Publications by authors named "H Shimizu"

5,417 Publications

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Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry.

BMJ Open 2021 Jun 11;11(6):e044319. Epub 2021 Jun 11.

Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Japan.

Objective: Data on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients.

Design: Observational study.

Setting: This study included patients with AS from a Japanese multicentre registry who underwent TAVI.

Participants: The overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%-9.50%), the Euro II score was 3.74% (IQR 2.34%-6.02%) and the Clinical Frailty Scale score was 3.9±1.2.

Interventions: We classified patients based on statin at admission and identified 936 matched pairs after propensity score matching.

Primary And Secondary Outcome Measures: The outcomes were all-cause and cardiovascular mortality.

Results: The median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01).

Conclusions: Statin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.

Trial Registration Number: UMIN000020423.
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http://dx.doi.org/10.1136/bmjopen-2020-044319DOI Listing
June 2021

[A Case of Pelvic Unicentric Castleman Disease Treated by Preoperative Transcatheter Arterial Embolization and Tumor Complete Resection with Combined Lower Abdominal and Posterior Approach].

Hinyokika Kiyo 2021 Apr;67(4):157-162

The Department of Urology, Kyoto University Hospital.

A 22-year-old woman was referred to our hospital for further examination of an incidentally discovered hypervascular pelvic tumor with a maximum diameter of 10 cm. Although Castleman disease was suspected based on the imaging findings and pathologic findings of the needle biopsy, a definitive diagnosis was not made. Preoperative transcatheter arterial embolization was performed to decrease intraoperative bleeding, and tumor resection was performed on the following day. As for posterior approach prior to anterior approach, the patient was placed in a prone position, and the dorsal aspect of tumor was approached through the dissection of gluteal muscles. Then, dilated branches of the internal iliac vein was found on the tumor capsule, which were safely ligated under direct vision with favorable visual field. Then, the patient was placed in a supine position, the tumor was completely resected by anterior approach without transfusion. Histopathological diagnosis was Castleman disease hyaline vascular type. The patient was discharged without complication and has been free from recurrence for 6 months after surgery.
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http://dx.doi.org/10.14989/ActaUrolJap_67_4_157DOI Listing
April 2021

Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients.

Appl Clin Inform 2021 May 9;12(3):564-572. Epub 2021 Jun 9.

Department of Neurosurgery, Akita University Hospital, Akita, Japan.

Background:  Health information exchange (HIE) may improve diagnostic accuracy, treatment efficacy, and safety by providing treating physicians with expert advice. However, most previous studies on HIE have been observational in nature.

Objectives:  To examine whether collaboration between specialists and general practitioners (GPs) in rural areas via HIE can improve outcomes among patients at low-to-moderate risk of cardiovascular disease, kidney disease, and stroke.

Methods:  In this randomized controlled trial, the Miyagi Medical and Welfare Information Network was used for HIE. We evaluated the clinical data of 1,092 patients aged ≥65 years living in the rural areas of the Miyagi Prefecture and receiving care from GPs only. High-risk patients were immediately referred to specialists, whereas low-to-moderate risk patients were randomly assigned to an intervention group in which GPs were advised by specialists through HIE ( = 518, 38% male, mean age = 76 ± 7 years) or a control group in which GPs received no advice by specialists ( = 521, 39% male, mean age = 75 ± 7 years).

Results:  In the intention-to-treat analysis, all-cause mortality and cumulative incidence of serious adverse events (e.g., hospital admission or unexpected referral to specialists) did not differ between the groups. However, per-protocol analysis controlling for GP adherence with specialist recommendations revealed significantly reduced all-cause mortality ( = 0.04) and cumulative serious adverse event incidence ( = 0.04) in the intervention group compared with the control group.

Conclusion:  HIE systems may improve outcomes among low-to-moderate risk patients by promoting greater collaboration between specialists and GPs, particularly in rural areas with few local specialists.
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http://dx.doi.org/10.1055/s-0041-1731287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189760PMC
May 2021

Hair follicle stem cell progeny heal blisters while pausing skin development.

EMBO Rep 2021 Jun 4:e50882. Epub 2021 Jun 4.

Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Injury in adult tissue generally reactivates developmental programs to foster regeneration, but it is not known whether this paradigm applies to growing tissue. Here, by employing blisters, we show that epidermal wounds heal at the expense of skin development. The regenerated epidermis suppresses the expression of tissue morphogenesis genes accompanied by delayed hair follicle (HF) growth. Lineage tracing experiments, cell proliferation dynamics, and mathematical modeling reveal that the progeny of HF junctional zone stem cells, which undergo a morphological transformation, repair the blisters while not promoting HF development. In contrast, the contribution of interfollicular stem cell progeny to blister healing is small. These findings demonstrate that HF development can be sacrificed for the sake of epidermal wound regeneration. Our study elucidates the key cellular mechanism of wound healing in skin blistering diseases.
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http://dx.doi.org/10.15252/embr.202050882DOI Listing
June 2021

Prediction of human pharmacokinetics for low-clearance compounds using pharmacokinetic data from chimeric mice with humanized livers.

Clin Transl Sci 2021 Jun 3. Epub 2021 Jun 3.

Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Development of low-clearance (CL) compounds that can be slowly metabolized is a major goal in the pharmaceutical industry. However, the pursuit of low intrinsic CL (CL ) often leads to significant challenges in evaluating the pharmacokinetics of such compounds. Although in vitro-in vivo extrapolation is widely used to predict human CL, its application has been limited for low-CL compounds because of the low turnover of parent compounds in metabolic stability assays. To address this issue, we focused on chimeric mice with humanized livers (PXB-mice), which have been increasingly reported to accurately predict human CL in recent years. The predictive accuracy for nine low-CL compounds with no significant turnover in a human hepatocyte assay was investigated using PXB-mouse methods such as single-species allometric scaling (PXB-SSS) approach and a novel physiologically based scaling (PXB-PBS) approach that assumes that the CL per hepatocyte is equal between humans and PXB-mice. The percentages of compounds with predicted CL within 2- and 3-fold ranges of the observed CL for low-CL compounds were 89% and 100%, respectively, for both PXB-SSS and PXB-PBS approaches. Moreover, the predicted CL was mostly consistent among the methods. Conversely, percentages of compounds with predicted CL within 2- and 3-fold ranges of the observed CL for low-CL compounds were 50% and 63%, respectively for multispecies allometric scaling (MA). Overall, these PXB-mouse methods were much more accurate than conventional MA approaches, suggesting that PXB-mice are useful tool for predicting the human CL of low-CL compounds that are slowly metabolized.
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http://dx.doi.org/10.1111/cts.13070DOI Listing
June 2021