PubMed | University of Minnesota, Kobe City Medical Center General Hospital, Tokyo Metropolitan Hiroo Hospital, Harvard University and 11 more.
Type: | Journal: International journal of cardiology | Year: 2016
Renal dysfunction is a common comorbidity in acute heart failure (AHF) patients. The prognostic significance of early treatment with tolvaptan in AHF patients complicated with renal dysfunction has not been elucidated.Post hoc analysis was performed on a randomized clinical study for prespecified prognostic endpoints and prespecified subgroups. 217 AHF patients with renal dysfunction (eGFR 15 to 60mL/min/1.73m(2)) were randomized within 6h from hospitalization to either tolvaptan treatment for 2days or conventional treatment. The primary outcome was the combined endpoint of all-cause death and HF readmission.During follow-up (636days, median) 99 patients experienced combined endpoint and 53 patients died. There was no significant difference in event-free survival rate for either the combined events (Log-rank: P=0.197) or all-cause death (Log-rank: P=0.894) between tolvaptan and conventional groups. In prespecified subgroup analysis, in patients whose BUN/creatinine ratio was above the median (>20), tolvaptan significantly reduced the risk of combined events (HR: 0.52, 95% CI: 0.30-0.91, P=0.021) with a significant interaction (P value for interaction=0.045). Likewise, in patients whose eGFR was 30mL/min/1.73m(2) or above, tolvaptan reduced the risk of combined events (HR: 0.54, 95% CI: 0.32-0.90, P=0.017) with a significant interaction (P value for interaction=0.015).Short-term use of tolvaptan in acute-phase in AHF with renal dysfunction showed a neutral effect on prognosis. Patients with relatively preserved renal function and relatively high BUN/creatinine ratios are potentially favorable subgroups for treatment with tolvaptan.
PubMed | Red Cross, Kashiwa City Hospital, Tokyo Medical and Dental University, National Disaster Medical Center and Tsuchiura Kyodo Hospital
Type: | Journal: The Canadian journal of cardiology | Year: 2017
Atrial fibrillation (AF) affects millions of individuals worldwide. The genome-wide association studies have identified robust genetic associations with AF.We genotyped 5461 participants of Japanese ancestry for 11 AF-related loci and determined the effects of carrying different numbers of risk alleles on disease development and age at disease onset. The weighted genetic risk score (GRS) was calculated, and its ability to predict AF was determined.Six single-nucleotide polymorphisms-rs593479 (1q24 in PRRX1), rs1906617 (4q25 near PITX2), rs11773845 (7q31 in CAV1), rs6584555 (10q25 in NEURL), rs6490029 (12q24 in CUX2), and rs12932445 (16q22 in ZFHX3) (P < 1.9 10Six loci were validated as associated with AF in a Japanese population. This study suggests that a combination of common genetic markers modestly facilitates discrimination of AF. This is the first report, to our knowledge, to demonstrate that the age of onset of AF is affected by common risk alleles.
Hifumi T.,National Disaster Medical Center |
Okada I.,National Disaster Medical Center |
Inoue J.,National Disaster Medical Center |
Koido Y.,National Disaster Medical Center
BMJ Case Reports | Year: 2013
We report the first case of cardiopulmonary arrest (CPA), caused by oesophageal achalasia, which recovered completely with cardiopulmonary resuscitation (CPR) followed by therapeutic hypothermia. A 53-year-old woman arrived at our hospital with recovery of spontaneous circulation (ROSC) after cardiac arrest. Dysphagia, vomiting and general fatigue had progressed for a week before. After an ambulance was called for severe dyspnoea, she collapsed in CPA. Emergency medical technicians arrived and CPR was started immediately. She experienced CPA and ROSC twice during transport to the hospital. On arrival, the patient was in respiratory distress prompting immediate intubation to eliminate airway obstruction. A CT scan revealed a transformed, occluded trachea owing to a dilated oesophagus. A large amount of food, air and saliva was suctioned with a nasogastric tube, and the patient was admitted to the intensive care unit for therapeutic hypothermia. Neurological recovery was evident. On the 11th day, pneumatic dilatation was performed and she was discharged on the 33rd day. Copyright 2013 BMJ Publishing Group. All rights reserved.
Hifumi T.,National Disaster Medical Center
BMJ case reports | Year: 2013
We report the first case of cardiopulmonary arrest (CPA), caused by oesophageal achalasia, which recovered completely with cardiopulmonary resuscitation (CPR) followed by therapeutic hypothermia. A 53-year-old woman arrived at our hospital with recovery of spontaneous circulation (ROSC) after cardiac arrest. Dysphagia, vomiting and general fatigue had progressed for a week before. After an ambulance was called for severe dyspnoea, she collapsed in CPA. Emergency medical technicians arrived and CPR was started immediately. She experienced CPA and ROSC twice during transport to the hospital. On arrival, the patient was in respiratory distress prompting immediate intubation to eliminate airway obstruction. A CT scan revealed a transformed, occluded trachea owing to a dilated oesophagus. A large amount of food, air and saliva was suctioned with a nasogastric tube, and the patient was admitted to the intensive care unit for therapeutic hypothermia. Neurological recovery was evident. On the 11th day, pneumatic dilatation was performed and she was discharged on the 33rd day.
Ikeda T.,Toho University |
Yusu S.,Kyorin University |
Yokoyama Y.,National Disaster Medical Center
Heart Rhythm | Year: 2012
BACKGROUND: It has been reported that intracardiac electrogram T-wave alternans (IE-TWA) is greater prior to spontaneous ventricular tachyarrhythmia (VTA) than for baseline recordings. OBJECTIVE: To investigate IE-TWA just prior to VTA episodes and at baseline and compare these with microvolt TWA (M-TWA) measured during exercise. METHODS: We analyzed right ventricular ring-can electrogram recordings just prior to VTA episodes and compared T-wave pattern and degree of variation to baseline recordings from 3 patients (2 with idiopathic ventricular fibrillation and 1 with hypertrophic cardiomyopathy) who were enrolled in the Japan Intracardiac Electrogram TWA Study of ICD Recipients. In a stable state, we measured the M-TWA of the surface electrocardiogram during treadmill exercise in these 3 patients. RESULTS: We found 3 patterns of IE-TWA among these 3 patients with implantable cardioverter-defibrillator immediately prior to spontaneous VTAs. Case 1 had AB pattern of IE-TWA, case 2 ABC pattern, and case 3 nonspecific pattern but great T-wave amplitude variations. These IE-TWA amplitudes and the distribution of T-amplitude difference were greater than at baseline. Case 1 had a positive outcome in regard to the M-TWA determination, whereas cases 2 and 3 did not. CONCLUSIONS: We indicate different patterns of IE-TWA prior to spontaneous VTAs. The phenomena of IE-TWA correspond to outcomes of M-TWA measured during exercise in the surface electrocardiogram. © 2012 Heart Rhythm Society. All rights reserved.
Matsuoka Y.,National Institute of Mental Health |
Matsuoka Y.,National Disaster Medical Center |
Matsuoka Y.,Japan Science and Technology Agency
BioPsychoSocial Medicine | Year: 2011
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately after accidental injury can reduce subsequent PTSD symptoms. © 2011 Matsuoka; licensee BioMed Central Ltd.
Nishi D.,National Disaster Medical Center
PloS one | Year: 2012
The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake. In this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms. The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.
Nishi D.,National Disaster Medical Center |
Nishi D.,Japan Science and Technology Agency |
Nishi D.,National Institute of Mental Health |
Hashimoto K.,Chiba University |
And 5 more authors.
Neuroscience Research | Year: 2014
Although neuropeptide Y (NPY) has received attention for its potential anti-depressive and anti-anxiety effect, evidence in humans has been limited. This study aimed to clarify the relationships between serum NPY and depressive disorders, and posttraumatic stress disorder (PTSD) in accident survivors. Depressive disorders and PTSD were diagnosed by structural interviews at 1-month follow-up, and serum NPY was measured at the first assessment and 1-month follow-up. Analysis of variance was used to investigate significance of the differences identified. Furthermore, resilience was measured by self-report questionnaires. Multiple linear regression analyses were used to examine the relationship between resilience and serum NPY. Three hundred accident survivors participated in the assessment at the first assessment, and 138 completed the assessment at 1-month follow-up. Twenty-six participants had major depressive disorder and 6 had minor depressive disorder. Nine participants had PTSD and 16 had partial PTSD. No relationship existed between serum NPY and depressive disorders, PTSD, and resilience. The results of cannot be compared with those of NPY in the central nervous system (CNS), but these findings might be due to the nature of depression and PTSD in accident survivors. Further studies are needed to examine the relationships between NPY in CNS and depression and PTSD. © 2014 Elsevier Ireland Ltd and the Japan Neuroscience Society.
Yoshikawa E.,Nippon Medical School |
Nishi D.,National Disaster Medical Center |
Matsuoka Y.,National Disaster Medical Center
Lipids in Health and Disease | Year: 2015
Background: Depression is a common disorder that is influenced by psychosocial factors in the workplace. Increasing resilience, the ability to cope with stress in the face of adversity, is considered an important strategy to prevent depression. It has been suggested that consumption of fish, which is a major source of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA), may prevent depression. However, associations between depression, resilience, and fish consumption have not been documented. The aim of the study is to investigate the association between fish consumption and resilience to depression. Methods: Participants were 527 Japanese employees at three worksites of a large company. The Center for Epidemiologic Studies Depression (CES-D) Scale was administered to assess depressive symptoms, and the 14-item Resilience Scale (RS-14) was administered to assess resilience. A self-report questionnaire extracted from the Food Frequency Questionnaire was used to measure fish consumption frequency. Regression analyses were conducted to assess a mediation model based on a statistical analysis framework defined by Baron and Kenny. The indirect association of resilience was calculated with the bootstrapping method. Each analysis was adjusted by age, sex, marital status, work position, and educational background. Results: The association between fish consumption frequency and total CES-D score was significant (B = -0.94; p = 0.011). The association between fish consumption frequency and total RS-14 score was significant (B = 1.4; p = 0.010), as was association total RS-14 score and the total CES-D score (B = -0.34; p < 0.001). When controlling for total RS-14 score, there was no longer a significant association between fish consumption frequency and total CES-D score. The bootstrapping results revealed that significant indirect association though fish consumption frequency and total CES-D score (bias corrected and accelerated confidence interval = -0.83 to -0.13; 95 % confidence interval) through total RS-14 score. Conclusions: Fish consumption might be associated with resilience to depression. Further studies are needed, particularly double blind randomized placebo controlled intervention trials on the potential preventative effect of LC n-3 PUFA on resilience to depression. © 2015 Yoshikawa et al.; licensee BioMed Central.
PubMed | Nippon Medical School and National Disaster Medical Center
Type: | Journal: BMC public health | Year: 2016
Regular physical exercise has been reported to reduce depressive symptoms. Several lines of evidence suggest that physical exercise may prevent depression by promoting social support or resilience, which is the ability to adapt to challenging life conditions. The aim of this study was to compare depressive symptoms, social support, and resilience between Japanese company workers who engaged in regular physical exercise and workers who did not exercise regularly. We also investigated whether regular physical exercise has an indirect association with depressive symptoms through social support and resilience.Participants were 715 Japanese employees at six worksites. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression (CES-D) scale, social support with the short version of the Social Support Questionnaire (SSQ), and resilience with the 14-item Resilience Scale (RS-14). A self-report questionnaire, which was extracted from the Japanese version of the Health-Promoting Lifestyle Profile, was used to assess whether participants engage in regular physical exercise, defined as more than 20min, three or more times per week. The group differences in CES-D, SSQ, and RS-14 scores were investigated by using analysis of covariance (ANCOVA). Mediation analysis was conducted by using Preacher and Hayes bootstrap script to assess whether regular physical exercise is associated with depressive symptoms indirectly through resilience and social support.The SSQ Number score (F=4.82, p=0.03), SSQ Satisfaction score (F=6.68, p=0.01), and RS-14 score (F=6.01, p=0.01) were significantly higher in the group with regular physical exercise (n=83) than in the group without regular physical exercise (n=632) after adjusting for age, education, marital status, and job status. The difference in CES-D score was not significant (F=2.90, p=0.09). Bootstrapping revealed significant negative indirect associations between physical exercise and CES-D score through the SSQ Number score (bias-corrected and accelerated confidence interval (BCACI)=-0.61 to -0.035; 95 % confidence interval (CI)), SSQ Satisfaction score (BCACI=-0.92 to -0.18; 95 % CI), and RS-14 score (BCACI=-1.89 to -0.094; 95 % CI).Although we did not find a significant direct association between exercise and depressive symptoms, exercise may be indirectly associated with depressive symptoms through social support and resilience. Further investigation is warranted.