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Naito H, Sugimoto T, Kimoto K, Abe T, Ohno N, Giga M, Kono T, Ueno H, Nomura E, Maruyama H. Detection of episodic nocturnal hypercapnia in patients with neurodegenerative disorders. Sleep Breath 2024; 28:393-399. [PMID: 37422580 DOI: 10.1007/s11325-023-02876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Episodic nocturnal hypercapnia (eNH) in transcutaneous carbon dioxide pressure (PtcCO2) corresponding to rapid eye movement sleep hypoventilation is a useful biomarker for detecting nocturnal hypoventilation. However, the relationship between eNH and neurodegenerative diseases with sleep-related breathing disorders (SRBDs) is unknown. The aim of this study was to evaluate the relationship between eNH and nocturnal hypoventilation in neurodegenerative diseases. METHODS Patients with neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), multiple system atrophy (MSA), Parkinson's disease, progressive supranuclear palsy, corticobasal syndrome, and idiopathic normal pressure hydrocephalus, were enrolled and received overnight PtcCO2 monitoring. The patients were divided into groups for eNH and sleep-associated hypoventilation (SH) prevalence analysis: A (ALS), B (MSA), and C (others). RESULTS Among 110 patients, twenty-three (21%) and 10 (9%) of the patients met eNH and SH criteria, respectively. eNH and SH were significantly more frequent in groups A and B than in C. The prevalence of SH in the patients with eNH was 39% whereas most of patients with SH (90%) presented with eNH. Among patients with daytime carbon dioxide pressure in arterial blood ≤ 45 mmHg, eNH frequency was 13%, whereas none of the patients met SH criteria. The frequency of noninvasive positive pressure ventilation after PtcCO2 monitoring was significantly higher in those with than without eNH. CONCLUSIONS eNH is common in patients with MSA and ALS who present with SRBD. eNH with overnight PtcCO2 monitoring is a useful biomarker to detect hypoventilation among neurodegenerative diseases with different SRBD mechanisms.
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Affiliation(s)
- Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan.
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Takafumi Abe
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Hiroki Ueno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
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Kikumoto M, Kurashige T, Ohshita T, Kume K, Kikumoto O, Nezu T, Aoki S, Ochi K, Morino H, Nomura E, Yamashita H, Kaneko M, Maruyama H, Kawakami H. 'Raisin bread sign' feature of pontine autosomal dominant microangiopathy and leukoencephalopathy. Brain Commun 2023; 5:fcad281. [PMID: 37953842 PMCID: PMC10636559 DOI: 10.1093/braincomms/fcad281] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/15/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Pontine autosomal dominant microangiopathy and leukoencephalopathy is one of hereditary cerebral small vessel diseases caused by pathogenic variants in COL4A1 3'UTR and characterized by multiple small infarctions in the pons. We attempted to establish radiological features of this disease. We performed whole exome sequencing and Sanger sequencing in one family with undetermined familial small vessel disease, followed by clinicoradiological assessment and a postmortem examination. We subsequently investigated clinicoradiological features of patients in a juvenile cerebral vessel disease cohort and searched for radiological features similar to those found in the aforementioned family. Sanger sequencing was performed in selected cohort patients in order to detect variants in the same gene. An identical variant in the COL4A1 3'UTR was observed in two patients with familial small vessel disease and the two selected patients, thereby confirming the pontine autosomal dominant microangiopathy and leukoencephalopathy diagnosis. Furthermore, postmortem examination showed that the distribution of thickened media tunica and hyalinized vessels was different from that in lacunar infarctions. The appearance of characteristic multiple oval small infarctions in the pons, which resemble raisin bread, enable us to make a diagnosis of pontine autosomal dominant microangiopathy and leukoencephalopathy. This feature, for which we coined the name 'raisin bread sign', was also correlated to the pathological changes.
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Affiliation(s)
- Mai Kikumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
- Department of Neurology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 7310293, Japan
- Department of Molecular Epidemiology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 7348553, Japan
| | - Takashi Kurashige
- Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 7370023, Japan
| | - Tomohiko Ohshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
- Department of Neurology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 7310293, Japan
- Department of Neurology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 7370023, Japan
| | - Kodai Kume
- Department of Molecular Epidemiology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 7348553, Japan
| | | | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
| | - Kazuhide Ochi
- Department of Neurology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 7310293, Japan
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima 7348530, Japan
| | - Hiroyuki Morino
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
- Department of Medical Genetics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 7708503, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 7308518, Japan
| | - Hiroshi Yamashita
- Department of Neurology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 7310293, Japan
| | - Mayumi Kaneko
- Department of Diagnostic Pathology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 7310293, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 7348551, Japan
| | - Hideshi Kawakami
- Department of Molecular Epidemiology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 7348553, Japan
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Ohno N, Kono T, Kimoto K, Ueno H, Nomura E. [Recanalization of an occluded artery of Percheron causing acute bilateral thalamic infarction]. Rinsho Shinkeigaku 2023:cn-001826. [PMID: 37197972 DOI: 10.5692/clinicalneurol.cn-001826] [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: 05/19/2023]
Abstract
An 87-year-old woman was admitted with acute onset of disturbed consciousness. On neurological examination, both pupils were dilated and non-reactive to light. Decerebrate rigidity was present. Babinski testing was positive. CTA suggested an isolated left P1 segment occlusion. The P2 segment was supplied from the left internal carotid artery via the posterior communicating artery. MRI showed bilateral paramedian thalamic infarctions. Because occlusion of the artery of Percheron was suspected, intravenous thrombolysis was performed. Digital subtraction angiography (DSA) revealed occlusion of the left P1 segment and spontaneous recanalization before endovascular treatment. Her consciousness improved immediately. When acute bilateral thalamic infarction suggests top of the basilar artery syndrome but no basilar artery occlusion is found, occlusion of the artery of Percheron should be considered. Thrombectomy of the affected P1 segment may be needed.
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Affiliation(s)
- Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Hiroki Ueno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
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Huang SK, Ishii M, Mizuki Y, Kawagoe T, Takeuchi M, Nomura E, Mizuki N. Circadian Fluctuation Changes in Intraocular Pressure Measured Using a Contact Lens Sensor in Patients with Glaucoma after the Adjunctive Administration of Ripasudil: A Prospective Study. J Pers Med 2023; 13:jpm13050800. [PMID: 37240970 DOI: 10.3390/jpm13050800] [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: 02/24/2023] [Revised: 04/23/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Nocturnal and circadian intraocular pressure (IOP) fluctuations are important issues in glaucoma treatment. Ripasudil 0.4% eye drops, a new glaucoma medication, lowers IOP by increasing aqueous humor outflow through the trabecular meshwork. We aimed to compare differences between circadian IOP fluctuations measured using a contact lens sensor (CLS) before and after administering 0.4% ripasudil eye drops adjunctively to patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). Patients with POAG (n = 1) and NTG (n = 5) underwent 24 h IOP monitoring with a CLS before and after administering ripasudil eye drops every 12 h (8 a.m., 8 p.m.) for 2 weeks without discontinuing currently used glaucoma medications. No vision-threatening adverse event occurred. The reduction in IOP fluctuation and the reduction in the SD of IOP in 24 h, awake time and sleep time did not reach statistical significance. The baseline office-hour IOP, which was measured using Goldmann applanation tonometry (GAT), ranged in the low teens, and the reduction in office-hour IOP also did not show a significant difference. Further study is necessary to evaluate whether the low baseline IOP with less IOP reduction relates to attenuated IOP fluctuation reduction.
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Affiliation(s)
- Shih-Kung Huang
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
- Department of Ophthalmology, Yokohama Hodogaya Central Hospital, Yokohama 240-8585, Kanagawa, Japan
| | - Mai Ishii
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
| | - Yuki Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
| | - Tatukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
| | - Eiichi Nomura
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Kanagawa, Japan
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5
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Kimoto K, Nezu T, Nomura E, Aoki S, Kawano T, Katsumata R, Nonaka M, Yoshida Y, Yuge R, Maruyama H. A case of ischemic stroke associated with protein-losing gastroenteropathy and protein S deficiency. J Stroke Cerebrovasc Dis 2023; 32:107151. [PMID: 37116445 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107151] [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: 02/10/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
Protein-losing gastroenteropathies are characterized by an excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoalbuminemia. Some rare cases are complicated with ischemic stroke. We report a 24-year-old woman who developed acute dysarthria and right hemiplegia 4 months after delivering her first baby by cesarean section. Diffusion-weighted magnetic resonance imaging showed a high-intensity signal in the left anterior cerebral artery territory and middle cerebral artery territory. She had marked hypoalbuminemia and decreased protein S activity. We identified protein-losing gastroenteropathy as the cause of the hypoalbuminemia, and she had a missense mutation of the PROS 1 gene, which was associated with decreased protein S activity. We speculated that the development of protein-losing gastroenteropathy accelerated the decline in protein S activity and caused cerebral infarction.
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Affiliation(s)
- Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan..
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohito Kawano
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Riho Katsumata
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Nonaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryo Yuge
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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6
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Sugimoto T, Yamawaki T, Naito H, Ohno N, Giga M, Kono T, Ochi K, Kohriyama T, Nomura E, Maruyama H. [The Myasthenia Gravis Activities of Daily Living score and associated factors to distinguish the refractory phase in generalized myasthenia gravis patients with 5 years or more disease duration]. Rinsho Shinkeigaku 2022; 62:915-921. [PMID: 36450489 DOI: 10.5692/clinicalneurol.cn-001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Associated factors of the Myasthenia Gravis Activities of Daily Living (MG-ADL) score were investigated in 55 patients who had had generalized MG for more than 5 years. In multivariate analysis, correlates of the MG-ADL score at the last follow-up were the total number of fast-acting treatments (FTs) (standardized regression coefficient 0.617,P < 0.001) and Myasthenia Gravis Foundation of America (MGFA) classification (standardized regression coefficient 0.227,P = 0.032) (F = 32.7,P < 0.001). In patients with a score of 5 or more on MG-ADL at the last follow-up, tendency as follows were seen: 1) early-onset (P = 0.002), 2) longer duration (P = 0.014), 3) high frequency of MGFA classification V (P = 0.017), 4) high frequency of the total number of FTs (P < 0.001), and 5) higher dose of prednisolone at the last follow-up (P = 0.003). MGFA V, early-onset without depending on E-L-T classification, or difficulty of reduction for high doses of prednisolone can be the target of novel treatment for MG, and future prospective study will be expected.
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Affiliation(s)
- Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Internal Medicine, Hiroshima Teishin Hospital
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Kazuhide Ochi
- Department of Neurology, Hiroshima Prefectural Hospital
| | - Tatsuo Kohriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University
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Ueno H, Ohno N, Abe T, Kimoto K, Matsuoka C, Giga M, Naito H, Kono T, Takasu M, Kidani N, Yamasaki R, Ichimura K, Nomura E. Prognosis Prediction Using Magnetic Resonance Spectroscopy and Oligoclonal Bands in Central Nervous System Methotrexate-associated Lymphoproliferative Disorder. Intern Med 2022; 61:3733-3738. [PMID: 35598995 PMCID: PMC9841117 DOI: 10.2169/internalmedicine.9296-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Central nervous system methotrexate-associated lymphoproliferative disorder (CNS-MTX-LPD) is rare, but its spontaneous regression has been observed in some patients after withdrawal of agents. We herein report three cases of primary CNS-MTX-LPD that received oral MTX for rheumatoid arthritis. Epstein-Barr virus and oligoclonal bands (OCBs) were positive, while proton magnetic resonance spectroscopy (1H-MRS) showed an elevated lipid peak and slightly elevated choline/N-acetylaspartate ratio in common. After MTX withdrawal, brain lesions showed spontaneous regression in all cases. Our patient's 1H-MRS findings and OCBs may reflect a non-monoclonal lymphoproliferative histology as benign-type lesions in CNS-MTX-LPD.
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Affiliation(s)
- Hiroki Ueno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Takafumi Abe
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Chika Matsuoka
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Miyuki Takasu
- Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Naoya Kidani
- Department of Neurosurgery and Neuroendovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Rie Yamasaki
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Koichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
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Kato A, Horita N, Namkoong H, Nomura E, Masuhara N, Kaneko T, Mizuki N, Takeuchi M. Prophylactic antibiotics for postcataract surgery endophthalmitis: a systematic review and network meta-analysis of 6.8 million eyes. Sci Rep 2022; 12:17416. [PMID: 36258003 PMCID: PMC9579149 DOI: 10.1038/s41598-022-21423-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023] Open
Abstract
To reveal optimal antibiotic prophylactic regimen for postoperative endophthalmitis (POE), we conducted systematic review and network meta-analysis. A total of 51 eligible original articles, including two randomized controlled trials, were identified. In total, 4502 POE cases occurred in 6,809,732 eyes (0.066%). Intracameral injection of vancomycin had the best preventive effect (odds ratio [OR] 0.03, 99.6% confidence interval [CI] 0.00-0.53, corrected P-value = 0.006, P-score = 0.945) followed by intracameral injection of cefazoline (OR 0.09, 99.6% CI 0.02-0.42, corrected P-value < 0.001, P-score = 0.821), cefuroxime (OR 0.18, 99.6% CI 0.09-0.35, corrected P-value < 0.001, P-score = 0.660), and moxifloxacin (OR 0.36, 99.6% CI 0.16-0.79, corrected P-value = 0.003, P-score = 0.455). While one randomized controlled trial supported each of intracameral cefuroxime and moxifloxacin, no randomized controlled trial evaluated vancomycin and cefazoline. Sensitivity analysis focusing on the administration route revealed that only intracameral injection (OR 0.19, 99.4% CI 0.12-0.30, corrected P-value < 0.001, P-score = 0.726) significantly decreased the risk of postoperative endophthalmitis. In conclusion, intracameral injection of either vancomycin, cefazoline, cefuroxime, or moxifloxacin prevented POE.
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Affiliation(s)
- Ai Kato
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan ,Department of Ophthalmology, Chigasaki Municipal Hospital, Chigasaki, Kanagawa Japan
| | - Nobuyuki Horita
- grid.470126.60000 0004 1767 0473Chemotherapy Center, Yokohama City University Hospital, Yokohama, Kanagawa Japan
| | - Ho Namkoong
- grid.26091.3c0000 0004 1936 9959Department of Infectious Diseases, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Eiichi Nomura
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Nami Masuhara
- Department of Ophthalmology, Chigasaki Municipal Hospital, Chigasaki, Kanagawa Japan
| | - Takeshi Kaneko
- grid.268441.d0000 0001 1033 6139Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa Japan
| | - Nobuhisa Mizuki
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Masaki Takeuchi
- grid.268441.d0000 0001 1033 6139Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
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Ishikawa R, Sugimoto T, Abe T, Ohno N, Tazuma T, Giga M, Naito H, Kono T, Nomura E, Hara K, Yorifuji T, Yamawaki T. A 36-year-old Man with Repeated Short-term Transient Hyperammonemia and Impaired Consciousness with a Confirmed Carbamoyl Phosphate Synthase 1 Gene Monoallelic Mutation. Intern Med 2022; 61:1387-1392. [PMID: 34670888 PMCID: PMC9152872 DOI: 10.2169/internalmedicine.7961-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 36-year-old man experienced severely impaired consciousness twice after drinking because of hyperammonemia. No abnormal blood tests were found other than ammonia levels. However, magnetic resonance imaging (MRI) showed atrophy of the brain parenchyma. One the second occasion, the patient suffered severe impairment of consciousness, and because of seizures and glossoptosis, mechanical ventilation was started. Urea cycle disorders (UCDs) were assumed to be involved. Genetic testing revealed a monoallelic mutation of the carbamoyl phosphate synthase 1 (CPS1) gene. When transient hyperammonemia of unknown cause occurs repeatedly in adults, an active investigation for UCDs should be conducted.
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Affiliation(s)
- Ruoyi Ishikawa
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Takafumi Abe
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Taku Tazuma
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Keiichi Hara
- Department of Pediatrics and Institute for Clinical Research, NHO Kure Medical Center, Japan
| | - Tohru Yorifuji
- Division of Pediatric Endocrinology and Metabolism, Osaka City General Hospital, Japan
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
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10
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Hiyama R, Oiwa H, Kanou Y, Nishibe S, Kono T, Nomura E. A case of giant cell arteritis lacking typical symptoms presenting with recurrent cerebellar infarctions: A case report and case-based review. Mod Rheumatol Case Rep 2021; 6:220-225. [PMID: 34850091 DOI: 10.1093/mrcr/rxab030] [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] [Received: 07/08/2021] [Revised: 08/03/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022]
Abstract
Giant cell arteritis (GCA) occasionally presents with ischaemic stroke. Generally, symptoms related to GCA or elevated levels of inflammation markers would be a clue for the diagnosis of GCA. However, we encountered a rare case of GCA that presented with recurrent cerebellar infarctions without symptoms related to GCA (headache, fever, or jaw claudication). Furthermore, C-reactive protein levels, measured at the time of two of the stroke attacks, were within the normal range. On physical examination, the temporal arteries were prominent and weakly pulsatile. Temporal artery ultrasonography showed halo signs, and temporal artery biopsy revealed GCA. To our knowledge, this is the first case of GCA presenting with recurrent ischaemic stroke lacking GCA features but diagnosed before death. Considering this case-based review, we suggest that GCA may have been missed in elderly patients with ischaemic stroke, especially in those with posterior circulation infarction. Therefore, physical examination of the temporal arteries, temporal artery ultrasonography, and vessel wall magnetic resonance imaging may be useful in those patients.
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Affiliation(s)
- Ryuichiro Hiyama
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yukari Kanou
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Shiho Nishibe
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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11
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Naito H, Sugimoto T, Kimoto K, Abe T, Kawano T, Matsuoka C, Ohno N, Giga M, Kono T, Ueno H, Nomura E. Clinical comorbidities correlated with a response to the cerebrospinal fluid tap test in idiopathic normal-pressure hydrocephalus. J Neurol Sci 2021; 430:120024. [PMID: 34627053 DOI: 10.1016/j.jns.2021.120024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
AIMS The mainstay of treatment for idiopathic normal-pressure hydrocephalus (iNPH) is spinal fluid shunting. A tap test (TT) is recommended as an indication of shunting. Patients with iNPH are often elderly and have multiple comorbidities affecting the shunting outcome. We investigated the factors affecting TT in patients with iNPH. METHODS Seventy-five patients with iNPH were admitted to our department for a TT from April 2010 to May 2021. The patients were divided into a responsive group and an unresponsive group according to the clinical outcomes after TT on the Timed Up and Go Test (TUG), Mini-Mental State Examination (MMSE), or iNPH grading scale. Factors affecting the TT were compared between the responders and nonresponders. RESULTS There were 38 patients (50.7%) in the TT responder group, and the prevalence of improvement was 82.9% in the TUG, 27.6% in the MMSE, and 76.3% in the iNPH grading scale. There were no significant differences in the vascular risk factors between the two groups. The prevalence of lumbar spondylosis, compression fracture, severe periventricular hyperintensity, deep and subcortical white matter hyperintensity (DSWMH), and old cerebral infarcts was significantly higher among the TT nonresponders. The logistic regression analysis showed that severe DSWMH and lumbar spondylosis were associated with a TT nonresponse (p < 0.001 and p = 0.003, respectively). Shunting was performed in 22 patients, 19 of whom were TT responders. CONCLUSION Severe DSWMH and lumbar spondylosis were associated with a poor response to the TT in iNPH patients. We should consider risk factors when selecting candidates for shunt surgery.
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Affiliation(s)
- Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takafumi Abe
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomohito Kawano
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Chika Matsuoka
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroki Ueno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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12
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Ohno N, Sugimoto T, Giga M, Naito H, Kono T, Nomura E. [A case of meningoencephalitis and polyradiculoneuropathy induced by combination therapy with ipilimumab and nivolumab]. Rinsho Shinkeigaku 2021; 61:658-662. [PMID: 34565749 DOI: 10.5692/clinicalneurol.cn-001582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 76-year-old man with renal cell carcinoma exhibited consciousness disturbance and high fever after two cycles of combination therapy with ipilimumab and nivolumab. His cerebrospinal fluid (CSF) showed a protein concentration of 385 mg/dl, a cell count of 147/mm3, an interleukin-6 concentration of 1,280 pg/ml, and an adenosine deaminase concentration of 24.8 U/l. Contrast-enhanced FLAIR images were notable for diffuse meningeal enhancement. He was diagnosed with meningoencephalitis caused by an immune-related adverse event from immune checkpoint inhibitors (ICIs). His symptoms improved after repeated intravenous methylprednisolone pulse therapy and oral prednisolone. The meningeal enhancement disappeared, and the CSF findings became almost normal. As consciousness levels improved, we observed quadriplegia and peripheral neuropathy with antiganglioside antibodies, which led to a diagnosis of polyradiculoneuropathy. This is a rare case of a patient with overlapping meningoencephalitis and polyradiculo-neuropathy induced by ICIs.
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Affiliation(s)
- Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | | | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
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13
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Araki H, Uchida K, Yoshimura S, Kurisu K, Shime N, Sakamoto S, Aoki S, Ichinose N, Kajihara Y, Tominaga A, Naka H, Mizoue T, Sumida M, Hirotsune N, Nomura E, Matsushige T, Kanazawa J, Kato Y, Kawamoto Y, Kuroki K, Morimoto T. Effect of region-wide use of prehospital stroke triage scale on management of patients with acute stroke. J Neurointerv Surg 2021; 14:677-682. [PMID: 34413244 PMCID: PMC9209665 DOI: 10.1136/neurintsurg-2021-017863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals. OBJECTIVE To explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI). METHODS We implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO. RESULTS The cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO. CONCLUSIONS Use of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke.
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Affiliation(s)
- Hayato Araki
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan.,Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Yosuke Kajihara
- Department of Neurosurgery, Itsukaichi Memorial Hospital, Hiroshima, Japan
| | - Atsushi Tominaga
- Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiromitsu Naka
- Department of Neurology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masayuki Sumida
- Department of Neurosurgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Nobuyuki Hirotsune
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshinori Matsushige
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Yukio Kato
- Department of Neurosurgery, Saiseikai Hiroshima Hospital, Aki-gun, Japan
| | | | - Kazuhiko Kuroki
- Department of Neurosurgery, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
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14
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Akiyama T, Oiwa H, Hayashi M, Sugimoto T, Nomura E, Yamawaki T. Aseptic meningitis as an initial presentation of Sjögren syndrome: a report of two cases and literature review. Nagoya J Med Sci 2020; 82:595-602. [PMID: 33132443 PMCID: PMC7548251 DOI: 10.18999/nagjms.82.3.595] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sjögren syndrome (SS) is one of several collagen vascular diseases that occasionally involve the central nervous system. We report two cases of SS involving young patients who initially presented with aseptic meningitis. A male with recurrent AM was found to have anti-Ro/SSA and La/SSB antibodies in a screening test for autoimmune process. A minor salivary gland biopsy revealed lymphocytic infiltrations compatible with SS, although the patient did not exhibit sicca symptoms. A female presenting with AM and polyarthritis also reported xerophthalmia. Anti-Ro/SSA antibody testing and a positive result in a minor salivary gland biopsy led to the diagnosis of SS. In the literature review, we found that AM or aseptic meningoencephalitis (AME) preceded or had a concomitant onset with SS in approximately 70% of cases. Screening for anti-Ro/SSA antibody, as well as systemic assessment for rheumatic symptoms, may be useful for diagnosing AM/AME of unknown etiology.
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Affiliation(s)
- Takuya Akiyama
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Anesthesiology, University of Yamanashi, Kofu, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hayashi
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takamichi Sugimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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15
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Nishigaichi A, Oiwa H, Hosokawa Y, Hayashi M, Mine N, Nomura E, Yamawaki T. A case of systemic lupus erythematosus associated with cerebral arteritis: a case report and case-based literature review. Nagoya J Med Sci 2020; 82:807-814. [PMID: 33311811 PMCID: PMC7719457 DOI: 10.18999/nagjms.82.4.807] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 62-year-old female patient with systemic lupus erythematosus (SLE) was admitted for cerebral infarction. The magnetic resonance angiography showed focal narrowing of the cerebral arteries that was initially considered as atherosclerosis due to her cardiovascular risk factors. Ten weeks later, she was again admitted for multiple cerebral infarctions. Vessel wall magnetic resonance imaging revealed gadolinium enhancement of the arterial walls of the narrowing lesions, leading to a diagnosis of cerebral arteritis. Based on a literature review, cerebral medium-sized arteritis in SLE likely progresses insidiously during the active phase of SLE, which may later result in occlusion irrespective of disease activity.
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Affiliation(s)
- Akira Nishigaichi
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yohei Hosokawa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahiro Hayashi
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Naoko Mine
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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16
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Nomura E, Takemaru M, Himeno T, Kono R, Fukushima T, Ota S. Clinical features and efficacy of reperfusion therapy in minor ischemic stroke patients with atrial fibrillation. J Thromb Thrombolysis 2020; 50:608-613. [PMID: 32048168 DOI: 10.1007/s11239-020-02057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The efficacy of reperfusion therapy (RT) using intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy for minor ischemic stroke (MIS) has not yet been established. The present study aimed to elucidate the clinical features of MIS patients with atrial fibrillation (AF) and examine whether they could be potential candidates for RT. Data of MIS patients, defined as those with a score ≤ 5 on the National Institute of Health Stroke Scale, were extracted from patients admitted to our hospital between 2006 and 2018, and clinical characteristics were compared between the AF and non-AF groups. Thereafter, the impact of RT on outcomes in the AF- group was evaluated using the modified Rankin scale (mRS) score 3 months after onset and compared to that of standard medical therapy (SMT) using propensity score matching (PSM). Of 10,483 stroke patients, 3003 were shortlisted, and 457 AF patients and 2546 non-AF patients were finally selected. Patients in the AF group had more RT (13.3% vs. 5.7%, p < 0.001) than those in the non-AF group. Using PSM, 53 patients each were extracted from the AF-RT and AF-SMT groups. The frequencies of mRS = 0 or 1 for the AF-RT and AF-SMT groups were 69.8% and 64.2% (p = 0.536), respectively, with a significant difference in mRS = 0 (56.5% vs. 34.0%, p = 0.019). The present study found that MIS patients with AF underwent more RT than those without AF and that RT compared favorably with SMT for them; further study is warranted to examine whether these patients could be good candidates for RT.
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Affiliation(s)
- Eiichi Nomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan.
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Tomoko Fukushima
- Department of Cerebrovascular Research, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Shinzo Ota
- Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
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17
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Himeno T, Ota S, Ohtonari T, Kanbara M, Takemaru M, Nomura E, Kohriyama T. Efficacy of the Insertion-support Guiding Catheter in Approaching Intracranial or Craniocervical Lesions in Patients with the Difficulty of Extracranial Trans-arterial Access. J Neuroendovasc Ther 2019; 14:36-42. [PMID: 37502383 PMCID: PMC10370812 DOI: 10.5797/jnet.tn.2019-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/14/2019] [Indexed: 07/29/2023]
Abstract
Objective We aimed to investigate the efficacy of the insertion-support guiding catheter (ISGC) for approaching target lesions during endovascular therapy in patients with severe atherosclerotic or tortuous arteries. Case Presentations The ISGC is an 8 Fr, JB2 shape, stiff-type, short guiding catheter. We used ISGC for 52 patients between April 2007 and March 2018, microcatheters or therapeutic devices were delivered to target lesions via ISGC in 46 (88.4%) of the 52 patients, and none of them developed associated complications. Herein, we present three representative cases. Conclusions An ISGC is useful for vascular intervention in patients with atherosclerotic or tortuous arteries.
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Affiliation(s)
- Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Shinzo Ota
- Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Tatsuya Ohtonari
- Department of Spinal Surgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Mizuki Kanbara
- Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
- Department of Neurosurgery, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
| | - Tatsuo Kohriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
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18
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Nomura E, Himeno T, Takemaru M, Kanbara M, Ota S. Abstract TP18: Impact of Reperfusion Therapy on Short-Term Outcome in Patients With Mild Acute Ischemic Stroke. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purposes:
The efficacy of reperfusion therapies (RT), including both intravenous recombinant tissue plasminogen activator (iv rt-PA) and any endovascular therapy (EVT) for mild acute ischemic stroke (AIS), is yet to be established. The present study aimed to evaluate the impact of RT on mild AIS patients outcome compared with non-RT.
Methods:
Of all 9775 AIS patients admitted in our hospital between 2006 and 2017, those patients with values of 0-1 on the modified Rankin Scale (mRS) prior to the onset of AIS and of ≤ 10 on the National Institute of Health Stroke Scale (NIHSS) just before the therapy was started were selected. Of these, RT patients and comparable non-RT patients were selected using propensity score matching. The RT group included patients with iv rt-PA and any EVT (local arterial infusion of Urokinase, percutaneous transluminal angioplasty, Merci retriever, Penumbra system, and any stent retriever). The primary outcome was mRS 0-1 at three months after the onset, which was defined as an excellent outcome. Subgroup analysis for patients with NIHSS ≤ 5, 6-10, small vessel occlusion (SVO), and non-SVO was also performed.
Results:
Of the selected 3089 patients, we constructed the 526 (263 each) propensity score-matched patients cohort. The propensity score-matched RT patients consisted of 135 solely iv rt-PA, 109 EVT, and 19 both. The non-RT patients had a median age of 72 compared to 73 years for the RT patients and the median NIHSS was 5 in both patient groups. The frequencies of excellent outcome in RT and non-RT patients did not differ significantly with 57.8 % and 52.1 %, respectively. The odds ratio and 95 % confidence interval (CI) of RT patients for an excellent outcome was 1.26 (0.89-1.78). In the subgroup analysis, odds ratios of patients with NIHSS ≤ 5, NIHSS 6-10, SVO, and non-SVO were 0.97 (0.61-1.56), 1.75 (1.01-3.03), 1.24 (0.57-2.70), and 1.27 (0.86-1.86), respectively.
Conclusion:
The present study found an excellent outcome of RT only in patients with NIHSS 6-10. Further studies may be warranted to investigate the efficacy of RT for patients with mildest AIS (NIHSS ≤ 5).
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Affiliation(s)
- Eiichi Nomura
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
| | | | | | | | - Shinzo Ota
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
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19
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Takemaru M, Takeshima S, Hara N, Himeno T, Shiga Y, Takeshita J, Takamatsu K, Nomura E, Shimoe Y, Kuriyama M. [Reversible cerebral vasoconstriction syndrome: a clinical study of 11 cases]. Rinsho Shinkeigaku 2018; 58:377-384. [PMID: 29863100 DOI: 10.5692/clinicalneurol.cn-001143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study reports eleven cases of reversible cerebral vasospasm syndrome (RCVS). Of the 11 patients, two were males and nine were females, with the average age of 47.9 ± 14.1 years. Many of these patients were young. The rates of severe, intractable and pulsative headache, generalized convulsions, and motor hemiparesis were 64%, 27%, and 36%, respectively. As complications of intracerebral lesions in the early stage of disease onset, convexal subarachnoid hemorrhage, lobar intracerebral hemorrhage, and posterior reversible encephalopathy syndrome were observed in 63%, 9%, and 45% of cases, respectively. Cerebral infarction occurred in 45% of cases at around 1-3 weeks after onset. Improvement of cerebral vasoconstriction was recognized in several cases from about the first month of onset. The post-partum period, migraine, transfusion, rapid amelioration for anemia, renal failure, bathing, and cerebrovascular dissection were suspected as disease triggers. Abnormally high blood pressure at onset was confirmed in 55% of cases. It is important to analyze the pathophysiology of RCVS associated with these triggers from the viewpoint of the breakdown of the blood-brain barrier.
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Affiliation(s)
- Makoto Takemaru
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Shinichi Takeshima
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Showa University School of Medicine
| | - Naoyuki Hara
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takahiro Himeno
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Yuji Shiga
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
- Present address: Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Jun Takeshita
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | | | - Eiichi Nomura
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Yutaka Shimoe
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
| | - Masaru Kuriyama
- Brain Attack Center, Ota Memorial Hospital, Department of Neurology
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20
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Takeshita J, Nomura E, Takemaru M, Himeno T, Shimoe Y, Kuriyama M. [Rapidly deteriorated lobar intracerebral hemorrhages: possible association of varicella zoster virus-vasculopathy]. Rinsho Shinkeigaku 2018; 58:245-248. [PMID: 29607919 DOI: 10.5692/clinicalneurol.cn-001144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 75-year-old man having dementia and lifestyle related diseases developed a lobar intracerebral hemorrhage (LICH) in the left parietal and a small cerebellar infarction in the left occipital lobe. Many micro bleeds (MB) due to cerebral amyloid angiopathy (CAA) in the subcortical areas and multiple vascular stenosis were also found by MRI and MRA. He developed herpes zoster in his buttocks on day 6 of hospitalization and complicated with varicella zoster virus (VZV) meningitis with positive for VZV-DNA in the cerebrospinal fluid. Subsequently, LICHs occurred in the left frontal lobe and in the right parietal lobe for a short period of time and died on the day 18. We speculated that the repeating hemorrhages was primarily caused by VZV vasculopathy and additionally the subcortical MBs increased the hemorrhagic risk. The relationship between VZV vasculopathy and CAA should be studied in the future.
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Affiliation(s)
- Jun Takeshita
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Eiichi Nomura
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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Itaya T, Murakami Y, Ota A, Nomura E, Fukushima T, Nishigaki M. Abstract TP147: Factors Influencing Home Discharge Preference of Inpatients With Acute Cerebral Infarction: A Retrospective Cohort Study. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Many previous studies explained clinical predictors of discharge planning for inpatients with acute cerebral infarction, while the factors that influence inpatients and their family’s preference for discharge destination are not often investigated. The purpose of this study was to clarify the relationship between home discharge preference of inpatients with acute cerebral infarction and socio-demographic factors or clinical characteristics.
Methods:
We surveyed the electronic medical records of 2,495 (mean age 73.5+ years, 62% were male) acute cerebral infarction patients who were admitted to a stroke center in Japan between January 1, 2011 and December 31, 2015. The main outcome variable was the home discharge preference within 5 days after hospitalization. The explanatory variables were socio-demographic and clinical factors. Multiple logistic regression analysis with backward variable selection was performed to investigate relationships between home discharge preference and these factors.
Results:
In all, 1,056 (42%) patients showed their preference for discharge to their homes. Multiple logistic regression analysis identified relationships between discharge preference to home and five variables. Patients exhibiting the following characteristics tend to show the preference for discharge to their home: higher age, paresis, cancer, cohabitating, and higher functional independence measure motor (FIM-M) score on admission (13-91 points). The odds ratio of these factors for home discharge preference were 1.02 per a year (95% confidence interval[95%CI] 1.00-1.03), 3.68 (vs. without paresis, 95%CI 1.83-7.38), 2.35 (vs without cancer, 95%CI 1.11-4.94), 3.04 (vs. living alone, 95%CI 2.03-4.56), 1.06 (vs lower FIM-M score, 95% 1.05-1.07), respectively. The model showed an area under the curve equal to 0.83 (95%CI 0.80-0.86).
Conclusion:
Patients’ preference for home discharge is influenced largely by physical impairments and support availability. Additionally, patients with comorbidity such as cancer tend to choose facility care rather than home care. These results showed that development of a family support system for elder patients in multimorbid situations facilitated their decision for home discharge.
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Affiliation(s)
| | | | - Akiko Ota
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Japan
| | - Eiichi Nomura
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Japan
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Nomura E, Takemaru M, Kono R, Himeno T, Ando H, Nishigaki M, Ota S. Abstract TP19: Impact of Revascularization Therapy on Patient Outcome by the Severity of Acute Ischemic Stroke. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
It has not fully investigated whether the benefit from revascularization therapy for patients with mild acute ischemic stroke (AIS) can overweigh the risk. The aim of this study was to investigate the impact of revascularization therapy on patient outcome as related to the severity of the stroke.
Methods:
From our hospital’s stroke database from January 2006 to March 2017, we extracted data for patients with AIS. Eligible criteria for the patients were: modified Rankin Scale (mRS) of 0 or 1 before onset, admitted less than 24 hours after onset, and followed up for at least 3 months. Revascularization therapy included intravenous tissue plasminogen activator; endovascular therapy (intra-arterial urokinase infusion, percutaneous transluminal angioplasty, emergent carotid artery stenting, and thrombectomy); and carotid endarterectomy performed within 14 days from onset.
Patients were divided into 4 groups based on the severity using the National Institutes of Health Stroke Scale (NIHSS) on admission : Group 1 = 0-4, Group 2 = 5-9, Group 3 = 10-19, and Group 4=20-. We defined a good outcome as mRS score of 0-1 at 3 months after onset. The odds ratio of a good outcome was computed among 4 groups, adjusting for age and sex.
Results:
We extracted data for 3275 patients with AIS (71.3 years, 65.1% men). Of these, 17.9% received revascularization therapy of any type. This was distributed across the 4 NIHSS groups as follows: 6.1% of Group 1 (n=2193), 27.1% of Group 2 (n=527), 56.4% of Group 3 (n=298), and 55.6% of Group 4 (n=257). The odds ratios (95% confidence interval) of treatment for good outcome in group 1 to 4 were 0.42 (0.29-0.62), 1.15 (0.78-1.72), 2.80 (1.60-4.90), and 4.40 (1.79-10.82), respectively. Group 1 was further divided into 5 subgroups by each NIHSS scores of 0-4. The odds ratios for each subgroup (NIHSS scores 0, 1, 2, 3, and 4) were 0.20 (0.07-0.61), 0.28 (0.11-0.69), 0.27 (0.11-0.69), 0.93 (0.43-2.03), and 0.88 (0.42-1.85), respectively.
Conclusions:
Approximately half of the patients with NIHSS score of ≥10 received revascularization therapy and had significant benefit. However, revascularization therapy for patients with mild AIS (specifically NIHSS scores of 0, 1, or 2) could be rather harmful.
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Affiliation(s)
- Eiichi Nomura
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
| | | | - Ryuhei Kono
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
| | | | - Hitoshi Ando
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
| | | | - Shinzo Ota
- Brain Attack Ctr OTA Memorial Hosp, Hiroshima, Japan
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Kitamura J, Ueno H, Nagai M, Hosomi N, Honjo K, Nakamori M, Mukai T, Imamura E, Nezu T, Aoki S, Ohshita T, Nomura E, Wakabayashi S, Maruyama H, Matsumoto M. Blood Pressure Variability in Acute Ischemic Stroke: Influence of Infarct Location in the Insular Cortex. Eur Neurol 2018; 79:90-99. [DOI: 10.1159/000486306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Abstract
Background: The aim of this study was to elucidate the influence of insular infarction on blood pressure (BP) variability and outcomes according to the region of the insular cortex affected. Methods: A total of 90 patients diagnosed with acute unilateral ischemic stroke were registered. The BP variability was calculated over 24 h after admission (hyperacute) and for 2–3 days after admission (acute). Patients were classified into groups of right and left, and then right anterior, right posterior, left anterior, and left posterior insular infarction. Results: Patients with insular infarction showed a significantly larger infarct volume, higher modified Rankin scale scores, and lower SD and coefficient of variation (CV) of systolic BP in the hyperacute phase than shown by patients without insular infarction (p < 0.01, p < 0.01, p = 0.02, and p = 0.03, respectively). The SD and CV of systolic BP in the hyperacute phase showed significant differences among the 3 groups with right insular infarction, with left insular infarction, and without insular infarction (p < 0.05 and p < 0.05, respectively). There was a tendency for the systolic BP variability to be lower in patients with right anterior insular infarction than in patients with infarcts in other areas. Conclusion: The right insular cortex, especially the anterior part, might be a hub for autonomic nervous regulation.
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24
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Nomura E, Ohshita T, Naka H, Matsushima H, Kubo S, Takeshima S, Imamura E, Torii T, Hosomi N, Maruyama H, Matsumoto M. Stroke recurrence or death during 2 weeks after acute ischemic stroke with atrial fibrillation - multicenter prospective registry in Hiroshima –. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1789] [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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25
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Itaya T, Murakami Y, Ota A, Nomura E, Fukushima T, Nishigaki M. Assessment Model to Identify Patients With Stroke With a High Possibility of Discharge to Home. Stroke 2017; 48:2812-2818. [DOI: 10.1161/strokeaha.117.018075] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Takahiro Itaya
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yusuke Murakami
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Akiko Ota
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Eiichi Nomura
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Tomoko Fukushima
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Masakazu Nishigaki
- From the Department of Nursing, Human Health Sciences, Kyoto University, Japan (T.I., M.N.); and Department of Rehabilitation (Y.M.), Department of Neurology (E.N.), and Department of Cerebrovascular Research (A.O.,T.F., M.N.) Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
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26
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Nezu T, Naka H, Hosomi N, Takamatsu K, Nomura E, Kitamura T, Torii T, Ohshita T, Imamura E, Nakamori M, Shimomura R, Aoki S, Maruyama H, Matsumoto M. Microbleeds evaluation study for prevention of brain hemorrhage in ischemic stroke (MB-evidence): Pilot analysis for multicenter longitudinal study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1783] [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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27
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Okazaki S, Murai H, Kidoguchi S, Nomura E, Itoh N, Hashimoto N, Hamada T, Kawakita A, Yasutomi M, Ohshima Y. The Biomarker Salivary SP-D May Indicate Small Airway Inflammation and Asthma Exacerbation. J Investig Allergol Clin Immunol 2017; 27:305-312. [PMID: 28585516 DOI: 10.18176/jiaci.0174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Noninvasive and child-friendly biomarkers are important tools for understanding the various phenotypes of childhood asthma. Objective: The aim of this study was to examine the usefulness of salivary surfactant protein (SP) D in assessing the pathophysiology of childhood asthma. METHODS We measured salivary concentrations of SP-D and forced oscillation technique (FOT) indexes in 19 healthy controls and 21 asthmatic children. Regression equations for the predictive values of FOT indexes were generated from healthy controls. We analyzed the correlations between salivary SP-D concentration and percentages of the predictive values of FOT indexes, as well as the severity of exacerbation. RESULTS We found that salivary SP-D levels were higher in asthmatic children than in healthy controls. In the asthmatic children, salivary SP-D levels correlated with the percentages of predicted differences in resistance between 5 Hz and 20 Hz (%R5-R20), which represented the resistance of peripheral airways, and with the severity of asthma exacerbation. CONCLUSIONS Salivary SP-D may reflect asthmatic inflammation in peripheral small airways and may be a useful marker for monitoring the degree of exacerbation in childhood asthma.
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Affiliation(s)
- S Okazaki
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - H Murai
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - S Kidoguchi
- Department of Clinical Laboratory, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - E Nomura
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - N Itoh
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - N Hashimoto
- Department of Clinical Laboratory, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - T Hamada
- Department of Clinical Laboratory, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - A Kawakita
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - M Yasutomi
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
| | - Y Ohshima
- Department of Pediatrics, Faculty of Medial Sciences, University of Fukui, Fukui, Japan
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Shiga Y, Takeshima S, Nomura E, Sato M, Nishigaki M, Kuriyama M. Abstract WP367: Volume of Intracerebral Hemorrhage Varies According to the Kind of Anticoagulant: Direct Oral Anticoagulants vs Warfarin. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Hypothesis:
The effectiveness and safety of anticoagulants, which are widely used for preventing stroke recurrence, in stroke prevention is well established, they rarely cause severe adverse events, such as intracerebral hemorrhage (ICH). Direct oral anticoagulants (DOACs) have recently become an option for anticoagulation therapy. The incidence of hemorrhagic events in patients under DOAC therapy has been investigated in several studies, but it is unclear whether the severity of a hemorrhagic event is influenced by the use of DOACs. We hypothesized that the severity of ICH is different in patients under warfarin versus those under DOAC therapy.
Method:
We retrospectively reviewed medical records and computed tomography images of patients with ICH who were treated at our hospital during April 2011-May 2016. Patients’ clinical characteristics and ICH volume and location were compared between warfarin- and DOAC-treated patients.
Result:
Of the 1147 patients with ICH, 114 patients were taking anticoagulants on admission. Eighty-nine patients (78.1%) received warfarin, whereas 25 (21.9%) received DOACs. The following DOACs were used: dabigatran (two patients), rivaroxaban (10 patients), apixaban (12 patients), and edoxaban (one patients). Median ICH volume was significantly lesser in DOAC-treated patients than in warfarin-treated patients [8.1 (range, 0.05-160) ml vs 15.9 (range, 0.1-119) ml, respectively; p = 0.048). A significant correlation between ICH volume and HAS-BLED score was found only in the DOACs group (ρ= 0.560 p = 0.004) but not in the warfarin group (ρ= 0.025 p = 0.822). We found two patients with an ICH volume of >150 mL in the DOACs group. Their HAS-BLED score was 3, and they had experienced multiple stroke events (three or six times).
Conclusion:
ICH volume was lesser in DOAC-treated patients than in warfarin-treated patients. We also found that HAS-BLED can be a predictor of ICH volume in DOAC-treated patients.
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Affiliation(s)
- Yuji Shiga
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama,Hiroshima, Japan
| | | | - Eiichi Nomura
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama,Hiroshima, Japan
| | - Michiyoshi Sato
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama,Hiroshima, Japan
| | - Masakazu Nishigaki
- Graduate Sch of Med and Faculty of Medicine Kyoto Univ, Kyoto, Kyoto, Japan
| | - Masaru Kuriyama
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama,Hiroshima, Japan
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29
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Nomura E, Shiga Y, Takeshima S, Takemaru M, Takeshita J, Nishigaki M, Kuriyama M. Abstract WP370: Cerebral Microbleeds Play an Important Role in Turning Recurrent Stroke Towards Intracranial Hemorrhage in Patients With First-ever Ischemic Stroke/Transient Ischemic Attack. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
After ischemic stroke (IS) or transient ischemic attack (TIA), use of an antithrombotic agent to prevent recurrence is mandatory. However, antithrombotic agents rarely cause intracranial hemorrhage (ICH), frequently resulting in worse outcomes than recurrent IS. Cerebral microbleeds (CMBs) have been reported as a useful marker for finding ICH-prone patients. This retrospective study aimed to investigate the significance of CMB in the development of ICH in first-ever IS/TIA patients.
Methods:
The data source was our consecutive patient registry between 2005 and 2015. Patients with stroke/TIA admitted to our hospital more than twice (first as first-ever IS/TIA and second or later as recurrent IS/TIA or ICH) and underwent head MRI including T2*-weighted imaging on the first admission were extracted. Clinical characteristics including use of antithrombotic therapy and distribution of CMB on the first and second admissions were compared between recurrent IS/TIA and ICH groups. Distribution of CMB was divided into deep, lobar, or both.
Results:
In total, 708 IS/TIA patients (second stroke: 640 IS/TIA; 68 ICH) were extracted. The ICH group showed a longer period until second stroke (1,062 days vs. 817 days, p=0.022) and higher mean NIHSS score (14.8 vs. 6.1, p<0.001) on second admission than the IS/TIA group. On first admission, the ICH group had a higher frequency of CMB (72.1% vs. 49.5%, p<0.001) and lower frequency of cardioembolism (14.7% vs. 25.8%, p=0.044) than the IS/TIA group. About half of hemorrhages occurred in similar locations of the CMB depicted on first admission. A higher frequency of ICH was observed in patients with deep CMB (11.3% vs. 5.6%, p=0.022) or both deep and lobar CMBs (17.4% vs. 5.6%, p<0.001) than in those without CMB. Use of anticoagulants was a significant risk factor for transition from first IS/TIA to second ICH (odds ratio [95% confidence interval]: 3.75 [1.30-10.8], adjusted by sex, age, type of first stroke, and CMB location).
Conclusions:
This study found IS/TIA patients with CMB are at high risk of ICH compared to patients without CMB. Preventive antithrombotic treatment particularly use of anticoagulants for CI/TIA patients with CMB should be provided under careful monitoring for the risk of hemorrhage.
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Affiliation(s)
- Eiichi Nomura
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Hiroshima, Japan
| | - Yuji Shiga
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Hiroshima, Japan
| | | | - Makoto Takemaru
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Hiroshima, Japan
| | - Jun Takeshita
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Hiroshima, Japan
| | - Masakazu Nishigaki
- Graduate Sch of Medicine and Faculty of Medicine Kyoto Univ, Kyoto, Kyoto, Japan
| | - Masaru Kuriyama
- Brain Attack Cntr Ota Memorial Hosp, Fukuyama, Hiroshima, Japan
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Ohnishi S, Watari H, Kanno M, Oba Y, Takeuchi S, Miyaji T, Oyamada S, Nomura E, Kato H, Sugiyama T, Asaka M, Sakuragi N, Yamaguchi T, Uezono Y, Iwase S. Efficacy of rikkunshito, a Japanese herbal medicine, on nausea, vomiting and anorexia in patients with uterine cervical or corpus cancer treated with cisplatin and paclitaxel –A randomized phase II study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw390.13] [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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31
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Kamimura T, Nomura E, Hara N, Maetani Y, Agari D, Ichimura K, Yoshida H, Yamawaki T. Carotid Artery Dissection and Ischemic Stroke Originating from Localized Aortic Arch Dissection. J Stroke Cerebrovasc Dis 2016; 25:e209-e211. [PMID: 27612624 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/29/2016] [Revised: 06/25/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022] Open
Abstract
Aortic dissection is an infrequent but important cause of acute ischemic stroke (AIS), and must not be overlooked because of a possible worse outcome, especially with the use of an intravenous recombinant tissue plasminogen activator. We report a case of left carotid artery dissection and AIS originating from localized aortic arch dissection, pathologically caused by cystic medial necrosis in the tunica media.
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Affiliation(s)
- Teppei Kamimura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
| | - Naoyuki Hara
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yuta Maetani
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Dai Agari
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hideo Yoshida
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takemori Yamawaki
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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32
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Maetani Y, Agari D, Nomura E, Ueda M, Ando Y, Yamawaki T. [Familial amyloid polyneuropathy involving a homozygous Val30Met mutation in the amyloidogenic transthyretin gene presenting with superficial siderosis: a case report]. Rinsho Shinkeigaku 2016; 56:430-434. [PMID: 27212678 DOI: 10.5692/clinicalneurol.cn-000869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 06/05/2023]
Abstract
A 76-year-old woman was admitted to our hospital because of transthyretin-related familial amyloid polyneuropathy (TTR-FAP). She had developed bilateral vitreous opacity at the age of 58 and paroxysmal atrial fibrillation at the age of 62. She suffered gait disturbance and dysesthesia of the limbs at the age of 68 and was diagnosed with FAP involving a homozygous Val30Met mutation in the amyloidogenic transthyretin (ATTR) gene after a genetic test. Her parents were cousins, and her aunt's medical history included pacemaker implantation and polyneuropathy. At the age of 74, the patient developed gait disturbance and dysesthesia of her extremities. A neurological examination revealed visual loss, hearing impairment, distal muscle weakness, dysesthesia, and decreased sensation in all modalities in her extremities. She could neither walk nor remain standing without support. Brain magnetic resonance imaging (MRI) revealed a low intensity lesion on the surface of the cerebellum on T2*-weighted images and susceptibility-weighted images. A low intensity pattern that was indicative of the classical type of superficial siderosis was detected. At the age of 76, when she was admitted to our hospital because of the deterioration of her gait disturbance and dysesthesia, brain MRI showed that the patient's cerebellar atrophy and hemosiderin deposition had worsened. Some reports suggest that FAP patients that are homozygous for the ATTR Val30Met mutation are more likely to develop central nervous involvement than those that are heterozygous for the mutation. Superficial siderosis may be responsible for the central nervous involvement.
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Affiliation(s)
- Yuta Maetani
- Department of Neurology, Hiroshima City Hospital
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33
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Nishisako M, Meguro A, Nomura E, Yamane T, Takeuchi M, Ota M, Kashiwagi K, Mabuchi F, Iijima H, Kawase K, Yamamoto T, Nakamura M, Negi A, Sagara T, Nishida T, Inatani M, Tanihara H, Aihara M, Araie M, Fukuchi T, Abe H, Higashide T, Sugiyama K, Kanamoto T, Kiuchi Y, Iwase A, Chin S, Ohno S, Inoko H, Mizuki N. SLC1A1 Gene Variants and Normal Tension Glaucoma: An Association Study. Ophthalmic Genet 2016; 37:194-200. [PMID: 26771863 DOI: 10.3109/13816810.2015.1028649] [Citation(s) in RCA: 2] [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: 12/22/2022]
Abstract
BACKGROUND It has been hypothesized that dysfunction of the solute carrier family 1, member1 gene (SLC1A1), which encodes the glutamate aspartate transporter, may play a role in normal tension glaucoma. In this study we investigate whether SLC1A1 is associated with normal tension glaucoma in Japanese patients. METHODS A total of 292 Japanese patients with normal tension glaucoma and 500 healthy control subjects were recruited. We genotyped 12 single-nucleotide polymorphisms in SLC1A1. We also performed an imputation analysis to evaluate the potential association of un-genotyped SLC1A1 single-nucleotide polymorphisms, and 165 single-nucleotide polymorphisms were imputed. RESULTS We observed an increased frequency of the G allele of rs10739062 in patients compared to controls (p = 0.043, OR = 1.25). The rs10739062 polymorphism exhibited a dominant effect: individuals with genotype GG and GC showed a 1.91-fold increase in risk compared to genotype CC (p = 0.0082). However, the statistical significance disappeared after Bonferroni correction for multiple testing (pc > 0.05). We did not find any significant association between any of the remaining 176 single-nucleotide polymorphisms and disease risk. CONCLUSIONS Our study showed a lack of association between SLC1A1 variants and normal tension glaucoma in Japanese patients, suggesting that the SLC1A1 gene does not play a critical role in the development of the disorder in this patient population. However, further genetic studies with larger sample sizes are needed to clarify whether SLC1A1 may make some contribution that affects the risk of developing normal tension glaucoma.
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Affiliation(s)
- Mami Nishisako
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan
| | - Akira Meguro
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan
| | - Eiichi Nomura
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan
| | - Takahiro Yamane
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan
| | - Masaki Takeuchi
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan .,b Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Masao Ota
- c Department of Legal Medicine , Shinshu University School of Medicine , Nagano , Japan
| | - Kenji Kashiwagi
- d Department of Ophthalmology , University of Yamanashi, Faculty of Medicine , Yamanashi , Japan
| | - Fumihiko Mabuchi
- d Department of Ophthalmology , University of Yamanashi, Faculty of Medicine , Yamanashi , Japan
| | - Hiroyuki Iijima
- d Department of Ophthalmology , University of Yamanashi, Faculty of Medicine , Yamanashi , Japan
| | - Kazuhide Kawase
- e Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Tetsuya Yamamoto
- e Department of Ophthalmology , Gifu University Graduate School of Medicine , Gifu , Japan
| | - Makoto Nakamura
- f Department of Surgery, Division of Ophthalmology , Kobe University Graduate School of Medicine , Kobe , Hyogo , Japan
| | - Akira Negi
- f Department of Surgery, Division of Ophthalmology , Kobe University Graduate School of Medicine , Kobe , Hyogo , Japan
| | - Takeshi Sagara
- g Department of Ophthalmology , Yamaguchi University School of Medicine , Ube , Yamaguchi , Japan
| | - Teruo Nishida
- g Department of Ophthalmology , Yamaguchi University School of Medicine , Ube , Yamaguchi , Japan
| | - Masaru Inatani
- h Department of Ophthalmology and Visual Science , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan .,i Department of Ophthalmology, Faculty of Medical Science , University of Fukui , Fukui , Japan
| | - Hidenobu Tanihara
- h Department of Ophthalmology and Visual Science , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Makoto Aihara
- j Department of Ophthalmology , University of Tokyo School of Medicine , Tokyo , Japan
| | - Makoto Araie
- j Department of Ophthalmology , University of Tokyo School of Medicine , Tokyo , Japan
| | - Takeo Fukuchi
- k Division of Ophthalmology and Visual Science , Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Haruki Abe
- k Division of Ophthalmology and Visual Science , Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Tomomi Higashide
- l Department of Ophthalmology and Visual Science , Kanazawa University Graduate School of Medical Science , Kanazawa , Ishikawa , Japan
| | - Kazuhisa Sugiyama
- l Department of Ophthalmology and Visual Science , Kanazawa University Graduate School of Medical Science , Kanazawa , Ishikawa , Japan
| | - Takashi Kanamoto
- m Department of Ophthalmology and Visual Science , Graduate School of Biomedical Sciences, Hiroshima University , Hiroshima , Japan
| | - Yoshiaki Kiuchi
- m Department of Ophthalmology and Visual Science , Graduate School of Biomedical Sciences, Hiroshima University , Hiroshima , Japan
| | - Aiko Iwase
- n Department of Ophthalmology , Tajimi Municipal Hospital , Gifu , Japan
| | - Shinki Chin
- o Department of Ophthalmology , Hokkaido University Graduate School of Medicine , Sapporo , Hokkaido , Japan , and
| | - Shigeaki Ohno
- o Department of Ophthalmology , Hokkaido University Graduate School of Medicine , Sapporo , Hokkaido , Japan , and
| | - Hidetoshi Inoko
- p Department of Genetic Information, Division of Molecular Life Science , Tokai University School of Medicine , Sagamihara , Kanagawa , Japan
| | - Nobuhisa Mizuki
- a Department of Ophthalmology , Yokohama City University School of Medicine , Yokohama , Kanagawa , Japan
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Aoki S, Hosomi N, Sueda Y, Kono T, Takamatsu K, Ohyama H, Torii T, Kitamura T, Nomura E, Noda K, Ohtsuki T, Matsumoto M. Multicenter Study of Intravenous Recombinant Tissue Plasminogen Activator Infusion around Hiroshima, Japan: The Hiroshima Acute Stroke Retrospective and Prospective Registry Study. J Stroke Cerebrovasc Dis 2015; 24:2747-53. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.005] [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] [Received: 06/04/2015] [Revised: 07/15/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022] Open
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Asano H, Kinoshita R, Kitahara T, Nishi S, Watari H, Nomura E. Role of Radiation Therapy in Platinum-Resistant Recurrent Ovarian Cancer Diagnosed by FDG-PET/Contrast-Enhanced CT. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1199] [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: 10/22/2022]
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Ohshita T, Imamura E, Nomura E, Wakabayashi S, Kajikawa H, Matsumoto M. Hypoglycemia with focal neurological signs as stroke mimic: Clinical and neuroradiological characteristics. J Neurol Sci 2015; 353:98-101. [PMID: 25912175 DOI: 10.1016/j.jns.2015.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/28/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
Our aim was to investigate the clinical and radiological features of patients with hypoglycemia with focal neurological signs (HFNS). Among 80 consecutive hypoglycemic patients (blood glucose levels less than 50mg/dL), who had been admitted between October 2008 and May 2012, we selected 11 patients (6 men and 5 women; mean age, 73.2 ± 12 years) with focal neurological signs. The mean initial blood glucose level was 27.9 mg/dL (range, 13-39 mg/dL). The most frequent symptom was unilateral motor weakness (n = 9), which was usually accompanied with mild or moderate alteration of consciousness. All patients had improved initial neurological signs within 1h of glucose injection. The initial DWI demonstrated a hyperintense lesion in the contralateral internal capsule with decreased values on the ADC (apparent diffusion coefficient) map in 2 of the patients (18%). The DWI performed one day later shows only faint lesion. The initial DWI in patients with HFNS may display a hyperintense lesion, which was difficult to distinguish from acute cerebral infarction. Hypoglycemia should be considered in cases with DWI showing a disproportionally small lesion in contrast to neurological signs.
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Affiliation(s)
- Tomohiko Ohshita
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Eiichi Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | | | - Hiroshi Kajikawa
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
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Sueda Y, Hosomi N, Tsunematsu M, Takamatsu K, Nomura E, Torii T, Ohtsuki T, Aoki S, Mukai T, Nezu T, Kakehashi M, Matsumoto M. Effects of Meteorological Conditions on the Risk of Ischemic Stroke Events in Patients Treated with Alteplase--HEWS-tPA. J Stroke Cerebrovasc Dis 2015; 24:1500-5. [PMID: 25881777 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 01/23/2015] [Revised: 02/08/2015] [Accepted: 03/12/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Predicting a day that presents a high risk for the occurrence of ischemic stroke events may enable health professionals to prepare for emergency stroke therapy more properly. We evaluated the association between meteorological conditions and the frequency of ischemic stroke events in Japanese patients. METHODS Ischemic stroke patients (n = 299) who were treated with alteplase at 9 stroke hospitals in 3 restricted areas were examined. The daily rates of ischemic stroke events were compared with the daily mean thermo-hydrological index (THI), the atmospheric pressure, and the daily changes of these variables for the 6 days preceding an ischemic stroke event using Poisson regression analysis. RESULTS We trisected onset days based on the THI (low-temperature, intermediate-temperature, and high-temperature), atmospheric pressure (low-pressure, intermediate-pressure, and high-pressure), changes in THI for preceding 6 days from the previous day (cooler, unchanged-temperature, and warmer), and changes in atmospheric pressure (decreased-pressure, unchanged-pressure, and increased-pressure). The frequency of ischemic stroke was significantly higher on low-temperature or high-pressure days (risk ratio, 1.398, P = .022; risk ratio, 1.374, P = .039), on warmer-temperature days, and when atmospheric pressure varied from the day before (P < .05). There were significantly lower risks for ischemic stroke events on cooler-temperature days, and higher risks were associated with a variation in atmospheric pressure 3 days before the onset from 4 days before (P < .05). CONCLUSIONS There were higher risks for ischemic stroke events associated with low ambient temperature, high atmospheric pressure, increased temperature, and varied atmospheric pressure. Also, atmospheric pressure variation 3 days before may be associated.
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Affiliation(s)
- Yoshimasa Sueda
- Department of Neurology, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Miwako Tsunematsu
- Department of Health Informatics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuhiro Takamatsu
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Eiichi Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tsuyoshi Torii
- Department of Neurology, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Toshiho Ohtsuki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoya Mukai
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Tanaka J, Tanaka H, Mizuki N, Nomura E, Ito N, Nomura N, Yamane M, Hida T, Goshima Y, Hatano H, Nakagawa H. Semaphorin 3A controls allergic and inflammatory responses in experimental allergic conjunctivitis. Int J Ophthalmol 2015; 8:1-10. [PMID: 25709899 DOI: 10.3980/j.issn.2222-3959.2015.01.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/08/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To assess the efficacy of topical Semaphorin-3A (SEMA3A) in the treatment of allergic conjunctivitis. METHODS Experimental allergic conjunctivitis (EAC) mice model induced by short ragweed pollen (SRW) in 4-week-old of BALB/c mice, mice were evaluated using haematoxylin and eosin (H&E) staining, immunofluorescence and light microscope photographs. Early phase took the samples in 24h after instillation and late phase took the samples between 4 to 14d after the start of treatment. The study use of topical SEMA3A (10 U, 100 U, 1000 U) eye drops and subconjunctival injection of SEMA3A with same concentration. For comparison, five types of allergy eyedrops were quantified using clinical characteristics. RESULTS Clinical score of composite ocular symptoms of the mice treated with SEMA3A were significantly decreased both in the immediate phase and the late phase compared to those treated with commercial ophthalmic formulations and non-treatment mice. SEMA3A treatment attenuates infiltration of eosinophils entering into conjunctiva in EAC mice. The score of eosinophil infiltration in the conjunctiva of SEMA3A 1000 U-treated group were significantly lower than low-concentration of SEMA3A treated groups and non-treated group. SEMA3A treatment also suppressed T-cell proliferation in vitro and decreased serum total IgE levels in EAC mice. Moreover, Treatment of SEMA3A suppressed Th2-related cytokines (IL-5, IL-13 and IL-4) and pro-inflammatory cytokines (IFN-γ, IL-17 and TNF-α) release, but increased regulatory cytokine IL-10 concentration in the conjunctiva of EAC mice. CONCLUSIONS SEMA3A as a biological agent, showed the beneficial activity in ocular allergic processes with the less damage to the intraocular tissue. It is expected that SEMA3A may be contributed in patients with a more severe spectrum of refractory ocular allergic diseases including allergic conjunctivitis in the near future.
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Affiliation(s)
- Junmi Tanaka
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan ; Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hideo Tanaka
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Eiichi Nomura
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Norihiko Ito
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Naoko Nomura
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Masayuki Yamane
- Department of Environmental Immuno-Dermatology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku Yokohama 236-0004 Japan
| | - Tomonobu Hida
- Department of Environmental Immuno-Dermatology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku Yokohama 236-0004 Japan
| | - Yoshio Goshima
- Department of Environmental Immuno-Dermatology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku Yokohama 236-0004 Japan
| | - Hiroshi Hatano
- Hatano Eye Clinic, 438-1 Fujisawa, Fujisawa, Kanagawa-ken 251-0052, Japan
| | - Hisashi Nakagawa
- Tokushima Eye Clinic, 1-2-14 Fujimi-cho, Higashimurayama, Tokyo 189-0024, Japan
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Nomura E, Suzuki A, Inoue I, Nakagawara J, Takahashi K, Takahashi T, Manabe Y, Yokota C, Okada K, Nishihara T, Yamamoto Y, Noda K, Takahashi S, Ibayashi S, Takagi M, Kitagawa K, Tanahashi N, Kuriyama M, Hirata K, Hosomi N, Minematsu K, Kobayashi S, Matsumoto M. Subsequent Vascular Events after Ischemic Stroke: The Japan Statin Treatment against Recurrent Stroke—Longitudinal. J Stroke Cerebrovasc Dis 2015; 24:473-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/11/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022] Open
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Nomura E, Ohshita T, Imamura E, Wakabayashi S, Kajikawa H, Hosomi N, Matsumoto M. Early Administration of Non-Vitamin K Antagonist Oral Anticoagulants for Acute Ischemic Stroke Patients With Atrial Fibrillation in Comparison With Warfarin Mostly Combined With Heparin. Circ J 2015; 79:862-6. [DOI: 10.1253/circj.cj-14-0793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eiichi Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | | | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital
| | | | | | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
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Nomura E, Ohshita T, Imamura E, Wakabayashi S, Kajikawa H, Matsumoto M. Can early effective anticoagulation prevent new lesions on magnetic resonance imaging in acute cardioembolic stroke? J Stroke Cerebrovasc Dis 2014; 23:2099-2104. [PMID: 25106835 DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.016] [Citation(s) in RCA: 3] [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] [Received: 01/22/2014] [Revised: 03/08/2014] [Accepted: 03/21/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The timing of warfarin administration for acute ischemic stroke (AIS) patients with atrial fibrillation (Af) has not been established. We hypothesized that achieving targeted prothrombin time and international normalized ratio (PT-INR) at 2 weeks could prevent AIS patients with Af from developing a new lesion on diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS Of consecutively enrolled AIS patients with Af between 2008 and 2011, we selected the patients who were given warfarin within 2 weeks of admission and had DW-MRI and blood test for PT-INR both on admission and at 2 weeks. Warfarin was started as early as possible and heparin was administered until the targeted PT-INR (2.0-3.0 for patients aged <70 years or 1.6-2.6 for those aged ≥70 years) was achieved. RESULTS One hundred and twenty-three patients were selected, consisting of 88 patients without a new lesion and 35 patients with a new lesion. Patients with a new lesion had a significantly higher median score on National Institutes of Health Stroke Scale (11.0 vs. 5.5, P = .0053), a lower rate of achieving targeted PT-INR at 2 weeks (25.7% vs. 48.9%, P = .0190), and a lower median dosage of warfarin at 2 weeks (2.0 mg vs. 2.5 mg, P = .0209) than patients without a new lesion. Multivariate logistic regression analysis showed that failure to achieve targeted PT-INR (P = .0298) was significantly associated with the occurrence of a new lesion. CONCLUSIONS Our findings suggest that achieving targeted PT-INR at 2 weeks by using warfarin prevents new lesions in AIS patients with Af.
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Affiliation(s)
- Eiichi Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
| | - Tomohiko Ohshita
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | | | - Hiroshi Kajikawa
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Kawai M, Hiramatsu M, Lee SW, Tokuhara T, Fujita Y, Nomura E, Inoue K, Yoden A, Tamai H, Uchiyama K. Endoscopy-assisted percutaneous anterior gastropexy for gastric volvulus: a minimally invasive technique using a special instrument. Endoscopy 2014; 45 Suppl 2 UCTN:E151-2. [PMID: 23716107 DOI: 10.1055/s-0032-1326461] [Citation(s) in RCA: 4] [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: 12/10/2022]
Affiliation(s)
- M Kawai
- Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan.
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Kono T, Naka H, Nomura E, Hosomi N, Aoki S, Imamura E, Sueda Y, Nezu T, Mukai T, Ohshita T, Ohtsuki T, Wakabayashi S, Matsumoto M. The association between hyperintense vessel sign and final ischemic lesion differ in its location. J Stroke Cerebrovasc Dis 2014; 23:1337-43. [PMID: 24424335 DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery images can frequently be detected in patients with acute cerebral infarction attributable to large artery stenosis or occlusion. The prognostic values and clinical characteristics of HVS remain to be elucidated. The aim of this study was to evaluate the association of HVS with ischemic lesions and severity of neurologic deficit. METHODS A total of 96 consecutive acute ischemic stroke patients (54 women, median age 76.5 [range 39-97] years), who had symptomatic severe stenosis or occlusion in the proximal middle cerebral artery that was detected with magnetic resonance angiography within 24 hours of onset, were enrolled. The extent of HVS was graded by a systematic quantitative scoring system (the HVS distribution score) based on Alberta Stroke Program Early Computed Tomographic Score. RESULTS An HVS was detected in 89 patients (93%) at admission, and the patients who displayed wider HVS distribution scores exhibited more severe neurologic deficits at admission (P<.05). The follow-up magnetic resonance imaging, which was obtained in 79 patients (82%), was performed an average of 13 days. The association between HVS distribution score and final ischemic lesions was strongly observed (n=67, P<.05) but not in the patients with intravenous thrombolysis (n=12, P=.06). CONCLUSIONS Although the distribution of HVS reflected final ischemic lesion, this association might not apply to the patients with the thrombolysis treatment. The interpretation of HVS distribution score with acute ischemic stroke patients should be discussed dependent on thrombolysis.
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Affiliation(s)
- Tomoyuki Kono
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiromitsu Naka
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Yoshimasa Sueda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoya Mukai
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohiko Ohshita
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Toshiho Ohtsuki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Yoshizawa K, Fukui T, Sasaki Y, Sato T, Nomura E, Abe Y, Ito Y, Yoshioka T, Ueno Y. A Case of Gastric Neuroendocrine Carcinoma with Cavernous Sinus Metastasis. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagai Y, Kohriyama T, Origasa H, Minematsu K, Yokota C, Uchiyama S, Ibayashi S, Terayama Y, Takagi M, Kitagawa K, Nomura E, Hosomi N, Ohtsuki T, Yamawaki T, Matsubara Y, Nakamura M, Yamasaki Y, Mori E, Fukushima M, Kobayashi S, Shinohara Y, Yamaguchi T, Matsumoto M. Rationale, design, and baseline features of a randomized controlled trial to assess the effects of statin for the secondary prevention of stroke: the Japan Statin Treatment Against Recurrent Stroke (J-STARS). Int J Stroke 2013; 9:232-9. [PMID: 24015915 PMCID: PMC4283729 DOI: 10.1111/ijs.12099] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although statin therapy is beneficial for preventing first strokes, the benefit for recurrent stroke and its sub-types remains unknown in Asian populations. The aim of this study is to examine the role of pravastatin in the secondary prevention of stroke in Japanese patients. METHODS This is a multicenter, randomized, open-label, parallel group study of patients with noncardioembolic ischemic stroke (atherothrombotic infarction, lacunar infarction, and infarction of undetermined etiology). All patients were diagnosed with hyperlipidemia and with a total cholesterol level between 180 and 240 mg/dl at enrollment. Patients in the treatment group receive 10 mg/day of pravastatin, and those in the control group receive no statin treatment. The primary end-point is the recurrence of stroke, including transient ischemic attack. The secondary end-points include the onset of respective stroke sub-types and functional outcomes related to stroke. The patients were enrolled for five-years and will be followed up for five-years. RESULTS A total of 1578 eligible patients (age: 66·2 years, men: 68·8%), including 64·2% with lacunar infarction, 25·4% with atherothrombotic infarction, and 10·4% with infarction of undetermined etiology were included in this study. Lipid levels were generally well controlled (total cholesterol: 210·0 mg/dl, low density lipoprotein cholesterol: 129·5 mg/dl) at baseline. In addition, the disability of patients was relatively mild, and cognitive function was preserved in the majority of patients. CONCLUSION This article reports the rationale, design, and baseline features of a randomized controlled trial to assess the effects of statin for the secondary prevention of stroke. Follow-ups of patients are in progress and will end in 2014.
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Affiliation(s)
- Yoji Nagai
- Foundation for Biomedical Research and Innovation Translational Research Informatics Center, Kobe, Japan
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Yamamoto T, Kuwayama Y, Nomura E, Tanihara H, Mori K. Changes in visual acuity and intra-ocular pressure following bleb-related infection: the Japan Glaucoma Society Survey of Bleb-related Infection Report 2. Acta Ophthalmol 2013; 91:e420-6. [PMID: 23819592 DOI: 10.1111/aos.12079] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify changes in visual acuity and intra-ocular pressure (IOP) 12 months after the development of bleb-related infection. METHODS Data obtained from 146 eyes of 146 patients with bleb-related infection were analyzed as a part of the Japan Glaucoma Society Survey of Bleb-related Infection. Multiple logistic regression analysis was conducted to identify factors associated with poor prognosis in visual acuity and increased IOP and for being stage III. RESULTS The logMAR increased by a mean of 0.140, 0.440, 1.099 and 1.122 at 12 months postinfection for stage I, II, IIIa and IIIb infections, respectively. The logMAR was significantly worse at 6 and 12 months postinfection in stage IIIb (p = 0.002 and p = 0.003, respectively; Wilcoxon signed-rank test) and at 6 months postinfection in stage IIIa (p = 0.036). The IOP was significantly elevated following infection in both stage IIIa and stage IIIb (p = 0.028 and p = 0.008 at 6 and 12 months, respectively, for stage IIIa; p = 0.002 and p = 0.005 for stage IIIb). The multiple logistic regression analysis revealed that being stage III and positive culture were significant risk factors for poor outcome for visual acuity (Odds ratio: 9.26 and 6.29, respectively) and that being stage III was a prognostic factor for increased IOP (Odds ratio: 8.33). Pseudophakia or aphakia was significantly associated with stage III and stage IIIb infections (Odds ratio: 2.85 and 6.30). CONCLUSIONS Stage III bleb-related infection causes significant visual loss and IOP elevation within 12 months after development. Therefore, preventative measures should be taken, especially in cases that are pseudophakic or aphakic.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Japan.
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Kato T, Meguro A, Nomura E, Uemoto R, Nomura N, Ota M, Kashiwagi K, Mabuchi F, Iijima H, Kawase K, Yamamoto T, Nakamura M, Negi A, Sagara T, Nishida T, Inatani M, Tanihara H, Aihara M, Araie M, Fukuchi T, Abe H, Higashide T, Sugiyama K, Kanamoto T, Kiuchi Y, Iwase A, Chin S, Ohno S, Inoko H, Mizuki N. Association study of genetic variants on chromosome 7q31 with susceptibility to normal tension glaucoma in a Japanese population. Eye (Lond) 2013; 27:979-83. [PMID: 23743525 DOI: 10.1038/eye.2013.123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/04/2013] [Indexed: 12/14/2022] Open
Abstract
The caveolin 1 to caveolin 2 (CAV1-CAV2) gene region on chromosome 7q31 has been reported to be associated with susceptibility to primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) in previous studies. We investigated whether genetic variants in the CAV1-CAV2 region are associated with NTG in Japanese patients. Two hundred and ninety-two Japanese patients with NTG and 352 Japanese healthy controls were recruited. We genotyped three single-nucleotide polymorphisms; that is, rs1052990, rs4236601, and rs7795356, in the CAV1-CAV2 gene region and assessed the allelic diversity among cases and controls. The frequency of the minor allele (G) of rs1052990 was significantly decreased in NTG cases compared with controls (P=0.014, OR=0.71), whereas NTG or POAG cases had a significantly higher frequency of the allele than controls in previous studies. Conversely, rs7795356 did not show any significant association with NTG cases, and rs4236601 was monomorphic in the Japanese study population. Our findings did not correspond with previous positive results, suggesting that CAV1-CAV2 variants studied in the present study are not important risk factors for NTG susceptibility in all populations. Further studies are needed to elucidate the possible contribution of the CAV1-CAV2 region to the development of glaucoma.
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Affiliation(s)
- T Kato
- Department of Ophthalmology, Yokohama City University School of Medicine, Kanagawa, Japan
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Mikami T, Meguro A, Teshigawara T, Takeuchi M, Uemoto R, Kawagoe T, Nomura E, Asukata Y, Ishioka M, Iwasaki M, Fukagawa K, Konomi K, Shimazaki J, Nishida T, Mizuki N. Interleukin 1 beta promoter polymorphism is associated with keratoconus in a Japanese population. Mol Vis 2013; 19:845-51. [PMID: 23592922 PMCID: PMC3626376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/09/2013] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Polymorphisms in the interleukin 1 alpha (IL1A) and IL1B gene regions were previously associated with keratoconus in a Korean population. In the present study, we investigated whether the IL1A and IL1B polymorphisms are associated with keratoconus in a Japanese population. METHODS A total of 169 Japanese patients with keratoconus and 390 Japanese healthy controls were recruited. We genotyped one IL1A single nucleotide polymorphism (SNP; rs2071376) and two IL1B SNPs (rs1143627 and rs16944) to compare the frequencies of alleles, genotypes, and haplotypes between cases and controls. RESULTS Statistically significant association was observed for rs1143627 (-31 T>C) in the IL1B promoter region; the T allele of rs1143627 was associated with an increased risk of keratoconus (p=0.014, corrected p value [pc]=0.043, odds ratio=1.38). The C allele of rs16944 (-511 C>T) in the IL1B promoter region had a 1.33-fold increased risk of keratoconus, although this increase did not reach statistical significance (p=0.033, pc=0.098). The TT genotype of rs1143627 was weakly associated with an increased risk of keratoconus (p=0.033, pc=0.099, odds ratio=1.52). However, no significant differences were found in the allele and genotype frequencies between the cases and controls for rs2071376 in IL1A. Regarding haplotypic diversity, the haplotype created by the T allele of rs1143627 and C allele of rs16944 was associated with a 1.72-fold increased risk of keratoconus (p=4.0×10(-5), pc=1.6×10(-4)). CONCLUSIONS Our results replicate associations reported recently in a Korean population. Thus, IL1B may play an important role in the development of keratoconus through genetic polymorphisms.
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Affiliation(s)
- Takenori Mikami
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan,Yokosuka Chuoh Eye Clinic, Kanagawa, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takeshi Teshigawara
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan,Yokosuka Chuoh Eye Clinic, Kanagawa, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Riyo Uemoto
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tatsukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Eiichi Nomura
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yuri Asukata
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Misaki Ishioka
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan,Ryogoku Eye Clinic, Tokyo, Japan
| | | | | | - Kenji Konomi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Teruo Nishida
- Department of Biomolecular Recognition and Ophthalmology, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Kaseda Y, Yamawaki T, Ikeda J, Hayata M, Dohi E, Ohshita T, Ochi K, Nomura E, Matsumoto M. Amelioration of persistent, non-ketotic hyperglycemia-induced hemichorea by repetitive transcranial magnetic stimulation. Case Rep Neurol 2013; 5:68-73. [PMID: 23626568 PMCID: PMC3635686 DOI: 10.1159/000350434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diabetic hemichorea-hemiballism with non-ketotic hyperglycemia is usually a benign syndrome. Here, we report a 78-year-old woman with persistent hemichorea (HC) for longer than 1 year with a recurrence after rapid correction of hyperglycemia. Following the disappearance of the characteristic T1 hyperintensity at 3 months after onset, an MRI demonstrated T2* hypointensity and atrophic changes in the contralateral striatum, suggesting irreversible neuronal loss and some vascular proliferation. The electrophysiological examination using transcranial magnetic stimulation revealed significantly shorter cortical silent periods (CSPs) on the contralateral primary motor cortex (M1), possibly in relation to cortical hyperexcitability. We have applied 10 daily sessions of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralateral M1 to reduce the hyperexcitability. The HC was suppressed during and for several minutes after rTMS with prolongation of CSPs. After rehabilitation therapy, the patient was able to walk independently with a walker. We suggest that the combination of low-frequency rTMS and rehabilitation therapy may be a possible choice in medically refractory involuntary movements.
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Affiliation(s)
- Yumiko Kaseda
- Department of Neurology, Hiroshima City General Rehabilitation Center, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Ohtsuki T, Nomura E, Kato A, Matsumoto M. Abstract TP284: Association of Hemorrhagic Stroke with Recurrence Stroke caused by Infective Endocarditis. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Infective endocarditis causes not only brain infarcts and infection triggered by bacterial emboli, but also hemorrhagic stroke by inflamed arteries or aneurysms prone to rupture, when we make the requisite open-heart surgery delayed. We examined if hemorrhagic stroke caused by infective endocarditis and complicated microbleeds were associated with subsequent recurrent stroke.
Methods:
We conducted the observational study on 36 consecutive patients (19 men, aged 18-84, median 53) with acute symptomatic stroke caused by definite or possible infective endocarditis according to the Duke University criteria from October 2005 to April 2012. Brain hemorrhage/infarcts responsible for neurological signs and asymptomatic microbleeds were verified by CT and diffusion/T2*-weighted MRI. We had followed each patient as for recurrent symptomatic stroke for 3 months.
Results:
Out of 36, hemorrhagic stroke was noted in 15 patients, 13 of whom had simultaneous infarcts, and the other 21 patients showed pure ischemic stroke and TIA. Fifteen patients had asymptomatic microbleeds. Fourteen patients experienced recurrent stroke, which consisted of SAH in 4, hematoma/massive hemorrhagic transformation from infarcts in 4 and pure infarction in 6. Ten patients (71%) in the recurrent group had hemorrhagic stroke for initial attack, while 5 in 22 (23%) of the non-recurrent group did (p<0.01). The recurrent group had a higher average age (18-82 years, median 68 years) than the non-recurrent group (23-75 years, median 51 years). No statistically significant differences between the non-recurrent and the recurrent groups were observed of a proportion of patients that were female and had, infarction, microbleeds, hypertension, diabetes, antithrombotic treatment, attachment of 10-mm or larger vegetations to damaged valves, isolation of staphylococcus aureus from blood, embolization to other organs than the brain and complication of meningitis/abscess.
Conclusions:
Hemorrhagic stroke, but not asymptomatic microbleeds, was associated with recurrent stroke after infective endocarditis. Duration of waiting for the safe heart operation after symptomatic hemorrhagic stroke can be in face of recurrent stroke.
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