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1.
Ann Surg Oncol ; 31(2): 1393-1401, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37925655

ABSTRACT

OBJECTIVE: We aimed to develop and validate a preoperative nomogram that predicts low-grade, non-muscle invasive upper urinary tract urothelial carcinoma (LG-NMI UTUC), thereby aiding in the accurate selection of endoscopic management (EM) candidates. METHODS: This was a retrospective study that included 454 patients who underwent radical surgery (Cohort 1 and Cohort 2), and 26 patients who received EM (Cohort 3). Utilizing a multivariate logistic regression model, a nomogram predicting LG-NMI UTUC was developed based on data from Cohort 1. The nomogram's accuracy was compared with conventional European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) models. External validation was performed using Cohort 2 data, and the nomogram's prognostic value was evaluated via disease progression metrics in Cohort 3. RESULTS: In Cohort 1, multivariate analyses highlighted the absence of invasive disease on imaging (odds ratio [OR] 7.04; p = 0.011), absence of hydronephrosis (OR 2.06; p = 0.027), papillary architecture (OR 24.9; p < 0.001), and lack of high-grade urine cytology (OR 0.22; p < 0.001) as independent predictive factors for LG-NMI disease. The nomogram outperformed the two conventional models in predictive accuracy (0.869 vs. 0.759-0.821) and exhibited a higher net benefit in decision curve analysis. The model's clinical efficacy was corroborated in Cohort 2. Moreover, the nomogram stratified disease progression-free survival rates in Cohort 3. CONCLUSION: Our nomogram ( https://kmur.shinyapps.io/UTUC_URS/ ) accurately predicts LG-NMI UTUC, thereby identifying suitable candidates for EM. Additionally, the model serves as a useful tool for prognostic stratification in patients undergoing EM.


Subject(s)
Carcinoma, Transitional Cell , Kidney Neoplasms , Ureteral Neoplasms , Urinary Bladder Neoplasms , Urinary Tract , Humans , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/pathology , Nomograms , Retrospective Studies , Decision Making , Urinary Tract/pathology
4.
Biopsychosoc Med ; 17(1): 10, 2023 Mar 10.
Article in English | MEDLINE | ID: mdl-36895016

ABSTRACT

BACKGROUND: Eating alone has been significantly associated with psychological distress. However, there is no research that evaluates the effects or relation of eating together online to autonomic nervous system functions. METHODS: This is a randomized, open-label, controlled, pilot study conducted among healthy volunteers. Participants were randomized into either an eating together online group or an eating-alone group. The effect of eating together on autonomic nervous functions was evaluated and compared with that of the control (eating alone). The primary endpoint was the change in the standard deviation of the normal-to-normal interval (SDNN) scores among heart rate variabilities (HRV) before and after eating. Physiological synchrony was investigated based on changes in the SDNN scores. RESULTS: A total of 31 women and 25 men (mean age, 36.6 [SD = 9.9] years) were included in the study. In the comparison between the aforementioned groups, two-way analysis of variance revealed interactions between time and group on SDNN scores. SDNN scores in the eating together online group increased in the first and second halves of eating time (F[1,216], P < 0.001 and F[1,216], P = 0.022). Moreover, high correlations were observed in the changes in each pair before and during the first half of eating time as well as before and during the second half of eating time (r = 0.642, P = 0.013 and r = 0.579, P = 0.030). These were statistically significantly higher than those in the eating-alone group (P = 0.005 and P = 0.040). CONCLUSIONS: The experience of eating together online increased HRV during eating. Variations in pairs were correlated and may have induced physiological synchrony. TRIAL REGISTRATION: The University Hospital Medical Information Network Clinical Trials Registry, UMIN000045161. Registered September 1, 2021. https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000051592 .

5.
Ann Thorac Surg ; 2022 Sep 28.
Article in English | MEDLINE | ID: mdl-36181775

ABSTRACT

BACKGROUND: We developed an adventitial overlay method for reinforcing aortic anastomoses. This study evaluated the midterm morphological and clinical outcomes of this method. METHODS: We harvested and prepared adventitia from a resected aneurysm or dissected aortic wall and performed aortic repair using the adventitial overlay method. At the midterm follow-up, we examined the differences among overlay, inversion, and felt-sandwich (FS) methods by evaluating the morphology of the anastomosis using computed tomography (CT) scans. Moreover, we performed macroscopic evaluation of one patient who required a second operation. RESULTS: Between May 2009 and April 2020, 160 consecutive patients (104 males, 56 females; mean age, 68.6 ± 11; range, 39-88 years) underwent thoracic aortic surgery. The overlay technique was successfully performed in 84 cases. The anastomosis sites of the overlay method maintained their morphology without any clinical complications. The inner diameter ratio of anastomosis/graft was measured using CT, which revealed that the overlay method was not significantly different from inversion and was significantly larger than the FS method. There was no anastomotic stenosis in the proximal or distal overlay anastomosis. Only one patient required a second operation for an enlarged aneurysm of the distal false lumen. We observed that the proximal overlaid adventitia was smoothly attached to the native lumen and was macroscopically indistinguishable from the original intima. CONCLUSIONS: This study showed the midterm stability of the overlay technique. The midterm outcome was clinically acceptable. No anastomotic stenosis or pseudoaneurysm formation in either the true aortic aneurysm or dissection cases was observed.

6.
Front Hum Neurosci ; 16: 803542, 2022.
Article in English | MEDLINE | ID: mdl-35463923

ABSTRACT

The motor modules during human walking are identified using non-negative matrix factorization (NNMF) from surface electromyography (EMG) signals. The extraction of motor modules in healthy participants is affected by the change in pre-processing of EMG signals, such as low-pass filters (LPFs); however, the effect of different pre-processing methods, such as the number of necessary gait cycles (GCs) in post-stroke patients with varying steps, remains unknown. We aimed to specify that the number of GCs influenced the motor modules extracted in the consideration of LPFs in post-stroke patients. In total, 10 chronic post-stroke patients walked at a self-selected speed on an overground walkway, while EMG signals were recorded from the eight muscles of paretic lower limb. To verify the number of GCs, five GC conditions were set, namely, 25 (reference condition), 20, 15, 10, and 5 gate cycles with three LPFs (4, 10, and 15 Hz). First, the number of modules, variability accounted for (VAF), and muscle weightings extracted by the NNMF algorithm were compared between the conditions. Next, a modified NNMF algorithm, in which the activation timing profiles among different GCs were unified, was performed to compare the muscle weightings more robustly between GCs. The number of motor modules was not significantly different, regardless of the GCs. The difference in VAF and muscle weightings in the different GCs decreased with the LPF of 4 Hz. Muscle weightings in 15 GCs or less were significantly different from those in 25 GCs using the modified NNMF. Therefore, we concluded that the variability extracted motor modules by different GCs was suppressed with lower LPFs; however, 20 GCs were needed for more representative extraction of motor modules during walking in post-stroke patients.

7.
Children (Basel) ; 9(2)2022 Feb 20.
Article in English | MEDLINE | ID: mdl-35205010

ABSTRACT

It is desirable that noninvasive differential diagnosis takes place without lymph node biopsy for histiocytic necrotizing lymphadenitis (HNL) or malignant lymphoma (ML). In this study, we propose a novel scoring model for the differential diagnosis of these diseases using clinical information and clinical findings. We retrospectively analyzed the data from 15 HNL and 13 ML pediatric patients. First, a univariate analysis identified 14 clinical factors with significant differences. Second, a subsequent analysis using receiver operating characteristic (ROC) curve analysis identified three factors among them with area under the ROC curve values of >0.95: body temperature (°C), maximum lymph node size (cm), and serum ß2-microglobulin level (mg/L). Finally, the cut-off values of each of these three factors were determined and examined for the 28 cases. All 15 HNL cases were within 2-3 of the cut-off values among the three factors, no ML case was within two or more cut-off values. Thus, the diagnostic sensitivity and specificity of this novel scoring system were both 100%, indicating that clinical scoring with body temperature, maximum lymph node size, and ß2-microglobulin are useful for distinguishing between HNL and ML.

8.
J Hand Surg Asian Pac Vol ; 26(1): 65-69, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33559565

ABSTRACT

Background: Although extension block pinning for mallet fracture is popular, it occasionally results in poor outcome. We reviewed previous cases to elucidate the factors associated with poor outcome. Methods: From 2012 to 2017, 50 mallet fingers in 50 patients were consecutively repaired by extension block pinning using modified Ishiguro method. Inserted Kirschner-wires (K-wires) were removed at 6 weeks, followed by night splinting in extension. For outcome evaluation, distal interphalangeal (DIP) joint motion was measured and classified as either good or poor. Poor outcome was defined as either > 10° of extension lag or < 40° of active flexion or the presence of DIP joint pain. Associations between outcome and age, affected finger, interval to operation, fragment size (in terms of joint surface and dorsal cortex ratios), and fixation angle were evaluated. Results: 33 fingers (66%) had good outcome and 17 (34%) had poor outcome. Mean age was significantly greater in the poor (50.6 years) than in the good (40.1 years) outcome group (p < 0.05). The dorsal cortex ratio was also significantly larger in the poor than in the good outcome group (p = 0.006), but there was no significant difference between two groups in joint surface ratio. Affected finger, interval to surgery, and fixation angle also did not significantly differ between groups. Conclusions: Fracture fragments with a long dorsal cortex and older age associated with poor outcome following extension block pinning for mallet finger. The dorsal cortex ratio should be evaluated pre-operatively to determine the appropriate treatment method.


Subject(s)
Bone Wires , Finger Injuries/surgery , Fracture Fixation, Internal/methods , Fractures, Avulsion/surgery , Tendon Injuries/surgery , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Hand Deformities, Acquired/etiology , Hand Deformities, Acquired/surgery , Humans , Male , Middle Aged , Retrospective Studies , Splints , Tendon Injuries/complications , Young Adult
9.
Am J Otolaryngol ; 41(6): 102727, 2020.
Article in English | MEDLINE | ID: mdl-32979665

ABSTRACT

PURPOSE: In cases of unilateral vocal fold paralysis (UVFP), voice disorders caused by glottic insufficiency can lead to a considerable reduction in the patient's quality of life. Voice therapy (VT) is an effective treatment that must be started early after the onset of vocal fold paralysis. This study examined the effect of early VT for patients with UVFP occurring after esophagectomy. MATERIALS AND METHODS: Patients who had residual UVFP at 1 month postoperatively after esophagectomy for esophageal cancer between November 2014 and March 2017 were evaluated. Seventeen patients were divided into the VT group (n = 6) and non-VT group (n = 11). We compared these two groups and retrospectively examined the effect of early VT. The study endpoints included aerodynamic tests, laryngeal endoscopy, laryngeal stroboscopy, and glottal closure. All of these evaluations were performed at preoperatively and at 1 and 3 months postoperatively. RESULTS: Subglottal pressure reduced notably in the VT group, and both the mean flow rate and maximum phonation time tended to improve after VT. Conversely, there were no significant differences in MFR and MPT in the non-VT group. Furthermore, although UVFP remained after VT, we achieved glottal closure for all three patients. Conversely, only two of the six patients with glottic insufficiency in the non-VT group achieved glottal closure. CONCLUSION: VT may be effective for improving impaired vocal function in patients with UVFP. It is reasonable to expect that VT can be initiated 1 month after the onset of vocal fold paralysis.


Subject(s)
Glottis/physiopathology , Postoperative Complications/therapy , Pressure , Vocal Cord Paralysis/therapy , Voice Training , Aged , Esophageal Neoplasms/surgery , Esophagectomy/adverse effects , Female , Humans , Male , Middle Aged , Phonation , Postoperative Complications/etiology , Recovery of Function , Retrospective Studies , Time Factors , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/physiopathology
10.
Cancer Med ; 9(11): 3733-3741, 2020 06.
Article in English | MEDLINE | ID: mdl-32253820

ABSTRACT

OBJECTIVE: To develop and validate a preoperative nomogram to predict pathological locally advanced disease (pLAD) of clinically localized upper urinary tract urothelial carcinoma (UTUC) treated with extirpative surgery. METHODS: In total, 1101 patients with cN0M0 UTUC (development cohort, n = 604; validation cohort, n = 497) from 2 independent academic databases were retrospectively analyzed. pLAD was defined as pT3/4 and/or pN+. Multivariate logistic regression was used to develop a nomogram. The accuracy of the nomogram was evaluated with a receiver operating characteristic curve, calibration plot, and decision curve analysis. RESULTS: The development and validation cohorts comprised 204 (33.8%) and 178 (35.8%) patients with pLAD, respectively. The multivariate analyses showed that the neutrophil-to-lymphocyte ratio (hazard ratio [HR], 2.27; P < .001), chronic kidney disease (HR, 1.56; P = .032), tumor location (HR, 1.60; P = .029), hydronephrosis (HR, 2.71; P < .001), and local invasion on imaging (HR, 8.59; P < .001) were independent predictive factors. After bootstrapping, a well-calibrated nomogram achieved discriminative accuracy of 0.77 in the development cohort. The decision curve analysis demonstrated improved risk prediction against threshold probabilities (≥8%) of pLAD. These results were consistent in the validation cohort. CONCLUSION: Our novel nomogram allows for more highly accurate prediction of pLAD of UTUC. This nomogram integrates standard imaging and laboratory factors that help to identify patients who will benefit from preoperative chemotherapy, extended lymph node dissection, or both.


Subject(s)
Nephrectomy/methods , Nomograms , Preoperative Care , Urologic Neoplasms/pathology , Aged , Female , Follow-Up Studies , Humans , Male , Prognosis , ROC Curve , Retrospective Studies , Risk Factors , Urologic Neoplasms/surgery
11.
Gen Thorac Cardiovasc Surg ; 67(5): 450-456, 2019 May.
Article in English | MEDLINE | ID: mdl-30417221

ABSTRACT

OBJECTIVES: Thrombus formation in the pulmonary vein stump after left upper lobectomy is supposedly a risk factor for systemic thrombosis, resulting in a critical course for the patient. The purpose of this study was to assess the efficacy of the proximal ligation method preventing thrombus formation and thrombosis comparing the two groups of patients (those who did and those who did not undergo pulmonary vein ligation). METHODS: We performed a surgical procedure to shorten the pulmonary vein stump in the left upper lobectomy. In this procedure, we first dissected the pericardium from the left upper pulmonary vein, and then we ligated the pulmonary vein at the pericardial reflection before stapling transection. RESULTS: In the group that was not treated with the proximal ligation method, thrombus formation in the pulmonary vein stump was detected in all four cases. In contrast, thrombus formation in the pulmonary vein stump was detected in one only case of the eight cases treated with the proximal ligation method, which was significantly fewer than among those not treated with the ligation method (p = 0.010). The logistic regression analysis revealed in both the univariate (p = 0.0014) and multivariate analyses (p = 0.0071) that the proximal ligation method was significantly associated with reduced thrombus formation in the pulmonary vein stump. CONCLUSIONS: Thrombus formation in the pulmonary vein stump was significantly reduced by ligating the pulmonary vein at the pericardial reflection.


Subject(s)
Pericardium/surgery , Pneumonectomy/adverse effects , Pulmonary Veins/surgery , Venous Thrombosis/prevention & control , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Aged , Aged, 80 and over , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Female , Humans , Ligation , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Retrospective Studies , Risk Factors , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed , Venous Thrombosis/etiology
12.
BMJ Open ; 8(3): e016666, 2018 03 16.
Article in English | MEDLINE | ID: mdl-29549197

ABSTRACT

INTRODUCTION: Many researchers have addressed overdosage and inappropriate use of antibiotics. Many meta-analyses have investigated antibiotic prophylaxis for low-risk laparoscopic cholecystectomy with the aim of reducing unnecessary antibiotic use. Most of these meta-analyses have concluded that prophylactic antibiotics are not required for low-risk laparoscopic cholecystectomies. This study aimed to assess the validity of this conclusion by systematically reviewing these meta-analyses. METHODS: A systematic review was undertaken. Searches were limited to meta-analyses and systematic reviews. PubMed and Cochrane Library electronic databases were searched from inception until March 2016 using the following keyword combinations: 'antibiotic prophylaxis', 'laparoscopic cholecystectomy' and 'systematic review or meta-analysis'. Two independent reviewers selected meta-analyses or systematic reviews evaluating prophylactic antibiotics for laparoscopic cholecystectomy. All of the randomised controlled trials (RCTs) analysed in these meta-analyses were also reviewed. RESULTS: Seven meta-analyses regarding prophylactic antibiotics for low-risk laparoscopic cholecystectomy that had examined a total of 28 RCTs were included. Review of these meta-analyses revealed 48 miscounts of the number of outcomes. Six RCTs were inappropriate for the meta-analyses; one targeted patients with acute cholecystitis, another measured inappropriate outcomes, the original source of a third was not found and the study protocols of the remaining three were not appropriate for the meta-analyses. After correcting the above miscounts and excluding the six inappropriate RCTs, pooled risk ratios (RRs) were recalculated. These showed that, contrary to what had previously been concluded, antibiotics significantly reduced the risk of postoperative infections. The rates of surgical site, distant and overall infections were all significantly reduced by antibiotic administration (RR (95% CI); 0.71 (0.51 to 0.99), 0.37 (0.19 to 0.73), 0.50 (0.34 to 0.75), respectively). CONCLUSIONS: Prophylactic antibiotics reduce the incidence of postoperative infections after elective laparoscopic cholecystectomy.


Subject(s)
Antibiotic Prophylaxis , Cholecystectomy, Laparoscopic , Surgical Wound Infection , Humans , Cholecystectomy, Laparoscopic/methods , Elective Surgical Procedures , Meta-Analysis as Topic , Postoperative Complications/prevention & control , Surgical Wound Infection/prevention & control , Systematic Reviews as Topic
13.
J Hepatobiliary Pancreat Sci ; 24(11): 616-626, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28887834

ABSTRACT

BACKGROUND: The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). METHODS: To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. RESULTS: Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. CONCLUSIONS: Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.


Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy/methods , Liver Neoplasms/surgery , Liver/anatomy & histology , Adult , Aged , Biopsy, Needle , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Cohort Studies , Databases, Factual , Disease-Free Survival , Female , Hepatectomy/mortality , Humans , Immunohistochemistry , Japan , Liver/surgery , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Prognosis , Propensity Score , Proportional Hazards Models , Republic of Korea , Retrospective Studies , Risk Assessment , Survival Analysis , Treatment Outcome
14.
Cancer Imaging ; 16: 6, 2016 Apr 06.
Article in English | MEDLINE | ID: mdl-27052371

ABSTRACT

BACKGROUND: We hypothesized that indocyanine green (ICG) fluorescence patterns using Clairvivo OPT in resected liver specimens could confirm hepatocellular carcinoma (HCC) better than earlier commercial imaging systems. This preclinical trial evaluated the effectiveness of fluorescence imaging as an intraoperative cancer navigation tool. METHODS: ICG fluorescence images of resected specimens from 190 patients with HCC were classified into two groups according to whether high fluorescence was seen in the HCC (high cancerous [HC] group) or in the surrounding liver tissue (high surrounding [HS] group). The HC and HS groups were sub-classified into whole and partial types and whole and ring types, respectively. RESULTS: The HC group had significantly higher prevalence of esophageal or gastric varices, and worse liver function than patients in the HS group. The HC group also had a higher percentage of limited resection cases than did the HS group. Cirrhotic liver histology was significantly more common in the HC group than in the HS group. Multivariate analysis revealed that the HC group was a predictive factor for cirrhosis in HCC patients. Among the HC patients, a higher percentage of well-differentiated HCC cases were seen in the partial-type subgroup than in the whole-type subgroup (23/48 (48 %) vs. 7/68 (10 %)). In the HS group, the ring-type subgroup had a higher percentage of poorly differentiated HCC cases than did the whole-type subgroup (6/37 (16 %) vs. 0/37 (0 %)). CONCLUSION: Tumor differentiation and fibrosis in the non-cancerous liver parenchyma could affect ICG fluorescence imaging in HCC. ICG fluorescence imaging may be a good indication for fibrosis stage. In future, we will try to evaluate fluorescence imaging with ICG for intraoperative cancer navigation in HCC, using a portable near-infrared fluorescence imaging system.


Subject(s)
Carcinoma, Hepatocellular/diagnosis , Coloring Agents , Indocyanine Green , Liver Neoplasms/diagnosis , Optical Imaging/methods , Administration, Intravenous , Aged , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Coloring Agents/administration & dosage , Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/pathology , Female , Hepatectomy/methods , Humans , Indocyanine Green/administration & dosage , Infrared Rays , Intraoperative Care , Lasers, Semiconductor , Liver/pathology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/pathology , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Male , Microscopy, Fluorescence/instrumentation , Middle Aged , Optical Imaging/instrumentation , Retrospective Studies , Sex Factors
15.
Coron Artery Dis ; 21(7): 407-13, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20700051

ABSTRACT

OBJECTIVES: Based on well-established physiological theories, we studied correlations between changes in brachial-ankle pulse wave velocity (baPWV) relative to blood pressure (BP) elevation (elasticity of large-to-medium-sized arteries), and coronary artery disease (CAD). METHODS: The baPWV (in centimeters/second) and BP (in millimeters of mercury) were determined in 101 patients before, during, and/or after a cold pressor test using a volume-plethysmographic system. RESULTS: Significantly higher rates of increase in PWV relative to changes in BP were observed in the CAD(+) group than in the CAD(-) group when mean BP [median (25th-75th percentiles): 14.8 (8.3-24.9) vs. 8.6 (5.7-11.4) cm/s/mmHg, P<0.0001], and systolic [10.1 (6.0-17.5) vs. 6.4 (4.4-10.6) cm/s/mmHg, P=0.0023] and diastolic BP [21.0 (14.0-34.4) vs. 10.8 (6.8-16.1) cm/s/mmHg, P<0.0001] were used as BP indices. Similarly, the rates of increase in baPWV showed a significant correlation with the extent of CAD. The rate of increase in baPWV obtained using the mean, systolic and diastolic BP as indices showed an area under the receiver operating characteristic curve of 0.68-0.76, sensitivity of 65-75%, and specificity of 65-75% for the detection of CAD. The area under the receiver operating characteristic curve, sensitivity, and specificity for the rate of increase were slightly higher than those for baseline baPWV and baseline baPWV/baseline BP ratio, but not to a significant degree. CONCLUSION: The rate of increase in baPWV relative to BP elevation determined by cold pressor test is significantly and moderately correlated with CAD. To identify patients with CAD, the rate of increase in baPWV relative to changes in BP can provide considerable, but limited, information.


Subject(s)
Ankle Brachial Index , Coronary Artery Disease , Vascular Resistance , Adult , Aged , Arteries/pathology , Arteries/radiation effects , Blood Flow Velocity/radiation effects , Blood Pressure/radiation effects , Cold-Shock Response , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Elasticity/radiation effects , Female , Humans , Hypothermia, Induced/methods , Japan , Male , Middle Aged , Plethysmography/methods , Predictive Value of Tests , Vascular Resistance/radiation effects
16.
J Atheroscler Thromb ; 17(3): 249-58, 2010 Mar 31.
Article in English | MEDLINE | ID: mdl-20103976

ABSTRACT

AIM: The cardio-ankle vascular index (CAVI) has been proposed as a new noninvasive marker of arterial stiffness independent of blood pressure. We investigated the association of the CAVI with coronary atherosclerosis and left ventricular (LV) systolic and diastolic function in patients with ischemic heart disease (IHD). METHODS: A total of 206 consecutive subjects undergoing coronary angiography were enrolled. CAVI measurement and echocardiography were performed simultaneously. Patients having significant coronary stenosis were classified into the IHD group. RESULTS: CAVI in the IHD group (n=133) was significantly higher than in the non-IHD group(n=73)(9.1+/-1.3 vs. 8.7+/-1.2, p=0.02). In all IHD patients, CAVI was negatively correlated with LV ejection fraction (LVEF)(r=-0.31, p<0.01), LV mass index (r=0.24, p<0.01) and angiographic scores of coronary atherosclerosis. Stepwise regression analysis revealed that CAVI was independently associated with LVEF, along with a history of myocardial infarction, LV mass index, and left atrial diameter in all IHD patients (p<0.01). In the sub-analysis of IHD patients with preserved LVEF, CAVI was correlated with echocardiographic parameters regarding LV diastolic function. Multivariate analysis demonstrated that the increased CAVI was significantly associated with LV diastolic dysfunction in patients with preserved LVEF. CONCLUSION: CAVI, a new parameter of aortic stiffness, was independently associated with LV systolic and diastolic function as well as coronary artery disease in IHD patients.


Subject(s)
Arteries/pathology , Coronary Artery Disease/pathology , Myocardial Ischemia/diagnosis , Aged , Body Mass Index , Echocardiography/methods , Female , Humans , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/pathology , Myocardial Ischemia/pathology , Regression Analysis , Risk , Ventricular Function, Left
17.
J Electrocardiol ; 43(1): 48-53, 2010.
Article in English | MEDLINE | ID: mdl-19608196

ABSTRACT

OBJECTIVES: The relationships between filtered QRS duration and ventricular dyssynchrony were studied. METHODS: We measured filtered QRS duration on signal-averaged electrocardiography and analyzed tissue Doppler imaging in chronic heart failure patients with ejection fraction less than 50%. RESULTS: In 64 patients, interventricular and intraventricular dyssynchronies were observed in 25 and 38 patients, respectively. All patients with interventricular dyssynchrony were associated with intraventricular dyssynchrony. Filtered QRS showed 0.82 and 0.78 of the area under the curve (AUC) in the receiver operating characteristic curve (ROC) for the detection of interventricular and intraventricular dyssynchrony, respectively, with 89.7% and 96.2% specificity and 52.0% and 52.6% sensitivity, with cutoff values of 174 and 153 milliseconds. Specificity and sensitivity as well as AUC were lower in the ROC of QRS duration than filtered QRS duration. CONCLUSION: Filtered QRS duration provided more reliable information to estimate ventricular dyssynchrony in patients with reduced ventricular ejection fraction than QRS duration did.


Subject(s)
Algorithms , Diagnosis, Computer-Assisted/methods , Echocardiography/methods , Elasticity Imaging Techniques/methods , Signal Processing, Computer-Assisted , Stroke Volume , Ventricular Dysfunction, Left/diagnosis , Aged , Female , Humans , Male , Reproducibility of Results , Sensitivity and Specificity , Statistics as Topic
18.
Acta Med Okayama ; 63(2): 113-20, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19404343

ABSTRACT

The authors previously developed a mobile ecological momentary assessment (EMA) system as a real-time data collection device using a mobile phone. In this study, a real-time advice function and real-time reporting function were added to the previous system as a supportive intervention. The improved system was found to work effectively and was applied to several clinical cases, including patients with depressive disorder, dizziness, smoking habit, and bronchial asthma. The average patient compliance rate was high (89%) without the real-time advice and higher (93%) with the advice. The trends in clinical data for patients using a mobile EMA with/without the new function were analyzed for up to several months. In the case of dizziness, an improving trend in its clinical data was observed after applying the real-time advice, and in the case of depressive disorder, a stabilizing trend was observed. The mobile EMA system with the real-time advice function could be useful as a supportive intervention in behavior modification and for motivating patients in self-management of their disease.


Subject(s)
Behavior Therapy/methods , Cell Phone/statistics & numerical data , Data Collection/methods , Patient Participation/methods , Adult , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care/methods , Patient Compliance , Time Factors
19.
Hypertens Res ; 32(7): 611-6, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19407818

ABSTRACT

B-type natriuretic peptide (BNP) levels have been shown to be elevated in patients with paroxysmal atrial fibrillation (PAF); however, the underlying mechanisms have not been fully elucidated. Earlier, we reported that an increase in the augmentation index (AI), which is an index of wave reflection and arterial stiffness, is associated with PAF. In this study, we investigate the relationship between the BNP level and AI in patients with PAF. We enrolled 92 patients with a history of PAF and 90 age- and gender-matched individuals without PAF. AI was calculated using applanation tonometry of the radial artery when all patients were on sinus rhythm. Plasma BNP levels were measured simultaneously. An arterial stiffness parameter, the cardio-ankle vascular index (CAVI), was also evaluated. The increased AI in patients with PAF correlated with the elevation of the BNP level (r=0.47, P<0.01). When PAF patients were classified into tertiles on the basis of the BNP level, the left atrial volume index, left ventricular mass index, AI and CAVI increased, and mitral annular e' velocity (e'), as an index of left ventricular diastolic pressure, decreased with BNP tertiles. AI was also associated with e' and left ventricular mass index. Multiple regression analysis showed that the AI in PAF patients independently correlated with BNP levels. This study showed that AI was an independent correlate of the BNP level in PAF patients. Left ventricular diastolic dysfunction, which linked to an increase in arterial stiffness, may be involved in the elevated BNP level.


Subject(s)
Atrial Fibrillation/metabolism , Atrial Fibrillation/pathology , Natriuretic Peptide, Brain/metabolism , Adult , Aged , Aged, 80 and over , Ankle/blood supply , Atrial Fibrillation/diagnostic imaging , Echocardiography , Female , Heart/physiology , Humans , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/pathology , Male , Middle Aged , Radial Artery/pathology , Regional Blood Flow/physiology , Ventricular Function, Left/physiology
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