Publications by authors named "Makoto Shiraishi"

32 Publications

Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study.

Front Oncol 2022 23;12:815498. Epub 2022 May 23.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: Breast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term.

Methods: Patient-reported BREAST-Q outcomes were analyzed 1 and 5 years after breast reconstruction in a single-blinded, prospective study. Multiple regression analysis was performed to identify the risk and protective factors associated with BREAST-Q scores. These scores at 1 and 5 years were also compared across three types of operation: mastectomy only, tissue expander/implant (TE/Imp), and a deep inferior epigastric perforator (DIEP) flap.

Results: Surveys were completed by 141 subjects after 1 year and 131 subjects after 5 years. Compared to mastectomy only, breast reconstruction was significantly associated with greater "Satisfaction with breasts" (TE/Imp, p < 0.001; DIEP, p < 0.001) and "Psychosocial well-being" (TE/Imp, p < 0.001; DIEP, p < 0.001), higher body mass index (BMI) resulted in lower "Satisfaction with breasts" (p = 0.004), and a history of psychiatric or neurological medication was significantly associated with "Physical well-being" at 1-year postoperatively (p = 0.02). At 5 years, reconstructive procedures were significantly positively associated with greater "Satisfaction with breasts" (TE/Imp, p < 0.001; DIEP, p < 0.001) and "Psychosocial well-being" (TE/Imp, p = 0.03; DIEP, p < 0.001), and a bilateral procedure was a significant risk factor for lower "Psychosocial well-being" (p = 0.02).

Conclusions: The results of this study show that breast reconstruction improves "Satisfaction with Breasts" and "Psychosocial well-being" compared to mastectomy. Among all three types of operation, DIEP gave the best scores at 5 years postoperatively. Thus, autologous reconstruction is recommended for promotion of long-term HRQoL after breast surgery.
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http://dx.doi.org/10.3389/fonc.2022.815498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178786PMC
May 2022

Clinical application and outcomes of reconstructive microsurgery in Africa: A systematic review and meta-analysis.

J Plast Reconstr Aesthet Surg 2022 07 25;75(7):2035-2048. Epub 2022 Apr 25.

Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.

Background: Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa.

Methods: Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates.

Results: Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84).

Conclusion: This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care.

Review Registration: Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
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http://dx.doi.org/10.1016/j.bjps.2022.04.028DOI Listing
July 2022

Localization of Chronic Pain in Postmastectomy Patients: A Prospective Comparison Between Patients With and Without Breast Reconstruction.

Ann Plast Surg 2022 05;88(5):490-495

Pain Management and Palliative Care Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Background: After breast surgery with or without immediate reconstruction, chronic pain can be a major problem for patients. However, few studies have examined the details of the sites of long-lasting postoperative pain. In this study, we specified the postoperative pain location after breast surgery, including reconstruction, to find ways to improve surgical procedures or provide effective pain relief.

Methods: The subjects were 205 Japanese women undergoing mastectomy or breast reconstruction with a tissue expander (TE)/implant or a deep inferior epigastric perforator (DIEP) flap. Patients were asked whether they had pain in different parts of the body at 1 year after surgery. Differences were assessed by cross-tabulation and χ2 statistics.

Results: Surveys were completed by 157 subjects. Deep inferior epigastric perforator flap cases had significantly more pain and TE/Imp cases had significantly less pain in the medial breast, upper breast, breast upper medial quadrant, and abdomen (P = 0.006, P = 0.006, P < 0.001, P < 0.001, respectively). In the neck area, pain in TE/Imp cases was significantly worse than that in all other patients (P = 0.025). There was no significant difference in chronic pain in any other body regions among the mastectomy only, TE/Imp, and DIEP flap groups.

Conclusions: The results of the present study revealed that the localization of prolonged postoperative pain after breast surgery differs depending on the surgical procedure. In DIEP flap reconstruction, there was a marked tendency for pain in the inner and upper chest and in the abdomen, whereas TE/IMP surgery resulted in pain around the neck of the affected side. These findings may help improve surgical methods and establish effective pain relief that focuses on the identified pain areas.
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http://dx.doi.org/10.1097/SAP.0000000000003146DOI Listing
May 2022

Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects.

Plast Reconstr Surg Glob Open 2022 Apr 8;10(4):e4234. Epub 2022 Apr 8.

Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan.

Large cranial vault defects are challenging to manage due to the need to balance infection control, skin coverage, and restoration of the protective mechanical rigidity of the skull while also ensuring good head and neck aesthetic results. Conventional-staged treatment requires a long time period that includes debridement and scalp skin defect coverage with flaps as a first step, followed by definitive plate reconstruction 3-9 months later after infection control and flap atrophy resolution. We report a case of successful early cranioplasty in a factory worker who developed a large full-thickness cranial skull defect following artificial dura infection. Reconstruction was performed in two stages using an anterolateral thigh (ALT) flap. In the first stage, the scalp defect was covered with an ALT flap to close the skin following debridement. In the second stage performed 6 weeks later, the ALT flap was split into adiposal and adipocutaneous flaps to sandwich a computer-aided design custom-made titanium plate with an opening for the perforator to complete the cranioplasty. The patient successfully returned to work without recurrence of infection with 1-year follow-up. We report this case to demonstrate the utility of adipocutaneous flap plate sandwiching techniques in providing well-vascularized cover for early definitive cranial reconstruction and accelerated patient recovery.
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http://dx.doi.org/10.1097/GOX.0000000000004234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994073PMC
April 2022

Deep Brain Stimulation in a Patient with Parkinson's Disease and Cortical Superficial Siderosis.

Intern Med 2022 Mar 26. Epub 2022 Mar 26.

Department of Neurology, Graduate School of Medicine, Mie University, Japan.

Cortical superficial siderosis (cSS) is a rare condition that is regarded as a potential magnetic resonance marker of cerebral amyloid angiopathy (CAA). We describe the case of a 68-year-old man with cSS and Parkinson's disease (PD) who subsequently exhibited incidental microhemorrhages, which were only detected on magnetic resonance imaging (MRI), at one week after deep brain stimulation (DBS) surgery. cSS is now considered to be a significant risk factor for CAA and future bleeding. Therefore, because DBS surgery is invasive and may increase the risk of intracerebral hemorrhage, the procedure should be performed carefully when managing patients with PD and CAA.
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http://dx.doi.org/10.2169/internalmedicine.9253-21DOI Listing
March 2022

Long-term survey of sexual well-being after breast reconstruction using the BREAST-Q in the Japanese population.

Asian J Surg 2022 Feb 24. Epub 2022 Feb 24.

Department of Plastic and Reconstructive Surgery, University Hospital Kyoto Prefectural University of Medicine, Japan.

Background: The objective of this study was to identify response patterns related to sexual well-being following breast operations in the Japanese population.

Methods: Patient-reported outcomes were analyzed at 1 year and 5 years after breast operations, including breast reconstruction, for Japanese women at a single center, with a focus on "Sexual well-being" in BREAST-Q. Response analysis and multiple regression analysis were performed. The scores at years 1 and 5 were also compared across three types of operation: mastectomy only, TE/Imp, and DIEP.

Results: The response rate for Sexual well-being on BREAST-Q in the prospective cohort of patients with breast cancer dropped from 60.0% in postoperative year 1-34.3% in year 5. The mean score for Sexual well-being increased from 32 (year 1) to 38 (year 5). There were significant differences between respondents and non-respondents in age at year 1 (P = 0.007) and for mastectomy only (P = 0.01) and TE/Imp (P = 0.03) at year 5. In regression analysis, only DIEP was positively associated with Sexual well-being at year 1 (p < 0.001) and there were no significant factors at year 5. Among the operative procedures, scores after DIEP were significantly better than those after mastectomy only at year 1 (p < 0.001), but there was no difference at year 5. There were no significant changes from year 1 to year 5 for each operation.

Conclusions: A low response rate for Sexual well-being on BREAST-Q was found in Japanese women at 5 years postoperatively. This suggests the need for development of a modified evaluative scale that avoids nonresponse bias and considers ethnic differences.
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http://dx.doi.org/10.1016/j.asjsur.2022.02.007DOI Listing
February 2022

Relationship between cerebral blood flow reduction patterns on scintigraphy and nonmotor symptoms in new-onset Lewy body disease.

Nucl Med Rev Cent East Eur 2022 ;25(1):18-24

Department of Internal Medicine and Brain Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.

Background: This study aimed to investigate the relationship between patterns of reduced cerebral blood flow (CBF) evaluated by means of 123I-N-isopropyl-p-iodoamphetamine ([123I]IMP) scintigraphy and nonmotor symptoms in new-onset Lewy body disease (Parkinson's disease and dementia with Lewy bodies [DLB]).

Material And Methods: Twenty-four patients diagnosed with new-onset Parkinson's disease or DLB underwent [123I]IMP CBF scintigraphy at St. Marianna Medical University Hospital between January 1, 2010, and March 30, 2018. The reductions in CBF in various brain regions were analyzed using the three-dimensional stereotactic surface projection method and were compared to standard database values, yielding extent values (%). The extent values were evaluated in relation to the presence/absence of motor or nonmotor symptoms such as visual hallucinations, auditory hallucinations, delirium, depression, delusions, and dementia.

Results: The extent value was 100% in the angular, supramarginal, and lingual gyri; 95% in the orbital gyri; and 92.6% in the fusiform gyri. The extent value in patients without hallucinations and those with visual hallucinations was 41.2% and 54.3%, respectively, in the frontal lobe (p = 0.02) and 33.3% and 51.0%, respectively, in the medial prefrontal gyri (p = 0.02). Age-adjusted multivariate analysis showed that extent values in the frontal lobe were associated with visual hallucinations (odds ratio: 1.09, 95% confidence interval 1.00-1.18, p = 0.04).

Conclusions: The above results show that the CBF is reduced in several areas of the cerebral cortex and suggest an association between reduced blood flow in the frontal lobe and the appearance of visual hallucinations in patients with new-onset DLB.
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http://dx.doi.org/10.5603/NMR.a2022.0005DOI Listing
February 2022

Effect of subjective vertical perception on lateral flexion posture of patients with Parkinson's disease.

Sci Rep 2022 01 27;12(1):1532. Epub 2022 Jan 27.

Department of Neurology, Noborito Neurology Clinic, Kawasaki, Japan.

In a retrospective study we tested our hypothesis that the subjective postural vertical ratio (SPV ratio), i.e., the subjective postural vertical measured in relation to the lateral flexion axis, is predictive of lateral trunk flexion in patients with Parkinson's disease (PD). Twenty-five patients were included. The SPV angle, i.e., the subjective perception of a vertical position with reference to the vertical axis, and the SPV ratio, i.e., the SPV angle with reference to the axis of lateral flexion, were calculated. The SPV ratio (r = 0.698, P = 0.001) and LTF angle (r =  - 0.601, P = 0.001) correlated with change in the LTF angle at 1 year. The SPV ratio was significantly smaller in patients for whom lateral trunk flexion improved (n = 12) than in those for whom it did not improve (n = 13) (0.99 ± 0.78 vs 1.66 ± 0.71, P = 0.011). The AUC under the ROC curve of the SPV ratio for discrimination of improvement was 0.795 (95% confidence interval: 0.61-0.98). We found that the SPV ratio is associated with change in the LTF and that it can conceivably be used to predict the likelihood of improvement in PD-associated lateral trunk flexion.
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http://dx.doi.org/10.1038/s41598-022-05587-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795259PMC
January 2022

Treatment of cold intolerance following finger pulp amputations: a case comparison between immediate finger replantation and delayed pulp and digital arterial arch reconstruction with flow-through free hypothenar flap.

Case Reports Plast Surg Hand Surg 2022 27;9(1):33-36. Epub 2021 Dec 27.

Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan.

We report a unique case of cold intolerance following identical fingertip amputations of two fingers on the same hand. The index finger was replanted and the middle finger was reconstructed with a free flow-through hypothenar perforator flap to anatomically restore the digital arterial arch circulation and successfully treat cold intolerance.
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http://dx.doi.org/10.1080/23320885.2021.2020656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725866PMC
December 2021

Shaping the future of microsurgery: Combination of exoscope and smart glasses.

J Plast Reconstr Aesthet Surg 2022 Feb 18;75(2):893-939. Epub 2021 Nov 18.

Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2021.11.009DOI Listing
February 2022

Trust and Trade-Offs in Sharing Data for Precision Medicine: A National Survey of Singapore.

J Pers Med 2021 Sep 16;11(9). Epub 2021 Sep 16.

Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.

Background: Precision medicine (PM) programs typically use broad consent. This approach requires maintenance of the social license and public trust. The ultimate success of PM programs will thus likely be contingent upon understanding public expectations about data sharing and establishing appropriate governance structures. There is a lack of data on public attitudes towards PM in Asia.

Methods: The aim of the research was to measure the priorities and preferences of Singaporeans for sharing health-related data for PM. We used adaptive choice-based conjoint analysis (ACBC) with four attributes: uses, users, data sensitivity and consent. We recruited a representative sample of = 1000 respondents for an in-person household survey.

Results: Of the 1000 respondents, 52% were female and majority were in the age range of 40-59 years (40%), followed by 21-39 years (33%) and 60 years and above (27%). A total of 64% were generally willing to share de-identified health data for IRB-approved research without re-consent for each study. Government agencies and public institutions were the most trusted users of data. The importance of the four attributes on respondents' willingness to share data were: users (39.5%), uses (28.5%), data sensitivity (19.5%), consent (12.6%). Most respondents found it acceptable for government agencies and hospitals to use de-identified data for health research with broad consent. Our sample was consistent with official government data on the target population with 52% being female and majority in the age range of 40-59 years (40%), followed by 21-39 years (33%) and 60 years and above (27%).

Conclusions: While a significant body of prior research focuses on preferences for consent, our conjoint analysis found consent was the least important attribute for sharing data. Our findings suggest the social license for PM data sharing in Singapore currently supports linking health and genomic data, sharing with public institutions for health research and quality improvement; but does not support sharing with private health insurers or for private commercial use.
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http://dx.doi.org/10.3390/jpm11090921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465970PMC
September 2021

Utility of transoral motion-mode ultrasonography to detect tongue fasciculation in patients with amyotrophic lateral sclerosis.

Muscle Nerve 2021 06 16;63(6):909-913. Epub 2021 Mar 16.

Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Introduction: Increasing evidence suggests the utility of the submandibular approach for ultrasonography to detect tongue fasciculation in amyotrophic lateral sclerosis (ALS). We hypothesized that transoral motion-mode ultrasonography (TOMU) would be useful to detect tongue fasciculation in patients with ALS.

Methods: Patients with sporadic ALS showing clinically definite tongue fasciculation were enrolled, and the ultrasonography findings of patients' tongues on TOMU and ultrasonography by the conventional submandibular approach were analyzed.

Results: Six patients with clinically definite ALS were enrolled in this study. Although small, irregular muscle movements of 5 to 10 mm in amplitude and 0.1 to 0.2 second in duration were detected in all patients by TOMU, similar muscle movements were detected in only two of the six patients by the submandibular approach.

Discussion: TOMU appeared to be useful for detecting tongue fasciculation in ALS patients. Further study is needed to better determine its role as a diagnostic tool for ALS.
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http://dx.doi.org/10.1002/mus.27218DOI Listing
June 2021

Factors associated with chronic pain following breast reconstruction in Japanese women.

J Plast Surg Hand Surg 2020 Oct 26;54(5):317-322. Epub 2020 Jun 26.

Pain Management and Palliative Care Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Chronic pain after breast surgery including breast reconstruction is a major concern for patients. However, the factors associated with chronic pain after breast surgery are uncertain in Japanese population. The aim of this study was to identify patient-specific and medical/surgical factors that predict chronic pain after breast surgery in Japanese patients. The subjects were 189 Japanese women undergoing breast surgery including tissue expander/implant (TE/implant), deep inferior epigastric perforator (DIEP) procedures and mastectomy only. Pain was assessed at one year postoperatively using a validated survey instrument: the Japanese version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with postoperative pain. Surveys were completed by 141 subjects. A younger age ( = .04) and bilateral procedures ( < .05) were both closely associated with the extent of increased postoperative pain at 1 year using the MPQ-Total pain rating. Compared to total mastectomy only, TE/implant procedures showed a significantly lower visual analog scale (VAS) ( = .04) and present pain index (PPI) ( = .03) scores. No factor related to chronic pain was also significantly related to the frequency of pain medication use postoperatively or the effect of social life of the patients. This study identified patients at risk for greater chronic pain after breast surgery. These findings will allow surgeons to improve patient comfort, reduce clinical morbidity and enhance patient satisfaction with their surgical outcome. : BMI: body mass index; CI: confidence interval; DIEP: deep inferior epigastric perforator flap; MPQ: McGill pain questionnaire; PPI: present pain index; SD: standard deviation; SF-MPQ-JV: Japanese version of the short-form McGill pain questionnaire; TE: tissue expander; VAS: visual analog scale.
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http://dx.doi.org/10.1080/2000656X.2020.1780246DOI Listing
October 2020

Subjective postural vertical in Parkinson's disease with lateral trunk flexion.

Acta Neurol Scand 2020 Nov 9;142(5):434-442. Epub 2020 Jun 9.

Department of Neurology, Noborito Neurology Clinic, Kawasaki, Japan.

Background: Patients with Parkinson's disease (PD) and associated lateral trunk flexion (LTF) cannot accurately perceive their own verticality.

Objective: We measured the subjective postural vertical in coronal plane (SPVc) angle on patients' ipsilateral and contralateral sides and combined to clarify the effects of SPVc on LTF. We also investigated effects of the SPVc angle on LTF severity.

Methods: Thirty-nine patients (aged 74.1 ± 7.6 years) were divided between those with mild LTF (LTF angle < 10°, n = 34) and those with moderate to severe LTF (LTF angle ≥ 10°, n = 5) for comparison of the LTF angle, SPVc angle on both sides, inter-measurement variation in the SPVc angle, and the LTF to SPVc angle ratio (SPVc ratio).

Results: We found significant positive correlation between LTF and the SPVc angle on the combined (r = .54, P = .001), ipsilateral (r = .51, P = .002), and contralateral (r = .50, P = .002) sides. We found significant negative correlation between the LTF angle and the SPVc ratio on the combined SPVc (r = -.82, P = .001), ipsilateral (r = -.69, P = .001), and contralateral (r = -.75, P = .001) sides and between the LTF and ipsilateral side coefficient of variation (r = -.34, P = .038). SPVc angles on ipsilateral and contralateral sides were significantly greater in cases of moderate to severe LTF than in cases of mild LTF (P < .01).

Conclusions: Subjective postural vertical in coronal plane assessment may be useful for assessing patients with PD and associated LTF.
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http://dx.doi.org/10.1111/ane.13285DOI Listing
November 2020

Evaluation of the efficacy of simplified nutritional instructions from physicians on dietary salt restriction for patients with type 2 diabetes mellitus consuming excessive salt: protocol for a randomized controlled trial.

Trials 2019 Dec 23;20(1):761. Epub 2019 Dec 23.

Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.

Background: Hypertension is present in more than 50% of patients with type 2 diabetes mellitus. Dietary salt restriction is recommended for the management of high blood pressure. Instructions on dietary salt restriction, provided by a dietitian, have been shown to help patients reduce their salt intake. However, appointments for the dietitians in hospitals are often already fully booked, making it difficult for patients to receive instructions on the same day as the outpatient clinic visit.

Aim: The aim of this trial is to test a new intervention to assess whether guidance on dietary salt restriction provided by physicians during outpatient visits is effective in reducing salt intake in patients with type 2 diabetes mellitus who have an excessive salt intake.

Methods: In this unblinded randomized controlled trial (RCT), a total of 200 patients, male or female, aged between 20 and 90 years, who have type 2 diabetes mellitus and consume excessive salt will be randomly assigned to two groups: an intervention group and a control group. In addition to being given routine treatment, participants in the intervention group will be given individual guidance on restricting their dietary salt intake by a physician upon enrollment. The control group will only be given routine treatment. Participants will be followed up for 24 weeks. The primary outcome will be dietary salt intake, which will be assessed at baseline and at 8, 16, and 24 weeks. The secondary outcomes, including body weight, body mass index, hemoglobin A1c level, blood pressure, blood glucose level, serum lipid profile, and urinary albumin excretion level, will be assessed at baseline and at 8, 16, and 24 weeks.

Discussion: The results of this RCT have the potential to provide a simple and novel clinical approach to reduce salt intake among patients with type 2 diabetes, making regular visits to their physician, in outpatient facilities. This protocol will contribute to the literature because it describes a practical intervention that has not been tested previously, and it may serve as guidance to other researchers interested in testing similar interventions.

Trial Registration: University Hospital Medical Information Network (UMIN), UMIN000028809. Registered retrospectively on 24 August 2017. http://www.umin.ac.jp.
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http://dx.doi.org/10.1186/s13063-019-3864-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929491PMC
December 2019

Deterioration of postural deformity in Parkinson's disease patients with punding and hobbyism.

J Clin Neurosci 2019 Nov 7;69:179-183. Epub 2019 Aug 7.

Department of Neurology, Noborito Neurology Clinic, 434 Nobotitoshinmachi, Tama-ku, Kawasaki City, Kanagawa, Japan. Electronic address:

This study aimed to examine whether worsening of postural deformities is seen in Parkinson's disease (PD) patients who exhibit the behavioral disorders punding or hobbyism (P-H), which involve maintaining the same poor posture. The subjects were 80 patients with PD (aged 73.1 ± 8.8 years; duration of disease, 6.4 ± 5.5 years). Using the Japanese-language version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (J-QUIP), a group with P-H alone (P-H only group) and a group without impulsive-compulsive behaviors (non-ICB group) were compared with respect to the angles of forward and lateral trunk flexion while standing at rest. The group with ICBs (ICB group) identified by the J-QUIP consisted of 36 patients (45.0%). Of these, 25 (31.3%) were in the P-H only group. The non-ICB group, who were negative on all items of the J-QUIP, consisted of 44 patients (55.0%). Significantly higher values were seen in the P-H only group compared with non-ICB group for the angle of forward flexion of the trunk (FFT angle, p = 0.04), Unified Parkinson's Disease Rating Scale (UPDRS) part II score (p = 0.002), and UPDRS total score (p = 0.007). The FFT angle was increased and activities of daily living decreased in PD patients with P-H.
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http://dx.doi.org/10.1016/j.jocn.2019.07.069DOI Listing
November 2019

Relationship Between Asymptomatic Intracranial Stenosis and Extracranial Arteriosclerotic Findings in Workplace Health Checkups: A Pilot Study.

J Stroke Cerebrovasc Dis 2019 Sep 9;28(9):2429-2433. Epub 2019 Jul 9.

Fujitsu Limited Health Promotion Unit, Kawasaki, Kanagawa, Japan.

Background: Intracranial arteriosclerotic disease (ICAD) is common in Asians and has been presumed to be largely associated with metabolic syndrome (MetS), but the risks for asymptomatic ICAD detectable in examinations of the brain, among other tests, are not well known. The present study is aimed at identifying the risks for asymptomatic ICAD using data on risk factors obtained in health checkups, including data from magnetic resonance imaging (MRI), chest computed tomography (CT), and neck echography.

Methods: Subjects comprised 103 examinees more than equal to 40 years old (56.9 ± 4.7 years, 93 men) who underwent head MRI, chest CT, and carotid echography in the same period in a workplace health checkup between April and September 2014. Subjects were evaluated for ICAD based on stenosis of bilateral middle cerebral arteries and the basilar artery on previously reported scores from magnetic resonance angiography. Evaluations for extracranial arteriosclerotic disease (ECAD) were based on findings from carotid echography, and total calcium scores were calculated based on the number, areas, and peak Hounsfield computed tomographic numbers of the aortic arch calcified lesion detected.

Results: ICAD, including mild cases with stenosis less than 50%, was seen in 21 subjects (20.3%); and MetS was evident in 12 subjects (11.7%). Logistic regression analysis with multivariate adjustment for major vascular risk factor demonstrated that echogenic of plaque was significantly associated with the ICAD (OR 3.69, 95%CI 1.02-13.3), however age was significant predictor of the risk profile in patients with ECAD.

Conclusions: Carotid atherosclerosis could predict intracranial atherosclerosis in middle-aged people. However, further study with large sample size is warranted.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.029DOI Listing
September 2019

Subjective Vertical Position Allows Prediction of Postural Deterioration in Patients with Parkinson's Disease.

Parkinsons Dis 2019 2;2019:1875435. Epub 2019 Apr 2.

Department of Neurology, Noborito Neurology Clinic, Kawasaki, Kanagawa, Japan.

Background: We believe that, in patients with Parkinson's disease (PD), a forward-directed increase in the subjective vertical position (SV) leads to prolonged worsening of forward flexion of the trunk (FFT) mainly because the body adjusts to the SV. We conducted a study to clarify the relation between the SV angle, FFT angle, and various other clinical measures by comparing baseline values against values obtained 1 year later.

Methods: A total of 39 PD patients (mean age, 71.9 ± 10.1 years; disease duration, 7.2 ± 5.4 years; modified Hoehn & Yahr (mH&Y) score, 2.6 ± 0.7) were enrolled. The Unified Parkinson's Disease Rating Scale score, Mini-Mental State Examination (MMSE) score, mH&Y score, FFT angle, SV angle, and levodopa-equivalent dose (LED) were assessed at the time of enrollment (baseline evaluation) and 1 year later.

Results: Eighteen patients (46%) complied with the protocol and completed the study. Significant increases were observed in the 1-year SV angle (=0.02), MMSE score (=0.008), and LED (=0.001) compared to baseline values. Correlation was observed between the baseline SV angle and baseline and 1-year FFT angles (=0.64,  =0.008 and =0.58,  =0.012, respectively) and between the 1-year SV angle and 1-year FFT angle (=0.63,  =0.005).

Conclusion: Our data suggest that the SV contributes to increased FFT.
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http://dx.doi.org/10.1155/2019/1875435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466872PMC
April 2019

Potential impact of the joint association of total bilirubin and gamma-glutamyltransferase with metabolic syndrome.

Diabetol Metab Syndr 2019 4;11:12. Epub 2019 Feb 4.

1Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan.

Background: Metabolic syndrome is characterized by the clustering of different metabolic abnormalities. Total bilirubin and gamma-glutamyltransferase (GGT) levels have been reported to be associated with this condition. However, the extent to which the interaction between these parameters affects metabolic syndrome is unknown. Therefore, we examined the association of total bilirubin and GGT levels with metabolic syndrome, and investigated the combined effect of the two parameters.

Methods: In this retrospective cohort study, we analyzed 8992 middle-aged Japanese subjects (4586 men, 4406 women; mean age, 44.8 ± 9.3 years) without metabolic syndrome from a cohort of employees undergoing annual health examinations. They were divided into four groups according to median total bilirubin and GGT levels: both-low, GGT-high, total bilirubin-high, and both-high. The incident of metabolic syndrome was evaluated during a follow-up of 2.8 ± 1.2 years.

Results: The incident rate of metabolic syndrome during the follow-up was 4.6% in the both-low group, 12.1% in the GGT-high group, 2.7% in the total bilirubin-high group, and 10.6% in the both-high group. Total bilirubin and GGT have an interaction effect on the risk of incident metabolic syndrome (= 0.0222). The both-low [hazard ratio (HR), 1.37; 95% confidence interval (CI) 1.002-1.89], GGT-high (HR, 1.88; 95% CI 1.42-2.52), and both-high (HR, 2.07; 95% CI 1.56-2.80) groups showed an increased adjusted HR for incident metabolic syndrome after adjusting for covariates compared with the total bilirubin-high group.

Conclusions: The simultaneous presence of high total bilirubin and low GGT levels may be associated with a lower incidence of metabolic syndrome.
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http://dx.doi.org/10.1186/s13098-019-0408-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360758PMC
February 2019

Usefulness of the combination of iodine-123-metaiodobenzylguanidine scintigraphy and iodine-123-ioflupane scintigraphy in new-onset Parkinson's disease.

Nucl Med Commun 2018 Nov;39(11):983-988

Departments of Radiology.

Objectives: The aim of this study was to study the significance of combining iodine-123-cardiac metaiodobenzylguanidine scintigraphy (I-MIBG scintigraphy) and iodine-123-ioflupane (I-ioflupane) dopamine transporter scintigraphy (I-ioflupane scintigraphy) in patients suspected of having Parkinson's disease (PD).

Patients And Methods: We carried out a retrospective study from April 2014 to December 2015 in 48 patients suspected of having new-onset PD who underwent both I-MIBG and I-ioflupane scintigraphies within 3 months. Cases included 37 patients diagnosed as having PD. Controls included 11 patients who had never been diagnosed as having PD or other diseases showing parkinsonism. The cutoff for diagnosing PD was a heart to mediastinum ratio (H/M ratio) of less than or equal to 2.2 for I-MIBG scintigraphy in the delayed phase and a specific binding ratio (SBR) of less than or equal to 3.8 for I-ioflupane scintigraphy. The combined use of both scintigraphies was studied using the formula SBR×H/M ratio as a marker for the logistic regression model.

Results: Sixteen (33.3%) patients had SBR of greater than 3.8: eight with PD; eight were controls. Five of eight patients had an H/M ratio of less than or equal to 2.2 (62.5%) and had PD. In the receiver-operating characteristic analysis, the SBR×H/M ratio cutoff was 12.5, with an area under the curve of 0.844 (95% confidence interval: 0.619-1). In an age-adjusted regression analysis in patients with SBR of greater than 3.8, the SBR×H/M ratio was associated significantly with an odds ratio of 0.69 (95% confidence interval: 0.48-0.98, P=0.041).

Conclusion: If SBR is greater than 3.8, the SBR×H/M ratio can help diagnose PD. The combined use of the two scintigraphies can improve the diagnosis of PD.
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http://dx.doi.org/10.1097/MNM.0000000000000898DOI Listing
November 2018

Impact of inability to turn in bed assessed by a wearable three-axis accelerometer on patients with Parkinson's disease.

PLoS One 2017 9;12(11):e0187616. Epub 2017 Nov 9.

Department of Neurology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

Background: Difficulty turning over in bed is a common night-time symptom in Parkinson's disease (PD). We aimed to quantitatively evaluate overnight turnover movements using a three-axis accelerometer and to investigate whether inability to turn in bed is related to daytime sleepiness, sleep quality, and depressive mood in PD patients.

Methods: We examined 64 patients with PD (mean age, 73.3±8.21 years; modified Hoehn-Yahr [mH-Y] stage, 3.0±1.0; disease duration, 7.2±6.3 years; unified Parkinson's disease rating scale [UPDRS], 36.9±18.3). Overnight monitoring of turnover movements using a wearable three-axis accelerometer was performed in all patients. Nocturnal kinetic parameters including total time recumbent, total time supine, number of turnover movements, and mean interval between turnover movements were obtained. Daytime immobility was assessed using the Barthel index (B-I), UPDRS, and mH-Y stage. Patients were also assessed with the Epworth Sleepiness Scale (ESS), Parkinson's Disease Sleep Scale-2 (PDSS-2), and Beck Depression Inventory (BDI).

Results: Number of turnover movements in bed correlated negatively with disease duration (r = -0.305; p<0.05), L-dopa-equivalent dose (r = -0.281; p<0.05), mH-Y staging (r = -0.336; p<0.01), total score of UPDRS (r = -0.386; p<0.01) and positively with B-I score (r = 0.365; p<0.01). Number of turnover movements in bed was generally inconsistent with awareness of turnover movement impairment as evaluated by PDSS-2 Item 9 scores, but patients who were never aware of impaired turnover movements showed ≥5 turnover movements overnight. Multivariate logistic regression analyses revealed no correlations between number of nocturnal turnover movements in bed and BDI, ESS, or PDSS-2. Use of anti-psychotic drugs was associated with ESS (p = 0.045). UPDRS was associated with PDSS-2 (p = 0.016).

Conclusion: Decreased number of turnover movements may not be a direct determinant of daytime sleepiness, sleep disorders, or depressive mood in PD patients. Use of anti-psychotic drugs and higher UPDRS score are factors significantly associated with daytime sleepiness and uncomfortable sleep, respectively.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187616PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679594PMC
November 2017

Current-direction/amplitude-dependent single channel gating kinetics of mouse pannexin 1 channel: a new concept for gating kinetics.

Sci Rep 2017 09 5;7(1):10512. Epub 2017 Sep 5.

Department of Molecular Cell Physiology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, 602-8566, Japan.

The detailed single-channel gating kinetics of mouse pannexin 1 (mPanx1) remains unknown, although mPanx1 is reported to be a voltage-activated anion-selective channel. We investigated characteristics of single-channel conductances and opening and closing rates of mPanx1 using patch-clamp techniques. The unitary current of mPanx1 shows outward rectification with single-channel conductances of ~20 pS for inward currents and ~80 pS for outward currents. The channel open time for outward currents (Cl influx) increases linearly as the amplitude of single channel currents increases, while the open time for inward currents (Cl efflux) is constant irrespective of changes in the current amplitude, as if the direction and amplitude of the unitary current regulates the open time. This is supported by further observations that replacement of extracellular Cl with gluconate diminishes the inward tail current (Cl efflux) at a membrane potential of -100 mV due to the lowered outward current (gluconate influx) at membrane potential of 100 mV. These results suggest that the direction and rate of charge-carrier movement regulate the open time of mPanx1, and that the previously reported voltage-dependence of Panx1 channel gating is not directly mediated by the membrane potential but rather by the direction and amplitude of currents through the channel.
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http://dx.doi.org/10.1038/s41598-017-10921-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585217PMC
September 2017

Forward flexion of trunk in Parkinson's disease patients is affected by subjective vertical position.

PLoS One 2017 10;12(7):e0181210. Epub 2017 Jul 10.

Department of Neurology, Noborito Neurology Clinic, Kawasaki, Kanagawa, Japan.

Purpose: No method has been established to evaluate the dissociation between subjective and objective vertical positions with respect to the self-awareness of postural deformity in patients with Parkinson's disease (PD). The purpose of this study was to demonstrate, from the relationship between an assessment of the dissociation of subjective and objective vertical positions of PD patients and an assessment based on established PD clinical evaluation scales, that the dissociation regarding vertical position is a factor in the severity of the forward flexion of trunk (FFT).

Methods: Subjects were 39 PD patients and 15 age-matched healthy individuals (control group). Posture was evaluated with measurement of FFT angle during static standing and the subjective vertical position (SV) of the patient. For evaluation of motor function, the Modified Hoehn & Yahr scale, Unified Parkinson's Disease Rating Scale (UPDRS), 3-m Timed Up and Go Test (TUG), and Functional Reach Test (FRT) were used.

Results: In PD patients, FFT angle in the 3rd tertile of patients was 13.8±9.7°, significantly greater than those in the control group and the 1st and 2nd tertiles of PD patients (control group vs 3rd tertile, p = 0.008; 1st tertile vs 3rd tertile, p<0.001; 2nd vs 3rd tertile, p = 0.008). In multiple regression analysis for factors in the FFT angle, significant factors were SV, disease duration, and the standard deviation of each SV angle measurement.

Conclusion: The dissociation between SV and objective vertical position affects the FFT of PD patients, suggesting an involvement of non-basal ganglia pathologies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181210PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507338PMC
September 2017

Nerve conduction study of lower extremities in cutaneous arteritis patients with neurological manifestations.

J Dermatol 2017 Nov 30;44(11):1299-1302. Epub 2017 Jun 30.

Department of Internal Medicine, Division of Neurology, St Marianna University School of Medicine, Kawasaki, Japan.

Some patients originally diagnosed with cutaneous arteritis (CA) could develop additional disease manifestations, including peripheral neurological involvement. We evaluated the biological neurological parameters among CA patients who underwent nerve conduction studies for neurological involvement in the lower extremities. We reviewed 164 patients who were originally diagnosed with CA at our dermatology department between 2004 and 2015. Seventeen (10.4%) of the CA patients underwent further nerve conduction studies to determine their peripheral neurological manifestations, primarily in the lower extremities, in our neurology division. The frequency of low compound muscle action potential (CMAP) was significantly higher compared with that of delayed latency in both the peroneal nerve and sural nerve based on nerve conduction studies. The frequency of low CMAP was significantly higher compared with that of prolonged distal latency in both the peroneal and sural nerves. We suggest that impairment of the nerve axon pathways in the peroneal and sural nerves could result in the peripheral neurological manifestations in the lower extremities in CA patients.
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http://dx.doi.org/10.1111/1346-8138.13946DOI Listing
November 2017

Reversible Cerebral Vasoconstriction Syndrome Presenting with Transient Global Amnesia.

Intern Med 2017 15;56(12):1569-1573. Epub 2017 Jun 15.

Department of Neurology, St. Marianna University School of Medicine, Japan.

A 65-year-old man who had been diagnosed with transient global amnesia (TGA) 15 years previously was admitted to hospital with complaints of amnesia and headache. His symptoms improved on day-2. The initial brain MRI and electroencephalography findings were normal. He was diagnosed with a recurrence of TGA and discharged. However, he returned with right leg weakness and complained of a thunderclap headache. MRI demonstrated subarachnoid hemorrhage and multifocal segmental narrowing of the left posterior cerebral artery (PCA) and large intracranial arteries, and he was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). He was discharged on day-30 without any neurological deficits. This case suggested that TGA should be interpreted as one of the symptoms of RCVS or a prodromal symptom of RCVS.
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http://dx.doi.org/10.2169/internalmedicine.56.7460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505916PMC
December 2017

Mononeuritis multiplex in a patient with cutaneous arteritis diagnosed by skin biopsy.

Rinsho Shinkeigaku 2017 06 26;57(6):307-310. Epub 2017 May 26.

Department of Neurology, St. Marianna University School of Medicine.

A 55-year-old man was admitted with paralysis of the left lower leg. He had purpura in the left lower extremity for three years, left calf pain for two years, and dysesthesia in the left plantar region and first toe for one year. A physical examination revealed livedo reticularis on the left leg and mononeuritis multiplex was diagnosed in the bilateral tibial and left peroneal nerve area. Anti-neutrophil cytoplasmic antibody was negative. A nerve conduction study showed decreased amplitude of compound muscle-action potential in the bilateral tibial and the left peroneal nerve, sensory nerve action potential in the bilateral sural nerve. A skin biopsy revealed inflammatory cells on blood vessel walls and cutaneous arteritis was diagnosed. Cyclophosphamide pulse therapy with steroid and anti-coagulation improved the neurological symptoms. A skin biopsy should be considered when patients present with mononeuritis multiplex in the lower extremities and cutaneous findings such as livedo reticularis in the symptomatic area.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001013DOI Listing
June 2017

Steroid-resistant Tolosa-Hunt syndrome with a de novo intracavernous aneurysm: A case report.

Surg Neurol Int 2016 11;7(Suppl 30):S779-S784. Epub 2016 Nov 11.

Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan.

Background: We report a case of steroid-resistant Tolosa-Hunt syndrome (THS) with recurrent bilateral painful ophthalmoplegia, accompanied with sphenoid sinusitis, pituitary abscess, and an aneurysm arising from the cavernous portion of the internal carotid artery.

Case Description: A 53-year-old woman suffered severe left painful ophthalmoplegia. A magnetic resonance image (MRI) revealed thickness of the left cavernous sinus (CS). Steroid was administrated under the diagnosis of THS, and the symptom transiently diminished. However, painful ophthalmoplegia fluctuated bilaterally after tapering the steroid. An MRI showed development of bilateral cavernous lesions associated with sphenoid sinusitis, pituitary abscess, and an aneurysm in the left C4 segment. Biopsy and drainage of the lesions were performed with an endoscopic transsphenoidal procedure. The histological examination showed nonspecific granulomatous inflammation. The methotrexate (MTX) was effective to reduce the CS and pituitary lesions; however, the aneurysm slightly increased and remained unchanged in size thereafter.

Conclusions: To our knowledge, this is the first report of a growing de novo C4 aneurysm in THS. Surgical intervention and administration of MTX should be attempted in steroid-resistant THS. Careful observation with serial MRI and MR angiography is important to manage the complicated THS.
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http://dx.doi.org/10.4103/2152-7806.193925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122815PMC
November 2016

A case of refractory IgG4-related peripheral neuropathy with severe axonal damage.

Rinsho Shinkeigaku 2016 05 19;56(5):323-7. Epub 2016 Apr 19.

Department of Internal Medicine, Division of Neurology, St Marianna University School of Medicine.

A 78-year-old man presented complaining of tingling and pain. Neurological examination revealed dysesthesia and hypothermesthesia below both knees and areflexia in the lower extremities. Laboratory data revealed elevated serum levels of immunoglobulin IgG4 and para-aortic, and mesenteric lymphadenopathy was evident on plain computed tomography of the abdomen. Microscopic findings of a bone marrow biopsy specimen showed occlusion of blood vessels with IgG4-positive plasma cells. IgG4-related disease was diagnosed because the bone marrow biopsy exhibited > 10 IgG4-positive plasma cells per high-power field. Treatment was initiated with prednisolone starting at 30 mg/day, but no improvement in neurological symptoms was achieved. Sural nerve biopsy demonstrated obstructive thromboangiitis with severe loss of myelin and axons. Further investigations are needed to elucidate the relationship between obstructive thromboangiitis and steroid-resistant IgG4-related peripheral neuropathy.
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http://dx.doi.org/10.5692/clinicalneurol.cn-000835DOI Listing
May 2016

Progression of intracranial major artery stenosis is associated with baseline carotid and intracranial atherosclerosis.

J Atheroscler Thromb 2015 8;22(2):183-90. Epub 2014 Sep 8.

Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine.

Aim: Intracranial atherosclerotic major artery stenosis (IMAS) is associated with a high risk of ischemic stroke. Carotid ultrasound (US) has been widely used to evaluate an individual's atherosclerotic burden, but no information is available on whether the carotid US findings are associated with IMAS progression. The aim of the present study was to identify the associations among traditional risk factors, the duplex carotid US findings and IMAS progression in patients with varying degrees of carotid atherosclerosis.

Methods: All patients who underwent a set of imaging studies (MRI, MRA and carotid US) in our outpatient clinic were screened. A total of 101 patients with a mean age of 75.0±10.6 years, who received the same imaging studies with a mean interval of two years, were studied. In each patient, the extent of stenosis of three arteries (both middle cerebral arteries [MCAs] and the basilar artery [BA]) was classified into five grades. The total score of the three arteries was calculated as the global stenosis score (GSS). The progression of IMAS was defined as worsening of stenosis by ≥1 grade on final MRA. The maximum IMT (maxIMT), plaque findings and carotid stenosis were measured by carotid US. A multivariate stepwise logistic regression analysis was used to identify independent predictors of IMAS progression.

Results: Follow-up MRA revealed IMAS progression in 12 patients (11.9%). The logistic regression analysis demonstrated that the baseline GSS (p=0.008) and carotid stenosis ≥70% on the baseline carotid US (p=0.023) were significantly associated with IMAS progression.

Conclusions: The baseline severity of intracranial and extracranial atherosclerosis was significantly associated with the progression of IMAS.
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http://dx.doi.org/10.5551/jat.26054DOI Listing
December 2015

[A case of ventriculitis with bacterial meningitis occurred during the treatment of liver abscess].

Kansenshogaku Zasshi 2003 Nov;77(11):977-81

Division of Neurology, St. Marianna University School of Medicine.

A 47-case-year old male was admitted to our hospital because of high fever and general fatigue. He had no immune deficiency, and had no other disease in his past history. On admission, the white blood cell count and C-reacted protein were severely elevated (18,700/microliter, 27.7 mg/dl, respectively) and abdominal CT revealed multiple low density, From these results, he was diagnosed as liver abscess. Intravenous MINO and SBT/CPZ injection were started. On the fifth hospital day, he suffered from headache and nuchal rigidity. The clinical data revealed the cerebro-spinal fluid (CSF) counting 8,336 cells/mm3 (mononuclear 8,000,) protein at 119 mg/dl, and sugar 42 mg/dl. CSF cultures were negative, but Klebsiella was recognized in the blood culture and drainage fluid in liver abscess. This condition was diagnosed as bacterial meningitis and antibiotics were changed to intravenous CTRX and MEPM. Furthermore we administered oral PSL and intravenous steroid-pulse therapy. After these combination therapies his condition improved gradually. After 40 hospital day, however, he suddenly had double vision, Axial FLAIR (SE6,000/120) image revealed with high signal intensity at 4th ventricle. Intravenous MEPM was administered again. On the 60th hospital day, double vision was gradually improved and abnormal intensity at 4th ventricle was almost disappeared. This case may provide us a considerable suggestion on the treatment of bacterial meningitis.
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http://dx.doi.org/10.11150/kansenshogakuzasshi1970.77.977DOI Listing
November 2003
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