654 results on '"Hiroshi Okamoto"'
Search Results
2. Impact of Coronary Stent Design in Proximal Balloon Edge Dilation Technique for Bifurcation Percutaneous Coronary Intervention
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Teruyoshi Kume, Yoji Neishi, Koichiro Imai, Satoshi Koto, Yoshinobu Murasato, Terumasa Koyama, Ryotaro Yamada, Shiro Uemura, Hiroshi Okamoto, Ayano Enzan, Tomoko Tamada, and Yasuyuki Sudo
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Models, Anatomic ,business.industry ,medicine.medical_treatment ,Models, Cardiovascular ,Stent ,Percutaneous coronary intervention ,General Medicine ,Prosthesis Design ,Balloon ,Coronary Vessels ,Ostium ,Percutaneous Coronary Intervention ,Side branch ,Coronary stent ,medicine ,Humans ,Dilation (morphology) ,Stents ,Angioplasty, Balloon, Coronary ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, Optical Coherence ,Bifurcation - Abstract
The proximal optimizing technique (POT) -proximal balloon edge dilation (PBED) sequence for side branch (SB) dilatation with cross-over single-stent implantation decreases both strut obstruction at the SB ostium and stent deformation at the main branch (MB).The purpose of this experimental bench test was to assess the impact of stent design on stent deformation, obstruction by stent struts at a jailed SB ostium, and stent strut malapposition in the POT-PBED sequence.Fractal coronary bifurcation bench models (60- and 80-degree angles) were used, and crossover single-stent implantation (3-link stent: XIENCE Sierra, Abbott Vascular, Santa Clara, CA, n = 10; 2-link stent: Synergy, Boston Scientific, Marlborough, MA, n = 10) was performed from the MB using the POT-PBED sequence. Jailing rates at the SB ostium, stent deformation, and stent strut malapposition of the bifurcation segment were assessed using videoscopy and optical coherence tomography.After SB dilatation using the PBED technique, jailing rates at the SB ostium and stent deformation did not differ significantly between the two types of stents. Conversely, the rate of malapposed struts of the bifurcation segment after the PBED procedure was significantly lower with 3-link stents than with 2-link stents for both 60- and 80-degree angles (60-degree angle: 4.3% ± 4.4% versus 22.0% ± 11.1%, P = 0.044; 80-degree angle: 20.8% ± 15.1% versus 57.2% ± 17.0%, P < 0.001, respectively).In the POT-PBED sequence, 3-link stents might be a preferable coronary bifurcation stent, maintaining a jailed SB ostium while significantly reducing stent strut malapposition of the bifurcation segment when compared with 2-link stents.
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- 2021
3. Estimating Incidence of Acute Heart Failure Syndromes in Japan : An Analysis From the KUNIUMI Registry
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Soichiro Yamashita, Shunsuke Murata, Yutaka Hatani, Ryuji Toh, Takumi Inoue, Soshiro Ogata, Akihide Konishi, Masamichi Iwasaki, Koji Kuroda, Misa Takegami, Ken-ichi Hirata, Takatoshi Hayashi, Junichi Imanishi, Masanori Okuda, Masakazu Shinohara, Hiroshi Okamoto, Wataru Fujimoto, and Kunihiro Nishimura
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Male ,medicine.medical_specialty ,Population ,Aging society ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Acute care ,Humans ,Medicine ,Registries ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Mean age ,Syndrome ,General Medicine ,Prognosis ,medicine.disease ,Acute heart failure syndrome ,Heart failure with preserved ejection fraction ,Heart failure ,Acute Disease ,Emergency medicine ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Few registries have provided precise information concerning incidence rates for acute heart failure syndrome (AHFS) in Japan.Methods and Results:All hospitals with acute care beds in Awaji Island participated in the Kobe University heart failure registry in Awaji Medical Center (KUNIUMI Registry), a retrospective, population-based AHFS registration study, enabling almost every patient with AHFS in Awaji Island to be registered. From 1 January 2015 to 31 December 2017, 743 patients with de novo AHFS had been registered. Mean age was 82.1±11.5 years. Using the general population of Japan as of 2015 as a standard, age- and sex-adjusted incidence rates for AHFS were 133.8 per 100,000 person-years for male and 120.0 for female. In 2015, there were an estimated 159,702 new-onset patients with AHFS, which was predicted to increase to 252,153 by 2040, and reach a plateau. The proportion of patients aged >85 years accounted for 42.6% in 2015, which was predicted to increase up to 62.5% in 2040. The proportion of patients with heart failure with preserved ejection fraction was estimated at 52.0% in 2015, which was predicted to increase gradually to 57.3% in 2055. Conclusions The present analysis suggested that the number of patients with de novo AHFS keeps increasing with progressive aging in Japan. Establishment of countermeasures against the expanding burden of HF is urgently required.
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- 2021
4. Thoracoscopic esophagectomy for esophageal carcinoma after peroral endoscopic myotomy for esophageal achalasia: a case report
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Yusuke Gokon, Junichi Tsunokake, Toshiaki Fukutomi, Takuro Yamauchi, Yusuke Taniyama, Hiroshi Okamoto, Fumiyoshi Fujishima, Ryujiro Akaishi, Makoto Horiuchi, Chiaki Sato, Yohei Ozawa, Ken Koseki, Takashi Kamei, Michiaki Unno, and Naoto Ujiie
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Myotomy ,Lamina propria ,medicine.medical_specialty ,RD1-811 ,business.industry ,medicine.medical_treatment ,Thoracoscopic esophagectomy ,Esophageal achalasia ,Achalasia ,Case Report ,medicine.disease ,Dysphagia ,Surgery ,Dissection ,medicine.anatomical_structure ,Peroral endoscopic myotomy (POEM) ,Submucosa ,medicine ,Carcinoma ,otorhinolaryngologic diseases ,Esophagus ,medicine.symptom ,business - Abstract
Background Esophageal achalasia causes dysphagia following impaired relaxation of the lower esophageal sphincter due to the degeneration of Auerbach’s plexus in the esophageal smooth muscle. Recently, peroral endoscopic myotomy (POEM) has become one of the preferred treatment options for esophageal achalasia. However, pathomorphological changes after POEM have not been well examined. Case presentation A 65-year-old man with a history of POEM for esophageal achalasia was diagnosed with clinical stage II (cT2-N0-M0) thoracic esophageal squamous cell carcinoma and was consequently treated with neoadjuvant chemotherapy followed by thoracoscopic esophagectomy. Intraoperatively, the esophagus appeared dilated, reflecting esophageal achalasia; however, fairly slight fibrous adhesions were observed between the esophagus and the pericardial surface despite previously performed POEM via an anterior incision. Histopathological examination revealed esophageal wall thickening, edema, and fibrosis extending from the lamina propria to the submucosa. Besides, the majority of the inner layer and some proportion of the outer layer of the muscularis propria were found to be missing or atrophic at the esophagogastric junction (EGJ). No ganglion cells could be detected at the Auerbach’s plexus. Conclusions The previous history of POEM did not affect circumferential mediastinal periesophageal dissection during thoracoscopic esophagectomy. Nevertheless, a large proportion of the inner layer of the muscularis propria at the EGJ level seemed to have become lost or atrophic because of the POEM procedure.
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- 2021
5. Effects of Active Learning Education on Arterial Stiffness of Older Adults with Low Health Literacy: A Randomized Controlled Trial
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Hiroshi Okamoto, Kazuki Uemura, Minoru Yamada, and Masafumi Kuzuya
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Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,medicine.medical_treatment ,Health Promotion ,030204 cardiovascular system & hematology ,Cardiovascular ,Metabolic equivalent ,law.invention ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal Medicine ,Humans ,Medicine ,Exercise ,Health Education ,Aged ,Rehabilitation ,Physical activity ,business.industry ,Biochemistry (medical) ,Problem-Based Learning ,Prognosis ,medicine.disease ,Preventative health care ,Confidence interval ,Health Literacy ,Health promotion ,Behavioral change ,Case-Control Studies ,Active learning ,Arterial stiffness ,Physical therapy ,Female ,Original Article ,Health education ,Independent Living ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Aim: We examined the effects of active learning education on arterial stiffness and physical activity of community-dwelling older adults with low health literacy. Methods: This study is a secondary analysis of randomized controlled trial of 60 participants aged 65 and older with low health literacy. The intervention group ( n =30) participated in a weekly 90-minute active learning program session for 24 weeks, which addressed health promotion in older age. The control group ( n =30) attended a 90-minute health education class in a didactic manner. The outcomes were measured at baseline and in week 24. The degree of arterial stiffness was assessed based on the cardio-ankle vascular index (CAVI) using the VS-1500 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). The shortened version of the self-reported International Physical Activity Questionnaire was used to assess the amount of total physical activity determined by the metabolic equivalent hours per week. We used analysis by intention-to-treat, with multiple imputation for missing data. Results: Seven participants (11.7%) dropped out prior to the post-intervention assessment. The multiple imputation analysis revealed that the intervention group showed significant improvement in CAVI [between-groups difference (95% confidence interval)=-0.78 (-1.25 to -0.31), Cohen’s d =0.82] and physical activity [32.5 (0.3 to 64.7), Cohen’s d =0.57] as compared with the control group. The sensitivity analysis for the complete cases showed similar results. Conclusion: Active learning health education may be effective in improving arterial stiffness and physical activity in older adults with low health literacy.
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- 2021
6. Prevalence and predictors of hospital-acquired functional decline in patients with sepsis admitted to the intensive care unit
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Tetsuya Takahashi, Toshiyuki Fujiwara, Hiroshi Okamoto, Kazuhiro Aoki, Tomoyuki Morisawa, Masakazu Saitoh, and Yuta Takahashi
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medicine.medical_specialty ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,law.invention ,Sepsis ,law ,Internal medicine ,Prevalence ,Humans ,Medicine ,Hospital Mortality ,Retrospective Studies ,Rehabilitation ,business.industry ,Confounding ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Intensive care unit ,Hospitals ,Confidence interval ,Hospitalization ,Intensive Care Units ,business - Abstract
Although sepsis is known to cause functional decline, the prevalence and predictors of hospital-acquired functional decline (HAFD) in patients with sepsis are unclear. The purpose of this study was to investigate the prevalence and predictors of HAFD in patients with sepsis admitted to the ICU. This study is a single-center retrospective observational study from January 2014 to December 2019. We included all consecutive patients with sepsis who received rehabilitation in our ICU. The primary outcome was HAFD, which was defined as a decrease in at least five points of the Barthel index mobility score from prehospital to hospital discharge. We described the prevalence of HAFD and investigated the predictors of HAFD using the multivariate logistic regression analysis adjusting for potential confounders. Among 134 patients, 57 patients (42.5%) had HAFD. The longer time to initial ambulation and lower prehospital walking ability were associated with HAFD (adjusted odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.10 and adjusted OR 0.79; 95% CI, 0.66-0.95, respectively). In conclusion, nearly half of the patients with sepsis who received rehabilitation developed HAFD. Lower functional status prior to hospitalization and the longer time to initial ambulation was associated with HAFD, indicating the potential importance of early ambulation among septic patients in the ICU.
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- 2021
7. Characteristics of esophageal achalasia in geriatric patients over 75 years of age and outcomes after peroral endoscopic myotomy
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Yusuke Taniyama, Hiroshi Okamoto, Takashi Kamei, Michiaki Unno, Ken Koseki, Naoto Ujiie, Toshiaki Fukutomi, Chiaki Sato, and Kai Takaya
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Natural Orifice Endoscopic Surgery ,Myotomy ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Achalasia ,otorhinolaryngologic diseases ,medicine ,Humans ,Effective treatment ,In patient ,education ,Digestive System Surgical Procedures ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,medicine.disease ,Esophageal Achalasia ,Pneumonia ,Treatment Outcome ,Esophagoscopy ,Young group ,business ,Silent aspiration - Abstract
As the population ages, the proportion aged ≥75 years is expected to increase. Many studies on peroral endoscopic myotomy (POEM) as treatment for esophageal achalasia have already been reported; however, few studies have been designed on patients aged ≥75 years. The purpose of this study is to describe the characteristics of esophageal achalasia in patients75 years and to evaluate the outcomes of POEM.This study included 121 patients who underwent POEM for esophageal achalasia, which was divided into the geriatric (n = 18) group aged ≥75 and the young (n = 103) group ≤74 years. The characteristics of esophageal achalasia and the short-term outcomes after POEM in the geriatric group compared with the young group were retrospectively investigated.The median age of the geriatric group was 78 years, and two patients were initially diagnosed with refractory pneumonia, and esophageal achalasia was initially overlooked. The preoperative Eckardt score of the geriatric group was significantly lower than that of the young group (4 vs. 6, P = 0.007), particularly in the regurgitation score. The Eckardt score and integrated relaxation pressure of both groups were significantly improved after POEM (P 0.001). There were no cases of perioperative complications in the geriatric group.POEM for esophageal achalasia is a safe and effective treatment even in geriatric patients75 years of age. In geriatric patients with recurrent or intractable pneumonia, it is important to rule out esophageal achalasia. Geriatr Gerontol Int 2021; 21: 788-793.
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- 2021
8. Precipitating factors and clinical impact of early rehospitalization for heart failure in patients with heart failure in Awaji Island, Japan
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Ryuji Toh, Junichi Imanishi, Takumi Inoue, Masamichi Iwasaki, Wataru Fujimoto, Koji Kuroda, Soichiro Yamashita, Tomoyo Hamana, Yutaka Hatani, Akihide Konishi, Takatoshi Hayashi, Ken-ichi Hirata, Hiroshi Okamoto, Masakazu Shinohara, and Masanori Okuda
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medicine.medical_specialty ,Poor prognosis ,030204 cardiovascular system & hematology ,Patient Readmission ,Cardiovascular death ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Risk Factors ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged, 80 and over ,Heart Failure ,Hospital readmission ,business.industry ,Mortality rate ,Mean age ,Precipitating Factors ,medicine.disease ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Recent reports have revealed that patients who experienced early rehospitalization for heart failure (HF) had worse prognoses in terms of all-cause and cardiovascular deaths as compared to those who did not. However, precipitating factors for early rehospitalization for HF remain unknown. In this study, we assessed the precipitating factors for early rehospitalization and their impact in patients with HF.We consecutively included 242 patients (mean age: 80.4 years, females: 46.3%) with a history of rehospitalization for HF. They were divided into 2 groups: the early rehospitalization group (71 patients who were readmitted within 3 months of discharge) and the late rehospitalization group (171 patients who were readmitted after more than 3 months following discharge). During the mean follow-up period of 1,144 days (range: 857-1,417 days), 121 patients (50.0%) died. Kaplan-Meier analysis revealed that patients in the early rehospitalization group had worse prognosis (all-cause death and cardiovascular death) than those in the late rehospitalization group (log-rank p0.001). As the major precipitating factor for rehospitalization, poor compliance with the doctor's instructions on fluid and physical activity restrictions (determined by the patients or their families admittance of non-compliance with the instructions given at the time of discharge) was higher in the early rehospitalization group than in the late rehospitalization group [poor compliance with fluid restriction: 19.7% vs. 7.6% (p = 0.006), poor compliance with physical activity restriction: 21.1% vs. 9.4% (p = 0.013)].We concluded that early hospital readmission in patients with HF was associated with higher mortality rates. Compared to late rehospitalization, precipitating factors for early rehospitalization were more strongly dependent on the self-care behaviors of the patients. A more effective approach, such as multidisciplinary intervention, is essential to prevent early hospital readmission and subsequent poor prognosis.
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- 2021
9. Association Between Repeated Tracheal Intubation Attempts and Adverse Events in Children in the Emergency Department
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Yuri Kunitani, Yusuke Hagiwara, Tadahiro Goto, Hiroko Watase, Hiroshi Okamoto, Kohei Hasegawa, and Hiraku Funakoshi
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Tracheal intubation ,General Medicine ,Emergency department ,Heart Arrest ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Intubation, Intratracheal ,Emergency Medicine ,medicine ,Humans ,Prospective Studies ,Airway Management ,Child ,Emergency Service, Hospital ,Adverse effect ,business - Abstract
Studies have shown that multiple intubation attempts are associated with a higher risk of intubation-related adverse events. However, little is known about the relationship in children in the emergency department (ED).This is an analysis of the data from 2 prospective, observational, multicenter registries of emergency airway management. The data were collected from consecutive patients who underwent emergency airway management in 19 EDs across Japan from March 2010 to November 2017. We included children 18 years or younger who underwent tracheal intubation in the ED. The primary exposure was the number of intubation attempts (1 vs ≥2). The primary outcome was an adverse event during or immediately after the intubation.A total of 439 children were eligible for the analysis. Of 279 children with first-pass success, 24 children (9%) had an adverse event. By contrast, of 160 children with ≥2 intubation attempts, 50 children patients (31%) had an adverse event. In the unadjusted model, multiple intubation attempts were significantly associated with a higher rate of adverse events (unadjusted odds ratio, 4.83; 95% confidence interval, 2.57-9.06; P0.001). This association remained significant after adjusting for 7 potential confounders and patient clustering within the hospital (adjusted odds ratio, 4.49; 95% confidence interval, 2.36-8.53; P0.001). Similar associations were found across different age groups and among children without cardiac arrest (all, P0.05).In this analysis of large prospective multicenter data, multiple intubation attempts were associated with a significantly higher rate of intubation-related adverse events in children in the ED.
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- 2021
10. Longitudinal Effects of Active Learning Education on Lifestyle Behavior and Physical Function in Older Adults
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Tsukasa Kamitani, Minoru Yamada, Hiroshi Okamoto, and Kazuki Uemura
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medicine.medical_specialty ,Activities of daily living ,Health Promotion ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Activities of Daily Living ,medicine ,Humans ,030212 general & internal medicine ,Group work ,Exercise ,Life Style ,General Nursing ,Aged ,business.industry ,Health Policy ,Behavior change ,Problem-Based Learning ,General Medicine ,Physical activity level ,Health promotion ,Active learning ,Physical therapy ,Health education ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
Objectives Sustaining benefits of an exercise program is difficult as adherence is often poor after supervised intervention is over. This study aimed to determine whether the effects of active learning education on physical activity, dietary habits, and physical function were maintained 24 weeks after intervention termination in older adults. Design Non-randomized controlled trial. Setting and Participants Community-dwelling older adults aged ≥65 years who were independent in activities of daily living. Methods The intervention group (n = 36) underwent 24 weeks of active learning education. The control group (n = 59) attended a health education class didactically. In both groups, the education program focused on exercise, diet and nutrition, and cognitive activity for health promotion. Active learning included exploratory learning, group work, and self-planning for behavior change that promoted healthy lifestyles. Outcome measures were obtained at baseline (pre), 24 weeks (post), and 48 weeks (follow-up). Physical activity was objectively measured as physical activity level (PAL) using a triaxial accelerometer. Food intake was assessed by obtaining a dietary variety score. Physical function, including gait speed and Timed Up & Go score, was tested as secondary outcome. We used a linear mixed model to estimate the effects of intervention in intention-to-treat analyses. Results All outcomes in the intervention group significantly improved compared with the control group at 24 weeks, and the improvements were sustained over a 48-week follow-up period. For PAL, between-group difference in change from baseline was 0.043 (95% confidence interval = 0.007, 0.080) at 24 weeks and 0.061 (0.023, 0.099) at 48 weeks. Conclusions and Implications Active learning education is effective in enhancing healthy lifestyles and physical function sustainability beyond intervention cessation. A randomized controlled trial with a larger sample size is needed to conclusively clarify the beneficial effects of active health education learning on sustainable behavior change and functional improvement.
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- 2021
11. Development and validation of the predictive risk of death model for adult patients admitted to intensive care units in Japan: an approach to improve the accuracy of healthcare quality measures
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Nao Ichihara, Tomoyuki Nakamura, Yoshitaka Aoki, Eiji Hashiba, Satoru Hashimoto, Hideki Endo, Hiroaki Miyata, Tatsuya Kawasaki, Takashi Tagami, Kohei Takimoto, Katsura Hayakawa, Hiromasa Irie, Junji Kumasawa, Hiroshi Okamoto, Hidenobu Shigemitsu, Hiroshi Kurosawa, Masatoshi Uchida, Junji Hatakeyama, Shigehiko Uchino, Shunsuke Takaki, and Hiroyuki Ohbe
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Funnel plot ,medicine.medical_specialty ,Quality indicator ,Recalibration ,Critical Care and Intensive Care Medicine ,01 natural sciences ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Overdispersion ,Intensive care ,Medicine ,030212 general & internal medicine ,EWMA chart ,0101 mathematics ,Quality improvement ,Receiver operating characteristic ,business.industry ,Research ,Generalized additive model ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Risk of death ,lcsh:RC86-88.9 ,Benchmarking ,Standardized mortality ratio ,Brier score ,Emergency medicine ,business ,Risk prediction model - Abstract
Background The Acute Physiology and Chronic Health Evaluation (APACHE) III-j model is widely used to predict mortality in Japanese intensive care units (ICUs). Although the model’s discrimination is excellent, its calibration is poor. APACHE III-j overestimates the risk of death, making its evaluation of healthcare quality inaccurate. This study aimed to improve the calibration of the model and develop a Japan Risk of Death (JROD) model for benchmarking purposes. Methods A retrospective analysis was conducted using a national clinical registry of ICU patients in Japan. Adult patients admitted to an ICU between April 1, 2018, and March 31, 2019, were included. The APACHE III-j model was recalibrated with the following models: Model 1, predicting mortality with an offset variable for the linear predictor of the APACHE III-j model using a generalized linear model; model 2, predicting mortality with the linear predictor of the APACHE III-j model using a generalized linear model; and model 3, predicting mortality with the linear predictor of the APACHE III-j model using a hierarchical generalized additive model. Model performance was assessed with the area under the receiver operating characteristic curve (AUROC), the Brier score, and the modified Hosmer–Lemeshow test. To confirm model applicability to evaluating quality of care, funnel plots of the standardized mortality ratio and exponentially weighted moving average (EWMA) charts for mortality were drawn. Results In total, 33,557 patients from 44 ICUs were included in the study population. ICU mortality was 3.8%, and hospital mortality was 8.1%. The AUROC, Brier score, and modified Hosmer–Lemeshow p value of the original model and models 1, 2, and 3 were 0.915, 0.062, and < .001; 0.915, 0.047, and < .001; 0.915, 0.047, and .002; and 0.917, 0.047, and .84, respectively. Except for model 3, the funnel plots showed overdispersion. The validity of the EWMA charts for the recalibrated models was determined by visual inspection. Conclusions Model 3 showed good performance and can be adopted as the JROD model for monitoring quality of care in an ICU, although further investigation of the clinical validity of outlier detection is required. This update method may also be useful in other settings.
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- 2021
12. Influence of dual antiplatelet therapy duration on neointimal condition after second-generation drug-eluting stent implantation
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Kenzo Fukuhara, Ryotaro Yamada, Yoji Neishi, Ai Kawamura, Yutaka Goryo, Shiro Uemura, Teruyoshi Kume, Hiroshi Okamoto, Tomoko Tamada, Koichiro Imai, and Terumasa Koyama
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Neointima ,medicine.medical_specialty ,animal structures ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,Aspirin ,medicine.diagnostic_test ,Optical coherence tomography ,business.industry ,Antiplatelet therapy ,Percutaneous coronary intervention ,Stent ,Retrospective cohort study ,Interventional radiology ,Drug-Eluting Stents ,General Medicine ,medicine.disease ,Treatment Outcome ,Drug-eluting stent ,Cardiology ,Original Article ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,Tomography, Optical Coherence ,medicine.drug - Abstract
Guidelines recommend shorter duration (1–12 months) for dual antiplatelet therapy (DAPT) in the second-generation drug-eluting stent (DES) era. However, whether shorter DAPT duration affects stent strut conditions and neointimal characteristics at mid-term follow-up remains uncertain. Therefore, we studied the relation between DAPT duration and vascular healing response as assessed by optical coherence tomography (OCT). This study was retrospective observational study. Participants comprised 64 patients who underwent serial OCT at both 9 and 18 months after DES implantation. All patients received DAPT until the 9-month follow-up then were divided into two groups: 49 patients who continued DAPT (longer DAPT group); and 15 patients who stopped taking the P2Y12 inhibitor and were treated with aspirin alone (shorter DAPT group) at the 18-month follow-up. Using OCT, we evaluated and compared stent strut conditions and neointimal characteristics between groups at both 9 and 18 months after stent implantation. Baseline clinical and procedural parameters were mostly similar between groups. At the 18-month follow-up, no in-stent thrombus assessed by OCT was observed in either group. No significant differences in OCT characteristics or measurements of neointima were seen between groups at 9- or 18-month follow-ups. Neointimal volume increased from 9 to 18 months in both groups, with a similar degree of neointimal proliferation in both groups (shorter DAPT group, 0.23 ± 0.29 mm3/mm; longer DAPT group, 0.19 ± 0.27 mm3/mm; P = 0.56). In conclusion, interrupting DAPT 9 months after second-generation DES implantation did not affect the development of in-stent thrombus, neointimal proliferation or stent strut coverage at 18-month follow-up compared with continuing DAPT.
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- 2021
13. Reduction anesthesia time on spinal navigation surgery - by collaborative work of improvement group
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Nana Itoh, Kohei Tanaka, Takashi Kano, Nae Hinata, Hiroshi Okamoto, Youhei Oikawa, Tetuya Shimamine, Souhei Ebara, Fuminori Kamijo, Masao Takagi, Ryosuke Kasai, Minoru Ogino, Kazuhiko Shinohara, and Sunao Takeda
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medicine.medical_specialty ,Work (electrical) ,Group (mathematics) ,business.industry ,Anesthesia ,medicine.medical_treatment ,medicine ,business ,Reduction (orthopedic surgery) ,Surgery - Published
- 2021
14. A Case of Delayed Penetration of the Esophagus after Mesh Repair for Esophageal Hiatal Hernia Treated with Double Tract Reconstruction
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Chiaki Satoh, Hiroshi Okamoto, Toshiaki Fukutomi, Kai Takaya, Ryohei Ando, Yusuke Taniyama, and Takashi Kamei
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medicine.medical_specialty ,medicine.anatomical_structure ,Mesh repair ,business.industry ,Gastroenterology ,medicine ,Surgery ,Penetration (firestop) ,Esophagus ,business ,Esophageal hiatal hernia ,Esophageal hiatus hernia - Published
- 2020
15. Treatment of Aortic Graft Infection with in Situ Replacement with a Superficial Femoral Vein Graft
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Yasuyuki Fujimoto, Akinori Tamenishi, Junji Yanagisawa, Hiroshi Okamoto, and Chikao Teramoto
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Microbiology (medical) ,Aortic graft ,In situ ,medicine.medical_specialty ,business.industry ,Immunology ,medicine ,Femoral vein ,Immunology and Allergy ,business ,Surgery - Published
- 2020
16. A successful case of percutaneous transluminal septal myocardial ablation for left ventricular outflow tract obstruction caused by sigmoid septum
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Yutaka Hatani, Wataru Fujimoto, Hiroshi Okamoto, Tatsuya Kokawa, Tomoyo Hamana, Hiromasa Otake, Yuta Fukuishi, Takumi Inoue, Masamichi Iwasaki, Koji Kuroda, Susumu Odajima, Takatoshi Hayashi, and Masanori Okuda
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medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Ventricular outflow tract obstruction ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Mitral valve ,Internal medicine ,Ascending aorta ,medicine ,Valsalva maneuver ,Ventricular outflow tract ,cardiovascular diseases ,030212 general & internal medicine ,Interventricular septum ,business.industry ,Catheter ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A sigmoid septum is a state of angulation between the basal interventricular septum and the ascending aorta. Although considered to have no clinical importance, it may cause left ventricular outflow tract obstruction (LVOTO) in a hypercontractile state. Percutaneous transluminal septal myocardial ablation (PTSMA) is a catheter-based therapy aimed at improving drug-refractory symptoms in patients with hypertrophic obstructive cardiomyopathy. Few studies have reported the use of PTSMA for patients with LVOTO caused by sigmoid septum. We present a successful case of a 71-year-old female patient who presented with a long history of exertional dyspnea. The presence of a sigmoid septum was revealed on echocardiography. At rest, the left ventricular outflow tract pressure gradient was low and there were no signs of systolic anterior motion (SAM) of the mitral valve; however, during Valsalva maneuver, the gradient increased significantly, and SAM could be seen. We successfully performed PTSMA, resulting in a significant lowering of the pressure gradient and disappearance of SAM. The patient’s symptoms dramatically improved by the following day.
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- 2020
17. A review of autonomous agricultural vehicles (The experience of Hokkaido University)
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Hiroshi Okamoto, Ali Roshanianfard, Kazunobu Ishii, and Noboru Noguchi
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Future studies ,Process (engineering) ,Computer science ,business.industry ,Mechanical Engineering ,010401 analytical chemistry ,Control unit ,04 agricultural and veterinary sciences ,01 natural sciences ,0104 chemical sciences ,Unit (housing) ,Agriculture ,Component (UML) ,Sustainable agriculture ,040103 agronomy & agriculture ,Systems engineering ,0401 agriculture, forestry, and fisheries ,Performance indicator ,business - Abstract
Robotic farming will play an undeniably significant role in future sustainable agriculture. Autonomous agricultural vehicles for arable crops and their components are reviewed herein, and their differing possible components, advantages and disadvantages are discussed. The autonomous agricultural vehicles are qualified from technical points of view, including each vehicle's hardware unit (platform development, platform, transporter system, operation functions, communication, sensors [positional sensor, attitude sensor, and safety sensor], and control unit), the physical environment, and the control algorithm. The development process for different vehicles is described. As an operational case study, all investigations conducted at Hokkaido University between 1990 and 2018 are discussed and evaluated based on the described classification. The development procedure, the process of component selection, developmental challenges, and the performance indicators of the vehicles are discussed in detail. The development process and applicability of each component are then presented, and recommendations for future studies are noted. Finally, the most important experiences and lessons, and some recommendations are outlined.
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- 2020
18. Esophagectomy for Esophageal Cancer in a Patient with Protein C Deficiency: A Case Report
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Kai Takaya, Takashi Kamei, Toshiaki Fukutomi, Hiroshi Okamoto, Naoto Ujiie, Yusuke Taniyama, and Chiaki Sato
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,protein C deficiency ,Necrosis ,medicine.medical_treatment ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Protein C deficiency ,Medicine ,Thrombus ,Vein ,thrombus formation ,business.industry ,Gastroenterology ,perioperative management ,General Medicine ,Heparin ,Esophageal cancer ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Esophagectomy ,esophagectomy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Artery ,medicine.drug - Abstract
A 63-year-old man with protein C deficiency underwent thoracoscopic esophagectomy and digestive reconstruction using a gastric tube for thoracic esophageal cancer. On postoperative day 3, the gastric tube was removed because of anastomotic leakage and gastric tube necrosis. Digestive reconstruction using a free jejunal graft was attempted 140 days after the first surgery. However, thrombus formation in the artery and vein of the jejunal graft resulted in a failed reconstruction. Ten days after this surgery, digestive reconstruction using the colon was performed with intraoperative heparin administered for anticoagulation control. The surgery was successful, with no thrombus formation afterward. When performing digestive reconstruction in patients with conditions predisposing to thrombus formation, perioperative management should be completed with careful attention toward preventing thrombus formation. In particular, appropriate anticoagulation control, such as the administration of intraoperative heparin, is recommended in patients with protein C deficiency because necrosis of the reconstructed organ is likely.
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- 2020
19. Laser Pouch Motors: Selective and Wireless Activation of Soft Actuators by Laser-Powered Liquid-to-Gas Phase Change
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Yoshihiro Kawahara, Noriaki Kida, Ryuma Niiyama, Koya Narumi, Ken-ichi Nakahara, Naoki Takamura, Takefumi Hiraki, and Hiroshi Okamoto
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0209 industrial biotechnology ,Control and Optimization ,business.industry ,Computer science ,Mechanical Engineering ,Biomedical Engineering ,Electrical engineering ,Soft robotics ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Laser ,Computer Science Applications ,law.invention ,Human-Computer Interaction ,020901 industrial engineering & automation ,Artificial Intelligence ,Control and Systems Engineering ,law ,Wireless ,Robot ,Computer Vision and Pattern Recognition ,0210 nano-technology ,business ,Actuator - Abstract
Untethered control of soft-bodied robots is attractive for interactions in a variety of unstructured and dynamic environments. However, soft robotics systems are currently limited in terms of wireless, selective, and scalable control of multiple actuators. Therefore, we propose a method to wirelessly drive multiple soft actuators by laser projection. A small amount of low-boiling-point liquid inside a planar thin pouch can be heated by a laser and evaporated to inflate the whole body. Laser projection enables both wireless energy supply and the selection of target actuators. Further, the low-boiling-point liquid serves as an actuation source and as a receiver of laser irradiation. Thus, we do not need additional components such as electric circuits and batteries to achieve simple and scalable implementation of multiple soft actuators. We evaluated the mechanical properties and demonstrated that the system can wirelessly control the gestures of fingers of a robot hand. We also verified that our method can activate a group of mobile soft robots simultaneously and individually while tracking the actuator positions. Our approach contributes to the scalable deployment of soft robotic systems by removing tethers for power and communication.
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- 2020
20. Prognostic Impact of the Clinical Frailty Scale After Balloon Aortic Valvuloplasty
- Author
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Tomoyo Hamana, Wataru Fujimoto, Ryota Masaki, Yuta Fukuishi, Toshiro Shinke, Koji Kuroda, Takatoshi Hayashi, Ken-ichi Hirata, Yutaka Hatani, Tatsuya Kokawa, Susumu Odajima, Takumi Inoue, Masamichi Iwasaki, Masanori Okuda, and Hiroshi Okamoto
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Aortic stenosis ,medicine.medical_treatment ,Original article ,Hemodynamics ,General Medicine ,Balloon ,medicine.disease ,Aortic valvuloplasty ,Stenosis ,Valve replacement ,Aortic valve replacement ,Valvular Heart Disease ,Internal medicine ,Cohort ,medicine ,Cardiology ,Clinical frailty scale ,business ,Balloon aortic valvuloplasty - Abstract
Background: The clinical frailty scale (CFS) predicts late mortality in patients undergoing transcatheter aortic valve replacement. We evaluated the CFS and other parameters associated with 1-year mortality after balloon aortic valvuloplasty (BAV). Methods and Results: Between January 2013 and May 2018, 148 patients with severe aortic stenosis (AS) who underwent BAV at the present hospital were enrolled. We recorded pre-procedural CFS grade, baseline characteristics, echocardiographic, and hemodynamic parameters. To investigate the potential risk to patients before BAV, we evaluated the Society of Thoracic Surgeons (STS) score. After patients who underwent surgical aortic valve replacement, transcatheter aortic valve replacement or repeat BAV were excluded, we investigated 1-year survival. Of 127 patients, 41 (32.3%) died ≤1 year after BAV, 8 of whom (19.5% of all-cause deaths) had cardiac deaths. Higher grade of CFS and STS score significantly correlated with 1-year mortality. Severe frailty and the high operative risk group (CFS ≥7 and STS score ≥8.7%) had an extremely poor prognosis (1-year mortality, 81.2%). Conclusions: In this BAV cohort, severe frailty was a predictor of 1-year mortality in elderly patients with severe AS.
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- 2020
21. Multiple carcinosarcomas of the esophagus with adeno-carcinomatous components: A case report
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Hiroshi Naganuma, Hiroshi Okamoto, Takashi Kamei, and Hiroshi Kikuchi
- Subjects
Multiple carcinosarcomas ,Male ,Pathology ,medicine.medical_specialty ,Esophageal Neoplasms ,viruses ,Adenocarcinoma ,Neoplasms, Multiple Primary ,03 medical and health sciences ,Esophagus ,0302 clinical medicine ,Carcinosarcoma ,Case report ,Biomarkers, Tumor ,otorhinolaryngologic diseases ,Humans ,Medicine ,Epithelial–mesenchymal transition ,Multiple spindle cell carcinomas ,Epithelial-mesenchymal transition markers ,business.industry ,Thoracoscopy ,Gastroenterology ,General Medicine ,Middle Aged ,Epithelial-mesenchymal transition ,Neoplasms, Complex and Mixed ,digestive system diseases ,Esophagectomy ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
BACKGROUND Carcinosarcoma (spindle cell carcinoma) of the esophagus is an extremely rare event; the etiology and origins of this neoplasm have not yet been determined. Epithelial-mesenchymal transition (EMT) has been associated with invasion and metastasis, and may be related to the generation of a stem cell population within this tumor. CASE SUMMARY We present the case of a 61-year-old male with nausea and fever. Upper gastrointestinal endoscopy revealed the presence of type 1 and 0-IIc lesions located 35 cm from the incisors toward the esophago-gastric junction. Thoracoscopic esophagectomy was performed. Macroscopic analysis revealed three polypoid lesions in the abdominal esophagus that accompanied the main lesion in the lower thoracic esophagus and 0-IIc lesions that spread continuously with them. Histologically, the lesions included proliferating spindle cells. Adeno-carcinomatous components were detected in a section near the foot, and squamous cell carcinoma was identified in the mucosa at the base of the tumor. The patient was diagnosed with multiple carcinosarcomas, staged at pT1b (SM3), pN1 (#110, #7), cM0, Stage II (sarcomatous metastasis to the lymph nodes). Spindle cells did not express E-cadherin but were positive for EMT markers, including zinc finger E-box-binding homeobox 1, TWIST, and snail family transcriptional repressor 2. The patient has experienced no recurrence at 5 years and 2 mo after surgery. CONCLUSION This report suggests that multiple sarcomatous tumors may be generated from primary squamous cell carcinoma via mechanisms related to EMT.
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- 2020
22. Novel Trigone-Based Sizing Method for Mitral Ring Annuloplasty
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Yasuyuki Fujimoto, Hiroshi Okamoto, and Chikao Teramoto
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Male ,Pulmonary and Respiratory Medicine ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Humans ,Medicine ,Trigone of urinary bladder ,Aged ,Retrospective Studies ,Body surface area ,Mitral regurgitation ,Ejection fraction ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,Middle Aged ,Circumference ,medicine.disease ,Stenosis ,Treatment Outcome ,030228 respiratory system ,Mitral Valve ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
We devised a novel trigone-based sizing method, setting the trigones at one-quarter of the annular circumference, and used it for mitral annuloplasty in patients with mitral regurgitation (MR).Between 1999 and 2017, 436 patients with degenerative (n = 192), nonischemic functional (n = 124), or ischemic (n = 120) MR underwent mitral valvuloplasty at our institution using an incomplete ring. The intertrigonal distance and prerepair and postrepair annular diameter were measured. Then the diameters predicted from body surface area, the intertrigonal distance, and the ratios of these diameters to observed data were computed. We investigated the influence of these measurements on MR recurrence, transmitral pressure gradient, and systolic anterior motion.Initial repair was successful in 433 patients (99%), but 3 patients with systolic anterior motion and MR required conversion to valve replacement. After 1, 5, and 10 years (mean follow-up, 6.3 years), the rate of freedom from grade 2 or higher recurrent MR was 96%, 92%, and 86% in the degenerative group, 99%, 97%, and 90% in the nonischemic functional group, and 95%, 90%, and 79%, respectively, in the ischemic group (P = .052). The observed/body surface area predicted diameter ratio was negatively correlated with the mean transmitral pressure gradient (mm Hg); 12.3 - 8.2 × (ratio) (R = -0.37, P.001), despite a smaller ratio (0.9) not being associated with less recurrence of MR. In the degenerative group, systolic anterior motion developed in 7 of 71 patients (10%) with an observed/intertrigonal distance predicted diameter ratio of less than 0.9 (P.001).Our trigone-based sizing method achieved satisfactory control of MR, while avoiding functional mitral stenosis and systolic anterior motion.
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- 2020
23. Effect of proximal balloon edge dilation technique for opening a side branch ostium in repetitive‐proximal optimizing technique sequence
- Author
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Yoji Neishi, Tomoko Tamada, Ayano Enzan, Hiroshi Okamoto, Koichiro Imai, Shiro Uemura, Ryotaro Yamada, Terumasa Koyama, Yoshinobu Murasato, and Teruyoshi Kume
- Subjects
Bench model ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Balloon ,Original Studies ,Main branch ,03 medical and health sciences ,0302 clinical medicine ,Side branch ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,stenting technique ,optical coherence tomography ,business.industry ,percutaneous coronary intervention ,Stent ,General Medicine ,Coronary Vessels ,Dilatation ,Ostium ,Treatment Outcome ,Balloon dilation ,Dilation (morphology) ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Objective The purpose of this experimental bench test was to compare stent deformation, obstruction of stent struts at a jailed side branch (SB) ostium, and stent strut malapposition between SB inflation using proximal balloon edge dilation (PBED) technique and SB inflation using conventional balloon dilation in repetitive-proximal optimizing technique (re-POT) sequence. Background The second proximal optimizing technique (POT) procedure in the re-POT sequence might increase obstruction of stent struts at a jailed SB ostium, because deformation of stent cells at the main branch (MB) occurred during SB inflation for opening the SB ostium. Methods A fractal coronary bifurcation bench model made of flexible urethane was used, and crossover single-stent implantation (Xience Sierra, Abbott Vascular, Santa Clara, CA, n = 12) was performed from the MB with the re-POT sequence. During the re-POT sequence, the jailing rate at the SB ostium assessed by videoscopy was compared between SB inflation using PBED technique (PBED group, n = 6) and SB inflation using conventional balloon dilation (conventional group, n = 6). Results The jailing rate after the second POT procedure tended to be lower in the PBED group than in the conventional group (26 ± 12% vs. 34 ± 8%, p = .211), and the change in the jailing rate during the second POT procedure was significantly smaller in the PBED group than in the conventional group (4.8 ± 5.3% vs. 11.6 ± 3.5%, p = .026). Conclusions In the re-POT sequence, the PBED technique with a short balloon for SB inflation might minimize worsening of the jailing rate at the SB ostium during the second POT procedure.
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- 2020
24. Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department
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Tadayoshi Ishimaru, Tadahiro Goto, Jin Takahashi, Hiroshi Okamoto, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa, and Japanese Emergency Medicine Network Investigators
- Subjects
medicine.drug_class ,medicine.medical_treatment ,lcsh:Medicine ,Drug development ,Lower risk ,Article ,03 medical and health sciences ,0302 clinical medicine ,Fluid dynamics ,medicine ,Intubation ,Ketamine ,030212 general & internal medicine ,lcsh:Science ,Multidisciplinary ,business.industry ,Tracheal intubation ,lcsh:R ,030208 emergency & critical care medicine ,Emergency department ,Sedative ,Anesthesia ,Midazolam ,lcsh:Q ,business ,Propofol ,medicine.drug - Abstract
To determine whether ketamine use for tracheal intubation, compared to other sedative use, is associated with a lower risk of post-intubation hypotension in hemodynamically-unstable patients in the emergency department (ED), we analyzed the data of a prospective, multicenter, observational study—the second Japanese Emergency Airway Network (JEAN-2) Study—from February 2012 through November 2017. The current analysis included adult non-cardiac-arrest ED patients with a pre-intubation shock index of ≥0.9. The primary exposure was ketamine use as a sedative for intubation, with midazolam or propofol use as the reference. The primary outcome was post-intubation hypotension. A total of 977 patients was included in the current analysis. Overall, 24% of patients developed post-intubation hypotension. The ketamine group had a lower risk of post-intubation hypotension compared to the reference group (15% vs 29%, unadjusted odds ratio [OR] 0.45 [95% CI 0.31–0.66] p
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- 2019
25. Advancing emergency airway management practice and research
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Yusuke Hagiwara, Yukari Goto, Hiroko Watase, Tadahiro Goto, Kohei Hasegawa, and Hiroshi Okamoto
- Subjects
medicine.medical_specialty ,emergency department ,medicine.medical_treatment ,Airway management ,Review Article ,rapid sequence intubation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Intubation ,030212 general & internal medicine ,Intensive care medicine ,Adverse effect ,Review Articles ,Difficult airway ,Critically ill ,business.industry ,RC86-88.9 ,General Engineering ,rescue intubation ,030208 emergency & critical care medicine ,Medical emergencies. Critical care. Intensive care. First aid ,Emergency department ,respiratory system ,video laryngoscopy ,Video laryngoscopy ,business ,Airway - Abstract
Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.
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- 2019
26. Necroptosis in Esophageal Squamous Cell Carcinoma: An Independent Prognostic Factor and Its Correlation with Tumor-Infiltrating Lymphocytes
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Fumiyoshi Fujishima, Ryujiro Akaishi, Yusuke Gokon, Yohei Ozawa, Takashi Kamei, Masatoshi Hashimoto, Yusuke Taniyama, Tomohiro Nakamura, Naoki Nakaya, Hironobu Sasano, Takuro Yamauchi, Chiaki Sato, Shunsuke Ueki, Junichi Tsunokake, Toshiaki Fukutomi, and Hiroshi Okamoto
- Subjects
Cancer Research ,Tumor microenvironment ,biology ,medicine.diagnostic_test ,Tumor-infiltrating lymphocytes ,business.industry ,CD3 ,Necroptosis ,phosphorylated mixed lineage kinase domain-like protein ,FOXP3 ,necroptosis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,mixed lineage kinase domain-like protein ,Article ,esophageal squamous cell carcinoma ,Oncology ,Biopsy ,Cancer research ,biology.protein ,medicine ,Clinical significance ,business ,CD8 ,RC254-282 ,neoadjuvant chemotherapy - Abstract
Necroptosis is a pivotal process in cancer biology, however, the clinical significance of necroptosis in esophageal squamous cell carcinoma (ESCC) has remained unknown. Therefore, in this study, we aimed to verify the potential involvement of necroptosis in the clinical outcome, chemotherapeutic resistance, and tumor microenvironment of ESCC. Mixed lineage kinase domain-like protein (MLKL) and phosphorylated MLKL (pMLKL) were immunohistochemically examined in 88 surgically resected specimens following neoadjuvant chemotherapy (NAC) and 53 pre-therapeutic biopsy specimens, respectively. Tumor-infiltrating lymphocytes (TILs) were also evaluated by immunolocalizing CD3, CD8, and forkhead box protein 3 (FOXP3) in the residual tumors after NAC. High pMLKL status in the post-NAC resected specimens was significantly correlated with worse prognosis in ESCC patients. Multivariate analysis demonstrated that a high pMLKL status was an independent prognostic factor. In pre-NAC biopsy specimens, a high pMLKL status was significantly associated with a lower therapeutic efficacy. CD8+ TILs were significantly lower in the high-pMLKL group. FOXP3+ TILs were significantly higher in both high-MLKL and high-pMLKL groups. We first demonstrated pMLKL status as an independent prognostic factor in ESCC patients. Our study revealed the possible involvement of necroptosis in the immunosuppressive microenvironment, resulting in the attenuated therapeutic efficacy of NAC and eventual adverse clinical outcomes in ESCC.
- Published
- 2021
27. The pivotal role of the angiotensin-II–NF-κB axis in the development of COVID-19 pathophysiology
- Author
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Naomi Ichikawa and Hiroshi Okamoto
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Physiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Angiotensin-Converting Enzyme Inhibitors ,chemistry.chemical_compound ,Internal Medicine ,Medicine ,Humans ,business.industry ,Angiotensin II ,Comment ,NF-kappa B ,COVID-19 ,NF-κB ,NFKB1 ,Pathophysiology ,COVID-19 Drug Treatment ,chemistry ,Cancer research ,I-kappa B Proteins ,Signal transduction ,business ,Cardiology and Cardiovascular Medicine ,Signal Transduction - Published
- 2020
28. Conventional risk prediction models fail to accurately predict mortality risk among patients with coronavirus disease 2019 in intensive care units: a difficult time to assess clinical severity and quality of care
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Shunsuke Takaki, Shigehiko Uchino, Hideki Endo, Junji Hatakeyama, Hiroshi Kurosawa, Masatoshi Uchida, Kohei Takimoto, Satoru Hashimoto, Eiji Hashiba, Tatsuya Kawasaki, Ryo Uchimido, Hiromasa Irie, Hiroyuki Ohbe, Junji Kumasawa, Takehiko Asaga, Nao Ichihara, Hidenobu Shigemitsu, Hiroshi Okamoto, Katsura Hayakawa, Yoshitaka Aoki, Tomoyuki Nakamura, and Hiroaki Miyata
- Subjects
medicine.medical_specialty ,Quality management ,Coronavirus disease 2019 ,Coronavirus disease 2019 (COVID-19) ,RC86-88.9 ,business.industry ,Medical emergencies. Critical care. Intensive care. First aid ,Risk of death ,Critical Care and Intensive Care Medicine ,Risk prediction models ,Intensive care unit ,law.invention ,law ,Intensive care ,Health care ,Pandemic ,medicine ,Clinical severity ,Quality improvement ,Intensive care medicine ,business ,Letter to the Editor ,Risk prediction model - Abstract
Since the start of the coronavirus disease 2019 (COVID-19) pandemic, it has remained unknown whether conventional risk prediction tools used in intensive care units are applicable to patients with COVID-19. Therefore, we assessed the performance of established risk prediction models using the Japanese Intensive Care database. Discrimination and calibration of the models were poor. Revised risk prediction models are needed to assess the clinical severity of COVID-19 patients and monitor healthcare quality in ICUs overwhelmed by patients with COVID-19.
- Published
- 2021
29. HO-1 in lymph node metastasis predicted overall survival in patients with esophageal squamous cell carcinoma receiving neoadjuvant chemoradiation therapy
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Yusuke Gokon, Yusuke Taniyama, Hironobu Sasano, Naoki Nakaya, Chiaki Sato, Shunsuke Ueki, Ryujiro Akaishi, Takuro Yamauchi, Hirotaka Ishida, Hiroshi Okamoto, Tomohiro Nakamura, Junichi Tsunokake, Toshiaki Fukutomi, Kai Takaya, Takashi Kamei, and Fumiyoshi Fujishima
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,NF-E2-Related Factor 2 ,medicine.medical_treatment ,Internal medicine ,medicine ,Carcinoma ,Humans ,Lymph node ,Cisplatin ,Chemotherapy ,business.industry ,Esophageal cancer ,medicine.disease ,Neoadjuvant Therapy ,Radiation therapy ,medicine.anatomical_structure ,Esophagectomy ,Lymphatic Metastasis ,Carcinoma, Squamous Cell ,Immunohistochemistry ,Esophageal Squamous Cell Carcinoma ,Lymph Nodes ,business ,Heme Oxygenase-1 ,medicine.drug - Abstract
Background Lymph node metastasis is one of the pivotal factors of the clinical outcomes of patients with esophageal cancer receiving neoadjuvant chemoradiation therapy (NACRT). Both the nuclear factor-erythroid 2-related factor 2 (Nrf2) signaling pathway and heme oxygenase-1 (HO-1) are frequently upregulated in various human malignancies and associated with resistance to chemoradiation therapy, subsequently resulting in adverse clinical outcomes. However, the Nrf2 and HO-1 status in lymph node metastasis and their differences between primary and metastatic lesions are unknown. Aims To examine the levels of Nrf2 signaling proteins and HO-1 in primary and metastatic lesions of patients with esophageal squamous cell carcinoma using immunohistochemistry. Methods and results We immunolocalized Nrf2 signaling proteins in 69 patients with lymph node metastases, who received NACRT with 5-fluorouracil and cisplatin before esophagectomy. We also compared the findings between primary and metastatic lesions. Residual lymph node metastases were detected in 30 patients and among them, both primary and metastatic lesions were available for evaluation in 25 patients. Subsequently, we correlated the results with patients' survival. Nrf2, HO-1, and the Ki-67 labeling index were all significantly lower in the patients with lymph node metastases than in those with primary tumors. Carcinoma cells with high HO-1 levels were significantly associated with pathological resistance to NACRT. These results suggested that overall and disease-free survival of esophageal squamous cell carcinoma were significantly associated with both pN2 and high HO-1 levels, respectively. Conclusions Protein expression in the Nrf2 pathway was significantly lower in patients with lymph node metastases than in those with primary lesions. HO-1 levels in lymph node metastases could be used to predict the eventual clinical outcome of patients with esophageal cancer receiving NACRT.
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- 2021
30. Skin ulcer due to hemodialysis access-induced distal ischemia treated with arteriovenous fistula banding and endovascular therapy
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Tomoyo Hamana, Takumi Inoue, Masamichi Iwasaki, Koji Kuroda, Ryota Masaki, Yutaka Hatani, Wataru Fujimoto, Masanori Okuda, Takatoshi Hayashi, Hiroshi Okamoto, and Susumu Odajima
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Arteriovenous fistula ,030204 cardiovascular system & hematology ,Article ,Pallor ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Radial artery ,integumentary system ,medicine.diagnostic_test ,business.industry ,Skin ulcer ,medicine.disease ,Surgery ,body regions ,Giant cell arteritis ,Angiography ,Cardiology ,Hemodialysis ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 58-year-old woman with pallor on her left hand due to chronic hemodialysis presented with a recent intractable skin ulcer on her left 3rd finger; the skin perfusion pressure (SPP) was 19 mmHg. Preoperative angiography revealed an occluded proximal left radial artery, no communication between the ulnar and superficial palmar arteries, several collaterals from the left ulnar to the radial artery, and no visualization of the finger arteries. Successful endovascular therapy to the occluded radial artery increased flow to the arteriovenous fistula (AVF), but not to the fingertips. Slightly compressing the AVF augmented the flow and wound blush at the wound sites on the 3rd fingertip, leading to a diagnosis of hemodialysis access-induced distal ischemia (HAIDI). Surgical AVF banding with intra-operative SPP monitoring improved the SPP to 34 mmHg, leading to complete wound healing over 1 month with a preserved AVF. We performed a bilateral temporal artery biopsy and diagnosed giant cell arteritis. As the angiographic wound blush at wound sites is reportedly an important factor for wound healing, angiography with AVF manual compression is essential to diagnose HAIDI and evaluate the blood flow for wound healing.
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- 2019
31. The Influence of the Perioperative Nutritional Status on the Survival Outcomes for Esophageal Cancer Patients with Neoadjuvant Chemotherapy
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Yusuke Taniyama, Takuro Konno, Tadashi Sakurai, Hiroshi Okamoto, Makoto Hikage, Naoto Ujiie, Takeshi Naitoh, Takashi Kamei, Michiaki Unno, Kai Takaya, and Chiaki Sato
- Subjects
Male ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Nutritional Status ,Perioperative Care ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Longitudinal Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,Nutritional status ,Perioperative ,Middle Aged ,Esophageal cancer ,Prognosis ,medicine.disease ,University hospital ,Neoadjuvant Therapy ,Survival Rate ,Malnutrition ,Nutrition Assessment ,Oncology ,Chemotherapy, Adjuvant ,Esophagectomy ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Follow-Up Studies - Abstract
Studies have shown a variety of nutritional indices to be prognostic predictors for esophageal cancer patients. However, which nutritional index should be used and when it should be measured during the perioperative period remain unclear. This study attempted to clarify the details surrounding predictive nutritional evaluation by assessing the longitudinal data of serologic indices in perioperative esophageal cancer patients. The study included 141 esophageal cancer patients who underwent neoadjuvant chemotherapy after radical esophagectomy at Tohoku University Hospital from April 2008 to December 2017. The nutritional status was retrospectively assessed during the perioperative period, and the prognostic factors related to survival were analyzed. Use of the controlling nutritional status (CONUT) score showed that malnutrition occurred only from 14 days after surgery in most cases. Use of the prognostic nutritional index (PNI) showed that the ratio of malnutrition increased gradually from presurgery to 14 days after surgery. The timing of malnutrition that affected survival was 14 days after surgery with the CONUT score and presurgery and 4 months after surgery with the PNI. A multivariable analysis of independent prognostic factors predicting survival identified malnutrition 14 days after surgery with the CONUT score and a low PNI before surgery, invasion depth of the primary lesion, and node metastasis. Malnutrition occurring during the perioperative state of esophageal cancer was shown to be a survival prognostic factor. Development of an optimal nutritional intervention is recommended for esophageal cancer patients to prevent malnutrition both before and after surgery.
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- 2019
32. How does presurgical chemotherapy influence the efficiency of treatment for esophageal cancer recurrence after curative esophagectomy?
- Author
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Yusuke Taniyama, Takashi Kamei, Michiaki Unno, Makoto Hikage, Hiroshi Okamoto, Chiaki Sato, Kai Takaya, and Tadashi Sakurai
- Subjects
Male ,0301 basic medicine ,Pulmonary and Respiratory Medicine ,Curative resection ,medicine.medical_specialty ,recurrence ,Esophageal Neoplasms ,medicine.medical_treatment ,Antineoplastic Agents ,chemotherapy ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Drug Therapy ,medicine ,Humans ,In patient ,esophageal cancer ,Aged ,Retrospective Studies ,Chemotherapy ,business.industry ,Recurrent Esophageal Squamous Cell Carcinoma ,Retrospective cohort study ,Original Articles ,General Medicine ,Chemoradiotherapy ,Esophageal cancer ,Prognosis ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Survival Analysis ,Neoadjuvant Therapy ,Surgery ,Esophagectomy ,Treatment Outcome ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Female ,Original Article ,Esophageal Squamous Cell Carcinoma ,Neoplasm Recurrence, Local ,business - Abstract
Background The effectiveness of treatments for recurrent esophageal squamous cell carcinoma (ESCC), particularly chemotherapy and chemoradiotherapy (CRT), remains unclear in patients who have previously been administered the same drugs during neoadjuvant chemotherapy. Methods In this retrospective study, 117 patients with recurrent thoracic ESCCs who had undergone curative resection were included. Patients were divided into two groups based on presurgical treatment: no presurgical treatment (n = 74), and neoadjuvant chemotherapy (n = 43). Prognosis after recurrence was analyzed differently in the group of patients who received CRT and chemotherapy for a recurrent site because of differences in recurrence patterns. Results There were no differences in patterns and times to recurrence between the patients who underwent each presurgical treatment. For treatment of recurrence, CRT was administered to 66 patients, chemotherapy to 32, surgical resection to 5, and best supportive care to 14. In patients who underwent CRT for local recurrence, the survival rates of those administered neoadjuvant chemotherapy were similar to those who did not receive any presurgical treatment (P = 0.706). In patients who underwent chemotherapy for distant metastasis, the survival rates of those administered neoadjuvant chemotherapy were worse than in those who did not receive any presurgical treatment (P = 0.028). Conclusions The effects of CRT for recurrent cancers are not influenced by neoadjuvant chemotherapy, even when using the same anticancer agent. Chemotherapy is an acceptable treatment for patients who do not receive presurgical treatment.
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- 2019
33. Comparison of video laryngoscopy versus direct laryngoscopy for intubation in emergency department patients with cardiac arrest: A multicentre study
- Author
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Hiroko Watase, Tadahiro Goto, Kohei Hasegawa, Zoie Shui-Yee Wong, Yusuke Hagiwara, and Hiroshi Okamoto
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Resuscitation ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Tracheal intubation ,Laryngoscopy ,Emergency department ,Emergency Nursing ,Video laryngoscopy ,Anesthesia ,Propensity score matching ,Emergency Medicine ,medicine ,Intubation ,Airway management ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim To compare the tracheal intubation performance between video laryngoscopy (VL) and direct laryngoscopy (DL) in patients with cardiac arrest in the ED. Methods This is an analysis of the data from a prospective, multicentre study of 15 EDs in Japan. We included consecutive adult patients with cardiac arrest who underwent intubation with VL or DL from 2012 through 2016. The primary outcome was first-attempt success. The secondary outcomes were glottic visualisation assessed with Cormack grade (1 vs. 2–4) and occurrence of oesophageal intubation. To examine the between-device difference in outcome risks, we analysed the whole data and 1:1 propensity score matched data. Results Among 9694 patients who underwent intubation in the EDs, 3360 cardiac arrests (35%) were included in the analysis (90% were non-traumatic cardiac arrests). The first-attempt success rate was higher in the VL group compared to those in the DL (78% vs 70%; unadjusted OR 1.61 [95%CI 1.26–2.06] P Conclusions Based on large multicentre prospective data of ED patients with cardiac arrest, the use of VL was associated with a higher first-attempt success rate compared to DL, with a better glottic visualisation and lower oesophageal intubation rate.
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- 2019
34. Thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for esophageal cancer with a right superior pulmonary vein anomaly: a case report
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Takuro Konno, Shota Maruyama, Chiaki Sato, Kai Takaya, Takashi Kamei, Michiaki Unno, Tadashi Sakurai, Hiroshi Okamoto, Makoto Hikage, Yu Onodera, and Yusuke Taniyama
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medicine.medical_specialty ,medicine.medical_treatment ,Thoracoscopic esophagectomy ,lcsh:Surgery ,Case Report ,Pulmonary vein ,Prone ,03 medical and health sciences ,0302 clinical medicine ,Subcarina ,Thoracoscopy ,Medicine ,medicine.diagnostic_test ,business.industry ,Dissection ,Mediastinum ,lcsh:RD1-811 ,Esophageal cancer ,medicine.disease ,Subcarinal Lymph Node ,Prone position ,Anomaly ,medicine.anatomical_structure ,Esophagectomy ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,Virtual thoracoscopy ,business - Abstract
Background Superior posterior pulmonary vein anomaly in the right upper lobe (anomalous V2), which is one of the anomalies of the right superior pulmonary vein (RSPV), runs behind the right main or intermediate bronchus. Although this rarely occurs, attention should be given to this venous anomaly during thoracoscopic esophagectomy with subcarinal lymph node dissection. Here, we report a case of thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for lower thoracic esophageal cancer with anomaly of the superior posterior pulmonary vein in the right lobe (anomalous V2). Case presentation A 61-year-old man was diagnosed as having lower esophageal cancer with swelling of multiple lymph nodes in the mediastinum and abdomen. His clinical diagnosis based on the eighth TNM classification system was cT3 N2 M0 stage IIIB. In addition, an anomalous V2 was recognized on preoperative computed tomography imaging before the operation. The vein ran behind the intermediate bronchus and drained into the RSPV located at the area of the subcarinal lymph node. We performed preoperative simulation by using virtual thoracoscopic imaging with the same view as that during operation to help us better dissect the lymph nodes. As a result, thoracoscopic esophagectomy and subcarinal lymph node dissection were performed in the prone position without injuring the anomalous V2. Severe complications did not occur in the postoperative course except for paralysis of the left recurrent laryngeal nerve. The patient was discharged on postoperative day 17. Conclusions Injury to an anomalous V2 can cause severe hemorrhage during subcarinal lymph node dissection in esophagectomy. Preoperative simulation by using virtual thoracoscopic imaging is useful to avoid this complication in patients with an anatomical anomaly.
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- 2019
35. Esophageal cancer with severe funnel chest treated by simultaneous funnel chest surgery and thoracoscopic esophagectomy: a case report
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Yusuke Taniyama, Tadashi Sakurai, Keiichiro Hatoyama, Yu Onodera, Chiaki Sato, Takashi Kamei, and Hiroshi Okamoto
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Male ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,Sternum ,medicine.medical_treatment ,Thoracoscopic esophagectomy ,Population ,education ,Esophageal cancer ,Case Report ,030204 cardiovascular system & hematology ,Severity of Illness Index ,lcsh:RC254-282 ,03 medical and health sciences ,0302 clinical medicine ,Genetics ,medicine ,Humans ,Funnel chest ,education.field_of_study ,Funnel Chest ,business.industry ,Thoracoscopy ,Mediastinum ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Surgery ,Esophagectomy ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,business ,Thoracic esophageal cancer - Abstract
Background Funnel chest is the most common chest deformity, occurring in 0.06–0.3% of the general population. When it occurs concomitantly with esophageal cancer, it hinders intrathoracic surgery that is necessary for treatment. Although there are a few reports of esophagectomy performed in patients with funnel chest, simultaneous treatment of esophageal cancer and funnel chest with funnel chest surgery (Nuss method) and esophagectomy has not been reported. We report the first case of advanced esophageal cancer complicated by severe funnel chest that was treated using the Nuss method and radical thoracoscopic esophagectomy. Case presentation A 59-year-old man was diagnosed with advanced thoracic esophageal cancer and severe funnel chest. Because his sternum was almost attached to the vertebral bone, thereby creating a narrow space in the mediastinum, esophageal surgery was expected to be complicated. After the patient underwent neoadjuvant chemotherapy, we used the Nuss method to reconstruct the chest and widen the mediastinum. Subsequently, radical thoracoscopic esophagectomy was performed with the patient in the left decubitus position without any difficulty, and the postoperative course was uneventful. Conclusion Simultaneous funnel chest surgery (Nuss method) and thoracoscopic esophagectomy with the patient in the left decubitus position are recommended for esophageal cancer patients with severe funnel chest.
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- 2018
36. Predictive factors of health-related QOL in trauma patients: a prospective cohort study
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Nobuichiro Tamura, Misuzu Nakanishi, Yumi Kato, and Hiroshi Okamoto
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Health related ,Prospective cohort study ,business - Published
- 2018
37. Association of fentanyl use in rapid sequence intubation with post-intubation hypotension
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Takashi Shiga, Hiroshi Okamoto, Jin Takahashi, Kohei Hasegawa, Yusuke Hagiwara, Tadahiro Goto, and Hiroko Watase
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business.industry ,medicine.medical_treatment ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Fentanyl ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Anesthesia ,Emergency Medicine ,medicine ,Intubation ,Airway management ,030212 general & internal medicine ,Risk factor ,Adverse effect ,Prospective cohort study ,business ,medicine.drug - Abstract
Background The anesthesia literature has reported that pre-intubation fentanyl use is associated with post-intubation hypotension which is a risk factor of poor post-emergency department (ED) prognosis. However, little is known about the relations between fentanyl use for intubation and post-intubation hypotension in the ED. We aimed to determine whether pretreatment with fentanyl was associated with a higher risk of post-intubation hypotension in the ED. Methods We conducted a secondary analysis of data of ED airway management collected from a multicenter prospective study of 14 Japanese EDs from February 2012 through November 2016. We included all adult non-cardiac-arrest patients who underwent rapid sequence intubation for medical indication. Patients were divided into fentanyl and non-fentanyl groups. The primary outcome was post-intubation hypotension (systolic blood pressure ≤90 mm Hg) in the ED. Results Of 1263 eligible patients, 466 (37%) patients underwent pretreatment with fentanyl. The fentanyl group had a higher risk of post-intubation hypotension (17% vs. 6%; unadjusted OR, 1.73; 95%CI, 1.01–2.97; P = 0.048) compared to the non-fentanyl group. In the multivariable analysis adjusting for age, sex, weight, principal indication, sedatives, intubator's specialty, number of intubation attempts, and patient clustering within EDs, the fentanyl group had a higher risk of post-intubation hypotension (adjusted OR, 1.87; 95%CI, 1.05–3.34; P = 0.03) compared to the non-fentanyl group. In the sensitivity analysis using propensity score matching, this association remained significant (OR, 3.17; 95%CI, 1.96–5.14; P Conclusion In this prospective multicenter study of ED airway management, pretreatment with fentanyl in rapid sequence intubation was associated with higher risks of post-intubation hypotension.
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- 2018
38. The association of limited health literacy and risk of arterial stiffness in community-dwelling older adults
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Hiroshi Okamoto, Masafumi Kuzuya, Kazuki Uemura, and Minoru Yamada
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Male ,Health literacy ,Motor Activity ,030204 cardiovascular system & hematology ,Logistic regression ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Exercise ,Aged ,business.industry ,Confounding ,Arteries ,Odds ratio ,medicine.disease ,Confidence interval ,Health Literacy ,Quartile ,Arterial stiffness ,Female ,Health education ,Independent Living ,Geriatrics and Gerontology ,business ,Demography - Abstract
AIM This study aimed to investigate the effects of limited health literacy on arterial stiffness measured by the cardio-ankle vascular index (CAVI) in community-dwelling older adults. METHODS A total of 288 older adults (mean age, 72.4 years, men, n = 99) participated. The degree of arterial stiffness was assessed based on the CAVI using the VS-1500 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). Arterial stiffness was defined according to a cut-off point of ≥9.0. Comprehensive health literacy was assessed using the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Other potential confounding factors, such as demographics, number of prescribed medications, mini-mental state examination results, grip strength, gait speed, current smoking, alcohol consumption, and physical inactivity, were also assessed. An analysis of variance for continuous variables or chi-square test for categorical variables was used for group comparisons. A logistic regression analysis was performed to examine the association between quartiles of HLS-EU-Q47 and arterial stiffness in crude and multivariate models adjusted for age, gender, and other confounding factors. RESULTS The first quartile with the lowest health literacy showed a significantly higher CAVI and prevalence of arterial stiffness than the fourth quartile with the highest health literacy (p
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- 2018
39. Differential Response to Heart Rate Reduction by Carvedilol in Heart Failure and Reduced Ejection Fraction Between Sinus Rhythm and Atrial Fibrillation - Insight From J-CHF Study
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Akira Kitabatake, Yuji Nagatomo, Masatsugu Hori, Hiroshi Okamoto, and Tsutomu Yoshikawa
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Heart Failure ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Original article ,Atrial fibrillation ,General Medicine ,medicine.disease ,Heart failure with reduced ejection fraction ,Heart failure ,Multicenter trial ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Clinical endpoint ,Sinus rhythm ,Carvedilol ,business ,medicine.drug - Abstract
Background: Heart rate (HR) reduction by β-blocker might not benefit patients with heart failure and reduced ejection fraction (HFrEF) with atrial fibrillation (AF). Methods and Results: The J-CHF study was a prospective randomized multicenter trial that assigned 360 HFrEF patients to a 2.5 mg/5 mg/20 mg target dose of carvedilol. Carvedilol was uptitrated over 8 weeks and then the dose was fixed. Of 321 patients available for analysis, AF was identified in 65 (20%). Using the median absolute change in HR at 32 weeks (∆HR), the subjects were further divided into group A (∆HR >-6 beats/min) and B (∆HR ≤-6 beats/min). Both in sinus rhythm (SR) and AF, baseline characteristics and achieved carvedilol dose were similar between groups A and B. In SR, the time-dependent change in left ventricular EF (LVEF) and LV end-diastolic dimension (LVEDD) over 56 weeks was more favorable in B compared with A (∆LVEF, P=0.036; ∆LVEDD, P=0.047), and ∆HR was independently associated with ∆LVEF (P=0.040). Group B had a lower rate of the primary endpoint, defined as a composite of death and hospitalization due to cardiovascular causes including acute decompensated HF at 3 years (P=0.002). ∆HR was an independent predictor of the primary endpoint (P=0.01), but this was not observed in AF. Conclusions: Response to the carvedilol HR reduction might differ in HFrEF between SR and AF.
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- 2021
40. [Effects of health literacy on frailty status at two-year follow-up in older adults: A prospective cohort study]
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Kazuki Uemura, Hiroshi Okamoto, Tsukasa Kamitani, Atsuya Watanabe, and Minoru Yamada
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Response rate (survey) ,Gerontology ,Aged, 80 and over ,Male ,Frailty ,business.industry ,media_common.quotation_subject ,Health literacy ,Odds ratio ,Lower risk ,Literacy ,Health Literacy ,Health promotion ,Health care ,Medicine ,Humans ,Independent Living ,Prospective Studies ,Geriatrics and Gerontology ,business ,Body mass index ,media_common ,Aged ,Follow-Up Studies - Abstract
Aim To investigate the longitudinal association between health literacy and frailty status at two-year follow-up in community-dwelling older adults. Methods A total of 218 older adults (mean age, 72.5±4.9 [range 65-86] years old; men, n=81) without frailty at baseline participated in this study. Functional health literacy was assessed using the Newest Vital Sign (NVS). Comprehensive health literacy was assessed using the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Comprehensive health literacy indices are constructed as a general health literacy index comprising all items along with the three sub-indices of health care, disease prevention, and health promotion domains. Demographic data and other potential confounding factors were also assessed. The total Kihon checklist score was used to monitor the presence of frailty based on a score of ≥8 at the 2-year follow-up (postal survey). Results Of the 253 participants in the follow-up survey, 226 responded (response rate: 89.3%). Excluding the 8 participants with missing values, 25 (11.5%) of the 218 were reported to be frail. A multiple logistic regression analysis indicated that comprehensive health literacy (total score of HLS-EU-Q47) was independently associated with a lower risk of frailty (odds ratio per standard deviation = 0.54, 95% confidence interval = 0.33-0.87) after adjusting for the covariates (age, gender, education, body mass index, gait speed, cognitive function, and comorbidities). The health care and disease prevention domain scores of the HLS-EU-Q47 were also independently associated with a lower risk of frailty. Functional health literacy (NVS score) was not associated with frailty. Conclusions Older adults with higher comprehensive health literacy are less likely to be frail at two-year follow-up than those with a lower literacy.
- Published
- 2021
41. Effects of the Monomeric Components of Poly-Hydroxybutyrate-Co-Hydroxyhexanoate on the Growth of Vibrio Penaeicida In Vitro and on the Survival of Infected Kuruma Shrimp (Marsupenaeus japonicus)
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Kohei Sonoda, Fumika Takagi, Masaki Takita, Daisuke Kaneno, Kimio Fukami, Takao Horikawa, and Hiroshi Okamoto
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0301 basic medicine ,pathogenic Vibrio ,animal structures ,medicine.drug_class ,Marsupenaeus japonicus ,Antibiotics ,short- and medium-chain hydroxyalkanoic acids ,Marsupenaeus ,poly-hydroxybutyrate-co-hydroxyhexanoate (PHBH) ,Bacterial growth ,Article ,inhibitory effect ,Microbiology ,03 medical and health sciences ,Aquaculture ,lcsh:Zoology ,medicine ,lcsh:QL1-991 ,shrimp survival ,Bacterial disease ,lcsh:Veterinary medicine ,General Veterinary ,biology ,business.industry ,fungi ,Outbreak ,04 agricultural and veterinary sciences ,biology.organism_classification ,Shrimp ,030104 developmental biology ,040102 fisheries ,0401 agriculture, forestry, and fisheries ,lcsh:SF600-1100 ,Animal Science and Zoology ,business ,Bacteria - Abstract
Simple Summary Outbreaks of bacterial disease in shrimp aquaculture are major causes of economic and production losses. It is, therefore, important to prevent such outbreaks, preferably without the use of antibiotics to avoid encouraging the development of antibiotic-resistant bacterial strains. Several hydroxyalkanoic acids are known to inhibit the growth of pathogenic Vibrio species. Poly-hydroxybutyrate-co-hydroxyhexanoate is a biodegradable, water-insoluble polymer comprising two hydroxyalkanoic acids: 3-hydroxybutyrate and 3-hydroxyhexanoate. Here, we evaluated the inhibitory activities of 3-hydroxybutyrate and 3-hydroxyhexanoate on the growth of the shrimp-pathogenic bacterium Vibrio penaeicida in vitro, and the effect of adding poly-hydroxybutyrate-co-hydroxyhexanoate to the diet on the survival of infected kuruma shrimp (Marsupenaeus japonicus). We found that the activities of 3-hydroxybutyrate and 3-hydroxyhexanoate were pH dependent and that they inhibited bacterial growth at pH close to that found in the shrimp gut (pH 5.9–6.7). Moreover, in shrimp infected with V. penaeicida, survival rates were significantly increased in individuals reared on feed containing poly-hydroxybutyrate-co-hydroxyhexanoate compared with those reared on standard diet, without any negative effects on shrimp growth. These findings suggest that supplementation of standard diet with poly-hydroxybutyrate-co-hydroxyhexanoate could protect aquaculture shrimp from infection by V. penaeicida, which is expected to increase production and reduce overall operational costs. Abstract Here, we investigated the inhibitory effects of the biodegradable, water-insoluble polymer poly-hydroxybutyrate-co-hydroxyhexanoate (PHBH) and its two constituent monomers, the hydroxyalkanoic acids 3-hydroxybutyrate (3HB) and 3-hydroxyhexanoate (3HH), on the growth of the shrimp-pathogenic bacterium Vibrio penaeicida. In vitro experiments revealed that 3HH showed greater growth inhibitory activity than 3HB against V. penaeicida. In addition, the activities of hydroxyalkanoic acids were pH dependent, being greater at pH 6.0 than at pH 7.0. Investigation of the pH of the shrimp gut revealed a pH range of 5.9–6.7 (mean 6.29 ± SD 0.20), indicating that the physiological environment was suitable for 3HB and 3HH to exert their inhibitory activities against V. penaeicida. In vivo bacterial challenge experiments revealed that survival rates in kuruma shrimp (Marsupenaeus japonicus) infected by V. penaeicida were significantly increased in shrimp reared on feed containing PHBH (0.1%–5% w/w PHBH) compared with that in shrimp reared on standard diet alone. Supplementation with PHBH had no significant effects on three shrimp growth parameters: increase in body weight, daily feeding rate, and feed conversion ratio. These results suggest that supplementation of standard diet with PHBH will increase shrimp resistance to infection by V. penaeicida, thereby increasing shrimp aquaculture productivity.
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- 2021
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42. Effects of a Cloth Panel Containing a Specific Ore Powder on Patients with Chamaecyparis obtusa (Cypress) Pollen Allergy
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Suni Lee, Yukiyoshi Hyo, Yoshio Fujii, Takemi Otsuki, Hiroshi Okamoto, Hirotaka Hara, and Shoko Yamamoto
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Saliva ,Allergy ,Technology ,Article Subject ,Science ,Immunoglobulin E ,General Biochemistry, Genetics and Molecular Biology ,Animal science ,Chamaecyparis ,medicine ,Cypress ,General Environmental Science ,biology ,business.industry ,General Medicine ,Eosinophil ,medicine.disease ,biology.organism_classification ,medicine.anatomical_structure ,biology.protein ,Hay fever ,Medicine ,business ,Blood sampling - Abstract
Pollen allergy to Japanese cedar and cypress is a serious illness that impairs daily life and sleep, especially during pollen season. We have reported that placing a cloth panel containing a specific natural ore powder (CCSNOP) in a room may alleviate the symptoms of hay fever and may also benefit the immune system. This ore is from the Aso mountain range, a volcano on Kyushu Island in the southwestern part of Japan. The purpose of this study was to verify the effect of CCSNOP on cypress pollen. Thirty-one double-blind tests, which investigated cedar pollen allergies, were conducted from February to March 2018 and have already been reported. After this, in early April, 10 of these cases were recruited and all had CCSNOP installed in their bedrooms. Before that, various symptoms and changes in medication were recorded in a “Symptom Diary” and included a mood survey by a questionnaire, stress test using saliva amylase, changes in cypress-specific immunoglobulins IgE and IgG4 by blood sampling, and eosinophil changes. In addition, changes in 29 types of cytokines were investigated. Exposure to CCSNOP relieved symptoms and subjects decreased their intake of medication. There was no change in mood or stress, but eosinophil levels tended to decrease. Although there were no statistical changes in cypress-specific IgE or IgG4, an increase in the former and a decrease in the latter were observed in some individuals during the period of pollen dispersal. Furthermore, levels of GM-CSF and IL8 decreased significantly after use of CCSNOP. The CCSNOP was shown to be effective against cypress pollen allergy, and future investigations will be necessary to observe the long-term effects of CCSNOP.
- Published
- 2021
43. Acute coronary syndrome associated with diverticular perforation of sigmoid colon
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Kazuhiro Aoki, Kenji Ishii, Koichiro Seki, Sachiyo Sekiya, Taku Asano, Kenta Takeishi, Hiroshi Okamoto, and Yusuke Iizuka
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Acute coronary syndrome ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Perforation (oil well) ,medicine ,Sigmoid colon ,medicine.disease ,business ,Surgery - Published
- 2021
44. Observation of the Three-Dimensional Polarization Vector in Films of Organic Molecular Ferroelectrics Using Terahertz Radiation Emission
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Noriaki Kida, Tatsuo Hasegawa, M. Sotome, Tatsuya Miyamoto, Hiroshi Okamoto, Yohei Uemura, Yuto Kinoshita, Shunto Arai, and Sachio Horiuchi
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Materials science ,business.industry ,Phonon ,Terahertz radiation ,General Physics and Astronomy ,02 engineering and technology ,021001 nanoscience & nanotechnology ,Polarization (waves) ,Laser ,01 natural sciences ,Ferroelectricity ,law.invention ,Condensed Matter::Materials Science ,law ,Electric field ,0103 physical sciences ,Femtosecond ,Optoelectronics ,Thin film ,010306 general physics ,0210 nano-technology ,business - Abstract
For the application of a ferroelectric thin film to optical and electric devices, it is important to align its ferroelectric polarization parallel or perpendicular to the film surface. In this context, an effective method to characterize the polarization directions in the whole area of devices is needed. Here, we report an alternative method to determine a polarization vector in three dimensions using an emission of terahertz waves. The target material is an organic hydrogen-bonded molecular ferroelectric 2-methylbenzimidazole (MBI). By the irradiation of a femtosecond laser pulse on a bulk single-crystal thin film of MBI, we observe the emission of the terahertz waves originating from the polarization modulation of infrared-active phonons via the impulsive stimulated Raman-scattering mechanism. By measuring the terahertz electric field parallel to the ferroelectric polarization with rotating the single-crystal film around two independent axes, we succeed in determining the polarization vector in three dimensions, the direction of which is tilted by 45\ifmmode^\circ\else\textdegree\fi{} normal to the film surface and substrate. This method can be a powerful tool to characterize directions of ferroelectric polarizations in any kinds of thin-film samples.
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- 2020
45. Correlation between TXNRD1/HO-1 Expression and the Histological Response to Neoadjuvant Chemoradiation Therapy in patients with Esophageal Squamous Cell Carcinoma
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Hiroshi Okamoto, Yusuke Taniyama, Fumiyoshi Fujishima, Takashi Kamei, Hironobu Sasano, Yusuke Gokon, Takuro Yamauchi, Hirotaka Ishida, Kai Takaya, Ryujiro Akaishi, Junichi Tsunokake, Shunsuke Ueki, Toshiaki Fukutomi, and Chiaki Sato
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Histological response ,In patient ,business ,Esophageal squamous cell carcinoma - Abstract
BackgroundNrf2 signaling plays a pivotal role in antioxidant response, and its expression has been reported to increase in various human malignancies, including esophageal squamous cell carcinoma (ESCC). This also leads to resistance against chemotherapy and radiotherapy in patients. Thioredoxin reductase 1 (TXNRD1) and heme oxygenase-1 (HO-1) are proteins involved in this pathway that play key roles in antioxidant responses. However, the correlation between the expression of these two proteins and the therapeutic response to neoadjuvant chemoradiation therapy (NACRT), and the changes before and after chemoradiation therapy in patients with ESCC, remain unknown. MethodsThe proteins involved in the Nrf2 signaling pathway were immunolocalized in carcinoma cells in patients with ESCC undergoing NACRT with 5-fluorouracil and cisplatin followed by esophagectomy. The 8-OHdG levels were used to determine ROS levels in individual carcinoma cells. Fifty-two pre-operative endoscopic biopsy and fifty post-operative resected specimens were available for this study. Among these, 39 specimens were available for comparison of the results before and after NACRT. The changes in immunoreactivity before and after NACRT (Δ) were assessed. ResultsSignificant histological resistance to NACRT was observed in patients with high levels of Nrf2, TXNRD1, and HO-1 expression. Among pre-therapeutic biopsy specimens, the tumor reduction effect was significantly attenuated in those with high levels of Nrf2, TXNRD1, and HO-1 expression. TXNRD1Δ and HO-1Δ were both significantly higher, while 8-OHdGΔ was significantly lower in the ineffective (poor response) groups. In resected specimens, the overall survival was significantly lower in groups with high Nrf2, TXNRD1, HO-1, and HO-1Δ values. Disease-free survival was significantly lower in the groups with high expression of Nrf2, TXNRD1, HO-1, and Ki-67 and large values of HO-1Δ, and Ki-67Δ. ConclusionsThe results of this study indicate that high Nrf2, TXNRD1, and HO-1 expression in pre-therapeutic biopsy specimens could predict the histological response to NACRT, and their status in surgically resected specimens could predict clinical outcomes in patients with ESCC.
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- 2020
46. 46 ESOPHAGECTOMY FOR ESOPHAGEAL CANCER TO THE PATIENT ACCOMPANIED WITH PROTEIN C DEFICIENCY
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T Fukutomi, K Hatoyama, Takashi Kamei, Hiroshi Okamoto, Kai Takaya, Yusuke Taniyama, Naoto Ujiie, and Chiaki Sato
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medicine.medical_specialty ,Esophagectomy ,Protein C deficiency ,business.industry ,medicine.medical_treatment ,Internal medicine ,Gastroenterology ,medicine ,General Medicine ,Esophageal cancer ,medicine.disease ,business - Abstract
Protein C deficiency is a rare genetic disease that predisposes to thrombotic disease, which is characterized by tendency to form thrombus due to hypercoagulation. The incidence of protein C deficiency with clinical symptoms has been reported to be estimated at 1 in 20,000. Only a few cases of surgery for gastrointestinal cancer with protein C deficiency have been reported, however, there have been no reports regarding the perioperative management in detail for those patients. Methods We present. We assess perioperative management for the case of esophagectomy for an esophageal cancer accompanied with protein C deficiency. Results A 63-year-old male with protein C deficiency underwent thoracoscopic esophagectomy and digestive reconstruction using gastric tube for thoracic esophageal cancer whose clinical stage was T1bN0M0. On postoperative day 3, his gastric tube was removed due to gastric tube necrosis. Digestive reconstruction using free jejunal graft has been attempted after 140 days from first surgery, however, thrombus formation in the jejunal artery and vein caused the reconstruction to failure. Ten days after this surgery, digestive reconstruction using colon was performed with anticoagulation control by administrating intraoperative heparin. The patient went fine without thrombus formation afterward. Conclusion During digestive reconstruction in patients with conditions predisposing to thrombus formation as typified by protein C deficiency, the perioperative management should be done with careful attention to prevent thrombus formation. In particular, because there is likely to develop necrosis of reconstructed organ due to thrombus formation, the appropriate anticoagulation control such as intraoperative heparin administration is recommended in patients with protein C deficiency.
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- 2020
47. 55 OPTIMAL LYMPH NODE DISSECTION RANGE FOR ESOPHAGOGASTRIC JUNCTION CANCER
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Hiroshi Okamoto, Takashi Kamei, Kai Takaya, T Fukutomi, Chiaki Sato, Yusuke Taniyama, K Hatoyama, and T Kumagai
- Subjects
medicine.medical_specialty ,business.industry ,Range (biology) ,Gastroenterology ,Cancer ,General Medicine ,Dissection (medical) ,medicine.disease ,medicine.anatomical_structure ,Medicine ,Radiology ,Esophagogastric junction ,business ,Lymph node - Abstract
There is no consensus on the mediastinal lymph node dissection range for esophagogastric junction cancer (EGJC). Methods We enrolled 113 patients with EGJC (defined by Nishi’s classification) who underwent R0 resection between January 2001 and December 2016, focusing on comparisons between squamous cell carcinoma (SCC) and adenocarcinoma (AC). Results The characteristics of patients with SCC (n = 53) and AC (n = 55) were as follows: age: 65.4 ± 1.4 and 64.1 ± 1.5 years; male/female: 46/12 and 48/7; preoperative treatment (none/NAC/NACRT): 29/19/10 and 53/2/0; surgical method (subtotal esophagectomy/lower esophagectomy and gastrectomy): 39/19 and 34/21; pStage (I/II/III): 15/14/29 and 13/10/32, respectively. Esophageal invasion (EI) exceeding 20 mm was associated with an increased incidence of metastasis to the upper and middle mediastinal LN in patients with SCC and AC. However, for patients with SCC, the upper/middle mediastinal LN dissection effect index was 6.9/6.9 compared with 0/0 for AC patients. Conclusion In patients with EI exceeding 20 mm, esophagectomy with lymphadenectomy up to the upper mediastinum should be performed owing to the high incidence of upper and middle mediastinal LNM. However, the dissection effect is very poor in patients with AC; therefore, multidisciplinary treatment should be considered for these patients.
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- 2020
48. A case of esophageal achalasia presenting with empyema and septic shock differentiated from esophageal rupture
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Kai Takaya, Ryohei Ando, Yusuke Taniyama, Hiroshi Okamoto, Toshiaki Fukutomi, Chiaki Sato, Takashi Kamei, and Michiaki Unno
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Myotomy ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Achalasia ,Aspiration pneumonia ,Epigastric pain ,Esophageal Sphincter, Lower ,03 medical and health sciences ,0302 clinical medicine ,Esophageal dysphagia ,otorhinolaryngologic diseases ,Medicine ,Humans ,Abscess ,Empyema ,business.industry ,Septic shock ,Gastroenterology ,General Medicine ,medicine.disease ,Shock, Septic ,Surgery ,Esophageal Achalasia ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Deglutition Disorders - Abstract
The patient was a 44-year-old man with a history of schizophrenia. He had a history of esophageal dysphagia and vomiting and presented with sudden strong epigastric pain. He was taken to a medical emergency center in a state of septic shock. Computed tomography revealed a left thoracic abscess, and esophageal rupture was suspected. He was referred to our department for treatment. Gastrointestinal series and gastrointestinal endoscopy revealed marked esophageal dilation and strong contraction of the lower esophageal sphincter. We, therefore, diagnosed the patient with empyema thoracis secondary to aspiration pneumonia due to esophageal achalasia. Conservative treatment with antibiotics and computed tomography-guided chest drainage was initiated, but the inflammation persisted. Thus, we successfully performed a per-oral endoscopic myotomy to manage achalasia symptoms.
- Published
- 2020
49. Clinical Characteristics and Outcomes of Critically Ill COVID-19 Patients in Tokyo: A Single-Center Observational Study
- Author
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Kuniyoshi Hayashi, Shutaro Isokawa, Toru Hifumi, Shinichi Ishimatsu, Koichiro Seki, Minori Masaki, Norio Otani, Aya Banno, and Hiroshi Okamoto
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Critically ill ,medicine ,Observational study ,Intensive care medicine ,Single Center ,business - Abstract
Background: Japan has been successful in maintaining low mortality rates during the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the characteristics, inflammatory laboratory finding trends, and outcomes among critically ill Japanese patients who were admitted to the intensive care unit (ICU) with COVID-19. Methods: A retrospective observational study was performed in a single institution in the center of Tokyo. Laboratory-confirmed COVID-19 patients admitted to the ICU from March 19 to April 30, 2020 were included. Trends for significant inflammatory laboratory findings were analyzed. In-hospital death, days of mechanical ventilation or oxygen supplementation, days of ICU or hospital stay were followed until May 26, 2020. Results: Twenty-four patients were included. Median age was 57.5 years, and 79% were male. The neutrophil-to-lymphocyte ratio was elevated to a median of 10.1 on admission and peaked on Day 10 of illness. Seventeen patients were intubated on Day 11 of illness and received mechanical ventilation. One patient underwent extracorporeal membrane oxygenation. The majority (88%) received systemic steroids, including 16 patients who received high dose methylprednisolone (500-1000 mg). Favipiravir was used in 38% of patients. Two patients, including 1 who refused intensive care, died. Eighteen patients were discharged. Median length of ICU and hospital stay for all patients was 6 and 22 days, respectively. Median length of ventilator dependency was 7 days. Four patients underwent a tracheostomy and received prolonged ventilation for more than 21 days. One patient receiving mechanical ventilation died. All survivors discontinued ventilator use. Mortality was remarkably low and prolonged ventilation was inevitable yet discontinued.Conclusions: Mortality was remarkably low in our single institutional study. Prolonged ventilation was inevitable yet discontinued. Trends of systemic inflammatory laboratory markers reflected the clinical course of COVID-19.
- Published
- 2020
50. Clinical characteristics and outcomes of critically ill COVID-19 patients in Tokyo: a single-center observational study from the first wave
- Author
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Shinichi Ishimatsu, Kuniyoshi Hayashi, Toru Hifumi, Aya Banno, Hiroshi Okamoto, Shutaro Isokawa, Koichiro Seki, Norio Otani, and Minori Masaki
- Subjects
Male ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Single Center ,law.invention ,Leukocyte Count ,0302 clinical medicine ,Japan ,law ,030212 general & internal medicine ,Aged, 80 and over ,Systemic steroid ,Middle Aged ,Intensive care unit ,Coronavirus disease ,Hospitalization ,Intensive Care Units ,Infectious Diseases ,C-Reactive Protein ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Critical Illness ,Antiviral Agents ,Methylprednisolone ,lcsh:Infectious and parasitic diseases ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,Favipiravir ,Intensive care ,medicine ,Extracorporeal membrane oxygenation ,Humans ,lcsh:RC109-216 ,Mortality ,Tokyo ,Aged ,Retrospective Studies ,Mechanical ventilation ,business.industry ,COVID-19 ,Retrospective cohort study ,Length of Stay ,Respiration, Artificial ,Emergency medicine ,ICU ,Observational study ,business - Abstract
Background Many studies have been published about critically ill coronavirus disease 2019 (COVID-19) during the early phases of the pandemic but the characteristic or survival of critically ill Japanese patients have not yet been investigated. We sought to investigate the characteristics, inflammatory laboratory finding trends, and outcomes among critically ill Japanese patients who were admitted to the intensive care unit (ICU) with the first wave of COVID-19. Methods A retrospective observational study was performed in a single institution in the center of Tokyo. Laboratory-confirmed COVID-19 patients admitted to the ICU from March 19 to April 30, 2020 were included. Trends for significant inflammatory laboratory findings were analyzed. In-hospital death, days of mechanical ventilation or oxygen supplementation, days of ICU or hospital stay were followed until May 26, 2020. Results Twenty-four patients were included. Median age was 57.5 years, and 79% were male. The neutrophil-to-lymphocyte ratio was elevated to a median of 10.1 on admission and peaked on Day 10 of illness. Seventeen patients were intubated on Day 11 of illness and received mechanical ventilation. One patient underwent extracorporeal membrane oxygenation. The majority (88%) received systemic steroids, including 16 patients who received high dose methylprednisolone (500–1000 mg). Favipiravir was used in 38% of patients. Two patients, including 1 who refused intensive care, died. Eighteen patients were discharged. Median length of ICU and hospital stay for all patients was 6 and 22 days, respectively. Median length of ventilator dependency was 7 days. Four patients underwent a tracheostomy and received prolonged ventilation for more than 21 days. One patient receiving mechanical ventilation died. All survivors discontinued ventilator use. Conclusions Mortality was remarkably low in our single institutional study. Three survivors received mechanical ventilation for more than 3 weeks. Trends of clinically significant laboratory markers reflected the clinical course of COVID-19.
- Published
- 2020
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