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Thykjær AS, Andersen N, Bek T, Heegaard S, Hajari J, Laugesen CS, Möller S, Pedersen FN, Rosengaard L, Schielke KC, Kawasaki R, Højlund K, Rubin KH, Stokholm L, Grauslund J. Attendance in a national screening program for diabetic retinopathy: a population-based study of 205,970 patients. Acta Diabetol 2022; 59:1493-1503. [PMID: 35953626 PMCID: PMC9519674 DOI: 10.1007/s00592-022-01946-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/15/2022]
Abstract
AIMS A nationwide diabetic retinopathy (DR) screening program has been established in Denmark since 2013. We aimed to perform an evaluation of adherence to DR screenings and to examine whether non-adherence was correlated to DR progression. METHODS The population consisted of a register-based cohort, who participated in the screening program from 2013 to 2018. We analyzed age, gender, marital status, DR level (International Clinical DR severity scale, none, mild-, moderate-, severe non-proliferative DR (NPDR) and proliferative DR (PDR)), comorbidities and socioeconomic factors. The attendance pattern of patients was grouped as either timely (no delays > 33%), delayed (delays > 33%) or one-time attendance (unexplained). RESULTS We included 205,970 patients with 591,136 screenings. Rates of timely, delayed and one-time attendance were 53.0%, 35.5% and 11.5%, respectively. DR level at baseline was associated with delays (mild-, moderate-, severe NPDR and PDR) and one-time attendance (moderate-, severe NPDR and PDR) with relative risk ratios (RRR) of 1.68, 2.27, 3.14, 2.44 and 1.18, 2.07, 1.26, respectively (P < 0.05). Delays at previous screenings were associated with progression to severe NPDR or PDR (hazard ratio (HR) 2.27, 6.25 and 12.84 for 1, 2 and 3+ delays, respectively). Any given delay doubled the risk of progression (HR 2.28). CONCLUSIONS In a national cohort of 205,970 patients, almost half of the patients attended DR screening later than scheduled or dropped out after first screening episode. This was, in particular, true for patients with any levels of DR at baseline. DR progression in patients with delayed attendance, increased with the number of missed appointments.
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Affiliation(s)
- Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - N Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - T Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - S Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - J Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - C S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - S Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F N Pedersen
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Rosengaard
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - R Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - K Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - K H Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Stokholm
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Shimizu T, Kawashiri SY, Morimoto S, Kawazoe Y, Kuroda S, Kawasaki R, Ito Y, Sato S, Yamamoto H, Kawakami A. AB0157 EFFICACY AND SAFETY OF FILGOTINIB IN ACTIVE RHEUMATOID ARTHRITIS PATIENTS WITH INADEQUATE RESPONSE TO METHOTREXATE: COMPARATIVE STUDY WITH FILGOTINIB AND TOCILIZUMAB EXAMINED BY CLINICAL INDEX AS WELL AS MUSCULOSKELETAL ULTRASOUND ASSESSMENT (TRANSFORM STUDY): STUDY PROTOCOL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe administration of Janus kinase (JAK) inhibitors as well as biological disease-modifying anti-rheumatic drugs has dramatically improved even the clinical outcomes in rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX). The dysregulation of JAK- signal transducer and activator of transcription (STAT) pathways via overproduction of cytokines, such as interleukin-6 (IL-6) is involved in the pathogenesis of RA (1). Filgotinib, a preferential JAK1 inhibitor, is effective in suppressing disease activity and preventing the progression of joint destruction due to inhibition of the JAK-STAT pathway. IL-6 inhibitors such as tocilizumab also inhibit the JAK-STAT pathways due to inhibition of IL-6 signaling. Thus, it should be desirable to investigate whether the effectiveness of filgotinib monotherapy is non-inferior to those of tocilizumab monotherapy in RA patients with inadequate response to MTX. In addition, it is important to accurately evaluate disease activity at the joint level by using musculoskeletal ultrasound (MSUS) and clinical disease activity indices, including subjective parameters (2).ObjectivesThis study’s principal objective is to evaluate the effects of filgotinib monotherapy is non-inferior to those of tocilizumab monotherapy in RA patients with inadequate response to MTX. In addition, we will evaluate changes in patients’ parameters, including clinical disease activity indices, MSUS scores, serum biomarkers, patient-reported outcome (PRO), and modified total Sharp score (mTSS) after the administration of filgotinib or tocilizumab. Herein, we describe the study protocol for this study.MethodsThis study is an interventional, multicenter, randomized, open-label, parallel-group and non-inferiority clinical trial with a 52-week follow-up. In total, 400 RA patients with at least moderate disease activity during treatment with MTX will be included. Patients will be randomized in a 1:1 ratio to administration of filgotinib 200mg/day monotherapy or subcutaneous tocilizumab 162mg/biweekly monotherapy switched from MTX (Figure 1). We will evaluate disease activity by measuring clinical disease activity indices and by using MSUS. The primary endpoint is the proportion of patients who achieve an American College of Rheumatology 50 response at week 12. Important secondary endpoints are the changes from the baseline of the MSUS scores, PRO, and mTSS. We will also comprehensively analyze the serum levels of multiple biomarkers such as cytokines and chemokines.Figure 1.ResultsAlthough the study results cannot be shown because the research entry is in progress, they are expected to show the non-inferiority of filgotinib monotherapy to tocilizumab monotherapy in RA patients with inadequate response to MTX.ConclusionThe strength of this study is its prospective evaluation of therapeutic efficacy using not only clinical disease activity indices but also MSUS, which accurately and objectively evaluate disease activity at the joint level among patients drawn from multiple centers with a standardized evaluation by MSUS. In addition, we will evaluate the effectiveness of both drugs by integrating multilateral assessments, i.e., clinical disease activity indices, MSUS findings, and serum biomarkers.References[1]Gadina M, Le MT, Schwartz DM, Silvennoinen O, Nakayamada S, Yamaoka K, et al. Janus kinases to jakinibs: from basic insights to clinical practice. Rheumatology (Oxford). 2019;58(Suppl 1):i4-i16.[2]Colebatch AN, Edwards CJ, Ostergaard M, van der Heijde D, Balint PV, D’Agostino MA, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804-14.Disclosure of InterestsToshimasa Shimizu: None declared, Shin-ya Kawashiri: None declared, Shimpei Morimoto: None declared, Yurika Kawazoe: None declared, Shohei Kuroda: None declared, Rina Kawasaki: None declared, Yasuko Ito: None declared, Shuntaro Sato: None declared, Hiroshi Yamamoto: None declared, Atsushi Kawakami Grant/research support from: Gilead Sciences, Inc.
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Ohnishi M, Kawasaki R, Nakane H. Mental health status among male and female methamphetamine-dependent inmates in Japan. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1012] [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: 11/14/2022] Open
Abstract
Abstract
Background
Although the prevalence of drug addiction in Japan is lower than that of in European and/or American countries, the number of methamphetamine-related arrests in this decade has exceeded 10,000 every year, with 66.2% of the arrests made in 2017 being of re-offenders. This study was performed to assess the mental health status among prison inmates whose sentences were related to methamphetamine use.
Methods
Face-to-face individual interviews using a questionnaire including self-rated health questions (answered on a 4-point Likert scale) and the Kessler 6-item psychological distress scale (K6, range: 0-24) was established by the authors and conducted with 30 methamphetamine-dependent inmates (15 male and 15 female inmates) in Japan.
Results
The age of inmates ranged from the 20s to the 70s. The median time served in adulthood was 5 (range: 2 - 12) among male inmates, and 4.5 (range: 2 - 12) among female inmates (Mann-Whitney U test, P = 0.202). The median K6 scores were 4 (0-8) for the male inmates and 6 (1-17) for the female inmates (Mann-Whitney U test, P = 0.074). The cut-off point for K6 exhibited variation, and the authors considered a participant psychologically distressed if K6 was 10 or higher. Six (40.0%) female inmates were found to be psychologically distressed, which was a higher proportion than among the male inmates (0.0%) (Fisher's exact test, P = 0.017). Regarding self-rated health, 13 (86.7%) of both male and female inmates reported being in “very good/good health” (Cochran-Armitage Test, P ¬= 1.000). There was no statistical correlation between the K6 scores and the self-rated health scores among the male inmates (ρ = 0.148, P = 0.599) or the female inmates (ρ = -0.499, P = 0.058).
Conclusions
Although the interviewees were not representative samples, the male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders.
Key messages
The male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders. Gender differences in mental health status among inmates, should be considered when a drug addiction recovery program is implemented to ensure the successful prevention of relapse.
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Affiliation(s)
- M Ohnishi
- Nagasaki University, Nagasaki-shi, Japan
| | - R Kawasaki
- Oita University of Nursing and Health Sciences, Oita, Japan
| | - H Nakane
- Nagasaki University, Nagasaki-shi, Japan
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Wong I, Wong R, Gangwani R, Chong V, Kawasaki R. Improving the current diabetic macular oedema screening programme. Hong Kong Med J 2019; 25 Suppl 9:8-11. [PMID: 31889027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- I Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong
| | - R Wong
- Department of Ophthalmology, The Hong Kong Eye Hospital
| | - R Gangwani
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong
| | - V Chong
- Department of Ophthalmology, Oxford University, UK
| | - R Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Japan
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Kawasaki R, Sakuishi K, Kubota A, Kaneko K, Takahashi T, Hayashi T, Shimizu J, Tsuji S. Single institutional study on the clinical features of anti-MOG antibody-associated brain lesions. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3470] [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: 11/24/2022]
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Arnould L, Binquet C, Guenancia C, Kawasaki R, Daien V, Bron A, Creuzot-Garcher C. Association between the retinal vascular network, cardiovascular history and risk factors in the elderly. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Arnould
- Ophthalmology; University Hospital; Dijon France
| | - C. Binquet
- Ophthalmology; University Hospital; Dijon France
| | | | - R. Kawasaki
- Epidemiology; Department of Public Health; Yamagata Japan
| | - V. Daien
- Ophthalmology; University Hospital; Montpellier France
| | - A. Bron
- Ophthalmology; University Hospital; Dijon France
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Tanaka S, Kawasaki R, Tanaka-Mizuno S, Iimuro S, Matsunaga S, Moriya T, Ishibashi S, Katayama S, Ohashi Y, Akanuma Y, Sone H, Yamashita H. Severe hypoglycaemia is a major predictor of incident diabetic retinopathy in Japanese patients with type 2 diabetes. Diabetes Metab 2017; 43:424-429. [PMID: 28720342 DOI: 10.1016/j.diabet.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
AIM Hypoglycaemia is a common complication in diabetes patients. However, its relationship with retinopathy has not been well documented in patients with type 2 diabetes (T2D). This study aimed to investigate the associations between hypoglycaemia and the incidence and progression of diabetic retinopathy (DR). METHODS In this longitudinal cohort study, which was part of the Japan Diabetes Complications Study (JDCS), adult patients with T2D were recruited at 59 diabetes clinics across Japan. Their history of hypoglycaemia was assessed by standardized self-reported questionnaires. Severe hypoglycaemia was defined as having at least one episode with coma requiring an outpatients visit or hospitalization. Adjusted hazard ratios (HRs) for incidence and progression of DR over 8 years of follow-up were determined. RESULTS Of 1221 patients without DR, 127 (10.4%) had experienced non-severe hypoglycaemia within the previous year, whereas 10 (0.8%) reported severe hypoglycaemia episodes. During the 8-year follow-up involving 8492 person-years, 329 patients developed DR. In 410 patients with prevalent DR, the adjusted HRs for incident DR were 4.35 (95% CI: 1.98-9.56; P<0.01) and, for progression of DR, 2.29 (95% CI: 0.45-11.78; P=0.32) with severe hypoglycaemia. CONCLUSION Having a history of severe hypoglycaemia was one of the strongest predictors of incident DR in patients with T2D, with a fourfold increased risk. Identifying patients with greater risks of DR based on their history of hypoglycaemia may help to personalize risk evaluation in patients with diabetes.
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Affiliation(s)
- S Tanaka
- Department of pharmacoepidemiology, graduate longitudinal school of medicine and public health, Kyoto university, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - R Kawasaki
- Department of public health, Yamagata university graduate school of medical science, 2-2-2 Iida-Nishi, Yamagata, Japan.
| | - S Tanaka-Mizuno
- Division of medical statistics, Shiga university of medical science, Tsukinowa Seta-cho, Ohtsu, Shiga, Japan
| | - S Iimuro
- Teikyo academic research centre, Teikyo university, Kaga, Itabashi-ku, Tokyo, Japan
| | - S Matsunaga
- Department of haematology, endocrinology and metabolism, faculty of medicine, Niigata university, 1-757 Asahi-machi, Chuo-ku, Niigata, Japan
| | - T Moriya
- Health care centre, Kitasato university, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, Japan
| | - S Ishibashi
- Division of endocrinology and metabolism, school of medicine, Jichi medical university, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - S Katayama
- Kawagoe clinic, Saitama medical university, 21-7 Wakitahonchou, Kawagoe, Saitama, Japan
| | - Y Ohashi
- Department of integrated science and engineering for sustainable society, Chuo university, 1-13-27, Kasuga, Bunkyo-ku, Tokyo, Japan
| | - Y Akanuma
- The institute for adult diseases Asahi life foundation, 1-6-1 Marunouchi Chiyoda-ku, Tokyo, Japan
| | - H Sone
- Department of haematology, endocrinology and metabolism, faculty of medicine, Niigata university, 1-757 Asahi-machi, Chuo-ku, Niigata, Japan
| | - H Yamashita
- Department of ophthalmology and visual sciences, school of medicine, Yamagata university, 2-2-2 Iida-Nishi, Yamagata, Japan
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Koyama S, Fujisawa S, Watanabe R, Itabashi M, Ishibashi D, Ishii Y, Hattori Y, Nakajima Y, Motohashi K, Takasaki H, Kawasaki R, Hashimoto C, Yamazaki E, Koharazawa H, Takemura S, Tomita N, Sakai R, Motomura S, Nakajima H. Serum ferritin level is a prognostic marker in patients with peripheral T-cell lymphoma. Int J Lab Hematol 2016; 39:112-117. [PMID: 27885817 DOI: 10.1111/ijlh.12592] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/10/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The prognostic value of serum ferritin level in patients with peripheral T-cell lymphoma (PTCL) remains unknown. METHODS We retrospectively analyzed clinical data from 78 consecutive patients with newly diagnosed PTCL that were treated with anthracycline-containing regimens between 1998 and 2011. RESULTS The patients consisted of 50 males and 28 females with a median age of 64 years (range, 16-83 years). The subtypes of PTCL were 39 PTCL, not otherwise specified and 39 angioimmunoblastic T-cell lymphoma (AITL). The median observation period for the surviving patients was 50 months. The overall survival (OS) was poorer in patients with serum ferritin level above the upper normal limit (n = 28), compared with patients with serum ferritin level within normal range (n = 50; 4-year OS: 23% vs. 72%; P < 0.001). In the multivariate analysis, poor performance status (P = 0.006) and elevated serum ferritin level (P = 0.018) were independent risk factors for poor OS. CONCLUSION Serum ferritin level is a useful prognostic marker for PTCL.
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Affiliation(s)
- S Koyama
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - S Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - R Watanabe
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - M Itabashi
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - D Ishibashi
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Y Ishii
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Y Hattori
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Y Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - K Motohashi
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - H Takasaki
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - R Kawasaki
- Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan
| | - C Hashimoto
- Department of Hematology, Yamato Municipal Hospital, Yamato, Japan
| | - E Yamazaki
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - H Koharazawa
- Department of Hematology, Yamato Municipal Hospital, Yamato, Japan
| | - S Takemura
- Department of Internal Medicine, Yokohama Ekisaikai Hospital, Yokohama, Japan
| | - N Tomita
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - R Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - S Motomura
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - H Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Arnould L, Binquet C, Guenancia C, Alassane S, Kawasaki R, Daien V, Helmer C, Tzourio C, Bron A, Creuzot-Garcher C. Description of the retinal vascular network by semi-automated computer software (SIVA) in the MONTRACHET study. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kawasaki R, Sugimoto K, Miyamoto N, Kinoshita M, Horinouchi H, Sasaki K. Percutaneous transfer of an acute popliteal artery embolism to a deep femoral artery using balloon embolectomy technique: initial results. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.263] [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] Open
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Che Azemin MZ, Ab Hamid F, Aminuddin A, Wang JJ, Kawasaki R, Kumar DK. Age-related rarefaction in retinal vasculature is not linear. Exp Eye Res 2013; 116:355-358. [PMID: 24416767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The fractal dimension is a global measure of complexity and is useful for quantifying anatomical structures, including the retinal vascular network. A previous study found a linear declining trend with aging on the retinal vascular fractal dimension (DF); however, it was limited to the older population (49 years and older). This study aimed to investigate the possible models of the fractal dimension changes from young to old subjects (10–73 years). A total of 215 right-eye retinal samples, including those of 119 (55%) women and 96 (45%) men, were selected. The retinal vessels were segmented using computer-assisted software, and non-vessel fragments were deleted. The fractal dimension was measured based on the log–log plot of the number of grids versus the size. The retinal vascular DF was analyzed to determine changes with increasing age. Finally, the data were fitted to three polynomial models. All three models are statistically significant (Linear: R(2) = 0.1270, 213 d.f., p < 0.001, Quadratic: R(2) = 0.1536, 212 d.f., p < 0.001, Cubic: R(2) = 0.1529, 211 d.f., p < 0.001). The quadratic regression is significantly better than the linear regression (p < 0.001); however, the increase in R(2) from the quadratic model to the cubic model is not significant (p = 0.97). These results suggest that the decreasing trend of the fractal dimension associated with aging is better explained by the quadratic model than by the linear and cubic models in a sample with a broader age spectrum.
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Che Azemin MZ, Ab Hamid F, Aminuddin A, Wang JJ, Kawasaki R, Kumar DK. Age-related rarefaction in retinal vasculature is not linear. Exp Eye Res 2013; 116:355-358. [PMID: 24512773 DOI: 10.1016/j.exer.2013.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
The fractal dimension is a global measure of complexity and is useful for quantifying anatomical structures, including the retinal vascular network. A previous study found a linear declining trend with aging on the retinal vascular fractal dimension (DF); however, it was limited to the older population (49 years and older). This study aimed to investigate the possible models of the fractal dimension changes from young to old subjects (10-73 years). A total of 215 right-eye retinal samples, including those of 119 (55%) women and 96 (45%) men, were selected. The retinal vessels were segmented using computer-assisted software, and non-vessel fragments were deleted. The fractal dimension was measured based on the log-log plot of the number of grids versus the size. The retinal vascular DF was analyzed to determine changes with increasing age. Finally, the data were fitted to three polynomial models. All three models are statistically significant (Linear: R2 = 0.1270, 213 d.f., p < 0.001, Quadratic: R2 = 0.1536, 212 d.f., p < 0.001, Cubic: R2 = 0.1529, 211 d.f., p < 0.001). The quadratic regression is significantly better than the linear regression (p < 0.001); however, the increase in R2 from the quadratic model to the cubic model is not significant (p = 0.97). These results suggest that the decreasing trend of the fractal dimension associated with aging is better explained by the quadratic model than by the linear and cubic models in a sample with a broader age spectrum.
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Affiliation(s)
- M Z Che Azemin
- Department of Optometry and Visual Science, Faculty of Allied Health Sciences, International Islamic University Malaysia, Malaysia.
| | - F Ab Hamid
- Department of Optometry and Visual Science, Faculty of Allied Health Sciences, International Islamic University Malaysia, Malaysia
| | - A Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia
| | - J J Wang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia; Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia
| | - R Kawasaki
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia
| | - D K Kumar
- School of Electrical and Computer Engineering, RMIT University, Melbourne, Australia
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Alfiadh A, Uddin N, Patel S, Wilson A, Clark D, Kawasaki R, Burrell L, Wong T, Farouque O. Multiple vascular reactivity measures improves our ability to predict underlying coronary artery disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wickremasinghe SS, Xie J, Guymer RH, Wong TY, Kawasaki R, Qureshi S. Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period. Eye (Lond) 2012; 26:958-66. [PMID: 22562186 PMCID: PMC3396172 DOI: 10.1038/eye.2012.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Received: 10/11/2011] [Accepted: 03/13/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess retinal vascular calibre changes in eyes with neovascular age-related macular degeneration (AMD), treated with intravitreal anti-vascular endothelial growth factor agents, over a 1-year period and compare any such changes to untreated fellow eyes. METHODS Treatment naïve patients with neovascular AMD received three consecutive intravitreal injections of ranibizumab, followed by a pro re nata dosing regimen up to 1 year, with the aim of maintaining a 'fluid-free' macula. Retinal arteriolar and venular calibre was measured from digital fundus photographs at baseline and at three monthly intervals to 1 year, and summarised as central retinal artery equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively. RESULTS A total of 53 injected eyes and 41 fellow, non-injected eyes were analysed. At baseline, there were no differences in retinal vascular calibre between injected and non-injected eyes (mean CRAE (SD) 144.93 (14.07) vs 145.74 (13.10) μm, P=0.80 and mean CRVE (SD) 216.23 (25.93) vs 219.91 (22.82) μm, P=0.53). Over a 12-month period, retinal venular calibre dilatation occurred in injected eyes (mean CRVE change +5.71 (14.71) μm, P=0.007), with no change in retinal arterioles, +0.69 (14.71) μm, P=0.68. In non-injected eyes, arteriolar narrowing occurred as a whole, mean CRAE change -4.20 (7.00) μm, P=0.001, over 12 months, with a trend for narrowing in venules, -2.16 (11.56) μm, P=0.28. In injected eyes, after controlling for covariates, the changes in CRVE over 12 months mirrored improvements in macular thickness, -0.06 (-0.005, -0.11) μm, P=0.04, and visual acuity, +9.66 (-0.30, +19.32) μm, P=0.06. CONCLUSION Intravitreal ranibizumab significantly dilated retinal venules after a 1-year period.
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Affiliation(s)
- S S Wickremasinghe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - J Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - R H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - T Y Wong
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - R Kawasaki
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - S Qureshi
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Fenwick EK, Pesudovs K, Rees G, Dirani M, Kawasaki R, Wong TY, Lamoureux EL. Republished article: The impact of diabetic retinopathy: understanding the patient's perspective. Postgrad Med J 2012; 88:167-75. [PMID: 22343937 DOI: 10.1136/pgmj.2010.191312rep] [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: 11/04/2022]
Abstract
Understanding the impact of a condition from the patient's perspective is important, and different types of patient-reported outcomes or instruments are available to help with this. This review article summarises the current evidence on the impact of diabetic retinopathy (DR) and its associated vision impairment on patient-reported outcomes. We have included research that has used a range of outcome measures to assess the impact of DR on generic health-related quality of life, utility, vision-functioning and vision-specific quality of life. This review also offers clarification on frequently misused psychometric terminologies to help clinicians and researchers better understand the literature associated with patient-reported outcome research. Overall, the evidence suggests that DR, particularly in its vision-threatening stages, has a substantial, negative impact on the patient. However, our understanding of the impact of DR is currently restricted due to limitations inherent in currently available patient-reported outcome measures. We conclude by discussing potential directions for future research in this area, such as item banking and computer adaptive testing.
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Affiliation(s)
- E K Fenwick
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourn, Australia
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Al-Fiadh A, Uddin N, Glatz E, Kawasaki R, Patel S, Wilson A, Burrell L, Wong T, Farouque O. Baseline Brachial Artery Diameter, Reactive Hyperaemia Velocity and Shear Rate Correlates with Retinal Vascular Calibre. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.600] [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: 10/28/2022]
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Kawasaki R, Tanaka S, Tanaka S, Yamamoto T, Sone H, Ohashi Y, Akanuma Y, Yamada N, Yamashita H. Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS). Diabetologia 2011; 54:2288-94. [PMID: 21630126 DOI: 10.1007/s00125-011-2199-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/27/2011] [Indexed: 01/23/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine the incidence and progression rates of diabetic retinopathy and their associations in Japanese individuals with type 2 diabetes. METHODS This is a part of the Japan Diabetic Complications Study (JDCS), a multi-centred randomised trial of type 2 diabetes patients aged 40-70 years with an 8 year follow-up. There were 1,221 patients without diabetic retinopathy at baseline; incidence of diabetic retinopathy was defined as the development of any diabetic retinopathy. There were 410 patients with mild non-proliferative diabetic retinopathy at baseline; progression of diabetic retinopathy was defined as the development of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. We used multivariate proportional Cox hazard models, and generalised additive models were also applied to identify potential threshold effect. RESULTS The incidence and progression rate of diabetic retinopathy was 38.3/1,000 person-years and 21.1/1,000 person-years, respectively. Higher HbA(1c) (adjusted HR [aHR] per 1% [10.9 mmol/mol] 1.36 [95% CI 1.28-1.45]), longer duration of diabetes (aHR per 5 year period 1.26 [95% CI 1.17-1.35]), higher systolic blood pressure (aHR per +10 mmHg 1.01 [95% CI 1.00-1.02]) and higher body mass index (aHR per 1 kg/m(2) 1.05 [95% CI 1.00-1.09]) were associated with incident diabetic retinopathy. The association between HbA(1c) and incident diabetic retinopathy was linear; the association with duration of diabetes increased rapidly between 5 and 10 years. Higher HbA(1c) was also associated with progression of diabetic retinopathy (aHR per 1% [10.9 mmol/mol] 1.66 [95% CI 1.41-1.96]). CONCLUSIONS Observed incidence and progression rates of diabetic retinopathy seemed lower than that in western populations. HbA(1c) was the only factor associated with both incidence and progression of diabetic retinopathy. The strength of the association between duration of diabetes and incidence of diabetic retinopathy increased rapidly during a period of 5 to 10 years duration of diabetes. TRIAL REGISTRATION C000000222 ( www.umin.ac.jp ) FUNDING This study is supported by the Ministry of Health, Labour and Welfare, Japan.
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Affiliation(s)
- R Kawasaki
- Department of Ophthalmology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan
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Kawasaki R, Che Azemin MZ, Kumar DK, Tan AG, Liew G, Wong TY, Mitchell P, Wang JJ. Fractal dimension of the retinal vasculature and risk of stroke: A nested case-control study. Neurology 2011; 76:1766-7. [DOI: 10.1212/wnl.0b013e31821a7d7d] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Che Azemin MZ, Kumar DK, Wong TY, Wang JJ, Kawasaki R, Mitchell P, Arjunan SP. Fusion of multiscale wavelet-based fractal analysis on retina image for stroke prediction. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:4308-11. [PMID: 21095998 DOI: 10.1109/iembs.2010.5626209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper, we present a novel method of analyzing retinal vasculature using Fourier Fractal Dimension to extract the complexity of the retinal vasculature enhanced at different wavelet scales. Logistic regression was used as a fusion method to model the classifier for 5-year stroke prediction. The efficacy of this technique has been tested using standard pattern recognition performance evaluation, Receivers Operating Characteristics (ROC) analysis and medical prediction statistics, odds ratio. Stroke prediction model was developed using the proposed system.
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Azemin MZC, Kumar DK, Wong TY, Kawasaki R, Mitchell P, Wang JJ. Robust methodology for fractal analysis of the retinal vasculature. IEEE Trans Med Imaging 2011; 30:243-250. [PMID: 20851791 DOI: 10.1109/tmi.2010.2076322] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We have developed a robust method to perform retinal vascular fractal analysis from digital retina images. The technique preprocesses the green channel retina images with Gabor wavelet transforms to enhance the retinal images. Fourier Fractal dimension is computed on these preprocessed images and does not require any segmentation of the vessels. This novel technique requires human input only at a single step; the allocation of the optic disk center. We have tested this technique on 380 retina images from healthy individuals aged 50+ years, randomly selected from the Blue Mountains Eye Study population. To assess its reliability in assessing retinal vascular fractals from different allocation of optic center, we performed pair-wise Pearson correlation between the fractal dimension estimates with 100 simulated region of interest for each of the 380 images. There was Gaussian distribution variation in the optic center allocation in each simulation. The resulting mean correlation coefficient (standard deviation) was 0.93 (0.005). The repeatability of this method was found to be better than the earlier box-counting method. Using this method to assess retinal vascular fractals, we have also confirmed a reduction in the retinal vasculature complexity with aging, consistent with observations from other human organ systems.
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Al-Fiadh A, Rogers S, Kawasaki R, Freeman M, Patel S, Clark D, Wilson A, Burrell L, Wong T, Farouque O. The Presence of Retinal Microvascular Dysfunction is a Predictor of Underlying Coronary Artery Disease. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fenwick EK, Pesudovs K, Rees G, Dirani M, Kawasaki R, Wong TY, Lamoureux EL. The impact of diabetic retinopathy: understanding the patient's perspective. Br J Ophthalmol 2010; 95:774-82. [DOI: 10.1136/bjo.2010.191312] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yau JWY, Kawasaki R, Islam FMA, Shaw J, Zimmet P, Wang JJ, Wong TY. Retinal fractal dimension is increased in persons with diabetes but not impaired glucose metabolism: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Diabetologia 2010; 53:2042-5. [PMID: 20523965 DOI: 10.1007/s00125-010-1811-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS The fractal dimension (D(f)) of the retinal vasculature is a global measure of its branching pattern complexity. We examined the relationship of retinal D(f) with diabetes. METHODS We conducted a cross-sectional study of 1,577 participants with diabetes and impaired glucose metabolism and normal controls from the population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Retinal D(f) was quantified from fundus photographs using a computer-based programme and diabetes status was determined by oral glucose tolerance test based on the WHO criteria. RESULTS After adjustment for age, sex and vascular risk factors, persons with higher retinal D(f) were more likely to have diabetes (OR 1.56; 95% CI 1.14-2.14, highest vs lowest fractal tertile). This relationship remained with further adjustment for retinal arteriolar calibre and presence of retinopathy (OR 1.64; 95% CI 1.19-2.27), and after excluding participants with retinopathy (OR 1.60; 95% CI 1.16-2.21). Retinal D (f) was not related to impaired glucose tolerance or impaired fasting glucose (OR 1.19; 95% CI 0.85-1.67). CONCLUSIONS/INTERPRETATION Individuals with diabetes, but not with impaired glucose metabolism, have greater retinal D(f), reflecting greater complexity of the retinal vasculature. Our findings suggest the presence of early microvascular changes in the retinal vasculature of persons with diabetes, even in the absence of overt retinopathy.
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Affiliation(s)
- J W Y Yau
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia
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Grauslund J, Hodgson L, Kawasaki R, Green A, Sjølie AK, Wong TY. Retinal vessel calibre and micro- and macrovascular complications in type 1 diabetes. Diabetologia 2009; 52:2213-7. [PMID: 19618163 DOI: 10.1007/s00125-009-1459-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS The purpose of the study was to evaluate the association between retinal vascular calibre and micro- and macrovascular complications in a population-based cohort of Danish type 1 diabetic patients. METHODS This was a cross-sectional study of 208 long-surviving type 1 diabetic patients from a population-based Danish cohort. Retinal photographs were obtained at a clinical examination attended by each participant in 2007-2008, and retinal vascular calibre was measured and summarised as the central retinal artery or vein equivalent (CRAE or CRVE) using a computer-based program and a standardised protocol. Associations between retinal vascular calibre and micro- and macrovascular complications were examined after adjusting for confounding clinical characteristics. RESULTS Retinal photographs were gradable for 188 of 208 patients (90.3%). The median age and duration of diabetes for patients with gradable photos were 57.9 and 42 years, respectively. After multivariate adjustments, individuals with narrower retinal arterioles were more likely to have nephropathy (OR 2.17, 95% CI 1.29-3.68, per SD decrease in CRAE) and macrovascular disease (OR 3.17, 95% CI 1.59-6.34, per SD decrease in CRAE), but not neuropathy (OR 1.10, 95% CI 0.70-1.71, per SD decrease in CRAE). Retinal venular calibre was not associated with any micro- or macrovascular complications. CONCLUSIONS/INTERPRETATION In type 1 diabetic patients, retinal arteriolar narrowing is associated with nephropathy and macrovascular disease independently of other clinical characteristics. If supported by further prospective studies, measurement of retinal vessel diameter may allow a non-invasive evaluation of the risk of diabetes-related complications.
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Affiliation(s)
- J Grauslund
- Department of Ophthalmology, Odense University Hospital, Denmark.
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Tanabe Y, Kawasaki R, Wang JJ, Wong TY, Mitchell P, Daimon M, Oizumi T, Kato T, Kawata S, Kayama T, Yamashita H. Angiotensin-converting enzyme gene and retinal arteriolar narrowing: the Funagata Study. J Hum Hypertens 2009; 23:788-93. [PMID: 19369957 PMCID: PMC2834325 DOI: 10.1038/jhh.2009.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study is to determine whether the angiotensin-converting enzyme (ACE) gene polymorphism is associated with retinal arteriolar narrowing, a subclinical marker of chronic hypertension. The Funagata Study examined a population-based sample of Japanese aged 35+ years; 368 participants had both retinal vessel diameter measurements and ACE insertion/deletion (ACE I/D) polymorphism analyses performed. Assessment of retinal vessel diameter and retinal vessel wall signs followed the protocols used in the Blue Mountains Eye Study. ACE gene polymorphisms D/D, I/D and I/I were present in 34 (9.2%), 170 (46.2%) and 164 (44.5%) participants, respectively, distributed in Hardy-Weinberg equilibrium. After multivariable adjustment, retinal arteriolar diameter was significantly narrower in subjects with the D/D genotype compared to subjects with I/D and I/I genotypes (mean difference -6.49 microm, 95% confidence interval (CI): -12.86 microm, -0.11 microm). Our study suggests that the ACE I/D polymorphism may be associated with subclinical structural arteriolar changes related to chronic hypertension.
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Affiliation(s)
- Y Tanabe
- Department of Ophthalmology and Visual Science, Yamagata University, Yamagata, Japan
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Kawasaki R, Wang JJ, Mitchell P, Aung T, Saw SM, Wong TY. Racial difference in the prevalence of epiretinal membrane between Caucasians and Asians. Br J Ophthalmol 2008; 92:1320-4. [DOI: 10.1136/bjo.2008.144626] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kawasaki R, Wang JJ, Wong TY, Kayama T, Yamashita H. Impaired glucose tolerance, but not impaired fasting glucose, is associated with retinopathy in Japanese population: the Funagata study. Diabetes Obes Metab 2008; 10:514-5. [PMID: 18462198 DOI: 10.1111/j.1463-1326.2007.00824.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kawasaki R, Tielsch JM, Wang JJ, Wong TY, Mitchell P, Tano Y, Tominaga M, Oizumi T, Daimon M, Kato T, Kawata S, Kayama T, Yamashita H. The metabolic syndrome and retinal microvascular signs in a Japanese population: the Funagata study. Br J Ophthalmol 2007; 92:161-6. [PMID: 17965107 DOI: 10.1136/bjo.2007.127449] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To determine the relationship of metabolic syndrome and its components with retinopathy and other retinal microvascular signs in a Japanese population. METHODS The Funagata study recruited 1961 (53.3% of eligible) Japanese aged 35 or older. The metabolic syndrome was diagnosed primarily using definitions of the International Diabetes Federation. Retinopathy and retinal microvascular signs were assessed from fundus photographs. Retinal arteriolar and venular diameters were measured using a computer-assisted programme. RESULTS Data were available for analysis in 1638 persons for retinopathy and retinal microvascular signs and 921 persons for retinal vessel diameters. Various components of the metabolic syndrome were associated with retinal microvascular signs: a larger waist circumference was associated with wider venular diameter and retinopathy lesions; a higher blood pressure level was associated with focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar wall reflex and narrower arteriolar diameter; and a higher triglyceride level was associated with enhanced arteriolar wall reflex. Overall, persons with the metabolic syndrome were more likely to have retinopathy (odds ratio 1.64, 95% CI: 1.02 to 2.64) and wider venular diameter 4.69 microm (95% CI: 1.20 to 8.19 microm) than persons without the metabolic syndrome. CONCLUSION We report associations of metabolic syndrome components with retinopathy and wider venular diameter in Japanese adults. These data suggest that metabolic abnormalities, indicated by metabolic syndrome components, are associated with microvascular changes in the retina. There was no synergistic effect of the metabolic syndrome on retinal microvascular changes beyond its individual components.
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Affiliation(s)
- R Kawasaki
- Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, Yamagata, Japan.
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Kawasaki R, Okushiba S, Satou K, Ito K, Ohno K, Sugiura H, Morikawa T, Kondo S, Katoh H. Esophageal reconstruction using a stomach roll following endoscopic mucosal resection. Hepatogastroenterology 2001; 48:1372-4. [PMID: 11677967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A 73-year-old male patient presenting with synchronous triple cancer of the hypopharynx, esophagus and stomach is herein reported. To pursue safety by reducing surgical stress and better postoperative quality of life, we preserved the stomach by treating the gastric cancer by endoscopic mucosal resection and subsequently used the stomach for making an elongated stomach roll during the esophageal reconstruction. Postoperatively, no complications occurred and the patient has been on oral feeding for 23 months with no recurrence of primary cancer.
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Affiliation(s)
- R Kawasaki
- Second Department of Surgery, Hokkaido University Hospital, N-14, W-5, North ward, Sapporo, Japan, 060-8648
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Nakamoto A, Yoshitake J, Hase T, Harasawa H, Okamoto S, Fuse D, Kawasaki R, Kuga H, Kishiro I, Machida S, Oshiro H, Totsuka M, Kaneko N. Intravascular ultrasound imaging of the pulmonary arteries in primary pulmonary hypertension. Respirology 2000; 5:71-8. [PMID: 10728735 DOI: 10.1046/j.1440-1843.2000.00229.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Intravascular ultrasound has the unique ability to provide cross-sectional images of the arterial wall. This study examined intravascular ultrasound (IVUS) images of the proximal pulmonary arteries in primary pulmonary hypertension (PPH). METHODOLOGY Study 1: Specimens from four patients who had died of PPH (in vitro PPH group) were compared with those of three patients who had died of subarachnoid haemorrhage but had no evidence of cardiopulmonary disease (in vitro control group). Three-centimetre segments of the following levels were examined by IVUS: pulmonary trunk, eight secondary branch arteries of the upper, middle, and lower lobes of both lungs, and the thoracic descending aorta. Study 2: Four patients with PPH (in vivo PPH group) and five patients without pulmonary hypertension and no evidence of cardiopulmonary disease (in vivo control group) were examined. The IVUS images of the apical segmental artery of the right upper lobe and the descending branch of the right pulmonary artery were studied. RESULTS Echographic examination of formalin-fixed preparations of secondary branch sections of the pulmonary artery failed to show a clear three-layer structure in the in vitro control group (24 preparations), but a distinct three-layer structure and increased vessel wall thickness were observed in the in vitro PPH group (32 preparations). Similar findings were obtained in the in vivo study. The mean echo density of the proximal pulmonary arterial wall correlated well with the mean pulmonary arterial pressure (mPA) in the in vitro PPH, and also correlated with the mPA in the in vivo study (r = 0.960, P < 0.0001). The echo intensity of secondary branch sections of the pulmonary artery was higher in the in vitro PPH group than in the in vitro control group (180.5 +/- 27.0 vs 132.5 +/- 26.7 counts, P < 0.001); similar results were obtained in the in vivo study (144.7 +/- 23.4 vs 85.0 +/- 14.3 counts, P < 0.01). CONCLUSIONS These results suggest that the histological changes detected in the pulmonary artery walls in the PPH group were responsible for the increased echo intensity.
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Affiliation(s)
- A Nakamoto
- Department of Cardiology and Pneumology, Dokkyo University School of Medicine, Tochigi, Japan.
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Kawasaki R, Morita S, Hisa N, Tsuji A, Noda Y. [Evaluation of 389 cases with a central venous access device inserted peripherally in the forearm]. Gan To Kagaku Ryoho 1999; 26:2055-60. [PMID: 10584571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We describe the technique and the long-term results of a central venous access device inserted peripherally in the forearm. From July, 1994, 411 central venous access devices were implanted in 389 patients (365 patients with malignant disease and 24 with benign disease). The insertion was successful in 384 cases (99.0%). The mean follow up duration was 116.5 days (range 3 to 859 days) after insertion. Complications were observed in 90 cases (21.8%); drip insufficiency in 42 (10.2%), phlebitis in 15 (3.6%), local infection in 9 (2.2%), catheter obstruction in 8 (1.9%), skin defect in 6 (1.5%), thrombosis of the subclavian vein in 4 (1.0%), system destruction in 4 (1.0%), and subcutaneous injection in 2 (0.5%). The system was removed in 23 cases (5.6%). We conclude that this method is safe and effective and should be widely used for the management of outpatients.
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Affiliation(s)
- R Kawasaki
- Dept. of Radiology, Kochi Municipal Central Hospital
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Hata Y, Morita S, Noda Y, Kawasaki R, Morita Y, Awatani T, Horimi T. [The evaluation of weekly hepatic arterial infusion of high-dose 5-FU for liver metastases from colorectal cancer]. Gan To Kagaku Ryoho 1998; 25:901-5. [PMID: 9617329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A study was conducted on weekly infusion of high-dose 5-FU through the hepatic artery for liver metastases from colorectal cancer. In the evaluation of 38 cases, no CR and 16 PR were to control the extrahepatic metastases is a subject for forthcoming study.
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Affiliation(s)
- Y Hata
- Dept. of Radiology, Kochi Municipal Central Hospital
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Machado C, Baga JJ, Kawasaki R, Reinoehl J, Steinman RT, Lehmann MH. Torsade de pointes as a complication of subarachnoid hemorrhage: a critical reappraisal. J Electrocardiol 1997; 30:31-7. [PMID: 9005884 DOI: 10.1016/s0022-0736(97)80032-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Subarachnoid hemorrhage is widely accepted as a potential cause of torsade de pointes (TdP), yet this putative etiologic relationship has never been systematically evaluated. We therefore undertook a MEDLINE search from 1966 through 1993, with relevant back referencing, and identified 20 cases of TdP in the setting of subarachnoid hemorrhage. It was impossible in any of these cases (usually because of insufficient data) to completely exclude one or more alternative explanations for TdP, including congenital long QT syndrome, hypokalemia, hypomagnesemia, or drug-induced QT prolongation. Furthermore, of a total of 1,139 patients in 16 prospective series of subarachnoid hemorrhage with electrographic analyses, there were only five reported cases of TdP, all in patients with hypokalemia. Thus, extremely limited scientific data exist to support the notion that subarachnoid hemorrhage can be a distinct cause of TdP. Until more definitive evidence is available, the development of TdP in patients with subarachnoid hemorrhage is probably better characterized as a multifactorial phenomenon occurring in an acute, typically intensive care, setting.
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Affiliation(s)
- C Machado
- Arrhythmia Center, Division of Cardiology/Department of Internal Medicine, Sinai Hospital, Detroit, Michigan, USA
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Abstract
We describe a silent and unstable hemoglobin variant, Hb Toranomon, which was discovered by high performance liquid chromatography in an apparently healthy Japanese male during a Hb A1c assay. Isoelectrofocusing of his hemolysate and chromatographic separation of globin on a CM-cellulose column revealed no abnormality. The isopropanol precipitation test gave a positive result. Amino acid analysis of all peptides isolated from the tryptic digests of the aminoethylated and non-aminoethylated beta chain (beta A + beta X) by reversed phase high performance liquid chromatography indicated a substitution of Cys-->Trp at position 112 of the beta chain, which was confirmed by protein sequencing. cDNA sequencing showed the nucleotide sequence of the beta 112 codon to be TGG instead of TGT, confirming the amino acid substitution described above. The globin biosynthesis ratio (beta/alpha) was 1.00.
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Affiliation(s)
- T Harano
- Department of Biochemistry, Kawasaki Medical School, Okayama, Japan
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Reinoehl J, Frankovich D, Machado C, Kawasaki R, Baga JJ, Pires LA, Steinman RT, Fromm BS, Lehmann MH. Probucol-associated tachyarrhythmic events and QT prolongation: importance of gender. Am Heart J 1996; 131:1184-91. [PMID: 8644599 DOI: 10.1016/s0002-8703(96)90095-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
From published articles and adverse reactions reports filed with the FDA (available through the Freedom of Information Act), we analyzed occurrences of tachyarrhythmias and the magnitude of QTc prolongation associated with probucol therapy. Of 16 cases of tachyarrhythmic events reported in association with probucol, 15 (94%) occurred in women (p < 0.01 vs expected value of 58%). Tachyarrhythmias were specifically described as TdP in 11 (63%) cases, all women; additional potential contributory QT-prolonging factors (besides probucol) were not identifiable in 2 of the 11 cases. We also analyzed QTc responses in 359 probucol-treated patients, all having baseline QTc < or = 0.44 sec1/2. At doses of 500 to 1000 mg/day, probucol-associated prolongation of QTc to values > or = 0.45 sec1/2 was observed in 22% of women versus 7% of men (p < 0.001) and to values > or = 0.47 sec1/2 in 8% of women versus 2% of men (p < 0.03). Multivariate analysis identified baseline QTc (p < 0.0001) and female gender (p < 0.03), but neither age nor dose, as significant independent predictors of QTc prolongation to > or = 0.45 sec1/2 with probucol. These findings have relevance to the clinical use of probucol, provide further evidence that women have a relatively greater predisposition to development of acquired long QT syndrome, and carry implications for the design of trials involving QT-prolonging drugs.
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Affiliation(s)
- J Reinoehl
- The Arrhythmia Center, Sinai Hospital, Detroit, MI 48235, USA
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Kawasaki R, Machado C, Reinoehl J, Fromm B, Baga JJ, Steinman RT, Lehmann MH. Increased propensity of women to develop torsades de pointes during complete heart block. J Cardiovasc Electrophysiol 1995; 6:1032-8. [PMID: 8589872 DOI: 10.1111/j.1540-8167.1995.tb00380.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION To determine whether an increased female gender susceptibility to torsades de pointes (TdP) may exist in a clinical model of bradycardia-induced long QT syndrome, we investigated reported cases of TdP associated with acquired complete heart block. METHODS AND RESULTS Seventy-two cases reported in the medical literature dating from 1941 through 1993 were identified, all describing TdP or "transient ventricular tachycardia/fibrillation" (to include those cases reported prior to the use of TdP terminology) in the setting of acquired complete heart block unassociated with QT prolonging drugs. Expected female prevalence in complete heart block was estimated at 52%, based on projections derived from 206,016 hospital discharges in the National Inpatient Profile (Commission on Professional and Hospital Activities, Ann Arbor, MI), over the years 1985 through 1992. During complete heart block, mean heart rate was 37 beats/min in both sexes (combined n = 43), and absolute QT interval ranged from 0.52 to 0.88 seconds, with a mean of 0.68 seconds (n = 25). Female prevalence among patients with TdP during complete heart block was greater than expected: 72% for all studied cases (P < 0.001); 70% (P < 0.04) and 74% (P < 0.02) among those reported prior to (n = 35) and during or after (n = 37) 1980, respectively; 73% (P < 0.03) among those with documented normokalemia (n = 26); and 68% (P = 0.2) among those with a prolonged QT interval and known polymorphic VT (i.e., unequivocal TdP; n = 25). CONCLUSION Despite inherent limitations of this retrospective study, the data are consistent in suggesting a greater than expected female prevalence among patients with TdP related to complete heart block. This finding lends support to a broadening concept of increased susceptibility of women to the development of TdP in various settings of QT prolongation.
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Affiliation(s)
- R Kawasaki
- Department of Medicine/Division of Cardiology, Sinai Hospital, Detroit, Michigan, USA
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Abstract
Feeding behavior was initiated in juvenile and adult lampreys, Ichthyomyzon unicuspis, by attachment to goldfish or by injection of saline extracts of goldfish skin and muscle into the sucker cavity. Feeding was confirmed by the apparent swallowing of fish extract plus food dye by lampreys. Distinctive characteristics of feeding behavior included low frequency cycles, long duration (hours), variable biphasic pressure changes in the sucker cavity, and protraction of the tongue-like apicalis. In contrast, pumping behavior was used to move excess fluid from the sucker through the pharynx and out the gill pores; it was characterized by transient, high-frequency, monophasic suctions, simple retraction of the apicalis, and lack of swallowing.
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Affiliation(s)
- R Kawasaki
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Mo
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Abstract
To examine the breathing rhythm-generating mechanism, effects of brain sectioning, immobilization, and electric stimulation on medullary respiratory activities were investigated in adult lampreys. The rostral part of the medulla (rostrally to the level of the caudal border of "internal acoustic pore") is not indispensable for breathing rhythm-generation. The rostral part itself, however, was also capable of driving periodic movement of only the first branchial baskets. After immobilization, respiratory discharges continued without changing their pattern, indicating that respiratory afferents do not modulate the centrally generating rhythm. Respiratory discharges recorded simultaneously from the right and left side of the medulla showed bilateral synchronization. After sectioning the midline of the brain, each of the symmetric halves of the medulla behaved as an independent respiratory pacemaker. Respiratory discharges were driven in one-to-one fashion by electric stimulus applied to the medulla, almost independently of timing of stimulus delivery. Stimulus pulses applied during respiratory discharges did not inhibit these discharges: electrically driven discharge summated or fused with the spontaneous firing. Slow and smoothly depolarizing potential preceding respiratory spike discharges was recorded intracellularly from the half of the brain-stem divided by midline sagittal sectioning in the immobilized animal. These results were discussed in light of the hypothesis that respiratory burst generator mechanism in the lamprey may be similar to cardiac pacemakers.
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Abstract
1. The effect of medullary stimulation on breathing movement was studied in the adult lamprey, Entosphenus japonicus. 2. A single, as well as low frequency (less than 5 Hz) pulses applied extracellularly to the medial part of the medulla (as shown in Fig. 1) produced one-to-one movement (contraction followed by relaxation) of branchial baskets, which are similar in shape, as well as in bilateral synchronization, to spontaneously occurring movement. 3. medullary stimulation never produced active immediate relaxation of branchial baskets. Intravenous application of d-tubocurarine resulted in sustained relaxation of branchial baskets. EMG recorded from branchial muscles always correlated with the phase of contraction of branchial baskets. 4. The rhythm of respiratory movement was reset by driving stimuli at low frequencies. Alteration of driving frequency did not markedly affect the duration of branchial movement. 5. With high frequency stimulation (more than 5 Hz), individual responses fused into one continuous contraction (sustained compression) of branchial baskets; it may be called a systolic arrest or expiratory arrest of breathing movement. 6. After the repetitive stimulation had been turned off, there was a pause in the respiratory movement. This sustained relaxation of branchial baskets may be called a diastolic arrest or inspiratory arrest. During this arrest, applied pulse shocks induced one-to-one movement of branchial baskets. 7. These results were discussed whilst considering an analogy between respiratory rhythmogenesis in the lamprey and cardiac pacemaking in crustacean heart ganglion.
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Kawasaki R. Maintenance of respiratory rhythm-generation by vascular perfusion with physiological saline in the isolated head of the carp. Jpn J Physiol 1980; 30:575-89. [PMID: 6780714 DOI: 10.2170/jjphysiol.30.575] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
1) Vascular perfusion of the isolated head of the carp was carried out with physiological saline. Respiratory movement of the grill covers and respiratory discharges of cranial motor nerves were recorded in the preparation. 2) Blood vascular vessels supply the brain were anatomically investigated. Concentrations (electrolytes, O2, CO2, and glucose) and perfusing pressure of the saline were determined by reference to the useful information already available in fish physiology. 3) The movement of the operculum could be maintained in regular respiratory rhythm for more than 34 hr. Efferent discharges of cranial motor nerves also indicated that the respiratory rhythm generator functioned normally. Interruption of perfusate flow always immediately disturbed the opercular rhythm and resulted in respiratory arrest. 4) In conclusion, vascular perfusion is indispensable for the maintenance of breathing rhythm-generation in the isolated head of the carp; as the perfusate, the colloid-free physiological saline was found tenable for the long-term preservation of brain function in the carp.
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Abstract
1. The breathing rhythm-generation mechanism was studied throughout the entire body of the adult lamperey, Entosphenus japonicus, with the body fixed by a specially-designed holder. 2. After brain-stem transection, the rostral part (pontine area) and the caudal part of the medulla (Fig. 2) were found not essential for the generation of respiratory rhythm: the location of the medullary respiratory rhythm-generator was in the district limited by two cross-section lines (Fig.2). 3. Complete division of the brain-stem into two halves by midline section revealed that both of the two symmetrical halves could function independently with their own frequencies for 2 hr or longer. 4. Respiratory burst discharges were recorded from the isolated medial part of the medulla, preceded by a so-called diastolic slow depolarization. The forms of these neural activities resemble those reported in pacemaker cells in some crustacean heart ganglion. No periodic discharges correlating exclusively to the relaxation and/or resting period of branchial muscle were observed. 5. The reciprocal inhibition model was not necessarily considered a prerequisite for medullary respiratory rhythm-generation in the lamprey.
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Kawasaki R. [Proceedings: 91. The respiratory activity and cleaning motion of the perfused brain (carp) (author's transl)]. Nihon Seirigaku Zasshi 1973; 35:420. [PMID: 4799289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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