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1. Type 3 antenatal Bartter syndrome presenting with mild polyuria

Author: Yuto Otsubo, Yuji Kano, Hiroshi Suzumura, and Shigemi Yoshihara
Subjects: Male, Polyhydramnios, Pediatrics, medicine.medical_specialty, endocrine system diseases, 030232 urology & nephrology, Metabolic alkalosis, Case Report, 030204 cardiovascular system & hematology, Bartter syndrome, Urine sodium, 03 medical and health sciences, 0302 clinical medicine, Polyuria, Chloride Channels, Pregnancy, Hyperaldosteronism, medicine, Humans, CLCNKB, biology, medicine.diagnostic_test, business.industry, Infant, Newborn, nutritional and metabolic diseases, Bartter Syndrome, Infant, General Medicine, medicine.disease, Mutation, biology.protein, Amniocentesis, Female, medicine.symptom, business
Abstract: Bartter syndrome (BS) is a well-recognised inherited tubular dysfunction that causes polyuria, metabolic alkalosis and hypokalaemia. Among BS cases, antenatal/neonatal BS (ABS) usually shows distinct polyhydramnios prenatally and presents features of BS in the early neonatal period. We encountered a premature infant with type 3 ABS presenting with mild polyuria and discuss the pathogenesis of mild polyuria in type 3 ABS. A male infant was born at 31 weeks’ gestation. His mother received amniocentesis because of polyhydramnios. Hyponatraemia and hypokalaemia appeared within 3 days after birth. Metabolic alkalosis, hyperreninaemia and hyperaldosteronism were also identified. Temporary polyuria developed at 1 month after birth; however, the mean urine output during hospitalisation was within the normal range. CLCNKB compound heterozygous mutations were confirmed. Polyuria of type 3 ABS may be less severe than in other types of ABS. Lower urine sodium loss may be a characteristic feature of type 3 ABS.
Published: 2023

2. Low serum 25-hydroxyvitamin D level is associated with obesity and atherogenesis in adolescent boys

Author: Osamu Arisaka, Satomi Koyama, Junko Naganuma, and Shigemi Yoshihara
Subjects: Atherogenic diet, medicine.medical_specialty, Adiponectin, business.industry, Endocrinology, Diabetes and Metabolism, Overweight, medicine.disease, Obesity, vitamin D deficiency, Blood pressure, Endocrinology, Internal medicine, Pediatrics, Perinatology and Child Health, medicine, medicine.symptom, Underweight, business, Body mass index
Abstract: Purpose: We investigated the relationship of 25-hydroxyvitamin D (25[OH]D) level with obesity and atherosclerosis in Japanese adolescents.Methods: We examined 492 children (247 boys and 245 girls) aged 12–13 years. The serum 25(OH)D level was compared among underweight, healthy weight, and overweight children. Spearman correlation coefficient analysis was performed to examine the relationships between the 25(OH)D level and body mass index (BMI), plasma lipids, and blood pressure and to compare the latter between the normal (≥20 ng/mL) and low (
Published: 2022

3. Dysfunction of the circadian clock in the kidney tubule leads to enhanced kidney gluconeogenesis and exacerbated hyperglycemia in diabetes

Author: Frédéric Gachon, Daniel Ortiz, Camille Ansermet, Gabriel Centeno, Laure Menin, Dmitri Firsov, Yohan Bignon, Hikari Ai. Yoshihara, Sylvain Pradervand, and Andy Garcia
Subjects: medicine.medical_specialty, Circadian clock, Kidney, Diabetic nephropathy, Mice, Polyuria, Circadian Clocks, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Animals, Humans, Circadian rhythm, business.industry, Gluconeogenesis, Streptozotocin, medicine.disease, Circadian Rhythm, Kidney Tubules, Endocrinology, medicine.anatomical_structure, Nephrology, Hyperglycemia, medicine.symptom, business, medicine.drug
Abstract: The circadian clock is a ubiquitous molecular time-keeping mechanism which synchronizes cellular, tissue, and systemic biological functions with 24-hour environmental cycles. Local circadian clocks drive cell type- and tissue-specific rhythms and their dysregulation has been implicated in pathogenesis and/or progression of a broad spectrum of diseases. However, the pathophysiological role of intrinsic circadian clocks in the kidney of diabetics remains unknown. To address this question, we induced type I diabetes with streptozotocin in mice devoid of the circadian transcriptional regulator BMAL1 in podocytes (cKOp mice) or in the kidney tubule (cKOt mice). There was no association between dysfunction of the circadian clock and the development of diabetic nephropathy in cKOp and cKOt mice with diabetes. However, cKOt mice with diabetes exhibited exacerbated hyperglycemia, increased fractional excretion of glucose in the urine, enhanced polyuria, and a more pronounced kidney hypertrophy compared to streptozotocin-treated control mice. mRNA and protein expression analyses revealed substantial enhancement of the gluconeogenic pathway in kidneys of cKOt mice with diabetes as compared to diabetic control mice. Transcriptomic analysis along with functional analysis of cKOt mice with diabetes identified changes in multiple mechanisms directly or indirectly affecting the gluconeogenic pathway. Thus, we demonstrate that dysfunction of the intrinsic kidney tubule circadian clock can aggravate diabetic hyperglycemia via enhancement of gluconeogenesis in the kidney proximal tubule and further highlight the importance of circadian behavior in patients with diabetes.
Published: 2022

4. Rapidly progressive myocardial calcification following sepsis

Author: Masaki Matsunaga, Taku Yaegashi, Shu Yoshihara, and Masaaki Naito
Subjects: Myocardial calcification, medicine.medical_specialty, business.industry, medicine.medical_treatment, Organ dysfunction, Cardiomyopathy, Case Report, medicine.disease, Sepsis, Coronary artery disease, Internal medicine, Shock (circulatory), medicine, Cardiology, Renal replacement therapy, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Complication
Abstract: Sepsis is a clinical syndrome caused by a dysregulated host response to infection that can lead to multiple organ dysfunction and death. Cardiovascular abnormalities are frequent in sepsis and may result in myocardial injury unrelated to coronary artery disease. Myocardial calcification is a rare complication of sepsis, which shows rapid-onset extensive myocardial calcifications. We present a case of a 67-year-old man who developed severe sepsis complicated with shock, acute renal failure, and acute respiratory distress syndrome. Initial chest computed tomography (CT) on admission showed normal left ventricular (LV) myocardial attenuation. However, serial chest CT demonstrated a gradual increase of the LV myocardial attenuation, which ultimately resulted in extensive myocardial calcification within 6 weeks. Sepsis-related myocardial calcification is usually found in patients with severe sepsis complicated with hemodynamic failure requiring vasopressors, acute renal failure necessitating renal replacement therapy, and acute respiratory distress syndrome. Although the prognostic significance of this pathology is unclear, it may be a precursor to long-term irreversible cardiomyopathy or an arrhythmogenic substrate that induces life-threatening arrhythmias. Therefore, patients who have survived the acute phase of severe sepsis need to be monitored carefully for signs of this complication by an imaging modality such as CT.
Published: 2022

5. Impact of the use of hydroxyethyl starch in granulocyte apheresis using Spectra Optia

Author: Katsuji Kaida, Yuko Osugi, Satoshi Higasa, Keiko Fukunaga, Kenichi Yamahara, Hiroya Tamaki, Kazuhiro Ikegame, Junko Ikemoto, Masaya Okada, Hitomi Onomoto, Satoshi Yoshihara, Kyoko Yoshihara, Hiroki Sugiyama, Yoshihiro Fujimori, and Noriko Okuda
Subjects: medicine.medical_specialty, Renal function, 030204 cardiovascular system & hematology, Hydroxyethyl starch, Granulocyte, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Adverse effect, reproductive and urinary physiology, Retrospective Studies, business.industry, Potential risk, Starch, Hematology, Leukocyte Transfusion, Apheresis, medicine.anatomical_structure, Blood Component Removal, Absolute neutrophil count, biological phenomena, cell phenomena, and immunity, business, Granulocytes, 030215 immunology, medicine.drug
Abstract: OBJECTIVES To determine the impact of the use of hydroxyethyl starch (HES) in granulocyte apheresis using Spectra Optia. BACKGROUND Granulocyte transfusion (GT) is a therapeutic option for neutropenic patients with severe bacterial or fungal infections. Recent studies in emergency medicine have shown the potential risk of using HES, which is routinely used in granulocyte apheresis to increase yield by sedimenting red blood cells. We hypothesized that the use of a newer device (Spectra Optia) would spare the need for HES. METHODS We retrospectively compared granulocyte apheresis with HES (HES group, n = 89) and without HES (non-HES group, n = 36) using Spectra Optia. RESULTS The granulocyte yield was significantly higher in the HES group (7.3 × 1010 vs. 2.0 × 10, p
Published: 2021

6. Effects of different surgical procedures for meniscus injury on two-year clinical and radiological outcomes after anterior cruciate ligament reconstructions. -TMDU MAKS study

Author: Tomoyuki Mochizuki, Shinichi Shirasawa, Toshifumi Watanabe, Hiroko Ueki, Mindae Kim, Daisuke Hatsushika, Hiroki Katagiri, Shingo Fukagawa, Masaaki Isono, Koji Asano, Masayuki Shimaya, Tadanori Shimizu, Katsuaki Yanagisawa, Yusuke Nakagawa, Kanehiro Hiyama, Toru Takahashi, Tomohiko Tateishi, Jun Kitahama, Shinpei Kondo, Hideyuki Koga, Tsuyoshi Nagase, Jae-Sung An, Kenta Katagiri, Takashi Hoshino, Jyu Neishin, Kei Inomata, Takeshi Muneta, Masafumi Horie, Masaya Hayashi, Etsuko Matsumura, Naoko Araya, Ryusuke Saito, Takashi Ogiuchi, Mai Katakura, Akiho Hoshino, Ichiro Sekiya, Koji Otabe, Mari Uomizu, Hideya Yoshimura, Toshiyuki Ohara, Masaki Amemiya, Kazumasa Kawata, Kaori Nakamura, Mika Yamaga, Aritoshi Yoshihara, Mio Udo, Arata Yuki, and Enichi Nakatsuru
Subjects: medicine.medical_specialty, Anterior cruciate ligament, Osteoarthritis, Meniscus (anatomy), Lachman test, Menisci, Tibial, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Meniscus, Orthopedics and Sports Medicine, 030222 orthopedics, Anterior Cruciate Ligament Reconstruction, business.industry, Anterior Cruciate Ligament Injuries, Pivot-shift test, musculoskeletal system, medicine.disease, Surgery, medicine.anatomical_structure, Radiological weapon, business, Medial meniscus, 030217 neurology & neurosurgery, Cohort study
Abstract: Background The treatment of meniscus injuries combined with anterior cruciate ligament (ACL) reconstruction would be important to improve outcomes after ACL reconstruction. However, the effects of treatment methods for meniscus after ACL reconstruction have not been thoroughly investigated. The objective of this study was to investigate the effects of treatment methods for meniscus on clinical and radiological outcomes at 2 years after ACL reconstruction. Methods Three-hundred and eighteen patients with primary ACL reconstruction using autologous hamstring tendon registered in our multicenter study database and who were followed up for 2 years were included. They were then divided into 3 groups, the no meniscal lesion/untreated group (n = 149), the meniscal repair group (n = 139), and the meniscal resection group (n = 30). Patient-based subjective evaluations (Lysholm score, Knee injury and Osteoarthritis Outcome score and International Knee Documentation Committee subjective score), objective evaluations (Lachman test, pivot shift test and KT measurement), and radiological measurements (medial and lateral joint space width) were compared among the 3 groups preoperatively and at 2 years follow-up. Results All subjective scores and objective evaluations significantly improved in all groups without significant differences among the groups postoperatively. Regarding radiological findings, the medial joint space width significantly decreased only in the resection group during the 2-year period, and the medial joint space width in the resection group was significantly smaller than that of the other groups at the 2-year follow-up. Moreover, the medial joint space width significantly decreased during the 2-year period when MM was resected. Conclusions In radiological findings, medial meniscus resection decreased medial joint space width two years after ACL reconstruction. On the other hand, treatment methods for meniscus neither significantly affected subjective nor objective findings until the 2-year follow-up. Level of evidence Ⅱ, Cohort study.
Published: 2022

7. Clinical effects of cervical conization with positive margins in cervical cancer

Author: Akira Yokoi, Kaoru Niimi, Satoshi Tamauchi, Kosuke Yoshida, Masanori Sumi, Masato Yoshihara, Yukari Nagao, Hiroaki Kajiyama, Nobuhisa Yoshikawa, Kimihiro Nishino, and Yoshiki Ikeda
Subjects: Adult, medicine.medical_specialty, medicine.medical_treatment, Science, Conization, Uterine Cervical Neoplasms, Cervix Uteri, Hysterectomy, Article, Pelvis, Young Adult, Medicine, Humans, Radical Hysterectomy, Radical surgery, Lymph node, Aged, Neoplasm Staging, Cancer, Cervical cancer, Multidisciplinary, business.industry, Medical record, Margins of Excision, Middle Aged, medicine.disease, Cervical conization, Prognosis, Lymphovascular, Survival Rate, Dissection, medicine.anatomical_structure, Treatment Outcome, Oncology, Lymphatic Metastasis, Disease Progression, Lymph Node Excision, Female, Radiology, Lymph Nodes, business
Abstract: Radical surgery after cervical conization is a common approach for the treatment of cervical cancer. In some cases, disease progression is observed after positive margins at conization, but the effect of conization on disease progression remains unclear. Thus, the aim of this study was to investigate the clinical outcomes of positive margins at conization in cervical cancer. A total of 101 patients who underwent cervical conization before radical hysterectomy and pelvic lymph node dissection were considered eligible by reviewing medical records. The association between the positive margins and patient outcomes, including subsequent lymph node metastasis, was evaluated. The rate of lymphovascular space invasion (LVSI) positivity at radical surgery was significantly higher in patients with positive margins (p = 0.017) than in those with negative margins, although there was no significant difference in the rate of pelvic lymph node metastasis (p = 0.155). Moreover, there was no significant difference in the overall survival or progression-free survival between the two groups (p = 0.332 and 0.200, respectively). A positive margin at conization presented no significant prognostic disadvantage; thus, diagnostic conization is one of the most suitable treatment options for early-stage cervical cancer that is difficult to accurately assess.
Published: 2021

8. Long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery for epithelial ovarian cancer

Author: Munehisa Shigeyama, Kazuhisa Kitami, Hiroaki Kajiyama, Kaname Uno, Kazumasa Mogi, Masato Yoshihara, Nobuhisa Yoshikawa, Shohei Iyoshi, and Sho Tano
Subjects: Oncology, Longterm effects, medicine.medical_specialty, Population, Carcinoma, Ovarian Epithelial, Recurrence, Internal medicine, medicine, Humans, Fertility preservation, education, Survival analysis, Aged, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, education.field_of_study, business.industry, Hazard ratio, Obstetrics and Gynecology, Retrospective cohort study, Epithelial ovarian cancer, Confidence interval, Log-rank test, Reproductive Medicine, Propensity score matching, Female, Neoplasm Recurrence, Local, business
Abstract: Objective The aim of this study was to investigate long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery (FSS) to verify the feasibility of the limited surgery for epithelial ovarian cancer (OvCa). Study Design We performed a regional multicenter retrospective study from January 1986 and March 2020, using clinical data corrected under the central pathological review system. Patients with recurrent tumor after surgery for stage I epithelial OvCa, aged equal or younger than 45 years were included for this study. We evaluated effect of FSS regarding long-term post-recurrence survival with statistical adjustment of propensity score-based method. Results With the Kaplan–Meier method, original and adjusted survival curves were estimated for recurrence-after survival of patients with (n = 14) and without FSS (n = 26). Median time to disease-specific death was 18.6 months. In both original and adjusted cohorts, there were no significant difference between the two groups (log rank test; P > 0.05). Hazard ratio of disease-specific death was 1.264 (95% confidence interval, 0.563–2.836; P = 0.570) in original and 1.354 (95% confidence interval, 0.702–2.611; P = 0.366) in adjusted population. This result indicated that patients with FSS was not associated with poorer prognosis for recurrence-after survival than those without. When comparing patients not receiving FSS, patients receiving FSS with recurrence at spared ovary followed not significantly different survival outcome as well as those with extra-ovarian recurrence. Conclusion There was no significant difference of long-term post-recurrence survival outcomes between patients of epithelial OvCa with and without FSS in young women of reproductive age.
Published: 2021

9. Feasibility of six cycles of lenalidomide-based triplet induction before stem cell collection for newly diagnosed transplant-eligible multiple myeloma

Author: Yoshifumi Shimizu, Masaya Okada, Hiroyuki Kawamoto, Mahito Misawa, Hideki Ifuku, Takehito Imado, Hiroyuki Takatsuka, Yoshihiro Fujimori, Satoshi Yoshihara, Yokiko Ohe, and Kyoko Yoshihara
Subjects: Adult, Male, Oncology, medicine.medical_specialty, Stem Cell Collection, Dexamethasone, Bortezomib, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Autologous stem-cell transplantation, Induction therapy, Internal medicine, Humans, Medicine, Prospective Studies, Lenalidomide, Multiple myeloma, Aged, business.industry, Induction Chemotherapy, Hematology, Middle Aged, medicine.disease, Carfilzomib, Minimal residual disease, Hematopoietic Stem Cell Mobilization, chemistry, 030220 oncology & carcinogenesis, Feasibility Studies, Female, Multiple Myeloma, business, 030215 immunology, medicine.drug
Abstract: Achieving a deep response with induction therapy has a major impact on outcomes following autologous stem cell transplantation. Although longer and intensified induction therapy may provide better disease control, longer exposure to lenalidomide negatively affects stem cell yield. We examined the feasibility of 6 cycles of lenalidomide-based triplet induction therapy before stem cell collection in transplant-eligible multiple myeloma patients.In this prospective study, patients received a combination of bortezomib, lenalidomide, and dexamethasone for 6 cycles. For patients who did not achieve a deep response after 3 cycles, bortezomib was substituted with carfilzomib for the last 2 cycles (5th and 6th courses).Although only half of the patients achieved a deep response after 3 cycles, all but 1 patient achieved a very good partial response (This study demonstrates that 6 cycles of lenalidomide-based induction therapy before stem cell collection are a feasible and promising approach for transplant-eligible newly diagnosed multiple myeloma patients.The study is registered at UMIN Clinical Trials Registry as UMIN000026936.
Published: 2021

10. Prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis in 3299 black patients

Author: Vidushan Nadarajah, Evan Horowitz, and Hiroyuki Yoshihara
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Epidemiology, Science, Chest ct, Computed tomography, Comorbidity, Thoracic Vertebrae, Article, Body Mass Index, Young Adult, Risk Factors, Surveys and Questionnaires, Internal medicine, Diabetes mellitus, Spondyloarthritis, Diabetes Mellitus, Prevalence, medicine, Humans, Public Health Surveillance, In patient, Child, Bone, Aged, Diffuse Idiopathic Skeletal Hyperostosis, Aged, 80 and over, Hyperostosis, Diffuse Idiopathic Skeletal, Multidisciplinary, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Black or African American, Cross-Sectional Studies, Male patient, Medicine, Female, New York City, Tomography, X-Ray Computed, business, Body mass index
Abstract: The purpose of this study was to examine the prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis (T-DISH) in the Black patients using the computed tomography (CT) analysis. This study is a cross-sectional study. All patients who underwent chest CT for the trauma screening and whose race was categorized as “Black” on the questionnaire were recruited in the study from Mar 2019 to Mar 2020. Demographic data, including age, sex, body mass index (BMI), and presence of diabetes mellitus (DM), were recorded. A total of 3299 Black patients (1507 women and 1792 men) were included for the analysis. The prevalence of T-DISH was 7.7% (255 patients), with 8.6% for females and 7.0% for males. The highest prevalence was observed in patients at the age of 70 years (11.7%), followed by the age of 80 years (10.5%). The highest prevalence level of T-DISH segment was at T8, followed by T9, and T7. The most frequent number of contiguous vertebrae was seven (21%). BMI was not associated with T-DISH. The presence of DM was significantly higher in male patients with T-DISH than those without T-DISH (P = 0.02).
Published: 2021

11. Percutaneous Image-guided Needle Biopsy of Musculoskeletal Tumors: Technical Tips

Author: Ryota Tsukii, Hidekazu Yamaura, Takaaki Hasegawa, Yozo Sato, Shinichi Murata, Masanori Machida, Shohei Chatani, Kyohei Nagasawa, Terutaka Yoshihara, and Yoshitaka Inaba
Subjects: Osteolytic lesion, medicine.medical_specialty, Percutaneous, medicine.diagnostic_test, business.industry, Needle biopsy, Biopsy, Medicine, Soft tissue, Radiology, Image guidance, business
Abstract: With recent advances in imaging technology, the frequency of detecting musculoskeletal lesions has also increased. Percutaneous image-guided needle biopsy is occasionally required for the diagnosis of such lesions. Moreover, in the era of personalized cancer care, chances in histopathological diagnosis and the importance of histopathological diagnosis by percutaneous needle biopsy are increasing. However, as percutaneous needle biopsy is not a common procedure for musculoskeletal lesions, careful planning and the application of adequate techniques such as hydrodissection and the trans-osseous approach are occasionally required. In this review, we have summarized the indications and techniques for percutaneous image-guided needle biopsy for musculoskeletal lesions, including lymphatic lesions.
Published: 2021

12. Pharmacokinetic and pharmacodynamic similarity between SAR341402 insulin aspart and Japan-approved NovoRapid in healthy Japanese subjects

Author: Hiroki Takagi, Miyuki Kajiwara, Irene Nowotny, Masanari Shiramoto, Hideya Muto, Wolfgang Schmider, and Tatsuya Yoshihara
Subjects: Adult, Blood Glucose, Male, medicine.medical_specialty, Science, Drug development, Article, Insulin aspart, Young Adult, Glucose infusion, Double-Blind Method, Japan, Pharmacokinetics, Internal medicine, medicine, Humans, Hypoglycemic Agents, Potency, Biosimilar Pharmaceuticals, Insulin Aspart, Cross-Over Studies, Multidisciplinary, business.industry, Type 2 diabetes, Middle Aged, Crossover study, Healthy Volunteers, Confidence interval, Type 1 diabetes, Endocrinology, Therapeutic Equivalency, Pharmacodynamics, Medicine, Plasma insulin, Hormonal therapies, business, Biomarkers, medicine.drug
Abstract: This study compared the pharmacokinetic and glucodynamic profiles of biosimilar SAR341402 insulin aspart to Japan-approved insulin aspart (NovoRapid) in healthy Japanese males. In this single-center, randomized, double-blind, single-dose, two-period, crossover study, subjects received 0.3 U/kg of SAR341402 or NovoRapid before undergoing a 10 h euglycemic clamp procedure. Plasma insulin aspart concentrations and blood glucose levels were measured, and glucose infusion rates (GIRs) were assessed. Primary endpoints were maximum plasma insulin aspart concentration (INS-Cmax), area under the plasma insulin concentration–time curve to the last quantifiable concentration (INS-AUClast), area under the GIR–time curve during the clamp (GIR-AUC0–10 h), and maximum GIR (GIRmax). Forty subjects were randomized with 39 completing both treatment periods. Pharmacokinetic exposure showed a mean ratio between products of 1.00 (90% confidence interval [CI] 0.94–1.05) for INS-Cmax and 1.02 (90% CI 1.00–1.04) for INS-AUClast. Glucodynamic activity showed a mean ratio between products of 1.00 (95% CI 0.93–1.06) for GIR-AUC0–10 h and 1.01 (95% CI 0.95–1.08) for GIRmax. The 90% CIs for pairwise treatment ratios were within the predefined equivalence range of 0.80–1.25. Both treatments were well tolerated. We concluded that similar pharmacokinetic exposure and glucodynamic potency were shown for SAR341402 and NovoRapid in healthy Japanese males.
Published: 2021

13. Proposing a molecular classification associated with hypercoagulation in ovarian clear cell carcinoma

Author: Shujiro Okuda, Kosuke Yoshihara, Koji Matsuo, Ai Miyoshi, Kentaro Sugino, Hirofumi Nakaoka, Yutaka Ueda, Teiichi Motoyama, Akira Kikuchi, Yutaro Mori, Manako Yamaguchi, Ryo Tamura, Tatsuya Ishiguro, Kazuaki Suda, Nozomi Yachida, Ituro Inoue, Takayuki Enomoto, and Kotaro Takahashi
Subjects: Oncology, medicine.medical_specialty, Clinical Decision-Making, Datasets as Topic, Inflammation, Disease, Risk Assessment, Fibrin Fibrinogen Degradation Products, Tissue factor, Internal medicine, D-dimer, Biomarkers, Tumor, medicine, Humans, Thrombophilia, RNA-Seq, Stage (cooking), Blood Coagulation, Retrospective Studies, Ovarian Neoplasms, business.industry, Obstetrics and Gynecology, Middle Aged, Cell cycle, Prognosis, Phenotype, Progression-Free Survival, Gene Expression Regulation, Neoplastic, Clear cell carcinoma, Female, medicine.symptom, business, Adenocarcinoma, Clear Cell
Abstract: Background Although ovarian clear cell carcinoma (CCC) is associated with high incidence of thromboembolism, the clinicopathological and biological significance of hypercoagulable status in CCC remains unclear. Materials and methods We retrospectively analyzed pretreatment D-dimer levels, thromboembolic status, and clinical outcome of 125 CCCs in the discovery set and 143 CCCs in two other independent validation sets. Next, we performed RNA sequencing of 93 CCCs and compared coagulation-related gene profiles with 2492 pan-cancer data. We investigated differences in molecular characteristics of CCC subclasses based on coagulation status. Results In the discovery dataset, D-dimer elevation above the normal range was significantly associated with shorter progression-free and overall survival, irrespective to thromboembolic status. Multivariate analysis identified D-dimer elevation and clinical stage as an independent prognostic factors. We confirmed the prognostic significance of D-dimer elevation in the validation sets. Tissue factor and IL6, which are considered key elements of cancer-induced hypercoagulation, were highly expressed in CCC than in other cancers regardless of D-dimer level. Higher activity of various oncogenic pathways was observed in CCC with compared to without D-dimer elevation. Moreover, hierarchical cluster analysis divided 57 CCCs with D-dimer elevation into immunologically hot and cold tumor subtypes. Hot tumors were characterized by enrichment of T-cell inflamed phenotype, inflammation, the epithelial-mesenchymal transition, and high serum levels of CRP, and cold tumors by enrichment of cell cycle and MYC pathways. Conclusions CCC represents hypercoagulable disease and elevate D-dimer is a prognostic factor for decreased survival in CCC. D-dimer high CCC has distinct molecular characteristics into the inflammatory-driven pathway (hot tumor) and the immune-suppressive pathway (cold tumor). Treatment implication of our proposed molecular classification merits further investigation.
Published: 2021

14. Annual body mass index gain and risk of hypertensive disorders of pregnancy in a subsequent pregnancy

Author: Sho Tano, Takafumi Ushida, Kenji Imai, Tomoko Nakano-Kobayashi, Yasuyuki Kishigami, Shigeru Yoshida, Yukako Iitani, Hiroaki Kajiyama, Fumie Kinoshita, Yoshinori Moriyama, Mamoru Yamashita, Masato Yoshihara, Hidenori Oguchi, and Tomomi Kotani
Subjects: Adult, medicine.medical_specialty, Science, Weight Gain, Article, Body Mass Index, Young Adult, Medical research, Pregnancy, Weight management, Odds Ratio, medicine, Humans, Retrospective Studies, Multidisciplinary, business.industry, Obstetrics, Health care, Pregnancy Outcome, Retrospective cohort study, Hypertension, Pregnancy-Induced, Odds ratio, medicine.disease, Confidence interval, Risk factors, Medicine, Female, Subsequent pregnancy, medicine.symptom, business, Body mass index, Weight gain
Abstract: Weight gain during interpregnancy period is related to hypertensive disorders of pregnancy (HDP). However, in interpregnancy care/counseling, the unpredictability of the timing of the next conception and the difficulties in preventing age-related body weight gain must be considered while setting weight management goals. Therefore, we suggest considering the annual change in the body mass index (BMI). This study aimed to clarify the association between annual BMI changes during the interpregnancy period and HDP risk in subsequent pregnancies. A multicenter retrospective study of data from 2009 to 2019 examined the adjusted odds ratio (aOR) of HDP in subsequent pregnancies. The aORs in several annual BMI change categories were also calculated in the subgroups classified by HDP occurrence in the index pregnancy. This study included 1,746 pregnant women. A history of HDP (aOR, 16.76; 95% confidence interval [CI], 9.62 − 29.22), and annual BMI gain (aOR, 2.30; 95% CI, 1.76 − 3.01) were independent risk factors for HDP in subsequent pregnancies. An annual BMI increase of ≥ 1.0 kg/m2/year was related to HDP development in subsequent pregnancies for women without a history of HDP. This study provides data as a basis for interpregnancy care/counseling, but further research is necessary to validate our findings and confirm this relationship.
Published: 2021

15. Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting

Author: Tetsuya Matoba, Satoshi Yasuda, Koichi Kaikita, Masaharu Akao, Junya Ako, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui, Hisao Ogawa, Yukihiro Koretsune, Takafumi Hiro, Tetsuya Sumiyoshi, Kazumi Kimura, Yoichiro Hashimoto, Teruyuki Hirano, Hiroyuki Daida, Yasushi Okada, Tsutomu Yamazaki, A. Nakamura, E. Tamiya, T. Yamamoto, S. Suetake, T. Noguchi, S. Nakamura, A. Matsumura, J. Kojima, S. Suwa, H. Yamaguchi, K. Kaikita, T. Yasu, A. Nakajima, T. Yamada, H. Arai, Y. Hata, T. Sakanashi, H. Tateishi, T. Nakayama, Y. Nozaki, M. Akao, Y. Okumura, M. Tokue, N. Kuroki, Y. Maruyama, T. Matoba, N. Hagiwara, H. Suzuki, Y. Nishida, M. Ajioka, K. Yumoto, S. Shimizu, T. Aoyama, H. Shimomura, T. Takeda, K. Oshiro, N. Sugishita, Y. Shibata, T. Otonari, H. Kihara, H. Ogawa, A. Ohno, M. Hazama, M. Shimizu, K. Tsukahara, S. Haruta, T. Wakeyama, T. Haruna, M. Ito, K. Fujii, N. Atsuchi, M. Sata, K. Kimura, N. Hasebe, Y. Kobayasi, K. Ohsato, K. Hironaga, Y. Naganuma, K. Anzaki, K. Oiwa, S. Okazaki, Y. Nakagawa, K. Tokuhiro, K. Tanaka, T. Momose, Y. Fukushima, R. Kametani, K. Kawamitsu, Y. Saito, S. Akashi, K. Kumagai, K. Eshima, T. Tobaru, T. Seo, K. Okuhara, K. Kozuma, Y. Ikari, T. Takahashi, I. Michishita, H. Fujikura, S. Momomura, Y. Yamamoto, K. Otomo, T. Matsubara, H. Tashiro, T. Inoue, M. Ishihara, I. Shiojima, E. Tachibana, J. Ako, K. Sumii, N. Yamamoto, N. Ohmura, T. Nakamura, Y. Morita, N. Takahashi, K. Watanabe, H. Fujinaga, M. Maruyama, T. Oka, T. Shirayama, T. Amano, K. Fukui, K. Ando, S. Oshima, S. Kagiyama, H. Teragawa, M. Yuge, S. Ono, T. Koga, K. Fujiu, M. Kuwabara, Y. Ohya, Y. Yumoto, N. Kuji, M. Ikemura, K. Kario, K. Chatani, K. Sato, H. Miyagi, M. Murakami, K. Saito, M. Hoshiga, S. Sato, N. Kubo, Y. Sakamoto, K. Ashida, H. Sakamoto, S. Murasaki, H. Uehara, T. Akasaka, Y. Ooba, S. Nakahara, Y. Hanaoka, T. Nishimiya, R. Tsunoda, Y. Onuma, S. Higuchi, A. Tani, A. Wada, M. Kato, H. Obata, Y. Higuchi, T. Endo, R. Katou, T. Matsunaga, T. Matsuoka, H. Noguchi, M. Usui, T. Hayashi, Y. Otsuji, T. Osaki, H. Zaizen, H. Yoshihara, K. Kadota, T. Hirose, T. Miyazawa, A. Mori, M. Takano, W. Shimizu, M. Wake, S. Oriso, M. Yoshiyama, S. Kakinoki, T. Nishioka, T. Ozaki, K. Nomoto, K. Seki, K. Kawai, Y. Ozaki, S. Miura, M. Kawasaki, R. Funada, K. Dote, T. Nagano, S. Okamoto, T. Kubo, Y. Murozono, T. Owada, T. Doke, T. Matsumura, M. Horiuchi, A. Takaishi, M. Yamamoto, H. Nakashima, M. Munemasa, Y. Sakata, N. Inoue, T. Ota, Y. Hamano, N. Abe, T. Tsubokura, M. Goto, I. Kubota, M. Yano, K. Umetani, T. Date, H. Morimoto, T. Noda, S. Goto, K. Hibi, A. Nakano, S. Hiramitsu, Y. Kihara, M. Sugi, N. Shiba, D. Izumi, T. Sato, S. Tayama, T. Matsui, A. Suzuki, K. Ajiki, M. Oishi, M. Kiryu, T. Ko, H. Ando, S. Miyazaki, T. Kinugawa, H. Otake, H. Kitaoka, Y. Hirata, S. Honda, M. Manita, Y. Ishii, H. Oka, Y. Nanba, M. Nishino, T. Sakamoto, T. Saito, H. Sakai, M. Ichikawa, S. Namiuchi, K. Inoue, N. Komiyama, Y. Akashi, Y. Nakamura, T. Komaru, T. Hosokawa, T. Chikamori, H. Tanaka, O. Arasaki, K. Aonuma, Y. Wakasa, T. Yoshizawa, T. Sugano, N. Yokota, A. Kakutani, T. Suzuki, Y. Abe, T. Kataoka, H. Okayama, H. Yokoi, K. Chin, K. Hasegawa, H. Tomita, H. Honzyo, H. Kawai, K. Yamamoto, Y. Morino, S. Tsujiyama, S. Hamasaki, Y. Niijima, Y. Mizuno, A. Maki, K. Tanabe, T. Murohara, S. Naomi, M. Arikawa, T. Kato, N. Matsumoto, T. Minamino, H. Sairenji, N. Miyamoto, H. Ito, Y. Matsuura, S. Hata, Y. Nakatsu, T. Onodera, M. Yoshimura, H. Amano, E. Tokutake, M. Kasao, M. Moriguchi, M. Tsuji, H. Yamamoto, Y. Yanbe, T. Iwasawa, M. Suzuki, and H. Mori
Subjects: Rivaroxaban, medicine.medical_specialty, business.industry, Unstable angina, medicine.medical_treatment, Percutaneous coronary intervention, Atrial fibrillation, medicine.disease, Thrombosis, Coronary artery disease, Internal medicine, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Stroke, medicine.drug
Abstract: Objectives The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study [AFIRE]; UMIN000016612 , NCT02642419 )
Published: 2021

16. Racial and ethnic disparity in characteristics and outcomes of women with placenta accreta spectrum: a comparative study

Author: Joseph G. Ouzounian, Rauvynne N. Sangara, Kazuhide Matsushima, Richard H. Lee, Kosuke Yoshihara, Maximilian Klar, Nicole L. Vestal, Koji Matsuo, Shinya Matsuzaki, Lauren E. McCarthy, and Rachel S. Mandelbaum
Subjects: medicine.medical_specialty, Pregnancy, business.industry, Obstetrics, Placenta accreta, Reproductive medicine, Ethnic group, Obstetrics and Gynecology, Perioperative, medicine.disease, Placenta previa, Cohort, medicine, Coagulopathy, business
Abstract: Placenta accreta spectrum (PAS) refers to the spectrum of diagnoses involving abnormally and morbidly adherent trophoblastic tissue to the gravid uterus. These disorders are associated with significant maternal morbidity and mortality. While race/ethnicity is known to impact pregnancy outcomes, racial disparities have not been previously examined in women with PAS. The objective of current study was to compare patient characteristics and perioperative outcomes of women with PAS who underwent cesarean delivery across race/ethnicity. This is a comparative study that retrospectively queried the National Inpatient Sample, a hospital-based inpatient database in the USA. The study cohort was women diagnosed with PAS who underwent cesarean delivery from 10/2015 to 12/2018. The exposure group was race/ethnicity. Main outcomes were (i) patient/pregnancy characteristics and (ii) surgical morbidity for cesarean delivery, assessed in multivariable analysis. A total of 10,535 women comprised the study cohort (White n = 5,230 [49.6%], Black n = 2,045 [19.4%], Hispanic n = 2,540 [24.1%], and Asian n = 720 [6.8%]). Patient demographics, pregnancy characteristics, and hospital factors for the non-White groups significantly differed compared to the White group. Older age, obesity, diabetes, placenta previa, percreta, non-elective surgery, lower median household income, and Medicaid particularly represented the non-White groups. When perioperative outcomes were compared, non-White women were more likely to have any measured complications, hemorrhage/transfusion, and shock/coagulopathy compared to White women. Various sensitivity analyses redemonstrated the main cohort results. In conclusion, this study suggests that there were significant disparities in patient characteristics and outcomes of women with PAS across race/ethnicity.
Published: 2021

17. Does Age or Sex Relate to Severity or Treatment Prognosis in Graves' Disease?

Author: Nami Suzuki, Ayako Hoshiyama, Natsuko Watanabe, Jaeduk Yoshimura Noh, Koichi Ito, Kentaro Mikura, Ai Suzuki, Ai Yoshihara, Aya Kinoshita, Ran Yoshimura, Miho Fukushita, Kiminori Sugino, Takako Mitsumatsu, and Masako Matsumoto
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Adolescent, Graves hyperthyroidism, Endocrinology, Diabetes and Metabolism, Graves' disease, 030209 endocrinology & metabolism, Disease, Risk Assessment, Severity of Illness Index, Young Adult, 03 medical and health sciences, Age Distribution, Sex Factors, 0302 clinical medicine, Endocrinology, Antithyroid Agents, Risk Factors, Humans, Medicine, Sex Distribution, Child, Disease prognosis, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Remission Induction, Age Factors, Health Status Disparities, Middle Aged, medicine.disease, Graves Disease, Treatment Outcome, Child, Preschool, 030220 oncology & carcinogenesis, Female, business
Abstract: Background: The prognosis of Graves' disease (GD) is reportedly related to sex, age, and genetic factors, although there is no consensus. The objective of this study was to investigate the relation...
Published: 2021

18. Alterations in renin-angiotensin receptors are not responsible for exercise preconditioning of skeletal muscle fibers

Author: Rafael Deminice, Jensen Lawrence, Scott K. Powers, Mustafa Ozdemir, Hayden W. Hyatt, Branden L. Nguyen, and Toshinori Yoshihara
Subjects: medicine.medical_specialty, Medicine (General), Skeletal muscle disuse atrophy, Chemistry, Skeletal muscle, Physical Therapy, Sports Therapy and Rehabilitation, Angiotensin II, Muscle atrophy, Diaphragm (structural system), medicine.anatomical_structure, Endocrinology, R5-920, Endurance training, Internal medicine, Renin–angiotensin system, medicine, Orthopedics and Sports Medicine, medicine.symptom, Respiratory system, Renin-angiotensin system, Receptor, Exercise preconditioning
Abstract: Endurance exercise training promotes a protective phenotype in skeletal muscle known as exercise preconditioning. Exercise preconditioning protects muscle fibers against a variety of threats including inactivity-induced muscle atrophy. The mechanism(s) responsible for exercise preconditioning remain unknown and are explored in these experiments. Specifically, we investigated the impact of endurance exercise training on key components of the renin-angiotensin system (RAS). The RAS was targeted because activation of the classical axis of the RAS pathway via angiotensin II type I receptors (AT1Rs) promotes muscle atrophy whereas activation of the non-classical RAS axis via Mas receptors (MasRs) inhibits the atrophic signaling of the classical RAS pathway. Guided by prior studies, we hypothesized that an exercise-induced decrease in AT1Rs and/or increases in MasRs in skeletal muscle fibers is a potential mechanism responsible for exercise preconditioning. Following endurance exercise training in rats, we examined the abundance of AT1Rs and MasRs in both locomotor and respiratory muscles. Our results indicate that endurance exercise training does not alter the protein abundance of AT1Rs or MasRs in muscle fibers from the diaphragm, plantaris, and soleus muscles compared to sedentary controls (p > 0.05). Furthermore, fluorescent angiotensin II (AngII) binding analyses confirm our results that exercise preconditioning does not alter the protein abundance of AT1Rs in the diaphragm, plantaris, and soleus (p > 0.05). This study confirms that exercise-induced changes in RAS receptors are not a key mechanism that contributes to the beneficial effects of exercise preconditioning in skeletal muscle fibers.
Published: 2021

19. Allogeneic hematopoietic stem cell transplantation from a 2-HLA-haplotype-mismatched family donor for posttransplant relapse: a prospective phase I/II study

Author: Shinichi Ishii, Satoshi Fujino, Keiko Fukunaga, Yosihiro Fujimori, Hiroya Tamaki, Satoshi Maruyama, Masaya Okada, Takayuki Inoue, Yuko Osugi, Katsuji Kaida, Kazuhiro Ikegame, Masahiro Teramoto, Hiroyasu Ogawa, Takaya Yamashita, Azusa Mayumi, Kyoko Yoshihara, and Satoshi Yoshihara
Subjects: Oncology, Melphalan, Transplantation, medicine.medical_specialty, Neutrophil Engraftment, business.industry, medicine.medical_treatment, Hematology, Hematopoietic stem cell transplantation, Total body irradiation, Tacrolimus, Fludarabine, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, immune system diseases, hemic and lymphatic diseases, 030220 oncology & carcinogenesis, Internal medicine, medicine, Cytarabine, business, 030215 immunology, medicine.drug
Abstract: HLA haploidentical hematopoietic stem cell transplantation (HSCT), i.e., HSCT from a 1-HLA-haplotype-mismatched family donor, has been successfully performed even as a second transplantation for posttransplant relapse. Is the haploidentical the limit of HLA mismatches in HSCT? In order to explore the possibility of HLA-mismatched HSCT from family donors beyond haploidentical relatives, we conducted a prospective phase I/II study of 2-HLA-haplotype-mismatched HSCT (2-haplo-mismatch HSCT). We enrolled 30 patients with posttransplant relapse (acute myeloid leukemia: 18, acute lymphoblastic leukemia: 11, non-Hodgkin lymphoma: 1). 2-haplo-mismatch HSCT was performed as the second to sixth transplantations. The donors were siblings (n = 12), cousins (n = 16), and second cousins (n = 2). The conditioning regimen consisted of fludarabine, cytarabine, melphalan, low-dose anti-thymocyte globulin, and 3 Gy of total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus, methylprednisolone, and mycophenolate mofetil. All patients achieved neutrophil engraftment, except for a case of early death. The cumulative incidences of grades II–IV and III–IV acute GVHD were 36.7% and 16.7%, respectively. The overall survival at 1 year, relapse, and non-relapse mortality rates was 30.1%, 38.9%, and 44.3%, respectively. Considering the poor prognosis of posttransplant relapse, 2-haplo-mismatch HSCT can be an alternative option in a second or third transplantation.
Published: 2020

20. On-road driving behaviour characteristics of patients with brain injury

Author: Emi Ito, Ayami Yoshihara, and Hajime Tanaka
Subjects: Occupational therapy, medicine.medical_specialty, business.industry, Rehabilitation, Physical therapy, medicine, Physical Therapy, Sports Therapy and Rehabilitation, In patient, Patient group, Automobile driving, business
Abstract: Background/aims To clarify the characteristics of automobile driving performance in patients with brain injury, 26 patients (patient group) and 26 driving instructors (control group) were evaluated via an on-road driving assessment. Methods On-road driving performance was evaluated using an event data recorder, driving analysis software, and a video-based driving assessment scale. The number of unsafe driving events, the score on the driving analysis software, and the score on the driving assessment scale were then compared between the two groups. Results The patient group had 12 unsafe events (7 braking, 4 acceleration, 1 curving), but the instructors only had two sudden braking events, both of which were to avoid a collision when another vehicle forcibly entered from outside the roadway. In the case of the driving analysis software, the patient group showed significantly lower scores for braking (PConclusions These objective video and g-force-generated on-road driving assessments may provide important information regarding driving and advice for patients with brain injury.
Published: 2021

21. Serum albumin levels as a predictive biomarker for low-load resistance training programs’ effects on muscle thickness in the community-dwelling elderly Japanese population: interventional study result

Author: Hayao Ozaki, Shuji Sawada, Pengyu Deng, Toshinori Yoshihara, Takuya Osawa, Hiroyuki Kobayashi, Shuichi Machida, Daiki Nakano, Hisashi Naito, and Toshiharu Natsume
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Serum albumin, Muscle hypertrophy, Japan, Internal medicine, medicine, Humans, Muscle Strength, Muscle, Skeletal, Aged, Rehabilitation, biology, business.industry, Research, RC952-954.6, Training effect, Odds ratio, medicine.disease, Resistance training, Quartile, Geriatrics, Sarcopenia, biology.protein, Biomarker (medicine), Female, Independent Living, Geriatrics and Gerontology, business, Biomarkers
Abstract: Background Resistance training has been recommended as an effective measure against age-related loss of muscle mass and muscle strength, called sarcopenia, even in older adults. However, despite subjecting each participant to the same training program, the training effect solely depended on the individual. This study aimed to evaluate whether certain blood parameters influenced the effect of a low-load resistance training program on muscle thickness in the community-dwelling elderly population. Methods Sixty-nine community-dwelling Japanese (49 women and 20 men) subjects aged 69.4 ± 6.5 years were included. Low-load resistance training was performed twice a week for 12 weeks. Muscle thickness at the anterior aspects of the thigh (AT) was measured using a B-mode ultrasound device, and 22 blood parameter levels were assessed before and after the program. We checked the first quartile value of each parameter to establish cutoff values, and participants were divided into low or normal groups for each parameter. Results A low-load resistance training program significantly increased muscle thickness at the AT. The interaction between time and groups was examined at low ( Conclusions Serum Alb level may act as a biomarker to predict the effects of low-load resistance training programs on muscle hypertrophy in elderly individuals. Trial registration This study was retrospectively registered in UMIN-Clinical Trial Registry (CTR), ID: UMIN000042759 (date of registration, 14 Dec 2020).
Published: 2021

22. ePoster

Author: A. Keiichi, Tetsuya Matsuura, Noboru Misawa, Akiko Fuyuki, Tsutomu Yoshihara, A. Nakajima, Takuma Higurashi, Hidenori Ohkubo, and Tomohiro Takatsu
Subjects: medicine.medical_specialty, Hepatology, Coronavirus disease 2019 (COVID-19), business.industry, Colorectal cancer, Gastroenterology, Rectum, medicine.disease, Single Center, law.invention, medicine.anatomical_structure, Randomized controlled trial, law, Leukotriene Receptor Antagonists, Internal medicine, Montelukast Sodium, Medicine, business, Aberrant crypt foci
Abstract: Background and Aim: Aberrant crypt foci (ACF) in the rectum have been reported to correlate with the risk of colorectal tumorigenesis and are useful biomarkers for predicting the risk of colorectal cancer because they are quantitative and can be evaluated in a short period of time. Leukotriene receptor antagonists (LTRAs) have been reported to have inhibitory effects on various carcinomas, but their effects on colorectal cancer are unknown. Based on the report that colorectal cancer overexpresses the cysteinyl leukotriene receptor, we investigated whether LTRA medication affects the number of ACF. Methods: The eligibility criteria were patients who were between 30 and 80 years old, had colorectal tumors that were suitable for endoscopic resection, and had at least five ACFs in the rectum. First, 30 patients were enrolled in the LTRA group, who were treated with montelukast sodium 10 mg for 8 weeks, and rectal ACFs were counted during treatment of colorectal tumors. 10 patients in the no medication follow-up group were enrolled as the control group. Results: One patient in the control group was not examined due to the COVID-19 pandemic, so we examined 30 patients in the LTRA group and 9 patients in the control group. The number of rectal ACFs decreased to -2.4 (SD 2.2) in the LTRA group compared to baseline, while there was no decrease to 0.4 (SD 2.3) in the control group, and there was a significant difference in ACF trends between the two groups (P = 0.002). The Ki67 labeling index, which is a cell proliferation activity, was -1.34 (SD 2.68) in the LTRA group compared to baseline, while it was 0.13 (SD 1.89) in the control group, but there was no significant difference between the two groups. Conclusion: The LTRA treatment decreased rectal ACF and may reduce the risk of colorectal cancer.
Published: 2021

23. Elobixibat Effectively Relieves Chronic Constipation in Patients with Cancer Regardless of the Amount of Food Intake

Author: Tsutomu Yoshihara, Shunsuke Oyamada, Yasushi Ichikawa, Yasushi Honda, Akiko Fuyuki, Atsushi Nakajima, Hiroto Ishiki, Takuma Higurashi, Noritoshi Kobayashi, Naoki Okubo, Yuki Kasai, Takashi Kobayashi, Michihiro Iwaki, Yuma Takeda, Anna Ozaki, Masataka Taguri, and Takaomi Kessoku
Subjects: Cancer Research, medicine.medical_specialty, Palliative care, Constipation, Thiazepines, Gastroenterology, Eating, Elobixibat, Quality of life, Neoplasms, Internal medicine, medicine, Humans, Prospective Studies, Ileal bile acid transporter, Adverse effect, Cancer, Chronic constipation, business.industry, Dipeptides, medicine.disease, Oncology, Symptom Management and Supportive Care, Quality of Life, Defecation, medicine.symptom, business
Abstract: Background Constipation is a common, distressing complication in patients with cancer receiving palliative care. Elobixibat is a novel inhibitor of the ileal bile acid transporter that is used to treat chronic constipation by stimulating bowel function. However, its efficacy in patients with cancer has not been examined. This study investigated the drug's effectiveness in patients with cancer with chronic constipation. Patients and Methods This prospective‐sampling, single‐center, observational study included hospitalized patients with cancer diagnosed, using the Rome IV criteria, with chronic constipation. Within 2 weeks of hospitalization, each participant was administered elobixibat (5–15 mg) daily until discharge. Spontaneous bowel movements (SBMs), complete spontaneous bowel movements (CSBMs), Bristol stool form scale (BSFS) scores, and the Patient Assessment of Constipation Quality of Life questionnaire (PAC‐QOL) scores were assessed before and after elobixibat administration. We also evaluated the relationship between the amount of food consumed and the SBM frequency. Results Among the 83 participants, the mean pre‐ and post‐treatment frequencies of daily SBMs were 0.3 and 1.2 (p, Constipation is a common, distressing complication in cancer patients receiving palliative care. This study investigated the effectiveness of elobixibat in cancer patients with chronic constipation.
Published: 2021

24. Effects of Face Mask Use on Objective and Subjective Measures of Thermoregulation During Exercise in the Heat

Author: Yasuki Sekiguchi, Rebecca L. Stearns, Erin E. Dierickx, Gabrielle J. Brewer, Ayami Yoshihara, and Douglas J. Casa
Subjects: Adult, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Hot Temperature, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Physical Exertion, Physical Therapy, Sports Therapy and Rehabilitation, Walking, Random Allocation, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Heart Rate, medicine, Humans, Thermosensing, Orthopedics and Sports Medicine, 030212 general & internal medicine, Work of Breathing, Random allocation, Cross-Over Studies, SARS-CoV-2, business.industry, Masks, COVID-19, Humidity, Rectal temperature, Thermoregulation, Current Research, 030210 environmental & occupational health, Jogging, Female, Perception, business, Body Temperature Regulation
Abstract: Background: While increased face mask use has helped reduce COVID-19 transmission, there have been concerns about its influence on thermoregulation during exercise in the heat, but consistent, evidence-based recommendations are lacking. Hypothesis: No physiological differences would exist during low-to-moderate exercise intensity in the heat between trials with and without face masks, but perceptual sensations could vary. Study Design: Crossover study. Level of Evidence: Level 2. Methods: Twelve physically active participants (8 male, 4 female; age = 24 ± 3 years) completed 4 face mask trials and 1 control trial (no mask) in the heat (32.3°C ± 0.04°C; 54.4% ± 0.7% relative humidity [RH]). The protocol was 60 minutes of walking and jogging between 35% and 60% of relative VO2max. Rectal temperature (Trec), heart rate (HR), temperature and humidity inside and outside of the face mask (Tmicro_in, Tmicro_out, RHmicro_in, RHmicro_out) and perceptual variables (rating of perceived exertion (RPE), thermal sensation, thirst sensation, fatigue level, and overall breathing discomfort) were monitored throughout all trials. Results: Mean Trec and HR increased at 30- and 60-minute time points compared with 0-minute time points, but no difference existed between face mask trials and control trials ( P > 0.05). Mean Tmicro_in, RHmicro_in, and humidity difference inside and outside of the face mask (ΔRHmicro) were significantly different between face mask trials ( P < 0.05). There was no significant difference in perceptual variables between face mask trials and control trials ( P > 0.05), except overall breathing discomfort ( P < 0.01). Higher RHmicro_in, RPE, and thermal sensation significantly predicted higher overall breathing discomfort ( r2 = 0.418; P < 0.01). Conclusion: Face mask use during 60 minutes of low-to-moderate exercise intensity in the heat did not significantly affect Trec or HR. Although face mask use may affect overall breathing discomfort due to the changes in the face mask microenvironment, face mask use itself did not cause an increase in whole body thermal stress. Clinical Relevance: Face mask use is feasible and safe during exercise in the heat, at low-to-moderate exercise intensities, for physically active, healthy individuals.
Published: 2021

25. Angiotensin 1‐7 protects against ventilator‐induced diaphragm dysfunction

Author: Hayden W. Hyatt, Mustafa Ozdemir, Rafael Deminice, Toshinori Yoshihara, Branden L. Nguyen, and Scott K. Powers
Subjects: medicine.medical_specialty, medicine.medical_treatment, Diaphragm, RM1-950, medicine.disease_cause, Article, General Biochemistry, Genetics and Molecular Biology, Pathogenesis, Atrophy, Internal medicine, Renin–angiotensin system, medicine, Animals, Humans, Diaphragmatic weakness, General Pharmacology, Toxicology and Pharmaceutics, Infusions, Intravenous, Mechanical ventilation, Muscle Weakness, business.industry, Research, General Neuroscience, Articles, General Medicine, medicine.disease, Respiration, Artificial, Muscular Disorders, Atrophic, Peptide Fragments, Rats, Diaphragm (structural system), Disease Models, Animal, Oxidative Stress, Ras Signaling Pathway, Cardiology, Female, Therapeutics. Pharmacology, Angiotensin I, Public aspects of medicine, RA1-1270, business, Oxidative stress, Muscle Contraction
Abstract: Mechanical ventilation (MV) is a life‐saving instrument used to provide ventilatory support for critically ill patients and patients undergoing surgery. Unfortunately, an unintended consequence of prolonged MV is the development of inspiratory weakness due to both diaphragmatic atrophy and contractile dysfunction; this syndrome is labeled ventilator‐induced diaphragm dysfunction (VIDD). VIDD is clinically important because diaphragmatic weakness is an important contributor to problems in weaning patients from MV. Investigations into the pathogenesis of VIDD reveal that oxidative stress is essential for the rapid development of VIDD as redox disturbances in diaphragm fibers promote accelerated proteolysis. Currently, no standard treatment exists to prevent VIDD and, therefore, developing a strategy to avert VIDD is vital. Guided by evidence indicating that activation of the classical axis of the renin‐angiotensin system (RAS) in diaphragm fibers promotes oxidative stress and VIDD, we hypothesized that activation of the nonclassical RAS signaling pathway via angiotensin 1‐7 (Ang1‐7) will protect against VIDD. Using an established animal model of prolonged MV, our results disclose that infusion of Ang1‐7 protects the diaphragm against MV‐induced contractile dysfunction and fiber atrophy in both fast and slow muscle fibers. Further, Ang1‐7 shielded diaphragm fibers against MV‐induced mitochondrial damage, oxidative stress, and protease activation. Collectively, these results reveal that treatment with Ang1‐7 protects against VIDD, in part, due to diminishing oxidative stress and protease activation. These important findings provide robust evidence that Ang1‐7 has the therapeutic potential to protect against VIDD by preventing MV‐induced contractile dysfunction and atrophy of both slow and fast muscle fibers.
Published: 2021

26. A Case of Clear Nails Regeneration in a Patient with Epidermolysis Bullosa Acquisita Successfully Treated by Plasmapheresis and IVIG

Author: Shigaku Ikeda, Hiroko Sasano, and Nagisa Yoshihara
Subjects: Epidermolysis bullosa acquisita, medicine.medical_specialty, business.industry, medicine.medical_treatment, Regeneration (biology), medicine, Plasmapheresis, Dermatology, medicine.disease, business
Published: 2021

27. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. 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Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing Liu , J Jaime Miranda , Olfa Saidi , Sylvain Sebert , Maroje Sorić , Gregor Starc , Edward W Gregg , Leandra Abarca-Gómez , Ziad A Abdeen , Shynar Abdrakhmanova , Suhaila Abdul Ghaffar , Hanan F Abdul Rahim , Niveen M Abu-Rmeileh , Jamila Abubakar Garba , Benjamin Acosta-Cazares , Robert J Adams , Wichai Aekplakorn , Kaosar Afsana , Shoaib Afzal , Imelda A Agdeppa , Javad Aghazadeh-Attari , Carlos A Aguilar-Salinas , Charles Agyemang , Mohamad Hasnan Ahmad , Noor Ani Ahmad , Ali Ahmadi , Naser Ahmadi , Soheir H Ahmed , Wolfgang Ahrens , Gulmira Aitmurzaeva , Kamel Ajlouni , Hazzaa M Al-Hazzaa , Badreya Al-Lahou , Rajaa Al-Raddadi , Monira Alarouj , Fadia AlBuhairan , Shahla AlDhukair , Mohamed M Ali , Abdullah Alkandari , Ala'a Alkerwi , Kristine Allin , Mar Alvarez-Pedrerol , Eman Aly , Deepak N Amarapurkar , Parisa Amiri , Norbert Amougou , Philippe Amouyel , Lars Bo Andersen , Sigmund A Anderssen , Lars Ängquist , Ranjit Mohan Anjana , Alireza Ansari-Moghaddam , Hajer Aounallah-Skhiri , Joana Araújo , Inger Ariansen , Tahir Aris , Raphael E Arku , Nimmathota Arlappa , Krishna K Aryal , Thor Aspelund , Felix K Assah , Maria Cecília F Assunção , May Soe Aung , Juha Auvinen , Mária Avdicová , Shina Avi , Ana Azevedo , Mohsen Azimi-Nezhad , Fereidoun Azizi , Mehrdad Azmin , Bontha V Babu , Maja Bæksgaard Jørgensen , Azli Baharudin , Suhad Bahijri , Jennifer L Baker , Nagalla Balakrishna , Mohamed Bamoshmoosh , Maciej Banach , Piotr Bandosz , José R Banegas , Joanna Baran , Barbagallo CM, Alberto Barceló , Amina Barkat , Aluisio Jd Barros , Mauro Virgílio Gomes Barros , Abdul Basit , Joao Luiz D Bastos , Iqbal Bata , Anwar M Batieha , Rosangela L Batista , Zhamilya Battakova , Assembekov Batyrbek , Louise A Baur , Robert Beaglehole , Silvia Bel-Serrat , Antonisamy Belavendra , Habiba Ben Romdhane , Judith Benedics , Mikhail Benet , Ingunn Holden Bergh , Salim Berkinbayev , Antonio Bernabe-Ortiz , Gailute Bernotiene , Heloísa Bettiol , Jorge Bezerra , Aroor Bhagyalaxmi , Sumit Bharadwaj , Santosh K Bhargava , Zulfiqar A Bhutta , Hongsheng Bi , Yufang Bi , Daniel Bia , Elysée Claude Bika Lele, Mukharram M Bikbov , Bihungum Bista , Dusko J Bjelica , Peter Bjerregaard , Espen Bjertness , Marius B Bjertness , Cecilia Björkelund , Katia V Bloch , Anneke Blokstra , Simona Bo , Martin Bobak , Lynne M Boddy , Bernhard O Boehm , Heiner Boeing , Jose G Boggia , Elena Bogova , Carlos P Boissonnet , Stig E Bojesen , Marialaura Bonaccio , Vanina Bongard , Alice Bonilla-Vargas , Matthias Bopp , Herman Borghs , Lien Braeckevelt , Lutgart Braeckman , Marjolijn Ce Bragt , Imperia Brajkovich , Francesco Branca , Juergen Breckenkamp , João Breda , Hermann Brenner , Lizzy M Brewster , Garry R Brian , Lacramioara Brinduse , Sinead Brophy , Graziella Bruno , H Bas Bueno-de-Mesquita , Anna Bugge , Marta Buoncristiano , Genc Burazeri , Con Burns , Antonio Cabrera de León , Joseph Cacciottolo , Hui Cai , Tilema Cama , Christine Cameron , José Camolas , Günay Can , Ana Paula C Cândido , Felicia Cañete , Mario V Capanzana , Nadežda Capková , Eduardo Capuano , Vincenzo Capuano , Marloes Cardol , Viviane C Cardoso , Axel C Carlsson , Esteban Carmuega , Joana Carvalho , José A Casajús , Felipe F Casanueva , Ertugrul Celikcan , Laura Censi , Marvin Cervantes-Loaiza , Juraci A Cesar , Snehalatha Chamukuttan , Angelique W Chan , Queenie Chan , Himanshu K Chaturvedi , Nish Chaturvedi , Norsyamlina Che Abdul Rahim , Miao Li Chee , Chien-Jen Chen , Fangfang Chen , Huashuai Chen , Shuohua Chen , Zhengming Chen , Ching-Yu Cheng , Bahman Cheraghian , Angela Chetrit , Ekaterina Chikova-Iscener , Arnaud Chiolero , Shu-Ti Chiou , María-Dolores Chirlaque , Belong Cho , Kaare Christensen , Diego G Christofaro , Jerzy Chudek , Renata Cifkova , Michelle Cilia , Eliza Cinteza , Frank Claessens , Janine Clarke , Els Clays , Emmanuel Cohen , Hans Concin , Susana C Confortin , Cyrus Cooper , Tara C Coppinger , Eva Corpeleijn , Simona Costanzo , Dominique Cottel , Chris Cowell , Cora L Craig , Amelia C Crampin , Ana B Crujeiras , Semánová Csilla , Alexandra M Cucu , Liufu Cui , Felipe V Cureau , Ewelina Czenczek-Lewandowska , Graziella D'Arrigo , Eleonora d'Orsi , Liliana Dacica , María Ángeles Dal Re Saavedra , Jean Dallongeville , Camilla T Damsgaard , Rachel Dankner , Thomas M Dantoft , Parasmani Dasgupta , Saeed Dastgiri , Luc Dauchet , Kairat Davletov , Guy De Backer , Dirk De Bacquer , Giovanni de Gaetano , Stefaan De Henauw , Paula Duarte de Oliveira , David De Ridder , Karin De Ridder , Susanne R de Rooij , Delphine De Smedt , Mohan Deepa , Alexander D Deev , Vincent Jr DeGennaro , Abbas Dehghan , Hélène Delisle , Francis Delpeuch , Stefaan Demarest , Elaine Dennison , Katarzyna Dereń , Valérie Deschamps , Meghnath Dhimal , Augusto F Di Castelnuovo , Juvenal Soares Dias-da-Costa , María Elena Díaz-Sánchez , Alejandro Diaz , Zivka Dika , Shirin Djalalinia , Visnja Djordjic , Ha Tp Do , Annette J Dobson , Maria Benedetta Donati , Chiara Donfrancesco , Silvana P Donoso , Angela Döring , Maria Dorobantu , Ahmad Reza Dorosty , Kouamelan Doua , Nico Dragano , Wojciech Drygas , Jia Li Duan , Charmaine A Duante , Priscilla Duboz , Rosemary B Duda , Vesselka Duleva , Virginija Dulskiene , Samuel C Dumith , Anar Dushpanova , Vilnis Dzerve , Elzbieta Dziankowska-Zaborszczyk , Ricky Eddie , Ebrahim Eftekhar , Eruke E Egbagbe , Robert Eggertsen , Sareh Eghtesad , Gabriele Eiben , Ulf Ekelund , Mohammad El-Khateeb , Jalila El Ati , Denise Eldemire-Shearer , Marie Eliasen , Paul Elliott , Reina Engle-Stone , Macia Enguerran , Rajiv T Erasmus , Raimund Erbel , Cihangir Erem , Louise Eriksen , Johan G Eriksson , Jorge Escobedo-de la Peña , Saeid Eslami , Ali Esmaeili , Alun Evans , David Faeh , Albina A Fakhretdinova , Caroline H Fall , Elnaz Faramarzi , Mojtaba Farjam , Victoria Farrugia Sant'Angelo , Farshad Farzadfar , Mohammad Reza Fattahi , Asher Fawwad , Francisco J Felix-Redondo , Trevor S Ferguson , Romulo A Fernandes , Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen Gironella , Aleksander Giwercman , Konstantinos Gkiouras , Justyna Godos , Sibel Gogen , Marcel Goldberg , Rebecca A Goldsmith , David Goltzman , Santiago F Gómez , Aleksandra Gomula , Bruna Goncalves Cordeiro da Silva , Helen Gonçalves , David A Gonzalez-Chica , Marcela Gonzalez-Gross , Margot González-Leon , Juan P González-Rivas , Clicerio González-Villalpando , María-Elena González-Villalpando , Angel R Gonzalez , Frederic Gottrand , Antonio Pedro Graça , Sidsel Graff-Iversen , Dušan Grafnetter , Aneta Grajda , Maria G Grammatikopoulou , Ronald D Gregor , Tomasz Grodzicki , Else Karin Grøholt , Anders Grøntved , Giuseppe Grosso , Gabriella Gruden , Dongfeng Gu , Emanuela Gualdi-Russo , Pilar Guallar-Castillón , Andrea Gualtieri , Elias F Gudmundsson , Vilmundur Gudnason , Ramiro Guerrero , Idris Guessous , Andre L Guimaraes , Martin C Gulliford , Johanna Gunnlaugsdottir , Marc J Gunter , Xiu-Hua Guo , Yin Guo , Prakash C Gupta , Rajeev Gupta , Oye Gureje , Beata Gurzkowska , Enrique Gutiérrez-González , Laura Gutierrez , Felix Gutzwiller , Seongjun Ha , Farzad Hadaegh , Charalambos A Hadjigeorgiou , Rosa Haghshenas , Hamid Hakimi , Jytte Halkjær , Ian R Hambleton , Behrooz Hamzeh , Dominique Hange , Abu Am Hanif , Sari Hantunen , Jie Hao , Rachakulla Hari Kumar , Seyed Mohammad Hashemi-Shahri , Maria Hassapidou , Jun Hata , Teresa Haugsgjerd , Jiang He , Yuan He , Yuna He , Regina Heidinger-Felso , Mirjam Heinen , Tatjana Hejgaard , Marleen Elisabeth Hendriks , Rafael Dos Santos Henrique , Ana Henriques , Leticia Hernandez Cadena , Sauli Herrala , Victor M Herrera , Isabelle Herter-Aeberli , Ramin Heshmat , Allan G Hill , Sai Yin Ho , Suzanne C Ho , Michael Hobbs , Michelle Holdsworth , Reza Homayounfar , Clara Homs , Wilma M Hopman , Andrea Rvr Horimoto , Claudia M Hormiga , Bernardo L Horta , Leila Houti , Christina Howitt , Thein Thein Htay , Aung Soe Htet , Maung Maung Than Htike , Yonghua Hu , José María Huerta , Ilpo Tapani Huhtaniemi , Laetitia Huiart , Constanta Huidumac Petrescu , Martijn Huisman , Abdullatif Husseini , Chinh Nguyen Huu , Inge Huybrechts , Nahla Hwalla , Jolanda Hyska , Licia Iacoviello , Jesús M Ibarluzea , Mohsen M Ibrahim , Norazizah Ibrahim Wong , M Arfan Ikram , Violeta Iotova , Vilma E Irazola , Takafumi Ishida , Muhammad Islam , Sheikh Mohammed Shariful Islam , Masanori Iwasaki , Jeremy M Jacobs , Hashem Y Jaddou , Tazeen Jafar , Kenneth James , Kazi M Jamil , Konrad Jamrozik , Imre Janszky , Edward Janus , Juel Jarani , Marjo-Riitta Jarvelin , Grazyna Jasienska , Ana Jelakovic , Bojan Jelakovic , Garry Jennings , Anjani Kumar Jha , Chao Qiang Jiang , Ramon O Jimenez , Karl-Heinz Jöckel , Michel Joffres , Mattias Johansson , Jari J Jokelainen , Jost B Jonas , Jitendra Jonnagaddala , Torben Jørgensen , Pradeep Joshi , Farahnaz Joukar , Dragana P Jovic , Jacek J Jóźwiak , Anne Juolevi , Gregor Jurak , Iulia Jurca Simina , Vesna Juresa , Rudolf Kaaks , Felix O Kaducu , Anthony Kafatos , Eero O Kajantie , Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , Jelena Kos , Seppo Koskinen , Katsuyasu Kouda , Viktoria A Kovacs , Sudhir Kowlessur , Slawomir Koziel , Jana Kratenova , Wolfgang Kratzer , Susi Kriemler , Peter Lund Kristensen , Steinar Krokstad , Daan Kromhout , Herculina S Kruger , Ruzena Kubinova , Renata Kuciene , Urho M Kujala , Enisa Kujundzic , Zbigniew Kulaga , R Krishna Kumar , Marie Kunešová , Pawel Kurjata , Yadlapalli S Kusuma , Kari Kuulasmaa , Catherine Kyobutungi , Quang Ngoc La , Fatima Zahra Laamiri , Tiina Laatikainen , Carl Lachat , Youcef Laid , Tai Hing Lam , Christina-Paulina Lambrinou , Edwige Landais , Vera Lanska , Georg Lappas , Bagher Larijani , Tint Swe Latt , Laura Lauria , Maria Lazo-Porras , Gwenaëlle Le Coroller , Khanh Le Nguyen Bao , Agnès Le Port , Tuyen D Le , Jeannette Lee , Jeonghee Lee , Paul H Lee , Nils Lehmann , Terho Lehtimäki , Daniel Lemogoum , Naomi S Levitt , Yanping Li , Merike Liivak , Christa L Lilly , Wei-Yen Lim , M Fernanda Lima-Costa , Hsien-Ho Lin , Xu Lin , Yi-Ting Lin , Lars Lind , Allan Linneberg , Lauren Lissner , Mieczyslaw Litwin , Lijuan Liu , Wei-Cheng Lo , Helle-Mai Loit , Khuong Quynh Long , Luis Lopes , Oscar Lopes , Esther Lopez-Garcia , Tania Lopez , Paulo A Lotufo , José Eugenio Lozano , Janice L Lukrafka , Dalia Luksiene , Annamari Lundqvist , Robert Lundqvist , Nuno Lunet , Charles Lunogelo , Michala Lustigová , Edyta Łuszczki , Guansheng Ma , Jun Ma , Xu Ma , George Ll Machado-Coelho , Aristides M Machado-Rodrigues , Luisa M Macieira , Ahmed A Madar , Stefania Maggi , Dianna J Magliano , Sara Magnacca , Emmanuella Magriplis , Gowri Mahasampath , Bernard Maire , Marjeta Majer , Marcia Makdisse , Päivi Mäki , Fatemeh Malekzadeh , Reza Malekzadeh , Rahul Malhotra , Kodavanti Mallikharjuna Rao , Sofia K Malyutina , Lynell V Maniego , Yannis Manios , Jim I Mann , Fariborz Mansour-Ghanaei , Enzo Manzato , Paula Margozzini , Anastasia Markaki , Oonagh Markey , Eliza Markidou Ioannidou , Pedro Marques-Vidal , Larissa Pruner Marques , Jaume Marrugat , Yves Martin-Prevel , Rosemarie Martin , Reynaldo Martorell , Eva Martos , Katharina Maruszczak , Stefano Marventano , Luis P Mascarenhas , Shariq R Masoodi , Ellisiv B Mathiesen , Prashant Mathur , Alicia Matijasevich , Tandi E Matsha , Christina Mavrogianni , Artur Mazur , Jean Claude N Mbanya , Shelly R McFarlane , Stephen T McGarvey , Martin McKee , Stela McLachlan , Rachael M McLean , Scott B McLean , Breige A McNulty , Sounnia Mediene Benchekor , Jurate Medzioniene , Parinaz Mehdipour , Kirsten Mehlig , Amir Houshang Mehrparvar , Aline Meirhaeghe , Jørgen Meisfjord , Christa Meisinger , Ana Maria B Menezes , Geetha R Menon , Gert Bm Mensink , Maria Teresa Menzano , Alibek Mereke , Indrapal I Meshram , Andres Metspalu , Haakon E Meyer , Jie Mi , Kim F Michaelsen , Nathalie Michels , Kairit Mikkel , Karolina Milkowska , Jody C Miller , Cláudia S Minderico , G K Mini , Juan Francisco Miquel , Mohammad Reza Mirjalili , Daphne Mirkopoulou , Erkin Mirrakhimov , Marjeta Mišigoj-Durakovic , Antonio Mistretta , Veronica Mocanu , Pietro A Modesti , Sahar Saeedi Moghaddam , Bahram Mohajer , Mostafa K Mohamed , Shukri F Mohamed , Kazem Mohammad , Zahra Mohammadi , Noushin Mohammadifard , Reza Mohammadpourhodki , Viswanathan Mohan , Salim Mohanna , Muhammad Fadhli Mohd Yusoff , Iraj Mohebbi , Farnam Mohebi , Marie Moitry , Drude Molbo , Line T Møllehave , Niels C Møller , Dénes Molnár , Amirabbas Momenan , Charles K Mondo , Michele Monroy-Valle , Eric Monterrubio-Flores , Kotsedi Daniel K Monyeki , Jin Soo Moon , Mahmood Moosazadeh , Leila B Moreira , Alain Morejon , Luis A Moreno , Karen Morgan , Suzanne N Morin , Erik Lykke Mortensen , George Moschonis , Malgorzata Mossakowska , Aya Mostafa , Anabela Mota-Pinto , Jorge Mota , Mohammad Esmaeel Motlagh , Jorge Motta , Marcos André Moura-Dos-Santos , Malay K Mridha , Kelias P Msyamboza , Thet Thet Mu , Magdalena Muc , Boban Mugoša , Maria L Muiesan , Parvina Mukhtorova , Martina Müller-Nurasyid , Neil Murphy , Jaakko Mursu , Elaine M Murtagh , Kamarul Imran Musa , Sanja Music Milanovic , Vera Musil , Norlaila Mustafa , Iraj Nabipour , Shohreh Naderimagham , Gabriele Nagel , Balkish M Naidu , Farid Najafi , Harunobu Nakamura , Jana Námešná , Ei Ei K Nang , Vinay B Nangia , Martin Nankap , Sameer Narake , Paola Nardone , Matthias Nauck , William A Neal , Azim Nejatizadeh , Chandini Nekkantti , Keiu Nelis , Liis Nelis , Ilona Nenko , Martin Neovius , Flavio Nervi , Chung T Nguyen , Nguyen D Nguyen , Quang Ngoc Nguyen , Ramfis E Nieto-Martínez , Yury P Nikitin , Guang Ning , Toshiharu Ninomiya , Sania Nishtar , Marianna Noale , Oscar A Noboa , Helena Nogueira , Teresa Norat , Maria Nordendahl , Børge G Nordestgaard , Davide Noto , Natalia Nowak-Szczepanska , Mohannad Al Nsour , Irfan Nuhoglu , Eha Nurk , Terence W O'Neill , Dermot O'Reilly , Galina Obreja , Caleb Ochimana , Angélica M Ochoa-Avilés , Eiji Oda , Kyungwon Oh , Kumiko Ohara , Claes Ohlsson , Ryutaro Ohtsuka , Örn Olafsson , Maria Teresa A Olinto , Isabel O Oliveira , Mohd Azahadi Omar , Altan Onat , Sok King Ong , Lariane M Ono , Pedro Ordunez , Rui Ornelas , Ana P Ortiz , Pedro J Ortiz , Merete Osler , Clive Osmond , Sergej M Ostojic , Afshin Ostovar , Johanna A Otero , Kim Overvad , Ellis Owusu-Dabo , Fred Michel Paccaud , Cristina Padez , Ioannis Pagkalos , Elena Pahomova , Karina Mary de Paiva , Andrzej Pajak , Domenico Palli , Alberto Palloni , Luigi Palmieri , Wen-Harn Pan , Songhomitra Panda-Jonas , Arvind Pandey , Francesco Panza , Dimitrios Papandreou , Soon-Woo Park , Suyeon Park , Winsome R Parnell , Mahboubeh Parsaeian , Ionela M Pascanu , Patrick Pasquet , Nikhil D Patel , Ivan Pecin , Mangesh S Pednekar , Nasheeta Peer , Gao Pei , Sergio Viana Peixoto , Markku Peltonen , Alexandre C Pereira , Marco A Peres , Napoleón Pérez-Farinós , Cynthia M Pérez , Valentina Peterkova , Annette Peters , Astrid Petersmann , Janina Petkeviciene , Ausra Petrauskiene , Emanuela Pettenuzzo , Niloofar Peykari , Son Thai Pham , Rafael N Pichardo , Daniela Pierannunzio , Iris Pigeot , Hynek Pikhart , Aida Pilav , Lorenza Pilotto , Francesco Pistelli , Freda Pitakaka , Aleksandra Piwonska , Andreia N Pizarro , Pedro Plans-Rubió , Bee Koon Poh , Hermann Pohlabeln , Raluca M Pop , Stevo R Popovic , Miquel Porta , Georg Posch , Anil Poudyal , Dimitrios Poulimeneas , Hamed Pouraram , Farhad Pourfarzi , Akram Pourshams , Hossein Poustchi , Rajendra Pradeepa , Alison J Price , Jacqueline F Price , Rui Providencia , Jardena J Puder , Iveta Pudule , Soile E Puhakka , Maria Puiu , Margus Punab , Radwan F Qasrawi , Mostafa Qorbani , Tran Quoc Bao , Ivana Radic , Ricardas Radisauskas , Salar Rahimikazerooni , Mahfuzar Rahman , Mahmudur Rahman , Olli Raitakari , Manu Raj , Ellina Rakhimova , Sherali Rakhmatulloev , Ivo Rakovac , Sudha Ramachandra Rao , Ambady Ramachandran , Jacqueline Ramke , Elisabete Ramos , Rafel Ramos , Lekhraj Rampal , Sanjay Rampal , Vayia Rarra , Ramon A Rascon-Pacheco , Mette Rasmussen , Cassiano Ricardo Rech , Josep Redon , Paul Ferdinand M Reganit , Valéria Regecová , Luis Revilla , Abbas Rezaianzadeh , Lourdes Ribas-Barba , Robespierre Ribeiro , Elio Riboli , Adrian Richter , Fernando Rigo , Natascia Rinaldo , Tobias F Rinke de Wit , Ana Rito , Raphael M Ritti-Dias , Juan A Rivera , Cynthia Robitaille , Romana Roccaldo , Daniela Rodrigues , Fernando Rodríguez-Artalejo , María Del Cristo Rodriguez-Perez , Laura A Rodríguez-Villamizar , Ulla Roggenbuck , Rosalba Rojas-Martinez , Nipa Rojroongwasinkul , Dora Romaguera , Elisabetta L Romeo , Rafaela V Rosario , Annika Rosengren , Ian Rouse , Joel Gr Roy , Adolfo Rubinstein , Frank J Rühli , Jean-Bernard Ruidavets , Blanca Sandra Ruiz-Betancourt , Maria Ruiz-Castell , Emma Ruiz Moreno , Iuliia A Rusakova , Kenisha Russell Jonsson , Paola Russo , Petra Rust , Marcin Rutkowski , Charumathi Sabanayagam , Elena Sacchini , Harshpal S Sachdev , Alireza Sadjadi , Ali Reza Safarpour , Saeid Safiri , Nader Saki , Benoit Salanave , Eduardo Salazar Martinez , Diego Salmerón , Veikko Salomaa , Jukka T Salonen , Massimo Salvetti , Margarita Samoutian , Jose Sánchez-Abanto , Sandjaja , Susana Sans , Loreto Santa Marina , Diana A Santos , Ina S Santos , Lèlita C Santos , Maria Paula Santos , Osvaldo Santos , Rute Santos , Sara Santos Sanz , Jouko L Saramies , Luis B Sardinha , Nizal Sarrafzadegan , Thirunavukkarasu Sathish , Kai-Uwe Saum , Savvas Savva , Mathilde Savy , Norie Sawada , Mariana Sbaraini , Marcia Scazufca , Beatriz D Schaan , Angelika Schaffrath Rosario , Herman Schargrodsky , Anja Schienkiewitz , Sabine Schipf , Carsten O Schmidt , Ida Maria Schmidt , Peter Schnohr , Ben Schöttker , Sara Schramm , Stine Schramm , Helmut Schröder , Constance Schultsz , Aletta E Schutte , Aye Aye Sein , Rusidah Selamat , Vedrana Sember , Abhijit Sen , Idowu O Senbanjo , Sadaf G Sepanlou , Victor Sequera , Luis Serra-Majem , Jennifer Servais , Ludmila Ševcíková , Svetlana A Shalnova , Teresa Shamah-Levy , Morteza Shamshirgaran , Coimbatore Subramaniam Shanthirani , Maryam Sharafkhah , Sanjib K Sharma , Jonathan E Shaw , Amaneh Shayanrad , Ali Akbar Shayesteh , Lela Shengelia , Zumin Shi , Kenji Shibuya , Hana Shimizu-Furusawa , Dong Wook Shin , Majid Shirani , Rahman Shiri , Namuna Shrestha , Khairil Si-Ramlee , Alfonso Siani , Rosalynn Siantar , Abla M Sibai , Antonio M Silva , Diego Augusto Santos Silva , Mary Simon , Judith Simons , Leon A Simons , Agneta Sjöberg , Michael Sjöström , Gry Skodje , Jolanta Slowikowska-Hilczer , Przemyslaw Slusarczyk , Liam Smeeth , Hung-Kwan So , Fernanda Cunha Soares , Grzegorz Sobek , Eugène Sobngwi , Morten Sodemann , Stefan Söderberg , Moesijanti Ye Soekatri , Agustinus Soemantri , Reecha Sofat , Vincenzo Solfrizzi , Mohammad Hossein Somi , Emily Sonestedt , Yi Song , Thorkild Ia Sørensen , Elin P Sørgjerd , Charles Sossa Jérome , Victoria E Soto-Rojas , Aïcha Soumaré , Slavica Sovic , Bente Sparboe-Nilsen , Karen Sparrenberger , Angela Spinelli , Igor Spiroski , Jan A Staessen , Hanspeter Stamm , Maria G Stathopoulou , Kaspar Staub , Bill Stavreski , Jostein Steene-Johannessen , Peter Stehle , Aryeh D Stein , George S Stergiou , Jochanan Stessman , Ranko Stevanovic , Jutta Stieber , Doris Stöckl , Tanja Stocks , Jakub Stokwiszewski , Ekaterina Stoyanova , Gareth Stratton , Karien Stronks , Maria Wany Strufaldi , Lela Sturua , Ramón Suárez-Medina , Machi Suka , Chien-An Sun , Johan Sundström , Yn-Tz Sung , Jordi Sunyer , Paibul Suriyawongpaisal , Boyd A Swinburn , Rody G Sy , Holly E Syddall , René Charles Sylva , Moyses Szklo , Lucjan Szponar , E Shyong Tai , Mari-Liis Tammesoo , Abdonas Tamosiunas , Eng Joo Tan , Xun Tang , Maya Tanrygulyyeva , Frank Tanser , Yong Tao , Mohammed Rasoul Tarawneh , Jakob Tarp , Carolina B Tarqui-Mamani , Radka Taxová Braunerová , Anne Taylor , Julie Taylor , Félicité Tchibindat , William R Tebar , Grethe S Tell , Tania Tello , Yih Chung Tham , K R Thankappan , Holger Theobald , Xenophon Theodoridis , Lutgarde Thijs , Nihal Thomas , Betina H Thuesen , Lubica Tichá , Erik J Timmermans , Anne Tjonneland , Hanna K Tolonen , Janne S Tolstrup , Murat Topbas , Roman Topór-Madry , Liv Elin Torheim , María José Tormo , Michael J Tornaritis , Maties Torrent , Laura Torres-Collado , Stefania Toselli , Giota Touloumi , Pierre Traissac , Thi Tuyet-Hanh Tran , Dimitrios Trichopoulos , Antonia Trichopoulou , Oanh Th Trinh , Atul Trivedi , Lechaba Tshepo , Maria Tsigga , Shoichiro Tsugane , Azaliia M Tuliakova , Marshall K Tulloch-Reid , Fikru Tullu , Tomi-Pekka Tuomainen , Jaakko Tuomilehto , Maria L Turley , Gilad Twig , Per Tynelius , Themistoklis Tzotzas , Christophe Tzourio , Peter Ueda , Eunice Ugel , Flora Am Ukoli , Hanno Ulmer , Belgin Unal , Zhamyila Usupova , Hannu Mt Uusitalo , Nalan Uysal , Justina Vaitkeviciute , Gonzalo Valdivia , Susana Vale , Damaskini Valvi , Rob M van Dam , Johan Van der Heyden , Yvonne T van der Schouw , Koen Van Herck , Hoang Van Minh , Natasja M 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Weghuber , Wenbin Wei , Aneta Weres , Bo Werner , Peter H Whincup , Kurt Widhalm , Indah S Widyahening , Andrzej Wiecek , Rainford J Wilks , Johann Willeit , Peter Willeit , Julianne Williams , Tom Wilsgaard , Bogdan Wojtyniak , Roy A Wong-McClure , Andrew Wong , Jyh Eiin Wong , Tien Yin Wong , Jean Woo , Mark Woodward , Frederick C Wu , Jianfeng Wu , Li Juan Wu , Shouling Wu , Haiquan Xu , Liang Xu , Nor Azwany Yaacob , Uruwan Yamborisut , Weili Yan , Ling Yang , Xiaoguang Yang , Yang Yang , Nazan Yardim , Mehdi Yaseri , Tabara Yasuharu , Xingwang Ye , Panayiotis K Yiallouros , Moein Yoosefi , Akihiro Yoshihara , Qi Sheng You , San-Lin You , Novie O Younger-Coleman , Safiah Md Yusof , Ahmad Faudzi Yusoff , Luciana Zaccagni , Vassilis Zafiropulos , Ahmad A Zainuddin , Seyed Rasoul Zakavi , Farhad Zamani , Sabina Zambon , Antonis Zampelas , Hana Zamrazilová , Maria Elisa Zapata , Abdul Hamid Zargar , Ko Ko Zaw , Tomasz Zdrojewski , Kristyna Zejglicova , Tajana Zeljkovic Vrkic , Yi Zeng 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Lundqvist, Robert, Lunet, Nuno, Lunogelo, Charle, Lustigová, Michala, Łuszczki, Edyta, Ma, Guansheng, Ma, Jun, Ma, Xu, Machado-Coelho, George LL, Machado-Rodrigues, Aristides M, Macieira, Luisa M, Madar, Ahmed A, Maggi, Stefania, Magliano, Dianna J, Magnacca, Sara, Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Mäki, Päivi, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Rao, Kodavanti Mallikharjuna, Malyutina, Sofia K, Maniego, Lynell V, Manios, Yanni, Mann, Jim I, Mansour-Ghanaei, Fariborz, Manzato, Enzo, Margozzini, Paula, Markaki, Anastasia, Markey, Oonagh, Ioannidou, Eliza Markidou, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martin-Prevel, Yve, Martin, Rosemarie, Martorell, Reynaldo, Martos, Eva, Maruszczak, Katharina, Marventano, Stefano, Mascarenhas, Luis P, Masoodi, Shariq R, Mathiesen, Ellisiv B, Mathur, Prashant, Matijasevich, Alicia, Matsha, Tandi E, Mavrogianni, Christina, Mazur, Artur, Mbanya, Jean Claude N, McFarlane, Shelly R, McGarvey, Stephen T, McKee, Martin, McLachlan, Stela, McLean, Rachael M, McLean, Scott B, McNulty, Breige A, Benchekor, Sounnia Mediene, Medzioniene, Jurate, Mehdipour, Parinaz, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisfjord, Jørgen, Meisinger, Christa, Menezes, Ana Maria B, Menon, Geetha R, Mensink, Gert BM, Menzano, Maria Teresa, Mereke, Alibek, Meshram, Indrapal I, Metspalu, Andre, Meyer, Haakon E, Mi, Jie, Michaelsen, Kim F, Michels, Nathalie, Mikkel, Kairit, Milkowska, Karolina, Miller, Jody C, Minderico, Cláudia S, Mini, GK, Miquel, Juan Francisco, Mirjalili, Mohammad Reza, Mirkopoulou, Daphne, Mirrakhimov, Erkin, Mišigoj-Durakovic, Marjeta, Mistretta, Antonio, Mocanu, Veronica, Modesti, Pietro A, Moghaddam, Sahar Saeedi, Mohajer, Bahram, Mohamed, Mostafa K, Mohamed, Shukri F, Mohammad, Kazem, Mohammadi, Zahra, Mohammadifard, Noushin, Mohammadpourhodki, Reza, Mohan, Viswanathan, Mohanna, Salim, Yusoff, Muhammad Fadhli Mohd, Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Molbo, Drude, Møllehave, Line T, Møller, Niels C, Molnár, Déne, Momenan, Amirabba, Mondo, Charles K, Monroy-Valle, Michele, Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K, Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B, Morejon, Alain, Moreno, Luis A, Morgan, Karen, Morin, Suzanne N, Mortensen, Erik Lykke, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mota-Pinto, Anabela, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Moura-dos-Santos, Marcos André, Mridha, Malay K, Msyamboza, Kelias P, Mu, Thet Thet, Muc, Magdalena, Mugoša, Boban, Muiesan, Maria L, Mukhtorova, Parvina, Müller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Murtagh, Elaine M, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M, Najafi, Farid, Nakamura, Harunobu, Námešná, Jana, Ei K Nang, Ei, Nangia, Vinay B, Nankap, Martin, Narake, Sameer, Nardone, Paola, Nauck, Matthia, Neal, William A, Nejatizadeh, Azim, Nekkantti, Chandini, Nelis, Keiu, Nelis, Lii, Nenko, Ilona, Neovius, Martin, Nervi, Flavio, Nguyen, Chung T, Nguyen, Nguyen D, Nguyen, Quang Ngoc, Nieto-Martínez, Ramfis E, Nikitin, Yury P, Ning, Guang, Ninomiya, Toshiharu, Nishtar, Sania, Noale, Marianna, Noboa, Oscar A, Nogueira, Helena, Norat, Teresa, Nordendahl, Maria, Nordestgaard, Børge G, Noto, Davide, Nowak-Szczepanska, Natalia, Al Nsour, Mohannad, Nuhoglu, Irfan, Nurk, Eha, O'Neill, Terence W, O'Reilly, Dermot, Obreja, Galina, Ochimana, Caleb, Ochoa-Avilés, Angélica M, Oda, Eiji, Oh, Kyungwon, Ohara, Kumiko, Ohlsson, Clae, Ohtsuka, Ryutaro, Olafsson, Örn, Olinto, Maria Teresa A, Oliveira, Isabel O, Omar, Mohd Azahadi, Onat, Altan, Ong, Sok King, Ono, Lariane M, Ordunez, Pedro, Ornelas, Rui, Ortiz, Ana P, Ortiz, Pedro J, Osler, Merete, Osmond, Clive, Ostojic, Sergej M, Ostovar, Afshin, Otero, Johanna A, Overvad, Kim, Owusu-Dabo, Elli, Paccaud, Fred Michel, Padez, Cristina, Pagkalos, Ioanni, Pahomova, Elena, de Paiva, Karina Mary, Pajak, Andrzej, Palli, Domenico, Palloni, Alberto, Palmieri, Luigi, Pan, Wen-Harn, Panda-Jonas, Songhomitra, Pandey, Arvind, Panza, Francesco, Papandreou, Dimitrio, Park, Soon-Woo, Park, Suyeon, Parnell, Winsome R, Parsaeian, Mahboubeh, Pascanu, Ionela M, Pasquet, Patrick, Patel, Nikhil D, Pecin, Ivan, Pednekar, Mangesh S, Peer, Nasheeta, Pei, Gao, Peixoto, Sergio Viana, Peltonen, Markku, Pereira, Alexandre C, Peres, Marco A, Pérez-Farinós, Napoleón, Pérez, Cynthia M, Peterkova, Valentina, Peters, Annette, Petersmann, Astrid, Petkeviciene, Janina, Petrauskiene, Ausra, Pettenuzzo, Emanuela, Peykari, Niloofar, Pham, Son Thai, Pichardo, Rafael N, Pierannunzio, Daniela, Pigeot, Iri, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pistelli, Francesco, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N, Plans-Rubió, Pedro, Poh, Bee Koon, Pohlabeln, Hermann, Pop, Raluca M, Popovic, Stevo R, Porta, Miquel, Posch, Georg, Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

28. Expression of activated integrin β7 in multiple myeloma patients

Author: Masaki Ri, Shinsuke Iida, Naoki Hosen, Koichiro Minauchi, Shuji Ozaki, Shigeo Fuji, Shingen Nakamura, Hiroyuki Takamatsu, Ishikazu Mizuno, Yoichi Imai, Ichiro Hanamura, Hirohisa Nakamae, Eiju Negoro, Hiroshi Handa, Satoshi Yoshihara, Kenshi Suzuki, Yawara Kawano, Masahiro Kizaki, Rikio Suzuki, Junya Kuroda, Noriko Nishimura, Yasuyuki Nagata, Yoshimitsu Shimomura, Nobuhiko Uoshima, Hiroshi Kosugi, and Hiroshi Gomyo
Subjects: Male, medicine.medical_specialty, Integrin beta Chains, Plasma Cells, Integrin, Bone Marrow Cells, Immunotherapy, Adoptive, Flow cytometry, 03 medical and health sciences, 0302 clinical medicine, Refractory, Internal medicine, Humans, Medicine, Multiple myeloma, Aged, Hematology, medicine.diagnostic_test, biology, business.industry, Flow Cytometry, medicine.disease, Chimeric antigen receptor, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cancer research, biology.protein, Female, Bone marrow, Car t cells, Multiple Myeloma, business, 030215 immunology
Abstract: Multiple myeloma (MM) is still extremely difficult to cure, and new therapeutic drugs are needed. We recently found that integrin β7 is constitutively activated in MM cells, and chimeric antigen receptor (CAR) T cells targeting activated integrin β7 have a significant anti-MM effect. In this study, we performed flow cytometry analysis of the expression of activated integrin β7 in bone marrow cells from 137 symptomatic MM patients. In 60/137 (44%) MM patients, activated integrin β7 was detected in most MM cells (> 80% of MM cells were in the positive gate). Activated integrin β7 was highly expressed in MM cells even in heavily treated patients. It also showed high expression in many CD38lo/−CD138−CD19+B cells, which reportedly include clonotypic B cells, in the bone marrow of MM patients. Taken together, these results suggest that CAR T-cell therapy targeting activated integrin β7 has the potential to benefit many patients with relapsed or refractory MM.
Published: 2021

29. Evaluation of Nosocomial Infection Control Measures to Minimize the Risk of Aspergillus Dispersion During Major Demolition Work: A Case Study of a Japanese University Hospital

Author: Shingo Yoshihara, Keiichi Mikasa, Tomoaki Imamura, Yasuhiro Nakanishi, Kei Kasahara, Junko Tokutani, and Akira Koizumi
Subjects: Aspergillus, medicine.medical_specialty, biology, business.industry, Public Health, Environmental and Occupational Health, Critical Care and Intensive Care Medicine, biology.organism_classification, Nosocomial infection control, University hospital, Work (electrical), Emergency medicine, Demolition, medicine, Infection control, Statistical dispersion, Risk assessment, business
Abstract: Objectives: To verify the effectiveness of our infection control measures based on the infection control risk assessment (ICRA) to minimize the risk of Aspergillus dispersion before, during, and after demolition work in a university hospital. Background: It is widely accepted that invasive aspergillosis is associated with construction, renovation, and demolition activities within or close to hospital sites. However, the risk is underestimated, and only limited preventive measures are taken in Japanese hospitals. Method: The demolition process, carried out in July 2014, was supervised by our facility management in collaboration with the infection prevention team and followed an adapted ICRA tool. Dust containment measures were implemented to reduce the risk of airborne Aspergillus contamination. Air sampling was performed at four wards in the adjacent hospital buildings to assess the containment measures’ effectiveness. Results: A high, undetermined number of colonies of bacteria and molds were detected on all outside balconies before demolition. During demolition, Aspergillus spp. was detected only in the ward closest to the demolition site. However, no case of aspergillosis was reported. The difference-in-difference analysis revealed that the interaction between the demolition activity, height of the ward, and distance of the air intake to the demolition activities resulted in a significant increase in the numbers of Aspergillus spp. Conclusions: When large-scale demolition work occurs in hospital premises, Aspergillus spp. may increase in the ward where the vertical and horizontal distance of air intake from the demolition site is close, even though infection control measures based on the ICRA are implemented.
Published: 2021

30. Relationship Between Lipoprotein(a) and Angiographic Severity of Femoropopliteal Lesions

Author: Takahiro Imanaka, Nagataka Yoshihara, Masanori Asakura, Kojiro Miki, Toshio Kimura, Koji Yanaka, Hirokuni Akahori, Takamasa Tanaka, and Masaharu Ishihara
Subjects: Male, medicine.medical_specialty, Arterial disease, Endovascular therapy, 030204 cardiovascular system & hematology, Severity of Illness Index, Gastroenterology, Femoropopliteal lesion, Lesion, Peripheral Arterial Disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Internal Medicine, medicine, Humans, Popliteal Artery, In patient, Risk factor, Aged, Retrospective Studies, Aged, 80 and over, biology, business.industry, Endovascular Procedures, Biochemistry (medical), Angiography, Lipoprotein(a), medicine.disease, Femoral Artery, biology.protein, Original Article, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Calcification, Lipoprotein
Abstract: Aim: High levels of lipoprotein(a) [Lp(a)] are a risk factor for peripheral artery disease (PAD). However, the relationship between Lp(a) levels and the severity of femoropopliteal lesions in patients with PAD has not been systematically studied. This study aimed to assess the impact of Lp(a) levels on angiographic severity of femoropopliteal lesions in patients with PAD. Methods: We retrospectively analyzed a single-center database including 108 patients who underwent endovascular therapy for de novo femoropopliteal lesions and measured the Lp(a) levels before therapy between June 2016 and September 2019. Patients were divided into low Lp(a) [Lp(a) ＜30 mg/dL; 77 patients] and high Lp(a) [Lp(a) ≥ 30 mg/dL; 31 patients] groups. Trans-Atlantic Inter-Society Consensus (TASC) II classification, calcification [referring to the peripheral arterial calcium scoring system (PACSS) classification], and lesion length were compared between the groups. Results: The prevalence of TASC II class D (13% vs 38%, P ＜0.01) and severe calcification (PACSS 4) (6% vs 23%, P =0.02) was significantly higher and the lesion length longer (123±88 mm vs 175±102 mm, P ＜0.01) in the high Lp(a) group than in the low Lp(a) group. In multivariate analysis, Lp(a) ≥ 30 was an independent predictor for the prevalence of TASC II class D (HR=3.67, 95% CI 1.27–10.6, P =0.02) and PACSS 4 (HR=4.97, 95% CI 1.27–19.4, P =0.02). Conclusion: The prevalence of TASC II class D and severe calcification of femoropopliteal lesions was higher in patients with high Lp(a) than those with low Lp(a).
Published: 2021

31. The Japanese respiratory society guidelines for the management of cough and sputum (digest edition)

Author: Yasuhiro Gon, Yoko Shibata, Shigemi Yoshihara, Hiroyuki Mochizuki, Hiroto Matsuse, Yasushi Obase, Naoyuki Miyashita, Hirokazu Sakamoto, Akio Niimi, Shusaku Haranaga, Tsutomu Tamada, Kazuhiro Yatera, Masaharu Shinkai, Jiro Terada, Takashi Iwanaga, Takeshi Kaneko, sputum, Kiyoyasu Kurahashi, Arata Azuma, Hiroshi Mukae, Haruhiko Ogawa, Hirokazu Arakawa, Kiyoshi Takeyama, Yoshihiro Yamamoto, Toshio Katsunuma, Yasuhiko Nishioka, Akihito Yokoyama, Shigeharu Fujieda, and Jun Tamaoki
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Chronic bronchitis, Respiratory Tract Diseases, Lung injury, Japan, Internal medicine, Hypersensitivity, Pulmonary Medicine, medicine, Humans, Sinusitis, Societies, Medical, Asthma, Bronchiectasis, business.industry, Sputum, Respiratory infection, medicine.disease, respiratory tract diseases, Chronic cough, Cough, Acute Disease, Chronic Disease, Practice Guidelines as Topic, Gastroesophageal Reflux, Female, medicine.symptom, business
Abstract: Cough and sputum are common complaints at outpatient visits. In this digest version, we provide a general overview of these two symptoms and discuss the management of acute (up to three weeks) and prolonged/chronic cough (longer than three weeks). Flowcharts are provided, along with a step-by-step explanation of their diagnosis and management. Most cases of acute cough are due to an infection. In chronic respiratory illness, a cough could be a symptom of a respiratory infection such as pulmonary tuberculosis, malignancy such as a pulmonary tumor, asthma, chronic obstructive pulmonary disease, chronic bronchitis, bronchiectasis, drug-induced lung injury, heart failure, nasal sinus disease, sinobronchial syndrome, eosinophilic sinusitis, cough variant asthma (CVA), atopic cough, chronic laryngeal allergy, gastroesophageal reflux (GER), and post-infectious cough. Antibiotics should not be prescribed for over-peak cough but can be considered for atypical infections. The exploration of a single/major cause is recommended for persistent/chronic cough. When sputum is present, a sputum smear/culture (general bacteria, mycobacteria), cytology, cell differentiation, chest computed tomography (CT), and sinus X-ray or CT should be performed. There are two types of rhinosinusitis. Conventional sinusitis and eosinophilic rhinosinusitis present primarily with neutrophilic inflammation and eosinophilic inflammation, respectively. The most common causes of dry cough include CVA, atopic cough/laryngeal allergy (chronic), GER, and post-infectious cough. In the last chapter, future challenges and perspectives are discussed. We hope that the clarification of the pathology of cough hypersensitivity syndrome will lead to further development of "pathology-specific non-specific therapeutic drugs" and provide benefits to patients with chronic refractory cough.
Published: 2021

32. Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

Author: Hiroaki Kajiyama, Kazumasa Mogi, Akira Yokoi, Satoshi Tamauchi, Kaoru Niimi, Masato Yoshihara, Kimihiro Nishino, Yoshiki Ikeda, Shiro Suzuki, Satomi Hattori, Nobuhisa Yoshikawa, and Kosuke Yoshida
Subjects: Oncology, medicine.medical_specialty, Uterine Cervical Neoplasms, Primary tumor size, metastatic cervical cancer, Article, concurrent chemoradiotherapy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, RC254-282, Metastatic cervical cancer, Cervical cancer, 030219 obstetrics & reproductive medicine, Tumor size, business.industry, tumor size, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Chemoradiotherapy, medicine.disease, Concurrent chemoradiotherapy, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, biomarker, Biomarker (medicine), Female, Primary treatment, prognosis, Lymph Nodes, business
Abstract: (1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor &gt, 6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028), the corresponding five-year OS rates in patients with a tumor ≤6.9 and &gt, 6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.
Published: 2021

33. Clinical Significance of Mesenteric Lymph Node Involvement in the Pattern of Liver Metastasis in Patients with Ovarian Cancer

Author: Hitoshi Kameyama, Takayuki Enomoto, K. Tanaka, Toshifumi Wakai, Yoshifumi Shimada, Masato Nakano, Kosuke Yoshihara, and Koji Nishino
Subjects: medicine.medical_specialty, H&E stain, Gastroenterology, Metastasis, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Internal medicine, medicine, Humans, Cumulative incidence, Clinical significance, Lymph node, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, business.industry, Liver Neoplasms, digestive, oral, and skin physiology, Prognosis, medicine.disease, Debulking, body regions, medicine.anatomical_structure, Oncology, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Lymph Node Excision, Female, 030211 gastroenterology & hepatology, Surgery, Lymph Nodes, business, Ovarian cancer
Abstract: Mesenteric lymph node (MLN) involvement is often observed in ovarian cancer (OC) with rectosigmoid invasion. This study aimed to investigate the clinical significance of MLN involvement in the pattern of liver metastasis in patients with OC.We included 85 stage II-IV OC patients who underwent primary or interval debulking surgery. Twenty-seven patients underwent rectosigmoid resection, whose status of MLN involvement was judged from hematoxylin and eosin (HE) staining of resected specimens. The prognostic significance of clinicopathological characteristics, including MLN involvement, was evaluated using univariate and multivariate analyses.MLN involvement was detected in 14/85 patients with stage II-IV OC. Residual tumor status, cytology of ascites, and MLN involvement were independent prognostic factors for progression-free survival (PFS; p = 0.033, p = 0.014, and p = 0.008, respectively). When patients were classified into three groups (no MLN, one MLN, two or more MLNs), the number of MLNs involved corresponded to three distinct groups in PFS (p = 0.001). The 3-year cumulative incidence of liver metastasis of patients with MLN involvement was significantly higher than that of patients without MLN involvement (61.1% vs. 8.9%, p 0.001). MLN involvement was significantly associated with liver metastasis of hematogenous origin (p 0.001) compared with peritoneal disseminated origin.MLN involvement is an important prognostic factor in OC, predicting poor prognosis and liver metastasis of hematogenous origin.
Published: 2021

34. Concurrent Chemo-Proton Therapy Using Adaptive Planning for Unresectable Stage 3 Non-Small Cell Lung Cancer: A Phase 2 Study

Author: Hiromitsu Iwata, Misuzu Yoshihara, Toshiyuki Toshito, Eiji Kunii, Yusuke Yamaba, Kensuke Hayashi, Yuta Shibamoto, K. Nakajima, Y. Hattori, Hiroyuki Ogino, Kenji Akita, and Osamu Takakuwa
Subjects: Adult, Male, Radiation-Sensitizing Agents, Cancer Research, medicine.medical_specialty, Lung Neoplasms, Time Factors, Urology, Phases of clinical research, Antineoplastic Agents, Drug Administration Schedule, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Carcinoma, Non-Small-Cell Lung, Confidence Intervals, Proton Therapy, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Stage (cooking), Adverse effect, Lung cancer, Aged, Radiation, business.industry, Radiotherapy Planning, Computer-Assisted, Incidence (epidemiology), Remission Induction, Chemoradiotherapy, Middle Aged, medicine.disease, Progression-Free Survival, Confidence interval, Drug Combinations, Oncology, 030220 oncology & carcinogenesis, Quality of Life, Female, Cisplatin, business, Follow-Up Studies, Radiotherapy, Image-Guided
Abstract: Purpose This study prospectively evaluated the efficacy and safety of concurrent chemo-proton therapy (CCPT) using adaptive planning for unresectable stage III non-small cell lung cancer (NSCLC). Methods and Materials The primary endpoint was overall survival (OS). Secondary endpoints were local control rate (LCR), progression-free survival (PFS), incidence of grade 3 or higher adverse events, and changes in quality of life (QOL). Patients received cisplatin (60 mg/m2) on day 1 and S-1 (∼40 mg/m2 twice daily) on days 1 to 14, q4w, for up to 4 cycles, plus concurrent proton therapy at a total dose of 70 GyRBE for the primary lesion and 66 GyRBE for lymph node metastasis with 2 GyRBE per day. Proton therapy was performed using respiratory-gated and image guided techniques, and adaptive plans were implemented. Results Forty-seven patients were enrolled between August 2013 and August 2018. Four cycles of cisplatin plus S-1 were completed in 34 patients. The mean number of cycles was 4 (range, 1-4). The median follow-up of all and surviving patients was 37 (range, 4-84) and 52 months (range, 26-84), respectively. The mean number of replanning sessions was 2.5 (range, 1-4). The 2- and 5-year OS, LCR, and PFS were 77% (95% confidence interval 64%-89%) and 59% (43%-76%), 84% (73%-95%) and 61% (44%-78%), and 43% (28%-57%) and 37% (22%-51%), respectively. The median OS was not reached. No grade 3 or higher radiation pneumonitis was observed. There was no significant deterioration in the QOL scores after 24 months except for alopecia. Conclusions CCPT with adaptive planning was well tolerated and yielded remarkable OS for unresectable stage III NSCLC.
Published: 2021

35. Safety, speed, and effectiveness of air transportation for neonates

Author: Yoshiki Naito, Masato Kamitomo, Chie Ishihara, Yuta Mikami, Hiroshi Ohashi, Tomonori Kurimoto, Satoshi Ibara, Tatsu Takayama, Yuichi Kodaira, Masakatsu Yamamoto, Tsuyoshi Yamamoto, Masaya Kibe, Hideaki Yoshihara, and Eiji Hirakawa
Subjects: medicine.medical_specialty, Ambulances, Gestational Age, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, law, 030225 pediatrics, Intensive care, medicine, Birth Weight, Humans, Cerebral Hemorrhage, business.industry, Infant, Newborn, Infant, Gestational age, medicine.disease, Intensive care unit, Confidence interval, Transportation of Patients, Intraventricular hemorrhage, Respiratory failure, Pediatrics, Perinatology and Child Health, Emergency medicine, Apgar Score, Female, Apgar score, business, First aid
Abstract: BACKGROUND In Japan, 44.3% of neonates are delivered in private clinics without an attending pediatrician. Obstetricians in the clinics must resuscitate asphyxiated neonates in unstable condition, such as respiratory failure, and they are frequently transferred to tertiary perinatal medical centers. There has been no study comparing the physiological status and prognosis of neonates transported by ambulance with those transported by helicopter. METHODS Medical and transport records were used to compare the physiological status of neonates transported to Kagoshima City Hospital by land and those transported by air between January 1, 2013, and December 31, 2017. RESULTS Data from 425 neonates transferred by land and 143 by air were analyzed. There were no significant differences between the two groups in mean gestational age, mean birthweight, fetal blood pH, Apgar score, or the Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) on arrival to the tertiary center (16.3 ± 15.4 [95% confidence interval (CI): 13.2-17.7] vs 16.4 ± 15.4 [95% CI: 13.9-19.0], respectively; P = 0.999); both groups had SNAPPE-II score 10-19, indicating no difference in mortality risk. The times to starting first aid and to admission to the intensive care unit were significantly reduced in neonates transported by air than by land. In subgroup analysis of patients of a gestational age ≤28 weeks, all cases of severe intraventricular hemorrhage (IVH) were observed in the land transportation group. CONCLUSIONS Neonatal transportation by air is as safe as land transportation, and time to first aid and intensive care are significantly reduced by transportation by air than by land. Air transport could also contribute to the prevention of IVH in neonatal transportation.
Published: 2021

36. Use of a convolutional neural network for classifying microvessels of superficial esophageal squamous cell carcinomas

Author: Hideki Iijima, Keiichi Kimura, Mizuki Tani, Shinichiro Shinzaki, Ryotaro Uema, Yoshito Hayashi, Taku Tashiro, Minoru Kato, Takahiro Amano, Shunsuke Yoshii, Tetsuo Takehara, Akihiko Sakatani, Yoshiki Tsujii, Hirotsugu Saiki, Shuko Iwatani, Takanori Inoue, and Takeo Yoshihara
Subjects: medicine.medical_specialty, Esophageal Neoplasms, Esophageal squamous cell carcinoma, Convolutional neural network, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Esophagus, Microvessel, Retrospective Studies, Hepatology, Receiver operating characteristic, business.industry, Deep learning, Magnifying endoscopy, Gastroenterology, Clinical Practice, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Microvessels, 030211 gastroenterology & hepatology, Esophageal Squamous Cell Carcinoma, Esophagoscopy, Neural Networks, Computer, Artificial intelligence, Radiology, business
Abstract: BACKGROUND AND AIM The morphological diagnosis of microvessels on the surface of superficial esophageal squamous cell carcinomas using magnifying endoscopy with narrow-band imaging is widely used in clinical practice. Nevertheless, inconsistency, even among experts, remains a problem. We constructed a convolutional neural network-based computer-aided diagnosis system to classify the microvessels of superficial esophageal squamous cell carcinomas and evaluated its diagnostic performance. METHODS In this retrospective study, a cropped magnifying endoscopy with narrow-band images from superficial esophageal squamous cell carcinoma lesions was used as the dataset. All images were assessed by three experts, and classified into three classes, Type B1, B2, and B3, based on the Japan Esophagus Society classification. The dataset was divided into training and validation datasets. A convolutional neural network model (ResNeXt-101) was trained and tuned with the training dataset. To evaluate diagnostic accuracy, the validation dataset was assessed by the computer-aided diagnosis system and eight endoscopists. RESULTS In total, 1777 and 747 cropped images (total, 393 lesions) were included in the training and validation datasets, respectively. The diagnosis system took 20.3 s to evaluate the 747 images in the validation dataset. The microvessel classification accuracy of the computer-aided diagnosis system was 84.2%, which was higher than the average of the eight endoscopists (77.8%, P
Published: 2021

37. Streptococcal Toxic Shock Syndrome Induced by Group A Streptococcus with the emm28 Genotype That Developed after a Uterine Cancer Test

Author: Ichiro Tatsuno, Kenro Imaeda, Misuzu Yoshihara, Osamu Takakuwa, Yusuke Yamaba, Manami Saito, Daisuke Kawae, Kenji Akita, Tadao Hasegawa, Chiaki Ida, and Eiji Kunii
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Streptococcus, business.industry, Septic shock, General Medicine, medicine.disease_cause, medicine.disease, Gastroenterology, Group A, Sepsis, Diarrhea, Uterine cancer, Internal medicine, Genotype, Internal Medicine, medicine, Blood culture, medicine.symptom, business
Abstract: A 69-year-old woman without pre-existing disease visited our hospital due to general malaise, diarrhea, and arthralgia 3 days after a uterine cancer test. We diagnosed her with sepsis of unknown focus and started treatment immediately, but she died 20 hours after the first visit due to multi-organ failure and septic shock. Later, group A streptococcus was detected from the blood culture, and streptococcal toxic shock syndrome (STSS) was diagnosed. The strain had the emm28 genotype and a mutation in csrR with increased NADase activity. These virulence factors were considered to be related to STSS development in this patient.
Published: 2021

38. Effect of hearing aids on frailty in elderly patients seeking hearing aids

Author: Sayuri Sable-Morita, Izumi Kondo, Tsutomu Nakashima, Saiko Sugiura, Yasue Uchida, Anna Yoshihara, Koki Kawamura, Erina Ito, Emiko Shimizu, and Hirokazu Suzuki
Subjects: medicine.medical_specialty, Acquired immunodeficiency syndrome (AIDS), business.industry, medicine, General Medicine, Audiology, medicine.disease, business
Published: 2021

39. The relationship between pelvic incidence and anatomical acetabular anteversion in female Japanese patients with hip osteoarthritis: a retrospective iconographic study

Author: Takaomi Kobayashi, Charles Rivière, Tomohito Yoshihara, Motoki Sonohata, Masaaki Mawatari, and Tadatsugu Morimoto
Subjects: 0303 health sciences, medicine.medical_specialty, business.industry, Radiography, Pelvic incidence, Retrospective cohort study, Anterior pelvic plane, Osteoarthritis, medicine.disease, Sagittal plane, Pathology and Forensic Medicine, 03 medical and health sciences, medicine.anatomical_structure, 030301 anatomy & morphology, Orthopedic surgery, Hip osteoarthritis, medicine, Radiology, Nuclear Medicine and imaging, Surgery, Anatomy, business, Nuclear medicine
Abstract: This study aimed (1) to investigate the relationship between pelvic incidence (PI) and the anatomical acetabular anteversion (AA) relative to the spino-pelvic tilt (SPT) plane (anatomical AASPT), relative to the anterior pelvic plane (anatomical AAAPP), and functional standing AA; and (2) to compare AA and the sagittal spino-pelvic parameters of lumbo-pelvic complex types 1 (PI ≤ 30°) and 2 (PI > 30°), in Japanese females with hip osteoarthritis. We conducted a retrospective study on 110 Japanese females with unilateral hip osteoarthritis. PI, standing lumbar lordosis (LL), standing SPT, anatomical AASPT, anatomical AAAPP, and functional standing AA were measured and calculated using radiographs and computed tomography. The PI-LL difference was defined as the mathematical difference between the PI and standing LL angles. Pearson’s correlation test was used to measure the relationship between the PI and AA. Student’s t test was used to compare spino-pelvic parameters between lumbo-pelvic complex type 1 (n = 24) and type 2 (n = 86). There was a significant relationship between the PI and anatomical AASPT (r = −0.532, p
Published: 2021

40. Concomitant use of an immunomodulator with ustekinumab as an induction therapy for Crohn's disease: A systematic review and meta‐analysis

Author: Hideki Iijima, Takeo Yoshihara, Sakiko Hiraoka, Keisuke Hata, Taku Kobayashi, Nagamu Inoue, Takahiro Amano, Minoru Matsuura, Masayuki Saruta, Fumihito Hirai, Ken Sugimoto, Motohiro Esaki, Shinichiro Shinzaki, Tetsuo Takehara, Shiro Nakamura, Katsuyoshi Matsuoka, Mamoru Watanabe, Toshimitsu Fujii, Kenji Watanabe, Motoi Uchino, and Hiroshi Nakase
Subjects: medicine.medical_specialty, Combination therapy, Cochrane Library, Antibodies, Monoclonal, Humanized, 03 medical and health sciences, 0302 clinical medicine, Crohn Disease, Internal medicine, Ustekinumab, medicine, Humans, Immunologic Factors, Adverse effect, Hepatology, Interleukin-12 Subunit p40, business.industry, Remission Induction, Gastroenterology, Induction Chemotherapy, Odds ratio, Confidence interval, Treatment Outcome, 030220 oncology & carcinogenesis, Meta-analysis, Concomitant, Drug Therapy, Combination, 030211 gastroenterology & hepatology, business, medicine.drug
Abstract: Background and aim Ustekinumab (UST), a fully humanized monoclonal antibody against the p40 subunit of interleukin-12/23, is effective for the treatment of Crohn's disease (CD). The benefit of concomitant use of an immunomodulator (IM) with UST, however, is unclear. This study aimed to provide a systematic review and meta-analysis comparing the efficacy and safety of concomitant use of an IM with UST as an induction therapy for CD patients. Methods A systematic literature search was performed using PubMed/MEDLINE, the Cochrane Library, and the Japana Centra Revuo Medicina from inception to October 31, 2019. The main outcome measure was achievement of clinical efficacy (remission, response, and clinical benefit) at 6-12 weeks. The quality of the included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tools. The fixed-effects model was used to calculate the pooled odds ratios. Results From 189 yielded articles, six including a total of 1507 patients were considered in this meta-analysis. Concomitant use of an IM with UST was significantly effective than UST monotherapy as an induction therapy (pooled odds ratio in the fixed-effects model: 1.35, 95% confidence interval [1.06-1.71], P = 0.015). The heterogeneity among studies was low (I2 = 2.6%). No statistical comparisons of the occurrence of adverse events between UST monotherapy and concomitant use of an IM with UST were performed. Conclusion The efficacy of concomitant use of an IM with UST as an induction therapy for CD was significantly superior to that of monotherapy with UST.
Published: 2021

41. Relationship between vaginal group B streptococcus colonization in the early stage of pregnancy and preterm birth: a retrospective cohort study

Author: Teppei Suzuki, Takuma Yamada, Hidenori Oguchi, Mayu Ukai, Masato Yoshihara, Michinori Mayama, Takuji Ueno, Kaname Uno, Sho Tano, Yasuyuki Kishigami, and Takehiko Takeda
Subjects: Adult, Group B Streptococcus, medicine.medical_specialty, Fetal Membranes, Premature Rupture, lcsh:Gynecology and obstetrics, Group B, Streptococcus agalactiae, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030225 pediatrics, Streptococcal Infections, Medicine, Humans, 030212 general & internal medicine, Risk factor, Vaginitis, Asymptomatic Infections, Candidiasis, Vulvovaginal, lcsh:RG1-991, Retrospective Studies, Vaginal flora, business.industry, Obstetrics, Incidence (epidemiology), Obstetrics and Gynecology, Retrospective cohort study, Preterm birth, Odds ratio, medicine.disease, Pregnancy Trimester, First, Pregnancy Trimester, Second, Vagina, Gestation, Premature Birth, Female, business, Research Article
Abstract: Background Although infection and inflammation within the genital tract during pregnancy is considered a major risk factor for spontaneous preterm birth (PTB), there are few studies on association between vaginal microorganisms in the early stage of pregnancy and PTB. The aim of this study was to investigate relationship between vaginal Group B streptococcus (GBS) colonization, a leading cause of infection during pregnancy, in the early stage of pregnancy and PTB. Methods This single-center, retrospective cohort study utilized data from 2009 to 2017 obtained at TOYOTA Memorial Hospital. Women with singleton pregnancies who underwent vaginal culture around 14 weeks of gestation during their routine prenatal check-up were included. Vaginal sampling for Gram staining and culture was performed regardless of symptoms. GBS colonization was defined as positive for GBS latex agglutination assay. Statistical analysis was performed to determine the factors associated with PTB. Results Overall 1079 singleton pregnancies were included. GBS (5.7%) and Candida albicans (5.5%) were the most frequently observed microorganisms. The incidence of PTB (before 34 and before 37 weeks of gestation) were significantly higher in the GBS-positive group than in the GBS-negative group (6.6% vs 0.5%, p = 0.001 and 9.8% vs 4.3%, p = 0.047). Our multivariable logistic regression analysis revealed that GBS colonization was a factor associated with PTB before 34 and before 37 weeks of gestation (Odds ratio [OR] 15.17; 95% confidence interval [CI] 3.73–61.74), and OR 2.42; 95%CI 1.01–5.91, respectively). Conclusions The present study found that vaginal GBS colonization in the early stage of pregnancy was associated with PTB. Our study indicates that patients at a high risk for PTB can be extracted by a simple method using conventional culture method.
Published: 2021

42. Reduced response to controlled ovarian stimulation after radical trachelectomy: A pitfall of fertility‐sparing surgery for cervical cancer

Author: Satoshi Tamauchi, Satoko Osuka, Masato Yoshihara, Hiroaki Kajiyama, Yoshinori Moriyama, and Fumitaka Kikkawa
Subjects: Adult, Infertility, medicine.medical_specialty, Trachelectomy, medicine.medical_treatment, Urology, Oocyte Retrieval, Uterine Cervical Neoplasms, Stimulation, Fertilization in Vitro, 03 medical and health sciences, 0302 clinical medicine, Ovulation Induction, medicine, Humans, 030212 general & internal medicine, Fertility preservation, Ovarian reserve, Neoplasm Staging, Retrospective Studies, Unexplained infertility, Cervical cancer, 030219 obstetrics & reproductive medicine, In vitro fertilisation, business.industry, Fertility Preservation, Obstetrics and Gynecology, General Medicine, medicine.disease, Treatment Outcome, Female, business
Abstract: Objective To clarify the decrease in response to controlled ovarian stimulation in patients who receive in vitro fertilization treatment after radical trachelectomy. Methods The outcomes of ovarian stimulation were retrospectively evaluated and compared between patients who have undergone radical trachelectomy and control patients who had male factor infertility or unexplained infertility. Results A total of 30 ovarian stimulation cycles in 14 radical trachelectomy patients and 54 cycles in 30 control patients were reviewed. The median age at ovarian stimulation was 34.8 years in the radical trachelectomy group and 36.5 years in the control group. Compared with the control group, the radical trachelectomy group had significantly lower mean estradiol concentration (1461.7 pg/ml, SD 775.0 vs. 1950.9 pg/ml, SD 1057.3, P = 0.029) during controlled ovarian stimulation cycle and smaller median number of retrieved oocytes (5, range 1-14 vs. 8, range 1-19, P = 0.007), despite the higher use of gonadotropin (3527.5 IU, SD 1313.4 vs. 2670.8 IU, SD 905.1, P = 0.001). Conclusion The response to controlled ovarian stimulation decreased after radical trachelectomy.
Published: 2021

43. High ARHGEF2 (GEF-H1) Expression is Associated with Poor Prognosis Via Cell Cycle Regulation in Patients with Pancreatic Cancer

Author: Yuya Okamoto, Katsunori Imai, Noriko Yasuda-Yoshihara, Naoki Umezaki, Hirohisa Okabe, Yosuke Nakao, Yoko Ogata, Kohei Yamashita, Hideo Baba, Tatsunori Miyata, Toshihiko Yusa, Yo-ichi Yamashita, Shigeki Nakagawa, Hiromitsu Hayashi, and Rumi Itoyama
Subjects: Oncology, medicine.medical_specialty, Cell cycle checkpoint, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Pancreatic cancer, Internal medicine, medicine, Humans, Cell Proliferation, Cell growth, business.industry, Hazard ratio, Cell Cycle Checkpoints, Cell cycle, Prognosis, medicine.disease, Immunohistochemistry, Cell Cycle Gene, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, business, Rho Guanine Nucleotide Exchange Factors
Abstract: Pancreatic cancer has an extremely poor prognosis, even after curative resection. Treatment options for pancreatic cancer remain limited, therefore new therapeutic targets are urgently needed. We searched for genes predictive of poor prognosis in pancreatic cancer using a public database and validated the survival impact of the selected gene in a patient cohort. We used a public database to search for genes associated with early pancreatic cancer recurrence. As a validation cohort, 201 patients who underwent radical resection in our institution were enrolled. Expression of the target gene was evaluated using immunohistochemistry (IHC). We evaluated growth and invasiveness using small interfering RNAs, then performed pathway analysis using gene set enrichment analysis. We extracted ARHGEF2 from GSE21501 as a gene with a high hazard ratio (HR) for early recurrence within 1 year. The high ARHGEF2 expression group had significantly poorer recurrence-free survival (RFS) and poorer overall survival (OS) than the low ARHGEF2 expression group. Multivariate analysis demonstrated that high ARHGEF2 expression was an independent poor prognostic factor for RFS (HR 1.92) and OS (HR 1.63). In vitro, ARHGEF2 suppression resulted in reduced cell growth and invasiveness. Bioinformatic analysis revealed that ARHGEF2 expression was associated with MYC, G2M, E2F, and CDC25A expression, suggesting that c-Myc and cell cycle genes are associated with high ARHGEF2 expression. IHC revealed a positive correlation between ARHGEF2 and c-Myc expression. High ARHGEF2 expression is associated with cell cycle progression, and predicts early recurrence and poor survival in patients with pancreatic cancer.
Published: 2021

44. Effects of Combined Neuromuscular Electrical Stimulation and Voluntary Muscular Contraction on Interstitial Lung Disease

Author: Yuki Ogawa, Hiroshi Maruoka, Kaede Yoshihara, Satoshi Kido, Kenji Tsushima, Masashi Zenta, and Tomohiro Hattori
Subjects: medicine.medical_specialty, Contraction (grammar), business.industry, Internal medicine, Interstitial lung disease, medicine, Cardiology, Physical Therapy, Sports Therapy and Rehabilitation, Stimulation, medicine.disease, business
Published: 2021

45. The Validity of a New Edition of Classification for Ovarian Metastasis from Colorectal Cancer

Author: Keizo Dono, Kozo Noguchi, Yoshito Tomimaru, Hirotsugu Nagase, Takayuki Ogino, Hiroshi Imamura, Masashi Hirota, Shingo Noura, Tsukasa Tanida, and Terukazu Yoshihara
Subjects: Oncology, medicine.medical_specialty, endocrine system, endocrine system diseases, Colorectal cancer, Anal Carcinoma, business.industry, colorectal cancer, medicine.disease, female genital diseases and pregnancy complications, Resection, Metastasis, ovarian metastasis, Ovarian metastasis, Internal medicine, peritoneal metastasis, medicine, lcsh:Diseases of the digestive system. Gastroenterology, Original Research Article, Good prognosis, lcsh:RC799-869, Stage iv, business, Median survival
Abstract: Objectives In the 9th edition of the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (JCCRC), ovarian metastasis is classified as distant metastasis. We assessed the significance of resection of ovarian metastases and the validity of this 9th edition of JCCRC for ovarian metastases from colorectal cancer (CRC). Methods We retrospectively analyzed the clinicopathological factors and overall survival of 17 patients with ovarian metastases from CRC who underwent resection and 110 female CRC patients with Stage IV (M1a) disease. Results The patients with only ovarian metastases who underwent resection had a longer median survival time than patients with both ovarian and peritoneal metastases who underwent resection (45.4 months vs. 9.3 months, P = 0.029). The 5-year overall survival of the patients with only ovarian metastases who underwent R0 resection was as long as that of the female Stage IV (M1a) CRC patients after R0 resection (50% vs. 48%, P = 0.334). Conclusions We found that, after resection, patients with only ovarian metastases had significantly better prognoses than patients with ovarian and peritoneal metastases. R0 resection of ovarian metastasis indicated as good prognosis as R0 resection of metastasis to one distant organ without ovaries. So the 9th edition of JCCRC, which classifies ovarian metastasis from CRC as distant metastasis, is appropriate.
Published: 2021

46. Shear wave elastography for the assessment of breast tumors

Author: Misaki Usune, Sachiyo Konno, Naotoshi Takase, Akemi Yoshihara, Hidehiro Takekawa, Mitsuhiro Hayashi, and Natsuki Ejiri
Subjects: Shear wave elastography, Strain elastography, medicine.medical_specialty, Quantitative imaging, Breast cancer, medicine.diagnostic_test, business.industry, Medicine, Radiology, Nuclear Medicine and imaging, Radiology, business, medicine.disease, Breast ultrasound
Published: 2021

47. Characterization and assessment of vocalization responses of cows to different physiological states

Author: Yu Yoshihara and Kosei Oya
Subjects: medicine.medical_specialty, General Veterinary, Veterinary medicine, Biology, Audiology, cortisol, formant, stress, welfare, Formant, SF600-1100, medicine, otorhinolaryngologic diseases, Animal Science and Zoology
Abstract: The objective of our study was to characterize and assess the vocalization responses of cows in four different physiological states using different measurements and relate those to salivary cortisol concentrations as a possible indicator of stress. We characterized and assessed the vocalization responses of cows in four different physiological states: feed anticipation, estrus, communication between or among individuals, and parturition. We used video camera recordings of the calls made by the cattle during these four states. We measured the duration of the calls, intensity and pitch of vocalizations, and the formant, using vocalization analysis software. Two hundred and ninety calls were recorded from 32 cows during the study. Cortisol increased from the least values in communications and feed anticipation, to two-fold concentrations in estrus, and three-fold concentrations in parturition. All the formants tended to increase in the same order with the stress concentrations, whereas low intensity and lower pitched vocalizations were associated with greater cortisol concentrations during parturition. These results indicate that acoustic parameters of calls in each of the physiological states may reflect the stress level in cattle, and thus, the vocalization of animals could be an important behavioural indicator of their stress level.
Published: 2021

48. Ustekinumab as the First Biological Agent for Crohn’s Disease in a 10-Year-Old Girl

Author: Yuji Fujita, Takeshi Sugaya, Takanao Tanaka, Shigemi Yoshihara, and Keiichi Tominaga
Subjects: medicine.medical_specialty, Prednisolone, Colonoscopy, Gastroenterology, Inflammatory bowel disease, General Biochemistry, Genetics and Molecular Biology, Biological Factors, Crohn Disease, Gastrointestinal Agents, Internal medicine, Ustekinumab, medicine, Humans, Child, Mesalamine, Diet, Fat-Restricted, Food, Formulated, Crohn's disease, medicine.diagnostic_test, business.industry, Remission Induction, General Medicine, medicine.disease, Combined Modality Therapy, digestive system diseases, Infliximab, Diarrhea, Treatment Outcome, Female, medicine.symptom, Calprotectin, business, medicine.drug
Abstract: Pediatric inflammatory bowel disease is associated with growth failure due to chronic inflammation, nutrient disorder, and the side effects of drugs, such as corticosteroids. Biological agents are therapeutic drugs that significantly improve the prognosis of patients with inflammatory bowel disease. The effectiveness of ustekinumab has been reported in the management of adult patients with inflammatory bowel disease. There are very few reports regarding the effectiveness and safety of ustekinumab in pediatric patients with inflammatory bowel disease, especially those who are biologically naive. A 10-year-old girl presented with chronic abdominal pain, diarrhea, and weight loss. Colonoscopy showed a longitudinal ulcer and cobblestone appearance in the ileum and discontinuous inflammation of the colon; therefore, she was diagnosed with Crohn's disease. She was prescribed a fat-restricted diet, elemental diet, 5-aminosalicylic acid, transient prednisolone, and ustekinumab. She achieved clinical and endoscopic remission based on the weighted Pediatric Crohn's Disease Activity Index, fecal calprotectin, and colonoscopy findings at week 75. This patient developed no adverse events, such as infusion reaction or susceptibility to infection over the 75 weeks. The use of ustekinumab as the first biological agent may be an effective and safe treatment for pediatric Crohn's disease.
Published: 2021

49. Efficacy of Bifidobacterium bifidum G9-1 in improving quality of life in patients with chronic constipation: a prospective intervention study

Author: Koichiro Wada, Atsushi Nakajima, Masato Yoneda, Hidenori Ohkubo, Haruki Usuda, Takuma Higurashi, Keiichi Ashikari, Takashi Kobayashi, Akiko Fuyuki, Michihiro Iwaki, Noboru Misawa, Tsutomu Yoshihara, and Takaomi Kessoku
Subjects: medicine.medical_specialty, Chronic constipation, Constipation, Bifidobacterium bifidum, ved/biology, business.industry, Immunology, ved/biology.organism_classification_rank.species, Gastroenterology, medicine.disease, Applied Microbiology and Biotechnology, Microbiology, Functional disorder, law.invention, Probiotic, Quality of life, law, Internal medicine, medicine, Clinical endpoint, Defecation, medicine.symptom, business, Food Science
Abstract: Chronic constipation is a functional disorder that decreases a patient's quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in patients with constipation. This was a prospective, single-center, non-blinded, single-arm feasibility trial. A total of 31 patients with constipation and decreased QOL received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was change in the overall Japanese version of the patient assessment of constipation of QOL (JPAC-QOL) score after probiotic administration relative to that at baseline. Secondary endpoints included changes in gut microbiota, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. The overall JPAC-QOL scores and frequency of bowel movement significantly improved after BBG9-1 administration from those at baseline (p
Published: 2021

50. Target Embolization of Dilated Post-PICA Segment for Ruptured PICA-Involved Type Vertebral Artery Dissecting Aneurysm

Author: Taku Asanome, Daisuke Yamashita, Daigo Goto, Megumi Matsuda, Toshiaki Osato, Koichiro Shindo, Ryunosuke Yoshihara, Yasuyuki Tatsuta, Masahiro Morishita, Daishi Yamaguchi, Hirohiko Nakamura, Suguru Sakurai, Tatsuya Ogino, Hideki Endo, Masanori Kyono, and Mamoru Fukuda
Subjects: medicine.medical_specialty, pica involved type, Subarachnoid hemorrhage, subarachnoid hemorrhage, business.industry, Vertebral artery, medicine.medical_treatment, vertebral artery dissecting aneurysm, Neurosciences. Biological psychiatry. Neuropsychiatry, medicine.disease, Surgery, Aneurysm, medicine.artery, medicine, target embolization, Neurology (clinical), Pica (disorder), Embolization, medicine.symptom, Cardiology and Cardiovascular Medicine, business, RC321-571
Abstract: Objective: In parent artery occlusion (PAO) for ruptured vertebral artery dissecting aneurysms (RVADA), target embolization using coils in a short segment to occlude only the vasodilated area containing the rupture point is selected as a first-choice procedure at our institute. We focused on RVADA involving the posterior inferior cerebellar artery (PICA) and evaluated the treatment results.Methods: This study consisted of eight cases with RVADA involving the PICA which were treated between October 2007 and January 2020. Based on radiological findings such as the bleb, the rupture points were located at the affected vertebral artery (VA) distal to PICA in all cases. Target embolization, by which only coiling at the dilated segment distal to the VA was performed. We aimed to preserve blood flow to the PICA. The incidence and extent of medullary infarctions, and neurological outcome were retrospectively assessed.Results: Regarding the diameter of bilateral VA, there were no differences in six cases while the affected VA with RVADA were larger in the remaining two cases. PICA was preserved in all cases but one in which occlusion of complementary PICA was observed. Postoperative medullary infarction was not noted. There was no rebleeding during the follow-up period. However, recanalization of the VA was observed in four cases and additional coil embolization was performed. All patients were discharged with a good outcome (modified Rankin Scale [mRS] 0; seven patients, mRS 2; one patient).Conclusion: Target embolization preserving the PICA in PICA-involved type RVADA was considered to be an effective treatment method for cases whose rupture point was located in the VA distal to PICA orifice.
Published: 2021

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