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Fujiwara K, Kondo T, Fujimoto K, Yumita S, Ogawa K, Ishino T, Nakagawa M, Iwanaga T, Tsuchiya S, Koroki K, Kanzaki H, Inoue M, Kobayashi K, Kiyono S, Nakamura M, Kanogawa N, Ogasawara S, Nakamoto S, Chiba T, Koizumi J, Kato J, Kato N. Clinical risk factors for portal hypertension-related complications in systemic therapy for hepatocellular carcinoma. J Gastroenterol 2024:10.1007/s00535-024-02097-9. [PMID: 38583112 DOI: 10.1007/s00535-024-02097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND During systemic therapy, the management of portal hypertension (PH)-related complications is vital. This study aimed to clarify factors associated with the incidence and exacerbation of PH-related complications, including the usefulness of contrast-enhanced computed tomography (CECT) in the management of PH-related complications during systemic therapy. METHODS A total of 669 patients who received systemic therapy as first-line treatment (443 patients for sorafenib, 131 for lenvatinib, and 90 for atezolizumab/bevacizumab [ATZ/BEV]) were enrolled in this retrospective study. Additionally, the lower esophageal intramural vessel diameters (EIV) on CECT and endoscopic findings in 358 patients were compared. RESULTS The cutoff values of the EIV diameter on CECT were 3.1 mm for small, 5.1 mm for medium, and 7.6 mm for large varices, demonstrating high concordance with the endoscopic findings. esophageal varices (EV) bleeding predictors include EIV ≥ 3.1 mm and portal vein tumor thrombosis (PVTT). In patients without EV before systemic therapy, factors associated with EV exacerbation after 3 months were EIV ≥ 1.9 mm and ATZ/BEV use. Predictors of hepatic encephalopathy (HE) include the ammonia level or portosystemic shunt diameter ≥ 6.8 mm. The incidence of HE within 2 weeks was significantly higher (18%) in patients with an ammonia level ≥ 73 μmol/L and a portosystemic shunt ≥ 6.8 mm. The exacerbating factors for ascites after 3 months were PVTT and low albumin levels. CONCLUSIONS Careful management is warranted for patients with risk factors for exacerbation of PH-related complications; moreover, the effective use of CECT is clinically important.
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Affiliation(s)
- Kisako Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- Ultrasound Center, Chiba University Hospital, Chiba, Japan.
| | - Kentaro Fujimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sae Yumita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Miyuki Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Tsuchiya
- Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masanori Inoue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Koizumi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Ultrasound Center, Chiba University Hospital, Chiba, Japan
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Tsuchiya S, Koizumi J, Kondo T, Fujiwara K, Kato N, Fujimoto H, Uno T. TIPS Reduction by Parallel Placement of Amplatzer Vascular Plug and Stent. Cardiovasc Intervent Radiol 2023; 46:1107-1110. [PMID: 37414840 DOI: 10.1007/s00270-023-03506-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Satoshi Tsuchiya
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan.
| | - Jun Koizumi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Kisako Fujiwara
- Department of Gastroenterology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Naoya Kato
- Department of Gastroenterology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Hajime Fujimoto
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
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Toda Y, Tsuchiya S, Yamane K, Morita R, Oda M, Kurosawa T, Mertelj T, Mihailovic D. Optical vortex induced spatio-temporally modulated superconductivity in a high-T c cuprate. Opt Express 2023; 31:17537-17546. [PMID: 37381484 DOI: 10.1364/oe.487041] [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] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023]
Abstract
We report an experimental approach to produce spatially localized photoinduced superconducting state in a cuprate superconductor using optical vortices with ultrafast pulses. The measurements were carried out using coaxially aligned three-pulse time-resolved spectroscopy, in which an intense vortex pulse was used for coherent quenching of superconductivity and the resulting spatially modulated metastable states were analyzed by the pump-probe spectroscopy. The transient response after quenching shows a spatially localized superconducting state that remains unquenched at the dark core of the vortex beam for a few picoseconds. Because the quenching is instantaneously driven by photoexcited quasiparticles, the vortex beam profile can be transferred directly to the electron system. By using the optical vortex-induced superconductor, we demonstrate spatially resolved imaging of the superconducting response and show that the spatial resolution can be improved using the same principle as that of super-resolution microscopy for fluorescent molecules. The demonstration of spatially controlled photoinduced superconductivity is significant for establishing a new method for exploring novel photoinduced phenomena and applications in ultrafast optical devices.
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Tsuchiya S, Saiga A, Yokota H, Kubota Y, Wada T, Akutsu A, Koizumi J, Aramaki T, Uno T. Prophylactic Steroids for Preventing Postembolization Syndrome after Transcatheter Arterial Embolization of Renal Angiomyolipoma: A Comparative Study. Interv Radiol (Higashimatsuyama) 2023; 8:1-6. [PMID: 36936258 PMCID: PMC10017270 DOI: 10.22575/interventionalradiology.2021-0015] [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] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2022] [Indexed: 03/06/2023]
Abstract
Purpose Postembolization syndrome (PES) after renal arterial embolization (RAE) can reduce the patient's tolerance of the procedure and extend the length of hospital stay. We aimed to assess the efficacy of steroid administration in preventing PES in patients undergoing RAE for angiomyolipoma (AML). Material and Methods Between May 2004 and March 2020, 29 RAE procedures in 26 patients with AML were performed. Patient information, including age, sex, tumor size, tuberous sclerosis complex-associated/sporadic AML, hemorrhagic/nonhemorrhagic AML, embolic material, steroid use, medication type, some blood laboratory parameters, hospital stay, and PES occurrence were retrospectively obtained. The prophylactic steroid protocol used in the study was as follows: 250 mg of intravenous methylprednisolone (Solu-Medrol) 2 h before the RAE procedure, followed by 2 days of intravenous prednisolone (Predonine; 2 mg/kg/day), which was tapered by halving the dose every 2 days within the course of 2 weeks. After the discharge, intravenous prednisolone was changed to oral prednisolone (Predonine). PES was defined as the presence of fever, pain, nausea, or vomiting. Data were compared between the steroid and non-steroid groups and between PES and non-PES groups. Results The PES incidence rate was 76%, and a comparison between the steroid and non-steroid groups revealed that steroid use significantly decreased the incidence of PES (P < 0.001), including fever (P < 0.001), pain (P = 0.005), and nausea (P = 0.028). The use of anti-inflammatory drugs during the hospital stay was significantly lower in the steroid group (P = 0.019). Moreover, in the steroid group, C-reactive protein level was significantly lower (P = 0.006), whereas white blood cell count was significantly higher (P = 0.004). Conversely, the median length of hospital stay was not significantly shorter in the steroid group (P = 0.292). Conclusions The prophylactic use of steroids before and after embolization of renal AML may be effective in preventing PES in this small retrospective study.
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Affiliation(s)
- Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
- Department of Radiology, Chiba University Hospital, Japan
| | - Atsushi Saiga
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
- Department of Radiology, Chiba University Hospital, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Japan
| | | | - Takeshi Wada
- Department of Radiology, Chiba University Hospital, Japan
| | - Akira Akutsu
- Department of Radiology, Chiba University Hospital, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University Hospital, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Japan
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5
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Takeuchi M, Suzuki H, Matsumoto Y, Kikuchi Y, Takanami K, Wagatsuma T, Sugisawa J, Tsuchiya S, Nishimiya K, Hao K, Godo S, Shindo T, Shiroto T, Takahashi J, Kumagai K, Kohzuki M, Takase K, Saiki Y, Yasuda S, Shimokawa H. Prediction of the development of delirium after transcatheter aortic valve implantation using preoperative brain perfusion SPECT. PLoS One 2022; 17:e0276447. [PMID: 36327325 PMCID: PMC9632803 DOI: 10.1371/journal.pone.0276447] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Delirium is an important prognostic factor in postoperative patients undergoing cardiovascular surgery and intervention, including transcatheter aortic valve implantation (TAVI). However, delirium after transcatheter aortic valve implantation (DAT) is difficult to predict and its pathophysiology is still unclear. We aimed to investigate whether preoperative cerebral blood flow (CBF) is associated with DAT and, if so, whether CBF measurement is useful for predicting DAT. Methods We evaluated CBF in 50 consecutive patients before TAVI (84.7±4.5 yrs., 36 females) using 99mTc ethyl cysteinate dimer single-photon emission computed tomography. Preoperative CBF of the DAT group (N = 12) was compared with that of the non-DAT group (N = 38) using whole brain voxel-wise analysis with SPM12 and region of interest-based analysis with the easy-Z score imaging system. Multivariable logistic regression analysis with the presence of DAT was used to create its prediction model. Results The whole brain analysis showed that preoperative CBF in the insula was lower in the DAT than in the non-DAT group (P<0.05, family-wise error correction). Decrease extent ratio in the insula of the DAT group (17.6±11.5%) was also greater relative to that of the non-DAT group (7.0±11.3%) in the region of interest-based analysis (P = 0.007). A model that included preoperative CBF in the insula and conventional indicators (frailty index, short physical performance battery and mini-mental state examination) showed the best predictive power for DAT (AUC 0.882). Conclusions These results suggest that preoperative CBF in the insula is associated with DAT and may be useful for its prediction.
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Affiliation(s)
- Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
| | - Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshihiro Wagatsuma
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiichiro Kumagai
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Rehabilitation Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- National Cerebral and Cardiovascular Center, Suita, Japan
- * E-mail:
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
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Sato R, Moriguchi M, Iwai K, Tsuchiya S, Seko Y, Takahashi A, Kobayashi K, Ogasawara S, Watanabe S, Morimoto N, Kato N, Itoh Y, Aramaki T. Real-world outcomes of molecular targeted agents for patients with hepatocellular carcinoma over 80 years old. Hepatol Res 2022; 52:859-871. [PMID: 35921253 DOI: 10.1111/hepr.13818] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/19/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023]
Abstract
AIM There is insufficient evidence regarding the safety and efficacy of molecular targeted agents (MTAs) for elderly patients with hepatocellular carcinoma (HCC), who are likely to be vulnerable to adverse events (AEs) of therapy. The aim of this study was to compare sorafenib and lenvatinib use in elderly patients with HCC from the viewpoint of overall survival (OS) and rate of AE-induced MTA discontinuation. METHODS This retrospective study included patients with HCC over 80 years old who received first-line molecular targeted therapy (MTT) at four hospitals between June 2009 and September 2019. They were divided into three groups according to the era and type of first-line MTA: E1-Sora (sorafenib, between 2009 and 2016), E2-Sora (sorafenib, between 2017 and 2019), and E2-Len (lenvatinib, between 2017 and 2019). RESULTS The study included 173 patients (E1-Sora, n = 79; E2-Sora, n = 50; E2-Len, n = 44) with a median age of 81.9 years (range, 80-93 years). Median OS was 15.1 months in the entire cohort (E1-Sora, 12.7 months; E2-Sora, 20.5 months; E2-Len, 10.3 months). The rate of treatment discontinuation due to AEs was high in the entire cohort, especially in E1-Sora and E2-Len (49.4% in E1-Sora, 28.0% in E2-Sora, and 54.6% in E2-Len, p = 0.0753). More E2-Sora patients received subsequent MTT than E2-Len patients (E2-Sora, 50%; E2-Len, 28.6%; p = 0.0111). CONCLUSION Both sorafenib and lenvatinib were effective and feasible for elderly patients with HCC. In terms of discontinuation due to AEs and subsequent MTT, sorafenib might be more desirable for elderly patients with HCC over 80 years.
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Affiliation(s)
- Rui Sato
- Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Gun, Japan
| | - Michihisa Moriguchi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Iwai
- Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Gun, Japan
| | - Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Gun, Japan
| | - Yuya Seko
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aya Takahashi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiva University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiva University, Chiba, Japan
| | - Shunji Watanabe
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Naoki Morimoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiva University, Chiba, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Gun, Japan
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7
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Kobayashi K, Ogasawara S, Takahashi A, Seko Y, Unozawa H, Sato R, Watanabe S, Moriguchi M, Morimoto N, Tsuchiya S, Iwai K, Inoue M, Ogawa K, Ishino T, Iwanaga T, Sakuma T, Fujita N, Kanzaki H, Koroki K, Nakamura M, Kanogawa N, Kiyono S, Kondo T, Saito T, Nakagawa R, Suzuki E, Ooka Y, Nakamoto S, Tawada A, Chiba T, Arai M, Kanda T, Maruyama H, Nagashima K, Kato J, Isoda N, Aramaki T, Itoh Y, Kato N. Evolution of Survival Impact of Molecular Target Agents in Patients with Advanced Hepatocellular Carcinoma. Liver Cancer 2021; 11:48-60. [PMID: 35222507 PMCID: PMC8820147 DOI: 10.1159/000519868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS The prognosis of patients with advanced hepatocellular carcinoma (HCC) is expected to improve as multiple molecular target agents (MTAs) are now available. However, the impact of the availability of sequential MTAs has not been fully verified yet. APPROACH AND RESULTS We retrospectively collected the data on the whole clinical course of 877 patients who received any MTAs as first-line systemic therapy for advanced HCC between June 2009 and March 2019. The study population was divided into 3 groups according to the date of first-line MTA administration (period 1: 2009-2012, n = 267; period 2: 2013-2016, n = 352; period 3: 2017-2019, n = 258). Then, we compared the number of MTAs used, overall survival (OS), and MTA treatment duration among the 3 groups. Analysis was also performed separately for advanced-stage and nonadvanced-stage HCC. The proportion of patients who received multiple MTAs was remarkably increased over time (1.1%, 10.2%, and 42.6% in periods 1, 2, and 3, respectively, p < 0.001). The median OS times were prolonged to 10.4, 11.3, and 15.2 months in periods 1, 2, and 3, respectively (p = 0.016). Similarly, the MTA treatment durations were extended (2.7, 3.2, and 6.6 months in periods 1, 2, and 3, respectively; p < 0.001). We confirmed that the correlation between OS and MTA treatment duration was strengthened (period 1: 0.395, period 2: 0.505, and period 3: 0.667). All these trends were pronounced in the patients with advanced-stage HCC but limited in the patients with nonadvanced-stage HCC. CONCLUSIONS The availability of multiple MTAs had steadily improved the prognosis of patients with advanced HCC patients, particularly advanced-stage HCC patients.
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Affiliation(s)
- Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan,*Kazufumi Kobayashi,
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Translational Research and Development Center, Chiba University Hospital, Chiba, Japan,**Sadahisa Ogasawara,
| | - Aya Takahashi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuya Seko
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidemi Unozawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Rui Sato
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shunji Watanabe
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Michihisa Moriguchi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Morimoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenji Iwai
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Keita Ogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takamasa Ishino
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takafumi Sakuma
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoto Fujita
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masato Nakamura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Soichiro Kiyono
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Nakamoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuo Kanda
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kengo Nagashima
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan,Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norio Isoda
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshito Itoh
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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8
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Nagata H, Tsujimoto H, Horiguchi H, Sugasawa H, Kouzu K, Itazaki Y, Ishibashi Y, Tsuchiya S, Sugihara T, Ito N, Harada M, Nomura S, Kishi Y, Ueno H. Clinical Relevance of Tissue and Serum Human Epidermal Growth Factor Receptor 2 Expression in Patients With Esophageal Squamous Cell Carcinoma. J Surg Res 2021; 269:189-200. [PMID: 34583287 DOI: 10.1016/j.jss.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Serum and tissue human epidermal growth factor receptor 2 (HER2) levels were evaluated in resected esophageal squamous cell carcinoma (SCC) specimens to assess the relationship between HER2 expression and long-term prognosis. METHODS We included 95 patients who underwent esophagectomy for esophageal SCC. The serum HER2-extracellular domain (sHER2-ECD) levels were measured using an ELISA kit. A time-dependent receiver operating characteristics curve for censored survival outcomes was constructed to estimate the optimal cut-off value of sHER2-ECD (set at 4211 pg/mL). Immunohistochemical (IHC) staining was performed for HER2, and specimens were classified based on low (0 or 1+) or high HER2-IHC expression (2+ or 3+). RESULTS Patients with low sHER2-ECD levels showed poorly differentiated tumors, nodal involvement, and larger tumor size more frequently compared to patients with high sHER2-ECD levels. There were no differences in clinicopathological features based on HER2-IHC expression. Between patients with high and low HER2-IHC expression, the former group showed significantly higher sHER2-ECD levels. Patients with high sHER2-ECD levels had significantly favorable relapse-free survival (RFS) and overall survival (OS) compared to those with low sHER2-ECD levels. Conversely, patients with high HER2-IHC expression had significantly poorer RFS than did patients with low HER2-IHC expression, although no difference was observed in OS. Additionally, patients with high sHER2-ECD levels and low HER2-IHC expression had the highest OS and RFS among the patients studied. CONCLUSIONS The correlation among sHER2-ECD levels, HER2-IHC expression, and prognosis was demonstrated. Prospective studies are required to validate the impact of serum and tissue HER2 expression in esophageal SCC prognosis.
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Affiliation(s)
- Hiromi Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Takao Sugihara
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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9
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Itazaki Y, Tsujimoto H, Sugasawa H, Yaguchi Y, Nomura S, Ito N, Harada M, Sugihara T, Tsuchiya S, Ishibashi Y, Kouzu K, Kishi Y, Ueno H. Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis. Acta Med Okayama 2021; 74:521-524. [PMID: 33361872 DOI: 10.18926/amo/61211] [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] [Indexed: 11/03/2022]
Abstract
We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis.
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Affiliation(s)
| | | | | | | | | | - Nozomi Ito
- Department of Surgery, National Defense Medical College
| | - Manabu Harada
- Department of Surgery, National Defense Medical College
| | | | | | | | - Keita Kouzu
- Department of Surgery, National Defense Medical College
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College
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10
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Kobayashi K, Ogasawara S, Takahashi A, Seko Y, Tsuchiya S, Iwai K, Sato R, Watanabe S, Koroki K, Kanzaki H, Kanogawa N, Kondo T, Suzuki E, Chiba T, Arai M, Moriguchi M, Morimoto N, Aramaki T, Itoh Y, Kato N. Transition of molecular target agent therapy in advanced hepatocellular carcinoma: A multicenter, retrospective study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
317 Background: There have been considerable advances in systemic chemotherapy for hepatocellular carcinoma (HCC) in recent times. Currently, four molecular target agents (MTA) are available for HCC treatment in Japan. Sequential therapy using multiple MTAs is being considered as the gold standard of treatment. However, the effectiveness of the treatment strategy transition for HCC remains unclear. The present study aimed to clarify the current practical use of MTAs and its effectiveness in HCC treatment. Methods: In this multicenter, retrospective study, we collected and analyzed the clinical data of 877 patients who underwent MTA therapy for HCC from June 2009 to March 2019 at several institutes in Japan. The patients were classified into 3 groups as per the period of initial MTA treatment beginning (period 1: 2009–2012, n = 267; period 2: 2013–2016, n = 352; period 3: 2017–2019, n = 258). These 3 periods were defined to have approximately same term. Period 3 means the era of multiple MTAs because of the approval of regorafenib in Japan in 2017. We assessed the patient characteristics, MTA use, and prognosis of the 3 groups. Results: The proportion of patients with advanced-stage HCC, defined according to the Barcelona Clinic Liver Cancer staging system, in each period was 70.1%, 66.5%, and 62.0% in period 1, 2, and 3, respectively. MTA use for intermediate stages increased with the passage of time ( p = 0.052). The proportion of multiple MTAs use was remarkably increased in the 3 groups (1.1%, 10.2%, and 42.6%, respectively, p < 0.0001). Child-Pugh score, proportion of macrovascular invasion, extrahepatic metastasis, and α-fetoprotein (AFP) ≥400 ng/mL showed no significant difference among the 3 groups. The median overall survival was 11.9 months for the entire cohort and 10.4, 11.3, and 15.2 months, for period 1, 2, and 3, respectively. It is noteworthy that the prognosis of patients with HCC improved over time ( p = 0.016). With respect to progression-free survival, the median value was 3.0 months for the entire cohort and 2.7, 2.8, and 4.7 months for period 1, 2, and 3, respectively ( p < 0.0001). The treatment duration was also prolonged with time (2.7, 3.2, and 6.6 months for period 1, 2, and 3, respectively; p < 0.0001). Multivariate analysis using Cox proportional hazard model showed that HCV infection, Child-Pugh score, performance status, α-fetoprotein ≥400 ng/mL, presence of macrovascular invasion, and period 3 for initial MTA introduction were independent prognostic factors. Conclusions: Sequential therapy with multiple MTAs has gained popularity with time and is considered to improve patient prognosis. The development of MTA therapy for HCC is expected to continue. Therefore, further studies are needed to help determine the appropriate drugs, the sequence of MTA use, and the precise transition time.
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Affiliation(s)
- Kazufumi Kobayashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Aya Takahashi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuya Seko
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenji Iwai
- Division of Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Rui Sato
- Shizuoka Cancer Center, Shizuoka, Japan
| | - Shunji Watanabe
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Keisuke Koroki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroaki Kanzaki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takayuki Kondo
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michihisa Moriguchi
- Department of Gastroenterology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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11
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Hao K, Takahashi J, Kikuchi Y, Suda A, Sato K, Sugisawa J, Tsuchiya S, Shindo T, Nishimiya K, Ikeda S, Tsuburaya R, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Yasuda S, Shimokawa H. Prognostic Impacts of Comorbid Significant Coronary Stenosis and Coronary Artery Spasm in Patients With Stable Coronary Artery Disease. J Am Heart Assoc 2021; 10:e017831. [PMID: 33455423 PMCID: PMC7955295 DOI: 10.1161/jaha.120.017831] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Stable coronary artery disease is caused by a variable combination of organic coronary stenosis and functional coronary abnormalities, such as coronary artery spasm. Thus, we examined the clinical importance of comorbid significant coronary stenosis and coronary spasm. METHODS AND RESULTS We enrolled 236 consecutive patients with suspected angina who underwent acetylcholine provocation testing for coronary spasm and fractional flow reserve (FFR) measurement. Among them, 175 patients were diagnosed as having vasospastic angina (VSA), whereas the remaining 61 had no VSA (non-VSA group). The patients with VSA were further divided into the following 3 groups based on angiography and FFR: no organic stenosis (≤50% luminal stenosis; VSA-alone group, n=110), insignificant stenosis of FFR>0.80 (high-FFR group, n=36), and significant stenosis of FFR≤0.80 (low-FFR group, n=29). The incidence of major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, urgent percutaneous coronary intervention, and hospitalization attributed to unstable angina was evaluated. All patients with VSA received calcium channel blockers, and 28 patients (95%) in the low-FFR group underwent a planned percutaneous coronary intervention. During a median follow-up period of 656 days, although the incidence of major adverse cardiovascular events was low and comparable among non-VSA, VSA-alone, and high-FFR groups, the low-FFR group had an extremely poor prognosis (non-VSA group, 1.6%; VSA-alone group, 3.6%; high-FFR group, 5.6%; low-FFR group, 27.6%) (P<0.001). Importantly, all 8 patients with major adverse cardiovascular events in the low-FFR group were appropriately treated with percutaneous coronary intervention and calcium channel blockers. CONCLUSIONS These results indicate that patients with VSA with significant coronary stenosis represent a high-risk population despite current guideline-recommended therapies, suggesting the importance of routine coronary functional testing in this population.
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Takahashi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yoku Kikuchi
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Akira Suda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Koichi Sato
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Jun Sugisawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Tsuchiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Tomohiko Shindo
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Kensuke Nishimiya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Shohei Ikeda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Ryuji Tsuburaya
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Takashi Shiroto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuharu Matsumoto
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Miyata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Yasuhiko Sakata
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Satoshi Yasuda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroaki Shimokawa
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
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12
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Nagata H, Tsujimoto H, Kouzu K, Itazaki Y, Ishibashi Y, Tsuchiya S, Sugihara T, Ito N, Harada M, Nomura S, Kishi Y, Ueno H. Differences Between Laparoscopic and Open Gastrectomy on the Impact of Postoperative Infectious Complications on Prognosis. Anticancer Res 2020; 40:7109-7117. [PMID: 33288610 DOI: 10.21873/anticanres.14740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the impact of laparoscopic gastrectomy (LG) for gastric cancer on long-term survival in patients with postoperative infectious complications (PIC). PATIENTS AND METHODS A total of 608 patients who underwent gastrectomy were classified into two groups based on the surgical approach: LG (385 patients) and open gastrectomy (OG: 211 patients). Long-term survival after gastrectomy was compared between patients with and without PIC in both LG and OG groups. RESULTS Although the patients with PIC in OG group tended to have worse overall survival (OS) than those without PIC, the OS was not significantly different between the patients with and without PIC in LG group. Although multivariate analysis demonstrated that nodal involvement and PIC were significantly associated with OS in OG group, age and tumor depth, and not PIC, were associated with OS in LG group. CONCLUSION PIC were negative predictors of clinical outcomes in patients with gastric cancer, particularly those who underwent OG, and long-term prognosis may be impacted less by PIC in patients undergoing LG.
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Affiliation(s)
- Hiromi Nagata
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hironori Tsujimoto
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Keita Kouzu
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yujiro Itazaki
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Ishibashi
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tsuchiya
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Takao Sugihara
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Nozomi Ito
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Manabu Harada
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shinsuke Nomura
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoji Kishi
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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13
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Sugisawa J, Matsumoto Y, Takeuchi M, Suda A, Tsuchiya S, Ohyama K, Nishimiya K, Akizuki M, Sato K, Ohura S, Ota H, Ikeda S, Shindo T, Kikuchi Y, Hao K, Shiroto T, Takahashi J, Miyata S, Sakata Y, Takase K, Kohzuki M, Shimokawa H. Beneficial effects of exercise training on physical performance in patients with vasospastic angina. Int J Cardiol 2020; 328:14-21. [PMID: 33309635 DOI: 10.1016/j.ijcard.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/23/2020] [Revised: 11/04/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022]
Abstract
AIMS In vasospastic angina (VSA), coronary vasomotion abnormalities could develop not only in epicardial coronary arteries but also in coronary microvessels, where calcium channel blockers (CCBs) have limited efficacy. However, efficacy of exercise training for VSA remains to be elucidated. We thus aimed to examine whether vasodilator capacity of coronary microvessels is impaired in VSA patients, and if so, whether exercise exerts beneficial effects on the top of CCBs. METHODS We performed 2 clinical protocols. In the protocol 1, we measured myocardial blood flow (MBF) using adenosine-stress dynamic computed tomography perfusion (CTP) in 38 consecutive VSA patients and 17 non-VSA controls. In the protocol 2, we conducted randomized controlled trial, where 20 VSA patients were randomly assigned to either 3-month exercise training group (Exercise group) or Non-Exercise group (n= 10 each). RESULTS In the protocol 1, MBF on CTP was significantly decreased in the VSA group compared with the Non-VSA group (138 ± 6 vs 166 ± 10 ml/100 g/min, P = 0.02). In the protocol 2, exercise capacity was significantly increased in the Exercise group than in the Non-Exercise group (11.5 ± 0.5 to 15.4 ± 1.8 vs 12.6 ± 0.7 to 14.0 ± 0.8 ml/min/kg, P < 0.01). MBF was also significantly improved after 3 months only in the Exercise group (Exercise group, 145 ± 12 to 172 ± 8 ml/100 g/min, P < 0.04; Non-Exercise group, 143 ± 14 to 167 ± 8 ml/100 g/min, P = 0.11), although there were no significant between-group differences. CONCLUSIONS These results provide the first evidence that, in VSA patients, exercise training on the top of CCBs treatment may be useful to improve physical performance, although its effect on MBF may be minimal.
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Affiliation(s)
- Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Takeuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mina Akizuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shoko Ohura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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14
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Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Itazaki Y, Tsuchiya S, Kishi Y, Ueno H. Impact of postoperative reduced skeletal muscle on prognosis after recurrence in gastric cancer. Mol Clin Oncol 2020; 14:3. [PMID: 33235731 PMCID: PMC7678615 DOI: 10.3892/mco.2020.2165] [Citation(s) in RCA: 2] [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: 03/11/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
Little is known about the association between sarcopenia development after gastrectomy and gastric cancer prognosis after recurrence. The present study retrospectively examined the effects of decreased psoas muscle index (PMI) on post-recurrence prognosis after gastrectomy. A total of 67 patients with gastric cancer recurrence were included in the present study. PMI at pre-operation and recurrence were calculated, and 25 patients whose PMI reduction rate value was lower than the cutoff values (male=0.766 and female=0.704) were classified into the sarcopenia group and 42 patients into the non-sarcopenia group. There were no significant differences between the groups regarding age, sex, pathological stage, and nutrition and inflammation indices at the time of recurrence. Post-recurrence overall survival (OS) was significantly shorter in the sarcopenia group compared with the non-sarcopenia group (P<0.001). The post-recurrence survival rate was significantly worse in the sarcopenia group compared with the non-sarcopenia group (P<0.001). In multivariate analysis, sarcopenia (HR=5.04) and the total courses of chemotherapy after recurrence (HR=3.88) were independent unfavorable prognostic factors. In conclusion, sarcopenia and fewer total courses of post-recurrence chemotherapy were poor prognostic factors after gastric cancer recurrence. To improve prognosis, preventing sarcopenia development after gastrectomy is required.
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Affiliation(s)
- Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-0042, Japan
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15
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Watanabe T, Matsumoto Y, Amamizu H, Morosawa S, Ohyama K, Sugisawa J, Tsuchiya S, Sato K, Shindo T, Nishimiya K, Watanabe-Asaka T, Hayashi M, Kawai Y, Shimokawa H. A novel therapeutic approach for coronary inflammation and lymphatic vessels using non-invasive low-intensity pulsed ultrasound in a porcine model with DES-induced coronary hyperconstricting responses. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1421] [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: 11/13/2022] Open
Abstract
Abstract
Background
The coronary adventitia harbors lymphatic vessels (LVs). We previously demonstrated that coronary adventitial inflammation and LV dysfunction play important roles in the pathogenesis of coronary artery spasm, including drug-eluting stent (DES)-induced coronary hyperconstricting responses, in pigs and humans. However, a direct therapeutic approach to the coronary adventitia remains to be developed.
Purpose
In this study, we aimed to examine whether our novel and non-invasive therapy with low-intensity pulsed ultrasound (LIPUS) ameliorates DES-induced coronary hyperconstricting responses, and if so, what mechanisms are involved.
Methods
An everolimus-eluting stent (EES) was implanted into the left anterior descending (LAD) coronary artery in normal male pigs. They were randomly assigned to the LIPUS or the sham therapy groups. After EES implantation, in the LIPUS group, LIPUS (32 cycles, 193 mW/cm2) was applied to the heart at 3 different levels (proximal and distal stent edges and middle portion of the stent) through X-ray fluoroscopy for 20 min at each level for every other day for 2 weeks (6 days in total) (Fig. 1A, B). The sham therapy group was treated in the same manner but without LIPUS. At 4 weeks after the procedure, we performed coronary angiography to examine coronary vasoconstricting responses to intracoronary serotonin in vivo. Finally, stented coronary vessels were harvested for immunohistochemistry of vasa vasorum (vWF), LVs (LYVE-1), vascular inflammation (CD68-positive macrophages and IL-1β expression), vascular endothelial growth factor A (VEGF-A, angiogenesis marker), VEGF-C and VEGF receptor 3 (VEGFR3, lymphangiogenesis markers).
Results
Coronary vasoconstricting responses to intracoronary serotonin at the DES edges in the LAD were significantly enhanced in the sham group but were significantly suppressed in the LIPUS group, while those responses were comparable at the non-DES implanted left circumflex (LCx) coronary artery between the 2 groups (Fig. 1C, D). In addition, in vivo lymph transport speed was significantly faster in the LIPUS group than in the sham group (Fig. 1E–G). In histological analysis, the number of LVs was significantly increased in the LIPUS group compared with the sham group, whereas those of CD68 and IL-1β expressions were significantly reduced in the LIPUS group compared with the sham group. In contrast, the density of vasa vasorum was comparable between the 2 groups. Mechanistically, the extents of VEGF-C and VEGFR3 expressions were increased in the LIPUS group, whereas that of VEGF-A was comparable between the 2 groups (Fig. 1G–K). Importantly, there were significant correlations among the LV-related changes and enhanced coronary vasoconstricting responses.
Conclusion
These results provide the first evidence that the LIPUS therapy ameliorates DES-induced coronary hyperconstricting responses in pigs in vivo through structural and functional alterations of LVs (Fig. 1L).
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Watanabe
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Amamizu
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Morosawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Nishimiya
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Watanabe-Asaka
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - M Hayashi
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - Y Kawai
- Tohoku Medical and Pharmaceutical University, Physiology, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
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Moriguchi M, Aramaki T, Sato R, Iwai K, Tsuchiya S, Asakura K, Takahashi A, Seko Y, Umemura A, Ymaguchi K, Endo M, Itoh Y. Intrahepatic Tumor Burden as a Novel Factor Influencing the Introduction of Second-line Chemotherapy for Hepatocellular Carcinoma. Anticancer Res 2020; 40:3953-3960. [PMID: 32620637 DOI: 10.21873/anticanres.14387] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To examine the factors influencing the introduction of the second-line chemotherapy and discuss the selection of first-line agent for hepatocellular carcinoma (HCC). PATIENTS AND METHODS We retrospectively studied 154 patients with HCC who received sorafenib therapy. RESULTS A total of 109 (70.8%) patients, maintained Child-Pugh grade A and Eastern Cooperative Oncology Group performance status (ECOG-PS) ≤1 upon sorafenib discontinuation. Multivariate analysis revealed that the up-to-seven criteria status in the hepatic lesion [p=0.019; odds ratio=OR, 2.685], albumin-bilirubin (ALBI) grade (p=0.002; OR=3.589), and macroscopic vascular invasion (MVI) (p=0.008; OR=2.972) were significant factors at sorafenib initiation that influenced the maintenance of Child-Pugh grade A and ECOG-PS ≤1 upon therapy discontinuation. CONCLUSION Not only ALBI grade and MVI, but also up-to-seven criteria status in the hepatic lesion influence the introduction of second-line therapy, and could affect the selection of the first-line therapy.
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Affiliation(s)
- Michihisa Moriguchi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan .,Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Rui Sato
- Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Kenji Iwai
- Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Koiku Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Aya Takahashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuya Seko
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Umemura
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kanji Ymaguchi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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17
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Ishibashi Y, Tsujimoto H, Kouzu K, Itazaki Y, Tsuchiya S, Fujishima S, Yaguchi Y, Sugasawa H, Nomura S, Ito N, Harada M, Nagata H, Shinto E, Kishi Y, Ueno H. Impact of Antiplatelet and Anticoagulant Therapies on Platelet-related Prognostic Markers in Patients With Esophageal Cancer. In Vivo 2020; 34:1941-1949. [PMID: 32606166 PMCID: PMC7439896 DOI: 10.21873/invivo.11991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND/AIM In recent years, platelet-related markers were recognized as useful prognostic factors in various malignancies. We investigated the relationship between platelet-related prognostic markers and anti-platelet or anti-coagulant therapies for survival outcomes in esophageal squamous cell carcinoma. PATIENTS AND METHODS Preoperative platelet-related prognostic markers were evaluated from peripheral blood testing and statistical analyses were performed to evaluate the prognostic value of these markers and reveal the effects of antiplatelets and/or anticoagulants regarding their prognostic relevance. RESULTS In all 176 patients, preoperative platelet-to-lymphocyte ratio (PLR) was not found to be a predictor of overall survival (OS). However, in patients without antiplatelet or anticoagulant therapies, PLR was significantly associated with a poor OS (p=0.03). Although platelet large cell ratio (P-LCR) was not associated with the prognosis in patients with antiplatelet and/or anticoagulant therapies, higher P-LCR was associated with a poor prognosis in patients without antiplatelet or anticoagulant therapies (p<0.0001). CONCLUSION Researching detailed antiplatelet and anticoagulant therapies could reinforce the prognostic value of platelet-related prognostic markers in ESCC.
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Affiliation(s)
- Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | | | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | | | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Hiromi Nagata
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
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18
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Tsujimoto H, Horiguchi H, Takahata R, Ono S, Yaguchi Y, Nomura S, Ito N, Harada M, Nagata H, Ishibashi Y, Kouzu K, Tsuchiya S, Itazaki Y, Fujishima S, Kishi Y, Ueno H. Impact of perioperative high mobility group box chromosomal protein 1 expression on long-term outcomes in patients with esophageal squamous cell carcinoma. J Gastroenterol Hepatol 2020; 35:788-794. [PMID: 31498489 DOI: 10.1111/jgh.14854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM High mobility group box chromosomal protein-1 (HMGB-1) is a potential late mediator of sepsis and a possible risk factor for postoperative pulmonary complications after esophagectomy. This study aimed to determine the relationship between HMGB-1 and clinicopathological factors and long-term prognosis after esophagectomy for esophageal cancer. METHODS We measured perioperative serum HMGB-1 levels using ELISA and HMGB-1 protein by immunohistochemistry expression in resected specimens. RESULTS Postoperative serum HMGB-1 levels were significantly higher than preoperative levels. Preoperative serum HMGB-1 levels were significantly higher in patients with more intraoperative bleeding, longer intensive care unit stays, and postoperative pneumonia. Postoperative serum HMGB-1 levels were significantly higher in older patients and those with longer operation time and more intraoperative bleeding. There were significant differences in long-term outcomes according to postoperative but not preoperative serum HMGB-1 levels. Multivariate analysis demonstrated that advanced pathological stage, postoperative pulmonary complications, and higher postoperative serum HMGB-1 levels were independently associated with relapse-free survival and overall survival. Preoperative serum HMGB-1 levels were significantly higher in patients with high HMGB-1 expression than those with low HMGB-1 expression by immunohistochemistry, whereas such statistical differences were not observed in postoperative serum HMGB-1. There were no differences in relapse-free survival and overall survival according to HMGB-1 expression by immunohistochemistry. Serum HMGB-1 levels were significantly increased after esophagectomy for esophageal cancer. CONCLUSION Elevated postoperative serum HMGB-1, which was associated not only with poor long-term but also short-term outcomes such as postoperative complications, might serve as a potential marker for prognosis in esophageal cancer.
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Risa Takahata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Ono
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hiromi Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | | | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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19
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Ohura-Kajitani S, Shiroto T, Godo S, Ikumi Y, Ito A, Tanaka S, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Hao K, Kikuchi Y, Nochioka K, Matsumoto Y, Takahashi J, Miyata S, Shimokawa H. Marked Impairment of Endothelium-Dependent Digital Vasodilatations in Patients With Microvascular Angina. Arterioscler Thromb Vasc Biol 2020; 40:1400-1412. [DOI: 10.1161/atvbaha.119.313704] [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] [Indexed: 02/06/2023]
Abstract
Objective:
It remains to be elucidated whether and how endothelial functions are impaired in peripheral circulation of patients with coronary functional disorders, such as vasospastic angina (VSA) and microvascular angina (MVA). We simultaneously examined endothelial functions of peripheral conduit and resistance arteries in patients with coronary functional disorders, with a special reference to NO and endothelium-dependent hyperpolarization factors.
Approach and Results:
Based on the results of invasive coronary acetylcholine testing and coronary physiological measurements, we divided 43 patients into 3 groups; VSA, MVA, and VSA+MVA. Endothelium-dependent vasodilatations of the brachial artery and fingertip arterioles to intra-arterial infusion of bradykinin were simultaneously evaluated by ultrasonography and peripheral arterial tonometry, respectively. To assess NO and endothelium-dependent hyperpolarization factors, measurements were repeated after oral aspirin and intra-arterial infusion of N
G
-monomethyl-L-arginine. Additionally, endothelium-independent vasodilatations to sublingual nitroglycerin and plasma levels of biomarkers for endothelial functions were measured. Surprisingly, digital vasodilatations to bradykinin were almost absent in patients with MVA alone and those with VSA+MVA compared with those with VSA alone. Mechanistically, both NO- and endothelium-dependent hyperpolarization–mediated digital vasodilatations were markedly impaired in patients with MVA alone. In contrast, endothelium-independent vasodilatations to nitroglycerin were comparable among the 3 groups. Plasma levels of soluble VCAM (vascular cell adhesion molecule)-1 were significantly higher in patients with MVA alone compared with those with VSA alone.
Conclusions:
These results provide the first evidence that both NO- and endothelium-dependent hyperpolarization–mediated digital vasodilatations are markedly impaired in MVA patients, suggesting that MVA is a cardiac manifestation of the systemic small artery disease.
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Affiliation(s)
- Shoko Ohura-Kajitani
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigeo Godo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Ikumi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiyo Ito
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuhei Tanaka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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20
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Tsuchiya S, Matsumoto Y, Suzuki H, Takanami K, Kikuchi Y, Takahashi J, Miyata S, Tomita N, Kumagai K, Taki Y, Saiki Y, Arai H, Shimokawa H. Transcatheter aortic valve implantation and cognitive function in elderly patients with severe aortic stenosis. EUROINTERVENTION 2020; 15:e1580-e1587. [PMID: 31951203 DOI: 10.4244/eij-d-19-00489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/23/2022]
Abstract
AIMS The aim of this study was to examine the mechanisms of cognitive impairment and reversibility in elderly patients with severe aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI) with special reference to cerebral blood flow (CBF). METHODS AND RESULTS We examined 15 elderly patients with severe AS (mean age 83.2±4.5 years, 12 female) who underwent TAVI. Before and three months after TAVI, we evaluated cognitive function with the Logical Memory II test (LM II), cardiac output (CO) with echocardiography, and CBF with 99mTc single-photon emission computed tomography (SPECT). LM II score and CO were significantly increased after TAVI compared with baseline (p<0.01 for LM II, p<0.005 for CO). Notably, CBF in the local regions, including that in the right hippocampus, was significantly increased after TAVI (p<0.005 at each voxel). The patients with increased CO after TAVI also showed significantly increased CBF in the right hippocampus compared with those without it (p<0.01). Importantly, CBF in the right hippocampus was positively correlated with LM II scores (p<0.05). CONCLUSIONS These results provide the first evidence that TAVI may improve cognitive functions associated with increased cerebral perfusion especially in the hippocampus in elderly patients with severe AS.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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21
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Kouzu K, Tsujimoto H, Nishikawa M, Harada M, Sugihara T, Nagata H, Hiraki S, Yaguchi Y, Takahata R, Nomura S, Ito N, Ishibashi Y, Itazaki Y, Tsuchiya S, Hase K, Kishi Y, Ueno H. Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer. Gastric Cancer 2020; 23:356-362. [PMID: 31555950 DOI: 10.1007/s10120-019-01009-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/15/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) refers to hepatic steatosis caused by something other than alcoholic liver injury, and often occurs after gastrointestinal surgeries such as pancreatoduodenectomy and gastrectomy. This study aimed to identify the risk factors for NAFLD after gastrectomy for gastric cancer. METHODS A total of 721 patients who underwent gastrectomy for gastric cancer and plane abdominal computed tomography (CT) preoperatively and 1 year after surgery were included in this study. NAFLD was defined as having a mean hepatic CT attenuation value of < 40 Hounsfield units. We retrospectively examined the relationship between the onset of NAFLD and clinicopathological findings to identify the risk factors associated with the development of NAFLD after gastrectomy. RESULTS The incidence of postoperative NAFLD was 4.85% (35/721). The univariate analysis identified the following factors as being significantly associated with the incidence of NAFLD: age, preoperative BMI ≥ 25 kg/m2, tumor depth of pT3 ≤, lymph node metastasis grade of pN2 ≤, cholecystectomy, D2 lymphadenectomy, adjuvant chemotherapy, high preoperative cholinesterase serum level, and low grade of preoperative FIB-4 index. Adjuvant chemotherapy (p < 0.001) and high preoperative cholinesterase serum level (p = 0.021) were identified as independent risk factors for NAFLD 1 year after gastrectomy. CONCLUSION Our study showed that adjuvant chemotherapy with S-1 and high level of serum cholinesterase were considered as the risk factors for NAFLD occurring after gastrectomy for gastric cancer.
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Affiliation(s)
- Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
| | - Makoto Nishikawa
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Takao Sugihara
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hiromi Nagata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Risa Takahata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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22
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Tsuchiya S, Saiga A, Yokota H, Kubota Y, Wada T, Akutsu A, Horikoshi T, Uno T. Abstract No. 402 Prophylactic steroids for preventing post embolization syndrome after transcatheter arterial embolization for renal angiomyolipoma. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.463] [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: 10/25/2022] Open
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23
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Tsuchiya S, Saiga A, Yokota H, Nishiyama A, Kubota Y, Horikoshi T, Uno T. Hemoptysis Due to Type II Endoleak after Thoracic Endovascular Aortic Repair: Successful Treatment with Percutaneous CT-Guided Embolization. Interventional Radiology 2020; 5:23-26. [PMID: 36284834 PMCID: PMC9550394 DOI: 10.22575/interventionalradiology.2019-0005] [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] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/25/2019] [Indexed: 11/02/2022]
Abstract
An 81-year-old woman presented with massive hemoptysis. She had a history of total arch replacement with an elephant trunk followed by concomitant antegrade thoracic endovascular aortic repair for the aortic arch and the descending aortic aneurysm. Computed tomography (CT) showed expansion of the aortic aneurysm with type II endoleak, lung parenchymal consolidation, and ground-glass opacity. An aortopulmonary fistula was suspected. Surgery posed a very high risk for the patient; hence, a less invasive approach was considered. Left subclavian arteriography revealed a type II endoleak. A transarterial approach would be difficult due to the small and tortuous access route and longer procedure time. Therefore, CT-guided puncture embolization was performed. She had no recurrence of hemoptysis for 1.4 years after the embolization.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
| | | | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
| | | | | | | | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University
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24
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Nagata H, Tsujimoto H, Yaguchi Y, Kouzu K, Itazaki Y, Ishibashi Y, Tsuchiya S, Sugihara T, Ito N, Harada M, Nomura S, Utsumi Y, Shimazaki H, Kishi Y, Ueno H. Mixed adenoneuroendocrine carcinoma with loss of HER2 positivity after trastuzumab-based chemotherapy for HER2-positive gastric cancer: a case report. Surg Case Rep 2020; 6:5. [PMID: 31916037 PMCID: PMC6949340 DOI: 10.1186/s40792-020-0774-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Trastuzumab (T-mab)-based chemotherapy is a standard regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. However, some patients have demonstrated a change in HER2 status after T-mab-based treatment of breast cancer. We report a rare case of mixed adenoneuroendocrine carcinoma with loss of HER2 positivity after T-mab-based chemotherapy for HER2-positive gastric cancer. CASE PRESENTATION A 60-year-old man presented with a mass of the upper abdomen, which was diagnosed as adenocarcinoma with a HER2 score of 3+ by endoscopic biopsy. He received seven cycles of combination chemotherapy with capecitabine, cisplatin, and T-mab. Subsequently, he underwent open total gastrectomy, distal pancreatosplenectomy, and extended left hepatic lobectomy as a conversion surgery. The surgically resected specimen demonstrated both adenocarcinoma and neuroendocrine components; therefore, it was diagnosed as HER2-negative mixed adenoneuroendocrine carcinoma. Although the patient received additional chemotherapy, multiple liver metastases appeared at 3 months postoperatively and he died at 6 months postoperatively because of the rapidly progressing metastatic tumor. CONCLUSIONS We encountered a rare case of rapidly progressive mixed adenoneuroendocrine carcinoma that was negative for HER2 expression after T-mab treatment combined with chemotherapy.
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Affiliation(s)
- Hiromi Nagata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Takao Sugihara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yoshitaka Utsumi
- Department of Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Hideyuki Shimazaki
- Department of Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513 Japan
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Ishibashi Y, Tsujimoto H, Hiraki S, Kouzu K, Tsuchiya S, Itazaki Y, Yaguchi Y, Horiguchi H, Nomura S, Ito N, Shinto E, Kishi Y, Ueno H. Predictive value of immuno-inflammatory and nutritional measures modulated by neoadjuvant chemotherapy on the response of neoadjuvant chemotherapy and long-term outcomes in patients with esophageal cancer. Oncol Lett 2019; 19:487-497. [PMID: 31897162 PMCID: PMC6924116 DOI: 10.3892/ol.2019.11122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/25/2019] [Accepted: 11/08/2019] [Indexed: 01/08/2023] Open
Abstract
It has been reported that immuno-inflammatory and nutritional parameters are associated with long-term survival in various malignancies. However, little is known regarding the associations between alterations of these parameters during neoadjuvant chemotherapy (NAC) and the response to NAC in patients with esophageal cancer. The present study examined the clinical significance of alterations in these parameters during NAC in terms of the response to NAC and the long-term outcomes in patients with esophageal cancer. Various systemic immuno-inflammatory and nutritional measures including the systemic neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR) and psoas muscle index (PMI) were examined before and after NAC. Statistical analyses were performed to determine the significance of immuno-inflammatory and nutritional parameters prior to NAC and alterations during NAC regarding the response to NAC and long-term outcomes. The NLR, PMI, neutrophil count and platelet count declined significantly following NAC, whereas no alterations in PLR, CAR, lymphocyte counts, CRP levels and albumin concentration were observed. The decreases in NLR and neutrophil counts following NAC were strongly associated with a favorable overall survival (P=0.006). In conclusion, decreases in NLR and neutrophil counts following NAC were clinically significant predictors of the response to NAC and of survival in esophageal cancer, respectively.
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Affiliation(s)
- Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Kikuchi Y, Takahashi J, Hao K, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Shiroto T, Matsumoto Y, Miyata S, Sakata Y, Shimokawa H. Usefulness of intracoronary administration of fasudil, a selective Rho-kinase inhibitor, for PCI-related refractory myocardial ischemia. Int J Cardiol 2019; 297:8-13. [PMID: 31611086 DOI: 10.1016/j.ijcard.2019.09.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intra-procedural myocardial ischemia as an iatrogenic complication still remains a critical issue in contemporary interventional cardiology. The aim of this study was to examine the usefulness of fasudil, a selective Rho-kinase inhibitor, for percutaneous coronary intervention (PCI)-related myocardial ischemia. METHODS Among 448 PCI sessions performed between October 2015 and December 2017, we retrospectively examined 36 patients (69.0 ± 9.1 [SD] yrs., M/F 26/10) who underwent intracoronary administration of fasudil during a procedure to resolve myocardial ischemia that was resistant to intracoronary nitrate administration. RESULTS The refractory myocardial ischemia was caused by distal embolization (69%), enhanced vasoconstriction at distal site of chronic total occlusion (11%), coronary spasm (11%), and coronary dissection (8%), most of which occurred immediately after balloon or stent dilatation. Intracoronary fasudil significantly improved corrected TIMI frame count (from 37 [30-56] to 24 [12-36]) and TIMI flow grade (from 2 [1-2.5] to 3 [2-3]) (both P < 0.001). Finally, 86% of all subjects successfully obtained TIMI flow grade 3 at the end of the procedure. Intracoronary fasudil tended to be more effective in patients with an attenuated plaque detected by intravascular ultrasound. Importantly, among the 19 elective cases, fasudil successfully prevented 17 patients from developing post-procedure myocardial infarction. Although fasudil-induced transient hypotension requiring a vasopressor was noted in 22% of the subjects, no other adverse effects were noted. CONCLUSIONS These results indicate that fasudil is a useful and safe therapeutic option for PCI-related myocardial ischemia refractory intracoronary nitrate.
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Affiliation(s)
- Yoku Kikuchi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Sato
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Ikeda
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Departments of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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27
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Tsuchiya S, Matsumoto Y, Suzuki H, Kikuchi Y, Sugisawa J, Shindo T, Hao K, Takeuchi M, Takahashi J, Kumagai K, Wagatsuma T, Saiki Y, Shimokawa H. 92Transcatheter aortic valve implantation improves cerebral blood flow and cognitive function in elderly patients with aortic stenosis - Brain perfusion SPECT imaging study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cognitive impairment and depression are commonly noted in elderly frail patients with severe aortic stenosis (AS). However, their mechanisms and reversibility after treatment remain remain to be examined.
Purpose
In this study, we examined whether transcatheter aortic valve implantation (TAVI) increases cerebral blood flow (CBF) in cognitive/emotional brain areas, such as the hippocampus, in the elderly patients with severe AS.
Methods
We examined consecutive 15 right-handed patients with severe AS who were eligible for TAVI (median age 83.2 years, 12 (80%) women). We evaluated the following assessments both at baseline and 3 months after TAVI. Frailty was evaluated based on Fried scale, which consists of 5 items, including gait speed, cognitive function, weight loss, exhaustion, and inactivity. Frail and pre-frail were defined as greater than 3 and 1∼2 in the scale, respectively. Cognitive and emotional status were evaluated with Logical Memory (LM) II, Mini Mental State Examination (MMSE), and geriatric depression scale (GDS). Lower LM II (less than 4 points) and MMSE (less than 24 points) and higher GDS (more than 6 points) indicate worse memory, general cognitive function, and depressive symptoms, respectively. CBF images were recorded with 99mTc single-photon emission computed tomography and were analyzed using SPM12. Briefly, CBF images were firstly normalized to the standard Montreal Neurological Institute space. Then, a voxel-wise parametric analysis was conducted between normalized CBF images at baseline and those after TAVI (P<0.005 at each voxel). Continuous variables were presented as mean ± standard error (SE). Normality was assessed using the Shapiro-Wilk test. Continuous variables were compared with the use of paired t test. Linear mixed-model analysis was performed to evaluate changes in neuropsychological tests and CBF over time.
Results
In the present study, all patients were not robust but pre-frail (47.3%) or frail (53.7%). LM II score was significantly improved at 3 months after TAVI compared with baseline (baseline, 8.7 vs. 3 months, 13.8, P<0.01) (Figure A), whereas no significant changes in MMSE or GDS scores were noted (baseline, 24.6 vs. 3 months, 25.2 for MMSE; baseline, 4.3 vs. 3 months, 4.2 for GDS). Importantly, although no patients showed clinical symptoms or signs for transient ischemic attack or stroke after TAVI, CBF in the local regions, including the right hippocampus, was significantly increased after TAVI compared with baseline (P<0.005 at each voxel) (green arrowheads) (Figure B). Furthermore, CBF in the right hippocampus were positively correlated with LM II scores (P=0.017) (Figure C).
Figure 1
Conclusions
These results provide the first evidence that TAVI improves cerebral perfusion (especially that in the hippocampus) and cognitive functions in elderly patients with severe AS.
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Affiliation(s)
- S Tsuchiya
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - H Suzuki
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Kumagai
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - T Wagatsuma
- Tohoku University Graduate School of Medicine, Anesthesiology and Perioperative Medicine, Sendai, Japan
| | - Y Saiki
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
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Hao K, Takahashi J, Suda A, Sato K, Sugisawa J, Tsuchiya S, Shindo T, Ikeda S, Kikuchi Y, Shiroto T, Matsumoto Y, Sakata Y, Shimokawa H. P3575Clinical importance of fractional flow reserve in patients with organic coronary stenosis and vasospastic angina. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Vasospastic angina (VSA), which is one of the important functional cardiac disorders, may also play a role in the pathogenesis of atherosclerosis. Conversely, organic coronary stenosis is also known as an independent predictor for poor clinical outcomes in VSA patients. Although VSA patients have a variable degree of organic coronary stenosis in clinical setting, the functional importance of organic stenosis in those patients remains to be elucidated.
Purpose
The aim of this study was to examine the clinical importance and prognostic impact of fractional flow reserve (FFR) in patients with VSA and organic coronary stenosis.
Methods
We enrolled 236 consecutive patients with suspected vasospastic angina who underwent acetylcholine provocation test for coronary spasm (M/F 148/88, 63.6±12.0 [SD] yrs.). Among them, 175 patients (74.1%) were diagnosed as having VSA, while the remaining non-VSA patients were regarded as controls (Group-C, n=61). We divided the VSA patients into 3 groups based on angiographical findings and FFR values; VSA with no organic stenosis (>50% luminal stenosis) (Group-N, n=110), organic stenosis and high FFR (≥0.80) (Group-H, FFR 0.87±0.05, n=36), and organic stenosis and low FFR (<0.80) (Group-L, FFR 0.71±0.07, n=29). We evaluated the incidence of major adverse cardiovascular events (MACE), including cardiovascular death (CVD), non-fatal myocardial infarction (MI), urgent percutaneous coronary intervention (PCI), and hospitalization due to unstable angina pectoris (UAP) during the median follow-up period of 656 days.
Results
The groups with organic stenosis (Groups H and L) were characterized by higher prevalence of diabetes mellitus (Group-C/N/H/L, 23.0/20.9/44.4/34.5%, P=0.03) and dyslipidemia (Group-C/N/H/L, 37.7/39.1/50.0/65.5%, P=0.03) as compared with Group-C. After provocation test, all VSA patients received calcium channel blockers (CCBs). In addition, 20 days (median) after provocation test, 26 patients (92.9%) in Group-L underwent elective PCI with coronary stents, while no patient underwent PCI in Groups N or H. The incidence of MACE during follow-up was significantly higher in Group-L (Group-C/N/H/L; 1.6/3.6/5.6/27.6%, log-rank P<0.001), whereas clinical outcomes were comparable among the remaining 3 groups (Figure). Importantly, all 8 patients with MACE in Group-L had poor outcomes (CVD/MI/urgent PCI/UAP; 2/1/3/2) despite complete revascularization and the prevention of coronary spasm with CCBs, indicating that they might be resistant to standard contemporary therapies. They were characterized by less frequent use of angiotensin convert enzyme inhibitor (0 vs. 47.6%, P=0.02) and higher prevalence of multi-vessel organic lesions (37.5 vs. 4.8%, P=0.052) compared with those without MACE.
Figure 1
Conclusions
These results provide the first evidence that evaluation of coronary functional abnormalities with FFR is useful for making therapeutic strategies in VSA patients with organic coronary stenosis.
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Affiliation(s)
- K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shiroto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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29
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Sugisawa J, Matsumoto Y, Suda A, Ota H, Tsuchiya S, Ohyama K, Takeuchi M, Shindo T, Ikeda S, Hao K, Kikuchi Y, Takahashi J, Takase K, Kohzuki M, Shimokawa H. 3332Exercise training ameliorates vasodilator capacity of coronary microvessels in patients with vasospastic angina - A new therapeutic approach for the coronary functional disorder. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0084] [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: 11/12/2022] Open
Abstract
Abstract
Background
We have recently demonstrated that coronary vasospasm could develop in both epicardial coronary arteries and intramuscular coronary microvessels in patients with vasospastic angina (VSA). However, it remains to be examined whether vasodilator capacity of coronary microvessels is impaired in VSA patients and if so, whether exercise training could ameliorate vasodilator capacity of coronary microvessels on the top of calcium channel blockers. The effectiveness of exercise training is established for organic coronary artery disease but remained to be examined for VSA.
Purpose
We thus examined whether vasodilator capacity of coronary microvessels is impaired in VSA patients without organic coronary stenosis using an adenosine-stress dynamic computed tomography perfusion (CTP) that can measure absolute value of myocardial blood flow (MBF). We also examined whether exercise training ameliorates not only vasodilator capacity of coronary microvessels but also exercise capacity and frequency of angina attack.
Methods
In the first protocol, we measured MBF using CTP in consecutive 32 VSA patients with acetylcholine-induced diffuse coronary spasm in the left anterior descending coronary arteries (LAD) and 12 non-VSA controls. In the second protocol, we conducted a randomized controlled trial (RCT; Exercise VSA trial, UMIN: ehz745.008423996), where 20 VSA patients were randomly assigned to either exercise group (Ex group: supervised exercise training session for 30-min using bicycle ergometer, once/week at the hospital and more than 3 times/week at home) or non-exercise group (Non-Ex group) (n=10 each) (Figure A). Before and 3 months after exercise training, we measured MBF with adenosine-stress dynamic CTP and peak VO2 by cardiopulmonary exercise tests, and also assessed angina attack with Seattle Angina Questionnaire (SAQ).
Results
In the first protocol, CTP showed that adenosine-stress MBF was significantly decreased in the VSA group compared with the non-VSA group (VSA, 137.2±6.6 vs. Non-VSA, 174.4±10.7 ml/100g/min, P<0.01) (Figure B), although patient characteristics were comparable between the 2 groups. In the second protocol, exercise training was performed safely in all patients, and RCT showed that MBF was significantly increased in the Ex group compared with the non-Ex group (Figures C, D), although patient characteristics were also comparable between the 2 groups. Furthermore, peak VO2 was significantly increased in the Ex group compared with the non-Ex group (Figure E), and frequency of angina was significantly decreased in the Ex group compared with the non-Ex group (Figure F). Finally, there was a significant positive correlation between the extents of the changes in peak VO2 and the SAQ score for angina frequency in the Ex group (P<0.01, R=0.67).
Figures
Conclusions
These results provide the first evidence that vasodilator capacity of coronary microvessels is impaired in VSA patients, which can be ameliorated by exercise training.
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Affiliation(s)
- J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Ota
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Takase
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - M Kohzuki
- Tohoku University Graduate School of Medicine, Department of Internal Medicine & Rehabilitation Science, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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30
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Tsuchiya S, Matsumoto Y, Doman T, Fujiya T, Sugisawa J, Suda A, Sato K, Ikeda S, Shindo T, Kikuchi Y, Hao K, Takahashi J, Hatta W, Koike T, Masamune A, Saiki Y, Horiuchi H, Shimokawa H. Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature. J Atheroscler Thromb 2019; 27:271-277. [PMID: 31378751 PMCID: PMC7113142 DOI: 10.5551/jat.49239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
An 83-year-old woman with severe aortic stenosis was admitted to our hospital due to heart failure with refractory anemia requiring blood transfusions. She had repetitive bleeding episodes from endoscopically proven angiodysplasia in the stomach. Moreover, she repeatedly underwent endoscopic argon plasma coagulation for hemostasis. Importantly, she had a deficiency of the high-molecular-weight (HMW) multimers of von Willebrand factor (VWF), and she was diagnosed with Heyde's syndrome.After she underwent transcatheter aortic valve implantation (TAVI), aortic valve area and mean left ventricular aorta pressure gradient improved. Notably, endoscopy showed cessation of bleeding at 10 days after TAVI and the disappearance of angiodysplasia at 4 months after TAVI. Even at 2 years after TAVI, follow-up endoscopy showed remaining free of angiodysplasia in the stomach. She experienced no episodes of anemia since TAVI procedure. Additionally, analysis of HMW multimers demonstrated immediate and lasting recovery after TAVI.Recovery of HMW multimers of VWF with cessation of gastrointestinal bleeding following aortic valve replacement has been previously reported in a patient diagnosed with Heyde's syndrome. To the best our knowledge, this is the first case to demonstrate that angiodysplasia disappears after TAVI for a long term with endoscopic images in a patient with Heyde's syndrome. Here, we summarized case reports of patients with Heyde's syndrome that required aortic valve intervention. Cessation of gastrointestinal bleeding and anemia after aortic valve intervention for severe aortic stenosis may be attributed not only to recovery of HMW multimers of VWF but also to the disappearance of angiodysplasia.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tsuyoshi Doman
- Department of Molecular and Cellular Biology, Institute of Development, Aging, and Cancer, Tohoku University
| | - Taku Fujiya
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koichi Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shohei Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Waku Hatta
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomoyuki Koike
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Department of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate school of Medicine
| | - Hisanori Horiuchi
- Department of Molecular and Cellular Biology, Institute of Development, Aging, and Cancer, Tohoku University
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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31
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Ohyama K, Matsumoto Y, Takanami K, Ota H, Nishimiya K, Sugisawa J, Tsuchiya S, Amamizu H, Uzuka H, Suda A, Shindo T, Kikuchi Y, Hao K, Tsuburaya R, Takahashi J, Miyata S, Sakata Y, Takase K, Shimokawa H. Coronary Adventitial and Perivascular Adipose Tissue Inflammation in Patients With Vasospastic Angina. J Am Coll Cardiol 2019; 71:414-425. [PMID: 29389358 DOI: 10.1016/j.jacc.2017.11.046] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/22/2017] [Accepted: 11/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies suggested that perivascular components, such as perivascular adipose tissue (PVAT) and adventitial vasa vasorum (VV), play an important role as a source of various inflammatory mediators in cardiovascular disease. OBJECTIVES The authors tested their hypothesis that coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina (VSA) using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). METHODS This study prospectively examined 27 consecutive VSA patients with acetylcholine-induced diffuse spasm in the left anterior descending artery (LAD) and 13 subjects with suspected angina but without organic coronary lesions or coronary spasm. Using CT coronary angiography and electrocardiogram-gated 18F-FDG PET/CT, coronary PVAT volume and coronary perivascular FDG uptake in the LAD were examined. In addition, adventitial VV formation in the LAD was examined with optical coherence tomography, and Rho-kinase activity was measured in circulating leukocytes. RESULTS Patient characteristics were comparable between the 2 groups. CT coronary angiography and ECG-gated 18F-FDG PET/CT showed that coronary PVAT volume and coronary perivascular FDG uptake significantly increased in the VSA group compared with the non-VSA group. Furthermore, optical coherence tomography showed that adventitial VV formation significantly increased in the VSA group compared with the non-VSA group, as did Rho-kinase activity. Importantly, during the follow-up period with medical treatment, both coronary perivascular FDG uptake and Rho-kinase activity significantly decreased in the VSA group. CONCLUSIONS These results provide the first evidence that coronary spasm is associated with inflammation of coronary adventitia and PVAT, where 18F-FDG PET/CT could be useful for disease activity assessment. (Morphological and Functional Change of Coronary Perivascular Adipose Tissue in Vasospastic Angina [ADIPO-VSA Trial]; UMIN000016675).
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Affiliation(s)
- Kazuma Ohyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirokazu Amamizu
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironori Uzuka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Amamizu H, Matsumoto Y, Morosawa S, Ohyama K, Uzuka H, Hirano M, Sugisawa J, Tsuchiya S, Nishimiya K, Hayashi M, Kawai Y, Shimokawa H. 2435Important roles of cardiac lymphatic vessels in the regulation of coronary vasomotion after DES implantation in pigs in vivo. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Amamizu
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - S Morosawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - H Uzuka
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - M Hirano
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - K Nishimiya
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
| | - M Hayashi
- Tohoku Pharmaceutical University Hospital, Physiology, Sendai, Japan
| | - Y Kawai
- Tohoku Pharmaceutical University Hospital, Physiology, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Cardiovascular Medicine, Sendai, Japan
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Tsuchiya S, Matsumoto Y, Kikuchi Y, Sugisawa J, Hao K, Takeuchi M, Takahashi J, Kawamoto S, Kumagai K, Wagatsuma T, Saiki Y, Shimokawa H. P6315Evidence for improved cognitive function following transcatheter aortic valve implantation in elderly patients with severe aortic stenosis - Brain perfusion SPECT imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6315] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Tsuchiya
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - M Takeuchi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
| | - S Kawamoto
- Tohoku Pharmaceutical University Hospital, Cardiovascular Surgery, Sendai, Japan
| | - K Kumagai
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - T Wagatsuma
- Tohoku University Graduate School of Medicine, Anesthesiology and Perioperative Medicine, Sendai, Japan
| | - Y Saiki
- Tohoku University Graduate School of Medicine, Cardiovascular Surgery, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, cardiovascular medicine, Sendai, Japan
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Hao K, Takahashi J, Suda A, Sato K, Sugisawa J, Tsuchiya S, Sindo T, Ikeda S, Kikuchi Y, Matsumoto Y, Sakata Y, Shimokawa H. P4628Clinical significance of fractional flow reserve in patients with vasospastic angina and organic coronary stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Sindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Sakata
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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Kikuchi Y, Takahashi J, Sato K, Sugisawa J, Tsuchiya S, Suda A, Shindo T, Ikeda S, Hao K, Shiroto T, Matsumoto Y, Sakata Y, Shimokawa H. P793Usefulness and safety of fasudil, a selective Rho-kinase inhibitor, for PCI-related myocardial ischemia in interventional cardiology. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p793] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - J Sugisawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Tsuchiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Ikeda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Matsumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Y Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - H Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sugisawa J, Matsumoto Y, Suda A, Ota H, Tsuchiya S, Ohyama K, Sato K, Shindo T, Ikeda S, Hao K, Kikuchi Y, Takahashi J, Shimokawa H. 1343Evidence for impaired vasodilator capacity of coronary microvessels in patients with vasospatic angina - Myocardial CT perfusion imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Sugisawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Matsumoto
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - A Suda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Ota
- Tohoku University Graduate School of Medicine, Department of Radiology, Sendai, Japan
| | - S Tsuchiya
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Ohyama
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Sato
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - T Shindo
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - S Ikeda
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - K Hao
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - Y Kikuchi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - J Takahashi
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Department of Cardiovascular Medicine, Sendai, Japan
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Kouzu K, Tsujimoto H, Hiraki S, Takahata R, Yaguchi Y, Kumano I, Horiguchi H, Nomura S, Nagata K, Harada M, Nagata H, Sugihara T, Ishibashi Y, Itazaki Y, Tsuchiya S, Aosasa S, Hase K, Yamamoto J, Ueno H. A case of pneumatosis intestinalis during neoadjuvant chemotherapy with cisplatin and 5-fluorouracil for esophageal cancer †. J Surg Case Rep 2017; 2017:rjx227. [PMID: 29181149 PMCID: PMC5697399 DOI: 10.1093/jscr/rjx227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/02/2017] [Accepted: 11/06/2017] [Indexed: 12/27/2022] Open
Abstract
Pneumatosis intestinalis (PI) is a relatively rare disease. A 70-year-old man with stage II squamous cell carcinoma of the middle thoracic esophagus was administered cisplatin plus 5-fluorouracil (CF) therapy as neoadjuvant chemotherapy. On Day 14 of the first course of CF therapy, he complained of acute abdominal pain. Computed tomography (CT) revealed PI of the entire colon and a small air bubble in the mesentery. A colonoscopy revealed that there was no finding suggestive of ischemia. Because there was no sign of peritoneal irritation, conservative treatment was selected. On Day 7 after PI diagnosis, CT indicated the disappearance of PI. The patient underwent a radical esophagectomy. Intraoperative laparoscopic findings showed the serosa of the colon to be intact. The patient was discharged without any complications. It is important to take into account that CF therapy may cause PI and that PI can be treated conservatively.
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Affiliation(s)
- Keita Kouzu
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Risa Takahata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Isao Kumano
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Ken Nagata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Hiromi Nagata
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Takao Sugihara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Junji Yamamoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
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Fletcher C, Tsuchiya S, Mehrotra DV. Current Practices in Choosing Estimands and Sensitivity Analyses in Clinical Trials: Results of the ICH E9 Survey. Ther Innov Regul Sci 2017; 51:69-76. [PMID: 30236003 DOI: 10.1177/2168479016666586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An addendum to the International Conference on Harmonisation E9 (ICH E9) guidance document (Statistical Principles for Clinical Trials) is currently under development. The aim of the addendum is to promote harmonized standards on the choice of estimand (a well-defined measure of the treatment effect that is being estimated) in clinical trials and to describe a consensual framework for planning, conducting, and interpreting sensitivity analyses of clinical trial data. METHODS In order to help understand current practices relating to the choice of estimands and sensitivity analyses for clinical trials, the ICH E9 working group developing the addendum conducted a survey with a primary focus on clinical trials involving drugs, vaccines, and biologics. The survey was distributed electronically between May 19, 2015, and June 11, 2015, to various stakeholder groups within ICH, including industry, regulatory, and academic communities. A total of 1305 respondents participated. RESULTS Of the 1305 respondents 547 (42%), 344 (26%) and 283 (22%) were from Europe, USA and Japan respectively. Over half of the respondents work in pharmaceutical companies, and approximately a quarter of respondents noted oncology as the primary therapeutic area they work in. Over half of the respondents (595, 55%) noted the treatment effect being estimated was 'in the entire target population of patients regardless of whether they will take treatment as instructed'. The most common methods for handling missing data in primary analyses were mixed-models repeated measures (555, 56% respondents) and last observation carried forward (549, 55% respondents). The majority of respondents (816, 83%) noted they conducted sensitivity analyses to estimate treatment effects in different ways compared to the primary analysis by using alternative assumptions (627, 78%) and/or using alternative statistical methods (616, 76%). CONCLUSIONS The survey results have provided useful information to the ICH E9 working group on current practices on the choice of primary estimands for measuring treatment effects in confirmatory clinical trials, and approaches used to select sensitivity analyses.
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Affiliation(s)
- C Fletcher
- 1 Amgen Ltd, Cambridge, UK.,2 Clinical Development Expert Group, European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
| | - S Tsuchiya
- 3 Sumitomo Dainippon Pharma Co Ltd, Tokyo, Japan.,4 Drug Evaluation Committee, Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - D V Mehrotra
- 5 Merck Research Laboratories, North Wales, PA, USA
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Tsuchiya S, Kino Y, Nakagawa K, Nakagawa D, Yamada JI, Toda Y. Development of an optical time-resolved measurement system under high-pressure and low-temperature with a piston-cylinder pressure cell. Rev Sci Instrum 2016; 87:043104. [PMID: 27131651 DOI: 10.1063/1.4945303] [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] [Indexed: 06/05/2023]
Abstract
To perform the femtosecond pump-probe spectroscopy under high pressure and low temperature, we constructed a measurement system with a piston cylinder type pressure cell installing an optical fiber bundle. The applied pressure was achieved to 6 kbar and the cell was cooled down to 15 K. Several demonstrations revealed that broadening and change of polarization of pulse (duration of ∼120 fs) owing to the dispersions in the fiber bundle are much small indicating that those have little influence on the measurement of carrier relaxation dynamics. In the measurements of κ-(BEDT-TTF)2Cu(NCS)2 under 1.3 kbar at 43 K, we have successfully detected the polarization anisotropy of the carrier relaxation dynamics and estimated the decay time in the same way as the normal measurement.
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Affiliation(s)
- Satoshi Tsuchiya
- Department of Applied Physics, Hokkaido University, Hokkaido 060-8628, Japan
| | - Yohei Kino
- Department of Applied Physics, Hokkaido University, Hokkaido 060-8628, Japan
| | - Koichi Nakagawa
- Department of Applied Physics, Hokkaido University, Hokkaido 060-8628, Japan
| | - Daisuke Nakagawa
- Department of Applied Physics, Hokkaido University, Hokkaido 060-8628, Japan
| | - Jun-Ichi Yamada
- Graduate School of Material Science, University of Hyogo, Hyogo 650-004, Japan
| | - Yasunori Toda
- Department of Applied Physics, Hokkaido University, Hokkaido 060-8628, Japan
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Ohtake Y, Emura T, Nishimoto M, Takano K, Yamamoto K, Tsuchiya S, Yeu SY, Kito Y, Kimura N, Takeda S, Tsukazaki M, Murakata M, Sato T. Development of a Scalable Synthesis of Tofogliflozin. J Org Chem 2016; 81:2148-53. [DOI: 10.1021/acs.joc.5b02734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yoshihito Ohtake
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Takashi Emura
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Masahiro Nishimoto
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Koji Takano
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Keisuke Yamamoto
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Satoshi Tsuchiya
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Sang-Yong Yeu
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
| | - Yasushi Kito
- Research Division,
Chugai Pharmaceutical Co., Ltd., 200
Kajiwara, Kamakura, Kanagawa 247-8530, Japan
| | - Nobuaki Kimura
- Pharmaceutical Technology
Division, Chugai Pharmaceutical Co., Ltd., 5-5-1 Ukima, Kita-ku, Tokyo 115-8543, Japan
| | - Sunao Takeda
- Pharmaceutical Technology
Division, Chugai Pharmaceutical Co., Ltd., 5-5-1 Ukima, Kita-ku, Tokyo 115-8543, Japan
| | - Masao Tsukazaki
- Research Division,
Chugai Pharmaceutical Co., Ltd., 200
Kajiwara, Kamakura, Kanagawa 247-8530, Japan
| | - Masatoshi Murakata
- Pharmaceutical Technology
Division, Chugai Pharmaceutical Co., Ltd., 5-5-1 Ukima, Kita-ku, Tokyo 115-8543, Japan
| | - Tsutomu Sato
- Research Division,
Chugai Pharmaceutical Co., Ltd., 1-135
Komakado, Gotemba, Shizuoka 412-8513, Japan
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Ohashi R, Sakatani T, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya S, Takei H, Naito Z. Mucinous carcinoma of the breast: a comparative study on cytohistological findings associated with neuroendocrine differentiation. Cytopathology 2016; 27:193-200. [PMID: 26804749 DOI: 10.1111/cyt.12298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Mucinous carcinoma (MCA) may show neuroendocrine differentiation (ND), but the cytological features characteristic of ND remains elusive. We compared fine needle aspiration (FNA) findings of MCA between cases with high and low degrees of ND. METHODS Histological sections of 37 MCA cases were immunohistochemically evaluated for expression of chromogranin A and synaptophysin, and were graded as 0 to 3+ degrees of ND. They were divided into low ND (grade 0 and 1+) and high ND (grade 2+ and 3+) groups. Pre-operative FNA samples of each group were assessed for cytological features. RESULTS The mean age of the high ND group (n = 18) was higher than the low ND group (n = 19, P = 0.01). In FNA samples of the high ND group, 17 cases showed moderate to severe degrees of discohesiveness, but low ND cases mainly showed no or only mild discohesiveness (P < 0.001). Nine of the low ND cases displayed overlapped, cohesive cell clusters, whereas, in the high ND cases, the cells were arranged in a loose, flat and monolayered pattern (P = 0.045). Fourteen of the high ND cases had round nuclei, but oval nuclei were predominant in the low ND cases (P = 0.027). The nuclei were eccentrically located in 12 of the high ND cases but were centrally located in 14 of the low ND cases (P = 0.01). CONCLUSIONS Mucinous carcinoma with high ND may be diagnosed by the presence of discohesiveness, a flat, monolayered pattern, and round or eccentrically located nuclei. Features of ND in carcinomas in other organs, such as intracytoplasmic granules and coarse chromatin, may not be reliable cytological features of ND in MCA.
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Affiliation(s)
- R Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - T Sakatani
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
| | - M Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Y Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yanagihara
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - K Yamashita
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - S Tsuchiya
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Iida Hospital, Nagano, Japan
| | - H Takei
- Division of Breast Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Z Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Departments of Pathology and Integrative Oncological Pathology, Nippon Medical School, Tokyo, Japan
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Kanzaki N, Tanaka SE, Fitza K, Kosaka H, Slippers B, Kimura K, Tsuchiya S, Tabata M. Deladenus nitobei n. sp. (Tylenchomorpha: Allantonematidae) isolated from Sirex nitobei (Hymenoptera: Siricidae) from Aomori, Japan, a new member of the siricidicola superspecies. NEMATOLOGY 2016. [DOI: 10.1163/15685411-00003025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Deladenus nitobein. sp., a parasite of a woodwasp species,Sirex nitobei, is described based on its typological characters and molecular profiles of part of the small subunit D2-D3 expansion segments of the large subunit and internal transcribed spacer region of the ribosomal RNA gene, as well as part of the mitochondrial cytochrome oxidase subunit I (mtCOI) gene. Adult host woodwasps emerging from dead Japanese red pine logs,Pinus densiflora, collected at Aomori, Japan, were dissected and examined for nematode association. The new species was isolated from the body cavity and reproductive system ofS. nitobeias large parasitic females and small parasitic juveniles. The nematodes were cultured successfully on 1.0% malt extract agar medium, inoculated withSirex-associated fungus,Amylostereumareolatum. The mycophagous adult nematodes were characterised by the relative position of the excretory pore, located at 25 (19-28) and 25 (18-30)μm anterior to the hemizonid in the male and female, respectively, and a broad female tail with a rounded distal end. Typologically, the new species forms a cryptic species complex withD. siricidicolaandD. canii. In addition, the new species andD. siricidicolashare the same host wasp, tree and fungal species in Japan. However, the cryptic species can be separated from each other based on the described morphological and molecular sequence differences in the mtCOI gene.
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Affiliation(s)
- Natsumi Kanzaki
- Forestry and Forest Products Research Institute (FFPRI), 1 Matsunosato, Tsukuba, Ibaraki 305-8687, Japan
| | - Suguru E. Tanaka
- Forestry and Forest Products Research Institute (FFPRI), 1 Matsunosato, Tsukuba, Ibaraki 305-8687, Japan
- Laboratory of Forest Botany, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8685, Japan
| | - Katrin Fitza
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
| | - Hajime Kosaka
- Kyushu Research Center, FFPRI, 4-11-16 Kurokami, Chuo, Kumamoto, Kumamoto, 860-0862, Japan
| | - Bernard Slippers
- Department of Genetics, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria 0002, South Africa
| | - Koki Kimura
- Forestry and Forest Products Research Institute, Aomori Prefectural Industrial Technology Research Center, 46-56 Kominato-Shinmichi, Hiranai, Higashi-Tsugaru, Aomori 039-3321, Japan
| | - Satoshi Tsuchiya
- Forestry and Forest Products Research Institute, Aomori Prefectural Industrial Technology Research Center, 46-56 Kominato-Shinmichi, Hiranai, Higashi-Tsugaru, Aomori 039-3321, Japan
| | - Masanobu Tabata
- Tohoku Research Center, FFPRI, 92-25 Nabeyashiki, Shimo-kuriyagawa, Morioka, Iwate 020-0123, Japan
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Hakata Y, Tsuchiya S, Michiue H, Ohtsuki T, Matsui H, Miyazawa M, Kitamatsu M. A novel leucine zipper motif-based hybrid peptide delivers a functional peptide cargo inside cells. Chem Commun (Camb) 2015; 51:413-6. [DOI: 10.1039/c4cc07459a] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We delivered a hybrid of an autophagy-inducing peptide and a cell-penetrating peptide via heterodimeric leucine zippers into the cell. By this method, the peptide successfully induced autophagy without significant cell death.
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Affiliation(s)
- Y. Hakata
- Department of Immunology
- Faculty of Medicine
- Kinki University
- Osaka 589-8511
- Japan
| | - S. Tsuchiya
- Department of Applied Chemistry
- Faculty of Science and Engineering Kinki University
- Osaka 577-8502
- Japan
| | - H. Michiue
- Department of Physiology
- Graduate School of Medicine
- Dentistry and Pharmaceutical Sciences
- Okayama University
- Okayama 700-8558
| | - T. Ohtsuki
- Department of Biotechnology
- Graduate School of Natural Science and Technology
- Okayama University
- Okayama 700-8530
- Japan
| | - H. Matsui
- Department of Physiology
- Graduate School of Medicine
- Dentistry and Pharmaceutical Sciences
- Okayama University
- Okayama 700-8558
| | - M. Miyazawa
- Department of Immunology
- Faculty of Medicine
- Kinki University
- Osaka 589-8511
- Japan
| | - M. Kitamatsu
- Department of Applied Chemistry
- Faculty of Science and Engineering Kinki University
- Osaka 577-8502
- Japan
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45
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Tsuchiya S, Fuyuhiro A, Fukuda T, Ishikawa N. Magnetic anisotropy and interaction between f-electronic systems in dinuclear inverted-sandwich-type lanthanide-phthalocyanine complexes. J PORPHYR PHTHALOCYA 2014. [DOI: 10.1142/s1088424614500795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The first detection and characterization of magnetic interaction between two 4f electronic systems in the dinuclear "inverted-sandwich-type" phthalocyanine complex with terbium ions and that of dysprosium ions are presented. Temperature dependent magnetic measurements for the diterbium complex, (μ-phthalocyaninato)bis[di(2,2,6,6-tetramethylheptane-3,5-dionato)terbium], show that the value of magnetic susceptibility times temperature, χT, sharply decreases as temperature is lowered, indicating the presence of an antiferromagnetic-type interaction between the Tb 3+ ions in the dinuclear complex. Similar temperature dependence was observed for the corresponding dinuclear dysprosium complex. These results are completely opposite to those observed for Pc triple-decker dinuclear terbium or dysprosium complexes, which are known to function as single molecule magnets. The NMR signals for the protons on the Pc ligand of the diterbium complex show up-field paramagnetic shifts due to the partially-filled 4f shells of the metal ions. This again makes sharp contrast to the triple-deckers, for which large down-field paramagnetic shifts are observed. These intriguing results seen in the NMR and magnetic susceptibility measurements are explained assuming the ligand field potential of the inverted-sandwich complexes gives strong easy-plain-type magnetic anisotropy, where Jz value of the lowest sublevel has a small value, while sandwich-type Pc3Ln2 ( Ln = Tb or Dy ) complexes have a strong easy-axis-type magnetic anisotropy.
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Affiliation(s)
- Satoshi Tsuchiya
- Graduate School of Science, Osaka University, 1-1 Machikaneyamacho, Toyonaka, Osaka, Japan
| | - Akira Fuyuhiro
- Graduate School of Science, Osaka University, 1-1 Machikaneyamacho, Toyonaka, Osaka, Japan
| | - Takamitsu Fukuda
- Graduate School of Science, Osaka University, 1-1 Machikaneyamacho, Toyonaka, Osaka, Japan
| | - Naoto Ishikawa
- Graduate School of Science, Osaka University, 1-1 Machikaneyamacho, Toyonaka, Osaka, Japan
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Matsukuma S, Obara K, Kato K, Ohshika Y, Takeo H, Tsuchiya S, Sato K. Non-sarcomatous spindle cell morphology in conventional lung adenocarcinoma: a clinicopathological study. Virchows Arch 2014; 465:165-72. [PMID: 24878756 DOI: 10.1007/s00428-014-1598-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/14/2014] [Accepted: 05/22/2014] [Indexed: 01/15/2023]
Abstract
Non-sarcomatous spindle cell foci (N-SSCF) without aggressive invasiveness, also called morule-like lesions, occur occasionally in conventional lung adenocarcinoma, but their characteristics remain poorly understood. We identified N-SSCF in 7 (4.0 %) of 173 lung adenocarcinomas and examined their clinicopathological features. The patients were six men and one woman with a mean age of 57.0 years (range, 43-76 years). All tumors were papillary-predominant adenocarcinomas, ranging in size from 1 to 4.5 cm (mean, 2.7 cm). N-SSCF occupied 10-30 % of the tumors, and in all cases, there were focal or multifocal transitions between the two morphotypes. Most N-SSCF were plug-like nodules filling the spaces of cancerous alveoli/tubules or patchy insular nests. N-SSCF frequently contained mucin + lumina and were positive for cytokeratin 7, thyroid transcription factor 1, and Napsin A, but negative for cytokeratin 5/6 and vimentin, similar to the adenocarcinoma cells of the same tumor. Five cases (71 %) were at stage I or II, suggesting that N-SSCF can occur in an early phase of lung cancer. In an age-, sex-, and stage-matched control study, N-SSCF were not associated with prognosis (P = 0.471). We consider tumors with N-SSCF a distinct structural variant of adenocarcinoma without prognostic significance. They should be distinguished from true sarcomatous spindle cells and micropapillary components, which are associated with aggressive behavior.
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Affiliation(s)
- Susumu Matsukuma
- Department of Pathology, Japan Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan,
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Isono T, Kamo H, Ueda A, Takahashi K, Kimata M, Tajima H, Tsuchiya S, Terashima T, Uji S, Mori H. Gapless quantum spin liquid in an organic spin-1/2 triangular-lattice κ-H3(Cat-EDT-TTF)2. Phys Rev Lett 2014; 112:177201. [PMID: 24836269 DOI: 10.1103/physrevlett.112.177201] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Indexed: 06/03/2023]
Abstract
We report the results of SQUID and torque magnetometry of an organic spin-1/2 triangular-lattice κ-H(3)(Cat-EDT-TTF)(2). Despite antiferromagnetic exchange coupling at 80-100 K, we observed no sign of antiferromagnetic order down to 50 mK owing to spin frustration on the triangular lattice. In addition, we found nearly temperature-independent susceptibility below 3 K associated with Pauli paramagnetism. These observations suggest the development of gapless quantum spin liquid as the ground state. On the basis of a comparative discussion, we point out that the gapless quantum spin liquid states in organic systems share a possible mechanism, namely the formation of a band with a Fermi surface possibly attributed to spinons.
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Affiliation(s)
- Takayuki Isono
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - Hiromichi Kamo
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - Akira Ueda
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | | | - Motoi Kimata
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - Hiroyuki Tajima
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - Satoshi Tsuchiya
- National Institute for Materials Science, Tsukuba, Ibaraki 305-0003, Japan
| | - Taichi Terashima
- National Institute for Materials Science, Tsukuba, Ibaraki 305-0003, Japan
| | - Shinya Uji
- National Institute for Materials Science, Tsukuba, Ibaraki 305-0003, Japan
| | - Hatsumi Mori
- The Institute for Solid State Physics (ISSP), The University of Tokyo, Kashiwa, Chiba 277-8581, Japan
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Looi CY, Sasahara Y, Watanabe Y, Satoh M, Hakozaki I, Uchiyama M, Wong WF, Du W, Uchiyama T, Kumaki S, Tsuchiya S, Kure S. The open conformation of WASP regulates its nuclear localization and gene transcription in myeloid cells. Int Immunol 2014; 26:341-52. [DOI: 10.1093/intimm/dxt072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Uji S, Kodama K, Sugii K, Takahide Y, Terashima T, Kurita N, Tsuchiya S, Kohno M, Kimata M, Yamamoto K, Yakushi K. Kosterlitz-Thouless-type transition in a charge ordered state of the layered organic conductor α-(BEDT-TTF)2I3. Phys Rev Lett 2013; 110:196602. [PMID: 23705731 DOI: 10.1103/physrevlett.110.196602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Indexed: 06/02/2023]
Abstract
The current-voltage characteristics in the charge order state of the two-dimensional organic conductor α-(BEDT-TTF)(2)I(3) exhibit power law behavior at low temperatures. The power law is understood in terms of the electric-field-dependent potential between electrons and holes, which are thermally excited from the charge order state. The power law exponent steeply changes from 1 to 3 in the range from 30 to 45 K with decreasing temperature, thereby suggesting the occurrence of a Kosterlitz-Thouless-type transition; many (few) unbound electron-hole pairs are thermally excited above (below) the transition. The effects of the finite size and interlayer coupling on the power law behavior are discussed.
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Affiliation(s)
- S Uji
- National Institute for Materials Science, Tsukuba, Ibaraki 305-0003, Japan
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Shida T, Aminaka M, Shirai Y, Okimoto K, Tsuruta S, Kita E, Tsuchiya S, Kato K, Takahashi M. Endoscopic submucosal dissection with a ligation device for the treatment of rectal carcinoid tumor. Endoscopy 2012; 44 Suppl 2 UCTN:E4-5. [PMID: 22396268 DOI: 10.1055/s-0030-1256960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- T Shida
- Department of Endoscopy, Funabashi Central Social Insurance Hospital, Funabashi, Japan.
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