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Okumura T, Horiba K, Tetsuka N, Sato Y, Sugiyama Y, Haruta K, Yamaguchi M, Suzuki T, Torii Y, Kawada JI, Ogi T, Hayakawa M, Ito Y. Next-generation sequencing-based detection of Ureaplasma in the gastric fluid of neonates with respiratory distress and chorioamnionitis. J Matern Fetal Neonatal Med 2023; 36:2207113. [PMID: 37150592 DOI: 10.1080/14767058.2023.2207113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Respiratory distress is common in neonates admitted to neonatal intensive care units. Additionally, infectious diseases such as intrauterine infections or vertical transmission are important underlying causes of respiratory failure. However, pathogens often cannot be identified in neonates, and there are many cases in which antibacterial drugs are empirically administered. Next-generation sequencing (NGS) is advantageous in that it can detect trace amounts of bacteria that cannot be detected by culturing or bacteria that are difficult to cultivate. However, there are few reports on the diagnosis of infectious diseases using NGS in the neonatal field, especially those targeting respiratory distress. OBJECTIVE The purpose of our study was to investigate the microorganisms associated with neonatal respiratory distress and to determine whether less invasive collection specimens such as plasma and gastric fluid are useful. METHODS Neonates were prospectively recruited between January and August 2020 from Nagoya University Hospital. The inclusion criteria were as follows: 1) admission to the neonatal intensive care unit; 2) respiratory distress presentation within 48 h of birth; and 3) suspected infection, collection of blood culture, and administration of antibiotics. Plasma samples and blood cultures were simultaneously collected. Gastric fluid samples were also collected if the patient was not started on enteral nutrition. Information on the patients and their mothers were collected from the medical records. DNA was extracted from 140 µL of plasma and gastric fluid samples. DNA sequencing libraries were prepared, and their quality was analyzed. DNA libraries were sequenced using high-throughput NGS. The NGS data of plasma and gastric fluid samples were analyzed using the metagenomic pipeline PATHDET, which calculated the number of reads assigned to microorganisms and their relative abundance. Putative pathogens were listed. RESULTS Overall, 30 plasma samples and 25 gastric fluid samples from 30 neonates were analyzed. Microorganism-derived reads of gastric fluid samples were significantly higher than those of plasma samples. Transient tachypnea of the newborn was the most common cause of respiratory distress with 13 cases (43%), followed by respiratory distress syndrome with 7 cases (23%). There were 8 cases (29%) of chorioamnionitis and 7 cases (25%) of funisitis pathologically diagnosed. All blood cultures were negative, and only two gastric fluid cultures were positive for group B Streptococcus (Patient 15) and Candida albicans (Patient 24). Putative pathogens that met the positive criteria for PATHET were detected in four gastric fluid samples, one of which was group B Streptococcus from Patient 15. In the gastric fluid sample of Patient 24, Candida albicans were detected by NGS but did not meet the positive criteria for PATHDET. Cluster analysis of the plasma samples divided them into two study groups, and the indicator genera of each cluster (Phormidium or Toxoplasma) are shown in Figure 1. Clinical findings did not show any significant differences between the two groups. Cluster analysis of the gastric fluid samples divided them into three study groups, and the indicator genera of each cluster (Ureaplasma, Nostoc, and Streptococcus) are shown in Figure 2. The incidence rate of chorioamnionitis was significantly higher in Ureaplasma group than in the other two groups. CONCLUSION Gastric fluid may be useful for assessing neonatal patients with respiratory distress. To the best of our knowledge, this was the first study to reveal that the presence of Ureaplasma in the gastric fluid of neonates with respiratory distress was associated with chorioamnionitis. The early diagnosis of intra-amniotic infections using gastric fluid and its treatment may change the treatment strategy for neonatal respiratory distress. Screening for Ureaplasma in neonates with respiratory distress may reduce the need for empirical antibiotic administration. Further research is required to confirm these findings.
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Affiliation(s)
- Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Tetsuka
- Department of Infection Control, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Kazunori Haruta
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Yamaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Makishima H, Iizumi T, Saito T, Numajiri H, Nakai K, Mizumoto M, Okumura T, Sakurai H. Proton Beam Therapy for HCC Exceeding up-to-Seven Criteria. Int J Radiat Oncol Biol Phys 2023; 117:e322-e323. [PMID: 37785150 DOI: 10.1016/j.ijrobp.2023.06.2364] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Whilst standard treatment for intermediate-stage hepatocellular carcinoma (HCC) is transcatheter arterial chemoembolization (TACE), those exceeding "up-to-seven" criteria don't respond as such as those within, and systemic therapy is suggested to be more beneficial. This is sought to be both because of the limited efficacy of TACE and its hepatic toxicity. Proton beam therapy (PBT) offers high local control and low toxicity rates, and we hypothesize that the same can be said in this patient group also. We here present the outcome of PBT for primary HCC exceeding "up-to-seven" criteria. MATERIALS/METHODS Primary HCC treated with PBT between 2010 and 2018 were extracted from an all-in treatment database and retrospectively reviewed. (Maximum diameter of the largest tumor in centimeters) + (tumor count) > 7 was considered as exceeding "up-to-seven" criteria. Local recurrence was defined as tumor re-enlargement or the appearance of arterial phase hyperenhancement. Adverse events were evaluated by CTCAE v5.0. Overall survival and recurrence-free survival were determined by the Kaplan-Meier method, and local recurrence was analyzed as cumulative incidence with death as a competing risk. All statistical analyses were done using R. RESULTS Out of 202 primary cases, 79 exceeded the "up-to-seven" criteria. The median tumor diameter was 8.0 cm (range 3.1 - 20 cm) and macroscopic vascular invasion (MVI) was observed in 26 cases. For tumor count, 36 were solitary, 28 were between 2 - 3, and 15 had 4 or more. According to the modified ALBI grade, 38 were grade 1, 18 were grade 2a and 23 were 2b. The prescribed dose was 66 Gy / 10 Fr for 6, 72.6 Gy / 22 Fr for 60, 74 Gy / 37 Fr for 12 and 60 Gy / 15 Fr for one case after relative biological effect weighting of 1.1. With a median follow-up period of 33 months (IQR 15 - 57 months), 2-year overall survival was 62% (95% C.I. 50 - 72%) and median survival time was 37 months (95% C.I. 30 - 52 months). 2-year recurrence-free survival and local recurrence rate were 42% (95% C.I. 30 - 53%) and 8% (95% C.I. 3 - 15%) respectively. Cox regression analysis revealed modified ALBI grade as the only significant risk factor for survival (hazard ratio 1.80, 95% C.I. 1.27 - 2.55, p = 0.0010) among age, sex, alpha-fetoprotein level, MVI, tumor count, and size. Other than one case of early death (2 weeks after treatment) with an unknown causal relationship, there were no adverse events of grade 4 or higher observed. CONCLUSION PBT for primary HCC exceeding "up-to-seven" criteria appears to be safe and effective. Local control of intrahepatic lesions may be beneficial even in intermediate-stage cases, while results of this study suggests that suppression of out-of-field recurrence is required for further survival prolongment.
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Affiliation(s)
- H Makishima
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Saito
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - K Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - M Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Niitsu H, Makishima H, Iizumi T, Saito T, Numajiri H, Nakai K, Mizumoto M, Okumura T, Sakurai H. Outcome of Proton Beam Therapy for Primary Hepatocellular Carcinoma with "Unfavorable" Macroscopic Classification. Int J Radiat Oncol Biol Phys 2023; 117:e328-e329. [PMID: 37785162 DOI: 10.1016/j.ijrobp.2023.06.2377] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Transcatheter arterial chemoembolization (TACE) is the standard treatment for early to intermediate-stage hepatocellular carcinoma (HCC) unfit for hepatectomy or radiofrequency/microwave ablation (RFA/MWA). Putting aside its hepatic toxicity, local control of TACE is far from satisfactory, especially with non- "simple nodular type" appearances, to an extent where systemic therapy is suggested to be more beneficial. We here analyzed the outcome of proton beam therapy (PBT) for primary HCC by macroscopic classification. MATERIALS/METHODS Primary HCC treated with PBT between 2010 and 2018 were extracted from an all-in treatment database. The macroscopic classification was defined by CT or MRI prior to PBT. Local recurrence was defined as tumor re-enlargement or the appearance of arterial phase hyperenhancement. Adverse events were evaluated by CTCAE v5.0. Overall survival, local control, intrahepatic recurrence-free survival, and extrahepatic recurrence-free survival were determined by the Kaplan-Meier method, and the association with treatment factors was analyzed by log-rank and cox regression model. RESULTS A total of 202 primary HCC cases were extracted, all not a candidate for hepatectomy nor RFA/MWA. Out of them, 75 cases were simple nodular type, 79 were simple nodular type with extranodular growth, 38 were confluent multinodular type, and 10 were infiltrative type. 26 cases were HBV positive, and 84 cases were HCV positive. 35 cases had macroscopic vascular invasion (MVI). With a median follow-up period of 3.72 years (IQR: 1.79-5.85years), the 3-year overall survival rate was 68.1% (95% CI 61.0 - 74.3%), the 3-year local control rate was 89.6% (95% CI 83.4-93.5), the 3-year intrahepatic recurrence-free survival rate was 53.7% (95% CI 45.9-60.8%), and the 3-year extrahepatic recurrence-free survival rate was 87.4% (95% CI: 81.5-91.6%). Simple nodular type had better overall survival (73.2% vs 65.2% p = 0.012) and extrahepatic recurrence free survival (96.9% vs 81.9% p<0.01), but there was no statistically significant difference in local control (92.7% vs 87.6% p = 0.06) and intrahepatic recurrence-free survival (62.0% vs 48.5% p = 0.114). Multivariate analysis of risk factors against OS, including age, sex, AFP, MVI, and macroscopic classification, revealed age and macroscopic classification as independent risk factors. Adverse events of grade 3 included 2 cases of gastrointestinal bleeding, 7 cases of liver function disorder, 1 cases of biliary hemorrhage, and 1 case of pleural effusion. Other than one case of early death (2 weeks after treatment) with an unknown causal relationship, there were no adverse events of grade 4 or severe. CONCLUSION PBT for non- "simple nodular type" primary HCC appears to be safe and effective, whilst suppression of out-of-field recurrence is needed for further survival prolongment.
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Affiliation(s)
- H Niitsu
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Makishima
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Saito
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - K Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - M Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Higuchi T, Ogawa E, Okumura T, Ito K, Yamamoto M, Muramatsu N. Blalock-Taussig Shunt Blockage Caused by Small Colony Variants of Enterococcus faecalis. Pediatr Infect Dis J 2023; 42:e185-e186. [PMID: 36917025 DOI: 10.1097/inf.0000000000003849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Toru Higuchi
- Department of Geeral Pediatrics, Aichi Children's Health and Medical Center, Japan
| | - Eiki Ogawa
- Department of Geeral Pediatrics, Aichi Children's Health and Medical Center, Japan
| | - Toshihiko Okumura
- Department of Geeral Pediatrics, Aichi Children's Health and Medical Center, Japan
| | - Kenta Ito
- Department of Geeral Pediatrics, Aichi Children's Health and Medical Center, Japan
| | - Mana Yamamoto
- Department of Clinical Laboratory, Aichi Children's Health and Medical Center, Japan
| | - Naoko Muramatsu
- Department of Clinical Laboratory, Aichi Children's Health and Medical Center, Japan
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Okumura T, Azuma T, Bennett DA, Chiu I, Doriese WB, Durkin MS, Fowler JW, Gard JD, Hashimoto T, Hayakawa R, Hilton GC, Ichinohe Y, Indelicato P, Isobe T, Kanda S, Katsuragawa M, Kawamura N, Kino Y, Mine K, Miyake Y, Morgan KM, Ninomiya K, Noda H, O'Neil GC, Okada S, Okutsu K, Paul N, Reintsema CD, Schmidt DR, Shimomura K, Strasser P, Suda H, Swetz DS, Takahashi T, Takeda S, Takeshita S, Tampo M, Tatsuno H, Ueno Y, Ullom JN, Watanabe S, Yamada S. Proof-of-Principle Experiment for Testing Strong-Field Quantum Electrodynamics with Exotic Atoms: High Precision X-Ray Spectroscopy of Muonic Neon. Phys Rev Lett 2023; 130:173001. [PMID: 37172243 DOI: 10.1103/physrevlett.130.173001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 05/14/2023]
Abstract
To test bound-state quantum electrodynamics (BSQED) in the strong-field regime, we have performed high precision x-ray spectroscopy of the 5g-4f and 5f- 4d transitions (BSQED contribution of 2.4 and 5.2 eV, respectively) of muonic neon atoms in the low-pressure gas phase without bound electrons. Muonic atoms have been recently proposed as an alternative to few-electron high-Z ions for BSQED tests by focusing on circular Rydberg states where nuclear contributions are negligibly small. We determined the 5g_{9/2}- 4f_{7/2} transition energy to be 6297.08±0.04(stat)±0.13(syst) eV using superconducting transition-edge sensor microcalorimeters (5.2-5.5 eV FWHM resolution), which agrees well with the most advanced BSQED theoretical prediction of 6297.26 eV.
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Affiliation(s)
- T Okumura
- Atomic, Molecular, and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - T Azuma
- Atomic, Molecular, and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - D A Bennett
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - I Chiu
- Institute for Radiation Sciences, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - W B Doriese
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - M S Durkin
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J W Fowler
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J D Gard
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - T Hashimoto
- Advanced Science Research Center (ASRC), Japan Atomic Energy Agency (JAEA), Tokai 319-1184, Japan
| | - R Hayakawa
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - Y Ichinohe
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - P Indelicato
- Laboratoire Kastler Brossel, Sorbonne Université, CNRS, ENS-PSL Research University, Collège de France, Case 74, 4, place Jussieu, 75005 Paris, France
| | - T Isobe
- RIKEN Nishina Center, RIKEN, Wako 351-0198, Japan
| | - S Kanda
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - M Katsuragawa
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - N Kawamura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - Y Kino
- Department of Chemistry, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - K Mine
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - Y Miyake
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K M Morgan
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
- Department of Physics, University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - K Ninomiya
- Institute for Radiation Sciences, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - H Noda
- Department of Earth and Space Science, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - G C O'Neil
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Okada
- Engineering Science Laboratory, Chubu University, Kasugai, Aichi 487-8501, Japan
| | - K Okutsu
- Department of Chemistry, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - N Paul
- Laboratoire Kastler Brossel, Sorbonne Université, CNRS, ENS-PSL Research University, Collège de France, Case 74, 4, place Jussieu, 75005 Paris, France
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - D R Schmidt
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - K Shimomura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - P Strasser
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - H Suda
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - D S Swetz
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - T Takahashi
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - S Takeda
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - S Takeshita
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - M Tampo
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - H Tatsuno
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - Y Ueno
- Atomic, Molecular, and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - J N Ullom
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Watanabe
- Department of Space Astronomy and Astrophysics, Institute of Space and Astronautical Science (ISAS), Japan Aerospace Exploration Agency (JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - S Yamada
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
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Horiba K, Torii Y, Yamaguchi M, Haruta K, Okumura T, Suzuki T, Kawano Y, Kawada JI, Hara S, Giske C, Ogi T, Ito Y. 542. Nanopore and Illumina sequencing for pathogen metagenomics and host transcriptomics of cerebrospinal fluid in infantile central nervous system infections. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Infantile central nervous system infections (CNSIs) can be life-threatening and severe sequelae can be observed in encephalitis and bacterial meningitis. The causative microorganism is unknown in > 40% of patients with aseptic infections. This study aimed to analyze metagenome for detection of pathogen, and transcriptome for host reaction of infection in a single cerebrospinal fluid (CSF) sample using two different next-generation sequencing (NGS) platforms, Illumina and Nanopore.
Methods
Twenty-eight CNSIs patients (< 12 months), treated between June 2012 and April 2020, were enrolled. A total of 49 clinical samples (28 CSF and 21 blood) from 28 patients were collected. Extracted RNA, which was obtained from 23 CSF in sufficient quantities, was sequenced using both Nanopore and Illumina platforms to compare their performances in the detection of pathogens. Human-derived reads subtracted during pathogen detection were used for host transcriptomic analysis from both Nanopore and Illumina sequencing. All the extracted DNA from 28 CSF and 21 blood, was sequenced using Illumina sequencer for the detection of pathogens. Data analysis was performed on the in-house PATHDET pipeline.
A flowchart for pathogen detection and transcriptome analysis
Pathogen detection was performed on the in-house PATHDET pipeline and transcriptome analysis was performed by using the secondary outputs.
Results
RNA sequencing of CSF samples in 23 cases revealed potential viral pathogens in 10 cases: coxsackievirus B5 (4 cases), coxsackievirus B4 (3 cases), coxsackievirus B2 (1 case), echovirus E7 (1 case), and human parechovirus 3 (1 case). DNA sequencing was performed in 28 cases using Illumina sequencing, and Proteus mirabilis (1 case, consistent with the culture test) and human parvovirus B19 (1 case) were detected. The results of Nanopore sequencing and Illumina sequencing were consistent. However, the mapping coverage and depth to the detected pathogen genome of Nanopore sequencing was superior to that of Illumina sequencing. MX1, ISG15, and OAS1 were differentially expressed genes in patients with identified pathogens via metagenomic NGS, both the Nanopore and Illumina sequencing, and were associated with antiviral roles in innate immunity.
A pie chart for patients with central nervous system infections (CNSIs)
Results of next-generation sequencing (NGS) and the detected pathogen candidates using DNA/RNA workflows.
Performance of Nanopore and Illumina sequencing for pathogen genome mapping
The sequencing output, which is 100,000 reads randomly extracted from original sequencing reads, was mapped to the pathogen reference genome to determine (A) mapping coverage and (B) mapping depth.
Volcano plot of all genes analyzed in Nanopore and Illumina sequencing
Volcano plots showing differentially expressed genes in the cerebrospinal fluid between identified-pathogen and unidentified-pathogen samples from (A) Nanopore sequencing and (B) Illumina RNA sequencing.
Conclusion
The use of Nanopore sequencing for metagenomic diagnostics of CSF samples should help to understand both pathogens and host immune responses of CNSI and could shed light on the pathogenesis of these infections.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - Yuka Torii
- Nagoya University Graduate School of Medicine , Nagoya, Aichi , Japan
| | - Makoto Yamaguchi
- Nagoya University Graduate School of Medicine , Nagoya, Aichi , Japan
| | - Kazunori Haruta
- Nagoya University Graduate School of Medicine , Nagoya, Aichi , Japan
| | | | - Takako Suzuki
- Nagoya University Graduate School of Medicine , Nagoya, Aichi , Japan
| | | | - Jun-ichi Kawada
- Nagoya University Graduate School of Medicine , Nagoya, Aichi , Japan
| | - Shinya Hara
- Department of Pediatrics , Toyota, Aichi , Japan
| | - Christian Giske
- Karolinska Institute and Karolinska University Hospital , Stockholm, Stockholms Lan , Sweden
| | - Tomoo Ogi
- Research Institute of Environmental Medicine, Nagoya University , Nagoya, Aichi , Japan
| | - Yoshinori Ito
- Nihon University School of Medicine , Itabashi-ku, Tokyo , Japan
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7
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Kondo T, Adachi T, Kobayashi K, Okumura T, Izawa H, Murohara T, McMurray JJV, Yamada S. Frailty and use of treatment in patients with heart failure and reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.965] [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
In heart failure with reduced ejection fraction (HFrEF), drugs including angiotensin-converting enzyme inhibitors (ACEi)/ angiotensin receptor blockers (ARB), beta-blockers, and mineralocorticoid receptor antagonists (MRA) have been shown to have robust survival benefits. However, these guideline-recommended therapies remain underutilized in clinical practice. Frailty is common in HFrEF and may lead to underprescription of life-saving therapy.
Purpose
We aimed to investigate the association between physical frailty and the use of evidence-based pharmacological therapy for HFrEF, and the impact of this on prognosis
Methods
The FLAGSHIP study included patients hospitalized for acute HF and data on physical frailty were collected prospectively. Of the total 3,272 patients registered in the FLAGSHIP study, 1,041 HFrEF patients (70 years; 73% male) with left ventricular ejection fraction ≤40% were analyzed and were divided into 4 groups by severity of frailty: category I (n=371) [least frail], II (n=275), III (n=224), and IV (n=171) [most frail].
Results
An ACEi/ARB was prescribed in 76% of category I and 53% of category IV patients; for a beta-blocker these proportions were 94% and 76%, respectively; for an MRA they were 55% and 46%, respectively. The proportion of patients using receiving all 3 drugs decreased as frailty increased, with approximately twice the rate of use of triple therapy in category I patients (40.2%) compared to category IV patients (23.4%) [p<0.001] (Figure 1). In adjusted analyses, the severity of frailty was an independent predictor for non-use of an ACEi/ARB (Odds ratio (OR): 1.23, 95% CI: 1.05–1.43, per 1 category increase) and a beta-blocker (OR: 1.32, 95% CI: 1.06–1.64), but not an MRA (OR: 0.97, 95% CI: 0.84–1.12). Risk of the composite outcome of all-cause death or HF rehospitalization increased with decreasing use of treatment across frailty categories: category I-II (Hazard ratio (HR): 1.80, 95% CI: 1.08–2.98, in 0–1 drug with 3 drugs as reference) and III–IV (HR: 1.53, 95% CI: 1.01–2.32). The relationship between the number of HF drugs prescribed and the composite outcome did not differ across frailty categories (p-interaction=0.86). The HRs for all 12 groups, reflecting frailty categories and a number of HF drugs is depicted in Figure 2. The HRs for composite outcome increased with increasing frailty category and with decreasing number of drugs, with an almost 4-fold difference in risk between the least frail patients receiving all three evidence-based therapies and the most frail receiving only 0–1 drug.
Conclusions
Prescription of guideline-recommended therapy decreased as the severity of frailty increased in patients with HFrEF. Sub-optimal medical therapy was associated with a worse outcome and underprescription of guideline-recommended therapy may contribute to the poor prognosis associated with frailty. An effective strategy is needed to improve the medical treatment of frail patients with HFrEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study issupported by a Grant-in-Aid for Scientifi c Research (A) from the Japan Society for the Promotion of Science (16H01862). ToruKondo receives grants from the Uehara Memorial Foundation and the Japanese Heart Failure Society Tsuchiya Foundation forthe research activities at the University of Glasgow.
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Affiliation(s)
- T Kondo
- University of Glasgow, British Heart Foundation Cardiovascular Research Centre , Glasgow , United Kingdom
| | - T Adachi
- Nagoya University Graduate School of Medicine, Department of Integrated Health Sciences , Nagoya , Japan
| | - K Kobayashi
- Nagoya University Hospital, Department of Rehabilitation , Nagoya , Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology , Nagoya , Japan
| | - H Izawa
- Fujita Health University School of Medicine, Department of Cardiology , Toyoake , Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology , Nagoya , Japan
| | - J J V McMurray
- University of Glasgow, British Heart Foundation Cardiovascular Research Centre , Glasgow , United Kingdom
| | - S Yamada
- Nagoya University Graduate School of Medicine, Department of Integrated Health Sciences , Nagoya , Japan
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Misumi K, Matsue Y, Nogi K, Kitai T, Oishi S, Suzuki S, Yamamoto M, Kida T, Okumura T, Nogi M, Ishihara S, Ueda T, Kawakami R, Saito Y, Minamino T. Derivation and validation of a machine learning-based risk prediction model for in-hospital mortality in patients with acute heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1083] [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
Although risk stratification is important in patients with acute heart failure (AHF) to predict patient prognosis, pre-existing risk models have not often been used due to its complexity. Recently, machine learning methods have been presented as an alternative approach to analyzing the predictive probability of large clinical datasets.
Purpose
The aim of this study is to develop a user-friendly risk score developed by one of machine learning methods and compare the performance of the new risk score to the existing conventional risk models.
Methods
A machine-learning-based risk model was developed using least absolute shrinkage and selection operator (LASSO) regression by identifying predictors of in-hospital mortality in the derivation cohort (REALITY-AHF) and externally validating and comparing its performance with two pre-existing risk models: the Get With The Guidelines risk score incorporating brain natriuretic peptide and hypochloremia (GWTG-BNP-Cl-RS) and the acute decompensated heart failure national registry (ADHERE) risk model.
Results
In-hospital deaths in the derivation and validation (NARA-HF) cohorts were 76 (5.1%) and 61 (4.9%), respectively. The risk score comprised four variables (systolic blood pressure, blood urea nitrogen, serum chloride, and C-reactive protein) and was developed according to the results of the LASSO regression weighting the coefficient for selected variables using a logistic regression model (4V-RS). Even though 4V-RS comprised fewer variables, In the validation cohort, it showed a higher area under the receiver operating characteristic curve (AUC) than the ADHERE risk model (AUC, 0.783 vs. 0.740; P=0.059) and a significant improvement in net reclassification (0.359; 95% CI, 0.10–0.67; p=0.006). 4V-RS performed similarly to GWTG-BNP-Cl-RS in terms of discrimination (AUC, 0.783 vs. 0.759; p=0.426) and net reclassification (0.176; 95% CI, −0.08–0.43; p=0.178).
Conclusions
The 4V-RS model comprising only four readily available data points at the time of admission performed similarly to the more complex pre-existing risk model in patients with AHF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Cardiovascular Research Fund
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Affiliation(s)
- K Misumi
- Saiseikai Utsunomiya Hospital, Department of Cardiology , Tochigi , Japan
| | - Y Matsue
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
| | - K Nogi
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Department of Cardiovascular Medicine , Kobe , Japan
| | - S Oishi
- National Cerebral and Cardiovascular Center Hospital, Department of Cardiology , Osaka , Japan
| | - S Suzuki
- Fukushima Medical University, Department of Cardiovascular Medicine , Fukushima , Japan
| | - M Yamamoto
- Tsukuba University, Cardiovascular Division, Faculty of Medicine , Tsukuba , Japan
| | - T Kida
- St. Marianna University School of Medicine, Department of Pharmacology , Kawasaki , Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology , Nagoya , Japan
| | - M Nogi
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - S Ishihara
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - T Ueda
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - R Kawakami
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - Y Saito
- Nara Medical University, Department of Cardiovascular Medicine , Kashihara , Japan
| | - T Minamino
- Juntendo University Graduate School of Medicine, Department of Cardiovascular Biology and Medicine , Tokyo , Japan
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9
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Slama M, Obici L, Okumura T, Arum S, Hale C, Jay PY, Capocelli K, Gonzalez-Duarte A. Effect of RNAi therapeutics patisiran and vutrisiran on orthostatic hypotension due to dysautonomia in patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2625] [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
Hereditary transthyretin-mediated (hATTR) amyloidosis, also known as ATTRv amyloidosis, is a rapidly progressive, multisystem disease. Orthostatic hypotension, due to autonomic neuropathy, is a common yet hard-to-treat disease manifestation in patients with hATTR amyloidosis. Fatigue, muscle weakness, and deterioration in cardiac function further exacerbate orthostatic symptoms. Efficacy of RNAi therapeutics patisiran and vutrisiran was assessed in patients with hATTR amyloidosis with polyneuropathy across the APOLLO (NCT01960348), Global Open-Label Extension (OLE) (NCT02510261), and HELIOS-A (NCT03759379) studies, respectively.
Purpose
Evaluate the quantitative effect of patisiran and vutrisiran on orthostatic hypotension in patients with hATTR amyloidosis with polyneuropathy.
Methods
In APOLLO, patients were randomised 2:1 to patisiran 0.3 mg/kg or placebo, IV q3w. Patients who completed APOLLO (APOLLO-placebo, APOLLO-patisiran) were eligible to enrol into the ongoing Global OLE (patisiran 0.3 mg/kg IV q3w). In HELIOS-A, patients were randomised 3:1 to vutrisiran (25 mg SC q3m) or patisiran (0.3 mg/kg IV q3w; reference group). Primary endpoint for APOLLO and HELIOS-A was change from baseline in the modified Neuropathy Impairment Score+7 (mNIS+7) vs APOLLO placebo at M18 (APOLLO) and M9 (HELIOS-A). Orthostatic hypotension was evaluated using the postural blood pressure (PBP) component of mNIS+7, calculated as the mean of 2 supine readings of systolic BP [SBP, mmHg] taken 15 min apart minus the lowest SBP upon standing at 1, 3, and 5 min. A smaller reduction in observed SBP between supine and upright readings indicated an improved PBP.
Results
APOLLO enrolled 225 patients (placebo, n=77; patisiran, n=148), Global OLE 211 and HELIOS-A 164 (vutrisiran, n=122; patisiran, n=42). At baseline, the severity of orthostatic hypotension was similar between within-study treatment arms in APOLLO and HELIOS-A. In APOLLO, patisiran-treated patients showed PBP improvement or stabilization from baseline to M18 (mean [SD] change in SBP: baseline, −17.6 [19.4]; M18, −13.5 [16.8]) and was maintained at Global OLE 36m (−13.4 [15.6]). In contrast, placebo-treated patients in APOLLO had an increased change in PBP over 18m (baseline, −17.5 [16.5]; M18, −20.4 [16.9]); their PBP improved after patisiran initiation (Global OLE 36m, −16.6 [18.1]). In HELIOS-A, stabilization in PBP was observed in the vutrisiran arm (baseline, −11.2 [14.0], M18, −11.7 [14.6]). In the smaller patisiran arm, while the change in PBP increased, the value remained in the normal range (baseline, −11.6 [17.2]; M18, −14.2 [15.5]). Patisiran and vutrisiran have acceptable safety profiles.
Conclusions
PBP analyses quantify the benefits of RNAi therapeutics patisiran and vutrisiran on autonomic function in patients with hATTR amyloidosis with polyneuropathy. The increase in change in PBP to a symptomatic range without treatment indicates the importance of early intervention.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Alnylam Pharmaceuticals
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Affiliation(s)
- M Slama
- Université Paris-Saclay, Cardiology Department, Hopital Bichat , Paris , France
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo , Pavia , Italy
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology , Nagoya , Japan
| | - S Arum
- Alnylam Pharmaceuticals , Cambridge , United States of America
| | - C Hale
- Alnylam Pharmaceuticals , Cambridge , United States of America
| | - P Y Jay
- Alnylam Pharmaceuticals , Cambridge , United States of America
| | - K Capocelli
- Alnylam Pharmaceuticals , Cambridge , United States of America
| | - A Gonzalez-Duarte
- Instituto Nacional de Ciencias Médicas y Nutriciόn Salvador Zubirán , México D.F. , Mexico
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10
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Horiba K, Torii Y, Aizawa Y, Yamaguchi M, Haruta K, Okumura T, Suzuki T, Kawano Y, Kawada JI, Hara S, Saitoh A, Giske CG, Ogi T, Ito Y. Performance of Nanopore and Illumina metagenomic sequencing for pathogen detection and transcriptome analysis in infantile central nervous system infections. Open Forum Infect Dis 2022; 9:ofac504. [PMID: 36299531 PMCID: PMC9587384 DOI: 10.1093/ofid/ofac504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Infantile central nervous system infections (CNSIs) can be life-threatening and cause severe sequelae. However, the causative microorganism remains unknown in >40% of patients with aseptic infections. This study aimed to analyze the metagenome for detection of pathogens and the transcriptome for host immune responses during infection in a single cerebrospinal fluid (CSF) sample using 2 different next-generation sequencing (NGS) platforms, Nanopore and Illumina. Methods Twenty-eight CNSIs patients (<12 months) were enrolled, and 49 clinical samples (28 CSF and 21 blood) were collected. The DNA extracted from all 49 samples was sequenced using the Illumina sequencer for the detection of pathogens. Extracted RNA was obtained in sufficient quantities from 23 CSF samples and subjected to sequencing on both Nanopore and Illumina platforms. Human-derived reads subtracted during pathogen detection were used for host transcriptomic analysis from both Nanopore and Illumina sequencing. Results RNA metagenomic sequencing using both sequencing platforms revealed putative viral pathogens in 10 cases. DNA sequencing using the Illumina sequencer detected 2 pathogens. The results of Nanopore and Illumina RNA sequencing were consistent; however, the mapping coverage and depth to the detected pathogen genome of Nanopore RNA sequencing were greater than those of Illumina. Host transcriptomic analysis of Nanopore sequencing revealed highly expressed genes related to the antiviral roles of innate immunity from pathogen-identified cases. Conclusions The use of Nanopore RNA sequencing for metagenomic diagnostics of CSF samples should help to elucidate both pathogens and host immune responses of CNSI and could shed light on the pathogenesis of these infections.
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Affiliation(s)
- Kazuhiro Horiba
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University , Nagoya , Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine , Nagoya , Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
- Department of Pediatrics, TOYOTA Memorial Hospital , Toyota , Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Makoto Yamaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazunori Haruta
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yoshihiko Kawano
- Department of Pediatrics, TOYOTA Memorial Hospital , Toyota , Japan
| | - Jun ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Shinya Hara
- Department of Pediatrics, TOYOTA Memorial Hospital , Toyota , Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital , Stockholm , Sweden
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University , Nagoya , Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine , Nagoya , Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine , Tokyo , Japan
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11
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Yamaguchi M, Tetsuka N, Okumura T, Haruta K, Suzuki T, Torii Y, Kawada JI, Ito Y. Post-exposure prophylaxis to prevent varicella in immunocompromised children. Infect Prev Pract 2022; 4:100242. [PMID: 36120112 PMCID: PMC9471438 DOI: 10.1016/j.infpip.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Varicella-zoster virus (VZV) infection can cause life-threatening events in immunocompromised patients. Post-exposure prophylaxis (PEP) is required to prevent secondary VZV infection. Limited evidence is available for the use of acyclovir (ACV)/valacyclovir (VCV) as PEP. Methods Herein, we retrospectively analyzed immunocompromised paediatric patients with significant exposure to VZV. Patients administered PEP were categorized into four groups: 1) ACV/VCV group; 2) intravenous immunoglobulin (IVIG) group; 3) ACV/VCV/IVIG group; 4) vaccine group. Results Among 69 exposure events, 107 patients were administered PEP (91, ACV/VCV; 16, ACV/VCV/IVIG) and 10 patients did not receive PEP (non-PEP group). The index case was diagnosed based on clinical symptoms in 55 cases (79.7%). Fourteen cases (20.3%) were confirmed using direct virological diagnostic procedures. In the PEP group, only 2 patients (2.2%) developed secondary VZV infections. Additionally, 2 patients in the non-PEP group (20.0%) developed secondary VZV infection. The incidence of secondary VZV infection was significantly lower in the PEP group than in the non-PEP group (P=0.036). Among patients administered PEP, no antiviral drug-induced side effects were detected. Conclusions Antiviral agents administered as PEP are effective and safe for preventing VZV infections in immunocompromised patients. Rapid virological diagnosis of index cases might allow efficient administration of PEP after significant exposure to VZV infection.
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12
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Mutsuga M, Okumura T, Morimoto R, Kondo T, Ito H, Uchida W, Terazawa S, Tokuda Y, Narita Y, Murohara T, Usui A. Impact of an Improved Standardized Strategy and Individually Tailored Protocol for Heartmate II and Heartmate 3 Left Ventricular Assist Devices on the Incidence of Driveline Infections. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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13
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Torii Y, Kawada JI, Horiba K, Okumura T, Suzuki T, Ito Y. MicroRNA expression profiling of cerebrospinal fluid/serum exosomes in children with human herpesvirus 6-associated encephalitis/encephalopathy by high-throughput sequencing. J Neurovirol 2022; 28:151-157. [PMID: 35212942 DOI: 10.1007/s13365-022-01058-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/13/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
Primary human herpesvirus 6 (HHV-6) infection is sometimes accompanied by acute encephalopathy with reduced subcortical diffusion (AED) in immunocompetent children. We investigated exosomal microRNA (miRNA) expression profiles in cerebrospinal fluid (CSF) and sera of patients with HHV-6-associated AED (n = 5) and febrile seizure (FS) (n = 5) using high-throughput sequencing. A total of 176 and 663 miRNAs were identified in CSF and serum exosomes, respectively. Comparative analysis determined that some miRNAs (miR-381-3p, miR-155) were exclusively expressed in the CSF exosomes of AED but not of FS patients, suggesting their potential application as novel diagnostic biomarkers for AED.
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Affiliation(s)
- Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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14
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Shibata N, Kondo T, Morimoto R, Kazama S, Sawamura A, Nishiyama I, Kato T, Hiraiwa H, Okumura T, Murohara T. Clinical value of the HATCH score for predicting adverse outcomes in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The HATCH score is employed as a risk assessment tool for atrial fibrillation (AF) development. However, the impact of the HATCH score on the long-term adverse outcomes in patients with acute heart failure (AHF) is unknown.
Aimes
To investigate the clinical value of the HATCH score in AHF.
Methods
From a multicenter AHF registry, we retrospectively evaluated 1,543 consecutive patients admitted with AHF (median age, 78 [69–85] years; 42.3% women) from 2012 to 2019. These patients were divided into five groups based on their HATCH score at admission (scores 0, 1, 2, 3, and 4–7). The correlation between the HATCH score and composite outcome, including all-cause mortality and re-hospitalization due to HF, was analyzed using Kaplan-Meier and Cox proportional-hazard analyses.
Results
The median HATCH score was 2 [1-3]. During the follow-up period (median, 16.8 months), the composite endpoint occurred in 691 patients (44.8%), including 416 (27%) patients who died and 455 (29.5%) patients requiring re-hospitalizations due to HF. The Kaplan-Meier analysis showed a significant increase in the composite endpoint with increasing HATCH score (log-rank, p < 0.001). The multivariate Cox regression model revealed that the HATCH score was an independent predictor of the composite endpoint (hazard ratio [HR] 1.181; 95% confidence interval [CI]: 1.111–1.255; p < 0.001) with all-cause mortality (HR 1.153, 95% CI: 1.065–1.249; p < 0.001) and re-hospitalizations due to HF (HR 1.21; 95% CI: 1.124–1.303; p < 0.001) in patients with AHF.
Conclusions
The HATCH score is an independent predictor of adverse outcomes in patients with AHF. Abstract Figure. Kaplan-Meier analysis for outcome
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Affiliation(s)
- N Shibata
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - S Kazama
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - A Sawamura
- Ichinomiya municipal hospital, Department of cardiology, Ichinomiya, Japan
| | - I Nishiyama
- Nagoya Ekisaikai Hospital, Department of Cardiology, Nagoya, Japan
| | - T Kato
- Nagoya Ekisaikai Hospital, Department of Cardiology, Nagoya, Japan
| | - H Hiraiwa
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
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15
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Horiba K, Torii Y, Okumura T, Takeuchi S, Suzuki T, Kawada JI, Muramatsu H, Takahashi Y, Ogi T, Ito Y. Next-Generation Sequencing to Detect Pathogens in Pediatric Febrile Neutropenia: A Single-Center Retrospective Study of 112 Cases. Open Forum Infect Dis 2021; 8:ofab223. [PMID: 34859110 PMCID: PMC8634086 DOI: 10.1093/ofid/ofab223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Febrile neutropenia (FN) is a frequent complication in immunocompromised patients. However, causative microorganisms are detected in only 10% of patients. This study aimed to detect the microorganisms that cause FN using next-generation sequencing (NGS) to identify the genome derived from pathogenic microorganisms in the bloodstream. Here, we implemented a metagenomic approach to comprehensively analyze microorganisms present in clinical samples from patients with FN. Methods FN is defined as a neutrophil count <500 cells/µL and fever ≥37.5°C. Plasma/serum samples of 112 pediatric patients with FN and 10 patients with neutropenia without fever (NE) were sequenced by NGS and analyzed by a metagenomic pipeline, PATHDET. Results The putative pathogens were detected by NGS in 5 of 10 FN patients with positive blood culture results, 15 of 87 FN patients (17%) with negative blood culture results, and 3 of 8 NE patients. Several bacteria that were common in the oral, skin, and gut flora were commonly detected in blood samples, suggesting translocation of the human microbiota to the bloodstream in the setting of neutropenia. The cluster analysis of the microbiota in blood samples using NGS demonstrated that the representative bacteria of each cluster were mostly consistent with the pathogens in each patient. Conclusions NGS technique has great potential for detecting causative pathogens in patients with FN. Cluster analysis, which extracts characteristic microorganisms from a complex microbial population, may be effective to detect pathogens in minute quantities of microbiota, such as those from the bloodstream.
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Affiliation(s)
- Kazuhiro Horiba
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
- Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Correspondence: Yoshinori Ito, MD, PhD, Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466–8550, Japan ()
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Araki T, Okumura T, Mizutani T, Kimura Y, Kazama S, Shibata N, Oishi H, Kuwayama T, Hiraiwa H, Kondo T, Morimoto R, Takefuji M, Murohara T. Serum autotaxin level predicts future cardiac events in patients with dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1730] [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
Autotaxin (ATX) has been reported to promote myocardial inflammation and subsequent cardiac remodeling through lysophosphatidic acid (LPA) production. However, the prognostic impact of ATX has not been clarified in dilated cardiomyopathy (DCM).
Purpose
We aimed to investigate the prognostic impact of ATX in patients with DCM.
Methods
We enrolled 104 DCM patients (49.8 years, 76 males). The subjects underwent blood sampling, echocardiography, cardiac catheterization, and endomyocardial biopsy. Gender differences in serum ATX levels have been reported, thus we divided the subjects into two groups using median serum ATX levels for men and women: High-ATX group and Low-ATX group. All patients were followed up by expert cardiologists. The cardiac event was defined as a composite of cardiac death and hospitalization for worsening heart failure.
Results
Eighty-nine percent of the subjects were classified as New York Heart Association functional class I or II. Female patients had higher serum ATX levels than male patients, with median values of 257.0 ng/mL and 203.5 ng/mL, respectively (Figure A). The average left ventricular ejection fraction and brain natriuretic peptide levels were 30.6% and 122.5 pg/mL. In survival analysis, cumulative event-free probability was significantly lower in High ATX group (p=0.007, Figure B). In Cox proportional hazards analysis, High-ATX was one of the independent predictors of composite cardiac events (Hazards Ratio, 2.575; p=0.043). On the other hand, high sensitive C-reactive protein and collagen volume fraction in myocardial samples were not significant predictors.
Conclusion
High serum ATX level was associated with poor prognosis in patients with DCM.
Funding Acknowledgement
Type of funding sources: None. Gender difference in autotaxin levelsSurvival analysis of cardiac events
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Affiliation(s)
- T Araki
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - T Mizutani
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - Y Kimura
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - S Kazama
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - N Shibata
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - H Hiraiwa
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - M Takefuji
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Cardiology, Nagoya, Japan
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17
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Hiraiwa H, Okumura T, Sawamura A, Kondo T, Araki T, Mizutani T, Kazama S, Kimura Y, Shibata N, Oishi H, Kuwayama T, Furusawa K, Morimoto R, Murohara T. Clinical significance of spleen size in patients with heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The spleen is an important organ that stores blood, releases erythrocytes or monocytes, and destroys no-longer-needed platelets. It can reserve 20–30% of the total blood volume, and its size is reduced in hypovolemic shock. However, the clinical significance of the spleen size in patients with heart failure (HF) remains unclear.
Purpose
The purpose of this study was to investigate the relationship between spleen size, hemodynamic parameters, and prognosis in patients with HF.
Methods
A total of 219 patients with clinically stable HF were enrolled. All patients underwent right heart catheterisation and computed tomography. The spleen size was measured using computed tomography volumetry. In addition, spleen volume was assessed using the spleen volume index (SVI), corrected for body surface area. Cardiac events were composite endpoints of cardiac death, hospitalisation for worsening HF, fatal arrhythmias, implantation of cardiac devices, implantation of left ventricular assist devices, and unexpected percutaneous coronary intervention or cardiac surgery. Spearman's rank correlation coefficient was used to examine the relationship between spleen volume and hemodynamic parameters. Multivariate Cox hazard regression models were used to investigate whether SVI was an independent determinant of cardiac events.
Results
Of the 219 patients (median age, 54 [interquartile range] 46–64 years), 145 (66%) were males. The median (interquartile range) spleen volume and SVI was 118.0 (91.5–156.0) mL and 67.8 (54.9–87.2) mL/m2, respectively. SVI was positively correlated with cardiac output (r=0.269, P<0.001), and negatively correlated with systemic vascular resistance (r=−0.302, P<0.001) (Figure 1). A total of 70 cardiac events were observed, and the optimal cut-off value of SVI for cardiac events was 68.9 mL/m2 in the receiver operating characteristic analysis. Patients were divided into two groups: low-SVI (n=107, <68.9 mL/m2) and high-SVI groups (n=112, ≥68.9 mL/m2). Blood adrenaline concentration was higher in the low-SVI group than in the high-SVI group (0.039 [0.020–0.057] ng/mL vs 0.026 [0.014–0.044] ng/mL, P=0.004). The low-SVI group had more cardiac events than the high-SVI group (log-rank test, P<0.001) (Figure 2). In the multivariate Cox proportional hazard model, the low-SVI group was an independent predictor of cardiac events, even when adjusted for the conventional validated HF risk score, blood catecholamine levels, and hemodynamic parameters.
Conclusion
The spleen size may affect the prognosis in patients with HF, reflecting haemodynamics, including systemic circulating blood volume status and sympathetic nerve activity.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- H Hiraiwa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - A Sawamura
- Ichinomiya municipal hospital, Department of Cardiology, Ichinomiya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Araki
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Mizutani
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Kazama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Kimura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - N Shibata
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - K Furusawa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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18
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Shibata N, Hiraiwa H, Kazama S, Kimura Y, Araki T, Mizutani T, Oishi H, Kuwayama T, Kondo T, Morimoto R, Okumura T, Murohara T. Clinical impact of pulmonary artery to aorta diameter ratio on left ventricular reverse remodeling in patients with dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0757] [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
Left ventricular reverse remodeling (LVRR) is an important predictor for a good prognosis in patients with dilated cardiomyopathy (DCM). Previous reports indicated the pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) ratio as a predictor of adverse outcomes in heart failure patients. However, the impact of the PAD/AoD ratio for predicting LVRR in patients with DCM is unknown.
Aim
The aim of this study is to investigate the association between PAD/AoD ratio and LVRR in patients with DCM.
Methods
From a prospective study, clinically stable DCM patients who were investigated the LVRR on echocardiography and underwent CT at baseline were enrolled. LVRR is defined as left ventricular (LV) ejection fraction increase of 10% and a decrease in indexed LV end-diastolic diameter of 10% compared to those at baseline. PAD and AoD data was collected with nonenhanced computed tomography images at baseline.
Results
In sixty-nine patients (mean age 50.0±13.3 years), the mean LV ejection fraction was 29.8%, and mean LV end-diastolic dimension was 64.5mm, and both of which data was no significant difference between patients with or without LVRR. LVRR was observed in 23 (33.3%) patients. The PAD/AoD ratio was significantly lower in patients with LVRR than without LVRR (81.4% vs. 92.4%, p=0.003). By ROC analysis, the best cut-off for the detection of LVRR was found for a PAD/AoD ratio of 0.9. From multivariate analyses, PAD/AoD ratio was identified as a significant predictor of LVRR. After a median follow-up duration of 2.5 years, the DCM patients with PAD/AoD≥0.9 revealed a significant higher cardiac event than those with PAD/AoD<0.9 (log-rank, p=0.007)
Conclusions
The PAD/AoD ratio is useful for predicting LVRR in patients with DCM. The DCM patients with high PAD/AoD ratio had a poor long-term outcome.
Funding Acknowledgement
Type of funding sources: None. ROC curve for LVRR predictionKaplan-Meier survival curves
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Affiliation(s)
- N Shibata
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - H Hiraiwa
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - S Kazama
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - Y Kimura
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Araki
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Mizutani
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Hospital, Department of cardiology, Nagoya, Japan
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19
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Iizumi T, Okumura T, Maruo K, Baba K, Murakami M, Shimizu S, Saito T, Nakajima M, Makishima H, Numajiri H, Mizumoto M, Nakai K, Sakurai H. 943P Long-term outcome of the oldest-old patients (85 years or older) underwent proton beam therapy for hepatocellular carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Okumura T, Azuma T, Bennett DA, Caradonna P, Chiu I, Doriese WB, Durkin MS, Fowler JW, Gard JD, Hashimoto T, Hayakawa R, Hilton GC, Ichinohe Y, Indelicato P, Isobe T, Kanda S, Kato D, Katsuragawa M, Kawamura N, Kino Y, Kubo MK, Mine K, Miyake Y, Morgan KM, Ninomiya K, Noda H, O'Neil GC, Okada S, Okutsu K, Osawa T, Paul N, Reintsema CD, Schmidt DR, Shimomura K, Strasser P, Suda H, Swetz DS, Takahashi T, Takeda S, Takeshita S, Tampo M, Tatsuno H, Tong XM, Ueno Y, Ullom JN, Watanabe S, Yamada S. Deexcitation Dynamics of Muonic Atoms Revealed by High-Precision Spectroscopy of Electronic K X Rays. Phys Rev Lett 2021; 127:053001. [PMID: 34397250 DOI: 10.1103/physrevlett.127.053001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
We observed electronic K x rays emitted from muonic iron atoms using superconducting transition-edge sensor microcalorimeters. The energy resolution of 5.2 eV in FWHM allowed us to observe the asymmetric broad profile of the electronic characteristic Kα and Kβ x rays together with the hypersatellite K^{h}α x rays around 6 keV. This signature reflects the time-dependent screening of the nuclear charge by the negative muon and the L-shell electrons, accompanied by electron side feeding. Assisted by a simulation, these data clearly reveal the electronic K- and L-shell hole production and their temporal evolution on the 10-20 fs scale during the muon cascade process.
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Affiliation(s)
- T Okumura
- Atomic, Molecular and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - T Azuma
- Atomic, Molecular and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - D A Bennett
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - P Caradonna
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - I Chiu
- Department of Chemistry, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - W B Doriese
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - M S Durkin
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J W Fowler
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J D Gard
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - T Hashimoto
- Advanced Science Research Center (ASRC), Japan Atomic Energy Agency (JAEA), Tokai 319-1184, Japan
| | - R Hayakawa
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - Y Ichinohe
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - P Indelicato
- Laboratoire Kastler Brossel, Sorbonne Université, CNRS, ENS-PSL Research University, Collège de France, Case 74, 4, place Jussieu, 75005 Paris, France
| | - T Isobe
- RIKEN Nishina Center, RIKEN, Wako 351-0198, Japan
| | - S Kanda
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - D Kato
- National Institute for Fusion Science (NIFS), Toki, Gifu 509-5292, Japan
| | - M Katsuragawa
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - N Kawamura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - Y Kino
- Department of Chemistry, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - M K Kubo
- Department of Natural Sciences, College of Liberal Arts, International Christian University, Mitaka, Tokyo 181-8585, Japan
| | - K Mine
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - Y Miyake
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - K M Morgan
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - K Ninomiya
- Department of Chemistry, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - H Noda
- Department of Earth and Space Science, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - G C O'Neil
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Okada
- Atomic, Molecular and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - K Okutsu
- Department of Chemistry, Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - T Osawa
- Materials Sciences Research Center (MSRC), Japan Atomic Energy Agency (JAEA), Tokai 319-1184, Japan
| | - N Paul
- Laboratoire Kastler Brossel, Sorbonne Université, CNRS, ENS-PSL Research University, Collège de France, Case 74, 4, place Jussieu, 75005 Paris, France
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - D R Schmidt
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - K Shimomura
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - P Strasser
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - H Suda
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - D S Swetz
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - T Takahashi
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - S Takeda
- Kavli IPMU (WPI), The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - S Takeshita
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - M Tampo
- High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki 305-0801, Japan
| | - H Tatsuno
- Department of Physics, Tokyo Metropolitan University, Tokyo 192-0397, Japan
| | - X M Tong
- Center for Computational Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8573, Japan
| | - Y Ueno
- Atomic, Molecular and Optical Physics Laboratory, RIKEN, Wako 351-0198, Japan
| | - J N Ullom
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Watanabe
- Department of Space Astronomy and Astrophysics, Institute of Space and Astronautical Science (ISAS), Japan Aerospace Exploration Agency (JAXA), Sagamihara, Kanagawa 252-5210, Japan
| | - S Yamada
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
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21
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Okumura T, Horiba K, Kamei H, Takeuchi S, Suzuki T, Torii Y, Kawada JI, Takahashi Y, Ogura Y, Ogi T, Ito Y. Temporal dynamics of the plasma microbiome in recipients at early post-liver transplantation: a retrospective study. BMC Microbiol 2021; 21:104. [PMID: 33823791 PMCID: PMC8025517 DOI: 10.1186/s12866-021-02154-w] [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: 01/01/2021] [Accepted: 03/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background Immunosuppression during liver transplantation (LT) enables the prevention and treatment of organ rejection but poses a risk for severe infectious diseases. Immune modulation and antimicrobials affect the plasma microbiome. Thus, determining the impact of immunosuppression on the microbiome may be important to understand immunocompetence, elucidate the source of infection, and predict the risk of infection in LT recipients. We characterized the plasma microbiome of LT recipients at early post-LT and assessed the association between the microbiome and clinical events. Results In this study, 51 patients who received LT at Nagoya University Hospital from 2016 to 2018 were enrolled. Plasma samples were retrospectively collected at the following time points: 1) within a week after LT; 2) 4 ± 1 weeks after LT; 3) 8 ± 1 weeks after LT; and 4) within 2 days after a positive blood culture. A total of 111 plasma samples were analyzed using shotgun next-generation sequencing (NGS) with the PATHDET pipeline. Relative abundance of Anelloviridae, Nocardiaceae, Microbacteriaceae, and Enterobacteriaceae significantly changed during the postoperative period. Microbiome diversity was higher within a week after LT than that at 8 weeks after LT. Antimicrobials were significantly associated with the microbiome of LT recipients. In addition, the proportion of Enterobacteriaceae was significantly increased and the plasma microbiome diversity was significantly lower in patients with acute cellular rejection (ACR) than non-ACR patients. Sequencing reads of bacteria isolated from blood cultures were predominantly identified by NGS in 8 of 16 samples, and human herpesvirus 6 was detected as a causative pathogen in one recipient with severe clinical condition. Conclusions The metagenomic NGS technique has great potential in revealing the plasma microbiome and is useful as a comprehensive diagnostic procedure in clinical settings. Temporal dynamics of specific microorganisms may be used as indirect markers for the determination of immunocompetence and ACR in LT recipients. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02154-w.
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Affiliation(s)
- Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan.,Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideya Kamei
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan.,Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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22
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Takeuchi S, Kawada JI, Horiba K, yamaguchi M, Okumura T, Suzuki T, Torii Y, Kawabe S, Wada S, Ikeyama T, Ito Y. 1224. Investigation of Infectious Etiologies in the Lower Respiratory Tract from Pediatric Patients with Unexpected Cardiopulmonary Deterioration using Next-Generation Sequencing. Open Forum Infect Dis 2020. [PMCID: PMC7776594 DOI: 10.1093/ofid/ofaa439.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background In pediatric patients, unexpected cardiopulmonary deterioration with or without following cardiopulmonary arrest (CPA) are rare events, but can be caused by any of several etiologies, including infectious diseases. The most common cause of out-of-hospital CPA in children ≤12 years old was sudden infant death syndrome (SIDS), whereas infectious diseases were responsible for approximately 10% of the CPA cases. However, the role of infection may have been underestimated as triggers of SIDS or CPA. This study aimed to investigate the infectious etiologies in pediatric patients with unexpected cardiopulmonary deterioration using next-generation sequencing (NGS). Methods A total of 16 pediatric patients who were admitted to the pediatric intensive care unit with unexpected cardiopulmonary deterioration with or without following CPA were enrolled. Ten bronchoalveolar fluid (BALF) and six transtracheal aspirates (TTA) samples obtained in the acute phase were used to prepare NGS libraries. The libraries were sequenced on HiSeq and analyzed using metagenome analysis tools. Results In ten of 16 patients, one or more bacterial/viral pathogens were detected in the BALF or TTA specimens using NGS. Compared to the conventional culture and viral antigen test results, an additional 6 bacterial (e.g., Chlamydia trachomatis) and 4 viral pathogens (e.g., coxsackievirus A6 and human coronavirus NL63) were identified by NGS in four of ten patients in whom no causative pathogen had been identified by conventional culture and viral antigen tests. A summary of the detected pathogens is listed in Table 1. Notably, sequencing results allowed us to define genotypes for all of the detected viruses in a single NGS assay per patient. Furthermore, based on phylogenetic analysis of the VP1 region, the coxsackievirus A6 strain detected in this study belongs to lineage E2 and harbors an amino acid change (T283A), a substitution that has potential to cause severe illness. Table 1 ![]()
Conclusion Our results suggest that viral and bacterial infection are common triggers in unexpected cardiopulmonary deterioration in pediatric patients. NGS has the potential to contribute to the clarification of the etiology of pediatric critical illness. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Suguru Takeuchi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun-ichi Kawada
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuhiro Horiba
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Makoto yamaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Takako Suzuki
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuka Torii
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Kawabe
- Aichi Children’s Health and Medical Center, Obu, Aichi, Japan
| | - Sho Wada
- Aichi Children’s Health and Medical Center, Obu, Aichi, Japan
| | | | - Yoshinori Ito
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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23
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Okumura T, Horiba K, Kamei H, Takeuchi S, Suzuki T, Torii Y, Kawada JI, Takahashi Y, Ogura Y, Ogi T, Ito Y. 1212. Temporal Dynamics of the Plasma Microbiome in Recipients at Early Post-liver Transplantation. Open Forum Infect Dis 2020. [PMCID: PMC7776645 DOI: 10.1093/ofid/ofaa439.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Immunosuppression during liver transplantation (LT) enables the prevention and treatment of organ rejection, but poses a risk for severe infectious diseases. Antimicrobials are often required for patients after LT. Recently, the genomes of multiple microorganisms have been detected in blood, which is essentially sterile. Immune modulation and antimicrobials affect the blood microbiome. Thus, determining the impact of immunosuppression and antimicrobials on the microbiome may be important to understand immunocompetence, predict clinical adverse events after LT such as acute cellular rejection (ACR), and treat infectious diseases.
Methods
Fifty-one patients who received LT at Nagoya University Hospital from 2016 to 2018 were enrolled. Plasma samples were retrospectively collected within a week after LT, 4±1 weeks after LT, 8±1 weeks after LT, and within 2 days after a positive blood culture. A total of 111 plasma samples were analyzed using shotgun next-generation sequencing (NGS). Sequence data were imported into the custom-made analysis pipeline PATHDET.
Results
The relative abundance of Anelloviridae, Nocardiaceae, Microbacteriaceae, and Enterobacteriaceae significantly changed during the postoperative period (figure 1). Microbiome diversity was higher within a week after LT than at 8 weeks after LT. Antimicrobials were significantly associated with the microbiome of LT recipients. In addition, the proportion of Enterobacteriaceae was significantly decreased (figure 2) and the plasma microbiome diversity was significantly higher in patients with ACR than in non-ACR patients. Finally, sequencing reads of bacteria isolated from blood cultures were predominantly identified by NGS in 8 of 16 samples (figure 3), and human herpesvirus 6 was detected as a causative pathogen in one recipient with severe infectious diseases.
Change in the relative abundance of each microorganism at the family level of taxonomic hierarchy in plasma samples after liver transplantation
Comparison of the plasma microbiome at the family level in patients with and without acute cellular rejection
Relative abundance of microorganisms at the species level in plasma from patients with positive blood cultures
Conclusion
The metagenomic NGS technique has great potential in revealing the plasma microbiome and is useful as a comprehensive diagnostic procedure in clinical settings. Temporal dynamics of specific microorganisms may be used as indirect markers for the determination of immunocompetence and ACR in LT recipients.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | - Kazuhiro Horiba
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Hideya Kamei
- Department of Transplantation Surgery, Nagoya University Hospital, nagoya, Aichi, Japan
| | - Suguru Takeuchi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takako Suzuki
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuka Torii
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun-ichi Kawada
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, nagoya, Aichi, Japan
| | - Tomoo Ogi
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Yoshinori Ito
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Kotsuka M, Hatta M, Matsushima H, Hishikawa H, Miki H, Nakatake R, Okumura T, Nishizawa M, Kaibori M, Sekimoto M. Cinnamomi cortex and scutellariae radix in japanese kampo medicine saireito inhibit expression of inos through different mechanisms in hepatocytes. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.331] [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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Okuyama T, Ihara A, Nakatake R, Kaibori M, Okumura T, Sekimoto M, Ikeya Y, Nishizawa M. Effects of a citrus fruit extract on nitric oxide production and inducible nitric oxide synthase expression In Interleukin-1β-treated rat hepatocytes. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Iizumi T, Okumura T, Sekino Y, Numajiri H, Mizumoto M, Nakai K, Ishikawa H, Sakurai H. PO-1058: Proton beam therapy for hepatocellular carcinoma of caudate lobe. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01075-6] [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: 11/16/2022]
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Murofushi K, Tomita T, Ishida T, Baba K, Numajiri H, Mizumoto M, Ohnishi K, Nakai K, Ishikawa H, Okumura T, Sakurai H. The Incidence of Venous Thromboembolism Induced by Prolonged Bed Rest during Interstitial Brachytherapy for Gynecological Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1530] [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: 11/26/2022]
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Hiraiwa H, Kasugai D, Okumura T, Kazama S, Kimura Y, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Murohara T. The prognostic impact of right ventricular dysfunction in patients with septic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sepsis is a systemic condition of profoundly impaired health in which an infection leads to a dysregulated host response, and consecutively causes organ dysfunction, shock, and even death. Septic cardiomyopathy (SCM) is one of the multiple organ dysfunctions. SCM is typically defined as left ventricular (LV) dysfunction, presented by decreased LV ejection fraction (LVEF). However, it remains unclear about the detailed mechanism of cardiac dysfunction. In addition, the prognostic impact of right heart dysfunction in SCM patients has not been fully investigated.
Purpose
The purpose of this study was to investigate the prognostic impact of right heart dysfunction in patients with SCM.
Methods
We used the MIMIC-III (Medical Information Mart for Intensive Care III) critical care database, which is a large, freely-available database comprising deidentified health-related data associated with over forty thousand patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. We retrospectively analyzed data of patients with septic shock on admission to intensive care unit (ICU). Septic shock was defined as the presence of any suspected infections, the need for vasopressors, and the lactate level exceeding 2 mmol/L, based on the Sepsis-3 criteria. Patients were performed portable transthoracic echocardiography (TTE) during hospitalization. LVEF and right ventricular (RV) function were determined predominately by visual estimation in the parasternal long-axis view. SCM was defined as having a minimum LVEF of 50% or less during hospitalization. Patients with hyperdynamic motion of LVEF >70% were excluded.
Results
In total, there were 2254 patients with septic shock. Of these, 604 patients who underwent TTE were enrolled, and 314 patients were diagnosed with SCM. At baseline, age, gender, Sequential Organ Failure Assessment (SOFA) score, maximum lactate levels, and maximum norepinephrine dosage were 70 [59–79] years, 194 males, 13 [11–15], 4.0 [2.7–6.2] mmol/L, and 0.20 [0.10–0.31] mcg/kg/min, respectively. All patients were treated with vasopressors. In Kaplan-Meier survival analysis, patients with SCM had increased 28-day mortality compared with those without SCM (log-rank, p=0.09). In addition, we divided SCM patients into two groups; SCM with and without RV dysfunction. SCM patients with RV dysfunction had significant increased 28-day mortality compared with those without RV dysfunction (log-rank, p=0.01) (Figure). In Cox proportional hazard regression analysis adjusted for age, male sex, SOFA score, and maximum lactate levels, RV dysfunction was an independent determinant of 28-day mortality (hazard ratio, 1.59; 95% confidence interval, 1.03–2.46; p=0.03).
Conclusions
The presence of RV dysfunction increased 28-day mortality in patients with SCM. It might be useful for predicting the prognosis of SCM to evaluate not only left heart function but also right heart function.
Kaplan-Meier survival curves
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Hiraiwa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - D Kasugai
- Nagoya University Hospital, Department of Emergency and Critical Care Medicine, Nagoya, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Kazama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Kimura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - N Shibata
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Arao
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Kato
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Yamaguchi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - K Furusawa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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Hiraiwa H, Okumura T, Sawamura A, Kazama S, Kimura Y, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Murohara T. Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1094] [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 spleen has been recognized as an important organ with several functions such as a reservoir of blood volume, and an involvement in iron metabolism by processing of aged red blood cells and recycling iron. During exercise, spleen contracts, and red blood cells pooled in the spleen are recruited into the systemic circulation. So far, we reported that spleen size changed in advanced heart failure (HF) with left ventricular assist device (LVAD). In addition, spleen volume was related to pulmonary capillary wedge pressure (PCWP) or right atrial pressure (RAP) as parameters of cardiac preload. However, it remains unclear about the relationship between spleen volume and exercise capacity in advanced HF with LVAD.
Purpose
The purpose of this study was to investigate the associations between spleen volume and exercise capacity in advanced HF patients with LVAD.
Methods
We enrolled 27 HF patients (21 males, 45±12 years) with LVAD (HeartMate II™; Abbott, Chicago, IL, USA) for use as a bridge to heart transplantation. All patients underwent blood test, echocardiography, right heart catheterization, computed tomography (CT) and cardiopulmonary exercise testing (CPET). Spleen size was measured by CT volumetry. We excluded patients with splenic infarction or aortic valve closure surgery.
Results
At baseline, body mass index, blood brain natriuretic peptide levels, hemoglobin levels, left ventricular ejection fraction were 21.4±3.1 kg/m2, 73.8 (51.9–165.8) pg/mL, 12.1 (10.6–13.4) g/dL, 24.8±14.7%, respectively. Total cardiac output (CO), the sum of pump flow and CO of native heart was 4.6±0.9 L/min, and spleen volume was 184.9±48.8 mL. As for parameters of CPET, peak heart rate (HR), peak VO2, and peak O2 pulse were 128±25 beats/min, 14.2±3.3 mL/kg/min, and 6.6±1.9 mL/beat. At rest, there were significant correlations between spleen volume and PCWP (r=0.382, p=0.049), RAP (r=0.406, p=0.035) or pulsatility index (r=0.384, p=0.047), despite no correlations with total CO or pump flow. During exercise, there were significant interrelations of spleen volume with peak VO2 (r=0.451, p=0.018) and peak O2 pulse (r=0.427, p=0.026). Furthermore, peak VO2 was interrelated with peak HR (r=0.481, p=0.011) or hemoglobin levels (r=0.649, p<0.001). Remarkably, spleen volume was significantly correlated with hemoglobin levels (r=0.391, p=0.043) (Figure). Interpreting these results based on Fick's formula, the proportion of native CO to total CO is very small at rest, but increases during exercise. The spleen during exercise may contribute to increased native CO, especially stroke volume. Moreover, the spleen may be related to both cardiac preload and oxygen carrying capacity, resulting in a significant association between spleen volume and peak VO2.
Conclusion
Spleen volume could be a useful predictor of exercise capacity in advanced HF patients with LVAD, reflecting splenic function to modulate cardiac preload and blood hemoglobin levels.
Spleen volume and exercise parameters
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Hiraiwa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - A Sawamura
- Ichinomiya municipal hospital, Department of Cardiology, Ichinomiya, Japan
| | - S Kazama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Kimura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - N Shibata
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Arao
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Kato
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Yamaguchi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - K Furusawa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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Kuwayama T, Morimoto R, Oishi H, Kato H, Kimura Y, Kazama S, Shibata N, Arao Y, Yamaguchi S, Hiraiwa H, Kondo T, Furusawa K, Okumura T, Murohara T. Efficacy of right ventricular dysfunction estimated by pulmonary artery pulsatility index in stable phased dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0902] [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
Dilated cardiomyopathy (DCM) is characterized by a reduction in left and/or right ventricular myocardial contraction, dilatation of biventricular cavity and major cause of heart failure with high morbidity and mortality rates. Right ventricular dysfunction (RVD) recently have been received attention because of 34% of DCM had RVD and considered as a powerful predictor of impaired prognosis in DCM. Pulmonary Artery Pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure, however, it is unknown that even at early phase, PAPi can reflects latent right myocardial damage and predict long-term prognosis in stable DCM patients.
Methods
From April 2000 to March 2018, we enrolled 566 consecutive patients with cardiomyopathy. All patients underwent laboratory measurement, echocardiography, and cardiac catheterization to evaluate their general conditions. After excluded secondary cardiomyopathy, ischemic cardiomyopathy, and valvular heart disease, finally 162 DCM patients were enrolled. All enrolled patients had NYHA I/II/III and NYHA I/II were 150 patients (92.6%). PAPi was calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure (Pulmonary artery pulse pressure: PAPP)) / right atrial pressure. Median followed up for 4.85 years. In this study 149 patients were performed endomyocardial biopsy in order to exclude secondary cardiomyopathies and 95 patients were assessed using Sirius red staining. Myocardial fibrosis in biopsy specimen was assessed using Sirius red staining, and the positive region was quantified as the collagen volume fraction (CVF).
Results
The mean age and LV ejection fraction (EF) was 50.9±12.6 years and 30.5±8.3%, respectively. When divided into two groups by median PAPi value [PAPi <3.06 (L-PAP) and PAPi ≥3.06 (H-PAP)], even though there were no significant difference in BNP, pulmonary vascular resistance and right ventricular stroke work index between two groups, the probability of cardiac event-survival was significantly higher in L-PAP than H-PAP by Kaplan-Meier analysis (P=0.012). Furthermore, cox proportional hazard regression analysis revealed that PAPi was independent predictor of cardiac events (hazard ratio: 0.624, P=0.025). In pathological analysis, there was no difference between H-PAPi and L-PAPi in CVF.
Conclusion
In the calculation of PAPi, PAPP reflects both RV contractility and left atrial filling pressure and this index considered as RV adaptive response to afterload. The denominator of the PAPP is defined by RA pressure, which serves as a marker of RV preload. Thus, PAPi reflect both preload and afterload of RV at the same time and even though estimated patients at early phase, RVD exists in DCM patients without severe myocardial fibrosis, and PAPi may help stratify DCM and predict cardiac events.
Kaplan-Meier analysis
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - H Oishi
- Nagoya University, Nagoya, Japan
| | - H Kato
- Nagoya University, Nagoya, Japan
| | - Y Kimura
- Nagoya University, Nagoya, Japan
| | - S Kazama
- Nagoya University, Nagoya, Japan
| | | | - Y Arao
- Nagoya University, Nagoya, Japan
| | | | | | - T Kondo
- Nagoya University, Nagoya, Japan
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Morimoto R, Kuwayama T, Ooishi H, Kazama S, Kimura Y, Shibata N, Hiraiwa H, Kondo T, Okumura T, Unno K, Murohara T. The efficacy of methotrexate for intolerance to prednisolone therapy in cardiac sarcoidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2131] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Fluorine-18-flurodeoxyglucose positron emission tomography (18FDG-PET) is a useful examination assessing active inflammatory myocardium noninvasively in patients with cardiac sarcoidosis (CS). Though immunosuppression like prednisolone (PSL) and Methotrexate (MTX) as alternative therapy is used to suppress the inflammation, little is known about the rate of response and efficacy of MTX for intolerance to PSL therapy.
Methods
From Aug 2016, we prospectively enrolled CS with positively accumulated of FDG in the heart. The initial dose of PSL was 30mg/day, wherefrom the dose was tapered down 5mg/month until 6 months. After 6 months, follow-up 18FDG-PET was performed. Using 18FDG-PET images, we calculated total lesion glycolysis (TLG; SUVmeam x metabolic volume) and calculated the reduction rate of TLG. In order to estimate the response rate to PSL therapy, responder group (R-group) was defined as TLG reduction rate ≥70% and poor-responder group (PR-group) was defined as TLG reduction rate <70% after PSL therapy. After prescribed PSL, subjects with PR-group randomized to PSL (maximum dose 30mg daily and tapered down 5mg/month until 6 months) or to MTX (6mg weekly).
Results
In 64 CS patients, 55 patients had serial 18FDG-PET before and 6 months after PSL therapy. 18FDG-PET images were acquired following 7 day's carbohydrate limitation and after at least 18-h fasting (mean free fatty acid level right before 18FDG-PET acquisition was 1.05 mEq/L). The mean age was 63.4 years old and 42 (76.4%) patients were female. Because of 6 months PSL therapy, even though there were no significant difference in BNP (from 59.9 (26.2–137.6) to 60.4 (18.5–122.0) (P=0.593), LV-Dd (from 50.9 (44.5–59.5) to 49.7 (45.5–61.3) (P=0.666) and LV-EF (from 49.5 (34.4–62.5) to 49.9 (38.0–62.0) (P=0.792) at pre and post therapy, respectively, TLG were detected significant reduction from 216.4 (74.2–411.6) to 0.8 (0.0–8.2), (p<0.001). In response to PSL therapy, 47 (85.5%) CS patients were classified to R-group and 8 (14.5%) were classified to PR-group. Furthermore, when performed block randomization and divide 8 PR-group patients into MTX (n=3) and re-increased PSL (n=5) for more 6 months, MTX group is prone to high rate of TLG reduction than re-increased PSL-group (89.4% vs 59.9%) and one patient belonged to re-increased PSL group showed that the further elevation of TLG level at additional 6-months PSL therapy (349⇒483) (Figure).
Conclusions
1) By immunosuppression therapy using PSL for CS, about 86% patients showed significant reduction of myocardial FDG accumulation. 2) When detected intolerance for PSL therapy, MTX might be effective for reduction of inflammation of sarcoidosis in the heart, which might be effective as an alternate therapy in CS.
The TLG level after randomization
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Grant-in-aid for scientific research
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Affiliation(s)
| | | | - H Ooishi
- Nagoya University, Nagoya, Japan
| | - S Kazama
- Nagoya University, Nagoya, Japan
| | - Y Kimura
- Nagoya University, Nagoya, Japan
| | | | | | - T Kondo
- Nagoya University, Nagoya, Japan
| | | | - K Unno
- Nagoya Daini Red Cross Hospital, catdiology, Nagoya, Japan
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Kohga A, Kawabe A, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K, Muramatsu K, Komiyama A. Does preoperative enhanced CT predict requirement of intestinal resection in the patients with incarcerated myopectineal hernias containing small bowel? Hernia 2020; 25:1279-1287. [PMID: 33128678 DOI: 10.1007/s10029-020-02325-0] [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: 08/17/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel. METHODS Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated. RESULTS Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80 years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria. CONCLUSIONS Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.
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Affiliation(s)
- A Kohga
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan.
| | - A Kawabe
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Yajima
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - T Okumura
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Yamashita
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - J Isogaki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Suzuki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Muramatsu
- Division of Radiology, Fujinomiya City General Hospital, Shizuoka, Japan
| | - A Komiyama
- Division of Pathology, Fujinomiya City General Hospital, Shizuoka, Japan
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Kawada JI, Takeuchi S, Imai H, Okumura T, Horiba K, Suzuki T, Torii Y, Yasuda K, Imanaka-Yoshida K, Ito Y. Immune cell infiltration landscapes in pediatric acute myocarditis analyzed by CIBERSORT. J Cardiol 2020; 77:174-178. [PMID: 32891480 DOI: 10.1016/j.jjcc.2020.08.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Myocarditis is an inflammatory disease of the myocardium, which leads to cardiac dysfunction and heart failure. Previous studies have suggested that complex cross-talk between innate and adaptive immune responses is involved in the pathogenesis of acute myocarditis. Immunohistochemistry is the current standard method for the evaluation of infiltrating immune cells, however, it is difficult to investigate and quantify many immune cell populations using this technique. METHODS Endomyocardial biopsy samples of five pediatric patients with myocarditis were analyzed by cell-type identification by estimating relative subsets of RNA transcript (CIBERSORT), a computational method for quantifying cell fractions from tissue gene expression profiles. CIBERSORT results were then compared with immunohistochemistry analyses. RESULTS Significant results of immune infiltrate deconvolution were obtained in four patients with fulminant myocarditis by CIBERSORT analysis. Among 22 immune cell types, 19 cell types were detected in one or more patients. Activated NK cells were the most prevalent population in two patients, whereas activated memory CD4+ T cells and M2 macrophages were the most prevalent population in one patient each. Overall CIBERSORT results were consistent with those of immunohistochemistry, although some discrepancies were observed. CONCLUSIONS Infiltrating immune cell subsets detected by CIBERSORT analysis can reflect the time course of innate and adaptive immune responses in acute myocarditis. CIBERSORT may have the potential to characterize the detail of infiltrating immune cells in myocardial tissues and provide novel insights into the pathogenesis of acute myocarditis.
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Affiliation(s)
- Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Imai
- Pathology Division, Mie University Hospital, Mie, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Horiba
- Department of Genetics, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan; Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazushi Yasuda
- Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Motoo I, Ando T, Ueda A, Ogawa K, Kajiura S, Hirano K, Okumura T, Tsukada K, Hara T, Suzuki N, Nakada N, Takatori S, Horikawa N, Fujii T, Yasuda I. P-178 Prognostic impact of immune-related adverse events with nivolumab or pembrolizumab monotherapy in patients with advanced gastric cancer: A multicenter retrospective analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Horiba K, Torii Y, Hara Y, Shimada M, Suzuki T, Takeuchi S, Okumura T, Kawada JI, Muramatsu H, Takahashi Y, Ogi T, Ito Y. 242. Comprehensive Pathogen Detection for Pediatric Febrile Neutropenia by Metagenomic Next-Generation Sequencing. Open Forum Infect Dis 2019. [PMCID: PMC6810412 DOI: 10.1093/ofid/ofz360.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Febrile neutropenia (FN) is a common complication in patients with solid tumors and hematologic malignancies. Identification of the causative microorganisms would contribute to optimization of antimicrobial treatment and thus improve the outcome of FN. However, causative microorganisms are detected in only 10% to 20% of FN patients. Next-generation sequencing (NGS) allows us to comprehensively analyze all microorganisms present in a clinical sample. In this study, we aimed to utilize NGS for the detection of microbial pathogens in infectious diseases and elucidate the infection source in FN. Methods FN is defined by two characteristics: (1) neutrophils count < 500/µL, and (2) fever ≥38.0°C. From 2016 to 2018, 112 plasma/serum samples of pediatric FN patients (11 positive blood cultures) were analyzed. Serum samples from 10 neutropenic patients without fever were also analyzed as controls. Shotgun sequencing method was applied for these samples. The metagenomic analyses were performed through the pipeline PATHDET, which has been newly established in our laboratory. Diagnosis based on NGS results was made based on the following criteria: (1) number of reads from all pathogens per million reads (PR) >650, (2) a specific pathogen’s reads per million reads (RPM) >200, and (3) diversity index >3.0. The NGS results were compared with those from blood culture. Results Sequencing reads of bacteria isolated through blood culture were identified by NGS in all 11 plasma/serum samples leading to the diagnosis of FN. The causative pathogens were diagnosed by NGS using the above criteria in 11 patients. However, the results were consistent with those of blood culture in only 4 samples. Of 101 cases with negative blood culture results, the causative pathogens were detected in 17 cases: Acinetobacter soli (2 cases), Burkholderia cepacian (1 case), Klebsiella variicola (1 case), and Roseomonas sp. (1 case) were identified at the species level. In addition, 7 cases (e.g., Acinetobacter) were identified at the genus level, and 5 cases (e.g., Enterobacteriaceae) were identified at the family level. Conclusion Metagenomic NGS technique has great potential for detecting causative pathogens with greater efficiency than the conventional methods. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kazuhiro Horiba
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Yuka Torii
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuichiro Hara
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Mayuko Shimada
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Takako Suzuki
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Suguru Takeuchi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Jun-ichi Kawada
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hideki Muramatsu
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoo Ogi
- Research Institute of Environmental Medicine (RIeM), Nagoya University, Nagoya, Aichi, Japan
| | - Yoshinori Ito
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Okumura T, Oishi H, Kondo T, Arao Y, Kato H, Haga T, Yamaguchi S, Kuwayama T, Yokoi T, Hiraiwa H, Sawamura A, Morimoto R, Murohara T. P6452Circulating human epididymis protein 4 is a novel prognostic predictor in ambulatory patients with non-ischemic dilated cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1045] [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
Myofibroblasts, which are activated fibroblasts, play an important role in interstitial fibrosis in non-ischemic dilated cardiomyopathy (NIDCM). Recently, human epididymal body protein 4 (HE4) has attracted attention as a marker specific to myofibroblasts. However, the prognostic impact of HE-4 on cardiovascular events in NIDCM patients has not been reported.
Purposes
The purpose of this study was to investigate the impact of circulating serum HE4 on the prognosis in patients with NIDCM.
Methods
Forty-four NIDCM patients underwent echocardiography, laboratory measurements, cardiac catheterization, and endomyocardial biopsy within one week under stable heart failure condition. Patients with cancer were excluded from this study. We collected blood samples from peripheral vain, ascending aorta, and coronary sinus during cardiac catheterization and measured serum HE4 level. They were divided into two groups at the median of HE4 level: High-HE4 group (HE4 >69 pmol/L); n=22, Low-HE4 group (HE4 <69 pmol/L); n=22. Cardiac composite event was defined as cardiac related deaths and hospitalization due to worsening heart failure.
Results
The mean age, left ventricular ejection fraction (LVEF), and plasma brain natriuretic peptide level were 56 years, 32%, and 205 pg/mL. Between two groups, there were no significant differences in age, gender, LVEF, left ventricular end-diastolic diameter, cardiac index, and pulmonary capillary wedge pressure. However, estimated glomerular filtration rate was significantly lower in the High-HE4 group (p=0.025). Kaplan-Meier survival analysis revealed that the High-HE group had a higher rate of cardiac composite event (p=0.011, see Figure). However, as for the pathological analysis, not only the peripheral HE4 level but also HE4 value subtracting coronary sinus from ascending aorta did not significantly correlate with collagen volume fraction in biopsy samples.
Circulating HE4 level and prognosis
Conclusion
Elevated circulating HE4 is associcated with poor prognosis in ambulatory patients with NIDCM.
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Affiliation(s)
- T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Arao
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Kato
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Haga
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Yamaguchi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Yokoi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Hiraiwa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - A Sawamura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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Matsue Y, Okumura T, Kida K, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kitai T. P3534Optimal dosing of initial bolus of intravenous furosemide in acute heart failure: insights from REALITY-AHF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0398] [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
Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated.
Methods
The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality.
Results
Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p<0.001) compared to the standard dose group after adjustment for covariates. During 60 days of admission, 91 deaths were observed, and 60-day mortality was significantly higher in the higher dose group (HR: 2.80, 95% CI: 1.49–5.26, p=0.001), but not in the lower dose group (HR: 1.18, 95% CI: 0.67–2.08, p=0.571) compared to the standard dose group after adjustment for other prognostic factors.
Conclusion
Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF.
Acknowledgement/Funding
This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.
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Affiliation(s)
- Y Matsue
- Juntendo University School of Medicine, Tokyo, Japan
| | - T Okumura
- Nagoya University, Department of Cardiology, Nagoya, Japan
| | - K Kida
- St. Marianna University, Department of Cardiology, Kawasaki, Japan
| | - S Oishi
- Himeji Cardiovascular Center, Department of Cardiology, Himeji, Japan
| | - E Akiyama
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - S Suzuki
- Fukushima Medical University, Department of Cardiovascular Medicine, Fukushima, Japan
| | - M Yamamoto
- Tsukuba University, Cardiovascular Division, Faculty of Medicine, Tsukuba, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Department of Cardiovascular Medicine, Kobe, Japan
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Akiyama E, Konishi M, Okumura T, Kida K, Oishi S, Suzuki S, Yamamoto M, Kitai T, Matsue Y. 428In-hospital coronary angiography is associated with increased evidence based medications and better survival in patients hospitalized with acute heart failure - results from REALITY-AHF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0106] [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
Coronary artery disease is a major cause of heart failure (HF). Urgent coronary angiography (CAG) is recommended for patients with acute HF (AHF) complicated with acute coronary syndrome (ACS); however, clinical usefulness of in-hospital CAG in AHF patients without ACS remains unknown.
Purpose
To investigate the association between in-hospital CAG and all-cause mortality at 1-year after hospital discharge and effects of medications at discharge on this association.
Methods
From the REALITY-AHF study, 1344 patients hospitalized with AHF were enrolled in this study and followed up for 1-year after hospital discharge.
Results
In-hospital CAG was undergone in 511 patients (38%). CAG group had a significantly lower 1-year mortality compared with non-CAG group (unadjusted hazard ratio [HR]; 0.30, 95%-confidence interval [CI] 0.21–0.43, P<0.001, after adjustment for MAGGIC score; HR 0.45, 95%-CI 0.29–0.70, P<0.001, in propensity-score matched 296 pairs; HR 0.60, 95%-CI 0.37–0.98, P=0.04). At discharge, aspirin, statins and beta blockers were prescribed more in CAG group compared with non-CAG group (aspirin 46% versus 30%, P<0.001, statins 51% versus 35%, P<0.001, and beta blockers 76% versus 65%, P=0.007). The prescription of aspirin or statins at discharge was associated with a better 1-year survival in patients with multivessel disease (P<0.001), but not in patients without significant stenosis or single vessel disease (P=0.95) (Figure).
CAG results, medications and mortality
Conclusions
In patients hospitalized with AHF, in-hospital CAG was associated with increased evidence based medications at discharge and a better long-term survival. Aspirin and statins at discharge might improve outcomes in AHF patients with multivessel disease.
Acknowledgement/Funding
This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.
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Affiliation(s)
- E Akiyama
- Yokohama City University Medical Center, Yokohama, Japan
| | - M Konishi
- Yokohama City University Medical Center, Yokohama, Japan
| | | | - K Kida
- St. Marianna University, Kawasaki, Japan
| | - S Oishi
- Himeji Cardiovascular Center, Himeji, Japan
| | - S Suzuki
- Fukushima Medical University, Fukushima, Japan
| | | | - T Kitai
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - Y Matsue
- Juntendo University, Tokyo, Japan
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Ammirati E, Veronese G, Brambatti M, Merlo M, Potena L, Okumura T, Pinney S, Braun O, Van De Heyning CM, Montero S, Shimokawa H, Sinagra G, Adler E, Frigerio M, Camici PG. 2422Outcome of histologically-proven fulminant versus acute non-fulminant myocarditis with left ventricular systolic dysfunction. Evidence from the International Registry on Acute Myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0170] [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
Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular (LV) dysfunction requiring inotropes and/or mechanical circulatory support. Based on a retrospective single-center study published in 2000, patients with FM were considered to have better outcomes than those affected by acute non-fulminant myocarditis (NFM) presenting with LV systolic dysfunction (LVSD). Recently, this tenet was challenged, though substantial disagreement still exists.
Purpose
Aim of the present study is to provide additional evidence on the outcome of FM and to ascertain if patient stratification based on the main histologic subtypes can provide additional prognostic information.
Methods
Two hundred and twenty patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms <30 days) presenting with LVSD were included in a retrospective, international registry comprising 16 tertiary hospitals in the United States, Europe, and Japan. The primary endpoint was the occurrence of cardiac death or heart transplant (HTx) within 60 days from admission and at long-term follow-up.
Results
Patients with FM (N=165) had significantly higher rates of cardiac death and HTx compared with those with NFM (N=55), both at 60 days (28.0% vs. 1.8%, p=0.0001) and at 7-year follow up (47.7% vs. 10.4%, p<0.0001; Figure). At Cox-multivariate analysis, the histologic subtype emerged as a further variable affecting outcome in FM patients, with giant cell myocarditis having a significantly worse prognosis compared with eosinophilic and lymphocytic myocarditis both at 60 days (62.5% vs. 26.3% vs. 21.0%) and at 3 years (81.3% vs. 39.9% vs. 37.3%, overall p<0.0001). In a sub-analysis including only adults with lymphocytic myocarditis, the main endpoints occurred more frequently in FM compared with NFM both at 60 days (19.5% vs. 0%, p=0.005) and up to 7 years (41.4% vs. 3.1%, p=0.0004).
Outcome of FM vs NFM
Conclusions
The results of this international registry confirm that patients with FM have higher rates of cardiac death and HTx both in the short and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition.
Acknowledgement/Funding
None
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Affiliation(s)
- E Ammirati
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Veronese
- University of Milano-Bicocca, Department of Health Sciences, Monza, Italy
| | - M Brambatti
- University of California San Diego, San Diego, United States of America
| | - M Merlo
- University Hospital Riuniti, Trieste, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - T Okumura
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Pinney
- Mount Sinai School of Medicine, New York, United States of America
| | - O Braun
- Skane University Hospital, Lund, Sweden
| | | | - S Montero
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - G Sinagra
- University Hospital Riuniti, Trieste, Italy
| | - E Adler
- University of California San Diego, San Diego, United States of America
| | - M Frigerio
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - P G Camici
- University Vita-Salute San Raffaele, Milan, Italy
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Okumura T, Sawamura A, Kondo T, Ito M, Ozaki Y, Ohte N, Amano T, Murohara T. 2421Immunosuppressive therapy and prognosis in biopsy-proven fulminant lymphocytic myocarditis requiring veno-arterial extracorporeal membranous oxygenation support. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0169] [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
Fulminant myocarditis is one of the fatal diseases for which effective management has not yet been established. Immunosuppressive therapy (IST) using corticosteroid has been actively applied to giant cell or eosinophilic myocarditis, there is no consensus on the efficacy of lymphocytic myocarditis, which is suspected of involving viral infection. Actually, IST for lymphocytic myocarditis is not recommended in the European Society of Cardiology guidelines, but in the Japanese Circulation Society guidelines, it is approved for use in refractory cases in the absence of curative therapy for myocarditis established.
Purpose
The purpose of this study was to explore the potential efficacy of immunosuppressive therapy on acute phase in fulminant lymphocytic myocarditis (FLM) requiring veno-arterial extracorporeal membranous oxygenation (VA-ECMO) support.
Method
We conducted CHANGE-PUMP study that was retrospectively enrolled 99 patients with fulminant myocarditis required VA-ECMO support in the Tokai area (central part of Japan) for the past 20 years. Lymphocytic myocarditis was defined by pathological category. Patients were divided into two groups depending on whether IST using corticosteroid was performed in the clinical course. Results: Sixty-six patients were pathologically diagnosed as fulminant myocarditis by endomyocardial biopsy, of which only 49 patients were FLM. IST were indicated in 8 (16%) out of 49 patients of FLM (IST group; n=8, non-IST group; n=41). Kaplan-Meier survival analysis showed a lower survival rate in the IST group than in the non-IST group (p=0.073). However, in all cases, based on our guidelines, IST was initiated after becoming refractory to MCS treatment.
Immunosupressive therapy and prognosis
Conclusion
In the retrospective analysis, biopsy-proven FLM patients with IST required VA-ECMO support had low survival rates. However, the timing of IST introduction was late and concerned. In the present era when advanced mechanical support appears and the survival rate of fulminant myocarditis is expected to improve, a multicenter prospective study is needed to establish an indication of IST in the acute phase of fulminant myocarditis.
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Affiliation(s)
- T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - A Sawamura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - M Ito
- Mie University Graduate School of Medicine, Tsu, Japan
| | - Y Ozaki
- Fujita Health University School of Medicine, Toyoake, Japan
| | - N Ohte
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Amano
- Aichi Medical University, Aichi, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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Hiraiwa H, Okumura T, Sawamura A, Kondo T, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Haga T, Yokoi T, Fukaya K, Furusawa K, Morimoto R, Murohara T. P5417Splenic volume changes as a hemodynamic parameter in advanced heart failure with left ventricular assist device. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0375] [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 spleen has been recognized as an important organ to reserve 20–30% of the total blood volume. Generally, splenomegaly has been thought to be related to congestion. However, in the setting of hypovolemic shock or hypoxemia, it has been reported that spleen contracted and splenic volume decreased. On the other hand, in advanced heart failure (HF), the hemodynamics is characterized by both low cardiac output (LO) and systemic congestion, and patients sometimes need support of left ventricular assist device (LVAD). However, it remains unclear about the association between spleen size and hemodynamic parameters in patients with LO who need LVAD support.
Purpose
The purpose of this study was to investigate the relationship between spleen size and hemodynamic parameters in advanced HF before and after LVAD implantation.
Methods
We enrolled 12 advanced HF patients with LVAD (11 males, 45±10 years). All patients underwent blood test, echocardiography, right heart catheterization, and computed tomography (CT) before and after LVAD implantation. Spleen size was measured by CT volumetry. We excluded patients with splenic infarction, or any infections, or mean right atrial pressure (RAP) <5mmHg because of a possibility of hypovolemic status. LO was defined as CI less than 2.2L/min/m2.
Results
At pre- and post-LVAD implantation, cardiac output, cardiac index (CI), mean RAP, and mean pulmonary capillary wedge pressure were 3.1±0.6 vs. 4.9±0.9L/min, p=0.002; 1.7±0.3 vs. 2.8±0.3L/min/m2, p=0.002; 14±5 vs. 9±3mmHg, p=0.059; and 30±7 vs. 10±3mmHg, p=0.002, respectively. The serum brain natriuretic peptide level had significantly decreased (1101 [517–1446] vs 74 [35–216] pg/mL, p=0.002). In all patients, CI had increased to over 2.2L/min/m2. The splenic volume significantly increased from pre- to post-LVAD implantation (172±48 vs. 233±78mL, p=0.002) (Figure). Furthermore, all patients were divided into two groups; elevated RAP group (n=4) and non-elevated RAP group (n=8) after LVAD support. In elevated RAP group, there were no significant changes in the spleen size between pre- and post-LVAD implantation (167±45 vs. 223±111mL, p=0.068). On the other hand, in non-elevated RAP group, the spleen volume had significantly increased from pre- to post-LVAD support (172±53 vs. 231±62mL, p=0.011). In addition, there was one patient whose hemodynamic state had changed to LO again because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212mL before LVAD implantation with LO, and increased to 418mL after LVAD implantation with non-LO, although decreased to 227mL after LVAD pump failure with LO again.
Splenic volume changes
Conclusions
The spleen may change its size in order to keep cardiac output by regulating cardiac preload depending on the systemic perfusion in advanced HF with LVAD.
Acknowledgement/Funding
None
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Affiliation(s)
- H Hiraiwa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - A Sawamura
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - Y Arao
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - H Kato
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - S Yamaguchi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Haga
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Yokoi
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - K Fukaya
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - K Furusawa
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan
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Arao Y, Sawamura A, Nakatochi M, Oishi H, Kato H, Yamaguchi S, Haga T, Kuwayama T, Yokoi T, Hiraiwa H, Kondo T, Morimoto R, Okumura T, Murohara T. P1581Early blood pressure reduction by intravenous vasodilators associates with acute kidney injury in patients with hypertensive acute decompensated heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0341] [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
In patients with hypertensive acute decompensated heart failure (ADHF), intravenous vasodilators are commonly used. However, little is known about optimal use in blood pressure (BP) management to avoid acute kidney injury (AKI).
Purpose
To investigate the association between systolic BP (SBP) changes in first 6 h and incidence of AKI within 48 h in patients with hypertensive ADHF.
Methods
Post-hoc analysis was performed on a prospectively enrolled cohort. We investigated 245 patients with ADHF and SBP >140 mmHg on arrival (mean age, 76 years; 40% female). We defined “SBP-fall” as maximum percent reduction in SBP 6h after intravenous treatment. AKI was defined as serum creatinine (SCr) ≥0.3 mg/dL, or urine output <0.5 mL/kg/h at 48 h.
Results
Mean SBP, SBP-fall and SCr level at arrival were 180 mmHg, 29.4%, and 1.21 mg/dL, respectively. Sixty-six patients experienced AKI. There were no significant differences in age, NYHA functional class, SBP and SCr at admission between AKI and Non-AKI group. AKI group had the greater SBP-fall compared with Non-AKI (36.7%versus 27.2%, p≤0.0001). Logistic regression analyses revealed that SBP-fall had an independent predictor of AKI (Table). In addition, SBP-fall had positive association with the number of concomitant used intravenous vasodilators in first 6 h (Figure).
Logistic regression analyses for AKI Univariate Multivariate AUC OR 95% CI P OR 95% CI P Ages, years, per 10 years 1.04 0.82–1.33 0.17 0.75 SBP at arrival, per 10 mmHg 1.01 0.93–1.11 0.77 SBP-fall, per 10% 1.49 1.22–1.81 <0.001 1.54 1.24–1.91 <0.001 HR, per 10 beat/min 1.12 1.00–1.25 0.049 1.07 0.95–1.21 0.28 COPD 2.95 1.06–8.21 0.04 3.06 0.99–9.43 0.054 SCr, per 1 mg/dL 1.40 0.83–2.37 0.21 Furosemide i.v. 1.12 0.42–2.95 0.82 Carperitide 3.22 1.69–6.13 0.0002 4.39 2.16–8.93 <0.001 NTG/ISDN i.v. 0.97 0.54–1.74 0.92 CCB i.v. 1.86 0.76–4.53 0.18 OR, odds ratio; CI, confidence interval; AUC, area under the curve; SBP, systolic blood pressure; COPD, chronic obstructive pulmonary disease; SCr, serum creatinine; i.v., intravenous; NTG, nitroglycerin; ISDN, isosorbide dinitrate; CCB, calcium channel blocker.
SBP-fall odds ration for AKI
Conclusion
In the first 6h of management for hypertensive ADHF patients, aggressive SBP reduction by the combination use of vasodilator agents predicted the incidence of AKI.
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Affiliation(s)
- Y Arao
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - A Sawamura
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - M Nakatochi
- Nagoya University Hospital, Data Science Division, Data Coordinating Center, Advanced Medicine, Nagoya, Japan
| | - H Oishi
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - H Kato
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - S Yamaguchi
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Haga
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Kuwayama
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Yokoi
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - H Hiraiwa
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Kondo
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - R Morimoto
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Okumura
- Nagoya University Graduate School of Medicine, Aichi, Japan
| | - T Murohara
- Nagoya University Graduate School of Medicine, Aichi, Japan
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Takeuchi S, Kawada JI, Horiba K, Okuno Y, Okumura T, Suzuki T, Torii Y, Kawabe S, Wada S, Ikeyama T, Ito Y. Metagenomic analysis using next-generation sequencing of pathogens in bronchoalveolar lavage fluid from pediatric patients with respiratory failure. Sci Rep 2019; 9:12909. [PMID: 31501513 PMCID: PMC6733840 DOI: 10.1038/s41598-019-49372-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/23/2019] [Indexed: 01/29/2023] Open
Abstract
Next-generation sequencing (NGS) has been applied in the field of infectious diseases. Bronchoalveolar lavage fluid (BALF) is considered a sterile type of specimen that is suitable for detecting pathogens of respiratory infections. The aim of this study was to comprehensively identify causative pathogens using NGS in BALF samples from immunocompetent pediatric patients with respiratory failure. Ten patients hospitalized with respiratory failure were included. BALF samples obtained in the acute phase were used to prepare DNA- and RNA-sequencing libraries. The libraries were sequenced on MiSeq, and the sequence data were analyzed using metagenome analysis tools. A mean of 2,041,216 total reads were sequenced for each library. Significant bacterial or viral sequencing reads were detected in eight of the 10 patients. Furthermore, candidate pathogens were detected in three patients in whom etiologic agents were not identified by conventional methods. The complete genome of enterovirus D68 was identified in two patients, and phylogenetic analysis suggested that both strains belong to subclade B3, which is an epidemic strain that has spread worldwide in recent years. Our results suggest that NGS can be applied for comprehensive molecular diagnostics as well as surveillance of pathogens in BALF from patients with respiratory infection.
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Affiliation(s)
- Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yusuke Okuno
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinji Kawabe
- Departments of Infection and Immunity, Aichi Children's Health and Medical Center, 7-426 Morioka-machi, Obu, 474-8710, Japan
| | - Sho Wada
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, 7-426 Morioka-machi, Obu, 474-8710, Japan
| | - Takanari Ikeyama
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, 7-426 Morioka-machi, Obu, 474-8710, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Nakamura M, Ohnishi K, Okumura T, Numajiri H, Murofushi K, Mizumoto M, Nonaka T, Ishikawa H, Sakurai H. Definitive Photon or Proton Radiotherapy for Oligo-recurrences at the Regional Lymph Nodes after Surgery in Patients with Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Torii Y, Yoshida S, Yanase Y, Mitsui T, Horiba K, Okumura T, Takeuchi S, Suzuki T, Kawada JI, Kotani T, Yamashita M, Ito Y. Serological screening of immunoglobulin M and immunoglobulin G during pregnancy for predicting congenital cytomegalovirus infection. BMC Pregnancy Childbirth 2019; 19:205. [PMID: 31221131 PMCID: PMC6585127 DOI: 10.1186/s12884-019-2360-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background Cytomegalovirus (CMV) is one of the most frequent pathogens for congenital infections. Most cases of congenital CMV infection (cCMV) are asymptomatic at birth, but sensorineural hearing loss (SNHL) or neurodevelopmental delay can appear later in childhood. This prospective study examined the practicability of serological screening for anti-CMV immunoglobulin (Ig) G and anti-CMV IgM in pregnant women. Methods A total of 11,753 pregnant women were examined for CMV IgG and CMV IgM during the first or second trimester. When IgM was positive, IgG was reevaluated more than two weeks later. When IgG was negative, IgG was reevaluated in the second or third trimester. All neonates from mothers with positive/borderline IgM or IgG seroconversion underwent polymerase chain reaction assay for CMV using urine samples to diagnose cCMV. Levels of IgG and IgM were compared between mothers with and without cCMV. Receiver operating characteristic (ROC) curves for IgM titers were analyzed. Results Eight of 500 neonates (1.6%) born from mothers with positive IgG and positive IgM, and 3 of 13 neonates (23.1%) born from mothers with IgG seroconversion were diagnosed with cCMV. Neither IgM titers nor IgG titers differed significantly between cCMV and non-cCMV groups. The area under the ROC curve was 0.716 and the optimal cut-off for IgM was 7.28 index (sensitivity = 0.625, specificity = 0.965, positive predictive value = 0.238, negative predictive value = 0.993). Titers of IgG were not frequently elevated in pregnant women with positive IgM during the observation period, including in those with cCMV. All 11 cCMV cases were asymptomatic at birth and none had shown SNHL or developmental delay as of the last regular visit (mean age, 40 months). Conclusions Seroconversion of CMV IgG and high-titer IgM during early pregnancy are predictors of cCMV. High IgM titer (> 7.28 index) is a predictor despite relatively low sensitivity. Levels of IgG had already plateaued at first evaluation in mothers with cCMV. Maternal screening offered insufficient positive predictive value for diagnosing cCMV, but allowed identifying asymptomatic cCMV cases in an early stage.
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Affiliation(s)
- Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shigeru Yoshida
- Department of Pediatrics, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Yoichiro Yanase
- Department of Pediatrics, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Takashi Mitsui
- Department of Obstetrics and Gynecology, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mamoru Yamashita
- Department of Obstetrics and Gynecology, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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Okumura T, Kawada JI, Tanaka M, Narita K, Ishiguro T, Hirayama Y, Narahara S, Tsuji G, Sugiyama Y, Suzuki M, Tsuji T, Hoshino S, Nakatochi M, Muramatsu H, Kidokoro H, Takahashi Y, Sato Y, Miyajima Y, Uno N, Nagai N, Ando S, Sudo Y, Naruse K, Takahashi Y, Suzui R, Nagata Y, Kawabe T, Shibata M, Shibata Y, Morishita M, Kajita M, Ito T, Kido S, Hasegawa S, Ikeda K, Tokumo N, Kato M, Kato K, Fukumi D, Doi S, Omori M, Watanabe N, Takada H. Comparison of high-dose and low-dose corticosteroid therapy for refractory Mycoplasma pneumoniae pneumonia in children. J Infect Chemother 2019; 25:346-350. [DOI: 10.1016/j.jiac.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/25/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
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Sekino Y, Okumura T, Fukumitsu N, Iizumi T, Miyauchi D, Mizoguchi N, Murofushi K, Ohnishi K, Mizumoto M, Nonaka T, Nakai K, Ishikawa H, Tsuboi K, Sakurai H. EP-1420 Utility of FIB-4 index for hepatocellular carcinoma patients treated with proton beam therapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shimizu S, Okumura T, Mizoguchi N, Numajiri H, Murofushi K, Onishi K, Oshiro Y, Mizumoto M, Nonaka T, Ishikawa H, Sakurai H. EP-1444 Clinical results of proton beam therapy for unresectable intrahepatic cholangiocarcinoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31864-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: 11/16/2022]
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Abstract
SummaryPresent knowledge of the structure and function of platelet glycocalicin is reviewed. Glycocalicin (M,. 150,000) is a glycoprotein component of the outer surface of intact platelets which is released in soluble form following platelet homogenization. Glycocalicin has been purified and shown to inhibit platelet aggregation induced by thrombin or by ristocetin. Thrombin binding activity is associated with the peptide “tail” of the molecule (Mr 45,000), the macroglycopeptide portion (Mr 120,000) being without effect. Glycocalicin and membrane-bound glycoprotein I have been shown to be functionally and immunologically identical. Studies with platelets modified by chymotrypsin, and with platelets from patients with Bemard-Soulier disease and an ill-defined bleeding abnormality show that the amount of thrombin bound is proportional to the total amount of glycocalicin and glycoprotein I present. These results support the concept of a single class of binding site for thrombin in platelets.
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Affiliation(s)
- G A Jamieson
- The American National Red Cross, Blood Research Laboratory, Bethesda, Maryland, U.S.A
| | - T Okumura
- The American National Red Cross, Blood Research Laboratory, Bethesda, Maryland, U.S.A
| | - M Hasitz
- The American National Red Cross, Blood Research Laboratory, Bethesda, Maryland, U.S.A
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50
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Ishikawa H, Nonaka T, Ohnishi K, Ohno T, Mizoguchi N, Murofushi K, Iizumi T, Sekino Y, Okumura T, Sakurai H. Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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