, Osaka, Japan
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Inohara H, Enomoto K, Tomiyama Y, Yoshii T, Osaki Y, Higuchi I, Inoue T, Hatazawa J. The role of CT and ¹⁸F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol 2009; 129:893-9. [PMID: 18839385 DOI: 10.1080/00016480802441747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION Patients showing a complete response on computed tomography (CT) can be spared from neck dissection. OBJECTIVE To determine whether CT or fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is superior in the evaluation of persistent nodal disease after chemoradiotherapy in patients with node-positive head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Study entry criteria included node-positive HNSCC treated with definitive chemoradiotherapy, a local complete response, and post-treatment CT and (18)F-FDG PET studies 7 weeks after chemoradiotherapy. Forty-eight patients with 60 node-positive necks were eligible. Nodes larger than 1 cm, or with central necrosis on CT, or any visually hypermetabolic nodes on (18)F-FDG PET were considered positive. Regardless of PET findings, necks with positive CT were subjected to neck dissection, whereas those with negative CT were observed without neck dissection. RESULTS Twenty-two necks showed positive CT, 20 and 2 of which underwent neck dissection and fine needle aspiration cytology, respectively, resulting in pathologic evidence of persistent nodal disease in 13 necks. Five of 38 necks with negative CT developed regional recurrence. Diagnostic accuracy was equivalent between CT and (18)F-FDG PET. There was no difference in 3-year cause-specific survival between patients with positive and negative CT (79% and 81%, respectively).
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Wada M, Marusawa H, Yamada R, Nasu A, Osaki Y, Kudo M, Nabeshima M, Fukuda Y, Chiba T, Matsuda F. Association of genetic polymorphisms with interferon-induced haematologic adverse effects in chronic hepatitis C patients. J Viral Hepat 2009; 16:388-96. [PMID: 19200137 DOI: 10.1111/j.1365-2893.2009.01095.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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: 12/09/2022]
Abstract
Interferon (IFN)-based combination therapy with ribavirin has become the gold standard for the treatment of chronic hepatitis C virus infection. Haematologic toxicities, such as neutropenia, thrombocytopenia, and anaemia, however, frequently cause poor treatment tolerance, resulting in poor therapeutic efficacy. The aim of this study was to identify host genetic polymorphisms associated with the efficacy or haematologic toxicity of IFN-based combination therapy in chronic hepatitis C patients. We performed comprehensive single nucleotide polymorphism detection in all exonic regions of the 12 genes involved in the IFN signalling pathway in 32 healthy Japanese volunteers. Of 167 identified polymorphisms, 35 were genotyped and tested for an association with the efficacy or toxicity of IFN plus ribavirin therapy in 240 chronic hepatitis C patients. Multiple logistic regression analysis revealed that low viral load, viral genotypes 2 and 3, and a lower degree of liver fibrosis, but none of the genetic polymorphisms, were significantly associated with a sustained virologic response. In contrast to efficacy, multiple linear regression analyses demonstrated that two polymorphisms (IFNAR1 10848-A/G and STAT2 4757-G/T) were significantly associated with IFN-induced neutropenia (P = 0.013 and P = 0.011, respectively). Thrombocytopenia was associated with the IRF7 789-G/A (P = 0.031). In conclusion, genetic polymorphisms in IFN signalling pathway-related genes were associated with IFN-induced neutropenia and thrombocytopenia in chronic hepatitis C patients. In contrast to toxicity, the efficacy of IFN-based therapy was largely dependent on viral factors and degree of liver fibrosis.
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Affiliation(s)
- M Wada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Nishijima N, Marusawa H, Kita R, Osaki Y, Chiba T. Education and Imaging. Hepatobiliary and pancreatic: spontaneous regression of hepatocellular cancer demonstrated by contrast-enhanced ultrasonography. J Gastroenterol Hepatol 2009; 24:1153. [PMID: 19638097 DOI: 10.1111/j.1440-1746.2009.05884.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- N Nishijima
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Osaki Y, Nishimoto S, Oyama T, Yoshimura Y. Congenital duplication of lower extremity--a case report and review of the literature. J Plast Reconstr Aesthet Surg 2009; 63:390-7. [PMID: 19272848 DOI: 10.1016/j.bjps.2009.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 12/16/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
Congenital duplication of the lower extremity is quite rare. Only 26 cases have been reported so far. A female infant with incomplete duplication of lower limb and with hypothyroidism was reported. Her mother's pregnancy and delivery was uneventful. A tube-like skin tissue was found on the posterior aspect of the infant's left thigh. Her left foot presented equinovarus deformity. There were three extra toes on the plantar side of her foot. A band of skin with a thin horny layer, similar to the dorsal surface, could be seen on the sole. The skin tube on the thigh was simply resected. A neuro-vascular-islanded toe was made from the plantar toes and rotated to restore five toes on the foot. The transferred toe thrived in accordance with the surrounding toes. The patient could run without difficulty at the age of 3. Previous reports about this case are summarised and reviewed here.
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Affiliation(s)
- Y Osaki
- Department of Plastic Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma, Kobe, Hyogo, Japan
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Yoshinami K, Kitahara T, Imai T, Osaki Y, Kizawa K, Maekawa C, Horii A. Canal Occlusion Surgery for Intractable Benign Paroxysmal Positional Vertigo. ACTA ACUST UNITED AC 2009. [DOI: 10.3757/jser.68.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Osaki Y, Sasaki T, Kondoh K, Iwaki T, Kubo T. [Implantation of a vibratory mass transducer on the round window: a report of two cases]. Nihon Jibiinkoka Gakkai Kaiho 2008; 111:668-671. [PMID: 19048940 DOI: 10.3950/jibiinkoka.111.668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The Vibrant Soundbridge (VSB, Med-El, Austria) is a semiimplantable hearing aid usually attached to the long process of the incus to vibrate the ossicular chain in patients with moderate to severe mixed hearing loss. We implanted a VSB vibratory transducer on the round window membrane of the left ear in two cases not treated effectively by tympanoplastic surgeries. Pure tone audiography did not differ significantly in the two cases pre- or postoperatively, indicating that the small mass transducer does not adversely affect middle-ear vibration. Postoperative hearing thresholds with VSBs were similar to those when patient 1 wore an air-conductive hearing aid and patient 2 wore a bone-anchored hearing aid (BAHA). VSB implantation on the round window could thus potentially benefit many patients with mixed hearing loss.
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Affiliation(s)
- Yasuhiro Osaki
- Department of Otorhinolaryngology, Osaka University Graduate School of Medicine, Suita
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Abstract
OBJECTIVE We investigated transcranial magnetic stimulation (TMS) parameters in patients with parkinsonism, particularly in the early stages of the disease. SUBJECTS AND METHODS We performed TMS in 48 patients with PD, progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). We measured motor threshold (MT), latency (L), motor-evoked potential amplitude and central motor conduction time (CMCT) and cortical silent period (CSP). Furthermore, we selected and compared 27 patients with a disease duration of less than 3 years. RESULTS CMCT, MT, L and CSP were different among the three groups. Post hoc analyses revealed that CMCT and CSP were the shortest in PD, and that MT was significantly lower in PD than in MSA. In patients whose disease duration was less than 3 years, CMCT and CSP were different among the three groups. Post hoc analyses showed significantly shorter CMCT in PD. CONCLUSIONS TMS can detect the pathophysiological difference among the groups in the early stages of the disease.
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Affiliation(s)
- Y Morita
- Department of Geriatrics, Cardiology and Neurology, Kochi Medical School, Nankoku, Japan.
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Takao T, Tsujimura A, Miyagawa Y, Kiuchi H, Ueda T, Hirai T, Komori K, Takada S, Nonomura N, Osaki Y, Enomoto K, Hatazawa J, Okuyama A. Brain responses during the first desire to void: a positron emission tomography study. Int J Urol 2008; 15:724-8. [PMID: 18522679 DOI: 10.1111/j.1442-2042.2008.02076.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES First desire to void (FDV) is defined as the first feeling that would lead the patient to pass urine. The aim of the present study is to identify the brain regions activated during FDV. METHODS Six healthy right-handed male volunteers, aged 31-40 years, agreed to participate in this study. Rather than inserting a urethral catheter, we used a urinary volume monitoring unit and a self-adhesive external condom catheter for this study. Positron emission tomography (PET) scans obtained in the FDV and post-voiding (absence of urge to void) (REST) states were analyzed and compared. RESULTS First desire to void state was associated with increased blood flow in the right and left cerebellum, right parahippocampal gyrus (Brodmann area [BA] 30), left superior frontal gyrus (BA9), and left cingulate gyrus (BA32). Rest state was associated with decreased blood flow in the right superior temporal gyrus (BA22), right uncus (BA28), right cingulate gyrus (BA32), left middle temporal gyrus (BA21), and left medial frontal gyrus (BA25). According to region of interest analysis, regional cerebral blood flow of the periaqueductal grey and pons was significantly increased at FDV as opposed to REST. CONCLUSIONS We located possible brain activity associated with the FDV sensation. Combined activation of the right and left cerebellum, parahippocampal gyrus, superior frontal gyrus, and left cingulate gyrus could be associated with FDV.
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Affiliation(s)
- Tetsuya Takao
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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