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Nakase K, Nakagawa I, Okamoto A, Morisaki Y, Maeoka R, Yokoyama S, Kotsugi M. Medulla and cervical cord contrast-induced encephalopathy detected by neuromonitoring during coil embolization of posterior circulation aneurysms. Neuroradiology 2024; 66:835-838. [PMID: 38531984 DOI: 10.1007/s00234-024-03344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Understanding the risks of contrast-induced encephalopathy (CIE), a serious complication of contrast agents, is crucial in endovascular treatment. We present the case of a 73-year-old woman who developed CIE in the medulla and cervical cord during coil embolization for unruptured left basilar-superior cerebellar artery and basilar artery tip aneurysms. The CIE was identified via neuromonitoring. In this case, spinal cord ischemia might have occurred due to reduced perfusion pressure after inserting the distal access catheter (DAC) in the vertebral artery. Multiple injections of contrast medium via the DAC during coil embolization likely contributed to an unusual form of CIE. Extreme caution is warranted during endovascular treatments involving the posterior circulation, due to the relatively high incidence of contrast-mediated encephalopathy, which can lead to severe consequences such as perforator infarction. Neuromonitoring is very useful for the early detection of neurological changes, particularly because intraoperative angiography may not reveal all irregularities.
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Affiliation(s)
- Kenta Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan.
| | - Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
| | - Ryousuke Maeoka
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, 634-8521, Japan
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Matsuda R, Maeoka R, Morimoto T, Nakazawa T, Morisaki Y, Yokoyama S, Kotsugi M, Takeshima Y, Yamada S, Nishimura F, Park YS, Nakagawa I. Pre-treatment systemic inflammation response index and systemic immune inflammation in patients with primary central nerve system lymphoma as a useful prognostic indicator. J Neurooncol 2024:10.1007/s11060-024-04692-5. [PMID: 38658464 DOI: 10.1007/s11060-024-04692-5] [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: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) are based on neutrophil, monocyte, platelet, and lymphocyte counts. The SIRI and SII are used to predict the survival of patients with malignant tumors. It is well known that the inflammatory immune response is closely related to cancer occurrence and progression. In the present study, we evaluated the potential prognostic significance of SIRI and SII in patients with primary central nervous system lymphoma (PCNSL). METHODS Fifty-eight consecutive patients were enrolled in this study between November 2006 and May 2022. Among the 58 patients, 47 patients with sufficient blood test data and follow-up were analyzed. The patients with steroid intake at the time point of the blood test and higher C-reactive protein were excluded. RESULTS The median follow-up and survival times were 31 and 36 months, respectively. The optimal cutoff SIRI value was based on the receiver operating characteristic curve (ROC) for overall survival (OS) and stratified patients into low (< 1.43 × 109/L, n = 22) and high (≥ 1.43 × 109/L, n = 25) SIRI groups. The optimal cutoff SII value based on the ROC for OS stratified patients into low (< 694.9, n = 28) and high (≥ 694.9, n = 19) SII groups. A low SIRI value was associated with longer OS (p = 0.006). Furthermore, a low SII value was associated with longer OS (p = 0.044). The prognostic factors associated with prolonged survival in univariate analysis using the Cox proportional hazard model were age < 65 years, low SIRI, and low SII. The multivariate analysis demonstrated that age < 65 years and low SIRI independently predicted longer OS. CONCLUSION Simple, less expensive, and routinely ordered preoperative blood count assessments such as SIRI and SII predict the OS of patients with PCNSL. This study demonstrated that PCNSL is associated with pre-treatment systemic immune-inflammation states.
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Affiliation(s)
- Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tsutomu Nakazawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Hoshino J, Saito S, Shibasaki I, Sairenchi T, Okubo S, Matsuoka T, Hirota S, Yokoyama S, Kanazawa Y, Tezuka M, Takei Y, Tsuchiya G, Konishi T, Ogata K, Fukuda H. Angiotensin Receptor-Neprilysin Inhibitor Suppresses Renin-Angiotensin-Aldosterone System Activation After Cardiac Surgery Using Cardiopulmonary Bypass. Circ J 2024:CJ-23-0879. [PMID: 38658351 DOI: 10.1253/circj.cj-23-0879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sacubitril/valsartan, being both a neprilysin inhibitor and angiotensin receptor blocker, exhibits a renin-angiotensin-aldosterone system (RAAS) inhibitory effect. However, no study has investigated the administration of sacubitril/valsartan in patients early after surgery using cardiopulmonary bypass.Methods and Results: This was a prospective observational study of 63 patients who underwent open heart surgery and were treated with sacubitril/valsartan. No serious adverse events occurred. Among the 63 patients, sacubitril/valsartan was discontinued in 13 due to hypotension (n=10), renal dysfunction (n=2), and dizziness (n=1). Atrial natriuretic peptide concentrations increased significantly from Day 3 of treatment (P=0.0142 vs. Postoperative Day 1) and remained high thereafter. In contrast, plasma renin activity was significantly suppressed from Day 3 onwards (P=0.00206 vs. Postoperative Day 1). A decrease in creatinine concentrations and an increase in the estimated glomerular filtration rate were observed on Day 3; this improvement in renal function was not observed in the historical control group, in which patients did not receive sacubitril/valsartan. New postoperative atrial fibrillation was less frequent in the study group compared with the historical control (12.7% vs. 38.0%; P=0.0034). CONCLUSIONS Sacubitril/valsartan administration was safe immediately after open heart surgery in patients without postoperative hypotension. It enhanced serum atrial natriuretic peptide concentrations and suppressed RAAS activation.
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Affiliation(s)
- Joji Hoshino
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
- Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Toshimi Sairenchi
- Medical Science of Nursing, School of Nursing, Dokkyo Medical University
| | - Shohei Okubo
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Taiki Matsuoka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University
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Matsuda R, Maeoka R, Morimoto T, Nakazawa T, Morisaki Y, Nakase K, Yokoyama S, Kotsugi M, Takeshima Y, Yamada S, Nakagawa I. Preoperative Blood Counts Predict Overall Survival in Patients Undergoing Surgical Removal of Brain Metastasis. World Neurosurg 2024:S1878-8750(24)00617-X. [PMID: 38636630 DOI: 10.1016/j.wneu.2024.04.054] [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: 03/11/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The prognosis for patients with cancer with brain metastasis (BM) requiring surgical removal is quite limited. Preoperative prognostic factors can provide meaningful information to surgeons, oncologists, and patients. This study evaluated the preoperative blood counts in patients with BM who were treated with surgical removal. METHODS Between January 2011 and November 2021, 221 consecutive surgeries were conducted on 198 patients with BM. Among the 198 patients, 188 patients with sufficient blood test data and follow-up were analyzed in this study. The tumors originated from the lungs (n = 102, 54.3%), colon (n = 26, 13.3%), breast (n = 13, 6.9%), kidney (n = 8, 4.3%), stomach (n = 6, 3.2%), and others (n = 33, 17.6%). The blood test data included neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cell count, hemoglobin, and albumin. RESULTS The median follow-up and median survival times were both 11 months (range: 0-139 months). Higher neutrophil-lymphocyte ratio ≥ 3.17, platelet-lymphocyte ratio ≥112.7, systemic immune-inflammation index ≥594.4, systemic inflammation response index ≥1.25 were unfavorable predictors of prognosis for the patients treated with surgical removal for BM (P < 0.001). Furthermore, lower lymphocyte-monocyte ratio < 2.33 and prognostic nutritional index < 48.5 were unfavorable predictors. CONCLUSIONS Simple, less expensive, routinely ordered preoperative blood count assessments, such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index, can predict the overall survival of patients treated with surgical removal for BM.
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Affiliation(s)
- Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
| | - Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Tsutomu Nakazawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Sasaki H, Nakagawa I, Furuta T, Yokoyama S, Morisaki Y, Saito Y, Nakase H. Mitochondrial Calcium Uniporter (MCU) is Involved in an Ischemic Postconditioning Effect Against Ischemic Reperfusion Brain Injury in Mice. Cell Mol Neurobiol 2024; 44:32. [PMID: 38568450 PMCID: PMC10991049 DOI: 10.1007/s10571-024-01464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
The phenomenon of ischemic postconditioning (PostC) is known to be neuroprotective against ischemic reperfusion (I/R) injury. One of the key processes in PostC is the opening of the mitochondrial ATP-dependent potassium (mito-KATP) channel and depolarization of the mitochondrial membrane, triggering the release of calcium ions from mitochondria through low-conductance opening of the mitochondrial permeability transition pore. Mitochondrial calcium uniporter (MCU) is known as a highly sensitive transporter for the uptake of Ca2+ present on the inner mitochondrial membrane. The MCU has attracted attention as a new target for treatment in diseases, such as neurodegenerative diseases, cancer, and ischemic stroke. We considered that the MCU may be involved in PostC and trigger its mechanisms. This research used the whole-cell patch-clamp technique on hippocampal CA1 pyramidal cells from C57BL mice and measured changes in spontaneous excitatory post-synaptic currents (sEPSCs), intracellular Ca2+ concentration, mitochondrial membrane potential, and N-methyl-D-aspartate receptor (NMDAR) currents under inhibition of MCU by ruthenium red 265 (Ru265) in PostC. Inhibition of MCU increased the occurrence of sEPSCs (p = 0.014), NMDAR currents (p < 0.001), intracellular Ca2+ concentration (p < 0.001), and dead cells (p < 0.001) significantly after reperfusion, reflecting removal of the neuroprotective effects in PostC. Moreover, mitochondrial depolarization in PostC with Ru265 was weakened, compared to PostC (p = 0.004). These results suggest that MCU affects mitochondrial depolarization in PostC to suppress NMDAR over-activation and prevent elevation of intracellular Ca2+ concentrations against I/R injury.
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Affiliation(s)
- Hiromitsu Sasaki
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan.
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
| | - Yasuhiko Saito
- Department of Neurophysiology, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Shijo-Cho 840, Kashihara City, Nara, 634-8522, Japan
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Nakase K, Nishimura F, Yokoyama S, Kakutani M, Kim T, Matsuda R, Takeshima Y, Yamada S, Park YS, Nakagawa I. Management Approaches and Patient Outcomes for Giant Pituitary Neuroendocrine Tumors Classified as Knosp Grade 3 and 4. Cureus 2024; 16:e57498. [PMID: 38707178 PMCID: PMC11066726 DOI: 10.7759/cureus.57498] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Background Treatment of patients with a giant pituitary neuroendocrine tumor (GPitNET) is challenging. Here, we present the methods used for the clinical management of patients who underwent GPitNET resection mainly via endoscopic endonasal surgery along with multimodal support to avoid surgical complications, which can affect the outcomes. Methodology The medical records of 25 patients with a GPitNET who underwent endonasal endoscopic surgery were retrospectively reviewed. Complications were analyzed and factors affecting the extent of resection were evaluated. Results Gross total resection was achieved in six (24%), near-total resection (>90%) in nine (36%), and partial resection in 10 (40%) patients. Multivariate analyses revealed that tumors invading the middle fossa had negative effects on the extent of resection (odds ratio = 0.092, p = 0.047). Postoperative vision improved or normalized in 16 (64%), remained stable in eight (32%), and worsened in one (4%), while a new hormonal deficit was noted in seven (28%) patients. Complications included permanent oculomotor nerve palsy in one (4%) and transient oculomotor palsy in one (4%), apoplexy of the residual tumor resulting in ischemic stroke in one (4%), postoperative cerebrospinal fluid leakage in one (4%), and permanent diabetes insipidus in six (24%) patients. Conclusions For GPitNETs that extend into the middle fossa, our study underscored the difficulties in surgical extraction and the necessity for tailored treatment approaches. To ensure the safest and most complete removal possible, the surgical strategy must be specifically adapted to each case. Additionally, employing a comprehensive support approach is essential to reduce the chance of complications in patients impacted by this condition.
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Affiliation(s)
- Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | | | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Miho Kakutani
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Taekyun Kim
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | | | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, JPN
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Saito S, Okubo S, Matsuoka T, Hirota S, Yokoyama S, Kanazawa Y, Takei Y, Tezuka M, Tsuchiya G, Konishi T, Shibasaki I, Ogata K, Fukuda H. Impella - Current issues and future expectations for the percutaneous, microaxial flow left ventricular assist device. J Cardiol 2024; 83:228-235. [PMID: 37926367 DOI: 10.1016/j.jjcc.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
The importance of temporary mechanical circulatory support for treating acute heart failure with cardiogenic shock is increasingly recognized, and Impella (Abiomed, Danvers, MA, USA) has received particular attention in this regard. Impella is an axial flow left ventricular assist device (LVAD) built into the tip of a catheter. It is inserted via a peripheral artery and implanted into the left ventricle. Although the morphology of Impella is different from a typical LVAD, it has similar actions and effects as an LVAD in terms of left ventricular drainage and aortic blood delivery. Impella increases mean arterial pressure (MAP) and systemic blood flow, thereby improving peripheral organ perfusion and promoting recovery from multiple organ failure. In addition, left ventricular unloading with increased MAP increases coronary perfusion and decreases myocardial oxygen demand, thereby promoting myocardial recovery. Impella is also useful as a mechanical vent of the left ventricle in patients supported with veno-arterial extracorporeal membrane oxygenation. Indications for Impella include emergency use for cardiogenic shock and non-emergent use during high-risk percutaneous coronary intervention and ventricular tachycardia ablation. Its intended uses for cardiogenic shock include bridge to recovery, durable device, heart transplantation, and heart surgery. Prophylactic use of Impella in high-risk patients undergoing open heart surgery to prevent postcardiotomy cardiogenic shock is also gaining attention. While there have been many case reports and retrospective studies on the benefits of Impella, there is little evidence based on sufficiently large randomized controlled trials (RCTs). Currently, several RCTs are now ongoing, which are critical to determine when, for whom, and how these devices should be used. In this review, we summarize the principles, physiology, indications, and complications of the Impella support and discuss current issues and future expectations for the device.
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Affiliation(s)
- Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan.
| | - Shohei Okubo
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Taiki Matsuoka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Japan
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Shibasaki I, Otani N, Ouchi M, Fukuda T, Matsuoka T, Hirota S, Yokoyama S, Kanazawa Y, Kato T, Shimizu R, Tezuka M, Takei Y, Tsuchiya G, Saito S, Konishi T, Ogata K, Toyoda S, Fukuda H, Nakajima T. Utility of growth differentiation factor-15 as a predictor of cardiovascular surgery outcomes: Current research and future directions. J Cardiol 2024; 83:211-218. [PMID: 37648079 DOI: 10.1016/j.jjcc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
In a world increasingly confronted by cardiovascular diseases (CVDs) and an aging population, accurate risk assessment prior to cardiac surgery is critical. Although effective, traditional risk calculators such as the Japan SCORE, Society of Thoracic Surgeons score, and EuroSCORE II may not completely capture contemporary risks, particularly due to emerging factors such as frailty and sarcopenia. These calculators often focus on regional and ethnic specificity and rely heavily on evaluations based on age and underlying diseases. Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine that has been identified as a potential biomarker for sarcopenia and a tool for future cardiac risk assessment. Preoperative plasma GDF-15 levels have been associated with preoperative, intraoperative, and postoperative factors and short- and long-term mortality rates in patients undergoing cardiac surgery. Increased plasma GDF-15 levels have prognostic significance, having been correlated with the use of cardiopulmonary bypass during surgery, amount of bleeding, postoperative acute kidney injury, and intensive care unit stay duration. Notably, the inclusion of preoperative levels of GDF-15 in risk stratification models enhances their predictive value, especially when compared with those of the N-terminal prohormone of brain natriuretic peptide, which does not lead to reclassification. Thus, this review examines traditional risk assessments for cardiac surgery and the role of the novel biomarker GDF-15. This study acknowledges that the relationship between patient outcomes and elevated GDF-15 levels is not limited to CVDs or cardiac surgery but can be associated with variable diseases, including diabetes and cancer. Moreover, the normal range of GDF-15 is not well defined. Given its promise for improving patient care and outcomes in cardiovascular surgery, future research should explore the potential of GDF-15 as a biomarker for postoperative outcomes and target therapeutic intervention.
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Affiliation(s)
- Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan.
| | - Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University, Nikko Medical Center, Nikko, Japan
| | - Motoshi Ouchi
- Department of Pharmacology and Toxicology, Dokkyo Medical University, School of Medicine, Mibu, Japan; Department of Health Promotion in Nursing and Midwifery, Innovative Nursing for Life Course, Chiba University Graduate School of Nursing, Chiba, Japan
| | - Taira Fukuda
- Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Yokosuka, Japan
| | - Taiki Matsuoka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Takashi Kato
- Department of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Riha Shimizu
- Department of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, School of Medicine, Mibu, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, School of Medicine, Mibu, Japan
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Kotsugi M, Nakagawa I, Sasaki H, Okamoto A, Nakase K, Maeoka R, Yokoyama S, Yamada S, Nakase H. Thin Calcification Predicts Lipid Component in Carotid Plaque-Relationship Between Lipid Distribution and Thin Calcification. World Neurosurg 2024; 183:e715-e721. [PMID: 38191057 DOI: 10.1016/j.wneu.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Accurately evaluating plaque characteristics is essential because lesions with lipid-rich plaque put patients at risk of thromboembolic complications from carotid artery stenting. Near-infrared spectroscopy (NIRS) is a diagnostic imaging modality that identifies lipid components from the near-infrared absorption pattern but does not reveal the distribution of calcification. The purpose of this study was to investigate the calcification characteristics of unstable carotid plaques, focusing on relationships between the calcification characteristics revealed by computed tomography angiography and the lipid core distribution derived from NIRS. METHODS Participants in this retrospective analysis comprised 35 patients (29 men, 6 women; mean age, 76.0 years; range, 52-89 years) who underwent carotid artery stenting in our institute between January 2021 and December 2022. We evaluated the thickness and length of carotid calcifications at the minimal lumen level from preoperative computed tomography angiography and analyzed the relationship with maximum lipid core burden index (max-LCBI) from NIRS. RESULTS Strong negative linear correlations were observed between the thickness of calcification and max-LCBI at Area (any segment in a target lesion) (r = -0.795, P < 0.001), max-LCBI at minimal lumen area (r = -0.795, P < 0.001) and lipid core burden index (LCBI) at lesion (rate of LCBI in entire plaque lesion) (r = -0.788, P < 0.001), respectively. Significant negative linear correlations were observed between distribution of calcification length and max-LCBI at area (r = -0.429, P = 0.01), max-LCBI at minimal lumen area (r = -0.373, P = 0.027), and LCBI at lesion (r = -0.443, P = 0.008). CONCLUSIONS Thin and ubiquitous carotid calcification was associated with LCBI values derived from NIRS indicative of carotid lipid plaque distribution, implying the possibility of predicting lesion instability.
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Affiliation(s)
- Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Nara, Japan.
| | - Hiromitsu Sasaki
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kenta Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ryosuke Maeoka
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
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10
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Nakase K, Nishimura F, Yokoyama S, Kakutani M, Morisaki Y, Kotsugi M, Takeshima Y, Matsuda R, Young-Soo P, Nakagawa I. Long-term outcomes and potential predictive recurrence factors after endonasal endoscopic surgical treatment of symptomatic Rathke's cleft cysts. Neurosurg Rev 2024; 47:85. [PMID: 38366128 DOI: 10.1007/s10143-024-02322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
Although patients with symptomatic Rathke's cleft cysts (RCCs) receive surgical treatment, recurrence sometimes occurs after surgery. However, the mechanism underlying recurrence remains unclear. We evaluated the outcomes of RCC decompression over a long-term follow-up period. We retrospectively reviewed the medical records of 35 patients with symptomatic RCC who underwent endonasal endoscopic surgery (EES) at our institution between 2008 and 2023. Patients' characteristics, intraoperative findings, and postoperative follow-up outcomes were evaluated. A univariate regression model was used to identify the predictors of recurrence. The median patient age was 48.0 years, and 74.2% of the patients were female. The mean follow-up duration was 94.7 ± 47.6 months. Cyst content recurrence was observed in 15 patients (42.8%). Five patients (14.2%) with symptomatic recurrence underwent reoperation. Postoperative vision improved in all 23 patients (100%); headaches improved in 20 patients (90.9%). A new hormonal deficit occurred in two patients (5.7%). Complications included intraoperative cerebrospinal fluid (CSF) leak in 10 patients (28.5%), postoperative CSF leak in two patients (5.7%), permanent diabetes insipidus in two patients (5.7%), and postoperative infection in three patients (8.5%). Univariate analyses revealed that the position of the anterior pituitary lobe (p = 0.019) and preoperative visual disturbances (p = 0.008) significantly affected recurrence after surgery. Although EES was efficient, the recurrence rate was relatively high over a long-term period. The anterior pituitary lobe position and preoperative visual disturbances were significantly associated with recurrence. The anterior-inferior position can predict a high risk of recurrence before surgery.
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Affiliation(s)
- Kenta Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Miho Kakutani
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Park Young-Soo
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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11
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Nakase K, Nishimura F, Kakutani M, Morisaki Y, Yokoyama S, Matsuda R, Takeshima Y, Yamada S, Takeda M, Nakagawa I, Park YS. Giant skull base periosteal chondroma treated with endonasal endoscopic surgery: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23668. [PMID: 38252934 PMCID: PMC10805587 DOI: 10.3171/case23668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Intracranial chondroma is an extremely rare type of tumor composed of mature hyaline cartilaginous tissues. No previous cases of skull base periosteal chondroma have been presented. OBSERVATIONS A 31-year-old male had progressive memory loss and diminished motivation for the previous 1.5 years. Magnetic resonance imaging revealed a giant tumor with partial calcification arising from the upper clivus and extending to the prepontine cistern. Compression of the brainstem and hypothalamus was significant. Surgery was performed and intentionally limited to an intracapsular resection with endoscopic endonasal surgery (EES), and the brainstem and hypothalamus were successfully decompressed. Pathological examination findings showed a composition of hyaline cartilage with chondrocyte clusters. Genetic testing with next-generation sequencing indicated alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. On the basis of these findings, a diagnosis of periosteal chondroma was made. Postoperatively, complete relief from all symptoms was noted, and MRI one year later showed no evidence of tumor regrowth. LESSONS This is the first known report of skull base periosteal chondroma. Genetic testing was useful for confirming the diagnosis, and EES was effective for treatment. Should such a tumor show adhesion to an important structure, an intracapsular excision can be beneficial for avoiding complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maiko Takeda
- Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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12
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Nakagawa I, Kotsugi M, Yokoyama S, Maeoka R, Furuta T, Tanaka H, Takeshima Y, Matsuda R, Yamada S, Nakase H. Dual-layered stents reduce cerebral embolism compared with first-generation stents during carotid stenting of high lipid core plaque lesions. J Neurointerv Surg 2023; 16:67-72. [PMID: 36944492 DOI: 10.1136/jnis-2023-020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Periprocedural lipid core plaque (LCP) has been detected in carotid arteries assessed by catheter-based near-infrared spectroscopy (NIRS). High LCP is associated with cerebral embolism after carotid artery stenting (CAS) using a first-generation stent. We aimed to evaluate whether dual-layered stents reduce embolic infarcts in patients with high LCP and change of lipid signal as assessed by NIRS during CAS. METHODS Participants comprised 210 consecutive patients undergoing CAS. The study was divided into two distinct periods, with first-generation closed-cell stents used in the earlier period and dual-layered stents used in the later period. NIRS was performed at baseline, after stent implantation, and after balloon post-dilatation to analyze maximal lipid core burden index at minimal luminal area (max-LCBIMLA). RESULTS The ipsilateral cerebral embolism rate was significantly lower with dual-layered stents (9%) than with first-generation stents (33%, p<0.001), particularly with highly lipidic lesions (12% vs 60%, p<0.001). On multivariate logistic regression analysis, high LCP and first-generation stent usage were factors related to ipsilateral cerebral embolism (both p<0.001; OR 8.28 (95% CI 3.49 to 19.64) and OR 8.07 (95% CI 2.33 to 27.93), respectively). Max-LCBIMLA decreased significantly after stenting in both groups (both p<0.01) and max-LCBIMLA after balloon post-dilatation was significantly lower with dual-layered stents (22.4±65.6) than with first-generation stents (124.2±208.2; p=0.006). CONCLUSIONS Dual-layered stents reduce embolic infarcts in patients with highly lipidic plaque lesions as assessed by NIRS who undergo CAS. Dual-layered stents significantly reduced NIRS-derived lipid signals after stenting.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Haku Tanaka
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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13
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Tanaka Y, Ota R, Hirata A, Yokoyama S, Nakagawa C, Uno T, Hosomi K. Effect of baseline urinary glucose levels on the relationship between sodium-glucose cotransporter 2 inhibitors and serum uric acid in Japanese patients with type 2 diabetes mellitus. Pharmazie 2023; 78:238-244. [PMID: 38178282 DOI: 10.1691/ph.2023.3602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
In patients with type 2 diabetes mellitus (T2DM), controlling serum uric acid (SUA) and blood glucose levels is important. Moreover, sodium-glucose cotransporter 2 (SGLT2) inhibitors decrease SUA levels by accelerating urinary uric acid excretion. We investigated the effect of baseline urinary glucose levels on the relationship between SGLT2 inhibitors and SUA levels. We conducted a retrospective observational study using the electronic medical records of patients with T2DM of Kindai University Nara Hospital (April 2013 to March 2022). We divided the patients into two groups according to their baseline urinary glucose levels: the N-UG group, which included patients with negative urinary glucose strip test results (-), and the P-UG group, which included patients with positive urinary glucose strip test results (± or more). The changes in SUA levels before and after SGLT2 inhibitor administration were investigated. For comparison, the changes in SUA levels before and after the prescription of antidiabetic agents, excluding SGLT2 inhibitors, were also investigated. Our results revealed that SGLT2 inhibitors significantly decreased the SUA levels in patients in the N-UG group but tended to decrease its levels in those in the P-UG group. Regardless of the urinary glucose status at baseline, the administration of SGLT2 inhibitors may be useful for patients with T2DM to prevent the complications of hyperuricemia.
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Affiliation(s)
- Y Tanaka
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka; Department of Pharmacy , Kindai University Nara Hospital, Nara, Japan
| | - R Ota
- Department of Pharmacy, Kindai University Nara Hospital, Nara, Japan
| | - A Hirata
- Department of Pharmacy, Kindai University Nara Hospital, Nara, Japan
| | - S Yokoyama
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka
| | - C Nakagawa
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka; Department of Pharmacy , Kindai University Nara Hospital, Nara, Japan
| | - T Uno
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka
| | - K Hosomi
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka
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14
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Kodera M, Nakamura K, Ezaki T, Suzuki T, Yokoyama S. Quantitative assessment of urinary equol levels, equol-producing bacteria, and the faecal microbiota in healthy Japanese individuals. Benef Microbes 2023; 14:445-458. [PMID: 38656099 DOI: 10.1163/18762891-20230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/22/2023] [Indexed: 04/26/2024]
Abstract
Equol (4',7-isoflavandiol) has attracted considerable attention for its potential efficacy in treating hormonal diseases. In this study we collected samples from healthy Japanese individuals (n = 91) to observe the relationship between the abundance of equol-producing bacteria in their faeces and the concentration of equol in their urine. Quantitative polymerase chain reaction (qPCR) targeting the dihydrodaidzein reductase gene (dhdr) was used to detect equol-producing bacteria. Equol producers, who were defined as individuals with >1000 nmol/l equol in their urine, exhibited 4-8 log10 copies of dhdr/g faeces of equol-producing bacteria. We assessed the accuracy of these findings by determining the rate of correspondence between possessing equol-producing bacteria and producing urinary equol. Of the 91 participants, 33 were found to be positive for both equol-producing bacteria and urinary equol, 52 were negative for both, one was positive for equol-producing bacteria and negative for urinary equol, and five were negative for equol-producing bacteria and positive for urinary equol. The sensitivity and specificity of the qPCR for detecting equol-producing bacteria were 86.8% and 98.1%, respectively. On the whole, the presence of equol-producing bacteria and urinary equol displayed 93.4% concordance, with a kappa coefficient of 0.862. No apparent correlation was observed between dhdr copy number in the faeces and urinary equol concentrations. Analysis of the faecal microbiota showed that alpha diversity indices (OTU, ACE, Chao1, Shannon) were significantly higher in equol producers. Specifically, the relative abundance of phylum Pseudomonadota was increased in non-equol producers, while abundance of genus Alistipes, Barnesiella, Butyricimonas, Odoribacter, and Ruminococcus, which produce short chain fatty acids and/or hydrogen, were only observed in equol producers. These results suggest that a certain amount of equol-producing bacteria must be present in the intestine to produce detectable levels of equol, and that equol productivity might be affected by other components of the microbiota.
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Affiliation(s)
- M Kodera
- The United Graduate School of Agricultural Science, Gifu University, 1-1 Yanagido, Gifu 501-1193, Japan
- Gifu Prefectural Research Institute for Food Science, 1-1 Yanagido, Gifu 501-1112, Japan
| | - K Nakamura
- The United Graduate School of Agricultural Science, Gifu University, 1-1 Yanagido, Gifu 501-1193, Japan
| | - T Ezaki
- Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - T Suzuki
- The United Graduate School of Agricultural Science, Gifu University, 1-1 Yanagido, Gifu 501-1193, Japan
| | - S Yokoyama
- Gifu Prefectural Research Institute for Food Science, 1-1 Yanagido, Gifu 501-1112, Japan
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15
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Sanda R, Yamashita K, Sawahata H, Sakamoto K, Yamagiwa S, Yokoyama S, Numano R, Koida K, Kawano T. Low-invasive neural recording in mouse models with diabetes via an ultrasmall needle-electrode. Biosens Bioelectron 2023; 240:115605. [PMID: 37669586 DOI: 10.1016/j.bios.2023.115605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
Diabetes is known to cause a variety of complications, having a high correlation with Alzheimer's disease. Electrophysiological recording using a microscale needle electrode is a promising technology for the study, however, diabetic brain tissue is more difficult to record neuronal activities than normal tissue due to these complications including the development of cerebrovascular disease. Here we show an electrophysiological methodology for diabetic db/db mice (+Leprdb/+Leprdb) using a 4-μm-tip diameter needle-electrode device. The needle electrode minimized the tissue injury when compared to a typical larger metal electrode, as confirmed by bleeding during penetration. The proposed electrode device showed both acute and chronic in vivo recording capabilities for diabetic mice while reducing the glial cells' responses. Because of these device characteristics, the 4-μm-tip diameter needle-electrode will allow electrophysiological studies on diabetes models of not only mice, as proven in this study, but also other animals.
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Affiliation(s)
- Rioki Sanda
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Koji Yamashita
- Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Hirohito Sawahata
- National Institute of Technology, Ibaraki College, 866 Nakane, Hitachinaka, 312-8508, Japan
| | - Kensei Sakamoto
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Shota Yamagiwa
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Shohei Yokoyama
- TechnoPro, Inc., TechnoPro R&D Company, 6-10-1 Roppongi, Minato-ku, 106-6135, Japan
| | - Rika Numano
- Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan; Department of Applied Chemistry and Life Science, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Kowa Koida
- Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan; Department of Computer Science and Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan
| | - Takeshi Kawano
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan; Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, 1-1 Hibarigaoka Tempaku-cho, Toyohashi, 441-8580, Japan.
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16
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Maeoka R, Ouji Y, Nakazawa T, Matsuda R, Morimoto T, Yokoyama S, Yamada S, Nishimura F, Nakagawa I, Park YS, Yoshikawa M, Nakase H. Local administration of shikonin improved the overall survival in orthotopic murine glioblastoma models with temozolomide resistance. Biomed Pharmacother 2023; 166:115296. [PMID: 37557011 DOI: 10.1016/j.biopha.2023.115296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Glioblastoma is a type of intracranial malignancy. Shikonin, a Chinese traditional medicine, has been shown to have anti-tumor efficacy toward human glioblastoma cells in vitro. However, shikonin cannot easily cross the blood-brain barrier. To address this issue, we evaluated the anti-tumor effects of direct intracranial infusion of shikonin in in vivo orthotopic syngeneic murine glioblastoma models using C57BL/6 mice. MATERIALS AND METHODS The cytotoxic effects of shikonin against murine glioblastoma cells, SB28 and CT-2A, were reported resistance to temozolomide, were evaluated using an allophycocyanin-conjugated annexin V and propidium iodide assay with flow cytometry. Impedance-based real-time cell analysis (RTCA) was used to analyze the inhibitory effects of shikonin on growth and proliferation. To evaluate the anti-tumor activity of shikonin in vivo, we used orthotopic syngeneic murine glioblastoma models with SB28 and CT-2A cells. RESULTS In flow cytometry-based cytotoxic assays, shikonin induced apoptosis. RTCA indicated that shikonin decreased the cell index of murine glioblastoma cells, SB28 and CT-2A, in a dose-dependent manner (p < 0.0001 for both cell lines), while temozolomide did not (p = 0.91 and 0.82, respectively). In murine glioblastoma models, SB28 and CT-2A, direct intracranial infusion of shikonin, as a local chemotherapy, improved the overall survival of mice in a dose-dependent manner compared with control groups (p < 0.0001 and p = 0.02, respectively). While temozolomide did not (p = 0.48 and 0.52, respectively). CONCLUSIONS The direct intracranial infusion of shikonin has potential as a local therapy for patients with glioblastoma.
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Affiliation(s)
- Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Yukiteru Ouji
- Department of Pathogen, Infection and Immunity, Nara Medical University, Kashihara, Nara, Japan
| | - Tsutomu Nakazawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan; Grandsoul Research Institute for Immunology, Inc., Uda, Nara, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masahide Yoshikawa
- Department of Pathogen, Infection and Immunity, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
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17
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Ohno Y, Nakatani M, Ito T, Matsui Y, Ando K, Suda Y, Ohashi K, Yokoyama S, Goto K. Activation of Lactate Receptor Positively Regulates Skeletal Muscle Mass in Mice. Physiol Res 2023; 72:465-473. [PMID: 37795889 PMCID: PMC10634564 DOI: 10.33549/physiolres.935004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/23/2023] [Indexed: 01/05/2024] Open
Abstract
G protein-coupled receptor 81 (GPR81), a selective receptor for lactate, expresses in skeletal muscle cells, but the physiological role of GPR81 in skeletal muscle has not been fully elucidated. As it has been reported that the lactate administration induces muscle hypertrophy, the stimulation of GPR81 has been suggested to mediate muscle hypertrophy. To clarify the contribution of GPR81 activation in skeletal muscle hypertrophy, in the present study, we investigated the effect of GPR81 agonist administration on skeletal muscle mass in mice. Male C57BL/6J mice were randomly divided into control group and GPR81 agonist-administered group that received oral administration of the specific GPR81 agonist 3-Chloro-5-hydroxybenzoic acid (CHBA). In both fast-twitch plantaris and slow-twitch soleus muscles of mice, the protein expression of GPR81 was observed. Oral administration of CHBA to mice significantly increased absolute muscle weight and muscle weight relative to body weight in the two muscles. Moreover, both absolute and relative muscle protein content in the two muscles were significantly increased by CHBA administration. CHBA administration also significantly upregulated the phosphorylation level of p42/44 extracellular signal-regulated kinase-1/2 (ERK1/2) and p90 ribosomal S6 kinase (p90RSK). These observations suggest that activation of GRP81 stimulates increased the mass of two types of skeletal muscle in mice in vivo. Lactate receptor GPR81 may positively affect skeletal muscle mass through activation of ERK pathway.
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Affiliation(s)
- Y Ohno
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan.
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18
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Nakagawa I, Kotsugi M, Yokoyama S, Maeoka R, Tamura K, Takeshima Y, Matsuda R, Yamada S, Nishimura F, Park YS, Nakase H. Extensive Roles and Technical Advances of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. Neurol Med Chir (Tokyo) 2023; 63:327-333. [PMID: 37286481 PMCID: PMC10482489 DOI: 10.2176/jns-nmc.2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 06/09/2023] Open
Abstract
Chronic subdural hematoma (CSDH) is a common pathology that typically affects the elderly in Japan, an aging society. Burr-hole irrigation is the standard treatment, but middle meningeal artery (MMA) embolization is a minimally invasive alternative. MMA embolization for CSDH has frequently been reported in recent years, and many technical innovations to improve clinical outcomes have been described. Embolic materials reaching more distally are found to avoid recurrences after MMA embolization. As a result, various studies have described the superiority of embolizing the anterior and posterior branches of the MMA, the advantages of embolic materials reaching beyond the midline, and a high degree of distal penetration using a "sugar rush technique" in which 5% soluble glucose is injected through an intermediate catheter during MMA embolization. Radiographically, reports have described the importance of a "bright falx" sign obtained by infiltrating embolic material beyond the midline and post-embolization enhancement of the dura, capsular membrane, septations, and subdural hematoma fluid as indicators of the spread of embolic materials. This review provides an overview of the current status and future challenges in MMA embolization for CSDH, focusing on technical aspects to improve clinical outcomes.
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Nakagawa I, Kotsugi M, Yokoyama S, Maeoka R, Takeshima Y, Matsuda R, Yamada S, Nakase H. Parenchymal Blood Volume Changes Immediately After Endovascular Thrombectomy Predict Futile Recanalization in Patients with Emergent Large Vessel Occlusion. World Neurosurg 2023; 176:e711-e718. [PMID: 37295462 DOI: 10.1016/j.wneu.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE More than one third of acute ischemic stroke (AIS) patients do not recover to functional independence even if endovascular thrombectomy (EVT) is performed rapidly and successfully. This suggests that angiographic recanalization does not necessarily lead to tissue reperfusion. Although recognition of reperfusion status after EVT is pivotal for optimal postoperative management, reperfusion imaging assessment immediately after recanalization has not been fully investigated. The present study aimed to evaluate whether reperfusion status based on parenchymal blood volume (PBV) assessment after angiographic recanalization influences infarct growth and functional outcome in patients who have undergone EVT following AIS. METHODS Seventy-nine patients who underwent successful EVT for AIS were retrospectively analyzed. PBV maps were acquired from flat-panel detector computed tomography (CT) perfusion images before and after angiographic recanalization. Reperfusion status was assessed from PBV values and their changes in regions of interest and collateral score. RESULTS Post-EVT PBV ratio and ΔPBV ratio, as PBV parameters indicating the degree of reperfusion, were significantly lower in the unfavorable prognosis group (P < 0.01 each). Poor reperfusion on PBV mapping was associated with significantly longer puncture-to-recanalization time, lower collateral score, and higher frequency of infarct growth. Logistic regression analysis identified low collateral score and low ΔPBV ratio as associated with poor prognosis after EVT (odds ratios, 2.48, 3.72; 95% confidence intervals, 1.06-5.81, 1.20-11.53; P = 0.04, 0.02, respectively). CONCLUSIONS Poor reperfusion in severely hypoperfused territories on PBV mapping immediately after recanalization may predict infarct growth and unfavorable prognosis in patients who undergo EVT following AIS.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan.
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ryosuke Maeoka
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | | | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Kotsugi M, Nakagawa I, Konishi K, Tanaka H, Sasaki H, Furuta T, Okamoto A, Nakase K, Maeoka R, Yokoyama S, Yamada S, Nakase H. Three-dimensional reconstruction imaging by C-arm computed tomography accurately visualizes in-stent neointimal formation in patients with stent-assisted coil embolization. Front Neurol 2023; 14:1131061. [PMID: 37588669 PMCID: PMC10427135 DOI: 10.3389/fneur.2023.1131061] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
Background Stent apposition to the vessel wall and in-stent neointimal formation after stent-assisted coil embolization for intracranial aneurysm are important factors associated with postoperative thromboembolic complications. No assessment methods have been established to depict 3-dimensional (3D) all-round in-stent neointimal formation. Objective To demonstrate the superiority of Dyna-3D imaging assessment as a modality for all-round ISNF in comparison with conventional two-dimensional digital subtraction angiography (2D-DSA). Methods Consecutive patients who underwent braided stent-assisted coil embolization for unruptured aneurysm between November 2016 and September 2021 were enrolled. Radiological assessments for stent apposition to the parent vessel after stent deployment and in-stent neointimal formation after 3 months were obtained. Dyna-3D was reconstructed by overlapping a plain image showing stent struts with a rotational DSA image showing the vessel lumen. Reconstructed Dyna-3D images can be rotated to any angle on the screen to evaluate to stent apposition around the vessel and in-stent neointimal formation in 3D, for comparison with 2D-DSA evaluations. Results Among the 73 patients enrolled, 70 patients (96%) showed complete stent wall apposition on Dyna-3D. Higher intra-rater agreement was confirmed on assessment of in-stent neointimal formation with Dyna-3D (Cohen's κ = 0.811) than with conventional 2D-DSA (Cohen's κ = 0.517). in-stent neointimal formation could not be confirmed on conventional imaging in 9 cases (16%) and on Dyna-3D in 2 cases (3%). The number of in-stent neointimal formations rated as stent wire completely outside the endothelial line was significantly higher with Dyna-3D than with 2D-DSA (p = 0.0001). Conclusion All-round 3D evaluation by Dyna-3D imaging appears useful for confirming in-stent neointimal formation after braided stent deployment in patients after stent-assisted coil embolization.
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Affiliation(s)
- Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kengo Konishi
- Division of Central Radiation, Nara Medical University, Nara, Japan
| | - Haku Tanaka
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiromitsu Sasaki
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takanori Furuta
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Kenta Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ryosuke Maeoka
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
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Nakagawa I, Yokoyama S, Kotsugi M. Human Basilar Arterial Plaque Detected by Near-Infrared Spectroscopy: Clinical Image. World Neurosurg 2023; 176:204-205. [PMID: 37224959 DOI: 10.1016/j.wneu.2023.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
A patient in their 70s presented with weakness of the left limb and aphasia. Left vertebral angiography showed acute basilar artery occlusion. After mechanical thrombectomy, basilar artery trunk stenosis was evident and catheter-based near-infrared spectroscopy (NIRS) showed lipid-rich atherosclerotic plaque extending to almost 220° of the vessel circumference in the culprit lesion. Loading doses of dual antiplatelet therapy and aggressive medical treatment were started because additional intervention might have increased risk of plaque protrusion and thrombotic reocclusion. The patient presented with minor stroke caused by restenosis of the basilar artery 4 months later; balloon angioplasty and stenting were performed without thromboembolic complications. The patient was discharged without any new neurologic deficits. NIRS visualizes the distribution of lipids in the culprit lesion and the plaque burden of residual stenosis, identifies mechanisms of in situ thrombosis, and provides suggestions for the timing of additional interventions.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan.
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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Tanaka H, Nishimura F, Nakase K, Yokoyama S, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Kotsugi M, Park YS, Nakase H. Case report: Giant pituitary neuroendocrine tumor presented along with acute visual loss due to pituitary apoplexy after receiving COVID-19 vaccination. Front Surg 2023; 10:1220098. [PMID: 37576925 PMCID: PMC10413133 DOI: 10.3389/fsurg.2023.1220098] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023] Open
Abstract
Objective A case of giant pituitary neuroendocrine tumor presented along with acute visual loss due to pituitary apoplexy after receiving a COVID-19 vaccination is reported. Case presentation A 45-year-old man was referred for a giant pituitary tumor with bitemporal hemianopsia. A surgical procedure was planned and then delayed due to the COVID-19 outbreak in Japan, with a Pfizer/BioNTech vaccine administered while awaiting surgery. Three days after the second COVID-19 vaccination the patient noted a progressively worsening headache that caused pituitary apoplexy and then a decrease in vision. Emergency surgery was thus performed. Conclusion Pituitary apoplexy is a rare and life-threatening complication that may occur after undergoing a COVID-19 vaccination.
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Takeshima Y, Okamoto A, Yokoyama S, Nishimura F, Nakagawa I, Park YS, Nakase H. Facet Articular Irregularity Is the Most Relevant Risk Factor for Rapidly Progressive Degenerative Cervical Myelopathy. Neurospine 2023; 20:365-373. [PMID: 37016885 PMCID: PMC10080442 DOI: 10.14245/ns.2245004.502] [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] [Received: 11/28/2022] [Accepted: 01/07/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Facet articular irregularity is associated with rapidly progressive degenerative cervical myelopathy (DCM). However, its significance compared with other known risk factors remains unknown. Therefore, this retrospective study aimed to clarify the potential impact of facet articular irregularity as a risk factor for rapid DCM progression.Methods: This study included 141 consecutive patients with DCM who underwent surgical treatment at our institution. Clinical variables and radiological findings related to DCM progression were collected. Imaging findings were analyzed at the segmental level of myelopathy in each case. The patients were divided into 2 groups based on the presence or absence of rapid DCM progression, and independent risk factors were determined using logistic regression analyses.Results: Overall, 131 patients with a mean age of 63.9 ± 12.6 years were analyzed; 27 patients (20.6%) were classified into the rapid DCM progression group. The mean age was significantly higher in the rapid progression group than in the slow progression group (72.4 ± 9.6 vs. 61.7 ± 12.4, p < 0.001). According to univariate analysis, facet articular irregularity, dynamic segmental translation (≥ 1.6 mm), upper cervical spine involvement above C4–5, history of cerebrovascular events, preceding minor trauma, local lordotic angle (≥ 4.5°), diabetes, hypertension, ligamentum flavum hypertrophy, and age were independent risk factors. Additionally, multivariate analysis showed that facet articular irregularity was the highest risk factor for rapid DCM progression (p = 0.001).Conclusion: Facet articular irregularity is the most clinically significant finding among the known risk factors in patients with rapid DCM progression.
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Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
- Corresponding Author Yasuhiro Takeshima Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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Nakagawa I, Okamoto A, Kotsugi M, Yokoyama S, Yamada S, Nakase H. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis after mRNA-based SIRS-CoV-2 vaccination. Interdisciplinary Neurosurgery 2022; 30:101644. [PMID: 35966341 PMCID: PMC9364928 DOI: 10.1016/j.inat.2022.101644] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background As vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue worldwide, increased rates of venous thrombotic events, mainly as cerebral venous sinus thrombosis (CVST), have been reported following adenovirus vector-based SARS-CoV-2 vaccination. However, few reports have described the occurrence of venous thrombosis after messenger RNA (mRNA)-based vaccination. Here, we describe a case of CVST after a first dose of mRNA-based vaccination that was treated with emergent endovascular mechanical thrombectomy and systemic heparinization. Case Description. A 43-year-old, previously healthy man suffered severe headache and partial seizures affecting the left arm 4 days after receiving the first dose of an mRNA-based SARS-CoV-2 vaccination (FC3661; Pfizer/BioNTech). Computed tomography showed intraparenchymal hemorrhage. Seven days after vaccination, symptoms worsened and he was transferred to our tertiary hospital. Magnetic resonance venography revealed CVST with occlusion of the superior sagittal sinus (SSS) and right transverse sinus (TS). Since no findings suggested thrombosis with thrombocytopenia syndrome, the patient underwent systemic heparinization and emergent mechanical thrombectomy with balloon transluminal angioplasty, a stent retriever and an aspiration catheter. Complete SSS and right TS recanalization were achieved and the patient was discharged without neurological deficits. Conclusion Clinicians should be aware that apparently healthy individuals with no risk factors can develop CVST after receiving an mRNA-based vaccine and appropriate treatment including EMT need to be performed immediately. (228 words)
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
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Tanaka H, Nishimura F, Nakase K, Kakutani M, Yokoyama S, Morimoto T, Kim T, Park YS, Nakagawa I, Yamada S, Tamura K, Matsuda R, Takeshima Y, Kotsugi M, Nakase H. Impact of surgical factors on delayed hyponatremia in patients with nonfunctioning pituitary adenoma after endonasal endoscopic transsphenoidal procedure. Endocrine 2022; 78:354-362. [PMID: 35984619 PMCID: PMC9584842 DOI: 10.1007/s12020-022-03164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Delayed hyponatremia can occur after pituitary surgery, resulting in prolonged hospitalization. However, the influence of surgical factors after such a procedure has not been well established. The impact of surgery and related factors on delayed hyponatremia was investigated. METHODS This was a retrospective analysis of 137 consecutive patients who underwent transsphenoidal surgery for a nonfunctioning pituitary adenoma between 2008 and 2019. Preoperative (demographics, comorbidities), intraoperative (resection extent, operation time, blood loss volume, cerebrospinal fluid leak, tumor consistency), and postoperative [hematoma, meningitis, diabetes insipidus (DI), hormonal assessment] data were collected, with statistical analysis of each factor performed. RESULTS Among the 137 patients, delayed hyponatremia occurred in 31 (22.6%). Multivariate analysis revealed that those with hypertension had a significantly higher likelihood of avoiding delayed hyponatremia (p = 0.004). Although no correlations of direct surgical factors with delayed hyponatremia were found, multivariate analysis of indirect surgical factors showed that presence of a firm tumor, transient DI, and meningitis were significantly associated with delayed hyponatremia (p = 0.014, 0.001, and 0.047, respectively). There was also a significant association of severe hyponatremia with appearance of symptoms (p = 0.002). CONCLUSION There was a tendency for hypertension to be associated with delayed hyponatremia avoidance, with indirect surgical factors including tumor consistency, transient DI, and meningitis found to have an influence on delayed hyponatremia. It was concluded that attention should be given to non-hypertensive patients with a firm tumor, transient DI, or meningitis after pituitary surgery, as delayed hyponatremia may occur.
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Affiliation(s)
- Haku Tanaka
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Miho Kakutani
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Takayuki Morimoto
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Taekyun Kim
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
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Saito S, Sairenchi T, Hirota S, Niitsuma K, Yokoyama S, Kanno Y, Kanazawa Y, Tezuka M, Takei Y, Tsuchiya G, Konishi T, Shibasaki I, Ogata K, Monta O, Tsutsumi Y, Fukuda H. Prosthetic Valve Function after Aortic Valve Replacement for Severe Aortic Stenosis by Transcatheter Procedure versus Surgery. J Cardiovasc Dev Dis 2022; 9:jcdd9100355. [PMID: 36286307 PMCID: PMC9604414 DOI: 10.3390/jcdd9100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background This study compared the clinical outcomes of transcatheter (TAVR) and surgical (SAVR) aortic valve replacements, focusing on postoperative valvular performance assessed by echocardiography. Method and Results A total of 425 patients who underwent TAVR (230 patients) or SAVR (195 patients) were included. Postoperative effective orifice area index (EOAI) was higher in the TAVR group (1.27 ± 0.35 cm2/m2) than in the SAVR group (1.06 ± 0.27 cm2/m2, p < 0.001), and patient−prosthesis mismatch (PPM) was more frequent in the SAVR group (22.6%) than in the TAVR group (8.7%, p < 0.001). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (21.3%) than in the SAVR group (0%, p < 0.001). Moreover, there was no difference in freedom from all-cause death, stroke, or rehospitalization between the groups. Patients with moderate or greater PPM (EOAI < 0.85 cm2/m2) had lower freedom from composite events than those without this PPM criterion (p = 0.008). Patients with mild or greater PVL also had lower freedom from composite events than those without this PVL criterion (p = 0.017). Conclusions Postoperative valvular performance of TAVR was superior to that of SAVR in terms of EOAI. This merit was counterbalanced by the significantly lower rates of PVL in patients who underwent SAVR. The overall clinical outcomes were similar between the study groups.
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Affiliation(s)
- Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
- Correspondence: ; Tel.: +81-282-86-1111; Fax: +81-282-86-2022
| | - Toshimi Sairenchi
- Medical Science of Nursing, School of Nursing, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Ken Niitsuma
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Shohei Yokoyama
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yasuyuki Kanno
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yuta Kanazawa
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Masahiro Tezuka
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Go Tsuchiya
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Taisuke Konishi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Koji Ogata
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui 910-0833, Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui 910-0833, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
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Arakawa H, Yokoyama S, Ohira T, Kang D, Honda K, Ueda Y, Tojo A. Juvenile Membranous Nephropathy Developed after Human Papillomavirus (HPV) Vaccination. Vaccines (Basel) 2022; 10:vaccines10091442. [PMID: 36146521 PMCID: PMC9502366 DOI: 10.3390/vaccines10091442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
A 16-year-old girl with no history of renal disease had a fever of 38 °C after her second HPV vaccination and was identified as positive for proteinuria. As she maintained urinary protein of 3.10 g/gCr and 5-9 urinary red blood cells/HPF, a renal biopsy was performed and small spikes on PAM staining with the granular deposition of IgG1++ and IgG3+ on the glomerular capillary wall were discovered by immunofluorescence, although PLA2R immunostaining was negative. Analysis by electron microscope showed electron density deposition in the form of fine particles under the epithelium. The diagnosis was secondary membranous nephropathy stage II. Immunostaining with the anti-p16 INK4a antibody was positive for glomerular cells, and Western blot analysis of urinary protein showed a positive band for p16 INK4a. However, laser-microdissection mass spectrometry analysis of a paraffin section of glomeruli failed to detect HPV proteins. It is possible that the patient was already infected with HPV and administration of the HPV vaccine may have caused secondary membranous nephropathy.
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Affiliation(s)
- Haruna Arakawa
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Shohei Yokoyama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Takehiro Ohira
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
| | - Dedong Kang
- Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
| | - Akihiro Tojo
- Department of Nephrology & Hypertension, Dokkyo Medical University, Mibu 321-0293, Japan
- Correspondence: ; Tel.: +81-282-86-1111
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Yamashiro K, Hosomi K, Yokoyama S, Ogata F, Nakamura T, Kawasaki N. Adverse event profiles of hypomagnesemia caused by proton pump inhibitors using the Japanese Adverse Drug Event Report (JADER) Database. Pharmazie 2022; 77:243-247. [PMID: 36199184 DOI: 10.1691/ph.2022.2416] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Proton pump inhibitors (PPIs) are commonly used for the prevention or treatment of gastric ulcers, but they can induce hypomagnesemia. Little is known about the onset duration and risk factors related to patient characteristics of this adverse event in Japanese patients. Therefore, we analyzed the time-to-onset of PPI-induced hypomagnesemia and evaluated the association between hypomagnesemia and PPIs using the Japanese Adverse Drug Event Report (JADER) database. We analyzed hypomagnesemia cases between 2004 and 2021. The time-to-onset analysis was performed using the Weibull distribution, and the adjusted reporting odds ratio (aROR) or 95% confidence interval (95% CI) was calculated using a multiple logistic regression analysis. The analysis database comprised 236,525 cases, with 188 cases associated with hypomagnesemia. The median onset duration (interquartile range) of PPI-induced hypomagnesemia was 99.0 (51.8-285.5 ) days, which is considered the random failure type. The multiple logistic regression analysis revealed that hypomagnesemia is significantly associated with male sex (aROR, 95% CI: 1.66, 1.23-2.25) , age < 60 (1.59, 1.14-2.21) , estimated body-mass index (eBMI) (0.94, 0.91-0.98) , PPIs (1.66, 1.18-2.30) , and the interaction of age (<60)*PPIs (1.58, 1.13-2.19) . However, diuretics were not significantly associated with hypomagnesemia. Our results suggest that serum magnesium levels should be measured regularly regardless of the duration of PPI use, especially in patients with male sex, age < 60, or low BMI. These findings will assist health professionals in the adequate use of PPIs. These findings need to be evaluated by cohort studies and long-term clinical investigations.
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Affiliation(s)
- K Yamashiro
- Laboratory of Public Health, Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - K Hosomi
- Division of Drug Informatics, Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - S Yokoyama
- Division of Drug Informatics, Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - F Ogata
- Laboratory of Public Health, Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - T Nakamura
- Laboratory of Public Health, Faculty of Pharmacy, Kindai University, Osaka, Japan
| | - N Kawasaki
- Laboratory of Public Health, Faculty of Pharmacy, Kindai University, Osaka, Japan;,
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Takeshima Y, Okamoto A, Yokoyama S, Nishimura F, Nakagawa I, Park YS, Nakase H. Reply Letter to "Cervical Facet Joint Degeneration". Neurospine 2022; 19:851-852. [PMID: 36203308 PMCID: PMC9537852 DOI: 10.14245/ns.2244654.327] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan,Corresponding Author Yasuhiro Takeshima Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Nara, Japan
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Okamoto A, Nakagawa I, Kotsugi M, Yokoyama S, Yamada S, Park YS, Nakase H. Endovascular vertebral artery orifice angioplasty for the prevention of acute ischemic stroke following vertebral artery stump syndrome. Surg Neurol Int 2022; 13:382. [PMID: 36128121 PMCID: PMC9479644 DOI: 10.25259/sni_515_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vertebral artery stump syndrome (VASS) involves repeated acute ischemic stroke (AIS) in the posterior circulation following vertebral artery (VA) orifice occlusion. The presence of VA orifice occlusion makes endovascular thrombectomy (EVT) difficult to achieve and leads to posterior circulation stroke with unfavorable functional outcomes. Here, we report a case of endovascular VA orifice angioplasty for the right VA pseudo-occlusion to prevent AIS following VASS pathology. Case Description: In a 76-year-old man presenting with dizziness, angiography revealed right pseudo-occluded VA at the origin concomitant with the left VA occlusion. The posterior circulation depended on the right VA through collateral flow to the distal portion. Prophylactic endovascular VA angioplasty for the right pseudo-occluded VA at the orifice was achieved to prevent AIS with tandem lesions. In the present case, endovascular VA angioplasty can prevent acute embolic stroke in the posterior circulation following EVT-resistant VASS pathology. Conclusion: Clinicians should be aware that EVT is not easy in AIS following VASS due to access difficulties and the treatment strategy should be carefully considered.
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Yano Y, Takeshima Y, Okamoto A, Yokoyama S, Nakagawa I, Nakase H. Simple sutureless closure of a thoracic ventral dural defect in a patient with superficial siderosis: technical report. Br J Neurosurg 2022:1-4. [PMID: 35913032 DOI: 10.1080/02688697.2022.2106351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/22/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Closure of the ventral dura mater of the thoracic spinal cord is challenging because it requires both avoiding spinal cord damage and obtaining sufficient working space in an anatomically narrow area. We report a case of superficial siderosis (SS) due to chronic bleeding from a thoracic ventral dural defect in which we preformed dural repair using as a simple sutureless method and obtained good results. CASE DESCRIPTION A 75-year-old man complained of slowly progressive gait, speech, and hearing disturbances over 5 years. Magnetic resonance imaging (MRI) showed SS in the brain and the spinal cord and a dural defect ventral to the spinal cord at the T2 level. Neurological examination revealed bilateral cerebellar ataxia and mild motor weakness in left iliopsoas muscle. T2 and T3 hemi-laminectomy was performed in the prone position. Transdurally, a dural defect on the ventral side of the spinal cord and a fluid-filled space beyond it could be observed. With endoscopic assistance, a blood clot in the space was confirmed. For dural closure, we performed a simple manipulation using a collagen-based dural graft. The graft was cut into pieces, softened with saline, and simply packed into the space with minimal strain on the spinal cord despite the narrow space. The postoperative clinical course was uneventful. Postoperative MRI at 1 year showed the space had disappeared. CONCLUSION In patients with SS, sutureless dural closure using a collagen-based dural graft allows for effective, minimally invasive dural closure, even for thoracic ventral lesions.
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Affiliation(s)
- Yuma Yano
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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Okamoto A, Takeshima Y, Yokoyama S, Nishimura F, Nakagawa I, Park YS, Nakase H. Prevalence and Clinical Impact of Cervical Facet Joint Degeneration on Degenerative Cervical Myelopathy: a Novel Computed Tomography Classification Study. Neurospine 2022; 19:393-401. [PMID: 35577337 PMCID: PMC9260546 DOI: 10.14245/ns.2143258.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate cervical facet joint degeneration using a newly developed classification, investigate its prevalence and relationship with cervical degenerative spondylolisthesis, and clarify its clinical significance in patients with degenerative cervical myelopathy (DCM).
Methods This study included 145 consecutive patients with DCM who underwent surgical treatment. Clinical variables and radiological findings were analyzed. A new 6-grade computed tomography (CT) classification for cervical facet joint degeneration was adapted, and its prevalence was evaluated by categorizing the joints into those at responsible and those at nonresponsible spinal segmental levels. We evaluated the association between rapidly progressive myelopathy and the presence of significant facet joint degeneration or spondylolisthesis at the responsible segmental level.
Results Finally, 140 patients with a mean age of 64.1 ± 12.8 years were analyzed. The prevalence of grade 1, 2, 3, 4, 5A, and 5B classification in all facet joints was 72.0%, 9.5%, 10.9%, 4.3%, 2.9%, and 0.4%, respectively. There was a statistically significant difference in the distribution of CT grades between the joints at the responsible and nonresponsible segmental levels (p < 0.001), with a high prevalence of grade 4 or 5B degeneration at the responsible segmental level, reflecting articular irregularity. There was also a statistically significant relationship between rapidly progressive myelopathy and grade 4 or 5B degeneration at the responsible segmental level (p < 0.001), but not between rapidly progressive myelopathy and spondylolisthesis (p = 0.255).
Conclusion This novel CT classification for facet joints deserves additional evaluation in patients with DCM. Abnormal findings on the articular surfaces might be related to the progression of myelopathy.
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Affiliation(s)
- Ai Okamoto
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
- Corresponding Author Yasuhiro Takeshima Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
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Yokoyama S, Kikuchi R, Matsuyama H, Ohashi K, Watarai R, Hayashi G, Numata Y, Hagiwara T, Kobayashi T, Ando Y, Matsushita T. M022 Performance evaluation of microslide and open channel on VITROS XT 7600 – Establish a clinical testing system for clinical chemistry in the event of a disaster-. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nakagawa I, Park H, Kotsugi M, Yokoyama S, Omoto K, Myochin K, Takeshima Y, Matsuda R, Nishimura F, Yamada S, Takatani T, Nakase H. Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm. Front Neurol 2022; 13:761263. [PMID: 35280302 PMCID: PMC8904750 DOI: 10.3389/fneur.2022.761263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function. Methods This study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed. Results Treated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case. Conclusion Although significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
- *Correspondence: Ichiro Nakagawa
| | - HunSoo Park
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kouji Omoto
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kaoru Myochin
- Departments of Radiology, Nara Medical University, Kashihara, Japan
| | | | - Ryosuke Matsuda
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Tsunenori Takatani
- Division of Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Kashihara, Japan
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Yamashita K, Sawahata H, Yamagiwa S, Yokoyama S, Numano R, Koida K, Kawano T. A floating 5 μm-diameter needle electrode on the tissue for damage-reduced chronic neuronal recording in mice. Lab Chip 2022; 22:747-756. [PMID: 35044407 DOI: 10.1039/d1lc01031j] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Microelectrode technology is essential in electrophysiology and has made contributions to neuroscience as well as to medical applications. However, it is necessary to minimize tissue damage associated with needle-like electrode on the brain tissue and the implantation surgery, which makes stable chronic recording impossible. Here, we report on an approach for using a 5 μm-diameter needle electrode, which enables the following of tissue motions, via a surgical method. The electrode is placed on the brain tissue of a mouse with a dissolvable material, reducing the physical stress to the tissue; this is followed by the implantation of the electrode device in the brain without fixing it to the cranium, achieving a floating electrode architecture on the tissue. The electrode shows stable recording with no significant degradation of the signal-to-noise ratios for 6 months, and minimized tissue damage is confirmed compared to that when using a cranium-fixed electrode with the same needle geometry.
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Affiliation(s)
- Koji Yamashita
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, Aichi, Japan.
| | | | - Shota Yamagiwa
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, Aichi, Japan.
| | | | - Rika Numano
- Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, Aichi, Japan
- Department of Applied Chemistry and Life Science, Toyohashi University of Technology, Aichi, Japan
| | - Kowa Koida
- Electronics-Interdisciplinary Research Institute (EIIRIS), Toyohashi University of Technology, Aichi, Japan
- Department of Computer Science and Engineering, Toyohashi University of Technology, Aichi, Japan
| | - Takeshi Kawano
- Department of Electrical and Electronic Information Engineering, Toyohashi University of Technology, Aichi, Japan.
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Murayama M, Iwano H, Obokata M, Harada T, Omote K, Tsujinaga S, Chiba Y, Ishizaka S, Motoi K, Nakabachi M, Nishino H, Yokoyama S, Nishida M, Kurabayashi M, Anzai T. Two-dimensional echocardiographic scoring system of the left ventricular filling pressure and clinical outcomes in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.154] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science (JSPS)
Introduction
Elevated left ventricular (LV) filling pressure in non-decompensated state is a powerful indicator of worse clinical outcomes in heart failure regardless of LV ejection fraction. However, its detection is often challenging in heart failure with preserved ejection fraction (HFpEF).
Purpose
This study aimed to elucidate the predictive value of recently proposed echocardiographic parameter of LV filling pressure, Visually assessed time difference between the Mitral valve and Tricuspid valve opening (VMT) score in HFpEF.
Methods
We retrospectively analyzed 310 well-differentiated HFpEF patients in stable conditions. Using two-dimensional echocardiographic images, time sequence of opening of mitral valve and tricuspid valve was visually assessed in the apical four-chamber view and scored to 0 to 2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava diameter was dilated, 1 point was added and VMT score was calculated as four grades from 0 to 3. Based on the previous study, VMT≥2 was regarded as a sign of elevated LV filling pressure (Figure 1). LV diastolic function was graded according to the guidelines. The primary endpoint was defined as a composite of cardiac death and heart failure hospitalisation during the two years after echocardiographic examination.
Results
During the follow-up period, 55 events (18%) occurred, including four cardiac deaths and 51 heart failure hospitalisations. Kaplan-Meier curves demonstrated that VMT≥2 (n = 54) was associated with worse outcomes compared to patients showing VMT ≤ 1 (n = 256) (log-rank test P <0.001). Furthermore, VMT≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (log-rank test P = 0.026) (Figure 2). In the adjusted model including age, systolic blood pressure, serum albumin level, and the LV diastolic function grading, VMT≥2 was independently associated with the primary outcome (hazard ratio: 2.23; 95% confidence interval: 1.17 to 4.24, P = 0.014). Additionally, the nested regression model showed that VMT scoring provided an incremental prognostic value over clinically relevant variables (age, sex, the plasma brain natriuretic peptide level, atrial fibrillation) and LV diastolic function grading (chi-square 10.8 vs 16.3, P = 0.035).
Conclusions
In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it discriminated worse clinical outcome even in HFpEF patients with atrial fibrillation. Abstract Figure. VMT scoring Abstract Figure. Kaplan-Meier analysis
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Affiliation(s)
- M Murayama
- Hokkaido University Hospital, Diagnostic Center for Sonography, Sapporo, Japan
| | - H Iwano
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - M Obokata
- Gunma University Graduate School of Medicine, Department of Cardiovascular Medicine, Gunma, Japan
| | - T Harada
- Gunma University Graduate School of Medicine, Department of Cardiovascular Medicine, Gunma, Japan
| | - K Omote
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - S Tsujinaga
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Y Chiba
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - S Ishizaka
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - K Motoi
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - M Nakabachi
- Hokkaido University Hospital, Diagnostic Center for Sonography, Sapporo, Japan
| | - H Nishino
- Hokkaido University Hospital, Diagnostic Center for Sonography, Sapporo, Japan
| | - S Yokoyama
- Hokkaido University Hospital, Diagnostic Center for Sonography, Sapporo, Japan
| | - M Nishida
- Hokkaido University Hospital, Diagnostic Center for Sonography, Sapporo, Japan
| | - M Kurabayashi
- Gunma University Graduate School of Medicine, Department of Cardiovascular Medicine, Gunma, Japan
| | - T Anzai
- Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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Aoyagi H, Tsujinaga S, Iwano H, Ishizaka S, Tamaki Y, Motoi K, Chiba Y, Murayama M, Nakabachi M, Nishino H, Yokoyama S, Sato T, Kaga S, Nagai T, Anzai T. Pathophysiological mechanism of worsened clinical outcome by lowered left ventricular cardiac power output in heart failure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.383] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac power output (CPO) is a measure of cardiac pumping function, and CPO during exercise is known to be a powerful prognostic marker of heart failure. Despite its prognostic significance, pathophysiological mechanism of the association between reduced CPO and worse clinical outcome is unknown. We hypothesized that reduced CPO is associated with worse outcome through the reduced exercise capacity and enhanced ventilatory response.
Methods
Cardiopulmonary exercise testing and exercise stress echocardiography were performed in consecutive 64 patients with chronic heart failure who admitted to our department for the management of heart failure [60 ± 14 years old, left ventricular (LV) ejection fraction 39 ± 16%, ischemic etiology 16%, brain natriuretic peptide 124 pg/ml (51-313)]. Peak oxygen uptake (peak VO2) and the lowest minute ventilation / carbon dioxide production ratio (VE/VCO2) were measured as a parameter of exercise tolerance and that of ventilatory response, respectively. LV ejection fraction was measured by disk summation method at peak exercise. By using Doppler images, E/e" at peak exercise was measured as a marker of LV filling pressure, and CPO normalized by LV mass was obtained as 0.222 × cardiac output × mean blood pressure / LV mass [W/100 g]. Cardiac events defined as hospitalization for heart failure, cardiac death, or implantation of a LV assist device after the examinations were recorded.
Results
CPO at rest was weakly correlated with peak VO2 (r = 0.25, p = 0.046) but not with VE/VCO2. In contrast, CPO at peak exercise was positively correlated with peak VO2 (r = 0.50, p < 0.001) and inversely correlated with VE/VCO2 (r=-0.40, p = 0.002). Moreover, CPO at peak exercise determined both peak VO2 (b = 0.50) and VE/VCO2 (β=-0.54) independently of LV ejection fraction and E/e" at peak exercise. During a median follow-up period of 1211 days, 12 cardiac events were observed. Each of reduced peak VO2 (hazard ratio 0.78, 95% confidence interval 0.66-0.90) and increased VE/VCO2 (hazard ratio 1.10, 95% confidence interval 1.02-1.18) was associated with worse clinical outcome.
Conclusions
In patients with chronic heart failure, CPO during exercise was associated with prognosis of heart failure through the reduced exercise capacity and enhanced ventilatory response.
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Affiliation(s)
- H Aoyagi
- Hokkaido University, Sapporo, Japan
| | | | - H Iwano
- Hokkaido University, Sapporo, Japan
| | | | - Y Tamaki
- Hokkaido University, Sapporo, Japan
| | - K Motoi
- Hokkaido University, Sapporo, Japan
| | - Y Chiba
- Hokkaido University, Sapporo, Japan
| | - M Murayama
- Hokkaido University Hospital, Sapporo, Japan
| | - M Nakabachi
- Hokkaido University Hospital, Sapporo, Japan
| | - H Nishino
- Hokkaido University Hospital, Sapporo, Japan
| | - S Yokoyama
- Hokkaido University Hospital, Sapporo, Japan
| | - T Sato
- Hokkaido University, Sapporo, Japan
| | - S Kaga
- Hokkaido University, Sapporo, Japan
| | - T Nagai
- Hokkaido University, Sapporo, Japan
| | - T Anzai
- Hokkaido University, Sapporo, Japan
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Ishimitsu A, Tojo A, Hirao J, Yokoyama S, Ohira T, Murayama Y, Ishimitsu T, Kang D, Honda K, Ehara T, Ishida K, Ueda Y. AL-Kappa Primary Amyloidosis with Apolipoprotein A-IV Deposition. Intern Med 2022; 61:871-876. [PMID: 35296622 PMCID: PMC8987257 DOI: 10.2169/internalmedicine.7955-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 70-year-old woman with complaints of edema, general malaise, and hypotension was diagnosed with renal amyloidosis, and laser microdissection mass spectrometry revealed her amyloidosis to predominantly comprise the apolipoprotein A-IV type. The M-protein turned from negative to positive during the course, and a bone marrow biopsy showed smoldering myeloma. Treatment with bortezomib and dexamethasone failed to save her from heart failure six months after the onset. Western blotting of urine samples at the time of the renal biopsy showed that amyloid light-chain κ amyloidosis had been present since the onset. Unlike the myeloma, Congo red staining was positive in the plasma cells of the bone marrow.
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Affiliation(s)
- Akira Ishimitsu
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Akihiro Tojo
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Jun Hirao
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Shohei Yokoyama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Takehiro Ohira
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | - Yoshiki Murayama
- Department of Nephrology & Hypertension, Dokkyo Medical University, Japan
| | | | - Dedong Kang
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Japan
| | - Takashi Ehara
- Department of Pathology, Shinshu University School of Medicine, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Japan
| | - Yoshihiko Ueda
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Japan
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Yokoyama S, Fujita Y, Matsumura S, Yoshimura T, Kinoshita I, Watanabe T, Tabata H, Tsuji T, Ozawa S, Tamaki T, Nakatani Y, Oka M. Cribriform carcinoma in the lymph nodes is associated with distant metastasis, recurrence, and survival among patients with node-positive colorectal cancer. Br J Surg 2021; 108:e111-e112. [PMID: 33793704 DOI: 10.1093/bjs/znaa123] [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] [Received: 10/12/2020] [Accepted: 11/15/2020] [Indexed: 11/13/2022]
Abstract
Cribriform lymph node pattern is an independent risk factor for metachronous or synchronous distant metastasis in patients with stage III and IV node-positive colorectal cancer. Multivariable analysis in patients with stage III disease indicated that the cribriform pattern of carcinoma in the lymph nodes was an independent risk factor for recurrence and survival. Kaplan–Meier analysis demonstrated that the group with stage III cribriform-type lymph node carcinoma had shorter recurrence-free and overall survival times than the stage III group with the tubular type (P < 0.001).
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Affiliation(s)
- S Yokoyama
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - Y Fujita
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - S Matsumura
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Yoshimura
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - I Kinoshita
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Watanabe
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - H Tabata
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Tsuji
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - S Ozawa
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - T Tamaki
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - Y Nakatani
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
| | - M Oka
- Department of Surgery, National Hospital Organization Minami Wakayama Medical Centre, Wakayama, Japan
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Furuta T, Nakagawa I, Park H, Nakase K, Yokoyama S, Kotsugoi M, Takeshima Y, Nakase H. Thoracolumbar intraosseous spinal epidural arteriovenous fistulas after vertebral compression fracture: A case report and literature review. Surg Neurol Int 2021; 12:270. [PMID: 34221601 PMCID: PMC8247718 DOI: 10.25259/sni_349_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background: The pathophysiology of spinal epidural arteriovenous fistulas (SEAVFs) with perimedullary venous drainage remains to be elucidated. This report describes a case of intraosseous SEAVF in a patient with a history of a thoracolumbar vertebral fracture at the same level 10 years before presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. Case Description: A 71-year-old man presenting with progressive paraparesis was diagnosed with a SEAVF involving a previous Th12 and L1 vertebral compression fracture on which feeders from multiple segmental arteries converged. The interesting feature of this case was that the fistula was located in the fractured vertebral body. The fistula was totally obliterated by transarterial embolization of the segmental arteries followed by symptom improvement. Conclusion: We presented a rare case of an intraosseous SEAVF secondary to a thoracolumbar compression fracture with perimedullary venous reflux causing progressive myelopathy. The fistula was located in the fractured vertebral body.
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Affiliation(s)
- Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Masashi Kotsugoi
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Mitsui T, Nakagawa I, Kotsugi M, Park H, Yokoyama S, Myouchin K, Nakase H. Remarkable shrinkage of a thrombosed giant aneurysm by stent-assisted jam-packed coil embolization. Surg Neurol Int 2021; 12:328. [PMID: 34345469 PMCID: PMC8326107 DOI: 10.25259/sni_511_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Large and giant aneurysms are known to involve intra-aneurysmal thrombosis and present a poor prognosis because of compression of the surrounding brain tissue with enlargement of the aneurysm. These aneurysms are difficult to cure by endovascular treatment due to involvement of the vasa vasorum in their pathology. We report this technical note to describe stent-assisted jam-packed coil embolization for the treatment of a giant thrombosed aneurysm. Case Description: A 62-year-old man presented with right homonymous hemianopsia, and magnetic resonance imaging (MRI) showed a giant thrombosed aneurysm with poor wall contrast enhancement, which indicates little involvement of the vasa vasorum, at the terminal part of the left internal carotid artery. To block blood flow into the aneurysmal dome, stent-assisted “jam-packed” coil embolization was performed. For this, a braided stent was shortened to enhance metal coverage ratio and tight aneurysmal coil packing was performed using a hydrogel coil. Our technique resulted in complete obliteration of the aneurysm, and MRI performed 1 year later showed remarkable shrinkage of the aneurysm dome. Conclusion: Stent-assisted jam-packed coil embolization technique might be effective in shrinking the dome of giant thrombosed aneurysms with poor wall contrast enhancement.
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Affiliation(s)
- Takaaki Mitsui
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
| | - HunSoo Park
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery Nara Medical University, Kashihara, Nara, Japan
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Kajita N, Yoshida K, Morikawa E, Hirao K, Yokoyama S, Narita M. Predictor of buckwheat allergy in children based on challenge test results: a retrospective observational study in Japan. Eur Ann Allergy Clin Immunol 2021; 54:183-188. [PMID: 34218649 DOI: 10.23822/eurannaci.1764-1489.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Buckwheat (BW) is a major food allergen and one of the leading causes of food-induced anaphylaxis in Japan. The standard method of diagnosing food allergy is the oral food challenge (OFC). The BW-specific IgE (BW-sIgE) value is used to assess BW allergy but its utility is limited.The aim of the present study was to identify factors with predictive value for the diagnosis of BW allergy using the OFC.We evaluated 37 patients who were classified into the positive or negative group according to their OFC results. Ten patients (27.0%) showed objective or persistent, moderate, subjective symptoms during the OFC. The positive group had a significantly higher BW-sIgE/total IgE ratio than the negative group (p less than 0.001), but the total IgE (p = 0.139) and BW-sIgE (p = 0.130) did not differ significantly. Receiver operator characteristic (ROC) analysis showed that the BW-sIgE/total IgE ratio had a larger area under the curve (AUC, 0.885) than BW-sIgE (AUC, 0.667). The statistically optimal cut-off was 0.0058 for the BW-sIgE/total IgE ratio, which corresponded to a clinical sensitivity and specificity of 90.0% and 81.5%, respectively.BW-s IgE/total IgE ratio may be more useful predictor of BW OFC results than BW-s IgE.
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Affiliation(s)
- N Kajita
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - K Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - E Morikawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - K Hirao
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - S Yokoyama
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - M Narita
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Nakagawa I, Kotsugi M, Park H, Yokoyama S, Furuta T, Nakase K, Okamoto A, Myouchin K, Yamada S, Nakase H. Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging. Cerebrovasc Dis 2021; 50:597-604. [PMID: 34148038 DOI: 10.1159/000516888] [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: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vulnerable plaques are a strong predictor of cerebrovascular ischemic events, and high lipid core plaques (LCPs) are associated with an increased risk of embolic infarcts during carotid artery stenting (CAS). Recent developments in magnetic resonance (MR) plaque imaging have enabled noninvasive assessment of carotid plaque vulnerability, and the lipid component and intraplaque hemorrhage (IPH) are visible as high signal intensity areas on T1-weighted MR images. Recently, catheter-based near-infrared spectroscopy (NIRS) has been shown to accurately distinguish LCPs without IPH. This study aimed to determine whether the results of assessment of high LCPs by catheter-based NIRS correlate with the results of MR plaque imaging. METHODS We recruited 82 consecutive symptomatic carotid artery stenosis patients who were treated with CAS under NIRS and MR plaque assessment. Maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA), defined as max-LCBIMLA, and max-LCBI for any 4-mm segment in a target lesion, defined as max-LCBIAREA, were assessed by NIRS. Correlations were investigated between max-LCBI and MR T1-weighted plaque signal intensity ratio (T1W-SIR) and MR time-of-flight signal intensity ratio (TOF-SIR) in the same regions as assessed by NIRS. RESULTS Both T1W-SIRMLA and T1W-SIRAREA were significantly lower in the high LCP group (max-LCBI >504, p < 0.001 for both), while TOF-SIRMLA and TOF-SIRAREA were significantly higher in the high LCP group (p < 0.001 and p = 0.004, respectively). A significant linear correlation was present between max-LCBIMLA and both TIW-SIRMLA and TOF-SIRMLA (r = -0.610 and 0.452, respectively, p < 0.0001 for both). Furthermore, logistic regression analysis revealed that T1W-SIRMLA and TOF-SIRMLA were significantly associated with a high LCP assessed by NIRS (OR, 44.19 and 0.43; 95% CI: 6.55-298.19 and 0.19-0.96; p < 0.001 and = 0.039, respectively). CONCLUSIONS A high LCP assessed by NIRS correlates with the signal intensity ratio of MR imaging in symptomatic patients with unstable carotid plaques.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - HunSoo Park
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Takanori Furuta
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Kenta Nakase
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Kaoru Myouchin
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Syuichi Yamada
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery and Radiology, Nara Medical University, Nara, Japan
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Takeshima Y, Okamoto A, Yokoyama S, Nakagawa I, Nakase H. Unilateral Degenerative Facet Joint Pathology Eliciting Rapidly Progressive Cervical Spondylotic Myelopathy. Cureus 2021; 13:e14238. [PMID: 33959433 PMCID: PMC8093117 DOI: 10.7759/cureus.14238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a common age-related disease, but little is known concerning the impact of cervical facet degeneration in patients suffering from CSM without degenerative cervical spondylolisthesis or cervical instability. We report an instructive case of CSM with rapid neurological deterioration in which unilateral degenerative facet joint pathology at the affected spinal level and impressive radiological findings were observed. A 70-year-old female progressively developed C5 segmental myelopathy without any trauma within a two-week period. Radiological findings revealed C3-4 spinal canal stenosis with the emergence of increased intramedullary signal intensity on T2-weighted magnetic resonance imaging, articular surface damage at the left C3-4 facet joint on computed tomography, and unilateral “facet joint gap” on cervical radiogram, but did not meet the criteria of cervical instability or spondylolisthesis. This case suggests that some types of severe degenerative changes in cervical facet joints may contribute to cervical myelopathy, especially in cases with progressive neurological deterioration.
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Affiliation(s)
| | - Ai Okamoto
- Neurosurgery, Nara Medical University, Kashihara, JPN
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45
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Nakagawa I, Park HS, Kotsugi M, Yokoyama S, Nakase K, Furuta T, Myouchin K, Yamada S, Nakase H. Active management of the target P2Y12 reaction unit range in patients undergoing stent-assisted coil embolization for unruptured cerebral aneurysms. J Neurointerv Surg 2021; 13:1017-1021. [PMID: 33674394 DOI: 10.1136/neurintsurg-2020-017249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Platelet function tests have been increasingly adopted to measure patient responses to antiplatelet drugs, and to predict complications. However, no established optimal antiplatelet management for stent-assisted coil embolization (SAC) have been established. The purpose of the present study was to investigate the efficacy and feasibility of clopidogrel dose adjustment for active target P2Y12 reaction unit (PRU). METHODS A total of 202 consecutive patients undergoing SAC to treat unruptured intracranial aneurysms were prospectively recruited. All patients were given two antiplatelet agents starting 7 days prior to the procedure, and platelet function was measured with the VerifyNow test. Clopidogrel hyper-responsive patients received reduced dosing according to the values of follow-up PRUs before and 7, 14, 30, and 90 days after the procedure. Patients were divided into three groups according to clopidogrel responsiveness before treatment, and clinical outcomes and time in target PRU ranges (TTR) were analyzed. RESULTS No delayed ischemic or hemorrhagic events occurred that were associated with out-of-range PRU. PRU values in the hypo-responsive and hyper-responsive groups significantly improved 7 days after treatment with active target PRU management (p=0.05,<0.001, respectively). PRU values were controlled within the target PRU range with drug adjustment (p=0.034), and the time in TTR for all patients was 97% (4.8%-100%), which showed the feasibility of optimal control of PRU values with the protocol. CONCLUSION Active target PRU management can achieve control of optimal PRU values and may decrease perioperative ischemic and hemorrhagic events among patients undergoing SAC.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Hun Soo Park
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Kenta Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
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Morisaki Y, Nakagawa I, Ogawa Y, Yokoyama S, Furuta T, Saito Y, Nakase H. Ischemic Postconditioning Reduces NMDA Receptor Currents Through the Opening of the Mitochondrial Permeability Transition Pore and K ATP Channel in Mouse Neurons. Cell Mol Neurobiol 2020; 42:1079-1089. [PMID: 33159622 DOI: 10.1007/s10571-020-00996-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
Ischemic postconditioning (PostC) is known to reduce cerebral ischemia/reperfusion (I/R) injury; however, whether the opening of mitochondrial ATP-dependent potassium (mito-KATP) channels and mitochondrial permeability transition pore (mPTP) cause the depolarization of the mitochondrial membrane that remains unknown. We examined the involvement of the mito-KATP channel and the mPTP in the PostC mechanism. Ischemic PostC consisted of three cycles of 15 s reperfusion and 15 s re-ischemia, and was started 30 s after the 7.5 min ischemic load. We recorded N-methyl-D-aspartate receptors (NMDAR)-mediated currents and measured cytosolic Ca2+ concentrations, and mitochondrial membrane potentials in mouse hippocampal pyramidal neurons. Both ischemic PostC and the application of a mito-KATP channel opener, diazoxide, reduced NMDAR-mediated currents, and suppressed cytosolic Ca2+ elevations during the early reperfusion period. An mPTP blocker, cyclosporine A, abolished the reducing effect of PostC on NMDAR currents. Furthermore, both ischemic PostC and the application of diazoxide potentiated the depolarization of the mitochondrial membrane potential. These results indicate that ischemic PostC suppresses Ca2+ influx into the cytoplasm by reducing NMDAR-mediated currents through mPTP opening. The present study suggests that depolarization of the mitochondrial membrane potential by opening of the mito-KATP channel is essential to the mechanism of PostC in neuroprotection against anoxic injury.
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Affiliation(s)
- Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, Shijocho 840, Kashihara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Shijocho 840, Kashihara, Japan.
| | - Yoichi Ogawa
- Department of Neurophysiology, Nara Medical University, Shijocho 840, Kashihara, Japan
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Shijocho 840, Kashihara, Japan
| | - Takanori Furuta
- Department of Neurosurgery, Nara Medical University, Shijocho 840, Kashihara, Japan
| | - Yasuhiko Saito
- Department of Neurophysiology, Nara Medical University, Shijocho 840, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Shijocho 840, Kashihara, Japan
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Murayama M, Iwano H, Tsujinaga S, Nishino H, Yokoyama S, Nakabachi M, Sarashina M, Ishizaka S, Chiba Y, Okada K, Kaga S, Nishida M, Kamiya K, Nagai T, Anzai T. Simple echocardiographic scoring system to estimate left ventricular filling pressure based on visual assessment of time sequence of mitral and tricuspid valve opening. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1010] [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
Introduction
In the presence of elevated left ventricular (LV) filling pressure, mitral valve (MV) becomes to open early and precedes tricuspid valve (TV) opening in early diastole. Accordingly, time-delay of right ventricular inflow relative to LV inflow assessed by dual Doppler system was recently reported as a parameter of LV filling pressure. We assumed that visually-assessed time-delay of TV relative to MV opening could be a simple and alternative marker of elevated LV filling pressure.
Purpose
This study aimed to elucidate the clinical usefulness of the 2-dimensional echocardiographic scoring system, Visual assessment of time-difference between Mitral and Tricuspid valve opening (VMT) score, in patients with heart failure (HF).
Methods
We analyzed 119 consecutive HF patients who underwent echocardiography and cardiac catheterization within a day. Elevated LV filling pressure was defined as mean pulmonary arterial wedge pressure (PAWP) ≥15 mmHg. LV diastolic function was graded according to the ASE/EACVI recommendations. Time sequence of opening of MV and TV was visually assessed in the apical 4-chamber view and scored to 3 grades (0: TV opening first, 1: simultaneous, 2: MV opening first). When the inferior vena cava diameter was >21 mm and collapsed <20% during normal respiration, 1 point was added and VMT score was calculated as 4 grades from 0 to 3. We also investigated 113 patients without worsening HF at VMT scoring for cardiac events defined as worsening HF, LV assist device implantation, or cardiac death for 1 year after the echocardiography.
Results
VMT was scored as 0 in 20 patients, 1 in 50 patients, 2 in 37 patients, and 3 in 12 patients. PAWP was elevated in patients with VMT score of 2 and 3 (0: 10±5, 1: 12±4, 2: 22±8, 3: 28±4 mmHg, ANOVA P<0.001) (Figure). In overall patients, VMT≥2 predicted elevated PAWP with accuracy of 86%. When the accuracy was tested in patients with reduced (<40%, HFrEF) and preserved LV ejection fraction (≥40%) respectively, the accuracy was excellent in HFrEF (96% and 77%, respectively). Importantly, VMT≥2 also had good accuracy of 82% for elevated PAWP in 33 patients in whom recommendations usually cannot grade diastolic function due to monophasic LV inflow. In the sequential Cox models, the addition of VMT score to the model including the plasma brain natriuretic peptide (BNP) level and LV diastolic grading improved the predictive power for elevated PAWP (P<0.001). During the follow-up, 20 cardiac events were observed (6 worsening HF, 9 LV assist device implantation and 5 cardiac death). Kaplan-Meier analysis showed that the patients with VMT≥2 were at higher risk of cardiac events than those with VMT≤1 (log-rank test P<0.001) (Figure).
Conclusions
The VMT score was a simple and accurate marker of elevated LV filling pressure and has an incremental benefit over BNP and LV diastolic function grading. Moreover, it could be a novel prognostic marker in patients with HF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Murayama
- Hokkaido University Hospital, Sapporo, Japan
| | - H Iwano
- Hokkaido University Hospital, Sapporo, Japan
| | - S Tsujinaga
- Hokkaido University Hospital, Sapporo, Japan
| | - H Nishino
- Hokkaido University Hospital, Sapporo, Japan
| | - S Yokoyama
- Hokkaido University Hospital, Sapporo, Japan
| | - M Nakabachi
- Hokkaido University Hospital, Sapporo, Japan
| | - M Sarashina
- Hokkaido University Hospital, Sapporo, Japan
| | - S Ishizaka
- Hokkaido University Hospital, Sapporo, Japan
| | - Y Chiba
- Hokkaido University Hospital, Sapporo, Japan
| | - K Okada
- Hokkaido University, Sapporo, Japan
| | - S Kaga
- Hokkaido University, Sapporo, Japan
| | - M Nishida
- Hokkaido University Hospital, Sapporo, Japan
| | - K Kamiya
- Hokkaido University Hospital, Sapporo, Japan
| | - T Nagai
- Hokkaido University Hospital, Sapporo, Japan
| | - T Anzai
- Hokkaido University Hospital, Sapporo, Japan
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Hoshi K, Yoshitomi H, Aoki K, Tanimura Y, Tsujimura N, Yokoyama S. Eye lens dosimetry for workers at Fukushima Daiichi Nuclear Power Plant—1: Laboratory study on the dosemeter position and the shielding effect of full face mask respirators. RADIAT MEAS 2020. [DOI: 10.1016/j.radmeas.2020.106304] [Citation(s) in RCA: 3] [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: 10/24/2022]
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Narumiya Y, Yunoki K, Saiki M, Oga Y, Kishi Y, Yokoyama S, Kawabata T, Oshima Y, Hisamochi K, Yoshida H. [Mediastinal Bronchial Artery Aneurysm Resected together with the Descending Aorta under the Partial Extracorporeal Circulation;Report of a Case]. Kyobu Geka 2019; 72:939-941. [PMID: 31588114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bronchial artery aneurysm(BAA) is quite rare, but its rupture is often lethal. Once it is found, treatments should be aggressively considered. A 67-year-old woman was diagnosed to have a 26 mm mediastinal BAA on computed tomography (CT) which was performed for screening. CT revealed a very short inflow vessel of the BAA and arteriovenous fistula at the outflow. Considering these features of the aneurysm, endovascular interventions deemed difficult and surgery was carried out. Because of the fragility, the aneurysm was resected together with the descending aorta and the graft replacement was performed under partial extracorporeal circulation. The patient has no untoward event for 1 year postoperatively. Although most recent reports advocate endovascular interventions, we think surgical treatment is a variable option in selected patients. Careful evaluation for each BAA case would be essential to determine the treatment strategy.
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Affiliation(s)
- Yuto Narumiya
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizents Hospital, Hiroshima, Japan
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Yokoyama S, Nakagawa I, Kotsugi M, Wajima D, Wada T, Kichikawa K, Nakase H. Dural Arteriovenous Fistula Arising after Intracranial Surgery in Posterior Fossa of Nondominant Sinus: Two Cases and Literature Review. Asian J Neurosurg 2019; 14:602-606. [PMID: 31143294 PMCID: PMC6516029 DOI: 10.4103/ajns.ajns_5_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The results of recent clinical and experimental studies suggest that the most important factor associated with the pathogenesis of dural arteriovenous fistula (AVF) is sinus thrombosis and subsequent venous or intrasinus hypertension. Here, we describe two patients who each developed a dural AVF after a posterior fossa craniotomy on the side of the nondominant or hypoplastic transverse (TS)-sigmoid (SS) sinuses. A 63-year-old female underwent surgical resection of a meningioma in the left cerebellopontine angle. Preoperative subtraction digital angiography (DSA) revealed a hypoplastic, ipsilateral left TS-SS and the sinus occlusion was revealed after surgery. Sixteen months later, she presented with a progressive left retroauricular, pulse-synchronous bruit. An AVF in the left TS-SS region was diagnosed by DSA and treated with transvenous coil embolization. The patient recovered without neurological deterioration. A 56-year-old female underwent surgical removal of an epidermoid tumor in the right cerebellopontine angle. Preoperative DSA revealed severe, ipsilateral right TS stenosis and the sinus occlusion was revealed after surgery. Two years later, she presented with the progressive right retroauricular, pulse-synchronous bruit, which was diagnosed by DSA as dural AVF in the right TS-SS region. She was treated with transvenous coil embolization and recovered without neurological deterioration. Sinus manipulation during intracranial surgery carries a potential risk of dural AVF development and this should be carefully considered, even when the ipsilateral TS-SS is nondominant or appears hypoplastic.
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Affiliation(s)
- Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Daisuke Wajima
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Nara Prefecture, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Nara Prefecture, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara Prefecture, Japan
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