Yokohama-shi, Japan
Yokohama-shi, Japan

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Tokunaga T.,University of Fukui | Sakashita M.,University of Fukui | Haruna T.,Okayama University | Asaka D.,Jikei University School of Medicine | And 37 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

Background Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS. Methods This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS. Results We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti-inflammatory drugs intolerance were associated significantly with recurrence. Conclusion We subdivided CRSwNP in non-ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy. © 2015 The Authors. Allergy Published by John Wiley & Sons Ltd.


PubMed | Kanagawa Cardiovascular and Respiratory Center, Yokohama City Medical Center, Beth Israel Deaconess Medical Center and Yokohama City University
Type: Journal Article | Journal: Journal of the American Heart Association | Year: 2016

Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF).We studied 25 patients with HFpEF (mean and SD of age: 737 years), 13 with hypertensive left ventricular hypertrophy (LVH) (6710 years), and 18 controls (6515 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.210.55 in HFpEF vs 3.050.74 in hypertensive LVH, 3.830.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (=-68.0; 95% CI, -116.2 to -19.7; P=0.007).CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.


Kawahara T.,Yokohama City University | Kawahara T.,Yokohama City Medical Center | Yokomizo Y.,Yokohama City University | Ito Y.,Yokohama City University | And 8 more authors.
BMC Cancer | Year: 2016

Background: The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response in critical care patients, has been suggested as an independent prognostic factor for several solid malignancies. We investigated the utility of pretreatment NLR as a prognosticator in patients who presented with metastatic prostate cancer. Methods: We first investigated the correlation between NLR and prostate-specific antigen (PSA) levels in 1464 men who had both tests and were found to have prostate cancer on their biopsies at our institution from 1999 to 2015. We then assessed the relationship between pretreatment NLR and the prognosis in 48 patients who were diagnosed with prostate cancer metastasized to the lymph node and/or bone. Results: The NLR value was significantly elevated in men with higher PSA than in those with lower PSA (p < 0.001). In patients with metastatic prostate cancer, NLR (cut-off point of 3.37 determined by the AUROC curve) was correlated with both cancer-specific (p = 0.018) and overall (p = 0.008) survivals. Conclusions: Pretreatment NLR may function as a new biomarker that precisely predicts the prognosis in patients with metastatic prostate cancer. © 2016 Kawahara et al.


PubMed | Johns Hopkins University, Yokohama City University, Kanagawa Academy Of Science And Technology and Yokohama City Medical Center
Type: | Journal: BMC cancer | Year: 2016

The neutrophil-to-lymphocyte ratio (NLR), a simple marker of the systemic inflammatory response in critical care patients, has been suggested as an independent prognostic factor for several solid malignancies. We investigated the utility of pretreatment NLR as a prognosticator in patients who presented with metastatic prostate cancer.We first investigated the correlation between NLR and prostate-specific antigen (PSA) levels in 1464 men who had both tests and were found to have prostate cancer on their biopsies at our institution from 1999 to 2015. We then assessed the relationship between pretreatment NLR and the prognosis in 48 patients who were diagnosed with prostate cancer metastasized to the lymph node and/or bone.The NLR value was significantly elevated in men with higher PSA than in those with lower PSA (p < 0.001). In patients with metastatic prostate cancer, NLR (cut-off point of 3.37 determined by the AUROC curve) was correlated with both cancer-specific (p = 0.018) and overall (p = 0.008) survivals.Pretreatment NLR may function as a new biomarker that precisely predicts the prognosis in patients with metastatic prostate cancer.


Kou K.,Yokohama City University | Kou K.,Yokohama City Medical Center | Chin K.,Yokohama City Medical Center | Matsukura S.,Yokohama City Medical Center | And 4 more authors.
Annals of Saudi Medicine | Year: 2014

Lupus miliaris disseminatus faciei (LMDF) is characterized by discrete dome-shaped papules on the bilateral face and neck. We report the first case of LMDF with a widespread distribution of extrafacial papules and concomitant bilateral eyelid edema. A unique case of a 30-year-old man presented with nonpruritic, painless, papular eruptions (3-5 mm in diameter) involving the bilateral trunk and upper extremities, along with bilateral eyelid edema. There was no facial eruption involved. The outbreak initially involved the back, and gradually spread to the chest and wrists. The histologic examination of the eyelids revealed histiocytic epitheloid cells, dermal intercellular edema, and an expanded vascular space, which led to the diagnosis of Morbihan disease. The immunohistochemical staining of the truncal eruption revealed nodular inflammatory changes involving the middle to lower dermis around the follicles, containing histiocytes, multinucleated giant cells, and small lymphocytes. This led to the diagnosis of LMDF. The truncal papular eruption ultimately improved with roxithromycin treatment, but the eyelid edema required surgical treatment. © 2014, King Faisal Specialist Hospital and Research Centre. All rights reserved.


Kato S.,Kanagawa Cardiovascular and Respiratory Center | Sekine A.,Respiratory Medicine | Kusakawa Y.,Kanagawa Cardiovascular and Respiratory Center | Ogura T.,Respiratory Medicine | And 10 more authors.
Journal of Cardiovascular Magnetic Resonance | Year: 2015

Background: Cardiovascular magnetic resonance (CMR) provides non-invasive and more accurate assessment of right ventricular (RV) function in comparison to echocardiography. Recent study demonstrated that assessment of RV function by echocardiography was an independent predictor for mortality in patients with interstitial lung disease (ILD). The purpose of this study was to determine the prognostic significance of CMR derived RV ejection fraction (RVEF) in ILD patients. Methods: We enrolled 76 patients with ILD and 24 controls in the current study. By using 1.5 T CMR scanner equipped with 32 channel cardiac coils, we performed steady-state free precession cine CMR to assess the RVEF. RV systolic dysfunction (RVSD) was defined as RVEF ≤45.0% calculated by long axis slices. Pulmonary hypertension (PH) was defined as mean pulmonary artery pressure (mPAP) of more than 25 mmHg at rest in the setting of pulmonary capillary wedge pressure ≤15 mmHg. Results: The median RVEF was 59.2% in controls (n = 24), 53.8% in ILD patients without PH (n = 42) and 43.1% in ILD patients with PH (n = 13) (p < 0.001 by one-way ANOVA). During a mean follow-up of 386 days, 18 patients with RVSD had 11 severe events (3 deaths, 3 right heart failure, 3 exacerbation of dyspnea requiring oxygen, 2 pneumonia requiring hospitalization). In contrast, only 2 exacerbation of dyspnea requiring oxygen were observed in 58 patients without RVSD. Multivariate Cox regression analysis showed that RVEF independently predicted future events, after adjusting for age, sex and RVFAC by echocardiography (hazard ratio: 0.889, 95% confidence interval: 0.809 - 0.976, p = 0.014). Conclusions: The current study demonstrated that RVSD in ILD patients can be clearly detected by cine CMR. Importantly, low prevalence of PH (17%) indicated that population included many mild ILD patients. CMR derived RVEF might be useful for the risk stratification and clinical management of ILD patients. © 2015 Kato et al.


Kato S.,Kanagawa Cardiovascular and Respiratory Center | Fukui K.,Kanagawa Cardiovascular and Respiratory Center | Kirigaya H.,Kanagawa Cardiovascular and Respiratory Center | Gyotoku D.,Kanagawa Cardiovascular and Respiratory Center | And 6 more authors.
International Journal of Cardiology | Year: 2016

Background The present study determined whether dipeptidyl peptidase-4 (DPP-4) inhibition by alogliptin improves coronary flow reserve (CFR) and left ventricular election fraction (LVEF) in patients with type 2 DM and CAD. Materials and methods Twenty patients with type 2 DM and known or suspected CAD were randomly allocated to receive diet therapy plus alogliptin (n = 10; mean age, 73.3 ± 6.6 y) or a control group given diet therapy and glimepiride (n = 10; mean age, 76.7 ± 7.3 y). Breath-hold PC cine MR images of the coronary sinus (CS) were acquired using a 1.5 T MR scanner and 32 channel cardiac coils to assess blood flow of the CS at rest and during adenosine triphosphate (ATP) infusion. The CFR was calculated as CS blood flow during ATP infusion divided by that at rest. The CFR and LVEF were evaluated by MRI at baseline and at three months after starting therapy. Results Hemoglobin A1c (HbA1c) was significantly reduced in both groups (alogliptin, 7.2 ± 0.6% to 6.6 ± 0.5%, p = 0.034; control, 6.9 ± 0.4% to 6.4 ± 0.3%, p = 0.008). However, CFR and LVEF significantly improved only in the alogliptin group (alogliptin: CFR, 2.15 ± 0.61 to 2.85 ± 0.80, p = 0.042; LVEF, 59.4 ± 6.3% to 68.0 ± 8.6%, p = 0.03; control: CFR, 2.17 ± 0.37 to 2.38 ± 0.32, p = 0.19; LVEF, 58.2 ± 9.1 to 60.3 ± 8.8%, p = 0.61). The % increases in CFR and in LVEF positively correlated (R = 0.47 by Spearman's correlation coefficient; p = 0.036). Conclusion The inhibition of DPP-4 by alogliptin improved CFR and LVEF evaluated by MRI in patients with type 2 DM and CAD and the improvement in CFR was associated with increased LV systolic function. © 2016 Elsevier Ireland Ltd


Miyoshi Y.,Yokohama City Medical Center | Furuya M.,Yokohama City Medical Center | Teranishi J.-I.,Yokohama City Medical Center | Noguchi K.,Yokohama City Medical Center | And 4 more authors.
Urology Journal | Year: 2014

Purpose: In the present study, we compared 12- with 16-core biopsy in patients with prostate- specific antigen (PSA) levels of 4.0-20.0 ng/mL. Materials and Methods: Between 2003 and 2010, 332 patients whose serum PSA level was between 4.0 and 20.0 ng/mL underwent initial transrectal ultrasound (TRUS)-guided needle biopsy. Of those patients, 195 underwent 12-core biopsy and 137 underwent 16-core biopsy. Results: In the 12-core prostate biopsy group, 66 (33.8%) patients were found to have prostate cancer. On the other hand, in the 16-core prostate biopsy group of 137 patients, 61 (44.5%) were found to have prostate cancer. Among all patients, the prostate cancer detection rate was slightly higher in the 16-core biopsy group than in the 12-core biopsy group. Moreover, in patients with prostate volume > 30 mL or PSA density (PSAD) < 0.2, the prostate cancer detection rate was significantly higher in the 16-core biopsy group than in the 12-core biopsy group. There was no significant difference in pathological tumor grade, indolent cancer probability, or biopsy complication rate between the two groups. Conclusion: In order to detect prostate cancer, 16-core prostate biopsy is safe and feasible for Japanese patients with serum PSA level of 4.0-20.0 ng/mL.


PubMed | Kanagawa Cardiovascular and Respiratory Center and Yokohama City Medical Center
Type: | Journal: International journal of cardiology | Year: 2016

The present study determined whether dipeptidyl peptidase-4 (DPP-4) inhibition by alogliptin improves coronary flow reserve (CFR) and left ventricular election fraction (LVEF) in patients with type 2 DM and CAD.Twenty patients with type 2 DM and known or suspected CAD were randomly allocated to receive diet therapy plus alogliptin (n=10; mean age, 73.36.6y) or a control group given diet therapy and glimepiride (n=10; mean age, 76.77.3y). Breath-hold PC cine MR images of the coronary sinus (CS) were acquired using a 1.5T MR scanner and 32 channel cardiac coils to assess blood flow of the CS at rest and during adenosine triphosphate (ATP) infusion. The CFR was calculated as CS blood flow during ATP infusion divided by that at rest. The CFR and LVEF were evaluated by MRI at baseline and at three months after starting therapy.Hemoglobin A1c (HbA1c) was significantly reduced in both groups (alogliptin, 7.20.6% to 6.60.5%, p=0.034; control, 6.90.4% to 6.40.3%, p=0.008). However, CFR and LVEF significantly improved only in the alogliptin group (alogliptin: CFR, 2.150.61 to 2.850.80, p=0.042; LVEF, 59.46.3% to 68.08.6%, p=0.03; control: CFR, 2.170.37 to 2.380.32, p=0.19; LVEF, 58.29.1 to 60.38.8%, p=0.61). The % increases in CFR and in LVEF positively correlated (R=0.47 by Spearmans correlation coefficient; p=0.036).The inhibition of DPP-4 by alogliptin improved CFR and LVEF evaluated by MRI in patients with type 2 DM and CAD and the improvement in CFR was associated with increased LV systolic function.


PubMed | Yokohama City Medical Center
Type: Comparative Study | Journal: Urology journal | Year: 2014

In the present study, we compared 12- with 16-core biopsy in patients with prostate- specific antigen (PSA) levels of 4.0-20.0 ng/mL.Between 2003 and 2010, 332 patients whose serum PSA level was between 4.0 and 20.0 ng/mL underwent initial transrectal ultrasound (TRUS)-guided needle biopsy. Of those patients, 195 underwent 12-core biopsy and 137 underwent 16-core biopsy.In the 12-core prostate biopsy group, 66 (33.8%) patients were found to have prostate cancer. On the other hand, in the 16-core prostate biopsy group of 137 patients, 61 (44.5%) were found to have prostate cancer. Among all patients, the prostate cancer detection rate was slightly higher in the 16-core biopsy group than in the 12-core biopsy group. Moreover, in patients with prostate volume > 30 mL or PSA density (PSAD) < 0.2, the prostate cancer detection rate was significantly higher in the 16-core biopsy group than in the 12-core biopsy group. There was no significant difference in pathological tumor grade, indolent cancer probability, or biopsy complication rate between the two groups.In order to detect prostate cancer, 16-core prostate biopsy is safe and feasible for Japanese patients with serum PSA level of 4.0-20.0 ng/mL.

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