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Maeda T, Moriwaki K, Morimoto K, Mo X, Yoshioka T, Goto R, Shimozuma K. Cost-Effectiveness Analysis of Nivolumab Plus Ipilimumab Combination Therapy as First-line Treatment for Advanced Renal Cell Carcinoma in Japan. Value Health Reg Issues 2024; 40:118-126. [PMID: 38194896 DOI: 10.1016/j.vhri.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/19/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The purpose of this study is to examine the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) combination therapy (NIVO + IPI) compared with the sunitinib (SUN) therapy for Japanese patients with advanced renal cell carcinoma from the perspective of a Japanese health insurance payer. METHODS A lifetime horizon was applied, and 2% per annum was set as the discount rate. The threshold was set as $ 75 000 per quality-adjusted life-year (QALY) gained. For the analytical method, we used a partitioned survival analysis model to estimate the incremental cost-effectiveness ratio (ICER), which is calculated by dividing incremental costs by incremental QALYs. Progression-free survival, progressive disease, and death were set as health states. Additionally, cost parameters and utility weights were set as key parameters. We set the intermediate/poor-risk population as the base case. Scenario analysis was conducted for the intention-to-treat population and the favorable risk population. Furthermore, one-way sensitivity analysis and probabilistic sensitivity analysis were conducted for each population. RESULTS In the base-case analysis, the QALYs of NIVO + IPI and SUN were 4.32 and 2.99, respectively. NIVO + IPI conferred 1.34 additional QALYs. Meanwhile, the total costs in the NIVO + IPI and SUN were $692 288 and $475 481, respectively. As a result, the ICER of NIVO + IPI compared with SUN was estimated to be $162 243 per QALY gained. The parameter that greatly affected the ICER was the utility weight of progression-free survival in NIVO + IPI. CONCLUSIONS NIVO + IPI for advanced renal cell carcinoma seems to be not cost-effective compared with the SUN in the Japanese healthcare system.
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Affiliation(s)
- Tomomi Maeda
- Graduate School of Health Management, Keio University, Fujisawa city, Kanagawa, Japan.
| | - Kensuke Moriwaki
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto city, Kyoto, Japan
| | - Kosuke Morimoto
- Graduate School of Medicine, Kyoto University, Kyoto city, Kyoto, Japan
| | - Xiuting Mo
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto city, Kyoto, Japan
| | | | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama city, Kanagawa, Japan
| | - Kojiro Shimozuma
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto city, Kyoto, Japan
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Matsuzaki M, Mizushima S, Tsudzuki M, Maeda T, Sasanami T. Sperm replacement in sperm-storage tubules causes last-male sperm precedence in chickens. Br Poult Sci 2024; 65:97-104. [PMID: 38018517 DOI: 10.1080/00071668.2023.2287732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023]
Abstract
1. This study elucidated the last-male sperm precedence (LMSP) mechanism in chickens by examining replacement in storage tubules (SSTs) after multiple artificial inseminations (AI) and the effects of seminal plasma (SP) and male breed on sperm replacement in SSTs.2. Hens were artificially inseminated with fluorescent dye-labelled spermatozoa from White Leghorn (WL) chickens. Secondary AI was conducted 3 d later with sperm labelled with different nuclear fluorescent dye. Percentage of first and second inseminated sperm in SSTs and their logarithmic odds were calculated. The effect of SP on LMSP was examined using (1) Lake's solution-washed sperm before second insemination, and (2) SP injected continuously after first insemination. Effect of breed difference on sperm replacement was investigated using Barred Plymouth Rock (BP) sperm.3. Successive WL-sperm inseminations at three-day intervals caused > 70% stored sperm replacement in SSTs. Although SP removal from sperm from second insemination significantly decreased replacement, its intra-vaginal injection did not affect release. Secondary insemination using BP sperm significantly increased replacement.4. Sperm replacement is a major factor favouring LMSP in domestic chickens. Two fluorescent staining of sperm, and intra-vaginal multiple AI technique have enabled visualisation, differentiation, and quantification of multiple inseminated sperm stored in the SSTs.
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Affiliation(s)
- M Matsuzaki
- Program of Food and AgriLife Science, Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima City, Japan
| | - S Mizushima
- Department of Biological Sciences, Faculty of Science, Hokkaido University, Sapporo, Japan
| | - M Tsudzuki
- Program of Food and AgriLife Science, Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima City, Japan
- Japanese Avian Bioresource Project Center, Hiroshima University, Higashi-Hiroshima, Japan
| | - T Maeda
- Program of Food and AgriLife Science, Graduate School of Integrated Sciences for Life, Hiroshima University, Higashi-Hiroshima City, Japan
- Japanese Avian Bioresource Project Center, Hiroshima University, Higashi-Hiroshima, Japan
| | - T Sasanami
- Department of Applied Life Sciences, Faculty of Agriculture, Shizuoka University, Shizuoka, Japan
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Ozaki S, Ishigami G, Otsuki M, Miyamoto H, Wada K, Watanabe Y, Nishino T, Kojima H, Soda K, Nakao Y, Sutoh M, Maeda T, Kobayashi T. Publisher Correction: Granular flow experiment using artificial gravity generator at International Space Station. NPJ Microgravity 2023; 9:79. [PMID: 37739962 PMCID: PMC10517004 DOI: 10.1038/s41526-023-00325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Affiliation(s)
- S Ozaki
- Yokohama National University, Yokohama, Japan.
| | | | - M Otsuki
- Japan Aerospace Exploration Agency, Sagamihara, Japan
| | | | - K Wada
- Chiba Institute of Technology, Chiba, Japan
| | - Y Watanabe
- Yokohama National University, Yokohama, Japan
| | - T Nishino
- Yokohama National University, Yokohama, Japan
| | - H Kojima
- Keio University, Yokohama, Japan
| | - K Soda
- Keio University, Yokohama, Japan
| | - Y Nakao
- Keio University, Yokohama, Japan
| | - M Sutoh
- Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Maeda
- Tokyo University of Agriculture and Technology, Fuchu, Japan
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Sato T, Yamaguchi T, Aoki K, Kajiwara C, Kimura S, Maeda T, Yoshizawa S, Sasaki M, Murakami H, Hisatsune J, Sugai M, Ishii Y, Tateda K, Urita Y. Whole-genome sequencing analysis of molecular epidemiology and silent transmissions causing meticillin-resistant Staphylococcus aureus bloodstream infections in a university hospital. J Hosp Infect 2023; 139:141-149. [PMID: 37301229 DOI: 10.1016/j.jhin.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The emergence of novel genomic-type clones, such as community-associated meticillin-resistant Staphylococcus aureus (MRSA) and livestock-associated MRSA, and their invasion into hospitals have become major concerns worldwide; however, little information is available regarding the prevalence of MRSA in Japan. Whole-genome sequencing (WGS) has been conducted to analyse various pathogens worldwide. Therefore, it is important to establish a genome database of clinical MRSA isolates available in Japan. AIM A molecular epidemiological analysis of MRSA strains isolated from bloodstream-infected patients in a Japanese university hospital was conducted using WGS and single-nucleotide polymorphism (SNP) analysis. Additionally, through a review of patients' clinical characteristics, the effectiveness of SNP analysis as a tool for detecting silent nosocomial transmission that may be missed by other methods was evaluated in diverse settings and various time points of detection. METHODS Polymerase-chain-reaction-based staphylococcal cassette chromosome mec (SCCmec) typing was performed using 135 isolates obtained between 2014 and 2018, and WGS was performed using 88 isolates obtained between 2015 and 2017. FINDINGS SCCmec type II strains, prevalent in 2014, became rare in 2018, whereas the prevalence of SCCmec type IV strains increased from 18.75% to 83.87% of the population, and became the dominant clones. Clonal complex (CC) 5 CC8 and CC1 were detected between 2015 and 2017, with CC1 being dominant. In 88 cases, SNP analyses revealed nosocomial transmissions among 20 patients which involved highly homologous strains. CONCLUSIONS Routine monitoring of MRSA by whole-genome analysis is effective not only for gaining knowledge regarding molecular epidemiology, but also for detecting silent nosocomial transmission.
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Affiliation(s)
- T Sato
- Department of General Medicine and Emergency Care, Toho University Graduate School of Medicine, Tokyo, Japan; Department of General Medicine and Emergency Care, Toho University Omori Medical Centre, Tokyo, Japan.
| | - T Yamaguchi
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan.
| | - K Aoki
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - C Kajiwara
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - S Kimura
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - T Maeda
- Department of General Medicine and Emergency Care, Toho University Omori Medical Centre, Tokyo, Japan
| | - S Yoshizawa
- Department of Clinical Laboratories, Toho University Omori Medical Centre, Tokyo, Japan
| | - M Sasaki
- Department of Clinical Laboratories, Toho University Omori Medical Centre, Tokyo, Japan
| | - H Murakami
- Department of Clinical Laboratories, Toho University Omori Medical Centre, Tokyo, Japan
| | - J Hisatsune
- National Institute of Infectious Diseases, Tokyo, Japan
| | - M Sugai
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Y Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - K Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan; Department of Clinical Laboratories, Toho University Omori Medical Centre, Tokyo, Japan
| | - Y Urita
- Department of General Medicine and Emergency Care, Toho University Omori Medical Centre, Tokyo, Japan
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Ozaki S, Ishigami G, Otsuki M, Miyamoto H, Wada K, Watanabe Y, Nishino T, Kojima H, Soda K, Nakao Y, Sutoh M, Maeda T, Kobayashi T. Granular flow experiment using artificial gravity generator at International Space Station. NPJ Microgravity 2023; 9:61. [PMID: 37553360 PMCID: PMC10409782 DOI: 10.1038/s41526-023-00308-w] [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: 01/10/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
Studying the gravity-dependent characteristics of regolith, fine-grained granular media covering extra-terrestrial bodies is essential for the reliable design and analysis of landers and rovers for space exploration. In this study, we propose an experimental approach to examine a granular flow under stable artificial gravity conditions for a long duration generated by a centrifuge at the International Space Station. We also perform a discrete element simulation of the granular flow in both artificial and natural gravity environments. The simulation results verify that the granular flows in artificial and natural gravity are consistent. Further, regression analysis of the experimental results reveals that the mass flow rate of granular flow quantitatively follows a well-known physics-based law with some deviations under low-gravity conditions, implying that the bulk density of the granular media decreases with gravity. This insight also indicates that the bulk density considered in simulation studies of space probes under low-gravity conditions needs to be tuned for their reliable design and analysis.
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Affiliation(s)
- S Ozaki
- Yokohama National University, Yokohama, Japan.
| | | | - M Otsuki
- Japan Aerospace Exploration Agency, Sagamihara, Japan
| | | | - K Wada
- Chiba Institute of Technology, Chiba, Japan
| | - Y Watanabe
- Yokohama National University, Yokohama, Japan
| | - T Nishino
- Yokohama National University, Yokohama, Japan
| | - H Kojima
- Keio University, Yokohama, Japan
| | - K Soda
- Keio University, Yokohama, Japan
| | - Y Nakao
- Keio University, Yokohama, Japan
| | - M Sutoh
- Japan Aerospace Exploration Agency, Sagamihara, Japan
| | - T Maeda
- Tokyo University of Agriculture and Technology, Fuchu, Japan
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Iesato A, Ueno T, Takahashi Y, Kataoka A, Matsunaga Y, Saeki S, Ozaki Y, Inoue Y, Maeda T, Uehiro N, Kobayashi T, Sakai T, Takano T, Kogawa T, Kitano S, Ono M, Osako T, Ohno S. P145 Postpartum breast cancer diagnosed within 10 years of last childbirth is a prognostic factor for distant metastasis – analysis of lymphovascular invasion relating factors. Breast 2023. [DOI: 10.1016/s0960-9776(23)00262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Yamasaki S, Maeda T, Horiuchi T. Association between habitual hot spring bathing and depression in Japanese older adults: A retrospective study in Beppu. Complement Ther Med 2023; 72:102909. [PMID: 36526152 DOI: 10.1016/j.ctim.2022.102909] [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: 05/15/2022] [Revised: 09/29/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Thermal therapy is used to manage various psychological diseases, such as depression. We investigated the relationship between hot spring bathing and depression in older adults using questionnaire responses. DESIGN AND SETTING We comprehensively evaluated the preventive effects of long-term hot spring bathing in 10429 adults aged ≥ 65 years in Beppu, Japan, by conducting a questionnaire study on the prevalence of depression (n = 219). MAIN OUTCOME MEASURES Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a multivariable logistic regression model for history of depression. RESULTS A separate multivariable logistic regression model for inference showed that female sex (OR, 1.56; 95 % CI, 1.17-2.08; p = 0.002), arrhythmia (OR, 1.73; 95 % CI, 1.18-2.52; p = 0.004), hyperlipidemia (OR, 1.63; 95 % CI, 1.14-2.32; p = 0.006), renal disease (OR, 2.26; 95 % CI, 1.36-3.75; p = 0.001), collagen disease (OR, 2.72; 95 % CI, 1.48-5.02; p = 0.001), allergy (OR, 1.97; 95 % CI, 1.27-3.04; p = 0.002), and habitual daily hot spring bathing (OR, 0.63; 95 % CI, 0.41-0.94; p = 0.027) were independently significantly associated with a history of depression. CONCLUSIONS We found an inverse relationship between habitual daily hot spring bathing and history of depression. Prospective randomized controlled trials on habitual daily hot spring bathing as a treatment for depression are warranted to investigate whether the use of hot springs can provide relief to those with psychiatric and mental health disorders.
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Affiliation(s)
- S Yamasaki
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan; Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - T Maeda
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan
| | - T Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan
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Morishita N, Miura M, Kobayashi Y, Matsunaga R, Maeda T, Ochi M, Horiuchi T. P-039 Male age is associated with sperm DNA integrity: Selection of high DNA integrity sperm by microfluidics sorting is critical to clinical outcomes in older patients. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does sperm DNA integrity affect clinical outcomes of ICSI?
Summary answer
Use of high DNA integrity sperm selected by microfluidics sperm sorting results in lower miscarriage rates in the patients of 39-years old and more.
What is known already
High sperm DNA damage is associated with decreased normal fertilization, embryo development and pregnancy rates, and an increased miscarriage rate. On the other hand, oocytes from older women have decreased pregnancy rate, and increased miscarriage rate because of possibility of low ability to repair sperm with DNA fragmentation, and dramatical increases of aneuploidy as women age. A microfluidic sperm selection chamber (MSS, ZyMōt™; DxNow) is a device designed to collect sperm with higher chromatin integrity than density gradient centrifugation (DGC).
Study design, size, duration
Sperm analysis was performed by sperm chromatin dispersion (SCD) test and comet assay in the same sample of 15 cases between October 2020 and February 2021. ICSI outcomes by DGC and MSS were compared with blastocyst development, and pregnancy rates in vitrified-thawed single blastocyst transfers cycle for 518 cases between August 2018 and May 2021.
Participants/materials, setting, methods
SCD test was optimized as a rapid procedure, with sperm showing a halo deemed normal, and those without a halo abnormal. Comet assay results were analyzed using CometScore 2.0, with comparison of %Tail DNA. ICSI outcomes were analyzed using multiple logistics regressions of male and female ages.
Main results and the role of chance
We found a positive correlation between male age and sperm DNA fragmentation rates in raw semen using SCD test (r = 0.70) and Comet assay (r = 0.42). Higher DNA integrity sperm could select using MSS than DGC. In this study with ICSI outcomes, 170 of 318 (53.5%) blastocyst transfers resulted in pregnancy, and 49 (28.8%) subsequently miscarried. The data were classified according to less than or more than 39 years old of male age detected by multiple logistics regressions. In patients with ≥39 years of male age, the female age was significantly higher and blastocyst and pregnancy rates were significantly lower, and the miscarriage rate was significantly higher than <39 years of male age. Since sperm DNA fragmentation increased in accordance with male age, we compared MSS and DGC in the patients with male age ≥39 years. There was no significant difference in blastocyst, pregnancy, and miscarriage rates in female age <39 years. While in ≥ 39 years of female age, blastocyst and pregnancy rates in MSS were not significantly different from DGC, but the miscarriage rate in MSS was significantly lower than in DGC (27.3 vs. 57.1%).
Limitations, reasons for caution
The sample size for each study was small. Analysis of sperm DNA fragmentation and samples in ICSI outcomes were not the same. The retrospective nature of ICSI outcomes in this study does not allow controlling of unknown confounders.
Wider implications of the findings
Sperm DNA fragmentation depended on male age affected fertility outcomes. However, when male age is higher, masking the effect of male age by female age. In this study, we found out the improvement of ICSI outcome by using high DNA integrity sperm selected by MSS in both ≥39 years.
Trial registration number
Not applicable
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Affiliation(s)
- N Morishita
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - M Miura
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - Y Kobayashi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - R Matsunaga
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - T Maeda
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - M Ochi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
| | - T Horiuchi
- Ochi Yume Clinic Nagoya, IVF laboratory , Nagoya, Japan
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Tsuji Y, Tamai M, Koga T, Morimoto S, Kawashiri SY, Nonaka F, Yamanashi H, Arima K, Aoyagi K, Maeda T, Matsuda F, Kawakami A. POS1441 INFLUENCE OF ENVIRONMENTAL AND GENETIC FACTORS ON SERUM IGG4 DURING HEALTH CHECKUPS IN NAGASAKI ISLAND STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAlthough serum IgG4 levels are important for the diagnosis of IgG4-related diseases (IgG4-RD), few studies have validated IgG4 levels in healthy individuals in large resident medical examination cohorts and investigated background factors associated with serum IgG4.A report on genetic factors shows that HLA loci associate with IgG4-RD found in Japanese nation-wide IgG4-RD registry1). However, environmental and genetic factors related to the elevated serum IgG4 levels, which may closely associate with development of IgG4-RD, have previously been unclear in healthy subjects. The nephelometric immunoassay (NIA) is conventionally used to measure IgG4, but it requires a relatively large amount of serum. The magnetic bead panel assay (MBA), which can evaluate IgG4 levels with only a few ml of serum, has an advantage compared with NIA regarding to required sample volume, but the correlation between the two methods is unclear.ObjectivesFirst, we attempted to verify the accuracy of the MBA compared to the standard NIA in the first cohort. Next, we examined the relationship between IgG4 measured by the MBA and background information of healthy subjects to identify variables that correlate with serum IgG4 in the second cohort.MethodsFirst, Kanazawa University collected 947 samples from the resident health examination, and IgG4 levels were measured by both MBA and NIA, and the correlation between the two was verified using Spearman’s rank correlation coefficient (first cohort). Next (second cohort), serum IgG4 of 3240 samples of Nagasaki Island Study (NaIS), which had started in 2014 collaborating among Nagasaki University and Goto City, Nagasaki Prefecture, intended for research of varying conditions and diseases including IgG4-RD, were then measured by MBA. These subjects were stratified into the two groups as IgG4-high and IgG4-within normal limit using the aforementioned cutoff values, and compared with background information such as age, gender, drinking, smoking, uric acid, serum creatinine, comorbidities and HLA typing, including DRB1*04:06, *04:03, *04:05, *04:10 as disease-susceptibility gene, DRB1*09:01 and DQB1*03:03 as protective gene1).ResultsIgG4 by MBA correlated well with IgG4 by NIA (r=0.94, p-value<0.001) which was determined from Kanazawa samples (N=947). 1,463.6 mg/mL of IgG4 of MBA corresponded to 135 mg/dl, the normal cut-off value for IgG4 by NIA. In the analysis of NaIS samples (N=3240), the overall high IgG4 positivity rate was 6.3%. Multivariable analysis including age, gender, smoking and drinking, led by univariate analysis, showed that gender and smoking were significantly associated with high serum IgG4 positivity (male: odds ratio = 1.8, 95%CI =1.2-2.7, p = 0.009, smoking: odds ratio = 1.7, 95%CI =1.1-2.5, p = 0.012). There was no association between high serum IgG4 level and HLA genotyping.ConclusionWe concluded that MBA is a good method to measure serum IgG4 even by the very small sample volume. In our study, the prevalence of serum IgG4 positivity was high tendency than previous report2). Our data showed that male and smoking are independent factors associated with high serum IgG4 positivity. There were no association between serum IgG4 level and HLA genotyping in healthy subjects. Further comprehensive investigation is necessary to clarify high risk subjects who will develop IgG4-RD.References[1]Terao C, et al. Lancet Rheumatol 2019;1: e14–22.[2]Carballo I, et al. PLoS One. 2016;11: e0149330.Disclosure of InterestsNone declared
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van Wesemael TJ, Reijm S, Kawakami A, Maeda T, Kawashiri SY, Huizinga T, Tamai M, Toes R, van der Woude D. AB0071 ANTI-ACETYLATED PROTEIN IgM-ANTIBODIES AS THE STARTING POINT OF AUTOANTIBODY FORMATION IN RHEUMATOID ARTHRITIS? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAnti-modified protein antibodies (AMPA) are an important hallmark of rheumatoid arthritis (RA) and the fact that they have consistently been found to develop years before disease onset, has provided important insights into the immunopathology underlying RA. In (auto)antibody development, IgM is the first isotype to be produced. However, it is unclear whether IgM-autoimmunity differs between AMPA targeting different post-translational modifications (citrulline, homocitrulline and acetylated residues), which could provide clues about the starting point of the AMPA response.ObjectivesWe therefore investigated IgM-levels of anti-citrullinated protein antibodies (ACPA), anti-carbamylated protein antibodies (anti-CarP) and anti-acetylated protein antibodies (AAPA) in healthy individuals, non-RA and RA patients.MethodsAutoantibodies were investigated in 2 cohorts:1) a Japanese cohort of healthy individuals (community based Nagasaki Island study) known to be ACPA-positive (n=65) or ACPA-negative (n=197) were compared to Dutch healthy donors (n=30) and ACPA-positive RA patients (n=29). ACPA, anti-CarP and AAPA IgG were measured by ELISAs using CCP4, CHcitP4 and CAcetylP4 peptides with sequences similar to the commercial CCP2 antigen and native control peptides.2) early arthritis patients from the Leiden Early Arthritis Clinic who had RA (n=648) or another form of arthritis (non-RA, n=555) and healthy controls (n=80). ACPA and AAPA were determined by ELISAs using CCP2 and cACP2 peptides and their native control peptides, while anti-CarP was measured on homocitrullinated versus native fetal calf serum. Mann-Whitney U-tests were performed for statistical comparisons.ResultsACPA IgM reactivity was mainly present in established ACPA-positive RA patients (Figure 1A) and to a lesser extent in ACPA-positive healthy Japanese individuals, and non-RA arthritis patients (Figure 1D). A similar picture was observed for anti-CarP IgM reactivity, for which again highest levels were found in established RA patients (1B and 1E) and ACPA-positive compared to ACPA-negative healthy Japanese individuals (1B). Intriguingly, AAPA IgM reactivity-levels displayed a different pattern as these were comparable between healthy individuals and ACPA-positive RA patients (1C and 1F). Likewise, AAPA IgM reactivity-levels were also not increased in ACPA-positive healthy Japanese individuals, who instead had lower levels compared to their ACPA-negative counterparts. Furthermore, the AAPA IgM-reactivity levels did not differ between non-RA arthritis patients, healthy controls and RA patients (1F). AAPA IgG-levels on the other hand were clearly elevated in RA patients compared to healthy controls and non-RA arthritis patients (1G).ConclusionAAPA are exceptional compared to other AMPA because IgM AAPA-levels are similar among healthy individuals, non-RA arthritis and RA patients. This suggests that AAPA IgM is part of the “normal” immune repertoire and could constitute the starting point for RA-associated AMPA responses, with isotype switching and epitope spreading to other post-translational modifications leading to the typical RA-associated mature AMPA response.Disclosure of InterestsNone declared
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Volkov M, Kampstra ASB, van Schie KA, Kawakami A, Tamai M, Kawashiri S, Maeda T, Huizinga TWJ, Toes REM, van der Woude D. Evolution of anti-modified protein antibody responses can be driven by consecutive exposure to different post-translational modifications. Arthritis Res Ther 2021; 23:298. [PMID: 34876234 PMCID: PMC8653599 DOI: 10.1186/s13075-021-02687-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Besides anti-citrullinated protein antibodies (ACPA), rheumatoid arthritis patients (RA) often display autoantibody reactivities against other post-translationally modified (PTM) proteins, more specifically carbamylated and acetylated proteins. Immunizing mice with one particular PTM results in an anti-modified protein antibody (AMPA) response recognizing different PTM-antigens. Furthermore, human AMPA, isolated based on their reactivity to one PTM, cross-react with other PTMs. However, it is unclear whether the AMPA-reactivity profile is “fixed” in time or whether consecutive exposure to different PTMs can shape the evolving AMPA response towards a particular PTM. Methods Longitudinally collected serum samples of 8 human individuals at risk of RA and 5 with early RA were tested with ELISA, and titers were analyzed to investigate the evolution of the AMPA responses over time. Mice (13 per immunization group in total) were immunized with acetylated (or carbamylated) protein (ovalbumin) twice or cross-immunized with an acetylated and then a carbamylated protein (or vice versa) and their serum was analyzed for AMPA responses. Results Human data illustrated dynamic changes in AMPA-reactivity profiles in both individuals at risk of RA and in early RA patients. Mice immunized with either solely acetylated or carbamylated ovalbumin (AcOVA or CaOVA) developed reactivity against both acetylated and carbamylated antigens. Irrespective of the PTM-antigen used for the first immunization, a booster immunization with an antigen bearing the other PTM resulted in increased titers to the second/booster PTM. Furthermore, cross-immunization skewed the overall AMPA-response profile towards a relatively higher reactivity against the “booster” PTM. Conclusions The relationship between different reactivities within the AMPA response is dynamic. The initial exposure to a PTM-antigen induces cross-reactive responses that can be boosted by an antigen bearing this or other PTMs, indicating the formation of cross-reactive immunological memory. Upon subsequent exposure to an antigen bearing another type of PTM, the overall reactivity pattern can be skewed towards better recognition of the later encountered PTM. These data might explain temporal differences in the AMPA-response profile and point to the possibility that the PTM responsible for the initiation of the AMPA response may differ from the PTM predominantly recognized later in time. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02687-5.
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Affiliation(s)
- M Volkov
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - A S B Kampstra
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - K A van Schie
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - A Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Maeda
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - R E M Toes
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - D van der Woude
- Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
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Maeda T, Katae A, Terashima T, Yokota A, Sugawara M, Sekizawa H, Nishisozu T, Dochi O. 164 Effect of dissolving solution on embryo recovery results of superovulation with FSH single subcutaneous injection. Reprod Fertil Dev 2021; 34:320. [PMID: 35231373 DOI: 10.1071/rdv34n2ab164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- T Maeda
- North Bull Inc., Sendai, Miyagi, Japan
| | - A Katae
- North Bull Inc., Sendai, Miyagi, Japan
| | | | - A Yokota
- North Bull Inc., Sendai, Miyagi, Japan
| | | | - H Sekizawa
- Sekizawa Animal Clinic, Nasushiobara, Tochigi, Japan
| | - T Nishisozu
- Department of Dairy Science, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - O Dochi
- Department of Dairy Science, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
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Maeda T, Hiura A, Uehara J, Toyoshima R, Nakagawa T, Yoshino K. Early tumor response assessment may avoid serious immune-related adverse events in nivolumab and ipilimumab combination therapy for stage IV melanoma. Br J Dermatol 2021; 186:587-588. [PMID: 34747503 DOI: 10.1111/bjd.20879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/16/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
Nivolumab and ipilimumab combination therapy is one of the most promising treatments for patients with melanoma. However, this combination therapy is highly toxic and causes serious adverse events (SAEs) in more than half of the patients.
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Affiliation(s)
- T Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - A Hiura
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - J Uehara
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - R Toyoshima
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - T Nakagawa
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Miura N, Okaichi T, Okamoto S, Mouri S, Sogabe H, Arai A, Maeda T, Watanabe R, Noda T, Nishimura K, Fukumoto T, Miyauchi Y, Kikugawa T, Saika T. Extended robot-assisted laparoscopic prostatectomy and extended pelvic lymph node dissection as a monotherapy for very high-risk prostate cancer patients. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Maeda T, Hiura A, Uehara J, Toyoshima R, Nakagawa T, Yoshino K. Combined carboplatin and paclitaxel therapy improves overall survival in patients with nivolumab-resistant acral and mucosal melanoma. Br J Dermatol 2021; 186:361-363. [PMID: 34510408 DOI: 10.1111/bjd.20758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023]
Affiliation(s)
- T Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - A Hiura
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - J Uehara
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - R Toyoshima
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - T Nakagawa
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - K Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Tsuji Y, Tamai M, Morimoto S, Sasaki D, Kawashiri SY, Yanagihara K, Aoyagi K, Maeda T, Matsuda F, Kawakami A, Saito T. POS1429 ORAL DYSBIOSIS REFLECTS THE IMMUNOLOGICAL ALTERATION OF RA REGARDING TO HLA DRB1*SE, ACPA AND CIGARETTE SMOKING: NAGASAKI ISLAND STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Anti-citrullinated protein antibody (ACPA) production is observed in several organs even prior to the onset of rheumatoid arthritis (RA), and oral mucosa is considered to be one of the important tissues. Saliva is considered to reflect the oral microbiota(oralMB) including periodontal disease. A gene-environment interaction between cigarette smoking and shared epitope genes in HLA-DRB1*shared epitope (SE) provides a high risk of ACPA-positive RA. However, the interaction of HLA-DRB1*SE, ACPA, cigarette smoking and oralMB of RA patients remains to be elucidated.Objectives:We investigated that the difference of oralMB among RA patients and healthy subjects(HS) regarding to ACPA, HLA-DRB1*SE and cigarette smoking.Methods:The Nagasaki Island Study, which had started in 2014 collaborating with Goto City, Nagasaki Prefecture, Japan, is intended for research of the preclinical stage of RA, including ACPA, HLA genotype screening, oralMB and lifestyle habit. Both of blood and salivary samples were obtained from 1422 subjects out of 4276 participants in this study from 2016 to 2018. ACPA positivity was 1.7 % in total 4276 subjects. At this point, we selected 291 subjects, who were ACPA positive non-RA HS(n=22) and patients with RA (n=33, 11 subjects were ACPA positive and 22 ACPA negative, respectively) as the case, age and gender matched ACPA negative non-RA HS (n=236) as the control. In RA subjects, current smoker was n=1(3.0%) and ever smoker was n=8(24.2%). In HS, current smoker was n=29(11.2%) and ever smoker was n=55(21.3%). ACPA was measured by ELISA, and HLA genotyping was quantified by next-generation sequencing (Ref.1). The operational taxonomic unit (OTU) analysis using 16S rRNA gene sequencing were performed. The richness of microbial diversity within subject (α-diversity) was scaled via Shannon entropy. The dissimilarity between microbial community composition was calculated using Bray-Curtis distance as a scale, and differences between groups (β-diversity) were tested by permutational multivariate analysis of variance (PERMANOVA). In addition, UniFrac distance calculated in consideration of the distance on the phylogenetic tree were performed.Results:Median age 71 y.o., % Female 58.4 %. Among RA and non-RA subjects, not α-diversity but β-diversity was statistically smaller significantly in RA (p=0.022). In the HS, there was no decrease in α-diversity between the ACPA-positive and HLA-DRB1*SE-positive groups, but in the ACPA-positive group, there was a decrease in α-diversity in the HLA-DRB1*SE-positive group. When we compared α-diversity stratified by the presence or absence of three factors (RA, ACPA, and HLA-DRB1*SE), the RA group with ACPA and HLA-DRB1*SE positive tended to have the lowest diversity (Figure 1 lower right). RA subjects, presence of HLA-DRB1*SE did not show the difference but the tendency of lower α-diversity (p=0.29).Conclusion:HS with ACPA-positive HLA-DRB1*SE tended to show lower α-diversity than ACPA-positive HS and HLA-DRB1*SE positive HS. Furthermore, RA subjects with ACPA-positive HLA-DRB1*SE showed lower α-diversity than HS with ACPA-positive HLA-DRB1*SE.Our study suggested that the oral dysbiosis may reflect the immunological status of patients with RA. Because of the small number of ACPA-positive patients, stratification by smoking history was difficult. Further examination is needed to clarify the gene-environment interaction and microbiome.References:[1]Kawaguchi S, et al. Methods Mol Biol 2018;1802: 22.Disclosure of Interests:None declared
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Volkov M, Kampstra ASB, van Schie K, Kawakami A, Tamai M, Kawashiri SY, Maeda T, Huizinga T, Toes R, van der Woude D. POS0386 EVOLUTION OF ANTI-MODIFIED PROTEIN ANTIBODY RESPONSES CAN BE DRIVEN BY CONSECUTIVE EXPOSURE TO DIFFERENT POST-TRANSLATIONAL MODIFICATIONS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Besides anti-citrullinated protein antibodies (ACPA), rheumatoid arthritis patients (RA) often display autoantibody reactivities against other post-translationally modified (PTM) proteins, more specifically carbamylated and acetylated proteins. Immunizing mice with one PTM results in an anti-modified protein antibody (AMPA) response recognizing multiple PTMs. Furthermore, human AMPA, isolated based on their reactivity to one PTM, cross-react with other PTMs at the monoclonal and polyclonal level. However, it is unclear whether the AMPA reactivity profile is “fixed” in time, or whether consecutive exposure to different PTMs can shape the evolving AMPA-response.Objectives:To investigate the evolution of the AMPA response in mice with controlled exposure to PTMs as well as in AMPA-positive humans.Methods:Mice were immunized with acetylated (or carbamylated) protein (ovalbumin) twice or cross-immunized with an acetylated and then a carbamylated protein (or vice versa) and their serum was analyzed for AMPA responses with ELISA using a different backbone protein (fibrinogen) bearing the same modifications. Longitudinally collected serum samples of human individuals at risk of RA and with early RA were tested to investigate the evolution of the AMPA responses in humans.Results:Mice immunized twice with either solely acetylated or solely carbamylated ovalbumin (AcOVA or CaOVA) developed reactivity against both acetylated and carbamylated antigens. Irrespective of the PTM used for the first immunization, a booster immunization with the other PTM resulted in increased titers to the second/booster PTM (Figure 1A), suggesting that immunization with a defined PTM-antigen leads to the generation of anti-PTM memory B cells able to cross-recognize other PTMs. Furthermore, immunizing with CaOVA and boosting with AcOVA (or vice versa) skewed the overall AMPA-response profile towards a relatively higher reactivity against the “booster” PTM (Figure 1B). Human data also illustrated dynamic changes in AMPA reactivity profiles in both individuals at risk of RA and in early RA patients (not shown).Conclusion:The relationship between different reactivities within the AMPA response is dynamic. The initial exposure to a PTM antigen induces cross-reactive response that can be boosted by the same or other PTMs. The overall reactivity pattern can be skewed by subsequent exposure to other PTMs. These data might explain temporal changes in the reactivity profile of the AMPA response and point to the possibility that the PTM responsible for the initiation of the AMPA response may differ from the PTM predominantly recognized later in time.Disclosure of Interests:None declared
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Goto Y, Funada A, Maeda T, Goto Y. Subsequent shock delivery and outcomes in out-of-hospital cardiac arrests with initial unshockable rhythm. Europace 2021. [DOI: 10.1093/europace/euab116.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research)
Background
The conversion from initial non-shockable to shockable rhythms during cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA). However, the prognostic significance of rhythm conversion according to the type of initial nonshockable rhythm is unclear.
Purpose
To determine the association between shock after conversion to shockable rhythm with neurologically intact survival after OHCA and shock delivery time (time from EMS-initiated CPR to first shock delivery) in patients with two types of initial unshockable rhythm.
Methods
We analyzed the records of 90,334 adult patients with witnessed OHCA of cardiac origin who were treated by EMS providers and had an initial unshockable rhythm. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 5-year period (2013–2017). The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance categories score from 1 to 2. Patients were divided into initial pulseless electrical activity (PEA) (n = 37,977 [42.0%]) and initial asystole (n = 52,357 [58.0%]) groups.
Results
In the initial PEA group, the crude rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked than in the non-shocked patients (4.2% [121/2,896]) vs. 2.4% [857/35,081], p <0.0001). After adjustment for ten prehospital variables, the adjusted odds ratios (aORs) of subsequent shock for 1-month neurologically intact survival compared to no shock delivery were as follows: shock delivery time <10 min, 2.21 (95% confidence interval [CI], 1.77–2.77, p< 0.0001); 10–14 min, 1.43 (0.89–2.28, p = 0.14); and ≥15 min, 0.36 (0.16–0.81; p = 0.013). In the initial asystole group, the crude rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked than in the non-shocked (1.7% [47/2,687] vs. 0.4% [203/49,670], p <0.0001). A multivariate logistic regression model showed that subsequent shock with a shock delivery time <10 min was associated with increased odds of neurologically intact survival compared to no shock delivery (aOR, 5.67; 95% CI, 3.92–8.18; p <0.0001). However, there were no significant differences in neurological outcomes between subsequently shocked and non-shocked patients when the shock delivery time was 10–14 min (p = 0.21) or ≥15 min (p = 0.91).
Conclusions
In patients with witnessed OHCA of cardiac origin and initial nonshockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered <10 min from EMS-initiated CPR, regardless of the type of initial rhythm. Further, in patients with initial PEA, subsequent shock was associated with decreased odds of neurologically intact survival when shock was delivered ≥15 min from EMS-initiated CPR.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Goto Y, Funada A, Maeda T, Goto Y. Association of subsequent shock after conversion to shockable rhythm with outcomes stratified by the type of initial non-shockable rhythm in children with out-of-hospital cardiac arrest. Europace 2021. [DOI: 10.1093/europace/euab116.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research)
Background/Introduction: The rhythm conversion from initial non-shockable to shockable rhythm during cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA) in children with an initial non-shockable rhythm. However, the prognostic significance of rhythm conversion stratified by the type of initial non-shockable rhythm is still unclear.
Purpose
We aimed to investigate the association of subsequent shock after rhythm conversion to shockable rhythm with neurologically intact survival and shock delivery time (time from EMS-initiated CPR to first shock delivery) by the type of initial non-shockable rhythm in children with OHCA.
Methods
We analysed the records of 19,095 children (age <18 years) with OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 13-year period (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category score of 1 to 2. Patients were divided into the initial pulseless electrical activity (PEA) (n = 3,326 [17.4%]) and initial asystole (n = 15,769 [82.6%]) groups.
Results
The proportion of patients who received subsequent shock after conversion to shockable rhythm was significantly higher in the initial PEA than in the initial asystole groups (3.3% [109/3,326] vs. 1.4% [227/15,769], p < 0.0001). The shock delivery time was significantly shorter in the initial PEA than in the initial asystole groups (median [IQR], 8 min [5 min – 12 min] vs. 10 min [6 min – 16 min], p < 0.01). Among the initial PEA patients, there was no significant difference between subsequently shocked (10.0% [11/109]) and subsequently non-shocked patients (6.0% [192/3,217], p = 0.10) regarding the rate of 1-month neurologically intact survival. However, after adjusting for 9 pre-hospital variables, subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.16–5.16], p = 0.018). Among the initial asystole patients, the rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked (4.4% [10/227]) than in the subsequently non-shocked (0.7% [106/15,542], p < 0.0001). A multivariate logistic regression model showed that subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted OR, 9.77 [95% CI, 4.2–22.5], p < 0.0001).
Conclusions
In children with OHCA with an initial non-shockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered <10 min from EMS-initiated CPR regardless of the type of initial rhythm.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Aguilar-Vega L, López-Jácome LE, Franco B, Muñoz-Carranza S, Vargas-Maya N, Franco-Cendejas R, Hernández-Durán M, Otero-Zúñiga M, Campo-Beleño C, Jiménez-Cortés JG, Martínez-Vázquez M, Rodríguez-Zavala JS, Maeda T, Zurabian R, García-Contreras R. Antibacterial properties of phenothiazine derivatives against multidrug-resistant Acinetobacter baumannii strains. J Appl Microbiol 2021; 131:2235-2243. [PMID: 33884726 DOI: 10.1111/jam.15109] [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] [Received: 09/24/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
AIM As options to treat recalcitrant bacterial infections which are increasingly limited due to multidrug-resistant strains, searching for new, effective antibacterial compounds is necessary. One strategy is to generate treatment alternatives by drug repurposing. METHODS AND RESULTS In this work, phenotypic microarrays were used for the screening of miscellaneous compounds against the growth and biofilm formation of Acinetobacter baumannii, an important emergent multidrug-resistant opportunistic pathogen. The results showed that the phenothiazine derivatives, such as promethazine, trifluoperazine, thioridazine, and chlorpromazine, inhibited the growth of antibiotic-sensitive and multidrug-resistant strains (showing minimal inhibitory concentrations ranging from 0·05 to 0·6 g l-1 and minimal bactericidal concentrations ranging from 0·1 to 2·5 g l-1 ). All phenothiazine derivatives were active against biofilm cells (with minimal biofilm eradication concentrations ranging from 0·5 to >3 g l-1 ). Chlorpromazine promoted reactive oxigen species (ROS) production, and cell membrane and DNA damage. Chlorpromazine showed synergy with antibiotics such as ceftazidime, meropenem, and colistin and was an effective treatment for experimentally infected Galleria mellonella when combined with ceftazidime. CONCLUSIONS It was demonstrated that phenothiazine derivatives, especially chlorpromazine, are drugs with attractive antibacterial properties against nosocomial MDR strains of A. baumannii, by generating ROS and cell membrane and DNA damage. SIGNIFICANCE AND IMPACT OF THE STUDY The present study indicates that repurposing phenothiazine derivatives for treating recalcitrant infections by A. baumannii could be promising.
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Affiliation(s)
- L Aguilar-Vega
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México
| | - L E López-Jácome
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México.,División de Enfermedades Infecciosas, Instituto Nacional de Rehabilitación "Luis G. Ibarra Ibarra", Ciudad de México, México
| | - B Franco
- División de Ciencias Naturales y Exactas, Departamento de Biología, Universidad de Guanajuato, Guanajuato, México
| | - S Muñoz-Carranza
- División de Ciencias Naturales y Exactas, Departamento de Biología, Universidad de Guanajuato, Guanajuato, México
| | - N Vargas-Maya
- División de Ciencias Naturales y Exactas, Departamento de Biología, Universidad de Guanajuato, Guanajuato, México
| | - R Franco-Cendejas
- División de Enfermedades Infecciosas, Instituto Nacional de Rehabilitación "Luis G. Ibarra Ibarra", Ciudad de México, México
| | - M Hernández-Durán
- División de Enfermedades Infecciosas, Instituto Nacional de Rehabilitación "Luis G. Ibarra Ibarra", Ciudad de México, México
| | - M Otero-Zúñiga
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, UNAM, Ciudad de México, México
| | - C Campo-Beleño
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México
| | - J G Jiménez-Cortés
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México
| | - M Martínez-Vázquez
- Departamento de Química de Productos Naturales, Instituto de Química, UNAM, Ciudad de México, México
| | - J S Rodríguez-Zavala
- Departamento de Bioquímica, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - T Maeda
- Department of Biological Functions Engineering, Kyushu Institute of Technology, Kitakyushu, Japan
| | - R Zurabian
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México
| | - R García-Contreras
- Departamento de Microbiología y Parasitología, Facultad de Medicina, UNAM, Ciudad de México, México
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Maeda T, Funayama E, Yamamoto Y, Murao N, Osawa M, Ishikawa K, Hayashi T. Long-term outcomes and recurrence-free interval after the treatment of keloids with a standardized protocol. J Tissue Viability 2020; 30:128-132. [PMID: 33288386 DOI: 10.1016/j.jtv.2020.11.003] [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: 07/17/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recurrence rates of keloids have generally been reported at one time point. However, the longer the duration after treatment, the greater the likelihood that such lesions will recur. In this study, we analysed the time to recurrence during long-term follow-up. MATERIAL AND METHODS We retrospectively reviewed recurrence-free interval in 52 patients with keloid (age 8-79 years) who had been treated between June 2006 and January 2011 using a standardised protocol developed by our group. RESULTS Mean duration of follow-up was 37.5 (range, 7-120) months in patients with keloid. Kaplan-Meier survival curves revealed a statistically significant difference in recurrence-free interval between ear keloids and keloids excluding ear keloids. Recurrence rate for keloids was high in the first 2 years after treatment. CONCLUSIONS Kaplan-Meier analysis was useful for understanding the tendency of recurrence of keloids after treatment using a standardised protocol.
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Affiliation(s)
- T Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - E Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Y Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - N Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - M Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - K Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - T Hayashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan; Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Japan.
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Funada A, Goto Y, Maeda T, Okada H, Takamura M. Effect of chest-compression-only bystander cardiopulmonary resuscitation on the likelihood of initial shockable rhythm after out-of-hospital cardiac arrest: a propensity matching analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Shockable rhythm after cardiac arrest is highly expected after early initiation of bystander cardiopulmonary resuscitation (CPR) owing to increased coronary perfusion. However, the relationship between bystander CPR and initial shockable rhythm in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We hypothesized that chest-compression-only CPR (CC-CPR) before emergency medical service (EMS) arrival has an equivalent effect on the likelihood of initial shockable rhythm to the standard CPR (chest compression plus rescue breathing [S-CPR]).
Purpose
We aimed to examine the rate of initial shockable rhythm and 1-month outcomes in patients who received bystander CPR after OHCA.
Methods
The study included 59,688 patients (age, ≥18 years) who received bystander CPR after an OHCA with a presumed cardiac origin witnessed by a layperson in a prospectively recorded Japanese nationwide Utstein-style database from 2013 to 2017. Patients who received public-access defibrillation before arrival of the EMS personnel were excluded. The patients were divided into CC-CPR (n=51,520) and S-CPR (n=8168) groups according to the type of bystander CPR received. The primary end point was initial shockable rhythm recorded by the EMS personnel just after arrival at the site. The secondary end point was the 1-month outcomes (survival and neurologically intact survival) after OHCA. In the statistical analyses, a Cox proportional hazards model was applied to reflect the different bystander CPR durations before/after propensity score (PS) matching.
Results
The crude rate of the initial shockable rhythm in the CC-CPR group (21.3%, 10,946/51,520) was significantly higher than that in the S-CPR group (17.6%, 1441/8168, p<0.0001) before PS matching. However, no significant difference in the rate of initial shockable rhythm was found between the 2 groups after PS matching (18.3% [1493/8168] vs 17.6% [1441/8168], p=0.30). In the Cox proportional hazards model, CC-CPR was more negatively associated with the initial shockable rhythm before PS matching (unadjusted hazards ratio [HR], 0.97; 95% confidence interval [CI], 0.94–0.99; p=0.012; adjusted HR, 0.92; 95% CI, 0.89–0.94; p<0.0001) than S-CPR. After PS matching, however, no significant difference was found between the 2 groups (adjusted HR of CC-CPR compared with S-CPR, 0.97; 95% CI, 0.94–1.00; p=0.09). No significant differences were found between C-CPR and S-CPR in the 1-month outcomes after PS matching as follows, respectively: survival, 8.5% and 10.1%; adjusted odds ratio, 0.89; 95% CI, 0.79–1.00; p=0.07; cerebral performance category 1 or 2, 5.5% and 6.9%; adjusted odds, 0.86; 95% CI, 0.74–1.00; p=0.052.
Conclusions
Compared with S-CPR, the CC-CPR before EMS arrival had an equivalent multivariable-adjusted association with the likelihood of initial shockable rhythm in the patients with OHCA due to presumed cardiac causes that was witnessed by a layperson.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Funada
- Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - H Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - M Takamura
- Kanazawa University Graduate School of Medicine, Cardiovascular Medicine, Kanazawa, Japan
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Kawashiri SY, Nishino A, Shimizu T, Takatani A, Umeda M, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Maeda T, Kawakami A. Fluorescence optical imaging in patients with active rheumatoid arthritis: a comparison with ultrasound and an association with biomarkers. Scand J Rheumatol 2020; 50:95-103. [PMID: 33084461 DOI: 10.1080/03009742.2020.1794028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: This study compared indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) and musculoskeletal ultrasound (MSUS), and explored the significance of the FOI findings based on the association between the FOI and MSUS findings and serum biomarkers in patients with rheumatoid arthritis (RA). The study also explored the association between the FOI findings and patients' joint destruction at the joint-area level.Method: We enrolled 50 consecutive patients with active RA from among the patients hospitalized from May 2014 to March 2016 at Nagasaki University Hospital, Japan. FOI images were acquired with the Xiralite® fluorescence imaging system and compared with the patients' clinical examination results and MSUS findings. On the same day, the patients' clinical disease activity and levels of serum biomarkers (including vascular endothelial growth factor) were obtained.Results: Although the FOI detected synovitis with high sensitivity, the frequency of positive findings and the diagnostic performance with MSUS as the reference standard for FOI differed considerably among the phases of FOI as well as among the affected joint regions. The FOI scores were positively correlated with clinical disease activity, MSUS scores, and serum biomarkers. The severity of FOI-proven synovitis was associated with the presence of MSUS-proven bone erosion.Conclusion: FOI is effective for detecting joint inflammation in RA patients, with high accuracy. The severity of the FOI score was closely associated with the joint destruction at the joint-area level. However, the significance of positive FOI findings differed depending on not only the phase of FOI but also the affected joint regions.
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Affiliation(s)
- S-Y Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Nishino
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Takatani
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Umeda
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - K Ichinose
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Nakamura
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Kawakami
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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24
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Kawashiri SY, Tsuji Y, Tamai M, Nonaka F, Nobusue K, Yamanashi H, Maeda T, Kawakami A. Effects of cigarette smoking and human T-cell leukaemia virus type 1 infection on anti-citrullinated peptide antibody production in Japanese community-dwelling adults: the Nagasaki Islands Study. Scand J Rheumatol 2020; 50:295-298. [PMID: 32959708 DOI: 10.1080/03009742.2020.1810310] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: We investigated whether the positivity of anti-citrullinated peptide antibody (ACPA) is associated with cigarette-smoking status and human T-cell leukaemia virus type 1 (HTLV-1) infection in a general population in Nagasaki, Japan, which is an ageing and HTLV-1-endemic area.Method: Baseline data from community-dwelling people in the Nagasaki Islands Study (NaIS) were included in this cross-sectional analysis. ACPA and HTLV-1 were measured in 3887 subjects without a history of treatment for rheumatoid arthritis. A logistic regression analysis was performed to assess the relationship between ACPA positivity and candidates of correlation with ACPA, i.e. the cigarette-smoking status quantified by Brinkman's index (BI) and HTLV-1 positivity.Results: Fifty-one subjects (1.3%) showed ACPA positivity, and 650 subjects (16.6%) were HTLV-1 carriers. In an age- and gender-adjusted logistic regression analysis, the BI [odds ratio (OR) 1.09, 95% confidence interval (CI)1.02-1.14, p = 0.0031] and a BI value > 500 (OR 3.92, 95% CI 1.72-9.22, p = 0.0014) were each significantly associated with ACPA positivity. HTLV-1 positivity did not show any association with ACPA positivity.Conclusion: A significant effect of cigarette-smoking status on ACPA production was revealed, whereas HTLV-1 positivity was not associated with ACPA production in this general population.
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Affiliation(s)
- S-Y Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Y Tsuji
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - F Nonaka
- Department of Island and Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - K Nobusue
- Department of Island and Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - H Yamanashi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Department of General Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - T Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Department of Island and Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - A Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
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Maeda T, Kitamura S, Yanagi T. RANK-RANKL signalling pathway contributes to disease progression in cutaneous angiosarcoma: a case report with an immunohistochemical review and in vitro experiments. J Eur Acad Dermatol Venereol 2020; 34:e834-e837. [PMID: 32511804 DOI: 10.1111/jdv.16714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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)
- T Maeda
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - S Kitamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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26
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Kitamura S, Yanagi T, Maeda T, Shimizu H. Drp1 expression levels correlate with clinical stage in extramammary Paget’s disease. J Eur Acad Dermatol Venereol 2020; 34:e510-e513. [DOI: 10.1111/jdv.16422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/25/2020] [Indexed: 01/27/2023]
Affiliation(s)
- S. Kitamura
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - T. Yanagi
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - T. Maeda
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - H. Shimizu
- Department of Dermatology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
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27
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Fujita M, Fukuda K, Hayashi S, Kikuchi K, Takashima Y, Kamenaga T, Maeda T, Matsubara T, Kuroda R. AB0089 THE ANALYSIS FOR THE INHIBITION OF ANGIOGENESIS BY JAK INHIBITOR. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Many blood vessels are generated in the hyperplastic synovial tissue of patients with rheumatoid arthritis (RA), and lead to chronic tissue inflammation and joint destruction [1]. Janus kinase (JAK) family consisting of JAK1, JAK2, JAK3 and tyrosine kinase 2 (TYK2) are chain receptors which phosphorylate signal transducers and activators of transcription (STAT) and mediate inflammatory diseases including RA [2]. Nowadays, several JAK inhibitors such as Tofacitinib (TOF), Baricitinib (BAR) and Peficitinib (PEF) have been developed and demonstrated to have the inhibitory effects on inflammatory arthritis [3-5]. However, there were few reports concerning their effects on angiogenesis in vitro.Objectives:The purpose of the present study is to investigate the influence of JAK inhibitors on angiogenesis of human umbilical vein endothelial cell (HUVEC) activated by vascular endothelial growth factor (VEGF).Methods:The cell line of HUVECs were used for this study. The activity of proliferation and tube formation were analyzed by counting assay and tube formation assay, respectively.In counting assay, HUVECs (5 × 104cells/ml) were seeded onto 96-well cell culture plate with 20 ng/ml VEGF including various doses (0.1µM, 1µM, 5µM) of TOF, BAR or PEF. After 48 hours incubation at 37°C in a humidified atmosphere containing 5% CO2, cell proliferation of each groups was assessed using cell counting kit. In tube formation assay, HUVECs (5 × 104cells/ml) were treated with 20ng/ml VEGF including various dose (0.1µM, 1µM, 5µM) of TOF, BAR or PEF for 00 hours, then seeded onto 48-well plate applied with Matrigel. After 24 hours incubation on Matrigel, the capillary-like tube formation of each well was photographed using phase contrast microscopy. Tube formation were quantitated by measurement of the length of branch.Results:HUVECs were activated in proliferation and tube formation by VEGF treatment. And, the proliferation and tube formation of HUVECs activated by VEGF were suppressed by All of TOF, BAR and PEF. In particular, TOF and PEF could suppress them highly.Conclusion:This study showed the inhibitory effect of JAK inhibitors on proliferation and tube formation of HUVECs activated by VEGF. In particular, the angiogenesis of HUVECs activated by VEGF was highly suppressed by TOF and PEF. VEGF is reported to regulate the angiogenesis through multi JAK-STAT signaling pathways [6]. The inhibitory effects on angiogenesis of TOF, BAR and PEF might depend on the differences in their affinity for JAKs. VEGF has been shown to a have a central involvement in the angiogenic process in RA [7]. JAK inhibitors might suppress the angiogenesis in RA synovial tissues by inhibiting VEGF signaling.References:[1]Scott DL, et al. Rheumatoid arthritis. Lancet. 2010.[2]Banerjee S, et al. JAK-STAT signaling as a target for inflammatory and autoimmune diseases: current and future prospects. Drugs. 2017.[3]William D, et al. JAK inhibitors in dermatology: the promise of a new drug class. Journal of the American Academy of Dermatology. 2017.[4]Dhillon S. Tofacitinib: A Review in Rheumatoid Arthritis. Drugs. 2017.[5]Markham A, et al. Peficitinib: First Global Approval. Drugs. 2019.[6]Zhang HY, et al. Three important components in the regeneration of the cavernous nerve: brain-derived neurotrophic factor, vascular endothelial growth factor and the JAK/STAT signaling pathway. Asian journal of andrology. 2011.[7]Paleolog EM. Angiogenesis in rheumatoid arthritis. Arthritis research. 2002.Acknowledgments:noneDisclosure of Interests:None declared
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28
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Tsuji Y, Tamai M, Morimoto S, Sasaki D, Nagayoshi M, Nonaka F, Kawashiri SY, Yanagihara K, Saito T, Aoyagi K, Maeda T, Matsuda F, Kawakami A. AB1232 ORAL DYSBIOSIS REFLECTS THE IMMUNOLOGICAL ALTERATION OF RA REGARDING TO ACPA AND HLA DRB1*SE: NAGASAKI ISLAND STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-citrullinated protein antibody (ACPA) production is observed in several organs even prior to the onset of rheumatoid arthritis (RA), and oral mucosa is considered to be one of the important tissues. The presence of HLA-DRB1*SE closely associates with ACPA production. Saliva is considered to reflect the oral microbiota including periodontal disease. Alteration of oral microbiota of RA becomes to be normalized by DMARDs treatment, however, the interaction of HLA-DRB1*SE, ACPA and oral microbiota of RA patients remains to be elucidated.Objectives:The Nagasaki Island Study, which had started in 2014 collaborating with Goto City, is intended for research of the preclinical stage of RA, including ACPA/HLA genotype screening and ultrasound and magnetic resonance imaging examinations in high-risk subjects. Using the samples accumulated in this cohort, we have tried to investigate the difference of oral microbiota among RA patients and healthy subjects regarding to ACPA and HLA-DRB1*SE.Methods:Blood and salivary samples were obtained from 1422 subjects out of 4276 who have participated in the Nagasaki Island Study from 2016 to 2018. ACPA positivity was 1.7 % in total. Some of RA patients resided in Goto City participated in the Nagasaki Island Study. At this point, we selected 291 subjects, who were ACPA positive non-RA healthy subjects (n=22) and patients with RA (n=33, 11 subjects were ACPA positive and 22 ACPA negative respectively) as the case, age and gender matched ACPA negative non-RA healthy subjects (n=236) as the control. ACPA was measured by an enzyme-linked immunosorbent assay, and HLA genotyping was quantified by next-generation sequencing (Ref.1). The operational taxonomic unit (OUT) analysis using 16S rRNA gene sequencing were performed. The richness of microbial diversity within-subject (alpha diversity) was scaled via Shannon entropy. The dissimilarity between microbial community composition was calculated using Bray-Curtis distance as a scale, and differences between groups (beta diversity) were tested by permutational multivariate analysis of variance (PERMANOVA). In addition, UniFrac distance calculated in consideration of the distance on the phylogenetic tree were performed.Results:Median age 70 y.o., % Female 58.8 %. Among RA and non-RA subjects, not alpha diversity but beta diversity was statistically significance (p=0.022, small in RA). In RA subjects, both alpha and beta diversity is small (p<0.0001), especially significant in ACPA positive RA (Figure 1). Amongt RA subjects, presence of HLA-DRB1*SE did not show the difference but the tendency of being small of alpha diversity (p=0.29).Conclusion:Our study has suggested for the first time the association of oral microbiota alteration with the presence of ACPA and HLA-DRB1*SE. Oral dysbiosis may reflect the immunological status of patients with RA.References:[1]Kawaguchi S, et al. Methods Mol Biol 2018;1802: 22Disclosure of Interests:None declared
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Goto Y, Funada A, Maeda T, Okada F, Goto Y. P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest. Europace 2020. [DOI: 10.1093/europace/euaa162.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999)
Background
In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA.
Purpose
The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA.
Methods
We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site.
Results
The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to <10%, <5%, and <1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to <10%, <5%, and <1%, were 10, 11, and 15 minutes, respectively.
Conclusions
In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be <17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - F Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Goto Y, Funada A, Maeda T, Okada F, Goto Y. P498External validation of a field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan. Europace 2020. [DOI: 10.1093/europace/euaa162.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A universal basic life support termination-of-resuscitation (BLS-TOR) rule was developed to identify patients with out-of-hospital cardiac arrest (OHCA) eligible for field termination of cardiopulmonary resuscitation (CPR). In Japan, however, emergency medical service (EMS) providers are not allowed field termination of CPR and must transport all patients with OHCA to hospitals, regardless of return of spontaneous circulation (ROSC). Therefore, we previously developed a Japanese TOR (JP-TOR) rule in the field for refractory OHCAs using data from the All-Japan Utstein registry between 2011 and 2015, when CPR was performed according to the 2010 guidelines. The JP-TOR rule recommends CPR termination when patients meet all the following criteria: initial asystole, unwitnessed arrest, age ≥81 years, no bystander interventions before EMS arrival, and no ROSC after EMS-initiated CPR for 14 min.
Purpose
To validate the JP-TOR rule using more recent data where CPR was performed according to the 2015 guidelines, comparing the relevance of JP-TOR rule with the BLS-TOR rule, which consists of the following criteria: no prehospital ROSC after 6-min EMS-initiated CPR, arrest unwitnessed by EMS providers, and no shock received.
Methods
We analysed the records of 242,184 patients (age ≥18 years) who experienced OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database from 2016 to 2017. The primary endpoints were specificity and positive predictive value (PPV) for predicting the 1-month mortality after OHCA with the JP-TOR and BLS-TOR rules.
Results
The overall 1-month survival rate was 5.3% (12,847/242,184). The proportions of patients with OHCA fulfilled the JP-TOR and BLS-TOR criteria were 10.4% and 89.3%, respectively. The specificity and PPV of the JP-TOR and BLS-TOR rules for predicting 1-month mortality were 99.5% (95% confidence interval [CI], 99.4%–99.5%) and 99.8% (95% CI, 99.7%–99.8%) and 44.7% (95% CI, 43.8%–45.5%) and 96.7% (95% CI, 96.6%–96.8%), respectively.
Conclusions
The JP-TOR rule for EMS providers treating patients with OHCA in the field was successfully validated using more recent data from a Japanese registry where CPR was performed according to the 2015 guidelines. The JP-TOR rule was superior to the BLS-TOR rule in Japanese EMS systems, having both high specificity and PPV of >99% for predicting 1-month mortality. The JP-TOR rule may help EMS providers decide whether to terminate resuscitation efforts for unresuscitable patients with OHCA in the field. Prospective validation studies and establishment of prehospital EMS protocol are required before implementing this rule in Japan.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - F Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Goto Y, Funada A, Maeda T, Okada F, Goto Y. P489Survival in children with out-of-hospital cardiac arrest after standard or chest compression-only bystander cardiopulmonary resuscitation before emergency medical services arrival. Europace 2020. [DOI: 10.1093/europace/euaa162.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999)
Background
For out-of-hospital cardiac arrest (OHCA), current cardiopulmonary resuscitation (CPR) guidelines recommend chest compression-only bystander CPR (C- BCPR) for both untrained and trained bystanders unwilling to perform rescue breaths before emergency medical services personnel arrival. However, during 3 consecutive guideline periods, changes in type of BCPR and neurologically intact survival rate are unclear in paediatric OHCA cases.
Purpose
We aimed to determine the change in the rate and type of BCPR in correlation to the 1-month neurologically intact survival and causes of OHCA.
Methods
We reviewed 5461 children with bystander witnessed OHCA included in the All-Japan Utstein-style registry from 2005 to 2017. Patients were divided into 3 groups according to the type of BCPR: no BCPR (NO-BCPR), standard BCPR with rescue breaths (S-BCPR), and C-BCPR. Guideline periods 2005 to 2010 (pre-G2010), 2011 to 2015 (G2010), and 2016 to 2017 (G2015) were used for comparison over time. The study endpoint was 1-month neurologically intact survival (Cerebral Performance Category [CPC] scale 1 or 2; CPC 1–2).
Results
The rates of patients receiving any BCPR and 1-month CPC 1–2 by year significantly increased from 46.2% and 9.4% in 2005 to 61.3% and 15.7% in 2017 (all P for trend <0.0001), respectively. The rates of patients receiving C-BCPR in the pre-G2010 period significantly increased from 21.6% to 35.5% in the G2010 period, and to 40.4% in the G2015 period (P for trend <0.0001); the overall proportion of cases with 1-month CPC 1–2 increased from 9.1% to 10.8% and 14.7%, respectively (P for trend <0.0001). Particularly, in patients receiving C-BCPR, CPC 1–2 rate significantly increased from 9.5% in the pre-G2010 period to 19.0% in the G2015 period (P for trend <0.0001). For all time periods, 1-month CPC 1–2 rate in the S-BCPR (17.2%) cohort was significantly higher than those in the C-BCPR (12.5%) and NO-BCPR (6.4%) cohorts (adjusted odds ratio [aOR] of S-BCPR compared with C-BCPR, 1.59; 95% confidence interval [CI], 1.25–2.01; P < 0.0001; compared with NO-BCPR, aOR 2.31; 95% CI, 1.82–2.94; P < 0.0001). No significant difference between S-BCPR and C-BCPR was found in 1-month CPC 1–2 rate for patients with non-traumatic origin (17.7% vs. 16.3%; aOR, 1.23, 95% CI, 0.95–1.59, all P >0.05). However, in patients with traumatic origin, S-BCPR was superior to C-BCPR (15.1% vs. 3.4%; aOR, 4.53, 95% CI, 2.39–8.61, all P <0.0001). During the 3 guidelines periods, the CPC 1–2 rate in patients with non-traumatic origin significantly increased from 11.8% to 19.7% (P for trend < 0.0001), but not in patients with traumatic origin (from 4.9% to 4.1%, P for trend = 0.29).
Conclusions
During the 3 guidelines periods, the rate of C-BCPR and 1-month CPC 1–2 increased by approximately 2-fold each over time. C-BCPR was associated with increased odds of 1-month CPC 1–2 similar to S-BCPR for children with non-traumatic origin but not in those with traumatic origin.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - F Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Fukuda K, Miura Y, Hayashi S, Maeda T, Kuroda R. AB0090 DEATH RECEPTOR 3 REGULATES THE GENE EXPRESSIONS OF VARIOUS KEY MOLECULES IN RHEUMATOID SYNOVIAL FIBROBLASTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes hyperplasia of synovial tissue. Death receptor 3 (DR3) is a tumor necrosis factor receptor and binds to TL1A, a member of the TNF family. DR3 is involved in the mechanism of cell proliferation and apoptosis through NF-κB signaling. Suppression of DR3 in rheumatoid synovial fibroblasts (RA-FLS) is associated with hyperplasia of rheumatoid synovial tissue [1]. We previously revealed the expression profiles regulated by TL1A, suggesting that TL1A might affect the pathogenesis of RA, including proliferation, regulation of B cells and T cells, inflammation, and cytokine processing [2].Objectives:In this study, we investigated the gene expression profiles regulated by DR3 in RA-FLS to reveal how DR3 is involved in the pathogenesis of RA.Methods:RA-FLS were from patients with RA. Four individual lines of primary cultured RA-FLS were incubated either with 1000 ng/ml of human DR3-Fc protein or 1000ng/ml of human IgG1 as a control for 12h. Gene expressions were detected by microarray assay.Results:Microarray data analysis revealed that DR3 up-regulated or down-regulated the expression of various genes in RA-FLS (Figure). The function of regulated genes included protein-L-isoaspartate (D-aspartate) O-methyltransferase activity, carboxyl-O-methyltransferase activity, protein carboxyl O-methyltransferase activity, regulation of cilium assembly, O-methyltransferase activity, regulation of plasma membrane bounded cell projection assembly, regulation of cell projection assembly, regulation of organelle assembly, protein methyltransferase activity, and S-adenosylmethionine-dependent methyltransferase activity. The most up-regulated 2 genes by DR3 were KIAA1109 (KIAA1109), and adhesion G protein-coupled receptor A3 (ADGRA3). The most down-regulated 2 genes by DR3 were RNA exonuclease 2 (REXO2), and family with sequence similarity 120A (FAM120A).Conclusion:In this study, we first revealed the expression profiles of genes regulated by DR3 in RA-FLS. KIAA1109/TENR/IL2/IL21 gene is strongly associated with RA in European descent populations [3]. ADGRA3 is a member of G protein-coupled receptors (GPCRs). GPCRs associates with the regulation of cytoskeletal organization, the cell adhesion and migration, cell proliferation and apoptosis, and cell differentiation [4]. Loss of REXO2 affects cell growth and morphology [5], and REXO2 was identified as a target gene for inflammatory bowel disease-associated variants [6]. FAM120A regulates activity of Src kinase to protect cells from oxidative stress-induced apoptosis [7]. DR3 regulates the gene expressions of various key molecules in RA-FLS and may affect the pathogenesis of RA by regulating gene expression of RA-FLS.References:[1]Takami N. et al., Arthritis Rheuma. 2006;54:779-787.[2]Fukuda K. et al., Biomed Rep. 2019;1:1-5.[3]Teixeira VH. et al., Arthritis Research & Therapy. 2009;11:R45.[4]Hamann J. et al., Pharmacol Rev. 2015;67:338-367.[5]Bruni F, et al., PLoS One. 2013;8:e64670.[6]Hulur I, et al., BMC Genomics. 2015;16:138.[7]Tanaka M. et al., Mol Cell Biol. 2009;29:402-413.Disclosure of Interests:None declared
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Goto Y, Funada A, Maeda T, Okada F, Goto Y. P490Time boundaries of three-phase time-sensitive model for ventricular fibrillation cardiac arrest. Europace 2020. [DOI: 10.1093/europace/euaa162.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999)
Background
Recent clinical evidence has suggested that the pathophysiology of ventricular fibrillation (VF) cardiac arrest may consist of three time-sensitive phases, namely electrical, circulatory, and metabolic. According to this model of cardiopulmonary resuscitation (CPR), the optimal treatment of cardiac arrest is phase-specific. The potential survival benefit of bystander cardiopulmonary resuscitation (BCPR) depends in part on ischemic time (i.e., the collapse-to-shock interval), with the greatest benefit occurring during the circulatory (second) phase. However, the time boundaries between phases are not precisely defined in the current literature.
Purpose
The purpose of the present study was to determine the time boundaries of the three-phase time-sensitive model for VF cardiac arrest.
Methods
We reviewed 20,741 adult patients with initial VF after witnessed out-of-hospital cardiac arrest from a presumed cardiac origin who were included in the All-Japan Utstein-style registry from 2013 to 2017. We excluded patients who underwent bystander defibrillation prior to arrival of emergency medical services personnel. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Collapse-to-shock interval was defined as the time from collapse to first shock delivery by emergency medical services personnel. Patients were divided into two groups, BCPR (n = 11,606, 56.0%) and non-BCPR (n = 9135, 44.0%), according to whether they had received BCPR or not.
Results
The rate of 1-month neurologically intact survival in the BCPR group was significantly higher than that in the non-BCPR group (27.9% [3237/11,606] vs 17.9% [1632/9135], P < 0.0001; adjusted odds ratio [OR], 1.90; 95% confidence interval [CI], 1.75–2.07; P < 0.0001). Overall, increased collapse-to-shock interval was associated with significantly decreased adjusted odds of 1-month neurologically intact survival (adjusted OR for each 1-minute increase, 0.94; 95% CI, 0.93–0.95; P < 0.0001). In the BCPR group, the ranges of collapse-to-shock interval that were associated with increased adjusted 1-month neurologically intact survival were from 7 minutes (adjusted OR, 1.95; 95% CI, 1.44–2.63; P < 0.0001) to 17 minutes (adjusted OR, 2.82; 95% CI, 1.62–4.91; P = 0.0002) as compared with those in the non-BCPR group. However, the increase in neurologically intact survival of the BCPR group became statistically insignificant as compared with that of the non-BCPR group when the collapse-to-shock interval was outside these ranges.
Conclusions
The above-mentioned findings suggest that the time boundaries of the three-phase time-sensitive model for VF cardiac arrest may be as follows: electrical phase, from collapse to <7 minutes; circulatory phase, from 7 to 17 minutes; and metabolic phase, >17 minutes onward from collapse.
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Affiliation(s)
- Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - A Funada
- Osaka Saiseikai Senri Hospital, Department of Cardiology, Osaka, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - F Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Yawata Medical Center, Department of Cardiology, Komatsu, Japan
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Fujisawa Y, Fujimura T, Matsushita S, Yamamoto Y, Uchi H, Otsuka A, Funakoshi T, Miyagi T, Hata H, Gosho M, Kambayashi Y, Aoki M, Yanagi T, Ohira A, Nakamura Y, Maeda T, Yoshino K. The efficacy of eribulin mesylate for patients with cutaneous angiosarcoma previously treated with taxane: a multicentre prospective observational study. Br J Dermatol 2020; 183:831-839. [PMID: 32198756 DOI: 10.1111/bjd.19042] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Taxanes are the current first-line treatment for advanced cutaneous angiosarcoma (CAS) for patients who are considered difficult to treat with doxorubicin owing to advanced age or comorbidity. However, no effective second-line therapy for such patients has been established. METHODS We designed a single-arm prospective observational study of eribulin mesylate (ERB) administered at a dose of 1·4 mg m-2 on days 1 and 8 in a 21-day cycle. Patients with advanced CAS who were previously treated with a taxane and were scheduled to begin ERB treatment were enrolled. The primary endpoint was overall survival (OS) and the secondary endpoints were response rate (RR), progression-free survival (PFS) and toxicity assessment. RESULTS We enrolled a total of 25 patients. The median OS and PFS were 8·6 months and 3·0 months, respectively. The best overall RR was 20% (five of 25). In total, 16 grade 3/4 severe adverse events (SAEs) occurred; however, all patients recovered. Patients who achieved partial response or stable disease as best response had longer OS than those with progressive disease (median OS not reached and 3·3 months, respectively; P < 0·001). Patients who did not experience SAEs showed longer OS than those who did (median OS 18·8 months and 7·5 months, respectively; P < 0·05). Patients with distant metastasis had shorter median OS than those with locoregional disease, but without statistically significant difference. CONCLUSIONS ERB showed a promising RR and is a potential candidate for second-line treatment for patients with CAS, after treatment with taxanes. However, owing to the occurrence of SAEs in over half of the participants, caution should be exercised regarding ERB use in elderly patients. What is already known about this topic? Taxanes are the current first-line treatment for patients with advanced cutaneous angiosarcoma (CAS) who are considered difficult to treat with doxorubicin owing to advanced age or comorbidity. No effective therapy for taxane-resistant CAS has been established thus far. Eribulin suppresses microtubule polymerization and elicits an antitumour effect similar to that of taxanes. What does this study add? In our single-arm prospective observational study to evaluate the efficacy of eribulin for treating patients with advanced CAS who previously received taxanes, the median overall survival and progression-free survival were 8·6 and 3·0 months, respectively. Response rates at weeks 7, 13 and 25 were 20%, 17% and 14%, respectively. Although 16 grade 3/4 severe adverse events occurred, all patients recovered. Eribulin showed a promising response rate and is a potential candidate for second-line treatment in CAS after taxane treatment. Linked Comment: Smrke and Benson. Br J Dermatol 2020; 183:797-798.
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Affiliation(s)
- Y Fujisawa
- Dermatology Division, University of Tsukuba, Tsukuba, Japan
| | - T Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Y Yamamoto
- Department of Dermatology, Wakayama Prefectural Medical School, Wakayama, Japan
| | - H Uchi
- Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - A Otsuka
- Department of Dermatology, Kyoto University, Kyoto, Japan
| | - T Funakoshi
- Department of Dermatology, Keio University, Tokyo, Japan
| | - T Miyagi
- Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - H Hata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - M Gosho
- Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Tsukuba, Japan
| | - Y Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - T Yanagi
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - A Ohira
- Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Y Nakamura
- Dermatology Division, University of Tsukuba, Tsukuba, Japan
| | - T Maeda
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - K Yoshino
- Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
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Sakai J, Tarumoto N, Orihara Y, Kawamura R, Kodana M, Matsuzaki N, Matsumura R, Ogane K, Kawamura T, Takeuchi S, Imai K, Murakami T, Maesaki S, Maeda T. Evaluation of a high-speed but low-throughput RT-qPCR system for detection of SARS-CoV-2. J Hosp Infect 2020; 105:615-618. [PMID: 32446722 PMCID: PMC7242201 DOI: 10.1016/j.jhin.2020.05.025] [Citation(s) in RCA: 11] [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] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Abstract
With the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), a high-speed and convenient detection technology should be at the forefront of medical care worldwide. This study evaluated the usefulness of GeneSoC, a compact, high-speed reciprocal flow quantitative reverse transcription polymerase chain reaction system, for the detection of SARS-CoV-2. The results support the use of this system for the rapid identification of SARS-CoV-2. This approach can contribute to the strategic selection of initial management strategies for patients with COVID-19.
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Affiliation(s)
- J Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan
| | - N Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan.
| | - Y Orihara
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - R Kawamura
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - M Kodana
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - N Matsuzaki
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - R Matsumura
- Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan
| | - K Ogane
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - T Kawamura
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - S Takeuchi
- Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan
| | - K Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan
| | - T Murakami
- Department of Microbiology, Saitama Medical University, Saitama, Japan
| | - S Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan; Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan
| | - T Maeda
- Centre of Clinical Infectious Disease and Research, Saitama Medical University, Saitama, Japan; Department of Clinical Laboratory, Saitama Medical University Hospital, Saitama, Japan; Department of Laboratory Medicine, Saitama Medical University, Saitama, Japan
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Ulrey R, Maeda T, Datar A, Sarkislali K, Ishibashi N, Hanley P. Using the Quantum Cell Expansion System to Generate Mesenchymal Stromal Cells for Neuroprotection After Cardiopulmonary Bypass. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.199] [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: 10/24/2022]
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Fukui S, Ichinose K, Sada KE, Miyamoto J, Harigai M, Amano K, Atsumi T, Takasaki Y, Dobashi H, Arimura Y, Hasegawa H, Yuzawa Y, Yamagata K, Tsuboi N, Maruyama S, Matsuo S, Makino H, Maeda T, Kawakami A. Complement profile in microscopic polyangiitis and granulomatosis with polyangiitis: analysis using sera from a nationwide prospective cohort study. Scand J Rheumatol 2020; 49:301-311. [PMID: 32286129 DOI: 10.1080/03009742.2019.1695927] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The complement cascade, especially the alternative pathway of complement, has been shown in basic research to be associated with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). We aimed to elucidate relationships between serum complement components and clinical characteristics in AAV. METHOD In a nationwide prospective cohort study (RemIT-JAV-RPGN), we measured the serum levels of C1q, C2, C3, C3b/iC3b, C4, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, mannose-binding lectin, and properdin in 52 patients with microscopic polyangiitis (MPA) and 39 patients with granulomatosis with polyangiitis (GPA). RESULTS The properdin level of MPA and GPA was significantly lower than that of healthy donors. The properdin level was negatively correlated with the Birmingham Vasculitis Activity Score (BVAS) (ρ = -0.2148, p = 0.0409). The factor D level at 6 months was significantly positively correlated with the Vasculitis Damage Index (VDI) at 6, 12, and 24 months (ρ = 0.4207, 0.4132, and 0.3115, respectively). Patients with a higher ratio of C5a to C5 had higher neutrophil percentage and serum immunoglobulin G levels, and significantly lower creatinine levels. Cluster analysis divided the MPA and GPA patients into three subgroups. A principal component (PC) analysis aggregated 15 types of complements into alternative pathway-related PC 1 and complement classical pathway and common pathway-related PC 2. CONCLUSIONS The serum levels of properdin and factor D were correlated with the BVAS and the VDI in MPA and GPA, respectively. Our analyses suggested the pathological heterogeneity of MPA and GPA from the aspect of complement components.
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Affiliation(s)
- S Fukui
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan.,Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan
| | - K Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan
| | - K-E Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama, Japan
| | - J Miyamoto
- Nagasaki University Hospital Clinical Research Center , Nagasaki, Japan
| | - M Harigai
- Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Department of Rheumatology, School of Medicine, Tokyo Women's Medical University , Tokyo, Japan
| | - K Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University , Kawagoe, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University , Sapporo, Japan
| | - Y Takasaki
- Department of Rheumatology, Graduate School of Medicine, Juntendo University , Tokyo, Japan
| | - H Dobashi
- Division of Endocrinology and Metabolism, Haematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University , Miki-cho, Japan
| | - Y Arimura
- Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine , Tokyo, Japan
| | - H Hasegawa
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine , Toon, Japan
| | - Y Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine , Toyoake, Japan
| | - K Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tsukuba, Japan
| | - N Tsuboi
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine , Nagoya, Japan
| | - S Maruyama
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine , Nagoya, Japan
| | - S Matsuo
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine , Nagoya, Japan
| | - H Makino
- Okayama University , Okayama, Japan
| | - T Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan.,Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan
| | - A Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan
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Yoshiba N, Edanami N, Ohkura N, Maekawa T, Takahashi N, Tohma A, Izumi K, Maeda T, Hosoya A, Nakamura H, Tabeta K, Noiri Y, Yoshiba K. M2 Phenotype Macrophages Colocalize with Schwann Cells in Human Dental Pulp. J Dent Res 2020; 99:329-338. [PMID: 31913775 DOI: 10.1177/0022034519894957] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Macrophages are immune cells with high plasticity that perform many functions related to tissue injury and repair. They are generally categorized as 2 functional phenotypes: M1 (proinflammatory) and M2 (anti-inflammatory and prohealing). To investigate the role of macrophages in human dental pulp, we examined the localization and distributional alterations of macrophages in healthy dental pulp as well as during the reparative process of pulp capping with mineral trioxide aggregate (MTA) and in cariously inflamed pulp of adult human teeth. We also quantified the populations of M1/M2 macrophages in healthy dental pulp by flow cytometric analysis. CD68+CD86+ cells (M1 phenotype) and CD68+CD163+ cells (M2 phenotype) were 2.11% ± 0.50% and 44.99% ± 2.22%, respectively, of 2.96% ± 0.41% CD68+ cells (pan-macrophages) in whole healthy dental pulp. Interestingly, M2 phenotype macrophages were associated with Schwann cells in healthy pulp, during mineralized bridge formation, and in pulp with carious infections in vivo. Furthermore, the M2 macrophages associated with Schwann cells expressed brain-derived neurotrophic factor (BDNF) under all in vivo conditions. Moreover, we found that plasma cells expressed BDNF. Coculture of Schwann cells isolated from human dental pulp and human monocytic cell line THP-1 showed that Schwann cells induced M2 phenotypic polarization of THP-1 cell-derived macrophages. The THP-1 macrophages that maintained contact with Schwann cells were stimulated, leading to elongation of their cell shape and expression of M2 phenotype marker CD163 in cocultures. In summary, we revealed the spatiotemporal localization of macrophages and potent induction of the M2 phenotype by Schwann cells in human dental pulp. M2 macrophages protect neural elements, whereas M1 cells promote neuronal destruction. Therefore, suppressing the neurodestructive M1 phenotype and maintaining the neuroprotective M2 phenotype of macrophages by Schwann cells may be critical for development of effective treatment strategies to maintain the viability of highly innervated dental pulp.
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Affiliation(s)
- N Yoshiba
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N Edanami
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N Ohkura
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Maekawa
- Research Center for Advanced Oral Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N Takahashi
- Division of Periodontology, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A Tohma
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Izumi
- Division of Biomimetics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Maeda
- Research Center for Advanced Oral Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A Hosoya
- Division of Histology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-gun, Hokkaido, Japan
| | - H Nakamura
- Department of Oral Histology, Institute for Dental Science, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - K Tabeta
- Division of Periodontology, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Yoshiba
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Hiura A, Yoshino K, Maeda T, Oaku S, Nagai K, Kato M, Yamashita C, Uehara J, Fujisawa Y. Low-dose cisplatin and 5-fluorouracil combined concurrent chemoradiotherapy for unresectable cutaneous squamous cell carcinoma: Analysis of 23 cases. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz429.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Funada A, Goto Y, Okada H, Maeda T, Takamura M. P1703Impact of prehospital epinephrine administration and quality of cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest patients with non-shockable rhythm. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0458] [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 effects of prehospital epinephrine administration in combination with the quality of cardiopulmonary resuscitation (CPR) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remains unclear.
Purpose
This study aimed to elucidate the effects of prehospital epinephrine administration in combination with the quality of CPR on neurologically intact survival in OHCA patients with non-shockable rhythm.
Methods
We analysed 118,732 adult OHCA patients with non-shockable rhythm from the All-Japan OHCA registry between 2011 and 2016 (29,989 emergency medical service [EMS]-witnessed arrests with EMS-initiated CPR [high-quality CPR] and 88,743 bystander-witnessed arrests with bystander-initiated CPR continued by EMS providers [low-quality CPR]). Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. The primary outcome measure was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2). Time from collapse to prehospital epinephrine administration for patients with prehospital epinephrine administration, or to hospital arrival for patients without prehospital epinephrine administration was calculated and adjusted collectively in multivariate logistic regression analysis for 1-month CPC 1–2.
Results
Multivariate logistic regression analysis revealed that the time from collapse to prehospital epinephrine administration or to hospital arrival was negatively associated with 1-month CPC 1–2 (adjusted odds ratio [OR] 0.95 per 1-minute increment, 95% confidence interval [CI] 0.94–0.96). Compared with bystander-witnessed arrests without prehospital epinephrine administration, EMS-witnessed arrests with or without prehospital epinephrine administration were significantly associated with increased chances of 1-month CPC 1–2 (adjusted OR 2.04, 95% CI 1.50–2.75 and adjusted OR 1.97, 95% CI 1.57–2.48, respectively). Prehospital epinephrine administration was significantly associated with an increased chance of 1-month CPC 1–2 among bystander-witnessed arrests (adjusted OR 1.57, 95% CI 1.24–1.98), but not among EMS-witnessed arrests. EMS-witnessed arrests without prehospital epinephrine administration were significantly associated with an increased chance of 1-month CPC 1–2 compared with bystander-witnessed arrests with prehospital epinephrine administration (adjusted OR 1.26, 95% CI 1.01–1.56).
Conclusions
High-quality CPR is crucial for increasing neurologically intact survival in OHCA patients with non-shockable rhythm. The additional beneficial effects of prehospital epinephrine administration were observed only among OHCA patients with low-quality CPR.
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Affiliation(s)
- A Funada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - H Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - M Takamura
- Kanazawa University Graduate School of Medicine, Cardiovascular Medicine, Kanazawa, Japan
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Funada A, Goto Y, Okada H, Maeda T, Takamura M. 5227Effects of witness status and time to cardiopulmonary resuscitation by emergency medical services on neurological outcomes in out-of-hospital cardiac arrest patients with non-shockable rhythm. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0075] [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
Data on the effects of witness status and time from an emergency call to initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers on neurological outcome in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm according to the first documented rhythm are limited.
Purpose
We aimed to determine the effects of witness status and time from an emergency call to CPR initiation by EMS providers on neurologically intact survival in OHCA patients according to the type of non-shockable rhythm (pulseless electrical activity [PEA] and asystole).
Methods
We analysed the records of 583,431 adult OHCA patients with non-shockable rhythm (191,905 bystander-witnessed arrest and 391,526 unwitnessed arrest). Data were derived from the prospectively recorded All-Japan OHCA registry between 2011 and 2016. Call to EMS-CPR interval was defined as the time from an emergency call to CPR initiation by EMS providers. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2) and secondary outcome was presence of PEA.
Results
The rates of 1-month CPC 1–2 were 1.21% (2,326/191,905) for bystander-witnessed arrest and 0.24% (959/391,526) for unwitnessed arrest. When divided into 4 groups based on witness status and initial documented rhythm, these rates were 2.42% (1,869/77,190) for bystander-witnessed arrest with PEA (group A), 0.40% (457/114,715) for bystander-witnessed arrest with asystole (group B), 1.51% (679/44,926) for unwitnessed arrest with PEA (group C) and 0.08% (280/346,600) for unwitnessed arrest with asystole (group D). Multivariate logistic regression analysis revealed each 1-min delay of Call to EMS-CPR interval to be significantly associated with decreased chances of 1-month CPC 1–2 for groups A, B and D (adjusted odds ratio [OR]: 0.95, 0.91 and 0.96, respectively; 95% confidence interval [CI]: 0.93–0.96, 0.88–0.94 and 0.93–0.99, respectively). However, for group C, there was no significant relationship between these variables (adjusted OR: 1.00; 95% CI: 0.98–1.02). The proportion of PEA was 40.2% (77,190/191,905) for bystander-witnessed arrest and 11.5% (44,926/391,526) for unwitnessed arrest. Multivariate logistic regression analysis revealed that, as Call to EMS-CPR interval lengthened (per 1-min delay), the number of OHCA patients with PEA decreased for bystander-witnessed arrest (adjusted OR: 0.94; 95% CI: 0.93–0.94) and for unwitnessed arrest (adjusted OR: 0.96; 95% CI: 0.96–0.97).
Conclusions
The 1-month CPC 1–2 rate differed by witness status and initial documented rhythm in OHCA patients with non-shockable rhythm. Shortening of Call to EMS-CPR interval is crucial for improving 1-month CPC 1–2 rate and sustaining PEA, particularly in bystander-witnessed arrest.
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Affiliation(s)
- A Funada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - Y Goto
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - H Okada
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - T Maeda
- Kanazawa University Hospital, Department of Emergency and Critical Care Medicine, Kanazawa, Japan
| | - M Takamura
- Kanazawa University Graduate School of Medicine, Cardiovascular Medicine, Kanazawa, Japan
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Takeshita Y, Fujikawa S, Nishihara H, Maeda T, Shimizu F, Sano Y, Koga M, Kanda T. Identification of targeted membrane antigens of human brain microvascular endothelial cells in relapsing-remitting multiple sclerosis. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mizukami T, Yanagi T, Kitamura S, Narahira A, Maeda T, Hata H, Takakuwa E, Doi K, Sugita S, Hasegawa T, Ikenaga H, Shimizu H. A recurrent subcutaneous tumour of the thumb: a case of a capicua transcriptional repressor (CIC)-rearranged sarcoma. J Eur Acad Dermatol Venereol 2019; 34:e59-e61. [PMID: 31452282 DOI: 10.1111/jdv.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- T Mizukami
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - S Kitamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - A Narahira
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Maeda
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - H Hata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - E Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - K Doi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - S Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - T Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - H Shimizu
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Maeda T, Yoshino K, Nagai K, Oaku S, Kato M, Hiura A, Uehara J, Fujisawa Y. The effect of the lymphovascular plugging metastasis pattern in extramammary Paget disease on identifying metastatic lesions using imaging tests: an autopsy case series. Br J Dermatol 2019; 182:493-495. [PMID: 31420863 DOI: 10.1111/bjd.18444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- T Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - K Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - K Nagai
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - S Oaku
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - M Kato
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - A Hiura
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - J Uehara
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Y Fujisawa
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
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Kato M, Yoshino K, Maeda T, Nagai K, Oaku S, Hiura A, Fujisawa Y. Single-agent taxane is useful in palliative chemotherapy for advanced extramammary Paget disease: a case series. Br J Dermatol 2019; 181:831-832. [PMID: 30920650 DOI: 10.1111/bjd.17922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- M Kato
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - K Yoshino
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - T Maeda
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - K Nagai
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - S Oaku
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - A Hiura
- Department of Dermatologic Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Y Fujisawa
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
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Tada K, ITO K, Maeda T, Arima H, Yasuno T, Masutani K, Nakashima H. SUN-250 CIGARETTE SMOKING INFLUENCE THE NEW-ONSET OF CHRONIC KIDNEY DISEASE: IKI EPIDEMIOLOGICAL STUDY OF ARTHEROSCLEROSIS AND CHRONIC KIDNEY DISEASE (ISSA-CKD) RETROSPECTIVE PHASE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.655] [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: 10/26/2022] Open
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47
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Matsumoto Y, Harada K, Maeda T, Egusa C, Hirano H, Okubo Y, Tsuboi R. Molecular detection of fungal and bacterial DNA from pustules in patients with palmoplantar pustulosis: special focus on Malassezia species. Clin Exp Dermatol 2019; 45:36-40. [PMID: 31220362 DOI: 10.1111/ced.14026] [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] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a distinct, chronic skin disorder characterized by intraepidermal pustules on the palms and soles. It is hypothesized that microorganisms on the skin might induce the symptoms of PPP via inflammatory cell activation. However, the microbiota has not been studied in detail because of the assumption that the pustules in PPP are sterile. AIM To elucidate the role of microorganisms in pathogenesis of PPP. METHODS PCR analysis was performed of microbial DNA fragments in the pustules of patients with PPP. The sequence of the D1/D2 LSU 26s rRNA gene and that of the 16S rRNA gene was used for fungal and bacterial DNA detection, respectively. RESULTS In total, 71 samples were carefully collected from the pustules of patients with PPP. Fungal DNA bands were detected in 68 samples, and fungi including Malassezia spp. were identified in 30 of 71 samples (42.3%). Malassezia restricta was the most frequently encountered fungus (14/71; 19.7%). However, bacterial DNA was not detected by the methods used. Furthermore, identical fungal DNA was not detected in the outer lid of the pustules, suggesting that the fungi detected within the pustule did not derive from contamination via the skin surface. CONCLUSIONS In the present study, we demonstrated for the first time that certain pustules in patients with PPP contain fungal DNA fragments, especially those of Malassezia spp. Our findings provide new insights on the role of skin microbiota in the pathogenesis of PPP.
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Affiliation(s)
- Y Matsumoto
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - K Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - T Maeda
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - C Egusa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - H Hirano
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Y Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - R Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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48
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Saito H, Shibayama H, Miyoshi H, Toda J, Kusakabe S, Ichii M, Fujita J, Fukushima K, Yokota T, Maeda T, Mizuki M, Oritani K, Seto M, Ohshima K, Kanakura Y. THE INFLUENCE OF TUMOR IMMUNE MICROENVIRONMENT AND TUMOR IMMUNITY ON THE PATHOGENESIS, TREATMENT AND PROGNOSIS OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS (PTLD). Hematol Oncol 2019. [DOI: 10.1002/hon.15_2630] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- H. Saito
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - H. Shibayama
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - H. Miyoshi
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
| | - J. Toda
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - S. Kusakabe
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - M. Ichii
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - J. Fujita
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - K. Fukushima
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - T. Yokota
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - T. Maeda
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - M. Mizuki
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
| | - K. Oritani
- Department of Hematology; International University of Health and Welfare; Narita Japan
| | - M. Seto
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
| | - K. Ohshima
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
| | - Y. Kanakura
- Department of Hematology and Oncology; Osaka University Graduate School of Medicine; Osaka Japan
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Yamaguchi M, Suzuki R, Oguchi M, Miyazaki K, Taguchi S, Amaki J, Maeda T, Kubota N, Maruyama D, Terui Y, Sekiguchi N, Takizawa J, Tsukamoto H, Murayama T, Ando T, Matsuoka H, Hasegawa M, Wada H, Sakai R, Kameoka Y, Tsukamoto N, Choi I, Masaki Y, Shimada K, Fukuhara N, Utsumi T, Uoshima N, Kagami Y, Asano N, Katayama N. CLINICAL OUTCOMES AND DIAGNOSIS-TO-TREATMENT INTERVAL IN PATIENTS WITH NK/T-CELL LYMPHOMA: 7-YEAR FOLLOW-UP OF THE NKEA STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.86_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Yamaguchi
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - R. Suzuki
- Oncology and Hematology; Shimane University Hospital; Izumo Japan
| | - M. Oguchi
- Radiation Oncology; Cancer Institute Hospital of Japanese Foundation for Cancer Research; Tokyo Japan
| | - K. Miyazaki
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
| | - S. Taguchi
- Radiation Oncology; Cancer Institute Hospital of Japanese Foundation for Cancer Research; Tokyo Japan
| | - J. Amaki
- Hematology and Oncology; Tokai University School of Medicine; Kanagawa Japan
| | - T. Maeda
- Hematology; Kurashiki Central Hospital; Kurashiki Japan
| | - N. Kubota
- Hematology; Saitama Cancer Center; Ina Japan
| | - D. Maruyama
- Hematology; National Cancer Center Hospital; Tokyo Japan
| | - Y. Terui
- Hematology Oncology; Cancer Institute Hospital of Japanese Foundation for Cancer Research; Tokyo Japan
| | - N. Sekiguchi
- Comprehensive Cancer Therapy; Shinshu University School of Medicine; Matsumoto Japan
| | - J. Takizawa
- Hematology; Endocrinology and Metabolism, Niigata University Faculty of Medicine; Niigata Japan
| | - H. Tsukamoto
- Hematology; Showa University School of Medicine; Tokyo Japan
| | - T. Murayama
- Hematology; Hyogo Cancer Center; Akashi Japan
| | - T. Ando
- Hematology; Respiratory Medicine and Oncology, Saga University; Saga Japan
| | - H. Matsuoka
- Medical Oncology/Hematology; Kobe University; Kobe Japan
| | - M. Hasegawa
- Radiation Oncology; Nara Medical University; Kashihara Japan
| | - H. Wada
- Hematology; Kawasaki Medical School; Kurashiki Japan
| | - R. Sakai
- Medical Oncology; Kanagawa Cancer Center; Yokohama Japan
| | - Y. Kameoka
- Hematology; Nephrology and Rheumatology, Akita University; Akita Japan
| | - N. Tsukamoto
- Oncology Center; Gunma University Hospital; Maebashi Japan
| | - I. Choi
- Hematology; National Hospital Organization Kyushu Cancer Center; Fukuoka Japan
| | - Y. Masaki
- Hematology and Immunology; Kanazawa Medical University; Kanazawa Japan
| | - K. Shimada
- Hematology and Oncology; Nagoya University School of Medicine; Nagoya Japan
| | - N. Fukuhara
- Hematology & Rheumatology; Tohoku University School of Medicine; Sendai Japan
| | - T. Utsumi
- Hematology; Shiga Medical Center for Adults; Moriyama Japan
| | - N. Uoshima
- Hematology; Japanese Red Cross Kyoto Daini Hospital; Kyoto Japan
| | - Y. Kagami
- Hematology; Toyota Kosei Hospital; Toyota Japan
| | - N. Asano
- Molecular Diagnostics; Shinshu Medical Center; Suzaka Japan
| | - N. Katayama
- Department of Hematology and Oncology; Mie University Graduate School of Medicine; Tsu Japan
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Hiura A, Yoshino K, Maeda T, Nagai K, Oaku S, Kato M, Fujisawa Y. Chemoradiotherapy could improve overall survival of patients with stage
IV
cutaneous squamous cell carcinoma: analysis of 34 cases. Br J Dermatol 2019; 180:1557-1558. [DOI: 10.1111/bjd.17792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Hiura
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - K. Yoshino
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - T. Maeda
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - K. Nagai
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - S. Oaku
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - M. Kato
- Department of Dermatologic Oncology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo 113‐8677 Japan
| | - Y. Fujisawa
- Department of Dermatology University of Tsukuba Tsukuba Japan
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