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Seki H, Kuratani N, Shiga T, Iwasaki Y, Karita K, Yasuda K, Yamamoto N, Nakanishi Y, Shigematsu K, Kobayashi K, Saito J, Kondo I, Yaida N, Watanabe H, Higashi M, Shirasaka T, Doshu-Kajiura A, Edanaga M, Tanaka S, Ikumi S, Ito S, Okada M, Yorozu T. Incidence of sodium-glucose cotransporter-2 inhibitor-associated perioperative ketoacidosis in surgical patients: a prospective cohort study. J Anesth 2024:10.1007/s00540-024-03335-3. [PMID: 38494577 DOI: 10.1007/s00540-024-03335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are commonly prescribed anti-diabetic medications with various beneficial effects; however, they have also been associated with ketoacidosis. The aim of this study was to determine the incidence of SGLT2i-associated perioperative ketoacidosis (SAPKA) in surgical patients. METHODS We conducted a multicenter, prospective cohort study across 16 centers in Japan, enrolling surgical patients with diabetes who were prescribed SGLT2is between January 2021 and August 2022. Patients were monitored until the third postoperative day to screen for SAPKA, defined as urine ketone positivity with a blood pH of < 7.30 and HCO3 level ≤ 18.0 mEq/L, excluding cases of respiratory acidosis. RESULTS In total, 759 of the 762 evaluated patients were included in the final analysis. Among these, three patients (0.40%) had urine ketones with a blood pH of < 7.30; however, blood gas analysis revealed respiratory acidosis in all three, and none of them was considered to have SAPKA. The estimated incidence of SGLT2i-associated postoperative ketoacidosis was 0% (95% confidence interval, 0%-0.4%). CONCLUSIONS The observed incidence of SAPKA in our general surgical population was lower than expected. However, given that the study was observational in nature, interpretation of study results warrants careful considerations for biases.
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Affiliation(s)
- Hiroyuki Seki
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan.
| | - Norifumi Kuratani
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
| | - Toshiya Shiga
- Department of Anesthesiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kanae Karita
- Department of Hygiene and Public Health, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuki Yasuda
- Department of Diabetes, Endocrinology and Metabolism, Kyorin University School of Medicine, Tokyo, Japan
| | - Natsuko Yamamoto
- Department of Anaesthesia and Intensive Care Medicine, Graduate School of Medicine and Faculty of Medicine, Akita University, Akita, Japan
| | - Yuko Nakanishi
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Kenji Shigematsu
- Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kensuke Kobayashi
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ichiro Kondo
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nozomu Yaida
- Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hidenobu Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Shirasaka
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akira Doshu-Kajiura
- Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsutaka Edanaga
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Nagano, Japan
| | - Saori Ikumi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shingo Ito
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masayuki Okada
- Department of Anesthesiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
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Hoshijima H, Mihara T, Shiga T, Mizuta K. Indirect laryngoscopy is more effective than direct laryngoscopy when tracheal intubation is performed by novice operators: a systematic review, meta-analysis, and trial sequential analysis. Can J Anaesth 2024; 71:201-212. [PMID: 37989942 PMCID: PMC10884075 DOI: 10.1007/s12630-023-02642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE We sought to perform a systematic review and meta-analysis to determine whether indirect laryngoscopy has an advantage over direct laryngoscopy in terms of the tracheal intubation rate, glottic visualization, and intubation time when used by novice operators. METHODS We extracted adult prospective randomized trials comparing tracheal intubation with indirect vs direct laryngoscopy in novice operators from electronic databases. We extracted the following data from the identified studies: success rate, glottic visualization, and intubation time. Data from each trial were combined via a random-effects model to calculate the pooled relative risk (RR) or weighted mean difference (WMD) with a 95% confidence interval (CI). We also performed a trial sequential analysis. RESULTS We included 15 articles (17 trials) comprising 2,290 patients in the systematic review. Compared with the direct laryngoscopy, indirect laryngoscopy improved success rate (RR, 1.15; 95% CI, 1.07 to 1.24; P = 0.0002; I2 = 88%), glottic visualization (RR, 1.76; 95% CI, 1.36 to 2.28; P < 0.001; I2 = 85%), and intubation time (WMD, -9.06 sec; 95% CI, -16.4 to -1.76; P = 0.01; I2 = 98%) in tracheal intubation. Trial sequential analysis showed that the total sample size was sufficient to analyze the success rate and intubation time. CONCLUSION In this systematic review, we found that the tracheal intubation success rate, glottic visualization, and intubation time were improved when novice operators used indirect laryngoscopy rather than direct laryngoscopy. Trial sequential analysis results indicated that the sample size was sufficient for examining the success rate and intubation time. STUDY REGISTRATION PROSPERO (CRD42022309045); first registered 4 September 2022.
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Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Kentaro Mizuta
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Takeuchi R, Hoshijima H, Mihara T, Kokubu S, Sato (Boku) A, Nagumo T, Mieda T, Shiga T, Mizuta K. Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis. Children (Basel) 2023; 11:60. [PMID: 38255373 PMCID: PMC10814718 DOI: 10.3390/children11010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51-1.46; p = 0.59; Cochrane's Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI -1.18-9.30; p = 0.13; Cochrane's Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.
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Affiliation(s)
- Risa Takeuchi
- Bunkoukai Special Needs Center, 2765-5 Ujiie, Sakura 329-1311, Tochigi, Japan; (R.T.); (K.M.)
| | - Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryomachi, Aoba, Sendai 980-8575, Miyagi, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0004, Kanagawa, Japan;
| | - Shinichi Kokubu
- Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun 321-0293, Tochigi, Japan;
| | - Aiji Sato (Boku)
- Department of Anesthesiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 465-8651, Aichi, Japan;
| | - Takumi Nagumo
- Department of Anesthesiology, Saitama Medical University Hospital, Irumagun 350-0495, Saitama, Japan; (T.N.); (T.M.)
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Irumagun 350-0495, Saitama, Japan; (T.N.); (T.M.)
| | - Toshiya Shiga
- Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, 6-1-4 Kounodai, Ichikawa 272-0827, Chiba, Japan;
| | - Kentaro Mizuta
- Bunkoukai Special Needs Center, 2765-5 Ujiie, Sakura 329-1311, Tochigi, Japan; (R.T.); (K.M.)
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Hoshijima H, Mihara T, Seki H, Hyuga S, Kuratani N, Shiga T. Incidence of long-term post-acute sequelae of SARS-CoV-2 infection related to pain and other symptoms: A systematic review and meta-analysis. PLoS One 2023; 18:e0250909. [PMID: 38019841 PMCID: PMC10686440 DOI: 10.1371/journal.pone.0250909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 02/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as "long COVID" or "post-acute sequelae of SARS-CoV-2 infection" (PASC); however, evidence on their incidence is still lacking, and symptoms relevant to pain are yet to be assessed. METHODS A literature search was performed using the electronic databases PubMed, EMBASE, Scopus, and CHINAL and preprint servers MedRχiv and BioRχiv through January 15, 2021. The primary outcome was pain-related symptoms such as headache or myalgia. Secondary outcomes were symptoms relevant to pain (depression or muscle weakness) and symptoms frequently reported (anosmia and dyspnea). Incidence rates of symptoms were pooled using inverse variance methods with a DerSimonian-Laird random-effects model. The source of heterogeneity was explored using meta-regression, with follow-up period, age and sex as covariates. RESULTS In total, 38 studies including 19,460 patients were eligible. Eight pain-related symptoms and 26 other symptoms were identified. The highest pooled incidence among pain-related symptoms was chest pain (17%, 95% confidence interval [CI], 11%-24%), followed by headache (16%, 95% CI, 9%-27%), arthralgia (13%, 95% CI, 7%-24%), neuralgia (12%, 95% CI, 3%-38%) and abdominal pain (11%, 95% CI, 7%-16%). The highest pooled incidence among other symptoms was fatigue (44%, 95% CI, 32%-57%), followed by insomnia (27%, 95% CI, 10%-55%), dyspnea (26%, 95% CI, 17%-38%), weakness (25%, 95% CI, 8%-56%) and anosmia (19%, 95% CI, 13%-27%). Substantial heterogeneity was identified (I2, 50-100%). Meta-regression analyses partially accounted for the source of heterogeneity, and yet, 53% of the symptoms remained unexplained. CONCLUSIONS The current meta-analysis may provide a complete picture of incidence in PASC. It remains unclear, however, whether post-COVID symptoms progress or regress over time or to what extent PASC are associated with age or sex.
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Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hiroyuki Seki
- Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shunsuke Hyuga
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Norifumi Kuratani
- Department of Anesthesiology, Saitama Children’s Medical Center, Saitama, Saitama, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
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Nagumo T, Hoshijima H, Maruyama K, Mihara T, Mieda T, Sato Boku A, Shiga T, Nagasaka H. Hemodynamic response related to the Airway Scope versus the Macintosh laryngoscope: A systematic review and meta-analysis with trial sequential analysis. Medicine (Baltimore) 2023; 102:e33047. [PMID: 36827056 DOI: 10.1097/md.0000000000033047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND It is important to reduce the hemodynamic response during tracheal intubation. We performed a systematic review and meta-analysis of the Airway Scope and Macintosh laryngoscope to determine whether they reduce the hemodynamic responses of heart rate (HR) and mean blood pressure (MBP) after tracheal intubation under general anesthesia. METHODS We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim of our meta-analyst is to determine if the Airway Scope reduces hemodynamic responses (HR and mean MBP) 60 seconds after tracheal intubation compared to the Macintosh laryngoscope. We expressed pooled differences in hemodynamic responses between the 2 devices as weighted mean differences with 95% confidence intervals. We conducted trial sequential analysis. Secondarily, we investigated the ability of the Airway Scope and Macintosh laryngoscope to reduce hemodynamic responses at 120 seconds, 180 seconds, and 300 seconds after tracheal intubation. RESULTS We identified clinical trials comparing hemodynamic response via a comprehensive literature search. Of 185 articles found in the search, we selected 8. In comparison to the Macintosh laryngoscope, the Airway Scope significantly reduced HR and MBP at 60 seconds after tracheal intubation (HR; weighted mean difference = -7.29; 95% confidence interval, -10.9 to -3.62; P < .0001; I2 = 57%, MBP; weighted mean difference = -11.5; 95% confidence interval, -20.4 to -2.65; P = .01; I2 = 91%). At the secondary outcome, the Airway Scope significantly reduced the fluctuation of HR after 120 seconds and 180 seconds of tracheal intubation. However, the Airway Scope did not significantly reduce MBP 120 seconds, 180 seconds, and 300 seconds after tracheal intubation. Trial sequential analysis suggested that the total sample size reached the required information size for heart rate. CONCLUSIONS Our finding suggested that the Airway Scope attenuated hemodynamic responses at 60 seconds after tracheal intubation in comparison with that of the Macintosh laryngoscope. However, the MBP sample size is small and further research is needed.
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Affiliation(s)
- Takumi Nagumo
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Kanakgawa, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Aiji Sato Boku
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, Nagoya, Aichi, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
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Hoshijima H, Mihara T, Nagumo T, Sato (Boku) A, Shiga T, Mizuta K. Nasal protection strategy reduces the incidence of nasal pressure injuries during nasotracheal intubation: Meta-analysis with trial sequential analysis. Medicine (Baltimore) 2022; 101:e30638. [PMID: 36221363 PMCID: PMC9542826 DOI: 10.1097/md.0000000000030638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nasal pressure injury is a serious problem during nasotracheal intubation. We performed this systematic review and meta-analysis to determine whether use of a nasal protection strategy (a protective dressing or a modified fixation method for the tracheal tube) reduces the incidence of nasal pressure injury during nasotracheal intubation. METHODS Literature searches were performed using three electronic databases. Data from each of the eligible trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for nasal pressure injury were evaluated using the relative risk and 95% confidence interval, the Cochrane Q statistic, and the I2 statistic. We also performed trial sequential analysis (TSA) to assess sensitivity to prevent type I error. We separated patients into subgroups to analyze the incidence of nasal pressure injury according to whether a protective dressing or a modified fixation method for the tracheal tube was used. RESULTS The literature search yielded five eligible trials. Meta-analysis of these trials showed that a nasal protection strategy significantly reduced the incidence of nasal pressure injury during nasotracheal intubation (relative risk (RR) 0.34; 95% confidence interval (CI) 0.21-0.56; P < .0001; Cochrane's Q = 5.86, I2 = 32%). The TSA boundary for futility could not be calculated because of an insufficient sample size. In subgroup analysis, both methods significantly reduced the incidence of nasal pressure injury during nasotracheal intubation. CONCLUSIONS The findings of this meta-analysis suggest that a nasal protection strategy significantly reduces the incidence of nasal pressure injury during nasotracheal intubation. During nasotracheal intubation, the use of a protective dressing or modified fixation method for the tracheal tube can prevent to the incidence of nasal pressure injuries. However, the number of samples in our meta-analysis was too small for TSA and further studies are required. TRIALS REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews; registration number 252091).
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Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Japan
- * Correspondence: Hiroshi Hoshijima, Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Seiryomachi 4-1, Aoba, Sendai 980-8575, Japan (e-mail: )
| | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama, Japan
| | - Takumi Nagumo
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Japan
| | - Aiji Sato (Boku)
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Kentaro Mizuta
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Sonoda K, Nagase S, Aiba T, Kato K, Shiga T, Kusano K, Horie M, Ohno S. Different prognosis of ARVC patients between DSG2 and PKP2 variant carriers. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1753] [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
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy mainly caused by desmosomal gene variants. In Europe and North America, pathogenic variants in PKP2 were identified in most of the ARVC patients. On the other hand, we have reported that the genetic backgrounds of ARVC in Japanese were different from those in European; pathogenic variants in DSG2 were predominant in Japanese. Genotype-phenotype correlations, however, have not been clarified yet.
Purpose
In this study, we aimed to examine whether the genotype affect the phenotype and outcome in Japanese ARVC patients.
Methods and results
This study included 167 Japanese ARVC patients who received genetic testing (128 males [77%]). Their median age at diagnosis was 44 [24–55] years old and median follow-up duration was 10 [4–21] years. We found 90 patients with pathogenic variants: 52 in DSG2 (31%), 30 in PKP2 (18%), 3 in DSP (1.8%), 1 in DSC (0.6%), 1 in JUP (0.6%) and 3 in DES (1.8%). The age of the first sustained ventricular arrhythmia (SVT) were older in the patients with DSG2 than those with PKP2 variants (48±15 years vs. 35±15 years, P=0.008) but younger in DSG2 variant carriers at the first hospitalization for heart failure (41 [22–61] years vs. 67 [61–74] years, P=0.03). The left ventricular ejection fractions of DSG2 variant carriers were significantly lower at diagnosis than that of PKP2 (52 [41–60] % vs. 61 [56–66] %, P=0.002). Kaplan-Meier survival curve for lethal arrhythmic events including SVT, ventricular fibrillation and sudden death revealed that the event rate of DSG2 variant carriers was significantly lower than that of PKP2 (log-rank test, P=0.02) (Fig. 1).
Among 11 patients who had both SVT and hospitalizations for HF, 7 PKP2 variant carriers had SVT first, then, hospitalized for HF (48 [35–53] years and 67 [55–71] years, P=0.02). Contrary, the clinical course of 4 DSG2 variants carriers were different from those with PKP2 (54 [40–68] years for SVT and 65 [56–70, P=0.1] years for HF) (Fig. 2).
Conclusion
The patients with DSG2, which is the major causative gene for ARVC in Japanese, show different phenotype and outcome from those with PKP2. We should examine the effect of variants on the prognosis of ARVC patients in more large population including various ethnics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Sonoda
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - S Nagase
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - T Aiba
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - K Kato
- Shiga University of Medical Science, Department of Cardiovascular and Respiratory Medicine , Shiga , Japan
| | - T Shiga
- Tokyo Women's Medical University , Tokyo , Japan
| | - K Kusano
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - M Horie
- Shiga University of Medical Science, Center for Epidemiologic Research in Asia , Otsu , Japan
| | - S Ohno
- National Cerebral & Cardiovascular Center , Suita , Japan
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Wajima Z, Shiga T, Imanaga K. Comparisons of the segments of left-sided double-lumen tracheobronchial tubes as industrial products. BMC Anesthesiol 2022; 22:177. [PMID: 35676618 PMCID: PMC9175383 DOI: 10.1186/s12871-022-01698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are at least seven manufacturers producing left-sided double-lumen tubes (DLTs), there have been few reports comparing the segments of these DLTs. In this study, we compared various segments of left-sided DLTs further. MATERIALS AND METHODS We examined five manufacturers' left-sided DLTs: Mallinckrodt, Portex, Rüsch, Sheridan, and Daiken-medical. We conducted the following six trials or measurements, and three supplemental trials or measurements: First, we tried to pass various sizes of steel balls down each lumen in order from the smallest (3 mm) to largest (4.5 mm). If the ball passed on the first attempt, we tried just once; otherwise, we made a second attempt. Second, we measured the external diameter of tracheal and bronchial cuff using a profile projector. Third, we measured the length of the cuff and tip of the bronchial segment of the tubes using the profile projector. Fourth, we measured various lengths of the tubes. Fifth, we measured the external diameter of both lumens and the tubules for tracheal and bronchial cuff inflation. Finally, we measured various cross-sectional areas including the tracheal lumen, bronchial lumen, and tubules for cuff inflation. We also conducted three supplemental studies. First, we measured air volume in the cuff when intracuff pressure equaled 2 or 3 kPa. Second, we defined the configuration of the tracheal and bronchial cuffs. Third, we defined the presence or absence of bevels and also measured the angle of the bevels using the profile projector. RESULTS We performed nine trials and measurements and found large disparities between each manufacturer's tubes. CONCLUSIONS The large disparities found between the measurements of the five manufacturers' tubes may be due to different lots or changes in specifications made by each manufacturer. We found tubes exhibiting lower quality, such as deformations, and non-universal and inconsistent sizing, in the comparison of the manufacturers' tubes. Practitioners should be aware of the features and aspects of these tubes.
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Affiliation(s)
- Zen'ichiro Wajima
- Department of Anesthesia, Seijin Hospital, 3-2-1 Shimane, Adachi-ku, Tokyo, 121-0815, Japan. .,Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, 350-0495, Japan.
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare, Chiba, 286-8686, Japan
| | - Kazuyuki Imanaga
- Department of Anesthesia, Shonan Kamakura General Hospital, Kanagawa, 247-8533, Japan
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Seki H, Kuratani N, Shiga T, Iwasaki Y, Karita K, Yasuda K, Yorozu T. Multicentre prospective observational study of sodium-glucose cotransporter-2 inhibitor-associated postoperative ketoacidosis: the SAPKA study protocol. BMJ Open 2021; 11:e049592. [PMID: 34815277 PMCID: PMC8611445 DOI: 10.1136/bmjopen-2021-049592] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antihyperglycaemic agents that promote urinary glucose excretion in the renal proximal tubule and have cardio-protective and renal-protective properties. However, there are several safety concerns related to increased risks of hypoglycaemic, urinary tract infections and ketoacidosis. Ketoacidosis is a potentially fatal complication that often presents as euglycaemic ketoacidosis during SGLT2 inhibitor treatment. Furthermore, invasive treatment and related surgical stress may increase the risk of ketogenesis. Therefore, this study aims to clarify the incidence of SGLT2 inhibitor-associated postoperative ketoacidosis (SAPKA) among patients who are receiving SGLT2 inhibitors and undergoing surgery under general anaesthesia. METHODS AND ANALYSIS This multicentre, prospective, observational study will recruit 750 adult Japanese patients with diabetes who are receiving SGLT2 inhibitors and undergoing surgery under general anaesthesia. Urine samples will be collected on postoperative days 0, 1, 2 and 3. Blood gas analysis will be performed when urine ketone positivity is detected. The incidence of postoperative ketoacidosis will be identified based on urine ketone positivity and a blood pH of ≤7.3. The study will also collect data to identify risk factors for SAPKA. ETHICS AND DISSEMINATION The study protocol has been approved by the ethics committee of Kyorin University (approval number: 785, 26 October 2020) and local ethical approval will be required at each participating centre. Study findings will be submitted to peer-reviewed journals and abstracts will be submitted to relevant national and international meetings. TRIAL REGISTRATION NUMBER UMIN000042795.
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Affiliation(s)
| | | | - Toshiya Shiga
- Anesthesiology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Yudai Iwasaki
- Anesthesiology and Perioperative Medicine, Tohoku University, Sendai, Japan
| | - Kanae Karita
- Hygiene and Public Health, Kyorin University, Mitaka, Japan
| | - Kazuki Yasuda
- Diabetes, Endocrinology and Metabolism, Kyorin University, Mitaka, Japan
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Seki H, Shiga T, Mihara T, Hoshijima H, Hosokawa Y, Hyuga S, Fujita T, Koshika K, Okada R, Kurose H, Ideno S, Ouchi T. Effects of intrathecal opioids on cesarean section: a systematic review and Bayesian network meta-analysis of randomized controlled trials. J Anesth 2021; 35:911-927. [PMID: 34338864 DOI: 10.1007/s00540-021-02980-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to compare the beneficial and harmful effects of opioids used as adjuncts to local anesthetics in patients undergoing cesarean section under spinal anesthesia. METHODS We searched electronic databases and ClinicalTrials.gov from their inception until March, 2021 without language restrictions. The primary outcome was the complete analgesia duration (Time to VAS > 0). Data were synthesized using the Bayesian random-effects model. Evidence confidence was evaluated using the Confidence In Network Meta-Analysis. RESULTS We identified 66 placebo-controlled randomized controlled trials (RCTs) comprising 4400 patients undergoing elective cesarean section. Compared with the placebo, intrathecal opioids (fentanyl, sufentanil, and morphine) significantly prolonged the analgesia duration by 96, 96, and 190 min, respectively (mean difference). Despite morphine ranking first, opioid efficacy was similar; the results were inconsistent with respect to other analgesic outcomes. Except for diamorphine, all opioids were associated with significant increases in the pruritus incidence. Sufentanil and morphine were associated with increases in the respiratory depression incidence. CONCLUSIONS We confirmed that intrathecal opioids benefit postoperative analgesia. Although morphine seems to be the most appropriate agent, some results were inconsistent, and the evidence confidence was often moderate or low, especially for adverse outcomes. Well-designed RCTs with an evidence-based approach are imperative for determining the most appropriate opioid for cesarean sections.
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Affiliation(s)
- Hiroyuki Seki
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. .,Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2, ShinkawaTokyo, Mitaka, 181-8611, Japan.
| | - Toshiya Shiga
- Department of Anesthesiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.,Department of Health Data Science, Yokohama City University Graduate School of Data Science, Kanagawa, Japan
| | - Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Yuki Hosokawa
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Shunsuke Hyuga
- Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tomoe Fujita
- Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kyotaro Koshika
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Reina Okada
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Hitomi Kurose
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Ideno
- Department of Anesthesiology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Takashi Ouchi
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Hoshijima H, Maruyama K, Mihara T, Boku AS, Shiga T, Nagasaka H. Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23345. [PMID: 33235101 PMCID: PMC7710211 DOI: 10.1097/md.0000000000023345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope. METHODS We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data. RESULTS The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval -3.43 to 3.88 vs -0.82 to 5.93; P = .90 vs 0.14; I = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point. CONCLUSIONS Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, 4-1 Seiryomachi, Aoba, Sendai, Miyagi
| | - Koichi Maruyama
- Departments of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa
| | - Aiji Sato Boku
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama
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Hoshijima H, Mihara T, Denawa Y, Shiga T, Mizuta K. Comparison of Hemodynamic Responses to Administration of Vasopressin and Norepinephrine Under General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis. J Cardiothorac Vasc Anesth 2020; 35:61-69. [PMID: 32921616 DOI: 10.1053/j.jvca.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The authors performed a meta-analysis to determine if vasopressin improves hypotension more than norepinephrine under general anesthesia. DESIGN Meta-analysis. SETTING Operating room. PATIENTS Patients who underwent surgery, with general anesthesia. INTERVENTIONS Administration of vasopressin or norepinephrine in order to increase blood pressure. MEASUREMENTS AND MAIN RESULTS The primary outcome of this study was to determine if vasopressin increased mean blood pressure more effectively compared with norepinephrine for patients under general anesthesia. The secondary outcome was to see if vasopressin increased heart rate (HR), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI) more significantly compared with norepinephrine under general anesthesia. The authors calculated the weighted mean difference, with 95% confidence interval (CI) using the random-effects model, and calculated the required information size (RIS) by performing trial sequential analysis (TSA). The authors selected 6 studies for analysis. Vasopressin did not improve hypotension compared with norepinephrine under general anesthesia. (weighted mean difference = -0.84 mmHg, 95% CI: -5.90 to 4.23, p = 0.75, Cochran Q = 24.6, I2 = 84%) In TSA, only 35.5% of RIS was achieved. Similarly, vasopressin and norepinephrine were not significantly different in terms of HR, CVP, CO, and CI. In TSA, only 23.7% of the RIS was reached for HR but RIS was almost achieved for CVP and CO. CONCLUSIONS Vasopressin did not improve hypotension compared with norepinephrine under general anesthesia. The RIS was not reached in TSA, and Grading of Recommendations Assessment, Development and Evaluation is very low. Therefore, further research is needed to reach more robust conclusions.
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Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan.
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yohei Denawa
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Kentaro Mizuta
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Hoshijima H, Wajima Z, Nagasaka H, Shiga T. Association of hospital and surgeon volume with mortality following major surgical procedures: Meta-analysis of meta-analyses of observational studies. Medicine (Baltimore) 2019; 98:e17712. [PMID: 31689806 PMCID: PMC6946306 DOI: 10.1097/md.0000000000017712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Accumulation of the literature has suggested an inverse association between healthcare provider volume and mortality for a wide variety of surgical procedures. This study aimed to perform meta-analysis of meta-analyses (umbrella review) of observational studies and to summarize existing evidence for associations of healthcare provider volume with mortality in major operations.We searched MEDLINE, SCOPUS, and Cochrane Library, and screening of references.Meta-analyses of observational studies examining the association of hospital and surgeon volume with mortality following major operations. The primary outcome is all-cause short-term morality after surgery. Meta-analyses of observational studies of hospital/surgeon volume and mortality were included. Overall level of evidence was classified as convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), and non-significant (class V) based on the significance of the random-effects summary odds ratio (OR), number of cases, small-study effects, excess significance bias, prediction intervals, and heterogeneity.Twenty meta-analyses including 4,520,720 patients were included, with 19 types of surgical procedures for hospital volume and 11 types of surgical procedures for surgeon volume. Nominally significant reductions were found in odds ratio in 82% to 84% of surgical procedures in both hospital and surgeon volume-mortality associations. To summarize the overall level of evidence, however, only one surgical procedure (pancreaticoduodenectomy) fulfilled the criteria of class I and II for both hospital and surgeon volume and mortality relationships, with a decrease in OR for hospital (0.42, 95% confidence interval[CI] [0.35-0.51]) and for surgeon (0.38, 95% CI [0.30-0.49]), respectively. In contrast, most of the procedures appeared to be weak or "non-significant."Only a very few surgical procedures such as pancreaticoduodenectomy appeared to have convincing evidence on the inverse surgeon volume-mortality associations, and yet most surgical procedures resulted in having weak or "non-significant" evidence. Therefore, healthcare professionals and policy makers might be required to steer their centralization policy more carefully unless more robust, higher-quality evidence emerges, particularly for procedures considered as having a weak or non-significant evidence level including total knee replacement, thyroidectomy, bariatric surgery, radical cystectomy, and rectal and colorectal cancer resections.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama
| | - Zen’ichiro Wajima
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center, Tokyo
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
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Kikuchi N, Yamamoto E, Nagao M, Momose M, Hattori H, Suzuki A, Shiga T, Niinami H, Hagiwara N, Nunoda S. P3359Myocardial flow reserve using 13N ammonia PET for detection of cardiac allograft vasculopathy in heart transplant patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0235] [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
Purpose
Risk stratification and early detection of cardiac allograft vasculopathy (CAV) are essential in heart transplantation patients. CAV is associated with poor outcome in the chronic phase after heart transplantation. CAV presents a diffuse vascular involvement and has been difficult to noninvasively diagnose by the lack of a sensitive method to detect developing vascular pathology in the allograft. The present study investigates the ability of 13N-ammonia PET for detection of CAV in heart transplant patients.
Methods
Data of adenosine-stress 13N-ammonia PET imaging for thirty-one patients (mean age, 39 years-old) after 11 + 7 years from transplant was analyzed. Five patients had undergone percutaneous coronary intervention (PCI), and the remaining 26 patients had no history of definite myocardial ischemia. Myocardial flow was generated from the time activity curve of left ventricle input and myocardial uptake using 3-compartment model and the first 2 minutes' dataset of list-mode acquisition. Global - myocardial flow reserve (MFR) was calculated by stress to rest flow ratio. Patient with global-MFR <2.0 was defined as significant decrease. Summed difference score (SDS) was used as an estimate for the extent of ischemia, and the patient showing SDS >2 was identified as those having significant ischemia.
Results
The mean Global-MFR of our subjects were 2.3 (1.2 to 3.9). MFR using 13N-ammonia PET significantly decreases in one third of heart transplant patients in chronic stage. Eleven patients with Global-MFR <2.0 (35%) were observed, and eight of them had no history of clinical myocardial ischemia. The proportion of patients with a history of PCI is 18% in patients with Global-MFR <2.0 (vs 5%, p=0.210). Moreover, there were eight patients with SDS >2 (26%) including three patients having a history of PCI. The proportion of patients with a history of PCI tends to be high with SDS >2 (38% vs 9%, p=0.056).
Conclusion
This modality using 13N ammonia PET is useful for easily detection of CAV before manifestation of symptomatic myocardial ischemia in heart transplant patients.
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Affiliation(s)
- N Kikuchi
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - E Yamamoto
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - M Nagao
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - M Momose
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - H Hattori
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - A Suzuki
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - T Shiga
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - H Niinami
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - S Nunoda
- Tokyo Women's Medical University, Shinjuku-ku, Japan
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15
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Sekiguchi H, Ishida I, Suzuki A, Shiga T, Hagiwara N. P5745The Impact Of Brain Atrophy In The Young Patientwith Severe Heart Failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0685] [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
Recently, several reports recognized the heart failure (HF) effected the brain impairment by impaired vascular blood flow and brain atrophy. However, there are no report mentioned the relationship brain atrophy and the mortality in young patient with severe HF.
Methods
A total 368 patients with severe HF form 2009 to 2014. We analyzed 117 patients aged under 55 years old without past history of cerebral artery disease. We evaluated the brain atrophy using head CT data by AZE VitualPlace and compared their clinical background, cardiac function, and the mortality.
Results
The mean age was 41±10 years (male 80%) and the average LVEF was 39±8%. The median follow-up period was 1.264 days. During the observations, we observed a total of 12 all cause death. The ROC analysis revealed that 10.2% of atrophy area was cut-off and the sensitivity was 80%, specificity was 69.5% and the area under the curve was 0.71. In univariate analysis, severe NYHA class, low LVEF, large brain atrophy (>10%) were significant factors as predictor of mortality (P<0.05). Interestingly, as a result of multiple analysis, only the large brain atrophy was independent predictor of mortality. Kaplan-Meier analysis resulted that the patients with the large brain atrophy as over 10% were statistically significant worse mortality than the other patients (P=0.02).
Conclusion
This is a first report to evaluate the brain atrophy area by CT in young severe HF patients. HF patients with ≥10% of brain atrophy have higher mortality.
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Affiliation(s)
- H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - I Ishida
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - A Suzuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - T Shiga
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
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Tsukamoto K, Suzuki A, Shiga T, Sakai MW, Tanaka Y, Kouno E, Osada A, Matsuura J, Hayashi N, Nagara K, Ogiso MW, Nomura H, Kikuchi N, Hagiwara N. P3541Change in left ventricular ejection fraction and outcome in heart failure patients with mid-range ejection fraction: from the HIJ-HF prospective study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0404] [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
Introduction
Heart failure (HF) is categorized on the basis of the eft ventricular ejection fraction (LVEF). The European Society of Cardiology has proposed mid-range EF (HFmrEF) as a new category of HF that includes patients with an LVEF of 40–49%. However, the clinical characteristics, change in LVEF following treatment, and outcome of patients with HFmrEF remain clear.
Methods
We conducted a prospective observational study of Japanese hospitalized HF patients between 2015 and 2018 at a single-center (HIJ-HF III). HFmrEF was defined as 40–49% of LVEF on echocardiography at admission. We followed these patients and performed echocardiography to assess LVEF per year after hospital discharge. Clinical outcome was death from any cause.
Methods and results
We studied 138 patients with HFmrEF (median age 71 years, 69% male). They had 32% of ischemic heart disease, 9% of New York Heart Association functional class III or IV at discharge. During median follow-up of 20 [13–28] months, we assessed change in LVEF for 110 patients with HFmrEF. One year after hospital discharge, 49 patients (44%) improved LVEF (≥50%) and 21 patients (19%) reduced LVEF (<40%). HFmrEF patients who reduced LVEF (<40%) were significantly higher mortality rate than those who improved LVEF (≥50%) (14% vs. 2%, p<0.05) (Figure).
Conclusions
This study demonstrated that 44% of HFmrEF patients improved LVEF following treatment but 19% patients reduced LVEF. Reduced LVEF was associated with poor prognosis.
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Affiliation(s)
- K Tsukamoto
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - A Suzuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - T Shiga
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M W Sakai
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - Y Tanaka
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kouno
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - A Osada
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Matsuura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hayashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Nagara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M W Ogiso
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Nomura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Kikuchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
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Sakai M, Suzuki A, Shiga T, Tanaka Y, Kouno E, Osada A, Matsuura J, Hayashi N, Matsui Y, Hagiwara N. 4332Benefit of sinus rhythm restoration in acute decompensated heart failure patients with atrial tachyarrhythmia treated with landiolol. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0169] [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: 11/12/2022] Open
Abstract
Abstract
Background
Atrial tachyarrhythmias (ATA), such as atrial fibrillation / atrial tachycardia are frequently observed in patients with acute decompensated heart failure (ADHF). Because ATA leads to clinical deterioration and worsen HF, the conversion and prevention of ATA is important of ADHF with ATA. Landiolol, an ultrashort-acting intravenous beta-1 blocker, was developed and has been used for the treatment of ATA.
Purpose
We evaluated the acute effect of landiolol treatment on heart rate or blood pressure (BP), also the rates and benefits of sinus rhythm (SR) restoration among AHF patients with ATA treated with landiolol.
Methods
We studied 67 consecutive HF patients with ATA (age: 67±12 years, 36 male) treated with landiolol from 2015 to December 2017 at our University Hospital. They were compared with 50 paired subjects, matched for gender, age and baseline BP who developed HF with ATA from HIJ-HF 2 study (consisted of HF patients hospitalized between 2013 and 2014).
Results
At the start of landiolol treatment, mean left ventricular ejection fraction (LVEF) was 41±14%. The median maintenance dose of landiolol was 3.0 (1.0–12.0) μ/kg/min and the median treatment duration of landiolol was 5 (1–24) days. After 6 hours from administration of landiolol, mean HR decreased significantly from 140±18 to 100±21 bpm (p<0.05), whereas BP was not difference during landiolol treatment. Sinus rhythm was restored spontaneously in 15 (22%), and by electrical or pharmacological cardioversion in 5 (7%) during a treatment with intravenous landiolol. Furthermore, sinus rhythm was restored in 22 patients using additional rhythm control treatment, such as amiodarone or catheter ablation after intravenous landiolol treatement. Eight patients experienced in-hospital death. Forty-one (69%) of 59 patients discharged alive were in SR. During the follow-up period of 16±12 months, 4 patients died and 12 patients experienced rehospitalization due to worsening HF after hospital discharge. There was a significant higher rate of death or HF rehospitalization in patients without SR restoration than patients with SR restoration (44% vs. 20%, p<0.05) (Figure A). Compared with 50 paired subjects from HIJ-HF 2 study, those who treated with landiolol developed a significant higher rate of SR restoration (68% vs. 20%, p<0.05) (Figure B).
Figure 1
Conclusion
This study demonstrated that landiolol treatment was effective for both rate control and conversion to sinus rhythm in ADHF patient with ATA. We should consider that the benefits of rhythm control in ADHF patients with ATA during and after landiolol treatment.
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Affiliation(s)
- M Sakai
- Tokyo Womens Medical University, Tokyo, Japan
| | - A Suzuki
- Tokyo Womens Medical University, Tokyo, Japan
| | - T Shiga
- Tokyo Womens Medical University, Tokyo, Japan
| | - Y Tanaka
- Tokyo Womens Medical University, Tokyo, Japan
| | - E Kouno
- Tokyo Womens Medical University, Tokyo, Japan
| | - A Osada
- Tokyo Womens Medical University, Tokyo, Japan
| | - J Matsuura
- Tokyo Womens Medical University, Tokyo, Japan
| | - N Hayashi
- Tokyo Womens Medical University, Tokyo, Japan
| | - Y Matsui
- Tokyo Womens Medical University, Tokyo, Japan
| | - N Hagiwara
- Tokyo Womens Medical University, Tokyo, Japan
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18
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Kikuchi N, Yamamoto E, Hattori H, Nagao M, Momose M, Shiga T, Hagiwara N, Niinami H, Nunoda S. Myocardial Flow Reserve Using 13N Ammonia PET for Detection of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yasuda K, Takao S, Matsuo Y, Yoshimura T, Tamura M, Minatogawa H, Dekura Y, Matsuura T, Onimaru R, Shiga T, Shimizu S, Umegaki K, Shirato H. Intensity-Modulated Proton Therapy with Dose Painting based on Hypoxia Imaging for Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1125] [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: 11/27/2022]
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20
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Oguri T, Hiraide M, Shiga T, Yasuda C, Nishio M, Takahashi S. Safety and efficacy of direct oral anticoagulants vs warfarin for Japanese lung cancer patients with thromboembolism in real world settings. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy444.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Fujima N, Hirata K, Shiga T, Li R, Yasuda K, Onimaru R, Tsuchiya K, Kano S, Mizumachi T, Homma A, Kudo K, Shirato H. Integrating quantitative morphological and intratumoural textural characteristics in FDG-PET for the prediction of prognosis in pharynx squamous cell carcinoma patients. Clin Radiol 2018; 73:1059.e1-1059.e8. [PMID: 30245069 DOI: 10.1016/j.crad.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022]
Abstract
AIM To assess potential prognostic factors in pharynx squamous cell carcinoma (SCC) patients by quantitative morphological and intratumoural characteristics obtained by 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (FDG-PET/CT). MATERIALS AND METHODS The cases of 54 patients with pharynx SCC who underwent chemoradiation therapy were analysed retrospectively. Using their FDG-PET data, the quantitative morphological and intratumoural characteristics of 14 parameters were calculated. The progression-free survival (PFS) and overall survival (OS) information was obtained from patient medical records. Univariate and multivariate analyses were performed to assess the 14 quantitative parameters as well as the T-stage, N-stage, and tumour location data for their relation to PFS and OS. When an independent predictor was suggested in the multivariate analysis, the parameter was further assessed using the Kaplan-Meier method. RESULTS In the assessment of PFS, the univariate and multivariate analyses indicated the following as independent predictors: the texture parameter of homogeneity and the morphological parameter of sphericity. In the Kaplan-Meier analysis, the PFS rate was significantly improved in the patients who had both a higher value of homogeneity (p=0.01) and a higher value of sphericity (p=0.002). With the combined use of homogeneity and sphericity, the patients with different PFS rates could be divided more clearly. CONCLUSION The quantitative parameters of homogeneity and sphericity obtained by FDG-PET can be useful for the prediction of the PFS of pharynx SCC patients, especially when used in combination.
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Affiliation(s)
- N Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan.
| | - K Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - T Shiga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - R Li
- Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, USA; The Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, N15 W8, Kita-Ku, Sapporo 0608638, Japan
| | - K Yasuda
- The Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, N15 W8, Kita-Ku, Sapporo 0608638, Japan; Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - R Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - K Tsuchiya
- Department of Radiation Oncology, Otaru General Hospital, Wakamatsu1-1-1, Otaru 0478550, Japan
| | - S Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - T Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - A Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
| | - K Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo 0608638, Japan
| | - H Shirato
- The Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, N15 W8, Kita-Ku, Sapporo 0608638, Japan; Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo 0608638, Japan
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22
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Wajima Z, Shiga T, Imanaga K. Bolus administration of ephedrine and etilefrine induces transient vasodilation just after injection in combined epidural and general anesthesia patients: A randomized clinical study. Biosci Trends 2018; 12:382-388. [PMID: 30101824 DOI: 10.5582/bst.2018.01074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypotension commonly accompanies combined epidural and general anesthesia, and intravenous bolus ephedrine and etilefrine are widely used to correct hypotension. We have noticed that systemic vascular resistance (SVR) transiently decreases just after intravenous bolus administration of these drugs. The goal of the present study was to investigate whether bolus administration of these drugs decrease SVR just after intravenous administration in combined epidural and general anesthesia patients. We investigated 40 patients who were scheduled for elective abdominal surgery. Patients were chosen as subjects if their systolic arterial pressure decreased by 20% or to <100 mmHg at 30 min after the induction of general anesthesia. Baseline hemodynamic values were recorded, and after ephedrine 10 mg injection or etilefrine 2 mg injection (equipotent), the parameters were recorded again at 0.5 min and once each min for the next 5 min thereafter. The 40 patients were enrolled into the ephedrine (n = 20) or etilefrine (n = 20) treatment groups. Patient characteristics were comparable in both groups. After ephedrine injection, SVR decreased significantly at the 1-min time point, whereas after etilefrine injection, SVR decreased significantly at the 0.5- to 2-min time points compared with baseline values. SVR at the 0.5- to 1-min time points was lower in the etilefrine versus the ephedrine group. Both drugs transiently decreased SVR after intravenous injection, but etilefrine decreased SVR much more than ephedrine, indicating that more vasodilation occurred after the injection of etilefrine than after ephedrine. It is thus important to recognize the different characteristics of these drugs.
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Affiliation(s)
- Zen'ichiro Wajima
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine
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Koyanagawa K, Naya M, Aikawa T, Manabe O, Ohira H, Tsujino I, Shiga T, Anzai T. P2759Phase SD and bandwidth on myocardial perfusion imaging were increased in patients with cardiac sarcoidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Koyanagawa
- Hokkaido University, Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Naya
- Hokkaido University, Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - T Aikawa
- Hokkaido University, Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - O Manabe
- Hokkaido University, Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Ohira
- Hokkaido University, First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - I Tsujino
- Hokkaido University, First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - T Shiga
- Hokkaido University, Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - T Anzai
- Hokkaido University, Department of Cardiovascular Medicine, Hokkaido University Hospital, Sapporo, Japan
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Kikuchi N, Yoshimura A, Suzuki A, Shiga T, Hattori H, Nishinaka T, Saito S, Yamazaki K, Niinami H, Hagiwara N, Nunoda S. 3277Impact of congestion in worsening renal failure after implantation of a centrifugal, continuous-flow left ventricular device. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Kikuchi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - A Yoshimura
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - A Suzuki
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - T Shiga
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - H Hattori
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - T Nishinaka
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - S Saito
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - K Yamazaki
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - H Niinami
- Tokyo Women's Medical University, Cardiovascular surgery, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - S Nunoda
- Tokyo Women's Medical University, Therapeutic Strategy for Severe Heart Failure, Tokyo, Japan
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Hoshijima H, Mihara T, Maruyama K, Denawa Y, Mizuta K, Shiga T, Nagasaka H. C-MAC videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2018; 49:53-62. [PMID: 29894918 DOI: 10.1016/j.jclinane.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/27/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE The C-MAC laryngoscope (C-MAC) is a videolaryngoscope that uses a modified Macintosh blade. Although several anecdotal reports exist, it remains unclear whether the C-MAC is superior to the Macintosh laryngoscope for tracheal intubation in the adult population. DESIGN Systematic review, meta-analysis. SETTING Operating room, intensive care unit. MEASUREMENTS For inclusion in our analysis, studies had to be prospective randomised trials which compared the C-MAC with the Macintosh laryngoscope for tracheal intubation in the adult population. Data on success rates, intubation time, glottic visualisation and incidence of external laryngeal manipulations (ELM) during tracheal intubation were extracted from the identified studies. In subgroup analysis, we separated those parameters to assess the influence of the airway condition (normal or difficult) and laryngoscopists (novice or experienced). We conducted a trial sequential analysis (TSA). MAIN RESULTS Sixteen articles with 18 trials met the inclusion criteria. The C-MAC provided better glottic visualisation compared to the Macintosh (RR, 1.08; 95% CI, 1.03-1.14). TSA corrected the CI to 1.01-1.19; thus, total sample size reached the required information size (RIS). Success rates and intubation time did not differ significantly between the laryngoscopes. TSA showed that total sample size reached the RIS for success rates. The TSA Z curve surpassed the futility boundary. The C-MAC required less ELM compared to the Macintosh (RR, 0.83; 95% CI, 0.72-0.96). TSA corrected the CI to 0.67-1.03; 52.3% of the RIS was achieved. In difficult airways, the C-MAC showed superior success rates, glottic visualisation, and less ELM compared to the Macintosh. Among experienced laryngoscopists, the C-MAC offered better glottic visualisation with less ELM than the Macintosh. CONCLUSIONS The C-MAC provided better glottic visualisation and less ELM (GRADE: Very Low or Moderate), with improved success rates, glottic visualisation, and less ELM in difficult airways.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan
| | - Yohei Denawa
- Department of Anesthesiology, Allegheny Health Network, PA 15212, USA
| | - Kentaro Mizuta
- Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi 980-8577, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
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Sato J, Kitagawa Y, Watanabe S, Asaka T, Ohga N, Hirata K, Shiga T, Satoh A, Tamaki N. Hypoxic volume evaluated by 18 F-fluoromisonidazole positron emission tomography (FMISO-PET) may be a prognostic factor in patients with oral squamous cell carcinoma: preliminary analyses. Int J Oral Maxillofac Surg 2018; 47:553-560. [DOI: 10.1016/j.ijom.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/03/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
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Hoshijima H, Maruyama K, Mihara T, Mieda T, Shiga T, Nagasaka H. Airtraq® reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials. J Clin Anesth 2018; 47:86-94. [PMID: 29635148 DOI: 10.1016/j.jclinane.2018.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope. DESIGN Meta-analysis. SETTING Operating room. MEASUREMENTS The primary outcome of this meta-analysis was to determine whether laryngoscopy using the Airtraq® reduced hemodynamic responses-heart rate (HR) and mean blood pressure (MBP)-at 60 s (s) after tracheal intubation compared to laryngoscopy with the Macintosh laryngoscope. Pooled differences in these hemodynamic responses between the two devices were expressed as weighted mean difference with 95% confidence intervals. We then conducted trial sequential analysis (TSA). The secondary outcome was to investigate whether the Airtraq® reduce the hemodynamic response at 120 s, 180 s, and 300 s after tracheal intubation compared to the Macintosh laryngoscope. We also conducted sensitivity analysis of the hemodynamic responses to tracheal intubation with the laryngoscopes using a multivariate random effects model accounting for within-study correlation of the longitudinal data. MAIN RESULTS From electronic databases, we selected 11 randomized controlled trials for studies that enrolled subjects satisfying our inclusion criteria. Compared with the Macintosh laryngoscope, the Airtraq® significantly reduced both HR and MBP at 60 s after tracheal intubation. In secondary outcome, the Airtraq® significantly reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. TSA showed that total sample size reached the required information size for both HR and MBP. The sensitivity analysis revealed that the Airtraq® reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. CONCLUSIONS The Airtraq® attenuates the hemodynamic response at 60 s after tracheal intubation compared with the Macintosh laryngoscope. (GRADE: Low) These results were supported by the sensitivity analysis. TSA suggested that the total sample size was exceeded TSA monitoring boundary both HR and MBP.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
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Hoshijima H, Mihara T, Maruyama K, Denawa Y, Takahashi M, Shiga T, Nagasaka H. McGrath videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2018; 46:25-32. [PMID: 29414609 DOI: 10.1016/j.jclinane.2017.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. DESIGN Meta-analysis and systematic review. SETTING Operating room or intensive care unit. MEASUREMENTS A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). MAIN RESULTS Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. CONCLUSIONS Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan
| | - Yohei Denawa
- Department of Anesthesiology, Allegheny Health Network, PA, USA
| | - Masato Takahashi
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
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Hoshijima H, Denawa Y, Tominaga A, Nakamura C, Shiga T, Nagasaka H. Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis. J Clin Anesth 2018; 44:69-75. [DOI: 10.1016/j.jclinane.2017.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 01/23/2023]
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Wajima Z, Shiga T, Imanaga K. Does pneumoperitoneum affect perfusion index and pleth variability index in patients receiving combined epidural and general anesthesia? Biosci Trends 2018; 11:667-674. [PMID: 29249773 DOI: 10.5582/bst.2017.01253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Plethysmographic variability index (PVI) is a dynamic index used for the purpose of fluid responsiveness in patients, and the effect of pneumoperitoneum on PVI is still unclear. We therefore attempted to determine whether PVI and perfusion index (PI) change before/after pneumoperitoneum in patients receiving combined epidural and general anesthesia, which is a common anesthesia method with intravenous remifentanil. Twenty patients underwent laparoscopic cholecystectomy or colectomy. Immediately before pneumoperitoneum, variables were measured at baseline I and were then measured every min for 5 min after pneumoperitoneum start. Immediately before pneumoperitoneum release, variables were measured at baseline II and were measured every min for 5 min after pneumoperitoneum release. Compared with baseline I values, after pneumoperitoneum start, significant increases occurred in stroke volume variation (SVV) at 1-5 min, and significant decreases occurred in PI at 1-5 min. PVI did not change. Compared with baseline II values, after pneumoperitoneum release, significant increases occurred in PI at 1-5 min, and significant decreases occurred in PVI at 4-5 min and SVV at 1-5 min. In patients receiving combined epidural and general anesthesia, we newly found that PI decreased but PVI remained unchanged with a sufficient dose of remifentanil and epidural anesthesia that can block noxious stimuli and also most sympathetic activity. Furthermore, we reconfirmed that PI increased and PVI decreased upon release of pneumoperitoneum. PI and PVI values must be estimated cautiously during and after pneumoperitoneum.
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Affiliation(s)
- Zen'ichiro Wajima
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine
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Funakoshi H, Sugawara S, Nakashima Y, Homma Y, Mizobe M, Takahashi J, Inoue T, Shiga T, Yasunaga H. 268 The Effectiveness of Fasudil Hydrochloride Administration to Prevent Cerebral Vasospasm After Intervention for Subarachnoid Hemorrhage. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Serizawa N, Fukushima K, Momose M, Shiga T, Hagiwara N. P4341Detection of undiagnosed cardiac sarcoidosis by FDG-PET and SPECT among patients with Atrioventricular Block routinely followed in a pacemaker outpatient clinic. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Serizawa N, Momose M, Fukushima K, Nomura A, Shiga T, Hagiwara N. 4783The incidence and clinical significance of 18F-fluorodeoxyglucose re-uptake on cardiac positron emission tomography in patient with cardiac sarcoidosis after receiving corticosteroid therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kikuchi N, Shiga T, Minami Y, Suzuki A, Nomura A, Serizawa N, Ejima K, Shoda M, Hagiwara N. P6395Short-term prevalence of fatal ventricular arrhythmic events in patients with newly diagnosed reduced left ventricular ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ishimoto T, Kataoka S, Shiga T, Takaishi M, Sano S. 572 Intralesional blood, an easy-to-access tool for determination of diffusible mediators by skin lesions. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.594] [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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Hoshijima H, Denawa Y, Mihara T, Takeuchi R, Kuratani N, Mieda T, Iwase Y, Shiga T, Wajima Z, Nagasaka H. Efficacy of prophylactic doses of intravenous nitroglycerin in preventing myocardial ischemia under general anesthesia: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2017. [PMID: 28625438 DOI: 10.1016/j.jclinane.2017.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. DESIGN Meta-analysis. SETTING Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). MAIN RESULTS Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR=0.61; CI, 0.33 to 1.13; P=0.12; I2=55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD=-7.27; 95% CI -14.2 to -0.33; P=0.04; I2=97%; MBP post-induction: WMD=-5.13; 95% CI -9.17 to -1.09; P=0.01; I2=73%). CONCLUSIONS Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan.
| | - Yohei Denawa
- Department of Anesthesiology, Allegheny Health Network, PA, USA
| | - Takahiro Mihara
- Departments of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Risa Takeuchi
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Norifumi Kuratani
- Department of Anesthesiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Yoshinori Iwase
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Toshiya Shiga
- Department of Anesthesia, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan
| | - Zen'ichiro Wajima
- Department of Anesthesiology, International University of Health and Welfare Shioya Hospital, Tochigi, Japan and Department of Anesthesiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama, Japan
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Hoshijima H, Takeuchi R, Mihara T, Kuratani N, Mizuta K, Wajima Z, Masaki E, Shiga T. Weekend versus weekday admission and short-term mortality: A meta-analysis of 88 cohort studies including 56,934,649 participants. Medicine (Baltimore) 2017; 96:e6685. [PMID: 28445269 PMCID: PMC5413234 DOI: 10.1097/md.0000000000006685] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
It is widely accepted that higher mortality related to weekend admissions basically exists; however, there has been no systematic exploration of whether weekend admissions are associated with higher risk of death in patients on the basis of certain diagnoses, geographic regions, and study subtypes.A meta-analysis was performed according to the reporting guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE Compliant). Literature search was conducted using electronic databases. Primary outcome was short-term (≤30-day) mortality. Patients were divided into 7 regions (North America, South America, Europe, Asia, Oceania, Africa, and Antarctica) for subgroup analyses and into 7 categories evaluating 24 major diagnoses. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated with DerSimonian and Laird random-effects models.Eighty-eight studies including 56,934,649 participants met our inclusion criteria. Overall pooled adjusted and crude OR of weekend to weekday admission for short-term mortality was 1.12 (95% CI, 1.07-1.18; I = 97%) and 1.16 (95% CI, 1.14-1.19; I = 97%), respectively. In subgroup analyses, higher risk of death on the weekend was significantly identified in patients living in all five continents (North America, South America, Europe, Asia, and Oceania). However, significant weekend effect was identified only in 15 of 24 diagnostic groups. Patients admitted on the weekend were more likely to die in an emergency situation (crude OR = 1.17, 95% CI, 1.12-1.22).Although weekend admissions were associated with higher risk of death compared with weekday admissions on all five continents, the effect was limited to certain diagnostic groups and admission subtypes. Weekend effect remains highly heterogeneous and limited, suggesting that further well-conducted cohort studies might be informative.
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Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Risa Takeuchi
- Department of Anesthesiology, Saitama Medical University Hospital, Saitama, Japan
| | - Takahiro Mihara
- Department of Anesthesiology, Kanagawa Children's Medical Center, Kanagawa, Japan, Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Kanagawa
| | - Norifumi Kuratani
- Department of Anesthesia, Saitama Children's Medical Center, Saitama
| | - Kentaro Mizuta
- Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi
| | - Zen’ichiro Wajima
- Department of Anesthesiology, International University of Health and Welfare Shioya Hospital, and Department of Anesthesiology, International University of Health and Welfare Hospital, Tochigi (Current Institution: Department of Anesthesiology, Tokyo Medical University, Hachioji Medical Center, Tokyo)
| | - Eiji Masaki
- Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi
| | - Toshiya Shiga
- Department of Anesthesiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan
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Nakajima K, Hashida Y, Shiga T, Nakajima H, Daibata M, Sano S. 278 High burden of Merkel cell polyomavirus DNA in the nonlesional, sun-exposed skin of patients with Merkel cell carcinoma. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.298] [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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Hoshijima H, Takeuchi R, Kuratani N, Nishizawa S, Denawa Y, Shiga T, Nagasaka H. Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis. J Clin Anesth 2016; 32:300-12. [DOI: 10.1016/j.jclinane.2015.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/03/2015] [Indexed: 11/28/2022]
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Nishikawa Y, Yasuda K, Okamoto S, Ito Y, Mori T, Onimaru R, Shiga T, Tsuchiya K, Watanabe S, Takeuchi W, Katoh N, Kuge Y, Tamaki N, Shirato H. The Voxel-based Analysis of FMISO-PET Image in Patients With Local Recurrence of Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Inoue T, Okamoto S, Watanabe S, Yasuda K, Katoh N, Harada K, Onimaru R, Shiga T, Tamaki N, Kuge Y, Shirato H. Respiration-gated 18F-fluoromisonidazole PET/CT for Stage I Non-Small Cell Lung Cancer Treated by Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sato J, Kitagawa Y, Watanabe S, Asaka T, Ohga N, Miyakoshi M, Hata H, Okamoto S, Shiga T, Shindoh M, Tamaki N. FMISO-PET reflects not only hypoxia but also cell proliferation in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.777] [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: 11/17/2022]
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Mizuta K, Zhang Y, Mizuta F, Hoshijima H, Shiga T, Masaki E, Emala CW. Novel identification of the free fatty acid receptor FFAR1 that promotes contraction in airway smooth muscle. Am J Physiol Lung Cell Mol Physiol 2015; 309:L970-82. [PMID: 26342087 DOI: 10.1152/ajplung.00041.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/31/2015] [Indexed: 02/03/2023] Open
Abstract
Obesity is one of the major risk factors for asthma. Previous studies have demonstrated that free fatty acid levels are elevated in the plasma of obese individuals. Medium- and long-chain free fatty acids act as endogenous ligands for the free fatty acid receptors FFAR1/GPR40 and FFAR4/GPR120, which couple to Gq proteins. We investigated whether FFAR1 and FFAR4 are expressed on airway smooth muscle and whether they activate Gq-coupled signaling and modulate airway smooth muscle tone. We detected the protein expression of FFAR1 and FFAR4 in freshly dissected native human and guinea pig airway smooth muscle and cultured human airway smooth muscle (HASM) cells by immunoblotting and immunohistochemistry. The long-chain free fatty acids (oleic acid and linoleic acid) and GW9508 (FFAR1/FFAR4 dual agonist) dose-dependently stimulated transient intracellular Ca(2+) concentration ([Ca(2+)]i) increases and inositol phosphate synthesis in HASM cells. Downregulation of FFAR1 or FFAR4 in HASM cells by small interfering RNA led to a significant inhibition of the long-chain free fatty acids-induced transient [Ca(2+)]i increases. Oleic acid, linoleic acid, or GW9508 stimulated stress fiber formation in HASM cells, potentiated acetylcholine-contracted guinea pig tracheal rings, and attenuated the relaxant effect of isoproterenol after an acetylcholine-induced contraction. In contrast, TUG-891 (FFAR4 agonist) did not induce the stress fiber formation or potentiate acetylcholine-induced contraction. These results suggest that FFAR1 is the functionally dominant free fatty acid receptor in both human and guinea pig airway smooth muscle. The free fatty acid sensors expressed on airway smooth muscle could be an important modulator of airway smooth muscle tone.
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Affiliation(s)
- Kentaro Mizuta
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York; Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan; and
| | - Yi Zhang
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Fumiko Mizuta
- Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan; and
| | - Hiroshi Hoshijima
- Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan; and
| | - Toshiya Shiga
- Department of Anesthesiology, Chemotherapy Research Institute, Kaken Hospital, International University of Health and Welfare, Chiba, Japan
| | - Eiji Masaki
- Department of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan; and
| | - Charles W Emala
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York
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Wajima Z, Shiga T, Imanaga K. Pneumoperitoneum affects stroke volume variation in humans. J Anesth 2014; 29:508-14. [DOI: 10.1007/s00540-014-1963-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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Hoshijima H, Kuratani N, Hirabayashi Y, Takeuchi R, Shiga T, Masaki E. Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia 2014; 69:911-8. [PMID: 24820205 DOI: 10.1111/anae.12705] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 12/01/2022]
Abstract
The Pentax Airway Scope(®) is a single-use optical videolaryngoscope designed to assist with difficult tracheal intubation. We systematically reviewed the efficacy of the Pentax Airway Scope with that of a conventional laryngoscope for tracheal intubation in adults with 'normal' and 'difficult' airways. We included 17 randomised controlled trials with a total of 1801 participants. We used the DerSimonian and Laird random-effects model to calculate pooled relative risk or weighted mean differences. The relative risk (95% CI) of a Cormack-Lehane grade-1 laryngeal view was 2.40 (1.76-2.49) with the Pentax Airway Scope compared with the Macintosh laryngoscope, p < 0.00001. We found no other differences between the two laryngoscopes. Despite a superior laryngeal view, the Pentax Airway Scope provides little clinical benefit over the conventional laryngoscope.
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Affiliation(s)
- H Hoshijima
- Division of Dento-Oral Anaesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Nozaki Y, Kinoshita K, Yano T, Shiga T, Hino S, Niki K, Kishimoto K, Funauchi M, Matsumura I. Estimation of kidney injury molecule-1 (Kim-1) in patients with lupus nephritis. Lupus 2014; 23:769-77. [DOI: 10.1177/0961203314526292] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/04/2014] [Indexed: 02/01/2023]
Abstract
Objective Biomarkers of disease activity in lupus nephritis (LN) are needed. Ideally, such biomarkers would be capable of detecting early sub-clinical disease and could be used to gauge response to therapy, thus obviating the need for serial renal biopsies. Much of the focus in the search for LN biomarkers has been on the measurement of urinary chemokines and cytokines in LN patients. However, these have yet to be widely implemented in clinical practice. Kidney injury molecule-1 (Kim-1) is expressed in damaged tubules, but whether urinary (u) and tubular (t)-Kim-1 could serve as a biomarker of active LN is unknown. To investigate the disease activity and histological findings in LN, we evaluated u-Kim-1 levels and t-Kim-1 cells in patients with systemic lupus erythematosus (SLE). Method We measured u-Kim-1 levels and stained t-Kim-1 expression in 57 patients with LN using an ELISA and immunohistochemistry staining. Patients were classified into two groups (active LN, n = 37; inactive LN, n = 20) based on the presence of active renal disease according to the renal SLE disease activity index. correlations of clinical, laboratory data, and histological findings with urinary and t-Kim-1 expression were assessed. Result The u-Kim-1 levels were significantly correlated with the expression of t-Kim-1 ( R = 0.64; P = 0.004) in the SLE patients. The active LN patients exhibited elevated u-Kim-1 levels compared to the inactive LN patients. The number of t-Kim-1 cells was also correlated with histological findings (both glomerular and interstitial inflammation). The u-Kim-1 levels were also correlated with proteinuria and tubular damage in the active LN group. The number of t-Kim-1 cells at baseline was significantly correlated with the estimated glomerular filtration rate ( R = 0.72; P = 0.005) and serum creatinine ( R = 0.53; P = 0.005) after 6–8 months of treatment. Conclusion These data suggest the potential use of the u-Kim-1 levels to screen for active LN and for the estimation of t-Kim-1 expression in renal biopsies to predict renal damage, ongoing glomerular nephritis and tubulointerstitial inflammation, and tubular atrophy.
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Affiliation(s)
- Y Nozaki
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - K Kinoshita
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - T Yano
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - T Shiga
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - S Hino
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - K Niki
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - K Kishimoto
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - M Funauchi
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
| | - I Matsumura
- Department of Hematology and Rheumatology, Kinki University School of Medicine, Osaka, Japan
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Shiga T, Watanabe N, Sugita M, Kamada Y, Inoue S, Kubo T. Two cases of osteochondromatosis which developed in the iliopectineal bursa of an osteoarthritic hip. Mod Rheumatol 2014; 11:360-2. [PMID: 24383786 DOI: 10.3109/s10165-001-8072-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract Two osteoarthritis patients had osteochondromatosis in the iliopectineal bursa which communicated with the hip joint space. They received surgical resection of the cystic mass and total hip arthroplasty and had good clinical outcomes. The authors consider that these patients' osteochondromatosis was a secondary development on the synovium of the iliopectineal bursa due to chronic inflammation caused by osteoarthritis.
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Affiliation(s)
- T Shiga
- Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine , Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566 , Japan
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Hoshijima H, Kuratani N, Takeuchi R, Shiga T, Masaki E, Doi K, Matsumoto N. Effects of oral hygiene using chlorhexidine on preventing ventilator-associated pneumonia in critical-care settings: A meta-analysis of randomized controlled trials. J Dent Sci 2013. [DOI: 10.1016/j.jds.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Yamada A, Shiraishi Y, Miura H, Yambe T, Omran MH, Shiga T, Tsuboko Y, Homma D, Yamagishi M. Peristaltic hemodynamics of a new pediatric circulatory assist system for Fontan circulation using shape memory alloy fibers. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:683-6. [PMID: 24109779 DOI: 10.1109/embc.2013.6609592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fontan procedure is one of the common surgical treatments of congenital heart diseases. Patients with Fontan circulation have single ventricle in the systemic circulation with the total cavopulmonary connection. We have been developing a pulmonary circulatory assist device using shape memory alloy fibers for Fontan circulation with total cavopulmonary connection. It consisted of the shape memory alloy fibers, the diameter of which are 100 µm. The fibers could wrap the ePTFE conduit for Fontan TCPC connection from the outside. We designed the sequential motion control system for sophisticated pulmonary hemodynamics by the pulsatile flow generation. In order to achieve pulsatile flow assistance in pulmonary arterial system, we fabricated a mechanical structure by sequential contraction of shape memory alloy fibers. Then, we developed a sequential contraction controller for the assist system, which could reproduce the wall contractile velocity at 6.0 to 20.0 cm/sec. We examined hemodynamic characteristic of its function using a mock circulatory system, which consisted of two overflow tanks representing venous and pulmonary arterial pressures in Fontan circulation. As a result, the pulmonary circulation assist device with sequential contraction could achieve effective promotion of the pulsatility in pulmonary arterial flow.
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Funakoshi H, Iwasaki T, Mori K, Nakashima Y, Homma Y, Takahashi J, Kamura H, Toda H, Shiga T. Can We Appropriately Triage Emergency Patients Using the Simplified Japan Triage and Acuity Scale-Based Triage Scale?: Validation of a Triage Scale Emphasizing Physiologic Variables or Mechanism of Injuries. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.099] [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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