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Qi P, Qi B, Gu C, Huo S, Dang X, Liu Y, Zhao B. Construction of an immune-related prognostic model and potential drugs screening for esophageal cancer based on bioinformatics analyses and network pharmacology. Immun Inflamm Dis 2024; 12:e1266. [PMID: 38804848 PMCID: PMC11131936 DOI: 10.1002/iid3.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 02/29/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Esophageal cancer (ESCA) is a highly invasive malignant tumor with poor prognosis. This study aimed to discover a generalized and high-sensitivity immune prognostic signature that could stratify ESCA patients and predict their overall survival, and to discover potential therapeutic drugs by the connectivity map. METHODS The key gene modules significantly related to clinical traits (survival time and state) of ESCA patients were selected by weighted gene coexpression network analysis (WCGNA), then the univariate and least absolute shrinkage and selection operator (LASSO) Cox regression analyses were used to construct a 15-immune-related gene prognostic signature. RESULTS The immune-related risk model was related to clinical and pathologic factors and remained an effective independent prognostic factor. Enrichment analyses revealed that the differentially expressed genes (DEGs) of the high- and low-risk groups were associated with tumor cell proliferation and immune mechanisms. Based on the gathered data, a small molecule drug named perphenazine (PPZ) was elected. The pharmacological analysis indicates that PPZ could help in adjuvant therapy of ESCA through regulation of metabolic process and cellular proliferation, enhancement of immunologic functions, and inhibition of inflammatory reactions. Furthermore, molecular docking was performed to explore and verify the PPZ-core target interactions. CONCLUSION We succeed in structuring the immune-related prognostic model, which could be used to distinguish and predict patients' survival outcome, and screening a small molecule drug named PPZ. Prospective studies also are needed to further validate its analytical accuracy for estimating prognoses and confirm the potential use of PPZ for treating ESCA.
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Affiliation(s)
- Pengju Qi
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
- Life Science Research CenterThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
| | - Bo Qi
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
| | - Chengwei Gu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
| | - Shuhua Huo
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
| | - Xinchen Dang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
| | - Yuzhen Liu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
- Life Science Research CenterThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
| | - Baosheng Zhao
- Department of Thoracic SurgeryThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiHenanChina
- Esophageal Cancer Institute of Xinxiang Medical UniversityWeihuiHenanChina
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Simsek EC, Sari C, Kucukokur M, Ekmekci C, Colak A, Ozdogan O. Endothelial dysfunction in patients with myocardial ischemia or infarction and nonobstructive coronary arteries. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:334-340. [PMID: 32776332 DOI: 10.1002/jcu.22902] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The syndromes of myocardial infarction/myocardial ischemia with No Obstructive Coronary Artery Disease (MINOCA/INOCA) are seen more and more often. Endothelial dysfunction (ED) leading to ischemic events has been reported in many of these patients. We aimed to compare patients with MINOCA and INOCA regarding brachial artery flow-mediated endothelium-dependent vasodilation (flow-mediated dilation [FMD]) and plasma concentration of cardiotrophin-1 (CT-1). METHODS We included 42 patients with MINOCA and 38 patients with INOCA. Endothelial function was assessed by measuring FMD% and nitroglycerin-mediated dilatation (NMD%) in the brachial artery. The plasma level of CT-1 was determined by solid-phase enzyme-linked immunosorbent assay. RESULTS FMD% was significantly lower in MINOCA than in INOCA patients (6.45 ± 2.65 vs 8.94 ± 3.32, P < .001), without significant difference in NMD% (10.69 ± 3.19 vs 12.16 ± 3.69, P = .06). Plasma CT-1 levels were not significantly different: 40.1 pg/mL (22.5-102.1) vs 37.2 pg/mL (23.5-67.2), P = .53. CONCLUSION Our results suggest worse ED in MINOCA than in INOCA patients, but demonstrated no difference in CT-1 levels between patients with stable and unstable ischemic heart disease and normal coronary arteries.
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Affiliation(s)
- Ersin Cagri Simsek
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
| | - Cenk Sari
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
| | - Murat Kucukokur
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
| | - Cenk Ekmekci
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
| | - Ayfer Colak
- Department of Biochemistry, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
| | - Oner Ozdogan
- Department of Cardiology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey
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Carneros D, Medina-Gómez G, Giralt M, León-Camacho M, Campbell M, Moreno-Aliaga MJ, Villarroya F, Bustos M. Cardiotrophin-1 contributes to metabolic adaptations through the regulation of lipid metabolism and to the fasting-induced fatty acid mobilization. FASEB J 2020; 34:15875-15887. [PMID: 33047392 DOI: 10.1096/fj.202000109r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
It is becoming clear that several human pathologies are caused by altered metabolic adaptations. During liver development, there are physiological changes, from the predominant utilization of glucose (fetal life) to the use of lipids (postnatal life). Fasting is another physiological stress that elicits well-known metabolic adjustments. We have reported the metabolic properties of cardiotrophin-1 (CT-1), a member of the interleukin-6 family of cytokines. Here, we aimed at analyzing the role of CT-1 in response to these metabolic changes. We used different in vivo models. Furthermore, a differential study was carried out with wild-type and CT-1 null mice in fed (ad libitum) and food-restricted conditions. We demonstrated that Ct-1 is a metabolic gene induced in the liver via PPARα in response to lipids in mice (neonates- and food-restricted adults). We found that Ct-1 mRNA expression in white adipose tissue directly involved PPARα and PPARγ. Finally, the physiological role of CT-1 in fasting is confirmed by the impaired food restriction-induced adipose tissue lipid mobilization in CT-1 null mice. Our findings support a previously unrecognized physiological role of CT-1 in metabolic adaptations, through the regulation of lipid metabolism and contributes to fasting-induced free fatty acid mobilization.
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Affiliation(s)
- David Carneros
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBiS), Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, Virgen del Rocio University Hospital, Seville, Spain
| | - Gema Medina-Gómez
- Department of Basic Sciences of Health, Area of Biochemistry and Molecular Biology, Rey Juan Carlos University, Madrid, Spain
| | - Marta Giralt
- Department of Biochemistry and Molecular Biomedicine, Barcelona University, Barcelona, Spain.,CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Manuel León-Camacho
- Department of Lipid Characterization and Quality, Instituto de la Grasa (CSIC), Seville, Spain
| | - Mark Campbell
- MRC MDU, Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Maria J Moreno-Aliaga
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain.,Centre for Nutrition Research and Department of Nutrition, Food Science and Physiology School of Pharmacy and Nutrition, University of Navarra, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biomedicine, Barcelona University, Barcelona, Spain.,CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Matilde Bustos
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBiS), Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, Virgen del Rocio University Hospital, Seville, Spain
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Ma D, Wang Y, Zhou G, Wang Y, Li X. Review: the Roles and Mechanisms of Glycoprotein 130 Cytokines in the Regulation of Adipocyte Biological Function. Inflammation 2019; 42:790-798. [PMID: 30661143 DOI: 10.1007/s10753-019-00959-6] [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] [Indexed: 02/06/2023]
Abstract
Chronic low-grade inflammation is now widely accepted as one of the most important contributors to metabolic disorders. Glycoprotein 130 (gp130) cytokines are involved in the regulation of metabolic activity. Studies have shown that several gp130 cytokines, such as interleukin-6 (IL-6), leukemia inhibitory factor (LIF), oncostatin M (OSM), ciliary neurotrophic factor (CNTF), and cardiotrophin-1 (CT-1), have divergent effects on adipogenesis, lipolysis, and insulin sensitivity as well as food intake. In this review, we will summarize the present knowledge about gp130 cytokines, including IL-6, LIF, CNTF, CT-1, and OSM, in adipocyte biology and metabolic activities in conditions such as obesity, cachexia, and type 2 diabetes. It is valuable to explore the diverse actions of these gp130 cytokines on the regulation of the biological functions of adipocytes, which will provide potential therapeutic targets for the treatment of obesity and cachexia.
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Affiliation(s)
- Dufang Ma
- Cardiology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yong Wang
- Cardiology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guofeng Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Li
- Cardiology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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Stephens J, Ravussin E, White U. The Expression of Adipose Tissue-Derived Cardiotrophin-1 in Humans with Obesity. BIOLOGY 2019; 8:biology8020024. [PMID: 31013924 PMCID: PMC6627495 DOI: 10.3390/biology8020024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/23/2023]
Abstract
Cardiotrophin-1 (CT-1) is a gp130 cytokine that was previously characterized for its effects on cardiomyocytes and identified as a marker of heart failure. More recent studies reported elevated circulating levels of CT-1 in humans with obesity and metabolic syndrome (MetS). However, a subsequent rodent study implicated CT-1 as a potential therapeutic target for obesity and MetS. Adipose tissue (AT) is broadly acknowledged as an endocrine organ and is a substantial source of CT-1. However, no study has examined the expression of adipose-derived CT-1 in humans. We present the first analysis of CT-1 mRNA expression in subcutaneous AT and its association with clinical variables in 22 women with obesity and 15 men who were 40% overfed for 8-weeks. We observed that CT-1 expression was higher in the subcutaneous abdominal (scABD) than the femoral (scFEM) depot. Importantly, we reveal that scFEM but not scABD, CT-1 expression was negatively associated with visceral adiposity and intrahepatic lipid, while positively correlated with insulin sensitivity in obese women. Also, men with higher CT-1 levels at baseline had less of a decline in insulin sensitivity in response to overfeeding. Our data provide new knowledge on the regulation of adipose-derived CT-1 in obesity and during weight gain in response to overfeeding in humans and suggest that CT-1 may play a protective role in obesity and related disorders.
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Affiliation(s)
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
| | - Ursula White
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
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Cardiotrophin-1 and leptin as cardiovascular risk markers in male patients with obstructive sleep apnea syndrome. ACTA ACUST UNITED AC 2019; 3:e123-e128. [PMID: 30775602 PMCID: PMC6374564 DOI: 10.5114/amsad.2018.79407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/01/2018] [Indexed: 11/19/2022]
Abstract
Introduction Elevated cardiotrophin-1 (CT-1) and leptin levels are important risk factors for cardiovascular diseases (CVDs). Obstructive sleep apnea syndrome (OSAS) has also been reported to increase this risk. The aim of this study is to evaluate serum concentrations of CT-1 and leptin in patients with OSAS and whether there is a possible association between CT-1, leptin and OSAS severity. Material and methods Fifty newly diagnosed OSAS patients and thirty nonapneic snoring subjects participated in this study. Fasting serum lipid profile markers were evaluated. The measurements of serum CT-1 and leptin levels were carried out using human ELISA kits. Results Significant differences were found in the serum CT-1 and leptin levels between the two groups. Serum median CT-1 levels in patient and control groups, respectively, were 19.47; 8.23 pg/ml and leptin levels were 2.07; 1.29 ng/ml (p < 0.001). In the severe patient group, serum median CT-1 level was statistically significantly higher than the median level in the mild/moderate group. There was no correlation between patients’ leptin and lipid profile parameters and CT-1 concentrations were not associated with triglyceride, cholesterol or LDL cholesterol levels except HDL cholesterol: CT-1 levels were positively correlated with HDL levels (p = 0.02). Conclusions Both CT-1 and leptin were significantly elevated in the patient group. Furthermore, CT-1 and leptin were associated with OSAS and CT-1 was associated with the disease severity.
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Hogas S, Bilha SC, Branisteanu D, Hogas M, Gaipov A, Kanbay M, Covic A. Potential novel biomarkers of cardiovascular dysfunction and disease: cardiotrophin-1, adipokines and galectin-3. Arch Med Sci 2017; 13:897-913. [PMID: 28721158 PMCID: PMC5507105 DOI: 10.5114/aoms.2016.58664] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/30/2015] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular disease is one of the main burdens of healthcare systems worldwide. Nevertheless, assessing cardiovascular risk in both apparently healthy individuals and low/high-risk patients remains a difficult issue. Already established biomarkers (e.g. brain natriuretic peptide, troponin) have significantly improved the assessment of major cardiovascular events and diseases but cannot be applied to all patients and in some cases do not provide sufficiently accurate information. In this context, new potential biomarkers that reflect various underlying pathophysiological cardiac and vascular modifications are needed. Also, a multiple biomarker evaluation that shows changes in the cardiovascular state is of interest. This review describes the role of selected markers of vascular inflammation, atherosclerosis, atherothrombosis, endothelial dysfunction and cardiovascular fibrosis in the pathogenesis and prognosis of cardiovascular disease: the potential use of cardiotrophin-1, leptin, adiponectin, resistin and galectin-3 as biomarkers for various cardiovascular conditions is discussed.
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Affiliation(s)
- Simona Hogas
- Nephrology Department, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Stefana C Bilha
- Endocrinology Department, "Sf. Spiridon" Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Dumitru Branisteanu
- Endocrinology Department, "Sf. Spiridon" Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Hogas
- Physiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Abduzhappar Gaipov
- Extracorporeal Hemocorrection Unit, JSC "National Scientific Medical Research Center", Astana, Kazakhstan
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Cardiotrophin-1 is inversely associated with obesity in non-diabetic individuals. Sci Rep 2015; 5:17438. [PMID: 26621340 PMCID: PMC4664929 DOI: 10.1038/srep17438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/29/2015] [Indexed: 12/11/2022] Open
Abstract
Cardiotrophin-1 is known to be a key regulator of energy homeostasis, as well as glucose and lipid metabolism in vivo. However, there are inconsistent results of the association between cardiotrophin-1 and obesity in humans, possibly confounded by hyperglycemia. Therefore, the aim of this study was to investigate the relationships among cardiotrophin-1 levels, overweight and obese individuals without diabetes in a Chinese population. The median (inter-quarter range) serum cardiotrophin-1 levels were 447.9 (230.9, 913.9), 350.6 (201.1, 666.5), and 288.1 (162.3, 572.4) pg/ml in non-diabetic subjects who were of normal weight (n = 522), overweight (n = 203), and obese (n = 93), respectively (trend test p < 0.001). Subjects who were overweight and obese had significantly lower cardiotrophin-1 levels than those with normal weight. The multivariate linear regression analyses showed that overweight (beta = −338.718, 95% CI = −552.786 ~ −124.651, p < 0.01), obese (beta = −530.275, 95% CI = −832.967 ~ −227.583, p < 0.01), and smoking (beta = −377.375, 95% CI = −654.353 ~ −100.397, p < 0.01) were negatively related to cardiotrophin-1 after adjusting for age, gender, HOMA-IR, hypertension, total cholesterol, HDL, triglyceride, eGFR, ALT, and alcohol drinking. The results of this study provided epidemiological evidence that non-diabetic subjects who were overweight or obesity had significantly lower cardiotrophin-1 concentrations than those with normal weight, and both obesity and being overweight were inversely associated with cardiotrophin-1 levels.
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Koyama K, Yoneyama K, Mitarai T, Ishibashi Y, Takahashi E, Kongoji K, Harada T, Akashi YJ. Association between inflammatory biomarkers and thin-cap fibroatheroma detected by optical coherence tomography in patients with coronary heart disease. Arch Med Sci 2015; 11:505-12. [PMID: 26170842 PMCID: PMC4495146 DOI: 10.5114/aoms.2015.52352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 06/07/2014] [Accepted: 06/15/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The relationship between plaque morphology detected by optical coherence tomography (OCT) and inflammatory biomarkers is not well known. MATERIAL AND METHODS This study included 47 patients with ischemic heart disease (22 patients with acute coronary syndrome and 25 patients with effort angina pectoris) who underwent percutaneous coronary intervention (PCI). Before PCI, peripheral blood levels of the inflammatory biomarkers high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) were measured. The OCT can detect thin-cap fibroatheroma (TCFA), a lesion with high potential for adverse cardiac events. We investigated the relationships between TCFAs in culprit lesions detected by OCT and the peripheral blood levels of these biomarkers. RESULTS We observed 12 lesions detected as TCFAs. The natural logs of hs-CRP and IL-6 levels in the TCFA group were higher than those in the non-TCFA group (hs-CRP 0.87 (-0.96 to 0.87) vs. -0.47 (-0.92 to 0.30) mg/l, p = 0.027; and IL-6 1.63 (0.63-3.23) vs. 0.53 (-0.21 to 1.05) pg/dl, p = 0.005, respectively). In multivariate logistic regression analysis, log IL-6 was an independent predictor for TCFA detected by OCT (log IL-6, 0.970 pg/dl, p = 0.023). Receiver operating characteristic curve analysis confirmed that IL-6, compared to hs-CRP, has a higher area under the curve for predicting TCFA (0.783 vs. 0.715, respectively). CONCLUSIONS Peripheral blood levels of both hs-CRP and IL-6 were associated with TCFAs, as detected by OCT. Moreover, IL-6 has a higher potential than hs-CRP for predicting TCFA.
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Affiliation(s)
- Kohei Koyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eiji Takahashi
- St. Marianna University School of Medicine, Yokohama-city Seibu Hospital, Yokohama, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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