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Migita S, Kitano D, Li Y, Yamada S, Mukaiyama T, Onishi A, Fuchimoto D, Suzuki S, Nakamura Y, Hirayama A, Okumura Y, Hao H. Pathology of coronary artery after drug-eluting stent implantation in low-density lipoprotein receptor knockout mini pigs; comparison with wild type pigs. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kamisaka K, Kamiya K, Iwatsu K, Iritani N, Iida Y, Adachi T, Yamada S. Weight loss early after discharge predicts the risk of rehospitalization in non-obese patients with heart failure preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Weight loss (WL) has been considered as a prognostic factor in heart failure with reduced ejection fraction (HFrEF). However, the prognosis and associated factors of WL in heart failure with preserved ejection fraction (HFpEF) have remained unclear.
Purpose
This study aimed to examine the prevalence, prognosis, and clinical characteristics of worse prognosis based on the identified WL after discharge in HFpEF.
Methods
The study was conducted as a part of a multicenter cohort study (Flagship). The cohort study enrolled ambulatory HF who hospitalized due to acute HF or exacerbation of chronic HF. Patients with severe cognitive, psychological disorders or readmitted within 6-month after discharge were excluded in the study. WL was defined as ≥5% weight loss in 6-month after discharge and HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% at discharge. Age, gender, etiology, prior HF hospitalization, New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-proBNP), anemia (hemoglobin; male <13g/dL, female <12g/dL), serum albumin, Geriatric Depression Scale, hand grip strength and comorbidities were collected at discharge. Patients were stratified according to their body mass index (BMI) at discharge as non-obese (BMI <25) or obese (BMI ≥25). We analyzed the association between WL and HF rehospitalization from 6 month to 2 years after discharge using Kaplan-Meier curve analysis and Cox regression analysis adjusted for age and gender, and clinical characteristics associated to worse prognosis in WL using logistic regression analysis adjusted for potential confounders in HFpEF.
Results
A total of 619 patients with HFpEF were included in the analysis. The prevalence of WL was 12.9% in 482 non-obese and 15.3% in 137 obese patients. During 2 years, 72 patients were readmitted for HF (non-obese: 48, obese: 24). WL in non-obese independently associated with poor prognosis (hazard ratio: 2.2: 95% confidence interval: 1.13–4.25) after adjustment for age and sex, while WL in obese patients did not. Logistic regression analysis chose age (odds ratio 1.02 per 1 year; 1.00–1.05), anemia (2.14; 1.32–3.48), and BNP ≥200pg/mL or NT-proBNP ≥900pg/mL (1.83; 1.18–2.86) as independent associated factors for worse prognosis of WL in non-obese patients.
Conclusion
In HFpEF, WL in early after discharge in non-obese elderly patients may be a prognostic indicator for HF rehospitalization. HF management including WL prevention along with controlling anemia is likely to improve prognosis in this population.
Kaplan Meier survival curves
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): A Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science
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Funaki K, Adachi T, Kameshima M, Fujiyama H, Iritani N, Asai C, Sakui D, Hara Y, Yamada S. Predicters of physical activity at 3-month after discharge in patients underwent percutaneous coronary intervention -A multicenter prospective cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Long-term prognosis after percutaneous coronary intervention (PCI), particularly non-target region stenosis, has not been well improved. Therefore, lifestyle modification should be considered along with medication to prevent the progression of coronary atherosclerosis. Particularly, the promotion of physical activity (PA) is recommended as a core intervention for secondary prevention because of its direct effects on coronary risk factors. However, the factors related to PA after PCI have not been fully investigated.
Purpose
To explore predictors of PA after discharge in patients underwent PCI.
Methods
We conducted a multicenter prospective cohort study. Participants were patients aged <75 years who underwent PCI. The main outcome was PA {step counts (SC) and a time of moderate-to-vigorous physical activity (MVPA)} measured for 7 consecutive days using an accelerometer at 3-month post discharge. We collected demographic data, comorbidities, medical history, laboratory data, and medications from medical record. In addition, severity of chest pain at the onset, physician's explanation regarding long-term prognosis, exercise environments, social support, work, lifestyle except exercise, self-efficacy for walking, difficulty in daily activities and depression were evaluated using questionnaires at discharge and 1-month post-discharge. The study participants were divided into two groups based on the median SC and MVPA at 3-month, and clinical characteristics were compared between the groups using χ2test or Mann Whitney U test. Then, multiple logistic regression analysis adjusted for age, gender, and diagnosis {stable angina or acute coronary syndrome (ACS)} was conducted with 3-month PA as dependent variable. Independent variables were those with a p<0.2 in the univariate analysis. In addition, the area under the curve (AUC) was calculated by receiver operating characteristic analysis to assess predictive accuracy of the regression model.
Results
We enrolled 313 patients [median age: 63 {inter-quartile range (IQR):56–67} years, women: 13.1%, ACS: 16.4%]. The median of SC and MVPA at 3-month were 6902 steps (IQR:5078–9095) and 16.2 min (IQR: 8.6–28.9), respectively. Predictors of SC at 3-month ≥the median were SC at 1-month (odds ratio 1.78, per 1000 steps/day; 95% confidence interval 1.51–2.09), hemoglobin (1.43, per 1g/dl; 1.10–1.86), body mass index (BMI) (0.87, per 1kg/m2; 0.82–0.99), use of β-blocker (0.49, 0.25–0.95), and self-efficacy for walking (1.06, per 1 point; 1.00–1.11). Predictors of MVPA ≥the median were MVPA at 1-month (5.66, per 10 minutes/day; 3.63–8.84), hemoglobin (1.57, per 1g/dl; 1.19–2.06), and BMI (0.85, per 1kg/m2; 0.76–0.94). The AUC of the regression model for SC and MVPA were 0.87 and 0.89, respectively.
Conclusion
PA after PCI could be predicted by modifiable factors with good predictive accuracy. The findings of this study suggest the possibility to develop tailored PA promotion program.
Funding Acknowledgement
Type of funding source: None
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Takino K, Kameshima M, Asai C, Kawamura I, Tomita S, Hirakawa A, Yamada S. Efficacy of neuromuscular electro stimulation on muscle strength in elderly patients with diabetes mellitus underwent cardiovascular surgery – a multicenter randomized controlled trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiovascular surgery causes muscle weakness probably due to a postoperative increase in inflammatory cytokine production, and diabetes mellitus (DM) may promote the postoperative muscle weakness because of increased insulin resistance.
Purpose
A multicenter randomized controlled trial was conducted to examine the effects of postoperative neuromuscular electrical stimulation (NMES) on muscle strength for elderly patients with DM after cardiovascular surgery (UMIN000029940).
Methods
Patients underwent cardiovascular surgery were consecutive screened for eligibility (With DM and age ≥65 years) as study subjects. If eligible, patients were randomly assigned either to the NMES or the sham group. Both of group underwent NMES or sham stimulation (60 minutes / 5 times) and usual postoperative early mobilization program until postoperative day (POD) 7. The primary outcome was the percent change in knee extensor isometric muscle strength (%ΔKEIS) between preoperative to POD 7. Secondary outcomes were the percent change in usual (%ΔUsual walking speed) and maximum walking speed (%ΔMaximum walking speed) and grip strength (%ΔGS). Assessors for physical function were blinded to the outcomes. The statistician who was blinded to the allocation analyzed the data using preoperative value adjusted ANCOVA.
Results
Of 1151 consecutive patients screened for eligibility from February 2018 to January 2020, 158 participants (NMES group, n=79; sham group, n=79) were enrolled. NMES group demonstrated significantly lower %ΔKEIS compared with those in the sham group (Table). Among secondary outcomes, NMES group showed significantly lower %ΔMaximum walking speed and tendency of lower %ΔUsual walking speed and %ΔGS (Table).
Conclusion
NMES prevented postoperative muscle weakness in the elderly patients with DM, indicating that NMES along with early mobilization could be implicated as specific intervention to those populations.
Funding Acknowledgement
Type of funding source: None
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Makishima H, Yasuda S, Kato H, Kaneko T, Sato H, Chang T, Kasuya G, Yamada S, Tsuji H. PO-1077: Carbon-ion radiotherapy for hepatocellular carcinoma with vascular invasion. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ehara M, Yamada S, Shibata K, Kameshima M, Fujiyama H, Matsui Y, Higashida Y, Shimada A, Ito T, Sano T, Okumura H, Masaoka K, Okawa Y. Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.
Purpose
We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.
Methods
This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.
Results
The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001).
Conclusion
Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.
Funding Acknowledgement
Type of funding source: None
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Hasebe M, Kawaguchi K, Saito T, Nakaoka K, Yamada S, Hamada Y. CT Would Predict to the Harvesting Weight of Iliac/Tibia Particulate Cancellous Bone and Marrows. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yamada S, Fujii T, Yamamoto T, Takami H, Yoshioka I, Yamaki S, Sonohara F, Shibuya K, Motoi F, Hirano S, Murakami Y, Inoue H, Hayashi M, Murotani K, Kitayama J, Ishikawa H, Kodera Y, Sekimoto M, Satoi S. Phase I/II study of adding intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis. Br J Surg 2020; 107:1811-1817. [PMID: 32638367 PMCID: PMC7689756 DOI: 10.1002/bjs.11792] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraperitoneal chemotherapy using paclitaxel is considered an experimental approach for treating peritoneal carcinomatosis. This study aimed to determine the recommended dose, and to evaluate the clinical efficacy and safety, of the combination of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis. METHODS The frequencies of dose-limiting toxicities were evaluated, and the recommended dose was determined in phase I. The primary endpoint of the phase II analysis was overall survival rate at 1 year. Secondary endpoints were antitumour effects, symptom-relieving effects, safety and overall survival. RESULTS The recommended doses of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel were 800, 75 and 20 mg/m2 respectively. Among 46 patients enrolled in phase II, the median time to treatment failure was 6·0 (range 0-22·6) months. The response and disease control rates were 21 of 43 and 41 of 43 respectively. Ascites disappeared in 12 of 30 patients, and cytology became negative in 18 of 46. The median survival time was 14·5 months, and the 1-year overall survival rate was 61 per cent. Conversion surgery was performed in eight of 46 patients, and those who underwent resection survived significantly longer than those who were not treated surgically (median survival not reached versus 12·4 months). Grade 3-4 haematological toxicities developed in 35 of 46 patients, whereas non-haematological adverse events occurred in seven patients. CONCLUSION Adding intraperitoneal paclitaxel had clinical efficacy with acceptable tolerability.
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Yamada S, Yamada K. 1215 Improving Sleep Disorders And Chronic Neck Pain By Adjusting Height Of The Pillow Through Cervical Posture Management. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Recent studies have suggested that chronic musculoskeletal system pain, including chronic neck pain, accounts for approximately 70% of all sleeping disorders. Simultaneously, sleeping disorders increase pain sensitivity and create a vicious cycle of chronic neck pain. Patients with chronic pain experience a variety of somatic symptoms (e.g., Stomach or bowel problems, Back pain, Pain in your joints, headaches, chest pain, shortness of breath, dizziness, fatigue, and Trouble sleeping) that are difficult to treat. However, treatment of both neck chronic pain and sleeping disorders through cervical posture management by adjusting height of the pillow used while sleeping has yet to be considered.
Methods
Patients who visited our hospital with chief complaints of chronic neck pain were rated according to the Numerical Rating Scale (NRS) and were asked to answer the Somatic Symptom Scale-8 (SSS-8), to ascertain the degree of somatic symptoms. Out of all the patients, only 84 scored at least 8 out of 32 in the SSS-8. Based on the individual results of the 84 respondents, they were given customized pillows to be used for 3 months. The pillows were adjusted using the SSS method developed at our clinic. We adjusted the height of the pillow by 5mm increments to check the cervical inclination angle at approximately 15 degrees in supine position, lateral position with the center line from face to neck at left-right symmetry and finally confirming smooth turning over. The respondents performed NRS and SSS-8 after 2 weeks and 3 months of using the pillow.
Results
The results of this study showed that at 0 weeks / 2 weeks / 3 months. NRS score was 6.8 / 5.1 / 4.1 (p <0.01), and the overall SSS-8 score was 13.2 / 9.9 / 8.2 (p <0.01), showed a marked improvement. By symptom, all symptoms except Stomach or bowel problems showed significant improvement. Trouble sleeping showed the highest improvement at 2.6 / 1.7 / 1.3 (p <0.01).
Conclusion
Chronic neck pain and sleeping disorders improved in the patients. These results suggested that cervical posture management by adjusting height of the pillow is an effective treatment method.
Support
None
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Tokuda K, Shimada M, Ikemoto T, Miyazaki K, Yamada S, Saito Y, Arakawa Y, Imura S, Morine Y. The investigation of optimal transplantation site of insulin producing cell differentiated from adipose derived stem cell. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Saito Y, Ikemoto T, Tokuda K, Yamada S, Arakawa Y, Imura S, Morine Y, Shimada M. Effective 3D culture of hepatocyte like cells from human adipose derived mesenchymal stem cells. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ikemoto T, Shimada M, Tokuda K, Miyazaki K, Yamada S, Saito Y, Arakawa Y, Imura S, Morine Y. The generation of effective insulin-producing cells from ADSC derived from type 1 diabetes mellitus patients. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Adachi I, Ahlburg P, Aihara H, Akopov N, Aloisio A, Anh Ky N, Asner DM, Atmacan H, Aushev T, Aushev V, Aziz T, Babu V, Baehr S, Bambade P, Banerjee S, Bansal V, Barrett M, Baudot J, Becker J, Behera PK, Bennett JV, Bernieri E, Bernlochner FU, Bertemes M, Bessner M, Bettarini S, Bianchi F, Biswas D, Bozek A, Bračko M, Branchini P, Briere RA, Browder TE, Budano A, Burmistrov L, Bussino S, Campajola M, Cao L, Casarosa G, Cecchi C, Červenkov D, Chang MC, Cheaib R, Chekelian V, Chen YQ, Chen YT, Cheon BG, Chilikin K, Cho K, Cho S, Choi SK, Choudhury S, Cinabro D, Corona L, Cremaldi LM, Cunliffe S, Czank T, Dattola F, De La Cruz-Burelo E, De Nardo G, De Nuccio M, De Pietro G, de Sangro R, Destefanis M, Dey S, De Yta-Hernandez A, Di Capua F, Doležal Z, Domínguez Jiménez I, Dong TV, Dort K, Dossett D, Dubey S, Duell S, Dujany G, Eidelman S, Eliachevitch M, Fast JE, Ferber T, Ferlewicz D, Finocchiaro G, Fiore S, Fodor A, Forti F, Fulsom BG, Ganiev E, Garcia-Hernandez M, Garg R, Gaur V, Gaz A, Gellrich A, Gemmler J, Geßler T, Giordano R, Giri A, Gobbo B, Godang R, Goldenzweig P, Golob B, Gomis P, Gradl W, Graziani E, Greenwald D, Guan Y, Hadjivasiliou C, Halder S, Hara T, Hartbrich O, Hayasaka K, Hayashii H, Hearty C, Hedges MT, Heredia de la Cruz I, Hernández Villanueva M, Hershenhorn A, Higuchi T, Hill EC, Hoek M, Hsu CL, Hu Y, Iijima T, Inami K, Inguglia G, Irakkathil Jabbar J, Ishikawa A, Itoh R, Iwasaki Y, Jacobs WW, Jaffe DE, Jang EJ, Jeon HB, Jia S, Jin Y, Joo C, Joo KK, Kahn J, Kakuno H, Kaliyar AB, Kandra J, Karyan G, Kato Y, Kawasaki T, Kim BH, Kim CH, Kim DY, Kim KH, Kim SH, Kim YK, Kim Y, Kimmel TD, Kindo H, Kleinwort C, Kodyš P, Koga T, Kohani S, Komarov I, Korpar S, Kovalchuk N, Kraetzschmar TMG, Križan P, Kroeger R, Krokovny P, Kuhr T, Kumar J, Kumar M, Kumar R, Kumara K, Kurz S, Kuzmin A, Kwon YJ, Lacaprara S, La Licata C, Lanceri L, Lange JS, Lautenbach K, Lee IS, Lee SC, Leitl P, Levit D, Li LK, Li YB, Libby J, Lieret K, Li Gioi L, Liptak Z, Liu QY, Liventsev D, Longo S, Luo T, Maeda Y, Maggiora M, Manoni E, Marcello S, Marinas C, Martini A, Masuda M, Matsuda T, Matsuoka K, Matvienko D, Meggendorfer F, Mei JC, Meier F, Merola M, Metzner F, Milesi M, Miller C, Miyabayashi K, Miyake H, Mizuk R, Azmi K, Mohanty GB, Moon T, Morii T, Moser HG, Mueller F, Müller FJ, Muller T, Muroyama G, Mussa R, Nakano E, Nakao M, Nayak M, Nazaryan G, Neverov D, Niebuhr C, Nisar NK, Nishida S, Nishimura K, Nishimura M, Oberhof B, Ogawa K, Onishchuk Y, Ono H, Onuki Y, Oskin P, Ozaki H, Pakhlov P, Pakhlova G, Paladino A, Panta A, Paoloni E, Park H, Paschen B, Passeri A, Pathak A, Paul S, Pedlar TK, Peruzzi I, Peschke R, Pestotnik R, Piccolo M, Piilonen LE, Popov V, Praz C, Prencipe E, Prim MT, Purohit MV, Rados P, Rasheed R, Reiter S, Remnev M, Resmi PK, Ripp-Baudot I, Ritter M, Rizzo G, Rizzuto LB, Robertson SH, Rodríguez Pérez D, Roney JM, Rosenfeld C, Rostomyan A, Rout N, Russo G, Sahoo D, Sakai Y, Sandilya S, Sangal A, Santelj L, Sartori P, Sato Y, Savinov V, Scavino B, Schueler J, Schwanda C, Seddon RM, Seino Y, Selce A, Senyo K, Sfienti C, Shen CP, Shiu JG, Shwartz B, Sibidanov A, Simon F, Sobie RJ, Soffer A, Sokolov A, Solovieva E, Spataro S, Spruck B, Starič M, Stefkova S, Stottler ZS, Stroili R, Strube J, Sumihama M, Sumiyoshi T, Summers DJ, Suzuki SY, Tabata M, Takizawa M, Tamponi U, Tanaka S, Tanida K, Taniguchi N, Taras P, Tenchini F, Torassa E, Trabelsi K, Tsuboyama T, Uchida M, Unger K, Unno Y, Uno S, Ushiroda Y, Vahsen SE, van Tonder R, Varner GS, Varvell KE, Vinokurova A, Vitale L, Vossen A, Wakai M, Wakeling HM, Wan Abdullah W, Wang CH, Wang MZ, Warburton A, Watanabe M, Webb J, Wehle S, Wessel C, Wiechczynski J, Windel H, Won E, Yabsley B, Yamada S, Yan W, Yang SB, Ye H, Yin JH, Yonenaga M, Yuan CZ, Yusa Y, Zani L, Zhang Z, Zhilich V, Zhou QD, Zhou XY, Zhukova VI. Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States. PHYSICAL REVIEW LETTERS 2020; 124:141801. [PMID: 32338980 DOI: 10.1103/physrevlett.124.141801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/24/2020] [Indexed: 06/11/2023]
Abstract
Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6 GeV/c^{2}.
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Itoh R, Braun N, Li C, Nakao M, Yamada S, Suzuki SY, Zhou Q, Konno T, Liu ZA, Zhao J, Hartbrich O, Park SH, Guan Y, Lautenbach K, Reiter S, Spruck B. The Performance of Belle II High Level Trigger in the First Physics Run. EPJ WEB OF CONFERENCES 2020. [DOI: 10.1051/epjconf/202024501040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Belle II experiment is a new generation B-factory experiment at KEK in Japan aiming at the search for New Physics in a huge sample of B-meson decays. The commissioning of the accelerator and the detector for the first physics run has started from March this year. The Belle II High Level Trigger (HLT) is fully working in the beam run. The HLT is now operated with 1600 cores clusterized in 5 units, which is 1/4 of the full configuration. The software trigger is performed using the same offline reconstruction code, and events are classified into a set of physics categories. Only the events in the categories of interest are finally sent out to the storage. Live data quality monitoring is also performed on HLT. For the selected events, the reconstructed tracks are extrapolated to the surface of the pixel detector (PXD) and quickly fed back to the readout electronics for the real time data reduction by sending only the associated hits. The maximum trigger rate in the first physics run was 3.5kHz, and the Belle II data acquisition system was stably operated. There were several problems in the HLT operation, but they have successfully been fixed during the data taking period. The HLT reduction factor is measured to be 8 which is still higher than the design because of the high background environment.
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Buyo M, Takahashi S, Iwahara A, Tsuji T, Yamada S, Hattori S, Uematsu Y, Arita M, Ukai S. Metabolic Syndrome and Cognitive Function: Cross-Sectional Study on Community-Dwelling Non-Demented Older Adults in Japan. J Nutr Health Aging 2020; 24:878-882. [PMID: 33009539 DOI: 10.1007/s12603-020-1412-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This is a cross-sectional study of relation between metabolic syndrome and cognitive function in community-dwelling non-demented older adults in Japan. We examine the effect of metabolic syndrome and its components on global cognitive function. We also aim to clarify differences of specific cognitive domains between the subjects with and without metabolic syndrome. METHODS We studied 2150 subjects aged between 60 and 90 years whose scores on mini mental state examination (MMSE) were over 23 points. We analyzed difference in MMSE scores between the subjects with and without metabolic syndrome. Logistic regression analysis was performed with MMSE score as the dependent variable and metabolic syndrome components as the independent variable adjusted with age. We also examined differences in attention, logical memory, and verbal and category fluency between the subjects with and without metabolic syndrome. RESULTS MMSE scores were not significantly different between subjects with and without metabolic syndrome. In logistic regression analysis, the score of MMSE was significantly negatively associated with triglycerides in males and significantly negatively associated with abdominal circumference in females. Subjects with metabolic syndrome showed significantly lower performance of attention tasks compared to subjects without metabolic syndrome. CONCLUSIONS Our results suggest that in community-dwelling non-demented Japanese older adults, attention but not global cognitive function may be impaired by metabolic syndrome. Inverted association between some components of metabolic syndrome and global cognitive function indicate necessity of further studies on the relation between undernutrition and cognitive function.
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Sakurai K, Onouchi T, Yamada S, Baba Y, Murata T, Tsukamoto T, Kuroda M, Urano M. Cytohistology of morule in cribriform-morular variant of papillary thyroid carcinoma. THE MALAYSIAN JOURNAL OF PATHOLOGY 2019; 41:339-343. [PMID: 31901919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Cribriform-morular variant (CMV) is a rare variant of papillary thyroid carcinoma. It frequently occurs in association with familial adenomatous polyposis (FAP), although some cases are sporadic. Herein, we report a case of CMV and analyse morule cytohistology. CASE REPORT The patient was a 47-year-old woman with no familial history of FAP. A 3.0-cm unifocal mass was identified in the left thyroidal lobe. Fine-needle aspiration cytology revealed papillary clusters of atypical cells with nuclear grooves, which was suspected to be conventional papillary thyroid carcinoma. Histologically, the tumour comprised a papillary and cribriform growth of atypical cells with cytoplasmic accumulation and nuclear translocation of b-catenin. In addition, frequent morule formation was identified. DISCUSSION In this case, we performed morule analysis through correlative light and electron microscopy (CLEM), and revealed its ultrastructure. Although CMV is a rare form of thyroid carcinoma, it should be considered along with its distinct clinicopathological characteristics.
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Toyono M, Yamada S, Aoki-Okazaki M, Takahashi T. P3467Tricuspid annular isovolumic acceleration is more useful for the assessment of right ventricular systolic function in patients after repair of tetralogy of Fallot with pulmonary regurgitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The detrimental impact of pulmonary regurgitation (PR) on right ventricular (RV) function of patients after repair of tetralogy of Fallot (TOF) is recognized. Although tricuspid annular isovolumic acceleration (IVA) is useful for the evaluation of RV function, it requires complicated measurement. Tricuspid annular plane systolic excursion (TAPSE) is measured easily and has also been validated as a marker of RV systolic function.
Hypothesis
We assessed the hypothesis that IVA has advantage to the stratification of the detrimental impact of PR on RV systolic function after TOF repair compared with TAPSE.
Methods
We prospectively examined patients after TOF repair. Patients <1 year after the repair, those with the history of sustained arrhythmia and those who required concomitant tricuspid and/or pulmonary valve surgery were excluded from the study. IVA was measured by dividing the myocardial velocity during isovolumic contraction by the time interval from the onset of the myocardial velocity during the isovolumic contraction to the time at the peak velocity of this wave. TAPSE was measured using M-mode echocardiography with the M-line passing through the lateral annulus of tricuspid valve in the apical 4-chamber plane. PR jets were evaluated in the parasternal short-axis plane. PR degree was assessed by the number of correspondence to the following conditions; 1) diastolic flow reversal in the main pulmonary artery, 2) diastolic flow reversal in the branch pulmonary arteries, 3) pressure half-time of PR signal <100 msec and 4) the ratio of the duration of the PR signal to the total duration of diastole <0.77. PR degree was graded from 0 to 4.
Results
Twenty-two patients were enrolled to the study. Age, female, period after the TOF repair and body height of the patients were 11±6 years, 55%, 9±5 years and 137±28 cm, respectively. In all the patients, IVA and TAPSE were 160±27 cm/sec2 and 12±2 mm, respectively. PR degrees were graded as 2, 3 and 4 in 4, 14 and 4 patients, respectively. By the Kruskal-Wallis test, only IVA showed a significant difference among the 3 PR degrees.
Conclusion
In conclusion, IVA can be a useful index for the stratification of RV function in patients after TOF repair with various degrees of PR.
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Adachi T, Iwatsu K, Kamisaka K, Iida Y, Yamada S. P6322Trajectories of functional limitations during 14 months after discharge among patients with heart failure: a multicenter cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Severity of functional limitations (FLs) has been considered as a prognostic factor in patients with heart failure (HF). However, trajectory patterns of FLs after discharge and their associated factors have remained unclear.
Purpose
This study aimed to explore trajectories of FLs after discharge and to examine clinical characteristics based on the identified trajectories.
Methods
This study was performed as a part of a multicenter cohort study. The cohort study enrolled hospitalized patients due to acute HF or exacerbation of chronic HF and who were able to walk at discharge. Patients with severe cognitive or psychological disorders or less than 6-month life expectancy were excluded. FLs were assessed using Performance Measure for Activities of Daily Living-8 (PMADL-8; higher scores indicate worse FLs) at discharge and 1-, 6-, 10- and 14-month after discharge. To identify FLs trajectories getting worse after discharge, we excluded patients already having severe FLs at discharge (PMADL-8 ≥21, a cut off value for predicting poor prognosis). Group-based trajectory modeling (GBTM) was conducted to identify distinct PMADL-8 trajectories. Then, associated factors of trajectory group that showed increasing FLs after discharge were examined using logistic regression analysis adjusted for potential confounders.
Results
A total of 953 patients were included in the analysis (age: 70.6±11.8 years, men: 70.9%, left ventricular ejection fraction <40%: 41.3%). GBTM identified four PMADL-8 trajectories: two separate trajectories where PMADL-8 remained low (T1: 14.1%, T2: 31.3%), mildly increasing PMADL-8 trajectory (T3: 41.0%) and rapidly increasing PMADL-8 trajectory (T4: 13.6%) (Figure). Logistic regression analysis showed that age (odds ratio 1.05, per 1 year; 95% confidence interval 1.02–1.07), women (2.12; 1.31–3.45), brain natriuretic peptide ≥200 pg/mL (1.88; 1.10–3.21), estimated glomerular filtration rate <30 mL/min/1.73m2 (2.50; 1.41–4.41), depression (2.34; 1.44–3.80), and re-hospitalization due to HF during 1-year follow-up (2.85; 1.56–5.21) were independent associated factors of T4 group.
Figure 1. Trajectories of PMADL-8
Conclusions
The high-risk population for increasing FLs after discharge was identified by GBTM. The findings of this study suggest the importance of long-term HF management for preventing FLs after discharge especially among those with older age, female gender and depression.
Acknowledgement/Funding
This work was supported by a Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science [16H01862].
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Ehara M, Shibata K, Kameshima M, Fujiyama H, Terai M, Shimizu K, Matsui Y, Higashida Y, Watanabe M, Shimada A, Ohkawa Y, Yamada S. P2528Responsiveness to nutritional intervention would impact on future cardiovascular prognosis in poor fitness patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Purpose
Nutritional improvement has been proposed for long-term cardiovascular prognosis as well as fitness recovery. We aimed to examine whether “responsiveness” to nutritional and exercise interventions would impact patients' cardiovascular prognosis even patients in low baseline fitness level.
Methods
We included 254 consecutive patients who participated in the phase II comprehensive cardiovascular rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion phases of CCR. Nutritional guidance was periodically performed individually during CCR. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided into “low fitness” and “normal fitness” groups based on the median of baseline PVO2. Each group was further classified into four categories according to the changes in VO2 and GNRI during CCR: “Both NOT improved”, “Only GNRI improved”, “Only PVO2 improved”, and “Both improved”.
Results
Cox proportional regression analysis showed that the category of “both NOT improved” was an independent predictor for cardiovascular risk among the baseline low fitness group (Hazard ratio: 4.5, p=0.007); whereas no significant difference among the normal fitness group. Kaplan-Meier analysis revealed that the event-free survival rate was significantly lower in the “both NOT improved” category (log rank p=0.002) among the baseline low fitness group (figure); whereas no significant difference among the normal fitness group.
GNRI/PVO2 improvement vs. prognosis
Conclusion
Responsiveness to nutritional and exercise intervention could be a predictive factor of cardiovascular prognosis even in low fitness patients.
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Yokoyama H, Nakayama G, Ishigure K, Hayashi N, Tanaka K, Tsutsuyama M, Hattori N, Yamada S, Kodera Y. Randomized phase II trial of CAPOX with planned oxaliplatin stop-and-go strategy as adjuvant chemotherapy after curative resection of colon cancer (CCOG-1302 study). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Iwatsu K, Adachi T, Kamisaka K, Iida Y, Yamada S. 296Clinical benefit of assessing cognitive function in frail patients with heart failure: a multicenter prospective cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive decline is highly prevalent in patients with heart failure (HF) and increases the risk of hospital readmission or mortality due to poor self-care ability. Although cognitive decline often coexists with physical frailty (PF) in HF, the clinical utility of combined assessment of both cognitive function and PF remains unclear.
Purpose
The aim of this study was to examine the prognostic value of assessing cognitive function and PF in patients with HF.
Methods
This prospective study was performed as a multicenter cohort study in Japan (FLAGSHIP). We enrolled 1611 patients admitted for acute HF or exacerbation of chronic HF and who were able to walk at discharge. Patients with severe dementia [Mini-Mental State Examination (MMSE) scores <18], severe psychological disorders or less than 6-month life expectancy were excluded. From data at discharge, we collected data on cognitive function, PF, age, gender, New York Heart Association class, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, hemoglobin, depression (5-item geriatric depression scale ≥2) and comorbidities, including atrial fibrillation, diabetes mellitus, stroke, and hyponatremia. PF was defined as ≥2 of the followings based on our previous publication: usual walking speed <0.8 m/s; grip strength <26 kg (men) or <17 kg (women); Performance Measure of Activity in Daily Living-8 ≥21; body mass index <20 kg/m2. Cognitive function was assessed by MMSE. We selected the optimal cutoff point of MMSE that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. Study outcome was a composite outcome of rehospitalization for worsening HF or all-cause mortality within 2 years after discharge. We used Cox proportional-hazard models to examine the association between the presence of cognitive decline and PF and 2-years prognosis, controlling for potential confound factors.
Results
A total of 507 events (31.5%) were observed (400 HF rehospitalization, 27 cardiac death, 80 non-cardiac death). The optimal cutoff point of MMSE was 28 (the area under the ROC curve: 0.58, p<0.01, sensitivity: 71.0%, specificity: 41.0%). There was a significant difference in event-free survival across the groups stratified by cognitive decline (MMSE <28) and PF (Figure). After adjusting for all variables, coexistence of both cognitive decline and PF was independently associated with 2-years prognosis (hazard ratio: 1.52, 95% confidence interval: 1.19–1.94).
Conclusion
Our data shows that even a slight decline in cognitive function leads to an increased risk of death or HF rehospitalization in frail patients with HF. Combined assessment both cognitive function and PF improves risk stratification for readmission and mortality in patients with HF.
Acknowledgement/Funding
This work was supported by a Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science [16H01862].
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Yamada S, Abe N, Sagayama H, Ogawa K, Yamagami T, Arima T. Room-Temperature Low-Field Colossal Magnetoresistance in Double-Perovskite Manganite. PHYSICAL REVIEW LETTERS 2019; 123:126602. [PMID: 31633958 DOI: 10.1103/physrevlett.123.126602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Indexed: 06/10/2023]
Abstract
We have discovered room-temperature low-field colossal magnetoresistance (CMR) in an A-site ordered NdBaMn_{2}O_{6} crystal. The resistance changes more than 2 orders of magnitude at a magnetic field lower than 2 T near 300 K. When the temperature and magnetic field sweep from an insulating (metallic) phase to a metallic (insulating) phase, the insulating (metallic) conduction changes to the metallic (insulating) conduction within 1 K and 0.5 T, respectively. The CMR is ascribed to the melting of the charge and orbital ordering. The entropy change which is estimated from the B-T phase diagram is smaller than what is expected for the charge and orbital ordering. The suppression of the entropy change is attributable to the loss of the short-range ferromagnetic fluctuation of Mn spin moments, which is an important key of the high temperature and low magnetic field CMR effect.
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Yamada S, Lav R, Li J, Tucker AS, Green JBA. Molar Bud-to-Cap Transition Is Proliferation Independent. J Dent Res 2019; 98:1253-1261. [PMID: 31393749 PMCID: PMC6761786 DOI: 10.1177/0022034519869307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Tooth germs undergo a series of dynamic morphologic changes through bud, cap, and bell stages, in which odontogenic epithelium continuously extends into the underlying mesenchyme. During the transition from the bud stage to the cap stage, the base of the bud flattens and then bends into a cap shape whose edges are referred to as “cervical loops.” Although genetic mechanisms for cap formation have been well described, little is understood about the morphogenetic mechanisms. Computer modeling and cell trajectory tracking have suggested that the epithelial bending is driven purely by differential cell proliferation and adhesion in different parts of the tooth germ. Here, we show that, unexpectedly, inhibition of cell proliferation did not prevent bud-to-cap morphogenesis. We quantified cell shapes and actin and myosin distributions in different parts of the tooth epithelium at the critical stages and found that these are consistent with basal relaxation in the forming cervical loops and basal constriction around enamel knot at the center of the cap. Inhibition of focal adhesion kinase, which is required for basal constriction in other systems, arrested the molar explant morphogenesis at the bud stage. Together, these results show that the bud-to-cap transition is largely proliferation independent, and we propose that it is driven by classic actomyosin-driven cell shape–dependent mechanisms. We discuss how these results can be reconciled with the previous models and data.
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Adachi T, Hori M, Ishimaru Y, Fujii N, Kondo T, Yamada S. Preferences for health information in middle-aged Japanese workers based on health literacy levels: a descriptive study. Public Health 2019; 174:18-21. [PMID: 31301551 DOI: 10.1016/j.puhe.2019.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 04/13/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the health information preferences in middle-aged Japanese workers based on health literacy (HL) levels and presence of medications. STUDY DESIGN A cross-sectional study. METHODS We performed a web-based questionnaire survey with Japanese workers aged below 60 years. HL was assessed using the total score of communicative skills (five items) and critical skills (four items) from the 14-item Health Literacy Scale. Regarding their health information preferences, participants were asked about the health information they wanted (four items), could easily understand (six items), or easily use (two items) and answered on a 4-point scale (strongly agree/agree/disagree/strongly disagree). The percentages of the affirmative responses (strongly agree or agree) were compared among tertiles based on the HL score. RESULTS We obtained data from a total of 3387 volunteers, of whom 510 participants were on either antihypertensive, lipid-lowering, or antidiabetic drugs. Compared with the high HL and middle HL groups, low HL had fewer affirmative responses to most health information items. Health information items received 70% of affirmative responses even in the low HL level. They were visually shown by figures or pictures, highlighted by colors for important points, could be read in 1-2 min, and were accessed on the Internet, regardless of the presence of medications. Additionally, the explanation for mechanisms of medications or lifestyle to prevent or improve diseases showed high affinity in all HL levels, only for those on medications. CONCLUSIONS This result generates a hypothesis that low HL individuals have a low interest in health information. Our data showed several possible forms of health information with high affinity based on HL levels that would help plan future population approaches.
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Yoshida K, Suzuki S, Kawada-Matsuo M, Nakanishi J, Hirata-Tsuchiya S, Komatsuzawa H, Yamada S, Shiba H. Heparin-LL37 complexes are less cytotoxic for human dental pulp cells and have undiminished antimicrobial and LPS-neutralizing abilities. Int Endod J 2019; 52:1327-1343. [PMID: 31002379 DOI: 10.1111/iej.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/12/2019] [Indexed: 12/13/2022]
Abstract
AIM To investigate whether glycosaminoglycans (GAGs) binding to high-dose LL37 eliminates its cytotoxicity to dental pulp cells (hDPCs) whilst retaining undiminished antimicrobial and LPS-neutralizing abilities. METHODOLOGY hDPCs were stimulated with varying concentrations of LL37, and their cell viability was analysed by MTT. Then, high-dose LL37 (10 μmol L-1 ) was bound to varying concentrations of three GAGs, heparin, chondroitin sulphate and hyaluronic acid, and their cytotoxic effects on hDPCs and antimicrobial effects were evaluated and compared. Furthermore, the LPS-neutralizing ability of heparin (5 μg mL-1 )-LL37 (10 μmol L-1 ) complexes, which were found to be less cytotoxic for hDPCs with undiminished antimicrobial ability, was investigated. Statistical analysis was performed using one-way analysis of variance (anova), followed by Dunnett's test. P values below 0.05 were considered significant. RESULTS LL37 significantly reduced the cell viability of hDPCs in a dose-dependent manner (P < 0.01). LL37 (10 μmol L-1 ) binding to heparin within a limited concentration range (2~6 μg mL-1 ) eliminated the cytotoxicity for hDPCs (P < 0.01) whilst exerting potent antimicrobial effects against Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius, Aggegatibacter actinomycetemcomitans and Escherichia coli. LL37 (10 μmol L-1 ) binding to chondroitin sulphate exhibited similar functions (P < 0.01); however, the effective chondroitin sulphate concentration was highly restricted (3 μg mL-1 ). LL37 (10 μmol L-1 ) binding to hyaluronic acid was unable to abrogate the cytotoxicity of LL37 even at higher concentrations (10 and 100 μg mL-1 ). Moreover, exogenous addition of LPS dose-dependently reduced the amount of LL37 precipitated with the heparin-LL37 agarose beads (P < 0.01), and the released LL37 simultaneously neutralized the pro-inflammatory ability of LPS in macrophages (P < 0.01). CONCLUSIONS Heparin-LL37 complexes generated at suitable concentration ratios are easy to make, are less cytotoxic and are broad-range antimicrobial materials that can neutralize LPS by providing LL37 in accordance with the amount of free LPS. They may be a potential treatment to save dental pulp tissue from the acute inflammation exacerbated by invading bacteria and the LPS they release.
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