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Kamouchi M.,Kyushu University | Sakai H.,Data Management | Sakai H.,Gunma University | Sakai H.,Kyushu University | And 4 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

Background: A free radical scavenger, edaravone, which has been used for the treatment of ischemic stroke, was reported to cause acute kidney injury (AKI) as a fatal adverse event. The aim of the present study was to clarify whether edaravone is associated with AKI in patients with acute ischemic stroke. Methods: From the Fukuoka Stroke Registry database, 5689 consecutive patients with acute ischemic stroke who were hospitalized within 24 hours of the onset of symptoms were included in this study. A logistic regression analysis for the Fukuoka Stroke Registry cohort was done to identify the predictors for AKI. A propensity score-matched nested case-control study was also performed to elucidate any association between AKI and edaravone. Results: Acute kidney injury occurred in 128 of 5689 patients (2.2%) with acute ischemic stroke. A multivariate analysis revealed that the stroke subtype, the basal serum creatinine level, and the presence of infectious complications on admission were each predictors of developing AKI. In contrast, a free radical scavenger, edaravone, reduced the risk of developing AKI (multivariate-adjusted odds ratio [OR].45, 95% confidence interval [CI].30-.67). Propensity score-matched case-control study confirmed that edaravone use was negatively associated with AKI (propensity score-adjusted OR.46, 95% CI.29-.74). Conclusions: Although AKI has a significant impact on the clinical outcome of hospital inpatients, edaravone has a protective effect against the development of AKI in patients with acute ischemic stroke. © 2013 Elsevier B.V. All rights reserved. Source


Fujita T.,National Cerebral and Cardiovascular Center Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

Cerebral event is the 2nd leading cause of mortality and morbidity after cardiac surgery. Therefore, management of cerebrovascular disease is essential to improve the outcome. We reviewed the literatures and cases in our institute to present the current strategy for these patients. Firstly, for the patients in high risk of stroke, if patients undergo coronary artery bypass grafting (CABG), off-pump CABG (OPCAB) with aorta non-touch technique is recommended. We experienced no intraoperative stroke in our recent consecutive 1,000 cases. If patients require cardiopulmonary bypass, keeping blood pressure high during bypass may prevent local hypoperfusion in brain. Second, for the patients having carotid artery disease, the team approach with neurologists is essential to determine to precede either of cardiac surgery or carotid endoarterectomy. Because preceding carotid endoarterectomy gives the best result to prevent stroke, these patients had better have carotid endoarterectomy first, unless there is indication of urgent cardiac surgery. Third, for the patients with active endocarditis, early indication of surgery is recently recommended, unless patients have intracranial hemorrhage. Recent magnetic resonance imaging (MRI) examination revealed more than 60% of patients have stroke regardless of size, therefore, team approach with neurologists is important to decide the timing of the surgery. Team approach and correct selection of procedural technique are important to prevent cerebrovascular events during cardiac surgery. Source


Minamino T.,Osaka University | Komuro I.,Osaka University | Kitakaze M.,National Cerebral and Cardiovascular Center Hospital
Circulation Research | Year: 2010

Cardiovascular disease constitutes a major and increasing health burden in developed countries. Although treatments have progressed, the development of novel treatments for patients with cardiovascular diseases remains a major research goal. The endoplasmic reticulum (ER) is the cellular organelle in which protein folding, calcium homeostasis, and lipid biosynthesis occur. Stimuli such as oxidative stress, ischemic insult, disturbances in calcium homeostasis, and enhanced expression of normal and/or folding-defective proteins lead to the accumulation of unfolded proteins, a condition referred to as ER stress. ER stress triggers the unfolded protein response (UPR) to maintain ER homeostasis. The UPR involves a group of signal transduction pathways that ameliorate the accumulation of unfolded protein by increasing ER-resident chaperones, inhibiting protein translation and accelerating the degradation of unfolded proteins. The UPR is initially an adaptive response but, if unresolved, can lead to apoptotic cell death. Thus, the ER is now recognized as an important organelle in deciding cell life and death. There is compelling evidence that the adaptive and proapoptotic pathways of UPR play fundamental roles in the development and progression of cardiovascular diseases, including heart failure, ischemic heart diseases, and atherosclerosis. Thus, therapeutic interventions that target molecules of the UPR component and reduce ER stress will be promising strategies to treat cardiovascular diseases. In this review, we summarize the recent progress in understanding UPR signaling in cardiovascular disease and its related therapeutic potential. Future studies may clarify the most promising molecules to be investigated as targets for cardiovascular diseases. © 2010 American Heart Association. All rights reserved. Source


Nakatani T.,National Cerebral and Cardiovascular Center Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

Since the organ transplantation law was passed, we performed 50 heart transplantation at National Cerebral and Cardiovascular Center. Of those, 2 patients have been doing well over 13 years and 10 years survival rate was 93.4%.During those years, we performed 139 applications of left ventricular assist systems( LVAS). Initially, extracorporeal LVASs had been used. Now, 2 implantable LVAS were approved by medical insurance as bridge to transplant in 2011. Now, our 1st option as bridge to transplantation(BTT) is implantable LVAS. Source


Shinjo H.,Nagoya University | Sato W.,Nagoya University | Imai E.,Nagoya University | Kosugi T.,Nagoya University | And 4 more authors.
Clinical and Experimental Nephrology | Year: 2014

Background: The Kidney Disease: Improving Global Outcomes (KDIGO) group proposed to adopt the 48-h time window for the 0.3  mg/dL rise in serum creatinine (sCr) proposed by the Acute Kidney Injury Network (AKIN) group as a modification to the original risk, injury, failure, loss, and end-stage renal disease criteria, keeping the 7-day window for the 50 % increase in sCr from baseline. The present study evaluates the prevalence of acute kidney injury (AKI) and the accuracy of predicting mortality based on the KDIGO and AKIN criteria.Patients and methods: We retrospectively studied a cohort of 2579 patients admitted to the intensive care unit of Nagoya University Hospital between 2005 and 2009.Results: The total AKI prevalence was higher according to the KDIGO than to the AKIN criteria (38.4 versus 29.5 %). In-hospital mortality rates were higher among 238 patients classified as non-AKI by the AKIN but AKI by the KDIGO criteria than among those classified as non-AKI by both criteria (7.1 versus 2.7 %). Survival curves generated using KDIGO significantly differed among all stages, but not between AKIN stages I and II. Multivariate analysis showed that KDIGO criteria were better in a statistical model than the AKIN criteria according to the Akaike information criterion. Harrell’s C statistic was greater for the KDIGO than for the AKIN criteria.Conclusions: The KDIGO criteria have improved sensitivity without compromising specificity for AKI and might predict mortality at least as well as the AKIN criteria. © 2013, Japanese Society of Nephrology. Source

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