Impact of insulin-treated diabetes and hemodialysis on long-term clinical outcomes following sirolimus-eluting stent deployment - Insights from a sub-study of the Cypher Stent Japan Post-Marketing Surveillance (Cypher J-PMS) registry
Nakamura M.,Toho University |
Yokoi H.,Kokura Memorial Hospital |
Hamazaki Y.,Showa University |
Watarai M.,Anjo Kosei Hospital |
And 2 more authors.
Circulation Journal | Year: 2010
Background: Long-term clinical outcomes of diabetes mellitus (DM) patients who underwent drug-eluting stent deployment has not well investigated. Methods and Results: A total of 2,050 cases were enrolled consecutively from 50 sites in Japan into the Cypher stent Japan Post-Marketing Surveillance (Cypher J-PMS) registry, and the 3-year outcomes of DM patients were analyzed. Subjects were divided into 2 groups based on the treatment of DM (insulin-treated diabetes (IT) group, n=207; and non insulin-treated diabetes (NIT) group, n=682). Major adverse cardiac event (MACE) rates in the IT group and the NIT group were 26.0% and 14.5% at 3 years, respectively (P<0.001). There were no significant differences in stent thrombosis rates (definite and probable by Academic Research Consortium (ARC) definition) (0% and 1.08%, respectively). Multivariate analysis suggested that hemodialysis and insulin-treated DM were independent predictors for MACE, and insulin-treated DM, hemodialysis and long lesions were strong independent predictors for target-lesion revascularization (TLR). Conclusions: Hemodialysis and insulin-treated DM were strong independent predictors of mortality and TLR in DM patients. These results might suggest that special attention to patients with hemodialysis and insulin-treated DM is warranted in the setting of sirolimus-eluting stent deployment for DM patients.
Orita Y.,Okayama University of Science |
Sugitani I.,Cancer Institute Hospital |
Amemiya T.,Anjo Kosei Hospital |
Fujimoto Y.,Cancer Institute Hospital
Surgery | Year: 2011
Background: We have previously performed retrospective analysis of patients with anaplastic thyroid carcinoma (ATC) treated between April 1976 and March 1999, revealing acute symptoms, large tumor (>5 cm), distant metastasis, and leukocytosis ≥10,000/mm 3 as the most important prognostic factors. We devised a novel prognostic index (PI) as the total number of these 4 factors present, giving a PI of 0-4. Methods: We have adopted this PI since April 1999. In principle, multimodal treatment has been encouraged for a PI of ≤1, whereas aggressive treatment has been avoided to maintain quality of life for a PI of ≥3. The validity of this therapeutic strategy was prospectively investigated in 74 patients with ATC. Results: Six-month survival rates for PI ≤ 1 and PI ≥ 3 were 72% and 12%, respectively. Among patients with a PI of ≤1,11 (42%) underwent multimodal treatment and showed significantly better survival than previous cases. Survival rates did not differ between stages. For patients with a PI of ≥3, survival rates were equally dismal, regardless of stage. Numbers of patients who underwent tracheostomy or died from local disease were significantly decreased compared with previous cases. Conclusion: Our PI is valid for anticipating prognosis and aiding timely decisions on treatment policy for ATC patients. © 2011 Published by Mosby, Inc.
Kunishima S.,National Hospital Organization Nagoya Medical Center |
Kashiwagi H.,Osaka University |
Otsu M.,Tokyo Medical University |
Takayama N.,Tokyo Medical University |
And 8 more authors.
Blood | Year: 2011
Congenital macrothrombocytopenia is a genetically heterogeneous group of rare disorders. αIIbβ3 has not been implicated in these conditions. We identified a novel, conserved heterozygous ITGA2B R995W mutation in 4 unrelated families. The surface expression of platelet αIIbβ3 was decreased to 50% to 70% of control. There was spontaneous PAC-1 and fibrinogen binding to resting platelets without CD62p expression. The activation state of αIIbβ3 in 293T cells was higher for αIIb-W995 than for β3-H723 but was weaker than for β3-N562. FAK was spontaneously phosphorylated in αIIb-W995/β3-transfected 293T cells. These results indicate that αIIb-W995/β3 has a constitutive, activated conformation but does not induce platelet activation. αIIb-W995/β3-transfected CHO cells developed membrane ruffling and abnormal cytoplasmic protrusions. The increased size and decreased number of proplatelet tips in αIIb-W995/ β3-transduced mouse fetal liver-derived megakaryocytes indicate defective proplatelet formation. We propose that activating mutations in ITGA2B and ITGB3 represent the etiology of a subset of congenital macrothrombocytopenias. © 2011 by The American Society of Hematology.
Fujinaga K.,Anjo Kosei Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012
We report a rare case of mediastinal desmoid tumor in a 17-year-old man. The patient was a 17-year old man who had underwent surgery for mediastinal tumor at our hospital 2 years before. The tumor was diagnosed as a solitary fibrous tumor of the mediastinum. After 2 years, chest computed tomography(CT) and magnetic resonance imaging( MRI) showed a mass at the previously resected site. Surgery was performed again under the diagnosis of recurrent tumor. The tumor densely adhered to the superior vena cava, right innominate vein, pericardium, and the right lung. The tumor was completely resected with the aid of the partial extracorporeal circulation. Finally, both previously resected tumor and the recurrent tumor were diagnosed pathologically as desmoid tumors.
Li Y.,Osaka University |
Li Y.,Nagoya University |
Yatsuya H.,Nagoya University |
Iso H.,Osaka University |
And 2 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2012
Background It was suggested that inflammation may mediate or modify biological effects of adiponectin. Few studies examined the association between circulating adiponectin levels and type 2 diabetes (T2DM) while controlling for variables related to inflammation. In addition, East Asians were reported to have lower adiponectin levels but higher diabetes prevalence at a given degree of obesity than Caucasians, raising some possibility that the adiponectin-diabetes association may differ by race. Therefore, we prospectively investigated the associations with a number of covariates including C-reactive protein and smoking status in a cohort of Japanese workers aged 35-66years. Methods Serum adiponectin concentration and other covariates were obtained in 2002 for 3008 civil servants free of T2DM at baseline in urban/suburban Japan. T2DM incidence was defined as the year when annually assessed fasting blood glucose level first exceeded 126mg/dL or self-reported initiation of medication through 2007. T2DM incidence was examined in relation to the adiponectin quintile. Results Age- and sex-adjusted homeostasis model assessment insulin resistance was inversely associated with adiponectin quintiles at baseline. During six years of follow-up, 164 individuals developed T2DM. In a fully adjusted model, hazard ratios (95% confidence intervals) of T2DM in Q2 to Q5 compared with that in Q1 were 0.62 (0.41-0.94), 0.44 (0.25-0.77), 0.40 (0.20-0.78) and 0.85 (0.48-1.49), respectively. Conclusions Low adiponectin was related to increased incidence of T2DM independent of baseline levels of blood glucose, insulin and C-reactive protein as well as other confounding variables in middle-aged Japanese. Whether high adiponectin is linearly associated with decreased T2DM risk needs further investigation. © 2012 John Wiley & Sons, Ltd.
Yamashita K.,Nagoya University |
Yatsuya H.,Nagoya University |
Muramatsu T.,Nagoya University |
Toyoshima H.,Nagoya University |
And 3 more authors.
Nutrition and Diabetes | Year: 2012
BACKGROUND: Mechanisms underlying coffee's beneficial actions against cardiovascular disease and glucose metabolism are not well understood. Little information is available regarding association between coffee consumption and adipocytokines. OBJECTIVE: We investigated potential associations between coffee consumption and adiponectin, leptin, markers for subclinical inflammation, glucose metabolism, lipids and liver enzymes. We then investigated whether adipocytokines played a role in the association between coffee consumption and these markers. DESIGN AND SUBJECTS: This is a cross-sectional study comprising 2554 male and 763 female Japanese workers. Potential relations between coffee consumption and adipocytokines or other markers were evaluated using a multiple linear regression model adjusted for confounding factors. We evaluated whether adiponectin and leptin partly explain the associations between coffee consumption and each marker by multiple mediation analysis. RESULTS: Coffee consumption showed significant positive associations with adiponectin and total and low-density lipoprotein cholesterol, and inverse associations with leptin, high sensitivity C-reactive protein (hs-CRP), triglycerides and liver enzymes (all P<0.05). An adjustment for adiponectin and leptin significantly attenuated the associations between coffee consumption and hs-CRP or triglycerides, but not for liver enzymes. No associations were observed between coffee consumption and glucose metabolism-related markers. CONCLUSION: Coffee consumption was associated with high adiponectin and low leptin levels. We speculated that adipocytokines mainly explain the associations of coffee consumption with lipids and hs-CRP. Factors other than adipocytokines may explain the association between coffee consumption and liver function. © 2012 Macmillan Publishers Limited. All rights reserved.
Takatsu F.,Anjo Kosei Hospital |
Watarai M.,Anjo Kosei Hospital
Coronary Artery Disease | Year: 2011
Objective: Several studies have shown that significant coronary narrowing makes the prognosis of vasospastic angina pectoris (VAP) worse. However, the effects of various factors on the prognosis of patients without significant arterial narrowing have not yet been shown. Methods and Results: We investigated 1248 consecutive patients with VAP who had no coronary stenosis of more than or equal to 50%. The mean follow-up was 11.7±6.8 years. Ninety-one patients (7.3%) developed unstable angina, acute myocardial infarction, or effort angina with new coronary narrowings. Thirty patients (2.4%) died suddenly. Multivariate analysis showed that the presence of coronary stenosis, even if trivial, made the prognosis worse (P=0.027; odds ratio, 1.66; 95% confidence interval, 1.06-2.61). In addition, unusually, female patients had a better prognosis than male patients (P=0.007; odds ratio, 0.35; 95% confidence interval, 0.16-0.75). Other factors, such as hyperlipemia, diabetes, and hypertension did not affect the prognosis. Conclusion: In patients with VAP, the presence of coronary narrowing, even if mild, was associated with worse prognosis. © 2010 Wolters Kluwer Health. Lippincott Williams & Wilkins.
Ando T.,Anjo Kosei Hospital
Clinical Neurology | Year: 2011
Mediation offers a process by which two parties work towards an agreement with the aid of a neutral third party. Physicians and nurses can apply healthcare mediation model to ordinary medical practice for preventing conflict. Communication using mediation skills improves patient-physician relationship, and prevents medical malpractice and conflict.
Tanabe N.,Niigata University |
Iso H.,Osaka University |
Seki N.,Niigata University |
Suzuki H.,Niigata University |
And 3 more authors.
International Journal of Epidemiology | Year: 2010
Background: Daytime napping is associated with elevated risk of all-cause mortality in the elderly. However, the association with cardiovascular disease (CVD) risk is inconsistent. Methods: From 1988 to 1990, a total of 67 129 Japanese non-workers or daytime workers (27 755 men and 39 374 women) aged 40-79 years, without a history of stroke, heart disease or cancer, completed a lifestyle questionnaire. They were followed for mortality until the end of 2003. Results: During the 879 244 person-year follow-up, 9643 deaths (2852 from CVD, 3643 from cancer, 2392 from other internal causes, 738 from external causes and 18 from unspecified causes) were observed. After adjustment for possible confounders, subjects with a daytime napping habit had elevated hazard ratios (HRs) for mortality from all causes [HR 1.19, 95% confidence interval (CI) 1.14-1.24, P < 0.001], CVD (HR 1.31, 95% CI 1.22-1.42, P < 0.001), non-cardiovascular/non-cancer internal diseases (HR 1.26, 95% CI 1.16-1.37, P < 0.001) and external causes (HR 1.28, 95% CI 1.10-1.50, P = 0.001), but not for cancer death (HR 1.03, 95% CI 0.96-1.10, P = 0.400). The risk of CVD mortality associated with daytime napping was diminished among overweight subjects, but pronounced in those with weight loss after age 20 years, with non-regular employment, with lower education level and with a follow-up period <5 years. Conclusions: Daytime napping is associated with elevated risk of CVD mortality as well as non-cardiovascular/non-cancer and external deaths. Daytime napping may elevate risk of CVD death through some biological effects but, to a larger extent, some comorbid disorders causing weight loss or associated with non-regular employment and low education level could explain this association. © The Author 2009; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.
Tatsumi N.,Anjo Kosei Hospital
Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases | Year: 2011
We report a case of enterohemorrhagic Escherichia coli (EHEC) infection in which EHEC was not detected by culture on DHL agar medium. The proportion of EHEC bacterial count to enterobacterial count in feces was 1.7%, and the detection probability by 5-colony angling was low (8.1%). The probability of angling detection using CHROMagar STEC, a chromogenic medium for detecting EHEC, was high (100%). An additional and collection test was done using E. coli bacterial solutions to which two main sera groups--O157 and O26 were added. The maximum detectable level in the bacterial solution with O157 was 10(3)-10(4) CFU/mL in DHL and 10(2) CFU/mL in CHROMagar STEC. Bacterial solution levels with O26 were 10(3) CFU/mL in DHL and 10(2) CFU/mL in CHROMagar STEC. Assuming that the EHEC bacterial amount in feces of those with EHEC infection is low, we speculated that CHROMagar STEC may be useful as on EHEC screening medium.