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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Moriwaki K, Yoshino A, Ikejiri Y, Nakamura R, Tsutsumi Y. A Case of a Father and Son With Complex Regional Pain Syndrome Type 1 Exhibiting Different Resting-State Functional Connectivity on Functional MRI. Cureus 2024; 16:e52589. [PMID: 38371121 PMCID: PMC10874683 DOI: 10.7759/cureus.52589] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Complex regional pain syndrome (CRPS) type 1 is a chronic pain condition whose pathogenesis involves changes in the central and peripheral nervous systems, with potential genetic contributions. Functional magnetic resonance imaging (fMRI) studies report that alterations in resting-state functional connectivity (rsFC) may reflect central nervous system anomalies in CRPS type 1. Herein, we describe the case of a father and son with CRPS type 1 who exhibited different rsFC patterns in fMRI analyses correlating with their individual CRPS phenotypes. A 39-year-old male and his 61-year-old father presented with severe pain and mobility limitations in their right upper limbs following a vehicle accident and a fall, respectively, and were diagnosed with CRPS type 1. Despite receiving treatment, they experienced severe pain and limited mobility. The son exhibited dystonia and musculoskeletal atrophy while the father experienced extensive sensory disturbances. Bone scintigraphy revealed increased uptake in affected regions. The patients' resting-state fMRI data were compared with those of 48 healthy adults using the CONN software, with the false discovery rate set at p<0.05. Distinct brain regions for the father and son exhibited decreased rsFC (between the rostral prefrontal cortex and orbitofrontal cortex in the father and between the supplementary motor area and pallidum in the son; all in the right hemisphere). These changes corresponded to pain sensation and cognitive-emotional alterations in the father and limb movement disorders (dystonia) in the son. Our findings strongly support the idea that abnormalities in rsFC are closely linked to CRPS type 1 phenotypes.
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Affiliation(s)
- Katsuyuki Moriwaki
- Department of Anesthesiology, Hiroshima University Hospital, Hiroshima, JPN
- Department of Anesthesiology, Hiroshima Hiramatsu Hospital, Hiroshima, JPN
| | - Atsuo Yoshino
- Health Service Center, Hiroshima University, Higashi-Hiroshima, JPN
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, JPN
| | - Yumi Ikejiri
- Department of Anesthesiology, Hiroshima University Hospital, Hiroshima, JPN
- Department of Anesthesiology, Shimura Hospital, Hiroshima, JPN
| | - Ryuji Nakamura
- Department of Anesthesiology, Hiroshima University Hospital, Hiroshima, JPN
| | - Yasuo Tsutsumi
- Department of Anesthesiology, Hiroshima University Hospital, Hiroshima, JPN
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Shorin D, Kamiya S, Nakamura R, Ishibashi A, Saeki N, Tsuji T, Tsutsumi YM. Prediction of blood pressure changes during surgical incision using the minimum evoked current of vascular stiffness value under sevoflurane anesthesia. Sci Rep 2023; 13:20486. [PMID: 37993532 PMCID: PMC10665398 DOI: 10.1038/s41598-023-46942-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Necessary and sufficient opioids should be administered for safe and stable anesthesia. However, opioid sensitivity varies among individuals. We previously reported that sympathetic responses to nociceptive stimuli under propofol anesthesia could be predicted by measuring the minimum evoked current of the vascular stiffness value (MECK). However, this result has only been proven under propofol anesthesia. We propose that MECK could be used under anesthesia with a volatile anesthetic. Thirty patients undergoing laparotomy with sevoflurane anesthesia received 0.7 minimum alveolar concentration (MAC) sevoflurane and intravenous remifentanil at a constant concentration of 2 ng/mL, followed by tetanic stimulation, to measure MECK. After tetanic stimulation, the same anesthetic conditions were maintained, and the rate of change in systolic blood pressure (ROCBP) during the skin incision was measured. The correlation coefficient between the MECK and ROCBP during skin incision under sevoflurane anesthesia was R = - 0.735 (P < 0.01), similar to that in a previous study with propofol (R = - 0.723). Thus, a high correlation was observed. The slope of the linear regression equation was - 0.27, similar to that obtained in the study on propofol (- 0.28). These results suggest that, as with propofol anesthesia, MECK can be used as a predictive index for ROCBP under 0.7 MAC sevoflurane anesthesia.Clinical trial registration: Registry, University hospital Medical Information Network; registration number, UMIN000047425; principal investigator's name, Noboru Saeki; date of registration, April 8, 2022.
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Affiliation(s)
- Daiki Shorin
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan.
| | - Ayaka Ishibashi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
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Toyota Y, Kondo T, Oshita K, Haraki T, Narasaki S, Kido K, Kamiya S, Nakamura R, Saeki N, Horikawa YT, Tsutsumi YM. Remimazolam-based anesthesia with flumazenil allows faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36081. [PMID: 37986333 PMCID: PMC10659722 DOI: 10.1097/md.0000000000036081] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Remimazolam is a novel, ultrashort-acting benzodiazepine that can be antagonized by flumazenil. This study aimed to determine whether remimazolam-based anesthesia with flumazenil provides a more rapid emergence than propofol-based anesthesia in older patients undergoing spinal surgery. METHODS This was a prospective, single-blind, randomized controlled trial. Forty-four patients > 75 years old who had undergone spinal surgery were enrolled in this study. They were randomly assigned to the remimazolam or propofol group (1:1) using a computer randomization system stratified by age and body weight. For anesthesia induction and maintenance, remifentanil was administered at a defined dose in both groups, and remimazolam or propofol was adjusted to maintain the bispectral index or state entropy monitoring within 40-60. All anesthetics were discontinued simultaneously after the postoperative X-ray and 0.5 mg flumazenil was administered to the remimazolam group. The primary outcome was extubation time after discontinuing anesthesia, and the secondary outcomes were time to eye opening, obeying commands, and achieving a white fast-track score (WFTS) of 12. RESULTS Thirty-nine patients were finally analyzed: remimazolam group (n = 20), propofol group (n = 19). There were no significant differences in intraoperative variables, such as operative time, anesthesia time, and patient background, between the 2 groups. Extubation times were significantly shorter in the remimazolam group than in the propofol group (4 vs 8 minutes, P < .001). The time to eye opening, obeying commands, and achieving a WFTS of 12 were significantly shorter in the remimazolam group (P < .001, for all comparisons). CONCLUSION Remimazolam-based anesthesia with flumazenil resulted in a faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery.
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Affiliation(s)
- Yukari Toyota
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoko Oshita
- Department of Anesthesiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Toshiaki Haraki
- Department of Anesthesiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yasuo M. Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
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Nakanishi T, Sento Y, Kamimura Y, Nakamura R, Hashimoto H, Okuda K, Nakanishi R, Sobue K. Combined use of the ProSeal laryngeal mask airway and a bronchial blocker vs. a double-lumen endobronchial tube in thoracoscopic surgery: A randomized controlled trial. J Clin Anesth 2023; 88:111136. [PMID: 37137259 DOI: 10.1016/j.jclinane.2023.111136] [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: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVE The combined use of the ProSeal laryngeal mask airway and a bronchial blocker may reduce postoperative hoarseness and sore throat. We aimed to test the feasibility and efficacy of this combination technique in thoracoscopic surgery. DESIGN A single-center, patient-assessor blinded, randomized controlled trial. SETTING Nagoya City University Hospital (between November 2020 and April 2022). PATIENTS A total of 100 adult patients undergoing lobectomy or segmentectomy by video- or robotic-assisted thoracoscopic surgery. INTERVENTIONS Patients were randomly assigned to either group using a combination of the ProSeal laryngeal mask airway and a bronchial blocker (pLMA+BB group) or a double-lumen endobronchial tube (DLT group). MEASUREMENTS The primary outcome was the hoarseness incidence on 1-3 postoperative days. Secondary outcomes included sore throat, intraoperative complications (hypoxemia, hypercapnia, surgical interruption, malposition of devices, unintended lung expansion, and ventilatory difficulty), lung collapse, device placement-related outcomes, and coughing during emergence. MAIN RESULTS A total of 100 patients underwent randomization (51 to the pLMA+BB group and 49 to the DLT group). After drop outs, a total of 49 patients in each group were analyzed per-protocol. The incidences of hoarseness in the pLMA+BB and DLT groups were 42.9% and 53.1% (difference, -10.2%; 95% confidence interval, -30.1% to 10.3%; p = 0.419), 18.4% vs. 32.7%, and 20.4% vs. 24.5% on postoperative day 1, 2, and 3, respectively. The incidences of sore throat in the pLMA+BB and DLT groups were 16.3% vs. 34.7% (difference, -18.4%; 95% confidence interval, -35.9% to -0.9%; p = 0.063) on postoperative day 1. In the pLMA+BB group, more intraoperative complications and less coughing during emergence were observed compared to the DLT group. Lung collapse and placement-related outcomes were comparable between the groups. CONCLUSIONS The combination of ProSeal laryngeal mask airway and bronchial blocker did not significantly reduce hoarseness compared to the double-lumen endobronchial tube.
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Affiliation(s)
- Toshiyuki Nakanishi
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Yoshiki Sento
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yuji Kamimura
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryuji Nakamura
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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Matsui T, Takahashi Y, Nakada T, Sugita Y, Shinohara S, Suzuki A, Sakakura N, Takano T, Chiba K, Nakamura R, Oda R, Tatematsu T, Yokota K, Mizuno K, Haneda H, Okuda K, Kuroda H. Thoracoscopic Anatomical Sublobar Resection Including Subsegmentectomy for Non-Small Cell Lung Cancer. World J Surg 2023; 47:2065-2075. [PMID: 37160778 DOI: 10.1007/s00268-023-07002-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Among anatomical sublobar resection techniques for non-small cell lung cancer (NSCLC), the clinical benefit of subsegmentectomy remains unclear. We investigated whether anatomical sublobar resection including subsegmentectomy-segmental resection with subsegmental additional resection or subsegmental resection alone-is an effective and feasible surgical procedure for NSCLC. METHODS We retrospectively reviewed data of 285 patients with clinical stage I NSCLC who underwent anatomical sublobar resection at our institution from January 2013 to March 2021 and compared surgical outcomes between patients who underwent anatomical sublobar resection including (IS; n = 50) and excluding (ES; n = 235) subsegmentectomy. RESULTS No significant intergroup differences were noted in terms of age, sex, smoking, comorbidities, tumor size or location, consolidation tumor ratio, and preoperative pulmonary function. The IS group had more preoperative computed tomography-guided markings (34 vs. 15%; p = .004) and smaller resected lung volumes converted to the total subsegment number [3 (2-4) vs. 3 (3-6); p = .02] than the ES group. No significant differences in margin distance [mm, 20 (15-20) vs. 20 (20-20); p = .93], readmission rate (2% vs. 3%; p > .99), and intraoperative (8% vs. 7%; p = .77) or postoperative (8% vs. 10%; p = .80) complication rates were observed, and the 5-year local recurrence-free survival (91% vs. 90%; p = .92) or postoperative pulmonary function change were comparable between both groups. CONCLUSIONS Although further investigations are required, anatomical sublobar resection including subsegmentectomy for clinical stage I NSCLC could be an acceptable therapeutic option.
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Affiliation(s)
- Takuya Matsui
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan.
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
| | - Shuichi Shinohara
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
| | - Ayumi Suzuki
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
| | - Takatsugu Takano
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Chiba
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryuji Nakamura
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Risa Oda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsutomu Tatematsu
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keisuke Yokota
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kotaro Mizuno
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Haneda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan
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Nakamura R, Hayama S, Yamamoto N. P122 Clinical impact of fine needle aspiration cytologyon sentinel node biopsy after preoperative chemotherapy for core needle biopsyproven metastatic lymph nodes. Breast 2023. [DOI: 10.1016/s0960-9776(23)00239-4] [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: 03/16/2023] Open
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Abe S, Asami S, Eizuka M, Futagi S, Gando A, Gando Y, Gima T, Goto A, Hachiya T, Hata K, Hayashida S, Hosokawa K, Ichimura K, Ieki S, Ikeda H, Inoue K, Ishidoshiro K, Kamei Y, Kawada N, Kishimoto Y, Koga M, Kurasawa M, Maemura N, Mitsui T, Miyake H, Nakahata T, Nakamura K, Nakamura K, Nakamura R, Ozaki H, Sakai T, Sambonsugi H, Shimizu I, Shirai J, Shiraishi K, Suzuki A, Suzuki Y, Takeuchi A, Tamae K, Ueshima K, Watanabe H, Yoshida Y, Obara S, Ichikawa AK, Chernyak D, Kozlov A, Nakamura KZ, Yoshida S, Takemoto Y, Umehara S, Fushimi K, Kotera K, Urano Y, Berger BE, Fujikawa BK, Learned JG, Maricic J, Axani SN, Smolsky J, Fu Z, Winslow LA, Efremenko Y, Karwowski HJ, Markoff DM, Tornow W, Dell'Oro S, O'Donnell T, Detwiler JA, Enomoto S, Decowski MP, Grant C, Li A, Song H. Search for the Majorana Nature of Neutrinos in the Inverted Mass Ordering Region with KamLAND-Zen. Phys Rev Lett 2023; 130:051801. [PMID: 36800472 DOI: 10.1103/physrevlett.130.051801] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/10/2022] [Accepted: 11/29/2022] [Indexed: 06/18/2023]
Abstract
The KamLAND-Zen experiment has provided stringent constraints on the neutrinoless double-beta (0νββ) decay half-life in ^{136}Xe using a xenon-loaded liquid scintillator. We report an improved search using an upgraded detector with almost double the amount of xenon and an ultralow radioactivity container, corresponding to an exposure of 970 kg yr of ^{136}Xe. These new data provide valuable insight into backgrounds, especially from cosmic muon spallation of xenon, and have required the use of novel background rejection techniques. We obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>2.3×10^{26} yr at 90% C.L., corresponding to upper limits on the effective Majorana neutrino mass of 36-156 meV using commonly adopted nuclear matrix element calculations.
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Affiliation(s)
- S Abe
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Asami
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - M Eizuka
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Futagi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Gando
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Gando
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Gima
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Goto
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Hachiya
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Hata
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Hayashida
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Hosokawa
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Ichimura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Ieki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Ikeda
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Inoue
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - K Ishidoshiro
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Kamei
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - N Kawada
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Kishimoto
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - M Koga
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - M Kurasawa
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - N Maemura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Mitsui
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Miyake
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Nakahata
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - R Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Ozaki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Graduate Program on Physics for the Universe, Tohoku University, Sendai 980-8578, Japan
| | - T Sakai
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Sambonsugi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - I Shimizu
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - J Shirai
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Shiraishi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Suzuki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Suzuki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Takeuchi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Tamae
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Ueshima
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Watanabe
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Yoshida
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Obara
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - A K Ichikawa
- Department of Physics, Tohoku University, Sendai 980-8578, Japan
| | - D Chernyak
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - A Kozlov
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - K Z Nakamura
- Kyoto University, Department of Physics, Kyoto 606-8502, Japan
| | - S Yoshida
- Graduate School of Science, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - Y Takemoto
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - S Umehara
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - K Fushimi
- Department of Physics, Tokushima University, Tokushima 770-8506, Japan
| | - K Kotera
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima 770-8502, Japan
| | - Y Urano
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima 770-8502, Japan
| | - B E Berger
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - B K Fujikawa
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J G Learned
- Department of Physics and Astronomy, University of Hawaii at Manoa, Honolulu, Hawaii 96822, USA
| | - J Maricic
- Department of Physics and Astronomy, University of Hawaii at Manoa, Honolulu, Hawaii 96822, USA
| | - S N Axani
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Smolsky
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z Fu
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - L A Winslow
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Y Efremenko
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - H J Karwowski
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - W Tornow
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - S Dell'Oro
- Center for Neutrino Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - T O'Donnell
- Center for Neutrino Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - J A Detwiler
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - S Enomoto
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - M P Decowski
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nikhef and the University of Amsterdam, Science Park, Amsterdam, Netherlands
| | - C Grant
- Boston University, Boston, Massachusetts 02215, USA
| | - A Li
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Boston University, Boston, Massachusetts 02215, USA
| | - H Song
- Boston University, Boston, Massachusetts 02215, USA
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10
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Chiba K, Nishimaki H, Ogawa Y, Tomita M, Nakamura R, Kinebuchi S, Kita S, Komagamine M, Nawata K, Chikada M, Miyairi T. Midterm Results of Thoracic Endovascular Aortic Repair with Reentry Closure for Chronic Type B Aortic Dissection with Aneurysmal Dilatation. Ann Vasc Dis 2022; 15:308-316. [PMID: 36644254 PMCID: PMC9816023 DOI: 10.3400/avd.oa.22-00065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study aims to discuss the midterm results of thoracic endovascular aortic repair (TEVAR) with reentry closure for chronic type B aortic dissection (CTBAD). Materials and Methods: This retrospective study analyzed 13 patients with CTBAD who underwent TEVAR with reentry closure between July 2014 and December 2020. We evaluated the false lumen (FL) cross-sectional area using computed tomography images of the descending aorta at the level of the bronchial bifurcation, Valsalva sinus, celiac artery, and infrarenal abdominal aorta pre- and postoperation. The study endpoints were technical and clinical success rates, freedom from additional aortic reintervention or surgery, and survival. Results: Technical success was obtained in 12 patients (92.3%) with no hospital mortality and neurological complications. The postoperative observation period was 49.2±21.5 months. The clinical success rate was 76.9% (10 cases), and a postoperative reduction of the FL cross-sectional area was obtained in 53.8% of patients. The 5-year overall survival rate was 64.8% with no aortic-related deaths while the 5-year freedom from additional aortic surgery rate was 66.7%. Conclusions: TEVAR with reentry closure suggests preventing FL dilatation or rupture in CTBAD, but the revision of our devices and further research with more patients and longer follow-up periods are required.
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Affiliation(s)
- Kiyoshi Chiba
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author: Kiyoshi Chiba, MD, PhD. Department of Cardiovascular Surgery, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Tel: +81-44-977-8111, Fax: +81-44-976-5792, E-mail:
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yukihisa Ogawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Tomita
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryuji Nakamura
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Kinebuchi
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shota Kita
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Komagamine
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kan Nawata
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Chikada
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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11
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Chikada M, Chiba K, Nawata K, Tomita M, Nakamura R, Kinebuchi S, Kita S, Komagamine M, Kogo M, Nishimaki H, Miyairi T. Longterm Followup of a Pediatric Patient with Congenital Abdominal Aortic Aneurysm with Coarctation. Ann Vasc Dis 2022; 15:341-343. [PMID: 36644269 PMCID: PMC9816021 DOI: 10.3400/avd.cr.22-00067] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
Abstract
Congenital abdominal aortic aneurysm (AAA) with coarctation has been considered an extremely rare condition. In this study, we present a 3-year-old boy, who was diagnosed by chance with congenital AAA at first operation. We replaced the AAA+coarctation with a 6-mm polytetrafluoroethylene (PTFE) graft. Histological examination of the aortic wall revealed no particular abnormalities. Collateral vessels were noted to develop over 14 years of followup. Good blood flow to both lower limbs and no intermittent claudication were observed. After growth, at the age 17, he underwent extra-anatomical bypass using a 12-mm PTFE graft. This is the first report of successful treatment of congenital AAA+coarctation with longterm followup.
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Affiliation(s)
- Masahide Chikada
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author: Masahide Chikada, MD. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Tel: +81-44-977-8111, Fax: +81-44-976-5792, E-mail:
| | - Kiyoshi Chiba
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kan Nawata
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Tomita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryuji Nakamura
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Kinebuchi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shota Kita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Komagamine
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Misa Kogo
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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12
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Miyoshi H, Nakamura R, Otsuki S, Noda Y, Saeki N, Tsutsumi YM. Electroencephalogram evaluation of accidental cerebral congestion during unexpected superior vena cava clamping: a case report. JA Clin Rep 2022; 8:40. [PMID: 35678927 PMCID: PMC9184690 DOI: 10.1186/s40981-022-00531-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intraoperative superior vena cava (SVC) clamping causes hypotension and cerebral congestion. There is no established method for monitoring brain function during cerebral congestion. We encountered a case of cerebral congestion caused by unexpected SVC clamping.
Case presentation
A 64-year-old man underwent SVC clamping during lung tumor resection. The entropy and electroencephalogram monitoring values decreased with SVC clamping and increased in response to the release of congestion by phlebotomy and SVC declamping.
Conclusions
Because entropy sharply reflects brain viability during cerebral congestion, it was considered helpful in evaluation of the monitoring of cerebral congestion.
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13
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Watanabe T, Miyoshi H, Nakamura R, Otsuki S, Saeki N, Tsutsumi YM. Rapid cyclic fluctuations in blood pressure during two surgeries associated with pheochromocytoma: a case report. JA Clin Rep 2022; 8:80. [PMID: 36195694 PMCID: PMC9532498 DOI: 10.1186/s40981-022-00569-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Background We measured catecholamine levels during periodic blood pressure fluctuations in patients with pheochromocytoma. Case presentation A 43-year-old man presented with periodic blood pressure fluctuations during surgery for a renal pelvic tumor. His blood levels of catecholamines (ng/mL) changed dramatically over a short time during blood pressure fluctuations: adrenaline 0.36 to 3.22, noradrenaline 0.47 to 1.98, and dopamine 0.02. After the diagnosis of pheochromocytoma, oral treatment with doxazosin 2 mg/day was administered, and left adrenalectomy was performed 4 months after the initial surgery. Periodic circulation fluctuations occurred after tracheal intubation at the time of anesthesia induction, but the degree of fluctuation was smaller than that of the first surgery. Conclusions The data suggest that the periodic blood pressure fluctuations in pheochromocytoma patients are caused by changes in blood catecholamine levels. Our data suggests that alpha blockers may also be effective against the cyclic fluctuations that occur in patients with pheochromocytoma.
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Affiliation(s)
- Tomoyuki Watanabe
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Hirotsugu Miyoshi
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Ryuji Nakamura
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Sachiko Otsuki
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Noboru Saeki
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
| | - Yasuo M. Tsutsumi
- grid.257022.00000 0000 8711 3200Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan
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14
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Alho M, Battarbee M, Pfau‐Kempf Y, Khotyaintsev YV, Nakamura R, Cozzani G, Ganse U, Turc L, Johlander A, Horaites K, Tarvus V, Zhou H, Grandin M, Dubart M, Papadakis K, Suni J, George H, Bussov M, Palmroth M. Electron Signatures of Reconnection in a Global eVlasiator Simulation. Geophys Res Lett 2022; 49:e2022GL098329. [PMID: 36249284 PMCID: PMC9541212 DOI: 10.1029/2022gl098329] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/13/2022] [Accepted: 06/02/2022] [Indexed: 06/16/2023]
Abstract
Geospace plasma simulations have progressed toward more realistic descriptions of the solar wind-magnetosphere interaction from magnetohydrodynamic to hybrid ion-kinetic, such as the state-of-the-art Vlasiator model. Despite computational advances, electron scales have been out of reach in a global setting. eVlasiator, a novel Vlasiator submodule, shows for the first time how electromagnetic fields driven by global hybrid-ion kinetics influence electrons, resulting in kinetic signatures. We analyze simulated electron distributions associated with reconnection sites and compare them with Magnetospheric Multiscale (MMS) spacecraft observations. Comparison with MMS shows that key electron features, such as reconnection inflows, heated outflows, flat-top distributions, and bidirectional streaming, are in remarkable agreement. Thus, we show that many reconnection-related features can be reproduced despite strongly truncated electron physics and an ion-scale spatial resolution. Ion-scale dynamics and ion-driven magnetic fields are shown to be significantly responsible for the environment that produces electron dynamics observed by spacecraft in near-Earth plasmas.
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Affiliation(s)
- M. Alho
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - M. Battarbee
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Y. Pfau‐Kempf
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | | | - R. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
| | - G. Cozzani
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - U. Ganse
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - L. Turc
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - A. Johlander
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
- Swedish Institute of Space PhysicsUppsalaSweden
| | - K. Horaites
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - V. Tarvus
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - H. Zhou
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - M. Grandin
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - M. Dubart
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - K. Papadakis
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - J. Suni
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - H. George
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - M. Bussov
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - M. Palmroth
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
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15
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Hasegawa H, Denton RE, Nakamura TKM, Genestreti KJ, Phan TD, Nakamura R, Hwang K, Ahmadi N, Shi QQ, Hesse M, Burch JL, Webster JM, Torbert RB, Giles BL, Gershman DJ, Russell CT, Strangeway RJ, Wei HY, Lindqvist P, Khotyaintsev YV, Ergun RE, Saito Y. Magnetic Field Annihilation in a Magnetotail Electron Diffusion Region With Electron-Scale Magnetic Island. J Geophys Res Space Phys 2022; 127:e2022JA030408. [PMID: 36248013 PMCID: PMC9541864 DOI: 10.1029/2022ja030408] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 06/16/2023]
Abstract
We present observations in Earth's magnetotail by the Magnetospheric Multiscale spacecraft that are consistent with magnetic field annihilation, rather than magnetic topology change, causing fast magnetic-to-electron energy conversion in an electron-scale current sheet. Multi-spacecraft analysis for the magnetic field reconstruction shows that an electron-scale magnetic island was embedded in the observed electron diffusion region (EDR), suggesting an elongated shape of the EDR. Evidence for the annihilation was revealed in the form of the island growing at a rate much lower than expected for the standard X-type geometry of the EDR, which indicates that magnetic flux injected into the EDR was not ejected from the X-point or accumulated in the island, but was dissipated in the EDR. This energy conversion process is in contrast to that in the standard EDR of a reconnecting current sheet where the energy of antiparallel magnetic fields is mostly converted to electron bulk-flow energy. Fully kinetic simulation also demonstrates that an elongated EDR is subject to the formation of electron-scale magnetic islands in which fast but transient annihilation can occur. Consistent with the observations and simulation, theoretical analysis shows that fast magnetic diffusion can occur in an elongated EDR in the presence of nongyrotropic electron effects. We suggest that the annihilation in elongated EDRs may contribute to the dissipation of magnetic energy in a turbulent collisionless plasma.
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Affiliation(s)
- H. Hasegawa
- Institute of Space and Astronautical ScienceJapan Aerospace Exploration AgencySagamiharaJapan
| | - R. E. Denton
- Department of Physics and AstronomyDartmouth CollegeHanoverNHUSA
| | - T. K. M. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
- Institute of PhysicsUniversity of GrazGrazAustria
| | | | - T. D. Phan
- Space Sciences LaboratoryUniversity of CaliforniaBerkeleyCAUSA
| | - R. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
| | - K.‐J. Hwang
- Southwest Research InstituteSan AntonioTXUSA
| | - N. Ahmadi
- Laboratory for Atmospheric and Space PhysicsUniversity of ColoradoBoulderCOUSA
| | - Q. Q. Shi
- Shandong Provincial Key Laboratory of Optical Astronomy and Solar‐Terrestrial EnvironmentInstitute of Space SciencesShandong UniversityWeihaiChina
| | - M. Hesse
- NASA Ames Research CenterMoffett FieldCAUSA
| | - J. L. Burch
- Southwest Research InstituteSan AntonioTXUSA
| | | | - R. B. Torbert
- Institute of PhysicsUniversity of GrazGrazAustria
- Physics DepartmentUniversity of New HampshireDurhamNHUSA
| | - B. L. Giles
- NASA Goddard Space Flight CenterGreenbeltMDUSA
| | | | - C. T. Russell
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - R. J. Strangeway
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | - H. Y. Wei
- Department of Earth, Planetary, and Space SciencesUniversity of CaliforniaLos AngelesCAUSA
| | | | | | - R. E. Ergun
- Department of Astrophysical and Planetary SciencesUniversity of ColoradoBoulderCOUSA
| | - Y. Saito
- Institute of Space and Astronautical ScienceJapan Aerospace Exploration AgencySagamiharaJapan
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Nakamura R, Okuda K, Chiba K, Matsui T, Oda R, Tatematsu T, Yokota K, Nakanishi R. A large intrathoracic goiter with tracheal stenosis: Complete resection using a robot-assisted thoracoscopic approach. Thorac Cancer 2022; 13:1874-1877. [PMID: 35567330 PMCID: PMC9200874 DOI: 10.1111/1759-7714.14470] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
Growing intrathoracic goiters may compress surrounding organs and deteriorate the cardiopulmonary function. Treating such cases requires carefully considering how to maintain oxygenation and resect the tumor with minimal invasiveness without complications. We herein report a surgically resected case of a large intrathoracic goiter‐compressed trachea extending from the right lower pole of the thyroid gland to the carina. We secured the airway by intubation preparing for extracorporeal membrane oxygenation and successfully performed surgical complete resection using a robot‐assisted thoracoscopic and cervical approach. Intrathoracic goiter is a tumor with abundant neovascularity, and the right vagus nerve is displaced in the thoracic cavity, but a robot‐assisted thoracoscopic approach using CO2 insufflation improved visualization at the narrow apex area of the thoracic cavity. Robot‐assisted thoracoscopic surgery is a useful surgical procedure enabling safe and minimally invasive surgery without recurrent laryngeal nerve palsy or tracheal injury for intrathoracic giant goiters extending into the thoracic cavity.
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Affiliation(s)
- Ryuji Nakamura
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Chiba
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Matsui
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keisuke Yokota
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Noda Y, Mukaida K, Miyoshi H, Nakamura R, Yasuda T, Saeki N, Nishino I, Tsutsumi YM. The effects of dantrolene in the presence or absence of ryanodine receptor type 1 variants in individuals predisposed to malignant hyperthermia. Anaesth Intensive Care 2022; 50:312-319. [PMID: 35549722 DOI: 10.1177/0310057x211053644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
Dantrolene is currently the only drug known to specifically treat malignant hyperthermia (MH) crises. Although dantrolene attenuates Ca2+ disorders by acting mainly on the ryanodine receptor type 1 (RYR1), some patients who manifest MH without RYR1 variants have also been successfully treated with dantrolene. Thus, dantrolene appears to have an inhibitory effect on patients with and without RYR1 variants. This study aimed to investigate whether the effects of dantrolene differed depending on the presence or absence of RYR1 variants using muscle cells from MH-predisposed individuals. The study participants were individuals diagnosed with MH predisposition by the Ca2+-induced Ca2+ release rate test. They were genetically tested and divided into two groups: with and without RYR1 variants. We investigated whether these two groups showed differences in the changes in the half-maximal effective concentration (EC50) for caffeine and the resting intracellular Ca2+ concentration ([Ca2+]i) before and after dantrolene administration. Dantrolene administration significantly increased the EC50 (P < 0.0001) and decreased the resting [Ca2+]i (P < 0.0001). The inhibitory effects of dantrolene and the presence of RYR1 variants showed no statistically significant interactions related to the EC50 (P = 0.59) and resting [Ca2+]i (P = 0.21). In conclusion, the presence or absence of RYR1 variants does not appear to influence the effect of dantrolene.
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Affiliation(s)
- Yuko Noda
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Keiko Mukaida
- Department of Anaesthesiology, Hiroshimakenritu-Syougaisya Rehabilitation Centre, Hiroshima, Japan
| | - Hirotsugu Miyoshi
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Ryuji Nakamura
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Toshimichi Yasuda
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Noboru Saeki
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Centre of Neurology and Psychiatry, National Centre Hospital, Tokyo, Japan
| | - Yasuo M Tsutsumi
- Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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18
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Sekiguchi Y, Kumamoto Y, Nakamura R, Minami K, Fujii M. Basic research to determine normal levels of androgens (testosterone, free testosterone, DHEA-S) in Japanese middle-aged women. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.596] [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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Narasaki S, Miyoshi H, Nakamura R, Sumii A, Watanabe T, Otsuki S, Tsutsumi YM. Venous cannula occlusion during cardiopulmonary bypass recognized by ultrasonography of the internal jugular vein. JA Clin Rep 2022; 8:29. [PMID: 35412158 PMCID: PMC9005582 DOI: 10.1186/s40981-022-00519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Occlusion or malposition of the venous cannula during cardiopulmonary bypass (CPB) increases central venous pressure (CVP). When high CVP is measured, we need to determine if it is actually high or if it is measured due to catheter occlusion or technical problems with the measurement. Case presentation We experienced a case of excessively high CVP due to malposition of the venous cannula during CPB. A 78-year-old woman underwent an aortic arch replacement for acute aortic dissection. During CPB, CVP increased up to 78 mmHg, and the time above 50 mmHg was 48 min. In this case, ultrasonography of the internal jugular vein (IJV) was useful to confirm high CVP. Conclusions Ultrasonography is now a familiar diagnostic tool and can be used at any time. We should consider ultrasonography as the first choice for diagnosing the cause of high CVP during CPB.
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Yokota K, Okuda K, Haneda H, Tatematsu T, Oda R, Sakane T, Matsui T, Chiba K, Nakamura R, Nakanishi R. A single-center analysis of 71 patients with thymic carcinoma: the chronological changes in the surgical procedure and prognosis. J Thorac Dis 2022; 14:3211-3220. [PMID: 36245584 PMCID: PMC9562546 DOI: 10.21037/jtd-22-490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 11/27/2022]
Abstract
Background Effective treatments for thymic carcinoma (TC) have not been established due to its rarity and the prognosis has not yet been improved. In the present study, data of patients who underwent treatment for TC at our single institution were retrospectively reviewed to investigate the chronological changes in the clinical characteristics, surgical procedure, and prognosis. Methods A total of 71 patients were included in this study. To investigate the chronological changes, the patients were divided into two groups at January 2009, when minimally invasive surgery (MIS) for thymic epithelial tumors (TETs) was introduced. Results Among the 71 TC patients, 24 patients underwent surgery through December 2008 (earlier period), and 21 underwent surgery from January 2009 (later period). The patients in the later group were more likely to be diagnosed by chest computed tomography (CT) scan without subjective symptom. The rates of MIS and complete resection were significantly higher and the number of the patients at the early stage were significantly greater in the later group. The 5-year overall survival (OS) rate of the patients who underwent surgery at earlier and later groups were 58.7% and 92.8% respectively (P<0.01). Conclusions The prognosis of TC has improved over time, thanks to early detection by CT screening and complete surgical resection.
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Affiliation(s)
- Keisuke Yokota
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Haneda
- Department of Thoracic Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadashi Sakane
- Department of Thoracic Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Takuya Matsui
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Chiba
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryuji Nakamura
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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21
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Maki Y, Okada K, Nakamura R, Hirano Y, Fujiwara T, Yamasaki R, Ichimura K, Matsuura M. A case of multiple lung carcinoid tumors localized in the right lower lobe. Respir Med Case Rep 2022; 38:101679. [PMID: 35656094 PMCID: PMC9151731 DOI: 10.1016/j.rmcr.2022.101679] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
Typical pulmonary carcinoid (TC) tumors are low-grade neuroendocrine tumors and usually detected as indolent solitary tumors. We herein report a case of multiple pulmonary carcinoid tumors and tumorlets localized in the right lower lobe with no underlying lung disorders suggesting diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). A 28-year-old man with multiple 1-to-8-mm pulmonary nodules in the peripheral pulmonary parenchyma of the right lower lobe was referred to our hospital. The patient underwent a surgical biopsy. Pathological examination revealed multiple nodules composed of spindle cells, and immunohistochemistry revealed staining for chromogranin A, synaptophysin, and CD56, suggesting neuroendocrine tumors. He was diagnosed as having multiple TC tumors and tumorlets. Neuroendocrine cell hyperplasia (NECH) was also observed on some bronchioles. A follow-up CT scan after 6 months showed no changes in the sizes of the nodules and no new lesions. The present case was histopathologically compatible with DIPNECH but it occurs mainly in elderly women. The patient might be in an early stage of DIPNECH before progression to symptomatic DIPNECH. In conclusion, clinicians should consider the possibility of carcinoid tumors and tumorlets in cases with multiple pulmonary nodules even if they are localized in one lobe.
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Affiliation(s)
- Yuho Maki
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
- Corresponding author. Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Kazuhiro Okada
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yutaka Hirano
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Rie Yamasaki
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Motoki Matsuura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
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22
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Cozzani G, Khotyaintsev YV, Graham DB, Egedal J, André M, Vaivads A, Alexandrova A, Le Contel O, Nakamura R, Fuselier SA, Russell CT, Burch JL. Structure of a Perturbed Magnetic Reconnection Electron Diffusion Region in the Earth's Magnetotail. Phys Rev Lett 2021; 127:215101. [PMID: 34860109 DOI: 10.1103/physrevlett.127.215101] [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] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Abstract
We report in situ observations of an electron diffusion region (EDR) and adjacent separatrix region in the Earth's magnetotail. We observe significant magnetic field oscillations near the lower hybrid frequency which propagate perpendicularly to the reconnection plane. We also find that the strong electron-scale gradients close to the EDR exhibit significant oscillations at a similar frequency. Such oscillations are not expected for a crossing of a steady 2D EDR, and can be explained by a complex motion of the reconnection plane induced by current sheet kinking propagating in the out-of-reconnection-plane direction. Thus, all three spatial dimensions have to be taken into account to explain the observed perturbed EDR crossing. These results shed light on the interplay between magnetic reconnection and current sheet drift instabilities in electron-scale current sheets and highlight the need for adopting a 3D description of the EDR, going beyond the two-dimensional and steady-state conception of reconnection.
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Affiliation(s)
- G Cozzani
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | | | - D B Graham
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | - J Egedal
- Department of Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M André
- Swedish Institute of Space Physics, Uppsala 75121, Sweden
| | - A Vaivads
- Space and Plasma Physics, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm 11428, Sweden
| | - A Alexandrova
- Laboratoire de Physique des Plasmas, CNRS, Sorbonne Université, Université Paris-Saclay, Observatoire de Paris, École Polytechnique Institut Polytechnique de Paris, Palaiseau 91128, France
| | - O Le Contel
- Laboratoire de Physique des Plasmas, CNRS, Sorbonne Université, Université Paris-Saclay, Observatoire de Paris, École Polytechnique Institut Polytechnique de Paris, Palaiseau 91128, France
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, Graz 8042, Austria
| | - S A Fuselier
- Southwest Research Institute, San Antonio, Texas 78238, USA
- University of Texas at San Antonio, San Antonio, Texas 78249, USA
| | - C T Russell
- University of California, Los Angeles, California 90095, USA
| | - J L Burch
- Southwest Research Institute, San Antonio, Texas 78238, USA
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Kamiya S, Nakamura R, Saeki N, Tsutsumi YM. Paradoxical increase in the photoplethysmography amplitude in response to nociceptive stimulation induced by tracheal intubation : A case report. J Med Invest 2021; 68:383-385. [PMID: 34759164 DOI: 10.2152/jmi.68.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : Although an increase in sympathetic nerve activity is generally associated with a decrease in the photoplethysmography (PPG) amplitude, the present case study demonstrates that nociceptive stimuli, such as tracheal intubation, paradoxically induce an increase in PPG amplitude. To the best of our knowledge, this is the first study to capture an increase in the PPG amplitude in response to sympathetic nerve activation. Case presentation : A 73-year-old woman underwent open surgery. Following anesthesia induction, tracheal intubation was performed, which resulted in increased heart rate and raised blood pressure. While nociception usually decreases the PPG amplitude, the opposite was found. Conversely, the vascular stiffness K value, our research group's unique monitoring method to quantify the strength of sympathetic activity, increased reflecting increased peripheral vascular resistance. Conclusions : We report a paradoxical case of increased PPG amplitude following tracheal intubation. It is important to note that the PPG amplitude does not always decrease with nociceptive stimuli. J. Med. Invest. 68 : 383-385, August, 2021.
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Affiliation(s)
- Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
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24
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Stein A, Al Malki M, Yang D, Liu A, Han C, Palmer J, Dandapani S, Farol L, Hui S, Marcucci G, Nakamura R, Pullarkat V, Rosenthal J, Salhotra A, Spielberger R, Forman S, Wong J. Total Marrow and Lymphoid Irradiation to 20 Gy Combined With Post-Transplant Cyclophosphamide Graft vs. Host Disease (GvHD) Prophylaxis is Associated With Low Non-Relapse Mortality Rates and Favorable GvHD-Free/Relapse-Free Survival in AML. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Miyoshi H, Nakamura R, Noda Y, Kimura H, Kamiya S, Morio A, Watanabe T, Narasaki S, Toyota Y, Saeki N, Tsutsumi YM. Relationship Between the Loaded Pressure and Flow Rate of Packed Red Blood Cells and Various Infusion Solutions in Normal Infusion Lines and Catheters. Anesth Analg 2021; 133:1107-1115. [PMID: 34437311 DOI: 10.1213/ane.0000000000005700] [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: 11/05/2022]
Abstract
BACKGROUND We investigated the relationship between the loaded pressure and flow rate in various catheters and the entire infusion line including the catheters, in several infusion solutions and packed red blood cells. METHODS We connected the infusion line and catheter to the infusion solution and used an outer pressure bag or a compressor to pressurize the infusion solution bag to a pressure within the clinical (up to 450 mm Hg) or higher range (up to 1050 mm Hg). We approximated the relationship between the loaded pressure and flow rate in the entire infusion line including the catheter, versus the catheter alone, as a power function and compared the power numbers. RESULTS In the clinical pressure range of normal saline, the power numbers of the entire infusion line for the 24-, 22-, 20-, and 18-gauge catheters were 0.76, 0.82, 0.81, and 0.86, respectively, while those for the catheter alone were 0.67, 0.63, 0.56, and 0.44, respectively. In the higher pressure range of normal saline, the power numbers of the entire infusion line for the 24-, 22-, 20-, and 18-gauge catheters were 0.68, 0.70, 0.71, and 0.73, respectively, while those for the catheter alone were 0.62, 0.61, 0.59, and 0.58, respectively. As the power number of the entire infusion line was closer to 1.00 than the values of the catheter, the relation between the loaded pressure and the flow rate was more linear in the entire infusion line than that in the catheter. Similar results were obtained using packed red blood cells and 40% glycerin mixture in normal saline. CONCLUSIONS Regardless of the type of infusion solution or transfusion, the pressure-flow relationship in the catheter was nonlinear and not directly proportional. However, within the clinical pressure range (up to 450 mm Hg), the relationship between the flow rate and pressure in the entire infusion line was almost linear and proportional.
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Affiliation(s)
- Hirotsugu Miyoshi
- From the Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
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Miyoshi H, Nakamura R, Noda Y, Yokomi H, Kamiya S, Morio A, Watanabe T, Narasaki S, Toyota Y, Saeki N, Hamada H, Tsutsumi YM. Intravenous patient-controlled analgesia does not increase the risk of postoperative delirium compared to patient-controlled epidural analgesia: a propensity score-matched retrospective cohort study. Ann Palliat Med 2021; 10:10160-10169. [PMID: 34498474 DOI: 10.21037/apm-21-1084] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is unclear whether the doses of opioids and the routes of administration used for postoperative analgesic management are associated with delirium. We aimed to compare the incidence of postoperative delirium (POD) between intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) in patients who underwent postoperative analgesic management using opioids. METHODS We retrospectively investigated surgical patients (n=3,324) who received patient-controlled analgesia (PCA). Morphine was used for IVPCA, and fentanyl and ropivacaine were used for PCEA. The patients' background characteristics, perioperative management, presence of POD, and postoperative analgesia technique after IVPCA (n=1,184) or PCEA (n=2,140) were assessed. We divided the patients into IVPCA and PCEA groups and compared the incidence of POD by propensity score matching. We used the independent t-test for comparisons between the groups, and P<0.05 as considered as statistically significant. RESULTS POD was noted in a total of 125 patients (3.8%); 55 patients (4.6%) with IVPCA and 70 patients (3.3%) with PCEA (P=0.046). There was no statistically significant difference in cumulative opioid usage up to postoperative day 2 (in mg) between patients with and without POD (POD 62.7±39.8 vs. non-POD 48.9±50.3, P=0.10). After propensity score matching, 1,156 patients with similar baseline characteristics were selected. POD was noted in 22 of 578 patients (3.8%) in the IVPCA group and 30 of 578 patients (5.2%) in the PCEA group, with no difference between the two groups (P=0.256). On the other hand, opioid usage was higher in the IVPCA group than in the PCEA group (P<0.001). CONCLUSIONS There was no difference in the incidence of POD between morphine IVPCA and fentanyl PCEA when the patient characteristics were matched using propensity score matching. POD occurs regardless of the route and dose of opioid administration.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Yuko Noda
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Yokomi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Atsushi Morio
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Watanabe
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Soushi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Yukari Toyota
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Hamada
- Department of Anesthesiology and Palliative Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
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Inoue H, Sekiguchi Y, Nakamura R. Can the mini-sling become the golden standard for treating stress urinary incontinence? Comment: The TFS retropubic tensioned minisling for SUI-a 14 year experience with high long-term RCT cure. Int Urogynecol J 2021; 32:2877-2878. [PMID: 34287656 PMCID: PMC8455488 DOI: 10.1007/s00192-021-04922-8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- H Inoue
- Department of Obstetrics and Gynecology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
| | - Y Sekiguchi
- LUNA Pelvic Floor Total Support Clinic, Women's Clinic LUNA Group, Yokohama, Japan
| | - R Nakamura
- LUNA Pelvic Floor Total Support Clinic, Women's Clinic LUNA Group, Yokohama, Japan
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28
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Kamiya S, Nakamura R, Saeki N, Kondo T, Miyoshi H, Narasaki S, Morio A, Kawamoto M, Hirano H, Tsuji T, Tsutsumi YM. Prediction of blood pressure change during surgical incision under opioid analgesia using sympathetic response evoking threshold. Sci Rep 2021; 11:9558. [PMID: 33953209 PMCID: PMC8100133 DOI: 10.1038/s41598-021-87636-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Opioid inhibition of nociceptive stimuli varies in individuals and is difficult to titrate. We have reported the vascular stiffness value (K) as a standard monitor to quantify sympathetic response with high accuracy. On the contrary, among individuals, a considerable variation in the rate of change in K for constant pain has been observed. In this study, we proposed a new index, the minimum stimulus intensity value that evoked the response on K (MECK: Minimum Evoked Current of K), and evaluated its accuracy in predicting sympathetic response to nociceptive stimuli under constant opioid administration. Thirty patients undergoing open surgery under general anesthesia were included. After anesthetic induction, remifentanil was administered at a constant concentration of 2 ng/ml at the effect site followed by tetanus stimulation. MECK was defined as the minimal current needed to produce a change in K. MECK significantly (P < 0.001) correlated with the rate of change of systolic blood pressure during skin incision (ROCBP). Bland–Altman plot analysis using the predicted ROCBP calculated from MECK and the measured ROCBP showed that the prediction equation for ROCBP was highly accurate. This study showed the potential of MECK to predict blood pressure change during surgical incision under opioid analgesia. Clinical trial registration Registry: University hospital medical information network; Registration number: UMIN000041816; Principal investigator's name: Satoshi Kamiya; Date of registration: July 9th, 2019.
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Affiliation(s)
- Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan.
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Soushi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Atsushi Morio
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | | | - Harutoyo Hirano
- Academic Institute, College of Engineering, Shizuoka University, Hamamatsu, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
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Miyoshi H, Nakamura R, Kido H, Narasaki S, Watanabe T, Yokota M, Ishii T, Kato T, Saeki N, Tsutsumi YM. Impact of fentanyl on acute and chronic pain and its side effects when used with epidural analgesia after thoracic surgery in multimodal analgesia: a retrospective cohort study. Ann Palliat Med 2021; 10:5119-5127. [PMID: 33894711 DOI: 10.21037/apm-21-136] [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] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the effects adding opioids to epidural anesthesia on acute and chronic pain and its side effects in multimodal analgesia. METHODS Retrospective cohort study. We retrospectively studied patients who received epidural anesthesia after thoracic surgery. Patients were divided into two groups: epidural anesthesia with fentanyl (group F) and without fentanyl (group N). Pain visual analog scale (VAS) scores at rest and after movement, use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, side effects (nausea, vomiting, pruritus, hypotension, urinary retention), and post-thoracotomy pain syndrome (PTPS) were compared between the two groups. A Mann-Whitney U test and chi-squared test were used for statistical analysis, with significance set at P<0.05. Values were presented as median [interquartile range]. RESULTS A total of 282 patients received epidural anesthesia, 142 in group F and 140 in group N. Resting pain and movement pain were lower in group F than those in group N {resting pain: group F 12 [0-29], group N 20.5 [7-38.5], P=0.01; movement pain, group F 43 [17-65]; group N, 51.5 [39-72]; P<0.001}. Incidence of hypotension was 9.9% in group F and 2.1% in group N (P=0.01), and that of pruritus was 41.5% in group F and 10.7% in group N (P<0.001). There is no difference in the incidence of nausea and vomiting and PTPS. CONCLUSIONS In multimodal analgesia management after thoracic surgery, the addition of fentanyl to epidural anesthesia reduced acute pain and increased the incidence of hypotension and pruritus but did not affect that of PTPS.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Kido
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Soushi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Watanabe
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Mayuko Yokota
- Department of Anesthesiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Tomomi Ishii
- Department of Anesthesiology and Critical Care, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima, Japan
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de Almeida CÁ, Guarçoni S, Leverone A, Nakamura R, Canella C. Characterization of nail changes in alopecia areata using 33-MHz ultrasonography. Clin Exp Dermatol 2021; 46:1108-1109. [PMID: 33665814 DOI: 10.1111/ced.14630] [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] [Received: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - S Guarçoni
- Alta Excelência Diagnóstica, Rio de Janeiro, Brazil
| | - A Leverone
- Professor Rubem David Azulay Institute of Dermatology, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Nakamura
- Professor Rubem David Azulay Institute of Dermatology, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Canella
- Alta Excelência Diagnóstica, Rio de Janeiro, Brazil.,Universidade Federal Fluminense, Niterói, Brazil
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31
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Tsuji T, Arikuni F, Sasaoka T, Suyama S, Akiyoshi T, Soh Z, Hirano H, Nakamura R, Saeki N, Kawamoto M, Yoshizumi M, Yoshino A, Yamawaki S. Peripheral arterial stiffness during electrocutaneous stimulation is positively correlated with pain-related brain activity and subjective pain intensity: an fMRI study. Sci Rep 2021; 11:4425. [PMID: 33627762 PMCID: PMC7904817 DOI: 10.1038/s41598-021-83833-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/06/2021] [Indexed: 11/09/2022] Open
Abstract
Brain activity associated with pain perception has been revealed by numerous PET and fMRI studies over the past few decades. These findings helped to establish the concept of the pain matrix, which is the distributed brain networks that demonstrate pain-specific cortical activities. We previously found that peripheral arterial stiffness [Formula: see text] responds to pain intensity, which is estimated from electrocardiography, continuous sphygmomanometer, and photo-plethysmography. However, it remains unclear whether and to what extent [Formula: see text] aligns with pain matrix brain activity. In this fMRI study, 22 participants received different intensities of pain stimuli. We identified brain regions in which the blood oxygen level-dependent signal covaried with [Formula: see text] using parametric modulation analysis. Among the identified brain regions, the lateral and medial prefrontal cortex and ventral and dorsal anterior cingulate cortex were consistent with the pain matrix. We found moderate correlations between the average activities in these regions and [Formula: see text] (r = 0.47, p < 0.001). [Formula: see text] was also significantly correlated with self-reported pain intensity (r = 0.44, p < 0.001) and applied pain intensity (r = 0.43, p < 0.001). Our results indicate that [Formula: see text] is positively correlated with pain-related brain activity and subjective pain intensity. This study may thus represent a basis for adopting peripheral arterial stiffness as an objective pain evaluation metric.
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Affiliation(s)
- Toshio Tsuji
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, 1-4-1 Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
| | - Fumiya Arikuni
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, 1-4-1 Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Takafumi Sasaoka
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shin Suyama
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, 1-4-1 Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Takashi Akiyoshi
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, 1-4-1 Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Zu Soh
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, 1-4-1 Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
| | - Harutoyo Hirano
- College of Engineering, Academic Institute, Shizuoka University, 3-5-1, Johoku, Nakaku, Hamamatsu, 432-8561, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masashi Kawamoto
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masao Yoshizumi
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shigeto Yamawaki
- Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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32
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Yamasaki T, Hattori T, Kakita K, Oota K, Miyai N, Nakamura R, Sawanishi T, Kinoshita N. Quantitative analysis of the isolation area after larger-size laser balloon ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0616] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The visually guided laser balloon ablation is a balloon-based catheter ablation technology used for atrial fibrillation (AF) ablation in recent years. This balloon catheter consists of a compliant balloon that has the capability of real-time endoscopic visualization of the targeted pulmonary vein (PV). The sizeable balloon is usually inflated to obtain optimal PV occlusion. The isolation area after laser balloon (LB) ablation was reported to be smaller than that after cryoballoon ablation. However, when LB is inflated with its maximum pressure, it can visualize wide-area PV antrum. Thereby, we suspected that larger-size LB can create wider isolation area.
Purpose
The aim of this study is to quantitatively evaluate the isolation area after LB ablation at the size larger than appropriate size for ablation in the pulmonary vein carina region.
Methods
We assessed 66 patients with AF who underwent LB ablation at the larger inflation size in our hospital during the period from July 2018 to July 2019. After LB ablation, we created voltage maps with a circular mapping catheter and calculated isolation areas with CARTO system.
Results
Figure shows a larger LB with its maximum pressure. PV antrum isolation was extended to the posterior wall in all patients. The left- and right-sided pulmonary vein antrum isolation area were 15.1±3.9 and 19.4±4.3 cm2, respectively.
Conclusion
LB at the larger inflation size with its maximum pressure can isolate wider-area circumferential PV antrum than previously reported. This method may be a new way of pulmonary vein antrum isolation.
Left atrial voltage mapping after PVI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Yamasaki
- Takeda Hospital, Cardiac Arrhythmia, Kyoto, Japan
| | - T Hattori
- Takeda Hospital, Cardiac Arrhythmia, Kyoto, Japan
| | - K Kakita
- Takeda Hospital, Cardiac Arrhythmia, Kyoto, Japan
| | - K Oota
- Takeda Hospital, Cardiology, Kyoto, Japan
| | - N Miyai
- Takeda Hospital, Cardiology, Kyoto, Japan
| | - R Nakamura
- Takeda Hospital, Cardiology, Kyoto, Japan
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33
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Wong J, Tsai N, Han C, Palmer J, Liu A, Al Malki M, Dandapani S, Radany E, Salhotra A, Nakamura R, Hui S, Rosenthal J, Forman S, Stein A. Phase II Study of Dose Escalated Total Marrow and Lymphoid Irradiation (TMLI) in Combination with Cyclophosphamide and Etoposide in Patients with Poor-Risk Acute Leukemia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Tsuji T, Nobukawa T, Mito A, Hirano H, Soh Z, Inokuchi R, Fujita E, Ogura Y, Kaneko S, Nakamura R, Saeki N, Kawamoto M, Yoshizumi M. Recurrent probabilistic neural network-based short-term prediction for acute hypotension and ventricular fibrillation. Sci Rep 2020; 10:11970. [PMID: 32686705 PMCID: PMC7371879 DOI: 10.1038/s41598-020-68627-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
In this paper, we propose a novel method for predicting acute clinical deterioration triggered by hypotension, ventricular fibrillation, and an undiagnosed multiple disease condition using biological signals, such as heart rate, RR interval, and blood pressure. Efforts trying to predict such acute clinical deterioration events have received much attention from researchers lately, but most of them are targeted to a single symptom. The distinctive feature of the proposed method is that the occurrence of the event is manifested as a probability by applying a recurrent probabilistic neural network, which is embedded with a hidden Markov model and a Gaussian mixture model. Additionally, its machine learning scheme allows it to learn from the sample data and apply it to a wide range of symptoms. The performance of the proposed method was tested using a dataset provided by Physionet and the University of Tokyo Hospital. The results show that the proposed method has a prediction accuracy of 92.5% for patients with acute hypotension and can predict the occurrence of ventricular fibrillation 5 min before it occurs with an accuracy of 82.5%. In addition, a multiple disease condition can be predicted 7 min before they occur, with an accuracy of over 90%.
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Affiliation(s)
- Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan.
| | - Tomonori Nobukawa
- Graduate School of Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Akihisa Mito
- Graduate School of Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Harutoyo Hirano
- Academic Institute, College of Engineering, Shizuoka University, 3-5-1, Johoku, Naka-ku, Hamamatsu, Shizuoka, 432-8561, Japan
| | - Zu Soh
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Etsunori Fujita
- Delta Kogyo Co. Ltd., 1-14 Shinchi, Fuchu-Cho, Aki-Gun, Hiroshima, 735-8501, Japan
| | - Yumi Ogura
- Delta Kogyo Co. Ltd., 1-14 Shinchi, Fuchu-Cho, Aki-Gun, Hiroshima, 735-8501, Japan
| | - Shigehiko Kaneko
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8656, Japan
| | - Ryuji Nakamura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Noboru Saeki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Masashi Kawamoto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8553, Japan
| | - Masao Yoshizumi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8553, Japan
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35
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Nakamura TKM, Plaschke F, Hasegawa H, Liu Y, Hwang K, Blasl KA, Nakamura R. Decay of Kelvin-Helmholtz Vortices at the Earth's Magnetopause Under Pure Southward IMF Conditions. Geophys Res Lett 2020; 47:e2020GL087574. [PMID: 32999512 PMCID: PMC7507125 DOI: 10.1029/2020gl087574] [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] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
At the Earth's low-latitude magnetopause, clear signatures of the Kelvin-Helmholtz (KH) waves have been frequently observed during periods of the northward interplanetary magnetic field (IMF), whereas these signatures have been much less frequently observed during the southward IMF. Here, we performed the first 3-D fully kinetic simulation of the magnetopause KH instability under the southward IMF condition. The simulation demonstrates that fast magnetic reconnection is induced at multiple locations along the vortex edge in an early nonlinear growth phase of the instability. The reconnection outflow jets significantly disrupt the flow of the nonlinear KH vortex, while the disrupted turbulent flow strongly bends and twists the reconnected field lines. The resulting coupling of the complex field and flow patterns within the magnetopause boundary layer leads to a quick decay of the vortex structure, which may explain the difference in the observation probability of KH waves between northward and southward IMF conditions.
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Affiliation(s)
| | - F. Plaschke
- Space Research InstituteAustrian Academy of SciencesGrazAustria
| | - H. Hasegawa
- Institute of Space and Astronautical ScienceJapan Aerospace Exploration AgencySagamiharaJapan
| | - Y.‐H. Liu
- Department of Physics and AstronomyDartmouth CollegeHanoverNHUSA
| | - K.‐J. Hwang
- Southwest Research InstituteSan AntonioTXUSA
| | - K. A. Blasl
- Space Research InstituteAustrian Academy of SciencesGrazAustria
- Institute of PhysicsUniversity of GrazGrazAustria
| | - R. Nakamura
- Space Research InstituteAustrian Academy of SciencesGrazAustria
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36
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Chen LJ, Wang S, Le Contel O, Rager A, Hesse M, Drake J, Dorelli J, Ng J, Bessho N, Graham D, Wilson LB, Moore T, Giles B, Paterson W, Lavraud B, Genestreti K, Nakamura R, Khotyaintsev YV, Ergun RE, Torbert RB, Burch J, Pollock C, Russell CT, Lindqvist PA, Avanov L. Lower-Hybrid Drift Waves Driving Electron Nongyrotropic Heating and Vortical Flows in a Magnetic Reconnection Layer. Phys Rev Lett 2020; 125:025103. [PMID: 32701350 DOI: 10.1103/physrevlett.125.025103] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
We report measurements of lower-hybrid drift waves driving electron heating and vortical flows in an electron-scale reconnection layer under a guide field. Electrons accelerated by the electrostatic potential of the waves exhibit perpendicular and nongyrotropic heating. The vortical flows generate magnetic field perturbations comparable to the guide field magnitude. The measurements reveal a new regime of electron-wave interaction and how this interaction modifies the electron dynamics in the reconnection layer.
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Affiliation(s)
- L-J Chen
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - S Wang
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- University of Maryland, College Park, Maryland 20747, USA
| | - O Le Contel
- CNRS/Ecole Polytechnique/Sorbonne Université/Univ. Paris Sud/Observatoire de Paris, Paris F91128, France
| | - A Rager
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - M Hesse
- University of Bergen, Bergen 5020, Norway
| | - J Drake
- University of Maryland, College Park, Maryland 20747, USA
| | - J Dorelli
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - J Ng
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- University of Maryland, College Park, Maryland 20747, USA
| | - N Bessho
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- University of Maryland, College Park, Maryland 20747, USA
| | - D Graham
- Swedish Institute of Space Physics, Uppsala SE-75121, Sweden
| | - Lynn B Wilson
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - T Moore
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - B Giles
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - W Paterson
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - B Lavraud
- Institut de Recherche en Astrophysique et Planétologie, Université de Toulouse (UPS), CNRS, CNES, Toulouse 31027 Cedex 4, France
| | - K Genestreti
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, Graz A-8042, Austria
| | | | - R E Ergun
- University of Colorado, Boulder, Colorado 80305, USA
| | - R B Torbert
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - J Burch
- Southwest Research Institute, San Antonio, Texas 78238, USA
| | - C Pollock
- Denali Scientific, Healy, Alaska 99743, USA
| | - C T Russell
- University of California, Los Angeles, Los Angeles, California 90095, USA
| | - P-A Lindqvist
- KTH Royal Institute of Technology, Stockholm SE-11428, Sweden
| | - L Avanov
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
- University of Maryland, College Park, Maryland 20747, USA
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Murakami C, Kakuta N, Satomi S, Nakamura R, Miyoshi H, Morio A, Saeki N, Kato T, Ohshita N, Tanaka K, Tsutsumi YM. [Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis]. Rev Bras Anestesiol 2020; 70:508-519. [PMID: 32753114 DOI: 10.1016/j.bjan.2020.04.005] [Citation(s) in RCA: 5] [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: 11/05/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists and Neurokinin-1 (NK-1) receptor antagonists, have been used to treat PONV. OBJECTIVES To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant. DATA SOURCES Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I-III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included. STUDY APPRAISAL AND SYNTHESIS METHODS All statistical assessments were conducted by a random effect approach and odds ratios and 95% Confidence Intervals were calculated. RESULTS Aprepitant 40mg and 80mg significantly reduced the incidence of vomiting 0-24hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30-0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19-0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0-24h and 0-48hours postoperatively (OR = 0.07; 95% CI 0.02-0.24; p < 0.001 and OR = 0.07; 95% CI 0.02-0.23; p < 0.001). LIMITATIONS Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42019120188.
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Affiliation(s)
- Chiaki Murakami
- Tokushima University, Department of Anesthesiology, Kumamoto, Japão
| | - Nami Kakuta
- Tokushima University, Department of Anesthesiology, Kumamoto, Japão
| | - Shiho Satomi
- University of California, Department of Anesthesiology, San Diego, EUA
| | - Ryuji Nakamura
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão
| | - Hirotsugu Miyoshi
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão
| | - Atsushi Morio
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão
| | - Noboru Saeki
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão
| | - Takahiro Kato
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão
| | - Naohiro Ohshita
- Osaka Dental University, Department of Anesthesiology, Chuo, Japão
| | - Katsuya Tanaka
- Tokushima University, Department of Anesthesiology, Kumamoto, Japão
| | - Yasuo M Tsutsumi
- Hiroshima University, Department of Anesthesiology and Critical Care, Minami, Japão.
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Kikuchi K, Nakamura R, Segawa T, Oikawa H, Ariga H. Modified Glasgow prognostic score can predict survival of muscle invasive bladder cancer patients after radiotherapy. J Radiat Res 2020; 61:616-621. [PMID: 32567660 PMCID: PMC7336815 DOI: 10.1093/jrr/rraa039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Indexed: 06/11/2023]
Abstract
In patients with various cancers, modified Glasgow prognostic score (mGPS) before treatment has predicted prognoses after antitumor therapy. This study aimed to assess whether pretreatment mGPS also has predictive value in patients with muscle-invasive bladder cancer (MIBC) after radiotherapy. A retrospective review accumulated 98 consecutive MIBC patients treated with definitive 3D-conformal radiotherapy from January 2011 to December 2016 in a single center. It included cT2-4bN0-3M0 patients with a median age of 79 years (range: 49 to 95 years). Radiotherapy was delivered at 60-66 Gy for bladder cancer. Patients were categorized in terms of their pretreatment serum albumin and C-reactive protein (CRP) values as mGPS_0, mGPS_1, and mGPS_2. Among them, cumulative overall survival (OS) rates were compared by Kaplan-Meier plots with log-rank tests. The number of patients with mGPS_0, mGPS_1, and mGPS_2 were 40, 40, and 18, respectively. The median follow-up time for all patients was 19 months (range: 2-73 months). The 2-year OS rate for all patients was 75.7%. The 2-year OS rates for mGPS_0, mGPS_1, and mGPS_2 were 85.1%, 71.3%, and 60.9%, respectively. Kaplan-Meier curves revealed a significantly higher cumulative OS rate for mGPS_0 compared with mGPS_1 and mGPS_2 (P = 0.003). Using multivariate Cox regression analysis, mGPS_0 and good performance status were associated with favorable OS rates, of which mGPS_0 was more significant (Hazard ratio 2.74, 95% CI 1.30-5.57, P = 0.008). Modified Glasgow prognostic score may be a novel biomarker that can predict survival in patients with MIBC after radiotherapy.
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Affiliation(s)
- Koyo Kikuchi
- Department of Radiation Oncology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Ryuji Nakamura
- Department of Radiation Oncology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Takafumi Segawa
- Department of Radiation Oncology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Hirobumi Oikawa
- Department of Radiation Oncology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan
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39
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Ninomiya N, Nakamura R, Sekiguchi Y, Nakatani T. 065 Vulvar Findings in GSM Patients Correlate with Severity of Overactive Bladder. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.301] [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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40
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Sekiguchi Y, Nakamura R, Ninomiya N. 071 Estradiol does not Increase with Low-dose Testosterone Replacement in Women after Menopause. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.307] [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: 10/23/2022]
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41
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Nakamura R, Sugawara J, Yamaguchi S, Kakuhara H, Kikuchi K, Ariga H. Stereotactic body radiotherapy with a single isocentre for multiple pulmonary metastases. BJR Case Rep 2020; 6:20190121. [PMID: 33299576 PMCID: PMC7709054 DOI: 10.1259/bjrcr.20190121] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022] Open
Abstract
A 45-year-old male developed a second set of pulmonary metastases 5 years after surgery for extraskeletal mucinous chondrosarcoma of the left shoulder. He already underwent a lobectomy and two segmentectomies for a first set of pulmonary metastases 2 years ago. The closely grouped three nodules within the left lower lung formed a planning target volume (PTV) for stereotactic body radiotherapy (SBRT) with a single isocentre, which was focused on the centre of the largest nodule (the simultaneous plan). Dose-volume histogram analysis confirmed that the plan was superior to an alternative plan, in which SBRT plans would have been produced for each individual tumour (the individual plan). The mean, maximum and minimum PTV doses were 54.0, 57.5 and 47.3 Gy, respectively, in the simultaneous plan, and 65.6, 87.2 and 52.3 Gy, respectively, in the individual plan. The homogeneity index, conformity index, and the maximum dose delivered to the surrounding healthy lung were 1.21, 0.71, and 37.7 Gy, respectively, in the simultaneous plan and 1.66, 4.44, and 46.2 Gy, respectively, in the individual plan. The patient developed Grade two pneumonitis, but remained healthy until 4 years after the SBRT. When multiple closely grouped metastases are treated using SBRT, the use of a single isocentre should be considered.
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Affiliation(s)
- Ryuji Nakamura
- Department of Radiology, Iwate Medical University, Morioka, Japan
| | - Jun Sugawara
- Department of Radiology, Iwate Prefectural Chubu Hospital, Kitakami, Japan
| | | | - Hisao Kakuhara
- Department of Radiation Oncology, Iwate Medical University, Morioka, Japan
| | - Koyo Kikuchi
- Department of Radiation Oncology, Iwate Medical University, Morioka, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Iwate Medical University, Morioka, Japan
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Satomi S, Morio A, Miyoshi H, Nakamura R, Tsutsumi R, Sakaue H, Yasuda T, Saeki N, Tsutsumi YM. Branched-chain amino acids-induced cardiac protection against ischemia/reperfusion injury. Life Sci 2020; 245:117368. [DOI: 10.1016/j.lfs.2020.117368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/11/2020] [Accepted: 01/26/2020] [Indexed: 02/08/2023]
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43
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Matsuda S, Kawakubo H, Takeuchi H, Hayashi M, Mayanagi S, Takemura R, Irino T, Fukuda K, Nakamura R, Wada N, Kitagawa Y. Minimally invasive oesophagectomy with extended lymph node dissection and thoracic duct resection for early-stage oesophageal squamous cell carcinoma. Br J Surg 2020; 107:705-711. [PMID: 32077101 DOI: 10.1002/bjs.11487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/05/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oesophageal squamous cell carcinoma is an aggressive disease owing to early and widespread lymph node metastases. Multimodal therapy and radical surgery may improve prognosis. Few studies have investigated the efficacy of radical lymph node and thoracic duct resection. METHODS Patients with oesophageal squamous cell carcinoma who underwent transthoracic minimally invasive oesophagectomy (TMIE) for cancer at Keio University Hospital between January 2004 and December 2016 were selected. Between 2004 and 2008, TMIE was performed in the lateral decubitus position without thoracic duct resection (standard TMIE). From 2009 onwards, TMIE with extended lymph node and thoracic duct resection was introduced (extended TMIE). Demographics, co-morbidity, number of retrieved lymph nodes, pathology, postoperative complications and recurrence-free survival (RFS) were compared between groups. RESULTS Forty-four patients underwent standard TMIE and 191 extended TMIE. There were no significant differences in clinical and pathological tumour stage or postoperative complications. The extended-TMIE group had more lymph nodes removed at nodal stations 106recL and 112. Among patients with cT1 N0 disease, RFS was better in the extended-TMIE group (P < 0·001), whereas there was no difference in RFS between groups in patients with advanced disease. CONCLUSION Extended TMIE including thoracic duct resection increased the number of lymph nodes retrieved and was associated with improved survival in patients with cT1 N0 oesophageal squamous cell carcinoma.
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Affiliation(s)
- S Matsuda
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - H Kawakubo
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - H Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - M Hayashi
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - S Mayanagi
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - R Takemura
- Biostatistics Unit, Clinical and Translational Research Centre, Keio University Hospital, Tokyo, Japan
| | - T Irino
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - K Fukuda
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - R Nakamura
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - N Wada
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Keio University Hospital, Tokyo, Japan
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Nakamura TKM, Umeda T, Nakamura R, Fu HS, Oka M. Disturbance of the Front Region of Magnetic Reconnection Outflow Jets due to the Lower-Hybrid Drift Instability. Phys Rev Lett 2019; 123:235101. [PMID: 31868466 DOI: 10.1103/physrevlett.123.235101] [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] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/02/2019] [Indexed: 06/10/2023]
Abstract
A 3D fully kinetic simulation shows that the lower-hybrid drift instability disturbs the front of magnetic reconnection outflow jets and additionally causes energy dissipation. The result is very consistent with a disturbance observed at the dipolarization front (DF) in Earth's magnetotail by the Magnetospheric Multiscale (MMS) mission. A fully kinetic dispersion relation solver, validated by the MMS observations, further predicts that the disturbance of the reconnection jet front could occur over different parameter regimes in space plasmas including Earth's DF and solar flares.
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Affiliation(s)
- T K M Nakamura
- Space Research Institute, Austrian Academy of Sciences, Graz 8042, Austria
| | - T Umeda
- Institute for Space-Earth Environmental Research, Nagoya University, Nagoya 464-8601, Japan
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, Graz 8042, Austria
| | - H S Fu
- School of Space and Environment, Beihang University, Beijing 100083, China
| | - M Oka
- Space Sciences Laboratory, University of California, Berkeley, California 94720, USA
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Ohara Y, Yabuki A, Nakamura R, Ichii O, Mizukawa H, Yokoyama N, Yamato O. Renal Infiltration of Macrophages in Canine and Feline Chronic Kidney Disease. J Comp Pathol 2019; 170:53-59. [PMID: 31375159 DOI: 10.1016/j.jcpa.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
During the progression of chronic kidney disease (CKD), macrophage infiltration is a crucial event leading to tubulointerstitial fibrosis. In the present study, macrophages infiltrating renal tissue in dogs and cats with CKD were analysed immunohistochemically. Iba-1 was used as a pan-macrophage marker, CD204 was used as a marker of M2 macrophages and tumour necrosis factor (TNF)-α was used as a marker of M1 macrophages. Signals for Iba1 and CD204 were observed in the interstitium of all tested kidney samples. In dogs, the signals were diffusely scattered. In cats, both diffuse and focal signals were observed. Cells that were positive for Iba1 and CD204 were also observed in the tubular lumina in cats. Co-expression of Iba1 and CD204 was also observed in the infiltrating cells by immunofluorescence labelling, and these cells were negative for TNF-α. By quantitative analysis, the indices for Iba1- and CD204-positive cells were significantly correlated with the concentrations of plasma creatinine and/or urea and the extent of interstitial fibrosis in both dogs and cats. These results demonstrated that renal infiltration of M2 macrophages plays an important role in the progression of CKD in dogs and cats. The distribution pattern of the kidney-infiltrating macrophages was unique in cats and may be associated with a cat-specific renal fibrotic process.
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Affiliation(s)
- Y Ohara
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima
| | - A Yabuki
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima.
| | - R Nakamura
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima
| | - O Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo
| | - H Mizukawa
- Laboratory of Environmental Analytical Chemistry, Department of Science and Technology for Biological Resources and Environment, Graduate School of Agriculture, Ehime University, Matsuyama
| | - N Yokoyama
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - O Yamato
- Laboratory of Veterinary Clinical Pathology, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima
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46
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Ninomiya N, Obayashi M, Nakamura R, Sekiguchi Y. 096 Effect of CO2 Fractional Laser on Female Lower Urinary Tract Symptoms by Genitourinary Syndrome of Menopause. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.535] [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: 12/01/2022]
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47
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Cozzani G, Retinò A, Califano F, Alexandrova A, Le Contel O, Khotyaintsev Y, Vaivads A, Fu HS, Catapano F, Breuillard H, Ahmadi N, Lindqvist PA, Ergun RE, Torbert RB, Giles BL, Russell CT, Nakamura R, Fuselier S, Mauk BH, Moore T, Burch JL. In situ spacecraft observations of a structured electron diffusion region during magnetopause reconnection. Phys Rev E 2019; 99:043204. [PMID: 31108651 DOI: 10.1103/physreve.99.043204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/07/2022]
Abstract
The electron diffusion region (EDR) is the region where magnetic reconnection is initiated and electrons are energized. Because of experimental difficulties, the structure of the EDR is still poorly understood. A key question is whether the EDR has a homogeneous or patchy structure. Here we report Magnetospheric Multiscale (MMS) spacecraft observations providing evidence of inhomogeneous current densities and energy conversion over a few electron inertial lengths within an EDR at the terrestrial magnetopause, suggesting that the EDR can be rather structured. These inhomogenenities are revealed through multipoint measurements because the spacecraft separation is comparable to a few electron inertial lengths, allowing the entire MMS tetrahedron to be within the EDR most of the time. These observations are consistent with recent high-resolution and low-noise kinetic simulations.
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Affiliation(s)
- Giulia Cozzani
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Dipartimento di Fisica "E. Fermi", Università di Pisa, I-56127 Pisa, Italy
| | - A Retinò
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - F Califano
- Dipartimento di Fisica "E. Fermi", Università di Pisa, I-56127 Pisa, Italy
| | - A Alexandrova
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - O Le Contel
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France
| | - Y Khotyaintsev
- Swedish Institute of Space Physics, SE-75121 Uppsala, Sweden
| | - A Vaivads
- Swedish Institute of Space Physics, SE-75121 Uppsala, Sweden
| | - H S Fu
- School of Space and Environment, Beihang University, Beijing, 100083, P.R. China
| | - F Catapano
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Dipartimento di Fisica, Università della Calabria, I-87036, Arcavacata di Rende (CS), Italy
| | - H Breuillard
- Laboratoire de Physique des Plasmas, CNRS/Ecole Polytechnique/Sorbonne Université, Université Paris Sud, Observatoire de Paris, 91128 Palaiseau, France.,Laboratoire de Physique et Chimie de l'Environnement et de l'Espace, CNRS-Université d'Orléans, UMR 7328, 45071 Orléans, France
| | - N Ahmadi
- Laboratory of Atmospheric and Space Physics, University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - P-A Lindqvist
- KTH Royal Institute of Technology, SE-10044, Stockholm, Sweden
| | - R E Ergun
- Laboratory of Atmospheric and Space Physics, University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - R B Torbert
- Space Science Center, University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B L Giles
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - C T Russell
- Department of Earth and Space Sciences, University of California, Los Angeles, California 90095, USA
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, 8042 Graz, Austria
| | - S Fuselier
- Southwest Research Institute, San Antonio, Texas 78238, USA.,University of Texas at San Antonio, San Antonio, Texas 78238, USA
| | - B H Mauk
- The Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland 20723, USA
| | - T Moore
- NASA Goddard Space Flight Center, Greenbelt, Maryland 20771, USA
| | - J L Burch
- Southwest Research Institute, San Antonio, Texas 78238, USA
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Sasaki T, Konno M, Hasegawa Y, Imaji A, Terabaru M, Nakamura R, Ohira N, Matsukura K, Seiwa K. Role of mycorrhizal associations in tree spatial distribution patterns based on size class in an old-growth forest. Oecologia 2019; 189:971-980. [DOI: 10.1007/s00442-019-04376-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
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49
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Tanaka H, Mito A, Hirano H, Soh Z, Nakamura R, Saeki N, Kawamoto M, Higashi Y, Yoshizumi M, Tsuji T. Estimation of Arterial Viscosity Based on an Oscillometric Method and Its Application in Evaluating the Vascular Endothelial Function. Sci Rep 2019; 9:2609. [PMID: 30796239 PMCID: PMC6384877 DOI: 10.1038/s41598-019-38776-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 01/10/2019] [Indexed: 11/20/2022] Open
Abstract
This paper proposes an algorithm for estimating the arterial viscosity using cuff pressures and pulse waves measured by an automatic oscillometric sphygmomanometer. A change in the arterial viscosity during the enclosed-zone flow-mediated dilation test is calculated as an index for evaluating the vascular endothelial function %η. In all, 43 individuals participated in this study. After the index %η was calculated, the accuracy of the index %η in distinguishing healthy subjects and subjects at a high risk of arteriosclerosis was tested via a receiving operating characteristic (ROC) analysis. The calculated %η for the healthy participants and those at a high risk of arteriosclerosis was 13.4 ± 55.1% and -32.7 ± 34.0% (mean ± S.D.), respectively. The area under the ROC curve was 0.77. Thus, it was concluded that the proposed method can be used to evaluate the vascular endothelial function.
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Affiliation(s)
- Hiroshi Tanaka
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, Higashi-Hiroshima, 739-8527, Japan
| | - Akihisa Mito
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, Higashi-Hiroshima, 739-8527, Japan
| | - Harutoyo Hirano
- Academic Institute, College of Engineering, Shizuoka University, Hamamatsu, 432-8561, Japan
| | - Zu Soh
- Department of System Cybernetics, Faculty of Engineering, Hiroshima University, Higashi-Hiroshima, 739-8527, Japan
| | - Ryuji Nakamura
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Noboru Saeki
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Masashi Kawamoto
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Yukihito Higashi
- Department of Regeneration and Medicine, Research Center for Radiation Genome Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, 734-8553, Japan
- Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Masao Yoshizumi
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Toshio Tsuji
- Department of System Cybernetics, Graduate School of Engineering, Hiroshima University, Higashi-Hiroshima, 739-8527, Japan.
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Nakamura R, Yamamoto N, Miyaki T, Itami M. Abstract P3-03-22: Prognostic impact of axillary lymph node status after neoadjuvant chemotherapy for patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-22] [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
Abstract
BACKGROUND:
Patients were stratified by final pathological axillary status: ypN0, ypN1, pN0 or pN1.
The prognostic impact of lymph node involvement after neoadjuvant chemotherapy (NAC) for breast cancer is not straightforward. The aim of this study was to compare overall survival (OS) between pathologically
node-positive T1,T2 T3 breast cancer patients treated with NAC, with ypN0 or ypN1 and those treated without NAC with pN0 or pN1.
METHODS:
A total of 3903 consecutive patients with operable breast cancer were prospectively identified at our institution between April 2006 and December 2017. Patients with suspicious axillary LN of breast cancer were assessed using preoperative imaging, underwent fine-needle aspiration cytology or core needle biopsy.
The patients in this study were divided into four groups as follows: the ER(+), the ER(+)/HER2(+) , the HER2(+) and the Triple negative (TN) group.
We evaluate the prognostic impact of the ypN0, ypN1 (with one to three positive lymph nodes after NAC), pN0 and pN1 with no NAC.
The main outcome measures DFS and OS were analyzed using Kaplan–Meier survival analysis.
Result
A number of 270 and 3633 patients were included for NAC and non NAC, respectively. Pathologic nodal status was ypN0 in 58%, ypN1 in 42% for NAC and pN0 in 76%, pN1 in 24% of patients for non NAC.
Overall, 10-year DFS and OS was 81%, 93% in ypN0, 67%, 80% in ypN1, in 90%, 97%, in pN0 and 83%, 94% in pN1 (p <0.001).
In subgroup analysis, 10-year DFS of ypN0, ypN1, pN0 and pN1 was 86%,77%,95% and 80% in the ER group, 91%,56%,93%,and 76% in the ER/HER2 group,89%,55%,91% and 80% in the HER2 group, 85%,59%,92% and 80% in the TN group.
10 years DFS for the ER group were significantly different between ypN0 and pN0 (HR, 2.42 (1.03–4.86, p = 0.04) but were not significantly different between ypN0 and pN0 for the ER/HER2 group (HR 3.58 (0.2–6.88, p = 0.66), for the HER2 group (HR 2.6 (0.78–7.65, p = 0.10) and for the TN group (HR 1.22(0.56–2.38, p = 0.58), respectively).
In all group, DFS for ypN1 was inferior to ypN0.
Conclusions
In the ER group treated with NAC, DFS for ypN0 be inferior to pN0 with adjuvant treatment. In the HER2, the ERHER2 and the TN group treated with NAC, ypN0 is similar to pN0 with adjuvant chemotherapy.
Axillary nodal status ypN1 in each subgroup is associated with a less favorable prognosis compared to ypN0. In conclusion, the HER2 or TN group is highest for predicting ypN0, shown to be most prognostic of long-term survival similar to the patients with pN0. They could be omitted the axillary dissection.
Citation Format: Nakamura R, Yamamoto N, Miyaki T, Itami M. Prognostic impact of axillary lymph node status after neoadjuvant chemotherapy for patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-22.
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Affiliation(s)
| | | | - T Miyaki
- Chiba Cancer Center, Chiba, Japan
| | - M Itami
- Chiba Cancer Center, Chiba, Japan
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