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Go S, Tsuzuki Y, Yoneda H, Ichikawa Y, Ikeda T, Imai N, Imamura K, Niikura M, Nishimura D, Mizuno R, Takeda S, Ueno H, Watanabe S, Saito TY, Shimoura S, Sugawara S, Takamine A, Takahashi T. Demonstration of nuclear gamma-ray polarimetry based on a multi-layer CdTe Compton camera. Sci Rep 2024; 14:2573. [PMID: 38336981 DOI: 10.1038/s41598-024-52692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
To detect and track structural changes in atomic nuclei, the systematic study of nuclear levels with firm spin-parity assignments is important. While linear polarization measurements have been applied to determine the electromagnetic character of gamma-ray transitions, the applicable range is strongly limited due to the low efficiency of the detection system. The multi-layer Cadmium-Telluride (CdTe) Compton camera can be a state-of-the-art gamma-ray polarimeter for nuclear spectroscopy with the high position sensitivity and the detection efficiency. We demonstrated the capability to operate this detector as a reliable gamma-ray polarimeter by using polarized 847-keV gamma rays produced by the [Formula: see text]([Formula: see text]) reaction. By combining the experimental data and simulated calculations, the modulation curve for the gamma ray was successfully obtained. A remarkably high polarization sensitivity was achieved, compatible with a reasonable detection efficiency. Based on the obtained results, a possible future gamma-ray polarimetery is discussed.
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Affiliation(s)
- S Go
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Saitama, Japan.
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan.
| | - Y Tsuzuki
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
- Department of Physics, The University of Tokyo, Tokyo, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo, Chiba, Japan
| | - H Yoneda
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
- Lehrstuhl für Astronomie, Fakultät für Physik und Astronomie, Institut für Theoretische Physik und Astrophysik, Julius-Maximilians-Universität Würzburg, Emil-Fischer-Str. 31, 97074, Würzburg, Germany
| | - Y Ichikawa
- Department of Physics, Kyushu University, Fukuoka, Japan
| | - T Ikeda
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
| | - N Imai
- Center for Nuclear Study, The University of Tokyo, Wako, Saitama, Japan
| | - K Imamura
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Saitama, Japan
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
| | - M Niikura
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
| | - D Nishimura
- Department of Natural Sciences, Tokyo City University, Tokyo, Japan
| | - R Mizuno
- Department of Physics, The University of Tokyo, Tokyo, Japan
| | - S Takeda
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo, Chiba, Japan
| | - H Ueno
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Saitama, Japan
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
| | - S Watanabe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, Kanagawa, Japan
| | - T Y Saito
- Center for Nuclear Study, The University of Tokyo, Wako, Saitama, Japan
- Atomic, Molecular, and Optical Physics Laboratory, RIKEN, Wako, Saitama, Japan
| | - S Shimoura
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
- Center for Nuclear Study, The University of Tokyo, Wako, Saitama, Japan
| | - S Sugawara
- Department of Natural Sciences, Tokyo City University, Tokyo, Japan
| | - A Takamine
- RIKEN Cluster for Pioneering Research, RIKEN, Wako, Saitama, Japan
- RIKEN Nishina Center for Accelerator-Based Science, RIKEN, Wako, Saitama, Japan
| | - T Takahashi
- Department of Physics, The University of Tokyo, Tokyo, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo, Chiba, Japan
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Miyoshi T, Maeno Y, Matsuda T, Ito Y, Inamura N, Kim KS, Shiraishi I, Kurosaki K, Ikeda T, Sago H. Neurodevelopmental outcome after antenatal therapy for fetal supraventricular tachyarrhythmia: 3-year follow-up of multicenter trial. Ultrasound Obstet Gynecol 2023; 61:49-58. [PMID: 36350016 DOI: 10.1002/uog.26113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Although many studies have supported the efficacy of transplacental treatment for fetal supraventricular tachyarrhythmia, the long-term neurodevelopmental outcome after antenatal antiarrhythmic treatment is not well understood. The aim of this study was to investigate the prognosis and neurodevelopmental outcome at 36 months of corrected age and the incidence of tachyarrhythmia after birth, following protocol-defined antenatal therapy for fetal supraventricular tachyarrhythmia. METHODS This was a 3-year follow-up study of a multicenter trial that evaluated the efficacy and safety of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The primary endpoints were mortality and neurodevelopmental impairment (NDI) at 36 months of corrected age. NDI was defined as any of the following outcomes: cerebral palsy, bilateral blindness, bilateral deafness or neurodevelopmental delay. Neurodevelopmental delay was evaluated using appropriate developmental quotient scales, mainly the Kyoto Scale of Psychological Development, or examination by pediatric neurologists. The detection rate of tachyarrhythmia at birth and at 18 and 36 months of corrected age was also evaluated as the secondary endpoint. In addition, the association of NDI at 36 months with perinatal and postnatal factors was analyzed. RESULTS Of 50 patients enrolled in the original trial, one withdrew consent and in two there was fetal death, leaving 47 patients available for enrollment in this follow-up study. Of these, 45 cases were available for analysis after two infants were lost to follow-up. The mortality rate was 2.2% (1/45) during a median follow-up of 3.2 (range, 2.1-9.4) years. The infant died at the age of 2.1 years. Another infant had missing neurodevelopmental assessment data. In the remaining 43 infants, at 36 months of corrected age, NDI was detected in 9.3% (4/43) overall and in two of three (66.7%) cases with fetal hydrops with subcutaneous edema. Cerebral palsy was noted in two infants with severe subcutaneous edema or ascites at an early gestational age. Neurodevelopmental delay was found in two infants with severe congenital abnormalities (one with tuberous sclerosis and the other with heterotaxy syndrome). Tachyarrhythmia was present in 31.9% (15/47) cases in the neonatal period and decreased to 8.9% (4/45) and 4.5% (2/44) at 18 and 36 months of corrected age, respectively. The median ventricular rate at diagnosis was significantly higher in infants with NDI compared to those without (265 vs 229 bpm; P = 0.003). In infants with NDI, compared to those without, fetal hydrops with subcutaneous edema at diagnosis was more common (50.0% vs 2.6%; P = 0.019) and the duration of fetal effusion was longer (median, 10.5 vs 0 days; P = 0.013). Postnatal arrhythmia and physical development abnormalities were not associated with NDI. CONCLUSIONS This multicenter 3-year follow-up study is the first to demonstrate the long-term mortality and morbidity of infants born following protocol-defined transplacental treatment for fetal SVT and AFL. NDI was associated with the presence of fetal hydrops with subcutaneous edema at diagnosis and longer duration of fetal effusion. Neurodevelopmental delay was detected only in infants with severe congenital abnormalities. Therefore, in infants that have undergone antenatal treatment for fetal tachyarrhythmia and in which there are no comorbidities, the risk of NDI is low. However, in those with fetal hydrops with subcutaneous edema and/or associated severe congenital abnormalities, the risk for long-term neurologic morbidity might be considered somewhat increased. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Miyoshi
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, Suita, Japan
- Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Y Maeno
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - T Matsuda
- Department of Pediatrics, Yonaha Okanoue Hospital, Kuwana, Japan
| | - Y Ito
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - N Inamura
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - K-S Kim
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - I Shiraishi
- Department of Pediatric Cardiology, NCVC, Suita, Japan
| | - K Kurosaki
- Department of Pediatric Cardiology, NCVC, Suita, Japan
| | - T Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - H Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Horii M, Fushida N, Ikeda T, Hamaguchi Y, Ikawa Y, Komuro A, Matsushita T. 052 Cytokine-producing B cell balance associated with skin fibrosis in patients with systemic sclerosis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.061] [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: 11/19/2022]
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Konegawa Y, Kuwahara T, Jo J, Murata K, Takeda T, Ikeda T, Minatoya K, Masumoto H, Tabata Y. Pioglitazone-incorporated microspheres alleviates cardiac dysfunction through macrophage polarization in a rat myocardial infarction model. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2900] [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
Inflammatory processes are essential for the repair processes after myocardial infarction. Among inflammatory cells involved in this process, macrophages play a critical role through polarization in pro-inflammatory M1 or reparative M2 subtype. Pioglitazone, known as a treatment drug for diabetes mellitus, is reported to regulate macrophage polarization toward reparative M2 subtype. Poly L-lactic-co-glycolic acid (PLGA) has been widely accepted as the delivery carrier in drug delivery system (DDS).
Here, we aimed to validate the therapeutic effects and investigate the mechanisms of DDS-based treatment using pioglitazone to left ventricular remodeling after myocardial infarction.
Pioglitazone-incorporated PLGA microspheres (PGZ-MS) were prepared and the drug release profile was evaluated. The concentration of interleukin-10 secreted from murine bone marrow derived macrophages incubated with PGZ-MS was quantified in the culture supernatant. To validate the therapeutic potential of PGZ-MS in vivo, Sprague-Dawley rats were subjected to permanent left coronary artery ligation to induce myocardial infarction. Mock-MS (100 μg) or PGZ-MS (100 μg) was injected to the infarct region just after induction (n=9–11/group). Cardiac function and left ventricular size were assessed by echocardiography. At 28-day after surgery, rats were sacrificed, and excised hearts were evaluated histologically.
PGZ-MS released 1.8±0.3% of incorporated PGZ within 24 hours and 29.5±1.2% within 14 days indicating sustained release of PGZ in vitro. PGZ-MS augmented Interleukin-10 release from bone marrow derived macrophages, indicating polarization toward reparative M2 subtype. PGZ-MS significantly ameliorated cardiac function after myocardial infarction (fractional shortening: MI vs MI+Mock-MS vs MI+PGZ-MS, 24.4±1.1 vs 24.3±1.6 vs 32.2±1.4%; P=0.0035) with reverse remodeling (wall thickness: MI vs MI+Mock-MS vs MI+PGZ-MS, 0.69±0.12 vs 0.71±0.13 vs 1.06±0.09; P=0.03). Immunohistochemical analyses revealed that PGZ-MS enhanced macrophage polarization toward reparative M2 subtype (ratio of reparative M2 macrophages: 0.39±0.03 vs 0.42±0.02 vs 0.54±0.02; P=0.0004) and attenuated apoptosis of cardiomyocytes in the ischemic border zone (MI vs MI+Mock-MS vs MI+PGZ-MS, 2.6±0.2 vs 1.9±0.2 vs 1.2±0.2 cells/field; P=0.002).
In the present study, we confirmed that PGZ-MS could realize sustained release of pioglitazone which resulted in sustained effect of macrophage polarization and attenuated left ventricular remodeling accompanied with the amelioration of cardiac dysfunction and cardiomyocytes apoptosis. The strategy of DDS-based macrophage polarization might serve as a promising strategy in cardiac regenerative therapy for ischemic heart disease in the future.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan
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Affiliation(s)
- Y Konegawa
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - T Kuwahara
- Kyoto University, Department of Biomaterials, Institute for Frontier Life and Medical Sciences , Kyoto , Japan
| | - J Jo
- Kyoto University, Department of Biomaterials, Institute for Frontier Life and Medical Sciences , Kyoto , Japan
| | - K Murata
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - T Takeda
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - T Ikeda
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - K Minatoya
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - H Masumoto
- Kyoto University, Department of Cardiovascular Surgery , Kyoto , Japan
| | - Y Tabata
- Kyoto University, Department of Biomaterials, Institute for Frontier Life and Medical Sciences , Kyoto , Japan
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Izumi H, Sakamoto T, Uchibori K, Nishino K, Sakakibara-Konishi J, Nomura S, Ryohei K, Udagawa H, Shibata Y, Ikeda T, Niho S, Sakai T, Zenke Y, Nosaki K, Matsumoto S, Yoh K, Goto K. 997P Phase I study of brigatinib plus panitumumab in patients with advanced EGFR-mutated non-small cell lung cancer resistant to osimertinib (BEBOP): Early termination due to severe early onset pneumonitis by brigatinib. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1123] [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] Open
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Toyozawa R, Niho S, Goto Y, Takahashi T, Ohashi K, Daga H, Tanaka H, Hattori Y, Morise M, Sakakibara-Konishi J, Kodani M, Ikeda T, Matsumoto S, Yoh K, Nomura S, Goto K. 977P Phase II study of brigatinib in patients with tyrosine kinase inhibitor (TKI)-naïve ROS1-rearranged advanced non-small cell lung cancer (NSCLC): Barossa cohort 1. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1105] [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: 11/01/2022] Open
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Cecchi R, Sassani M, Agugiaro G, Caroppo E, De Lellis P, Sannella A, Mazza M, Ikeda T, Kondo T, Masotti V. A medico-legal definition of femicide. Leg Med (Tokyo) 2022; 59:102101. [PMID: 35763984 DOI: 10.1016/j.legalmed.2022.102101] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/05/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
Femicide refers to the extreme form of violence against someone belonging to the female gender, i.e. the killing of a woman. Research shows that, to date, gender-based violence remains largely a hidden phenomenon with prevalence often being underestimated by official statistics and data missing in numerous countries. It can be argued that the under-reporting may be suggestive of a legislative gap that needs addressing. This work aims to reach a shared medico-legal definition of femicide stemming from a comprehensive review of the current legislation of countries around the world. In addition, it appraises forensic pathology studies focusing on the murder of women as well as the most relevant documents published by prominent international organizations fighting violence against women. Review of the literature shows a scarcity of national legislations concerning specifically femicide, despite the attention given to this phenomenon by international organizations fighting violence against women. Additionally, a non-homogeneous framing of the term femicide arises from the forensic pathology literature and national laws. Starting from one of the funding principle of medical ethics - autonomy - authors propose to define femicide as a murder perpetrated because of a failure to recognize the victim's right to self-determination. This definition would give the forensic pathologist a central role in identifying femicide cases among the murders of women. A shared forensic approach is needed, ideally employing standardized methodology to compare international data and to standardize scientific research in the field.
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Affiliation(s)
- R Cecchi
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy.
| | - M Sassani
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - G Agugiaro
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - E Caroppo
- Department of Mental Health - Local Health Authority Roma 2, Italy
| | - P De Lellis
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Italy
| | - A Sannella
- Department of Human and Social Sciences, University of Cassino, Italy
| | - M Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Ikeda
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy
| | - T Kondo
- Institute of Legal Medicine, Wakayama Medical University School of Medicine Graduate School of Medicine, Japan
| | - V Masotti
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy
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Yamamoto Y, Ikeda T, Uchiyama M, Iguchi K, Imazuru T, Shimokawa T. Effects of Each Domain in Recombinant Human Soluble Thrombomodulin on Prolongation of Murine Cardiac Allograft Survival. Transplant Proc 2022; 54:487-491. [DOI: 10.1016/j.transproceed.2021.12.024] [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] [Received: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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Wada R, Shinohara M, Yao S, Yano K, Akitsu K, Koike H, Kinoshita T, Yuzawa H, Nakanishi R, Fujino T, Ikeda T. Significance of mitral L wave to predict late recurrence of atrial fibrillation after radiofrequency catheter ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral L wave, prominent mid-diastolic filling wave in echocardiographic examinations, is associated with severe left ventricular diastolic dysfunction, and that has been reported to predict recurrent atrial fibrillation (AF) after cardioversion. However, association between mitral L wave and the outcome of AF after radiofrequency catheter ablation (RFCA) has not been established.
Objective
The aim of this study is to evaluate the predictive value of mitral L wave on AF recurrence after RFCA.
Methods
250 patients including 164 paroxysmal AF (65.6%) and 86 non-paroxysmal AF (34.4%) who received RFCA in single center from January 2015 to December 2016 were enrolled consecutively. Echocardiographic examinations before RFCA were recorded, and the mitral L wave was defined as a distinct mid-diastolic flow velocity with a peak velocity ≥20 cm/s following the E wave. Systematic follow-up was conducted after RFCA. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. Enrolled patients were divided into groups with the L wave (L-group; n=57) or without the L wave (NL-group; n=193) based on the findings of echocardiographic examinations.
Results
During a follow-up of 35.0±17.6 months, the ratio of LRAF in the L-group was significantly higher than that in the NL-group (32 (56.1%) vs. 41 (21.2%), Hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 2.33 - 5.42, p<0.001). Among the clinical factors, presence of mitral L wave, BNP value, non-paroxysmal AF and moderate-severe mitral regurgitation were related to LRAF. A multivariate analysis using a Cox proportional hazard model found that presence of mitral L wave (HR: 2.67, 95% CI: 1.30 - 5.48, p=0.007) was significantly associated with LRAF.
Conclusion
This study revealed that mitral L wave predicts late recurrence of AF after RFCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Wada
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - M Shinohara
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - S Yao
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - K Yano
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - K Akitsu
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - H Koike
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - T Kinoshita
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - H Yuzawa
- Toho University Faculty of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Tokyo, Japan
| | - R Nakanishi
- Toho University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Fujino
- Toho University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Graduate School of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
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12
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Hase T, Fujiwara Y, Makihara R, Hashimoto N, Tsubata Y, Okuno T, Naito T, Takahashi T, Kobayashi H, Shinno Y, Ikeda T, Goto K, Hosomi Y, Watanabe K, Kitazono S, Sakiyama N, Makino Y, Yamamoto N. 1249P Pharmacokinetic and dose finding study of osimertinib in patients with impaired renal function and low body weight. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1854] [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: 10/20/2022] Open
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13
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Ogawa S, Katsuragi H, Ikeda T, Oshima K, Satokawa S, Yamazaki Y, Tsubomura T. Dual mechanoluminescence system comprising a solid-state di-copper(I) complex containing N-heterocyclic carbene ligands. Dalton Trans 2021; 50:8845-8850. [PMID: 34100056 DOI: 10.1039/d1dt00501d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A simple N-heterocyclic carbene (NHC) ligand linked to a flexible propylene linker allows the formation of "Cu-Cu"- and "2 Cu"-type geometries inside a molecular framework. The incorporation of two Cu(i) ions in close proximity was observed in the Cu-Cu-type geometry but not in the 2 Cu-type geometry. In this study, the ground-state geometries of solid-state di-copper(i) complexes containing NHC ligands with ethyl substituents were modulated by external stimuli. A crystal with the 2 Cu-type geometry was obtained by the mechanical grinding and heating of a crystal with the Cu-Cu-type geometry, as confirmed by the disappearance of the absorption peak attributed to cuprophilic interaction in the diffuse reflection spectrum. The mechanical grinding of both crystals afforded composite states comprising small crystallites of the corresponding crystalline phases and an amorphous domain. This structural transition was accompanied by tribochromism and chronochromism. The results suggest that these di-copper(i) complexes show promise for the development of stimuli-responsive photoluminescent Cu(i) complexes.
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Affiliation(s)
- Shigesaburo Ogawa
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Haruka Katsuragi
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Tsukasa Ikeda
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Kazumasa Oshima
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Shigeo Satokawa
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Yasuomi Yamazaki
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
| | - Taro Tsubomura
- Department of Materials and Life Science, Seikei University, 3-3-1 Kichioji-kitamachi, Musashino-shi, Tokyo 180-8633, Japan.
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14
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Matsumoto S, Ikeda T, Zenke Y, Kato T, Sugawara S, Nishino K, Nakachi I, Daga H, Furuya N, Morise M, Sakakibara-Konishi J, Yoh K, Goto K. P89.06 Prospective Concordance Study of a Multi-Gene PCR Assay and NGS for the Detection of Targetable Gene Alterations in Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Georgieva A, Lear CA, Westgate JA, Kasai M, Miyagi E, Ikeda T, Gunn AJ, Bennet L. Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep. BJOG 2021; 128:1433-1442. [PMID: 33369871 DOI: 10.1111/1471-0528.16638] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cardiotocography is widely used to assess fetal well-being during labour. The positive predictive value of current clinical algorithms to identify hypoxia-ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic-ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension. DESIGN Prospective, controlled study. SETTING Laboratory. SAMPLE Near-term fetal sheep. METHODS One minute of complete umbilical cord occlusions (UCOs) every 5 minutes (1:5 min, n = 6) or every 2.5 minutes (1:2.5 min, n = 12) for 4 hours or until fetal mean arterial blood pressure fell <20 mmHg. MAIN OUTCOME MEASURES Deceleration area and capacity during the UCO series were related to evolving hypotension. RESULTS The 1:5 min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10/12 fetuses in the 1:2.5-min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8 ± 0.9 mmHg after 71.2 ± 6.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5-min group, but progressively increased in the 1:2.5-min group. The severity of hypotension was closely correlated with both deceleration area (P < 0.001, R2 = 0.66, n = 18) and capacity (P < 0.001, R2 = 0.67, n = 18). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123 minutes before the final occlusion, respectively. CONCLUSIONS Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic-ischaemic injury during labour. TWEETABLE ABSTRACT Deceleration area and capacity of fetal heart rate identify developing hypotension during labour-like hypoxia.
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Affiliation(s)
- A Georgieva
- Nuffield Department of Women's and Reproductive Health, The John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - C A Lear
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - J A Westgate
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - M Kasai
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand.,The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - E Miyagi
- The Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - T Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - A J Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - L Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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16
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Harada R, Kawahira Y, Ikeda T, Maruyama S, Matsumoto Y. Sequential variation of super periodic structures emerged in Bi-layered perovskite pillar-matrix epitaxial nanocomposite films with spinel ferrites. CrystEngComm 2021. [DOI: 10.1039/d1ce00990g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The phase stability of Aurivillius bismuth-layer structured Bi5Ti3FeO15 (BTFO15) has been investigated in an epitaxial pillar-matrix nanocomposite system with spinel ferrites.
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Affiliation(s)
- R. Harada
- Department of Applied Chemistry, School of Engineering, Tohoku University, 6-6-07 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Japan
| | - Y. Kawahira
- Department of Applied Chemistry, School of Engineering, Tohoku University, 6-6-07 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Japan
| | - T. Ikeda
- Department of Applied Chemistry, School of Engineering, Tohoku University, 6-6-07 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Japan
| | - S. Maruyama
- Department of Applied Chemistry, School of Engineering, Tohoku University, 6-6-07 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Japan
| | - Y. Matsumoto
- Department of Applied Chemistry, School of Engineering, Tohoku University, 6-6-07 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Japan
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17
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Ikeda T, Ogawa S, Kitazono T, Nakagawara J, Minematsu K, Miyamoto S, Murakawa Y, Iwashiro S, Hayashi Y, Okayama Y, Sunaya T, Sato S, Yamanaka S. Long-term outcomes of Japan-specific dosage of rivaroxaban in high-risk patients with non-valvular atrial fibrillation: analysis from the XAPASS. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0646] [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
XAPASS is a real-world, prospective, single-arm, observational study conducted as a post-marketing surveillance mandated by the health authority in Japan. Nowadays, direct oral anticoagulant therapy using factor Xa or thrombin inhibitor has been the standard of care for patients with non-valvular atrial fibrillation (NVAF) to prevent ischemic stroke. However, the clinical impact of reduced dosage (approved dose of 15 or 10 mg once daily in Japan is relatively reduced compared to global dosage) factor Xa inhibitor rivaroxaban in high-risk patients remains unclear.
Purpose
The present sub-analysis of XAPASS was carried out to assess long-term safety and effectiveness of reduced-dose rivaroxaban in high-risk NVAF patients for bleeding and thromboembolism.
Methods
All patients with NVAF who were newly started on rivaroxaban were eligible for surveillance. The principal safety outcome was a composite of major and non-major bleeding events, and the primary effectiveness outcome was a composite of ischaemic stroke, haemorrhagic stroke, non-central nervous system systemic embolism (non-CNS SE), and myocardial infarction (MI). In this present sub-analysis, high-risk patients were defined as those who had two of the following three risk factors: elderly (≥75 years old), low body weight (≤50 kg), and renal impairment (CrCl <50 mL/min).
Results
In total, 11,308 patients were enrolled between April 2012 and June 2014 from 1,419 hospitals, and overall data were analysed from 10,664 patients from whom data were collected. Among them, 3,694 patients matched the criteria for the high-risk patients defined in this sub-analysis, and 6,970 patients did not match the criteria (non-high-risk patients). The mean treatment duration was 791±673 days in the high-risk patients and 944±709 days in the non-high-risk patients. Mean patient age was 80.9±5.5 years and 69.0±9.0 years at baseline, respectively. Mean CHADS2 score was 2.8 and 1.8, and CHA2DS2-VASc score was 4.4 and 2.9, respectively. The rates of CHADS2 component comorbidities were lower in the non-high-risk patients except for diabetes mellitus. The incidence rates of any bleeding, major bleeding, and the primary effectiveness outcomes were 4.8, 1.6, and 2.1%/patient-year in the high-risk patients. The incidence rates of these clinical events in the non-high-risk patients were 3.3, 0.9, and 1.0%/patient-year, respectively.
Conclusions
Incidence rates of long-term bleeding and thromboembolism were higher in the high-risk patients than in the non-high-risk patients. However, the rates of these outcomes using the Japan-specific reduced dose were not so high. Furthermore, the balance between safety and effectiveness outcomes was within an acceptable range. The present study provides useful information for physicians to stratify high-risk patients using the reduced dose in daily clinical practice.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer Yakuhin Ltd.
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Affiliation(s)
- T Ikeda
- Toho University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - S Ogawa
- IUHW Mita Hospital, Tokyo, Japan
| | - T Kitazono
- Kyushu University Graduate School of Medical Sciences, Department of Medical and Clinical Science, Fukuoka, Japan
| | - J Nakagawara
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - K Minematsu
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - S Miyamoto
- Kyoto University Graduate School of Medicine, Department of Neurosurgery, Kyoto, Japan
| | - Y Murakawa
- Mizonokuchi Hospital, Teikyo University School of Medicine, The 4th Department of Internal Medicine, Kawasaki, Japan
| | - S Iwashiro
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - Y Hayashi
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - Y Okayama
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - T Sunaya
- Bayer Yakuhin Ltd., Research and Development, Osaka, Japan
| | - S Sato
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
| | - S Yamanaka
- Bayer Yakuhin Ltd., Medical Affairs, Osaka, Japan
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18
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Kinoshita T, Yuzawa H, Wada R, Yano K, Yao S, Akitsu K, Koike H, Shinohara M, Abe A, Fujino T, Ogata H, Ikeda T. Electrocardiographic evaluation of depolarization and repolarization abnormalities in breast cancer patients with HER2-inhibitor related cardiac dysfunction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The arrhythmic substrates of the myocardium such as depolarization and repolarization abnormalities are thought to reflect cardiac dysfunction prior to the morphologic left ventricular dysfunction. Activation time (AT), recovery time (RT) and T wave peek-end interval dispersion (Tpe-dispersion) are useful indicators of the arrhythmic substrate. We examined the appearance of depolarization and repolarization abnormalities in patients with cancer therapeutics-related cardiac dysfunction (CTRCD) using AT, RT and Tpe-dispersion.
Methods
We conducted a standardized case-control study of CTRCD with 40 patients who developed breast cancer and treated with trastuzumab (13 cases and 27 controls). We assessed the relation between electrocardiographic indexes, including AT, RT and corrected Tpe-dispersion, and CTRCD. QT intervals were measured by Fridericia method, and QT observer 3 software were used for the measurement of all electrocardiographic indexes.
Results
LVEF in case and control group were 45.7±8% and 69.2±6%, respectively. AT in aVR lead was significantly higher in case group compared with control (28.8±7ms vs 22.8±5ms, P=0.02). corrected Tpe-dispersion tended to be higher in case group than that of control group (43.2±19ms vs 31.9±10ms, P=0.06). QT dispersion and RT dispersion were not different between case and control group.
Conclusions
Our study demonstrated that AT in aVR may predict cardiac dysfunction in breast cancer patients with HER2-inhibitor related cardiac dysfunction. More detailed studies using other modalities which can detect depolarization and repolarization abnormalities, including ventricular late potentials and T wave alternans, are needed.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Kinoshita
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Yuzawa
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - R Wada
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Yano
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - S Yao
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Akitsu
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Koike
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Shinohara
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - A Abe
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Fujino
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Ogata
- Toho University Faculty of Medicine, Division of Breast and Endocrine Surgery (Omori), Department of Surgery, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
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19
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Yagi T, Nagao K, Tachibana E, Yonemoto N, Tahara Y, Nonogi H, Ikeda T, Sato N, Tsutsui H. Assessment of the 2015 cardiopulmonary resuscitation guidelines for patients with out-of-hospital cardiac arrest: results from the All-Japan Utstein registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1823] [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
The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).
Methods
From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2015 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines or 2015 CPR guidelines. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR in this registry. Study patients were divided into five groups based on different years (figure). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, instructed by dispatcher or not, and time interval from call EMS to scene.
Results
The figure showed favorable neurological outcomes at 30 days. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in 2016 as compared to in 2011 was 1.32 (95% CI: 1.04–1.68, p=0.022). On the other hands, there were no significant differences from 2011 to 2014.
Conclusion
In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Yagi
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - K Nagao
- Nihon University, Tokyo, Japan
| | - E Tachibana
- Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | | | - Y Tahara
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - H Nonogi
- Shizuoka General Hospital, Shizuoka, Japan
| | - T Ikeda
- Toho University, Tokyo, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
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20
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Osada H, Masumoto H, Kawatou M, Ikeda T, Tabata Y, Minatoya K, Yamashita J. Transplantation of clinical-grade human induced pluripotent stem cell derived cardiac tissues contributes to functional recovery in a rat myocardial infarction model. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical-grade human induced pluripotent stem cells (iPSCs) established from a healthy volunteer are currently being considered as a quality controlled cell source for regenerative therapy. Transplantation of three-dimensional bioengineered cardiac tissues composed of human iPSC-derived cardiovascular cell lineages is reported to hold potential for cardiac functional recovery.
Purpose
The aims of this study were to evaluate tissue conformation and cellular viability of human iPSC-derived cardiac tissues (HiCTs) generated from clinical-grade cells and to validate functional efficacy of HiCT transplantation.
Methods
Clinical-grade human iPSC lines were simultaneously differentiated into cardiovascular cell lineages by a high-density monolayer culture. The differentiation efficacy was analyzed by flow cytometry. We seeded the cells on temperature responsive culture dishes to form cell sheets. HiCTs are generated by stacking 5 cell sheets with insertion of gelatin hydrogel microspheres (GHMs) between each sheet to promote oxygen and nutrition supply. Characteristics of the HiCTs are histologically and immunohistochemically evaluated. The HiCTs were transplanted onto an athymic nude rat myocardial infarction (MI) model. Cardiac function was evaluated by echocardiography and cardiac magnetic resonance imaging (MRI) until 4 weeks after surgery, and compared to those in animals with sham operation and with cell sheet stacks without GHMs [GHM(−)].
Results
Flow cytometry at differentiation day15 revealed cellular components as follows: 52.5±1.4% of cardiomyocytes (cardiac isoform of troponin-T+), 9.8±0.7% of vascular endothelial cells (VE-cadherin+), 14.8±1.8% of vascular mural cells (PDGFRβ+) and 0.2±0.1% of undifferentiated cells (TRA-1-60+). HiCTs were significantly thicker [GHM(−) vs HiCT: 357.3±81.5 vs 723.0±84.0μm, p<0.05], composed of higher area of cardiomyocytes (27.7±7.9 vs 71.9±15.5mm2, p<0.05) and endothelial cells (CD31+) (1.6±0.7 vs 9.2±1.5mm2, p<0.05), free from hypoxia (HIF-1α+) (3.1±0.1 vs 0.8±0.2%, p<0.05) and cell death (TUNEL+) (3.2±0.1 vs 1.4±0.3%, p<0.05) after 7 days of in vitro culture. Echocardiography revealed significantly lower left ventricular end diastolic volume (LVEDV) and higher left ventricular ejection fraction (LVEF) in HiCT group [sham (n=27) vs GHM(−) (n=12) vs HiCT (n=12): LVEDV; 1.4±0.1 vs 1.3±0.1 vs 0.9±0.1mL, p<0.0001/LVEF; 55.3±1.1 vs 58.2±2.3 vs 78.2±1.5%, p<0.0001]. Cardiac MRI showed lower LVEDV and higher LVEF as well [sham (n=8) vs GHM(−) (n=6) vs HiCT (n=6): LVEDV; 0.7±0.03 vs 0.7±0.03 vs 0.6±0.02mL, p<0.01 / LVEF; 39.2±2.1 vs 43.8±1.4 vs 54.0±2.8%, p<0.001].
Conclusions
We conclude that HiCTs generated from clinical-grade cells hold sufficient viability and tissue conformation suitable for functional recovery validated by a rat MI model. Clinical-grade human iPSCs potentially serve as a reasonable cell source for stem cell-derived product transplantation therapy with foreseeable clinical applications.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Japan Agency for Medical Research and Development (AMED), Invited Research Project of Institute for Advancement of Clinical Transnational Science, Kyoto University Hospital
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Affiliation(s)
- H Osada
- Kyoto University Graduate School of Medicine, Cardiovascular Surgery, Kyoto, Japan
| | - H Masumoto
- Kyoto University Graduate School of Medicine, Cardiovascular Surgery, Kyoto, Japan
| | - M Kawatou
- Kyoto University Graduate School of Medicine, Cardiovascular Surgery, Kyoto, Japan
| | - T Ikeda
- Kyoto University Graduate School of Medicine, Cardiovascular Surgery, Kyoto, Japan
| | - Y Tabata
- Kyoto University, Institute for Frontier Life and Medical Sciences, Kyoto, Japan
| | - K Minatoya
- Kyoto University Graduate School of Medicine, Cardiovascular Surgery, Kyoto, Japan
| | - J.K Yamashita
- Kyoto University, Center for iPS Cell Research and Application, Kyoto, Japan
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Okubo R, Aikawa H, Matsumoto S, Noike R, Yabe T, Nakanishi R, Amano H, Toda M, Ikeda T. Clinical usefulness of Lipoprotein(a) for the prevalence and severity of peripheral artery disease among patients with acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lipoprotein(a) [LP(a)] is known to be a robust lipid marker associated with cardiovascular events. Though coronary artery disease and peripheral artery disease (PAD) are often coexist, little is known about the relationship between LP(a) and PAD among patients with acute coronary syndrome (ACS).
Purpose
The purpose of this study is to examine if LP(a) is of predictive value for PAD among ACS patients in Japanese population.
Methods
Of consecutive 238 ACS patient who received successful primary PCI, a total of 175 patients were enrolled in the current study. We excluded the patients who received hemodialysis (n=10), required multidisciplinary treatment (n=36) and incomplete data (n=17). PAD was diagnosed as ankle brachial index <0.9. Multiple lipid biomarkers [LP(a), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), malondialdehyde-modified LDL (MDA-LDL), docosahexaenoic acid and arachidonic acid] were compared between patients with PAD (n=21) and without PAD (n=154). Further, multivariable logistic regression models were used to assess if LP(a) was associated with PAD. In addition, serum LP(a) level were compared between 3 groups according to pattern of PAD [none (n=154), unilateral (n=10) and bilateral PAD (n=11), respectively].
Results
Compared to patients without PAD, those with PAD were older (74.4 vs. 65.4 years, p=0.003), and had a higher prevalence of chronic kidney disease (CKD) (61.9% vs. 20.1%, p<0.001), diabetes mellitus (DM) (66.7% vs. 27.3%, p<0.001). Serum LP(a) level was significantly higher in patients with PAD (36.4 vs. 18.5 mg/dl, p<0.001), whereas LDL-C and MDA-LDL were significantly lower in PAD (92.0 vs. 109.5 mg/dl, p=0.015 and 98.6 vs. 119.5 mg/dl, p=0.046, respectively). After adjusting for LDL-C and MDA-LDL, LP(a) >30 mg/dl was independently associated with a presence of PAD (OR 5.67, 95% CI 2.09–15.4, p=0.0006). When adjusting for CKD and DM in a different model, LP(a) >30 mg/dl was similarly associated with PAD (OR 4.98, 95% CI 1.66–14.9, p=0.004). Serum LP(a) levels were significantly higher in bilateral PAD group compared to none PAD group (Figure).
Conclusion
LP(a) was a useful lipid biomarker for the prevalence and severity of PAD among patients with ACS in Japanese population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Okubo
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Aikawa
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - S Matsumoto
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - R Noike
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Yabe
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - R Nakanishi
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - H Amano
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Toda
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, The Department of Cardiovascular Medicine, Tokyo, Japan
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Hosoi H, Nishikawa S, Kida Y, Kishi T, Murata S, Iwamoto M, Toyoda Y, Yamada Y, Ikeda T, Sonoki T. Susceptibility of patients receiving chemotherapy for haematological malignancies to scabies. J Hosp Infect 2020; 106:594-599. [PMID: 32866631 DOI: 10.1016/j.jhin.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scabies is a contagious dermatosis. The risk factors for its transmission remain unclear. A scabies outbreak, involving patients who were receiving chemotherapy for haematological malignancies, occurred at our hospital. METHODS The outbreak population was analysed to determine whether the incidence of scabies was higher among contact patients receiving chemotherapy for haematological malignancies. RESULTS A patient with crusted scabies was the index case, and 18 of 78 contact healthcare workers (HCWs) and 22 of 135 contact patients were diagnosed with classical scabies. Ten of 17 contact patients with haematological malignancies and 12 of 118 contact patients with other diseases were infected with scabies. The incidence rate was significantly higher among the patients with haematological malignancies (P<0.001). The patients with haematological malignancies had a significantly lower mean minimum neutrophil count than those with other diseases (1159/μL vs 3761/μL, P=0.0012). Most haematological patients did not require special nursing assistance, suggesting that the higher incidence of scabies among these patients resulted from their immunodeficiency rather than greater skin-to-skin contact with infected HCWs. CONCLUSION Our study suggests that patients receiving chemotherapy for haematological malignancies are more susceptible to scabies than patients with other diseases, and require stricter protection.
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Affiliation(s)
- H Hosoi
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan; Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan.
| | - S Nishikawa
- Department of Nursing, Kainan Municipal Medical Center, Wakayama, Japan; Infection Control Team, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Kida
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Kishi
- Department of Dermatology, Kainan Municipal Medical Center, Wakayama, Japan
| | - S Murata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - M Iwamoto
- Infection Control Team, Kainan Municipal Medical Center, Wakayama, Japan; Department of Pediatrics, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Toyoda
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - Y Yamada
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Ikeda
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - T Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
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Wang L, Ikeda T, Takagi K. Prenatal diagnosis of fetal bowel strangulation. Ultrasound Obstet Gynecol 2020; 56:114. [PMID: 31614029 DOI: 10.1002/uog.21896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Affiliation(s)
- L Wang
- Perinatal and Maternal Center of Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - T Ikeda
- The Department of Pediatric Surgeons, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - K Takagi
- Perinatal and Maternal Center of Saitama Medical Center, Jichi Medical University, Saitama, Japan
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24
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Ishizuka T, Fujioka K, Tangiku M, Inui S, Tani H, Miwa A, Ikeda T, Taguchi K, Morita H, Toma T, Yachie A. AB0988 CLINICAL FEATURES AND ANALYSIS OF MEFV GENE IN 31 PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER (FMF). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:FMF is recessive systemic autoinflammatory disorder characterized by recurrent fever, peritonitis, pleuritis, pericarditis and arthritis accompanied with headache and abdominal pain. Mutation of MEFV gene encoding pyrin resulted in inflammasome activation and the uncontrolled production of IL-1β. Overview of pathogenesis, clinical features and management in Japanese patients with FMF had been reported. However, the differences of clinical features between mutated and non-mutated of MEFV still remain unclear.Objectives:We have analyzed 31 Japanese patients with FMF in Gifu district to clarify the association between various clinical features and mutation ofMEFV.Methods:Genomic DNA were purified from white blood cells in 31 FMF patients, and mutated MEFV has been explored. We have analyzedMEFV, TNFRSF1A, MVK and NLRP3 genesin 31 patients with FMF except for 1 patient. Therefore, we excluded another autoinflammatory diseases such as TNF receptor-associated syndrome (TRAPS), mevalonate kinase deficiency and cryopyrin-associated periodic syndrome. Clinical symptoms and laboratory data were analyzed around onset time. Each patient had been treated with colchicine (0.5-2 mg).Results:Characteristics of Patients with FMF (22 female/9 male) were as follows; Onset time were 0-56 years-old (21.4 ±11.8), and Frequencies of clinical symptoms such as periodic fever, headache, abdominal pain, arthralgia, chest pain, cervical lymph nodes swelling, and myalgia were 31/31, 9/31, 8/31, 6/31, 5/31, 3/31 and 1/31, respectively (double symptoms were observed). Patients with FMF were divided into 3 groups as follows; Patients with typical compound heterozygous mutations of MEFV (E148Q /M694I) which indicated exon 10 mutation, were 5 cases (G1). Patients with atypical mutations, except for exon 10, such as 133G>A in 3UTR, exon 1 (E84K), 2 (L110P, E148Q), 3(R202Q, P257L, G304R, P369S, R408Q), 5(S503C) and 9(I591M) were 13 cases (G2). Patients with no mutations in MEFV gene were 12 cases (G3). There were no significant differences of age at first visiting hospital (FV)and onset age of fever attack (O) (FV: 29.0 ± 15.6, 27.1 ± 12.5 years-old (yo) and 34.7 ± 12.7 yo, O: 21.0 ± 17.6 yo, 17.8 ± 12.1 yo and 25.2 ± 6.5). But significant differences in duration of fever attack (D) and frequency of fever attack (FF) between G1 and G2 or G3 were observed as follows; (D: 2.2 ± 0.4 days vs 5.5 ± 3.1 days, P<0.05, and 3.8 ± 1.7 days), FF: 0.72 ± 0.3/month (M), 1.24 ± 1.1/M, and 1.5 ± 0.7/M vs group1, P<0.05), respectively. Laboratory examinations such as WBC, CRP and serum amyloid A (SAA)at fever attack were not significantly different between 3 groups. All of those patients were effective for colchicine treatment except for 2 patients in group 1 because of loss of hair, severe diarrhea and liver dysfunction due to side effects of colchicine. Finally, 4 patients in G1and G2 received canakinumab treatment. Patients withMEFVmutations have no family histories. Mutations of E148Q were found in 12 patients (40%).Conclusion:We have examined association between clinical features and mutations of MEFV in 31 patients in Gifu district, suggesting that duration of fever attacks and frequency of fever attacks in G1 are significantly shorter than G2 and G3, respectively in Japanese patients with FMF. Mutations of E148Q in exon 2 were observed in 16-23 % of normal Japanese patients, indicating that E148Q is the polymorphism or accelerating factor.Disclosure of Interests:None declared
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25
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Ikeda T, Aida M, Yoshida Y, Matsumoto S, Tanaka M, Nakayama J, Nagao Y, Nakata R, Oki E, Akahoshi T, Okano S, Nomura M, Hashizume M, Maehara Y. Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy. Br J Surg 2020; 107:1673-1685. [DOI: 10.1002/bjs.11654] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/02/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Background
Laparoscopic sleeve gastrectomy (LSG) is a well established treatment for severe obesity and type 2 diabetes. Although the gut microbiota is linked to the efficacy of LSG, the underlying mechanisms remain elusive. The effect of LSG for morbid obesity on the gut microbiota and bile acids was assessed here.
Methods
Severely obese subjects who were candidates for LSG were included and followed until 6 months after surgery. The composition and abundance of the microbiota and bile acids in faeces were assessed by 16S ribosomal RNA sequencing, quantitative PCR and liquid chromatography–mass spectrometry.
Results
In total, 28 patients with a mean(s.d.) BMI of 44·2(6·6) kg/m2 were enrolled. These patients had achieved excess weight loss of 53·2(19·0) per cent and showed improvement in metabolic diseases by 6 months after LSG, accompanied by an alteration in the faecal microbial community. The increase in α-diversity and abundance of specific taxa, such as Rikenellaceae and Christensenellaceae, was strongly associated with reduced faecal bile acid levels. These changes had a significant positive association with excess weight loss and metabolic alterations. However, the total number of faecal bacteria was lower in patients before (mean(s.d.) 10·26(0·36) log10 cells per g faeces) and after (10·39(0·29) log10 cells per g faeces) operation than in healthy subjects (10·83(0·27) log10 cells per g faeces).
Conclusion
LSG is associated with a reduction in faecal bile acids and greater abundance of specific bacterial taxa and α-diversity that may contribute to the metabolic changes.
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Affiliation(s)
- T Ikeda
- Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
- Department of Oral Medicine Research Centre, Fukuoka, Japan
| | - M Aida
- Yakult Central Institute, Tokyo, Japan
| | - Y Yoshida
- Yakult Central Institute, Tokyo, Japan
| | | | - M Tanaka
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Fukuoka, Japan
| | - J Nakayama
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School, Fukuoka, Japan
| | - Y Nagao
- Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - R Nakata
- Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - E Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Akahoshi
- Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - S Okano
- Department of Pathology, Fukuoka Dental College, Fukuoka, Japan
| | - M Nomura
- Department of Medicine and Bioregulatory Science, Fukuoka, Japan
| | - M Hashizume
- Department of Integration of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Y Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hasegawa J, Katsuragi S, Tanaka H, Kubo T, Sekizawa A, Ishiwata I, Ikeda T. How should maternal death due to suicide be classified? Discrepancy between ICD-10 and ICD-MM. BJOG 2020; 127:665-667. [PMID: 31919941 DOI: 10.1111/1471-0528.16087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- J Hasegawa
- Department of Obstetrics and Gynaecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - S Katsuragi
- Department of Obstetrics and Gynaecology, Mie University School of Medicine, Tsu, Japan
| | - H Tanaka
- Department of Obstetrics and Gynaecology, Mie University School of Medicine, Tsu, Japan
| | - T Kubo
- Shirota Obstetrical and Gynecological Hospital, Zama, Japan
| | - A Sekizawa
- Department of Obstetrics and Gynaecology, Showa University School of Medicine, Tokyo, Japan
| | - I Ishiwata
- Ishiwata Obstetrics and Gynaecology Hospital, Mito, Japan
| | - T Ikeda
- Department of Obstetrics and Gynaecology, Mie University School of Medicine, Tsu, Japan
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27
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Kinoshita T, Yuzawa H, Wada R, Yao S, Yano K, Akitsu K, Shinohara M, Koike H, Suzuki T, Abe A, Fujino T, Ikeda T. P93 The usefulness of dual cardiac autonomic nervous modulation assessment for prediction of mortality in patients with relatively preserved left ventricular ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent guidelines have stated that reduced left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. Although reduced LVEF identifies patients at an increased risk of cardiac arrest, sudden cardiac deaths (SCDs) occur considerably more often in patients with relatively preserved LVEF. Current guidelines on SCDs risk stratification do not adequately cover this general population pool. Heart rate variability (HRV) and heart rate turbulence (HRT) are non-invasive electrocardiography (ECG)-based techniques capable of providing relevant information on the cardiac autonomic nervous modulation. Although a large body of evidence about autonomic nervous modulation markers has been reported, the usefulness of HRV and HRT parameters for risk stratification in such patients with relatively preserved LVEF has not yet been elucidated.
Purpose
This study aimed to evaluate HRV and HRT parameters for predicting cardiac mortality in patients with structural heart disease (SHD), including ischemic heart disease, dilated cardiomyopathy and valvular heart disease, who have mid-range left ventricular dysfunction (LVD).
Methods
We prospectively enrolled 229 patients (187 men, age 63 ± 13 years) with SHD who have mid-range LVD (LVEF > 40%). HRV and HRT parameters based on 24-hour ambulatory ECG recordings (Fukuda Denshi Co., Ltd., Tokyo, Japan) were evaluated as follows; SDNN, triangular index, high and low frequency HRV, turbulence onset and slope. The primary endpoint was all-cause mortality. Univariate and multivariate Cox regression analysis were used to assess the association between these cardiac autonomic nervous modulation and mortality.
Results
During a mean follow-up of 21 ± 11 months, all-cause mortality was seen in 11 (4.8%) patients. Univariate Cox regression analysis showed that reduced SDNN (<50ms), reduced triangular index (<20ms) and HRT category 2 were significantly associated with the primary endpoint (P < 0.05). When HRT category 2 combined with reduced SDNN, Multivariate Cox regression analysis revealed that this combination more strongly associates with the primary endpoint (hazard ratio =7.91, 95%CI, 1.82-34.2; P = 0.006).
Conclusion
Dual cardiac autonomic nervous modulation assessment which combined HRT and HRV could be a superior technique to predict mortality in patients with relatively preserved LVEF.
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Affiliation(s)
- T Kinoshita
- Toho University Faculty of Medicine, Tokyo, Japan
| | - H Yuzawa
- Toho University Faculty of Medicine, Tokyo, Japan
| | - R Wada
- Toho University Faculty of Medicine, Tokyo, Japan
| | - S Yao
- Toho University Faculty of Medicine, Tokyo, Japan
| | - K Yano
- Toho University Faculty of Medicine, Tokyo, Japan
| | - K Akitsu
- Toho University Faculty of Medicine, Tokyo, Japan
| | - M Shinohara
- Toho University Faculty of Medicine, Tokyo, Japan
| | - H Koike
- Toho University Faculty of Medicine, Tokyo, Japan
| | - T Suzuki
- Toho University Faculty of Medicine, Tokyo, Japan
| | - A Abe
- Toho University Faculty of Medicine, Tokyo, Japan
| | - T Fujino
- Toho University Faculty of Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Tokyo, Japan
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28
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Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Yamanaka K, Ikeda T. P175 Prognostic value of 99mTc-ECD brain perfusion SPECT in patients with atrial fibrillation and dementia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehz872.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and those afflicted have reduced quality of life, functional status, and cardiac performance. The patients with AF have a high risk of coronary heart disease and cardiovascular disease. Although the prevalence of AF is increasing, cognitive disorders are also on the rise in tandem with the aging of the population. The patients with dementia have also experienced lower the quality of life and have increased mortality. Technetium 99m ECD brain perfusion single photon emission computed tomography (99mTc-ECD brain perfusion SPECT) is a useful modality for diagnosing dementia and identifying high risk patients with mild cognitive impairment. However, there are few reports about the relationship between the value of Z score calculated by 99mTc-ECD brain perfusion SPECT and prognosis of patients with AF and dementia.
Purpose
The aim of this study was to evaluate the prognostic values of brain perfusion using 99mTc-ECD SPECT in patients with AF and dementia.
Methods
Among 405 consecutive patients who were diagnosed as AF in cardiac outpatients and subsequently diagnosed as dementia using Mini-Mental State Examination by neurologists or psychiatrists, we identified 170 patients (81 ± 10 years) who underwent 99mTc-ECD brain perfusion SPECT for the current study. Of those, 73, 73, and 24 were diagnosed as Alzheimer’s dementia (AD), vascular dementia (VD), and non-specified dementia respectively. Multivariate Cox model was used to assess if higher Z score by 99mTc-ECD brain perfusion SPECT and clinical parameters were associated with major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, hospitalization for heart failure, and stroke. Sub-analyses of multivariate Cox models by AD or VD were also assessed. The cut-off values of Z score were determined using area under the curve by a receiver operating characteristic analysis based on MACE occurrences.
Results
During a mean follow-up of 1258 ± 1044 days, 62 MACE occurred. There was not significant difference of MACE between AD and VD (33%, vs. 44%, p = 0.153). By multivariable Cox model, the higher Z score of temporal-occipital-pariental lobe was associated with increased MACE compared to the lower group (HR 2.521, 95% CI 1.465–4.337, p < 0.001). In a sub-analysis of patients with AD, Z score was the most significant prognostic factor for MACE (HR 3.969, 95% CI 1.374–11.468, p = 0.011). The similar trend was observed in those with VD (HR 2.247, 95% CI 1.028–4.913, p = 0.043). Conclusion: This study demonstrated that the Z score of temporal-occipital-pariental lobe by 99mTc-ECD brain perfusion SPECT could be a potential prognostic value among patients with AF and dementia, regardless of type of dementia.
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Affiliation(s)
- H Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - R Nakanishi
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - S Mizumura
- Toho University Faculty of Medicine, Radiology, Tokyo, Japan
| | - Y Hashimoto
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - Y Okamura
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Yamanaka
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
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Bennet L, Ikeda T, Llanos AJ, Nijhuis J, Gunn AJ. Challenges and controversies in perinatal physiology. J Physiol 2019; 596:5485-5489. [PMID: 30499159 DOI: 10.1113/jp276299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- L Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, University of Auckland, Auckland, New Zealand
| | - T Ikeda
- Department of Obstetrics and Gynaecology, Mie University, Mie Prefecture, Japan
| | - A J Llanos
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - J Nijhuis
- Department of Obstetrics and Gynaecology, Maastricht University, Maastricht, The Netherlands
| | - A J Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, University of Auckland, Auckland, New Zealand
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30
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Kuo CH, Yoh K, Yang CT, Wang CC, Yen TC, Lin KJ, Ikeda T, Zenke Y, Matsumoto S, Goto K. Initial results of lung cancer genomic screening project for individualized medicine in Asia: LC-SCRUM-Asia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.044] [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: 11/13/2022] Open
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31
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Ikeda T, Sunami K, Huang SY, Wang MC, Koh Y, Min C, Yeh SP, Matsumoto M, Uchiyama M, Iyama S, Shimazaki C, Lee J, Kim K, Kaneko H, Kim J, Lin TL, Campana F, Tada K, Iida S, Suzuki K. Efficacy and safety of isatuximab plus pomalidomide and dexamethasone in East Asian patients with relapsed/refractory multiple myeloma: A subgroup analysis of ICARIA-MM study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz427.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Tsuchiya T, Kume T, Akiyama K, Yoshitsugu K, Fukaya M, Enami T, Tatara R, Shino M, Ikeda T. The prophylactic effect of 0.1% fluorometholone eye drops on eye disorders caused by high-dose cytarabine. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz434.024] [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: 11/13/2022] Open
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33
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Magawa S, Tanaka H, Maki S, Nii M, Umekawa T, Ikeda T. Effects of tadalafil on the uterine artery of fetal growth restriction. CLIN EXP OBSTET GYN 2019. [DOI: 10.12891/ceog4876.2019] [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: 11/01/2022]
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34
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Kirita K, Sugiyama E, Togashi Y, Udagawa H, Irie T, Iida S, Nakamoto M, Nomura S, Ikeda T, Zenke Y, Matsumoto S, Yoh K, Niho S, Sato A, Nishikawa H, Goto K. Clinical utility of precision immunoprofiling and monitoring of the tumour microenvironment using flow cytometry and CyTOF in patients with advanced NSCLC treated with atezolizumab: Results from a phase II study for biomarker analysis (EPOC1702). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.068] [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: 11/12/2022] Open
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35
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Kinoshita T, Hashimoto K, Yoshioka K, Miwa Y, Yodogawa K, Watanabe E, Nakamura K, Nakagawa M, Nakamura K, Watanabe T, Yusu S, Tachibana M, Nakahara S, Mizumaki K, Ikeda T. P5639Risk stratification for mortality using electrocardiographic markers based on 24-hour holter recordings: the JANIES-SHD study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent guidelines have stated that reduced left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. Although reduced LVEF identifies patients at an increased risk of cardiac arrest, sudden cardiac deaths (SCDs) occur considerably more often in patients with relatively preserved LVEF. Current guidelines on SCD risk stratification do not adequately cover this general population pool. Several noninvasive electrocardiographic (ECG) risk stratifiers that reflect depolarization abnormality, repolarization abnormality, and autonomic imbalance have been evaluated so far. With current therapeutic advances using new medicines or devices, an LVEF is often preserved in patients with structural heart disease (SHD). However, the usefulness of noninvasive ECG markers for risk stratification in such a patient population has not yet been elucidated.
Purpose
This study aimed to assess clinical indices and ECG markers based on 24-hour Holter ECG recordings for predicting cardiac mortality in patients with SHD who have left ventricular dysfunction (LVD) but relatively preserved LVEF.
Methods
In total, 1,829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64±13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events.
Results
During a mean follow-up of 21±11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT (hazard ratio=2.82, 95% confidence interval [CI]: 1.38–5.76, P=0.005) and abnormal HRT (hazard ratio=2.31, 95% CI: 1.15–4.65, P=0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment documented NSVT and abnormal HRT improved predictive accuracy.
Conclusion
This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in SHD patients who have relatively preserved LVEF.
Acknowledgement/Funding
Grants-in-Aid (21590909, 24591074, and 15K09103 to T.I.) for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technol
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Affiliation(s)
- T Kinoshita
- Toho University Faculty of Medicine, Tokyo, Japan
| | - K Hashimoto
- National Defense Medical College, Saitama, Japan
| | - K Yoshioka
- Tokai University School of Medicine, Kanagawa, Japan
| | - Y Miwa
- Kyorin University, Tokyo, Japan
| | - K Yodogawa
- Nippon Medical School Hospital, Tokyo, Japan
| | | | - K Nakamura
- Cardiovascular Hospital of Central Japan, Gunma, Japan
| | | | | | | | - S Yusu
- Inagi Municipal Hospital, Tokyo, Japan
| | | | - S Nakahara
- Dokkyo Medical University, Tochigi, Japan
| | | | - T Ikeda
- Toho University Faculty of Medicine, Tokyo, Japan
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Ikeda T, Iwatsu K, Matsumura K, Ashikawa H, Takabayashi K, Fujita R, Kitaguchi S, Nohara R. P2263Prognostic impact of perceived social isolation in patients with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Perceived social isolation (SI), the subjective sense of feelings of loneliness or isolation, has a negative impact on health outcomes, particularly in older adults. Although SI may also contribute to poor prognosis in patients with HF, evidence on the relationship between SI and outcomes in patients with HF is limited.
Purpose
The aim of this study was to investigate the relationship between SI and hospital readmission in patients with HF.
Methods
This study was a single center prospective cohort study. We consecutively enrolled 203 patients (mean age 72.9±11.7) who admitted for acute HF or exacerbation of chronic HF. At hospital discharge, we assessed perceived SI by using Lubben Social Network Scale - 6 (LSNS-6). Lower scores in LSNS-6 represents greater SI. Study outcome was rehospitalization for worsening HF within 180 days after discharge. We selected the optimal cutoff point of LSNS-6 that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. We investigate the association between SI and 180-days HF rehospitalization by using Cox proportional-hazard models, controlling for potential confounding factors.
Results
During follow up, A total of 40events (19.7%) were observed. The optimal cut-off point of LSNS-6 score was 17 points (the area under the ROC curve: 0.62, p<0.05, sensitivity: 82.5%, specificity 42.4%). Kaplan-Meier survival curves showed that those patients with greater SI (LSNS-6≤17) presented significantly higher HF rehospitalization rate (Figure). After adjusting for several pre-existing prognostic factors, LSNS-6≤17 was independently associated with HF rehospitalization (hazard ratio2.15,95% confidence interval 1.00–4.89).
Conclusion
The present study shows that SI is a independent predictor of HF rehospitalization in patients with HF. Assessing SI in the clinical practice with a brief screening tool may help identify patients with heart failure at greater risk of rehospitalization.
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Affiliation(s)
- T Ikeda
- Hirakata kohsai Hospital, Osaka, Japan
| | - K Iwatsu
- Hirakata kohsai Hospital, Osaka, Japan
| | | | | | | | - R Fujita
- Hirakata kohsai Hospital, Osaka, Japan
| | | | - R Nohara
- Hirakata kohsai Hospital, Osaka, Japan
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Naito T, Udagawa H, Kirita K, Ikeda T, Zenke Y, Matsumoto S, Yoh K, Niho S, Ishii G, Goto K. OA01.05 Cryobiopsy Compared with Forceps Biopsy in Pathological Diagnosis and Biomarker Research in Lung Cancer: A Prospective, Single-Arm Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.408] [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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38
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Ikeda T, Iida M, Yokoyama N, Shimokawa T. Mitral valve perforation due to coexisting severe aortic regurgitation. Eur J Cardiothorac Surg 2019; 56:815. [PMID: 31220234 DOI: 10.1093/ejcts/ezz109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tsukasa Ikeda
- Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan
| | | | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan
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Kato K, Otsuka T, Seino Y, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan.
Purpose
We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010.
Methods
Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively.
Results
Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001).
Conclusions
One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.
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Affiliation(s)
- K Kato
- Nippon Medical School, Department of Hygiene and Public Health, Tokyo, Japan
| | - T Otsuka
- Nippon Medical School, Department of Hygiene and Public Health, Tokyo, Japan
| | - Y Seino
- Nippon Medical School Chiba Hokusoh Hospital, Cardiovascular Center, Chiba, Japan
| | - Y Tahara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - N Yonemoto
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - H Nonogi
- Shizuoka General Hospital, Intensive Care Center, Shizuoka, Japan
| | - K Nagao
- Nihon University Hospital, Cardiovascular Center, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Cardiology, Kanagawa, Japan
| | - H Tsutsui
- Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Fukuoka, Japan
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Ichihara S, Hirayama A, Tahara Y, Yasuda S, Noguchi T, Nishimura K, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. P1701Sex-related difference in receiving bystander cardiopulmonary resuscitation and clinical outcome among out-of-hospital cardiac arrest patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0456] [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
Early studies from US and Europe have reported that female out-of-hospital cardiac arrest (OHCA) patients were less likely to receive bystander cardiopulmonary resuscitation (CPR). However, little is known about sex-related difference in receiving CPR and clinical outcome among adult OHCA patients in Japan.
Methods
This study was a nation-wide, population-based observational study of OHCA in Japan from 2011 to 2015. We included all adult cardiogenic OHCA patients. We excluded patients witnessed by emergency medical services (EMS) from the present analysis. To account for the age-related difference, we stratified by age category: 18–39, 40–64, 65–79, and ≥80. To examine the association between patient sex and neurological outcome at 30-day, we fitted multivariable logistic regression model with adjustment for age, bystander CPR status, first document rhythm, dispatcher instruction and EMS response time.
Results
There were 339,317 adult cardiogenic, not EMS-witnessed OHCA patients (median age, 80; female, 43.5%) in Japan from 2011 to 2015. Overall, 171,122 (50.4%) received CPR by citizen, 34,283 (10.1%) had initial shockable rhythm, and 11,421 (3.4%) had favorable neurological status at 30-day. Female patients were more likely to receive bystander CPR (vs. male; 53.8% vs. 47.8%), and were less likely to have initial shockable rhythm (5.2% vs. 13.9%) and favorable neurological status at 30-day (1.8% vs. 4.6%) (all; p<0.001). With stratification by age category, elderly female patients (aged ≥65) were more likely to received bystander CPR (P<0.001), whereas male patients were more likely to received bystander CPR among patients aged <40. Multivariable logistic regression analysis showed that female patients had a lower rate of favorable neurological status at 30-day, compared to male patients in all age categories (all; P<0.05).
Sex difference in bystander CPR Overall Male (n=191,672) Female (n=147,645) p-value All (n=339,317) 50.4% 47.8% 53.8% <0.001 Aged 18–39 (n=6,216) 56.0% 56.9% 53.5% 0.02 Aged 40–64 (n=50,320) 48.5% 48.5% 48.3% 0.69 Aged 65–80 (n=105,141) 46.5% 45.5% 48.3% <0.001 Aged ≥80 (n=177,640) 53.2% 49.0% 56.7% <0.001
OR for neurological outcome at 30-day
Conclusion
Unlike the situation in Europe and US, female OHCA patients, especially elderly female, were more likely to receive bystander CPR in Japan. However, female patients had worse clinical outcome after OHCA. Further investigations including in-hospital treatment are needed to clarify the sex-difference in clinical outcome after OHCA.
Acknowledgement/Funding
None
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Affiliation(s)
- S Ichihara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - A Hirayama
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - Y Tahara
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - T Noguchi
- National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan
| | - K Nishimura
- National Cerebral and Cardiovascular Center, Department of Preventive Medicine and Epidemiology, Osaka, Japan
| | - N Yonemoto
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - H Nonogi
- Shizuoka General Hospital, Intensive Care Center, Shizuoka, Japan
| | - K Nagao
- Nihon University, Cardiovascular Center, Tokyo, Japan
| | - T Ikeda
- Toho University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - N Sato
- Nippon Medical School, Department of Cardiology, Tokyo, Japan
| | - H Tsutsui
- Kyushu University, Department of Cardiovascular Medicine, Fukuoka, Japan
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Shinohara M, Wada R, Akitsu K, Kinoshita T, Yuzawa H, Fujino T, Ikeda T. P3754Comparison of the transdermal bisoprolol patch with the oral bisoprolol fumarate administration as a therapeutic agent for idiopathic frequent premature ventricular contractions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0606] [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
The transdermal bisoprolol patch (TB) was designed to maintain a sustained concentration of bisoprolol in plasma by higher trough concentration than the oral bisoporolol fumarate administration (OB). It is unclear whether the TB is as effective in treating idiopathic premature ventricular contractions (PVCs) as the OB.
Purpose
We compared the efficacy between the TB and OB in treating idiopathic PVCs while considering their duration of action.
Methods
Among 198 patients with a PVC count of ≥3,000 beats/24 hours, 84 patients were divided into groups treated with TB 4mg (n=50) or OB 2.5mg (n=34). The PVCs were divided into positive heart rate (HR)-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVCs density and hourly mean HR. To evaluate the efficacy, PVC counts by 24-hour Holter electrocardiograms were measured at baseline and at 1 month after the initiation of the therapy.
Results
There were no significant between-group differences for the mean HR, PVC count, or type of PVCs. Both the TB (from 16,692±9,737 to 10,442±10,711 beats/24 hours, P<0.001) and OB (from 19,633±16,298 to 9,235±12,124 beats/24 hours, P<0.001) significantly decreased the total PVC count after the initiation of therapy, and a comparison between the two drugs showed no significant difference (P=0.46). In the P-PVC group, both the TB and OB significantly decreased the total PVC count (P<0.001, P=0.022 respectively), PVC count during the day-time (P<0.001, P=0.030 respectively), and PVC count during the night-time (P=0.0038, P=0.022 respectively). In contrast, in the NP-PVC group, neither the TB nor OB made any significantly change in the total PVC count (P=0.079, P=0.10 respectively), PVC count during the day-time (P=0.35, P=0.12 respectively), or PVC count during the night-time (P=0.11, P=0.12 respectively). The TB exhibited a significant reduction during each time period regarding the changes within 24-hours in the P-PVC count from baseline, while the OB did not significantly reduce the P-PVC count from baseline during each time period between 0 and 5 o'clock.
Conclusions
Compared with the OB, the TB could be used with the same efficacy for reducing the PVC count. The TB could be a more useful therapeutic agent for idiopathic P-PVCs during a 24-hour period than the OB.
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Affiliation(s)
- M Shinohara
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - R Wada
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - K Akitsu
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Kinoshita
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - H Yuzawa
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Fujino
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Cardiovascular Medicine, Tokyo, Japan
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42
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Fujino T, Yuzawa H, Kinoshita T, Shinohara M, Koike H, Akitsu K, Yano K, Wada R, Suzuki T, Ikeda T. P6559Long-term follow-up and outcomes of patients with discontinuation of oral anticoagulant therapy after successful ablation procedures for atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Oral anticoagulant therapy (OAT) is effective for preventing strokes in atrial fibrillation (AF) patients. Currently, there is controversy regarding the discontinuation of OATs in patients with ablation procedures to eliminate AF.
Aim
We investigated the incidence of major bleeding and ischemic strokes/systemic embolisms in low-risk patients that discontinued OATs after successful AF ablation procedures.
Methods
Of 330 consecutive patients that underwent AF ablation procedures and were prescribed one of the direct oral anticoagulants or warfarin, 207 AF patients (158 men, mean age 61±11 years) who discontinued OATs three months after the procedure were enrolled. The average CHADS2 and HAS-BLED scores were 1.0±0.9 and 1.2±1.0, respectively, which meant that most patients had a low risk for strokes.
Results
During follow-up, 31 patients (15%) had recurrences of AF. Those patients underwent a re-ablation procedure and then re-discontinued their OATs three months after the session. During a 60±13 months follow-up, major bleeding was observed in five patients (2.4%) and was associated with a higher HAS-BLED score (2.2±0.4 vs. 1.1±1.0, P=0.027). In contrast, none of the patients experienced ischemic strokes/systemic embolisms.
Conclusions
This prospective study demonstrated that in patients with successful ablation procedures and low risk scores for AF management, OATs could be discontinued three months after the procedure. Unnecessary continuation of OATs may increase the incidence of major bleeding during the follow-up.
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Affiliation(s)
- T Fujino
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - H Yuzawa
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - T Kinoshita
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - M Shinohara
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - H Koike
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - K Akitsu
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - K Yano
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - R Wada
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - T Suzuki
- Toho University Graduate School of Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Graduate School of Medicine, Tokyo, Japan
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Amano H, Noike R, Saito D, Yabe T, Watanabe I, Koizumi M, Okubo R, Toda M, Ikeda T. P5623Plaque characteristics, slow flow during percutaneous coronary intervention, and clinical outcomes of irregular protrusion by optical coherence tomography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0567] [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
Introduction
In pathological studies, penetration of the lipid core into the stent strut is associated with neointimal growth and stent thrombosis. Irregular protrusion on optical coherence tomography (OCT) is associated with clinical events and target lesion revascularization. However, there are few reports about the relationship among irregular protrusion, plaque characteristics, and slow flow during percutaneous coronary intervention. We investigated clinical and procedure characteristics, plaque characteristics, slow flow after stent implantation, and clinical outcomes with irregular protrusion by using OCT.
Methods
Eighty-four lesions in 76 patients undergoing OCT before percutaneous coronary intervention were evaluated. Irregular protrusion was defined as protrusion of material with an irregular surface into the lumen between stent struts with a maximum height of ≥100 μm. Major adverse clinical outcomes were defined as death, acute myocardial infarction, acute coronary syndrome, or target lesion revascularization.
Results
Lesions with irregular protrusion were found in 56% (47/84). Compared with lesions without irregular protrusion, those with irregular protrusion had significantly higher low-density lipoprotein cholesterol (LDL-C) levels (108±31 mg/dL vs. 95±25 mg/dL, P=0.044); a tendency toward decreased use of statins (44% [19/43] vs. 67% [22/33], P=0.065); significantly larger reference vessel diameter (3.12±0.53 mm vs. 2.74±0.63 mm, P=0.004); significantly larger stent diameter (3.23±0.43 mm vs. 3.00±0.49 mm, P=0.025); a tendency toward longer total stent length (29.3±14.2 mm vs. 23.7±11.4 mm, P=0.056); significantly larger maximum balloon diameter (3.56±0.55 mm vs. 3.22±0.63 mm, P=0.010); significantly higher incidence of slow flow after stent implantation (38% [18/47] vs. 11% [4/37], P=0.006); significantly higher ΔTIMI flow from pre-stenting to post-stenting (0.4±0.6 vs. 0.1±0.3, P=0.009); significantly higher incidence of lipid-rich plaque (70% [33/47] vs. 35% [13/37], P=0.002); thin-cap fibroatheromas (TCFAs: 49% [23/47] vs. 5% [2/37], P<0.001); plaque rupture (40% [19/47] vs. 16% [6/37], P=0.018); macrophage accumulation (51% [24/47] vs. 24% [9/37], P=0.015); internal running vasa vasorum (51% [24/47] vs. 11% [4/37], P<0.001); thrombus (32% [15/47] vs. 3% [1/37], P<0.001); and a tendency higher incidence of one-year adverse clinical outcomes (12% [5/43] vs. 0% [0/33], P=0.075: log rank). The multivariable analysis showed that TCFA was an independent predictor of irregular protrusion (odds ratio 9.00, 95% CI 1.32–61.36, P=0.025).
Conclusions
Irregular protrusion on OCT was associated with high plaque vulnerability, higher LDL-C, less frequent use of statin, larger vessel diameter, longer total stent length, slow flow after stent implantation, and one-year adverse clinical outcomes.
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Affiliation(s)
- H Amano
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - R Noike
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - D Saito
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Yabe
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - I Watanabe
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Koizumi
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - R Okubo
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Toda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
| | - T Ikeda
- Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Tokyo, Japan
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Iwatsu K, Ikeda T, Matsumura K, Ashikawa H, Sakamoto M, Sakata T, Haratani K, Fujita R, Takabayashi K, Kitaguchi S, Nohara R. P6332Prevalence and prognostic impact of sarcopenia identified according to Asia Working Group for Sarcopenia definition in non-dependent elderly patients with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and muscle function. As the population ages, there is a growing worldwide interest in the intersection of sarcopenia and heart failure (HF). However, estimates of the prevalence of sarcopenia in HF vary widely because of difference in diagnostic criteria. Although the Asian Working Group of Sarcopenia (AWGS) has announced a consensus on the diagnostic criteria of sarcopenia in Asian people, the prevalence and prognostic impact of sarcopenia based on AWGS criteria in patients with HF remains unclear.
Purpose
The aim of this study was to investigate the prevalence and predictive value of sarcopenia identified according to AWGS definition in non-dependent elderly patients with HF.
Methods
This study was a prospective, single-center cohort study in Japan. We consecutively enrolled 274 patients, aged 65 years or older, hospitalized due to acute HF or acute exacerbation of chronic HF and who were able to walk at least 20 m at discharge. Patients with severe cognitive or psychiatric disorders were excluded. Patients with implantable cardiac pacemaker or cardioverter defibrillator were also excluded because skeletal muscle mass was estimated by using bioimpedance analysis. At hospital discharge, we collected data on age, gender, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, body mass index and sarcopenia. Sarcopenia was diagnosed according to the AWGS criteria: low skeletal muscle index (<7.0 kg/m2 in men, <5.7 kg/m2 in women) and either slow usual walking speed (<0.8 m/s) or low handgrip strength (<26 kg in men, <17 kg in women). Study outcome was rehospitalization for worsening HF within 180 days after discharge. We assessed the independent association between sarcopenia and HF rehospitalization by using multivariate Cox proportional hazards regression analysis.
Results
In this study, a total of 199 patents (43.4%) fulfilled sarcopenia criteria at discharge. During follow-up, 57 patients (20.8%) readmitted for HF. Kaplan-Meier survival curves showed that patients with sarcopenia had significantly lower event-free survival than those without sarcopenia (Figure). After adjusting for other prognostic factors, sarcopenia was independently associated with HF rehospitalization (hazard ratio: 2.31, 95% confidence interval: 1.20–4.53).
Conclusion
Based on AWGS criteria, sarcopenia is highly prevalent even among non-dependent elderly HF patients, and is an independent strong predictor of rehospitalization for worsening HF. AWGS criteria for sarcopenia may be useful for risk prediction in HF.
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Affiliation(s)
- K Iwatsu
- Hirakata Kohsai Hospital, Department of Rehabilitation, Hirakata, Japan
| | - T Ikeda
- Hirakata Kohsai Hospital, Department of Rehabilitation, Hirakata, Japan
| | - K Matsumura
- Hirakata Kohsai Hospital, Department of Rehabilitation, Hirakata, Japan
| | - H Ashikawa
- Hirakata Kohsai Hospital, Department of Rehabilitation, Hirakata, Japan
| | - M Sakamoto
- Hirakata Kohsai Hospital, Department of Rehabilitation, Hirakata, Japan
| | - T Sakata
- Hirakata Kohsai Hospital, Department of Nursing, Hirakata, Japan
| | - K Haratani
- Hirakata Kohsai Hospital, Department of Nursing, Hirakata, Japan
| | - R Fujita
- Hirakata Kohsai Hospital, Department of Cardiology, Hirakata, Japan
| | - K Takabayashi
- Hirakata Kohsai Hospital, Department of Cardiology, Hirakata, Japan
| | - S Kitaguchi
- Hirakata Kohsai Hospital, Department of Cardiology, Hirakata, Japan
| | - R Nohara
- Hirakata Kohsai Hospital, Department of Cardiology, Hirakata, Japan
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Fujita R, Takabayashi K, Iwatsu K, Matsumura K, Ikeda T, Kitaguchi S, Nohara R. P6360Prognostic value of polypharmacy in patients with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0956] [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
Polypharmacy creates an increased patient's burden by drug-drug interactions and poor adherence. However, there are very few studies available evaluating the association of polypharmacy with hospital readmission in patients with heart failure (HF).
Purpose
The aim of this study was to investigate the impact of polypharmacy on hospital readmission for HF.
Methods
We enrolled 1253 patients who were hospitalized with acute heart failure (AHF) or acute exacerbation of chronic heart failure in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to July 2018 (age 78.1±11.5 years, male 51.4%). Our Registry is a prospective multicenter community-based cohort study of HF patients in Japan. The inclusion criteria for the registry was a diagnosis of HF during hospitalization according to the Framingham criteria, and there were no exclusion criteria. From data at discharge, we collected data on clinical characteristics, medication schedule, and social backgrounds. We defined polypharmacy as the use of seven or more medications. The primary end point was HF rehospitalization within 1 year after discharge. Cox proportional hazards regression analysis was used to describe the association between polypharmacy and 1-year HF rehospitalization, controlling for potential confounding factors.
Results
In this study, the prevalence of polypharmacy was 59.7% of all patients. Patients with polypharmacy were more likely to have comorbidities such as hypertension, dyslipidemia, diabetes, chronic kidney disease, coronary artery disease and dementia. They also had lower EF (50.9±0.64 vs 53.6±0.80, p<0.01), compared to patients without polypharmacy. There was no significant difference in age, gender and BMI, compared to patients without polypharmacy. During the follow-up period, a total of 278 patients (24.9%) were readmitted for HF. In Kaplan-Meier analyses, hospital readmission for HF during 1-year follow-up was significantly higher in patients with polypharmacy (p<0.01) (figure). After adjusting for gender, age, EF, and the other co-morbidities, polypharmacy was independently associated with higher risk of rehospitalization for HF (hazard ratio 1.28, 95% confidence interval, 1.07–1.52, p<0.01).
Conclusion
Polypharmacy is an independent predictor of hospital readmission for HF. Our study suggests the need for developing an effective strategy to choose the appropriate drugs in patients with HF.
Acknowledgement/Funding
Nakajima Steel Pipe
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Affiliation(s)
- R Fujita
- Hirakatakohsai Hospital, Hirakata City, Japan
| | | | - K Iwatsu
- Hirakatakohsai Hospital, Hirakata City, Japan
| | - K Matsumura
- Hirakatakohsai Hospital, Hirakata City, Japan
| | - T Ikeda
- Hirakatakohsai Hospital, Hirakata City, Japan
| | - S Kitaguchi
- Hirakatakohsai Hospital, Hirakata City, Japan
| | - R Nohara
- Hirakatakohsai Hospital, Hirakata City, Japan
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Okawa S, Udagawa H, Naito T, Kirita K, Ikeda T, Zenke Y, Matsumoto S, Yoh K, Niho S, Goto K. P2.04-72 Clinical Feature and Management of Acquired Resistance to PD-1 Inhibitor in Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seto J, Wada T, Suzuki Y, Ikeda T, Araki K, Umetsu Y, Ishikawa H, Mizuta K, Ahiko T. A case of laboratory cross-contamination of Mycobacterium tuberculosis identified using comparative genomics. Int J Tuberc Lung Dis 2019; 22:1239-1242. [PMID: 30236195 DOI: 10.5588/ijtld.18.0237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two false-positive tuberculosis (TB) cases in Yamagata Prefecture, Japan, 2016. OBJECTIVE To report the effectiveness of comparative genomics of Mycobacterium tuberculosis for identification of cross-contamination cases. DESIGN Case report of laboratory cross-contamination. RESULTS Beginning with detection of an identical genotype in two M. tuberculosis strains using variable number of tandem repeat typing, we suspected M. tuberculosis cross-contamination of specimens collected in a mycobacteriology laboratory based on epidemiological investigations. This suspicion was confirmed using comparative genomics of the two M. tuberculosis strains and a strain from an epidemiologically unrelated specimen from the same batch as the two strains in the mycobacteriology laboratory. All strains had an identical genomic sequence with no single nucleotide variants. CONCLUSION Comparative genomics, which offers the highest discrimination power, is a potent tool for identifying laboratory cross-contamination using epidemiological investigations.
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Affiliation(s)
- J Seto
- Yamagata Prefectural Institute of Public Health, Yamagata
| | - T Wada
- Nagasaki University, Nagasaki
| | - Y Suzuki
- Yamagata Prefectural Institute of Public Health, Yamagata
| | - T Ikeda
- Yamagata Prefectural Institute of Public Health, Yamagata
| | - K Araki
- Murayama Public Health Center, Yamagata
| | - Y Umetsu
- Okitama Public Health Center, Yamagata
| | - H Ishikawa
- Shonai Public Health Center, Yamagata, Japan
| | - K Mizuta
- Yamagata Prefectural Institute of Public Health, Yamagata
| | - T Ahiko
- Yamagata Prefectural Institute of Public Health, Yamagata, Murayama Public Health Center, Yamagata
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Tani N, Ikeda T, Aoki Y, Shida A, Oritani S, Ishikawa T. Evaluation of screening for drug use using postmortem prolactin levels in serum and cerebrospinal fluid. Hum Exp Toxicol 2019; 38:1244-1253. [PMID: 31319705 DOI: 10.1177/0960327119864139] [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: 11/17/2022]
Abstract
Prolactin (PRL) levels can usually be controlled by PRL-inhibiting psychiatric drugs that include anti-dopamine agents. However, the use of dopamine (DA) antagonists may lead to hyperprolactinemia under certain clinical conditions. The aim of this study was to investigate postmortem PRL levels as potential markers of drug abuse, especially that of DA antagonists, in autopsy cases. We examined 121 autopsy cases, excluding cases involving acute hypoxia/ischemia, such as asphyxia, because PRL concentrations are reportedly increased under acute hypoxic conditions. Detected drugs were classified as either DA antagonists, stimulants, psychotropic drugs other than DA antagonists, or other non-psychotropic drugs, and many cases had no detected drugs. Samples comprised blood collected from the right heart chamber and cerebrospinal fluid (CSF). PRL protein level was measured by chemiluminescent immunoassay, and PRL gene expression in the anterior pituitary of autopsy cases was analyzed by reverse transcription-polymerase chain reaction. The PRL-positive cell ratio in the anterior pituitary gland was also measured by immunohistochemical analysis. The results indicated that PRL levels in the serum and CSF were higher in DA antagonist cases than in other cases. PRL levels in the serum and CSF also correlated with the PRL gene expression in cases with abuse of DA antagonists. However, no significant difference in the PRL-positive cell ratio in the anterior pituitary gland was evident between any of the classes of drug-detected and drug-undetected cases. These results suggest that postmortem measurements of PRL transcription levels may be useful for diagnosing cases of DA antagonist use.
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Affiliation(s)
- N Tani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - T Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - Y Aoki
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - A Shida
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - S Oritani
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
| | - T Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan.,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Osaka, Japan
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Makino S, Kawamoto C, Ikeda T, Doi T, Narise A, Tanaka T, Almas C, Hannig M, Carvalho R, Sano H. Whitening Efficacy of Chewing Gum Containing Sodium Metaphosphate on Coffee Stain: Placebo-controlled, Double-blind In Situ Examination. Oper Dent 2019; 44:469-475. [PMID: 31172873 DOI: 10.2341/17-385-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to evaluate the ability of chewing gum containing sodium metaphosphate (SMP) to remove coffee stains from enamel in situ. This was a double-blind (subjects, evaluators), parallel-group, crossover, randomized clinical trial with 30 healthy adult volunteers. Each participant held an appliance with a hydroxyapatite (HA) pellet on the lower lingual side of his or her mouth for two hours to allow pellicle formation. The appliances were subsequently immersed in coffee solution at 37°C for 48 hours. The color of the HA pellet before and after coffee immersion was measured using a spectrophotometer. The participant set the appliance and chewed two pieces of test gum, which contained 7.5 mg of SMP per piece, or control gum without SMP. Each cycle included five minutes of exposure to chewing gum, after which the appliances were placed in 100% relative humidity at room temperature for a 30-minute incubation. This cycle was repeated five times for each gum type. The color of the HA pellet was measured after each chewing cycle using the spectrophotometer. In addition, ΔE* values, which indicate the change in pellet color after each chewing cycle compared with after coffee immersion, were calculated. Data were analyzed using the paired t-test with Bonferroni adjustment to compare ΔE* values of control and test gum after each chewing cycle. The ΔE* values of test gum were significantly higher than those of control gum after all chewing cycles, excluding the first cycle (p<0.05). This finding indicates that test gum containing SMP was more effective at removing coffee stains from the HA pellet than control gum. We conclude that chewing gum containing SMP can effectively remove coffee stains from HA pellets. Thus, SMP is a promising agent to be further explored in tooth-cleaning studies.
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Mijiddorj T, Kajihara I, Tasaki Y, Otsuka-Maeda S, Sakamoto R, Sawamura S, Kanazawa-Yamada S, Egashira S, Inoue K, Makino K, Miyashita A, Aoi J, Igata T, Makino T, Masuguchi S, Fukushima S, Jinnin M, Morinaga J, Ikeda T, Ihn H. Serum cell-free DNA levels are a useful marker for extramammary Paget disease. Br J Dermatol 2019; 181:505-511. [PMID: 30706452 DOI: 10.1111/bjd.17709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) are useful markers for extramammary Paget disease (EMPD), serum CEA and CYFRA levels are not elevated in most patients with EMPD without metastasis. Cell-free (cf)DNA has attracted attention as an indicator of clinical conditions in several cancers. OBJECTIVES To identify further useful biomarkers for the detection of EMPD, including early lesions, and to study the clinical implications of cfDNA in EMPD. METHODS cfDNA were isolated from serum of patients with EMPD with and without metastasis, and from healthy volunteers. Serum extracts were amplified using polymerase chain reaction. RESULTS Serum cfDNA levels were significantly elevated in patients with EMPD with or without metastasis compared with those in healthy controls. Serum cfDNA was a better diagnostic marker for the presence of EMPD than serum CYFRA. Moreover, the postoperative serum cfDNA levels were significantly lower than those from the preoperative samples, and the change in serum cfDNA levels reflected the clinical courses of patients with EMPD treated with chemotherapy. CONCLUSIONS Taking the evidence together, serum cfDNA levels may be a useful marker for diagnosis and disease progression in EMPD. What's already known about this topic? Serum levels of carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) are not elevated in most patients with extramammary Paget disease (EMPD) without metastasis. Cell-free (cf)DNA has attracted attention as an indicator of clinical conditions in several cancers. There are few reports of the clinical implications of cfDNA in dermatology. What does this study add? Serum cfDNA levels were significantly elevated in patients with EMPD with or without metastasis compared with those in healthy controls. Postoperative serum cfDNA levels were significantly lower than those from the preoperative samples. Changes in serum cfDNA levels reflected the clinical courses of patients with EMPD treated with chemotherapy. What is the translational message? Serum cfDNA levels in patients with EMPD are a useful marker for the detection of EMPD, including localized EMPD. Changes in serum cfDNA levels in an individual patient may reflect the clinical course of EMPD.
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Affiliation(s)
- T Mijiddorj
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - I Kajihara
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Y Tasaki
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Otsuka-Maeda
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - R Sakamoto
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Sawamura
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Kanazawa-Yamada
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Egashira
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - K Inoue
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - K Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - A Miyashita
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - J Aoi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - T Igata
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - T Makino
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Masuguchi
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - S Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - M Jinnin
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - J Morinaga
- Department of Clinical Investigation (Biostatistics), Kumamoto University Hospital, Kumamoto, Japan
| | - T Ikeda
- Department of Clinical Investigation (Biostatistics), Kumamoto University Hospital, Kumamoto, Japan
| | - H Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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