Publications by authors named "Ryota Sato"

117 Publications

β1-blocker in sepsis.

J Intensive Care 2021 May 8;9(1):39. Epub 2021 May 8.

Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.

Background: The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers.

Main Body: A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation.

Conclusion: Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.
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http://dx.doi.org/10.1186/s40560-021-00552-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105957PMC
May 2021

Morphology-Dependent Coherent Acoustic Phonon Vibrations and Phonon Beat of Au Nanopolyhedrons.

ACS Omega 2021 Mar 16;6(8):5485-5489. Epub 2021 Feb 16.

Department of Chemistry, School of Science and Technology, Kwansei Gakuin University, 2-1 Gakuen, Sanda 669-1337, Japan.

Coherent acoustic phonon vibrations of Au nanopolyhedrons, including nanocubes, nano-octahedrons, and nanocuboctahedrons, in aqueous solutions and poly(vinyl alcohol) (PVA) films, were investigated using transient absorption (TA) spectroscopy combined with finite element analysis based on continuum elastic theory. In each type of nanopolyhedron, two vibrational modes with similar quality factors (Qs) and phases were observed, suggesting that both were induced by thermal expansion. The low-frequency vibrational mode represents a tip-to-tip displacement in each nanopolyhedron, whereas the high-frequency mode is the breathing vibration of the whole particle and reveals morphology dependence, displaying a face-to-face displacement in nanocuboctahedrons, an edge-to-edge displacement in nano-octahedrons, and a combination of face-to-face and edge-to-edge displacements in nanocubes. Moreover, a clear phonon beat was identified in the two vibrational modes of the nanocuboctahedrons. Our experimental results provide a possible application of morphology-controllable metal nanoresonators.
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http://dx.doi.org/10.1021/acsomega.0c05806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931377PMC
March 2021

Delayed retropharyngeal hematoma following a minor facial blunt trauma.

Trauma Case Rep 2021 Apr 20;32:100442. Epub 2021 Feb 20.

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States of America.

We described the case of 75 years old male patient with an airway obstruction due to retropharyngeal hematoma that developed after a minor blunt trauma to the face. The patient was not taking any anticoagulants or antiplatelet agents and did not have any coagulopathy. This case report indicates that emergency physicians must be aware of the risk of delayed airway obstruction in elderly patients regardless of whether the patient is using anticoagulants or antiplatelet agents.
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http://dx.doi.org/10.1016/j.tcr.2021.100442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907531PMC
April 2021

Comparison of coronary artery bypass graft versus drug-eluting stents in dialysis patients: an updated systemic review and meta-analysis.

J Cardiovasc Med (Hagerstown) 2021 Apr;22(4):285-296

Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.

Introduction: As percutaneous coronary intervention (PCI) technologies have been far improved, we hence conducted an updated systemic review and meta-analysis to determine the comparability between coronary artery bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD patients.

Methods: We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of cardiovascular outcomes among dialysis patients with CABG and DES. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Subgroup analyses and meta-regression were performed to explore heterogeneity.

Results: Thirteen studies were included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34 682). Compared with DES, our study demonstrated CABG had higher 30-day mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality (OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat revascularization (OR 0.35, P < 0.001). No statistical differences were found between CABG and DES for long-term mortality (OR 0.92, P = 0.055), composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457). Meta-regression suggested diabetes and the presence of left main coronary artery disease as an effect modifier of long-term mortality.

Conclusion: PCI with DES shared similar long-term mortality, composite outcomes and stroke outcomes to CABG among dialysis patients but still was associated with an improved 30-day survival. However, CABG had better rates of myocardial infarction, repeat revascularization and cardiac mortality.
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http://dx.doi.org/10.2459/JCM.0000000000001167DOI Listing
April 2021

Synthesis of mesoscopic particles of multi-component rare earth permanent magnet compounds.

Sci Technol Adv Mater 2021 Jan 22;22(1):37-54. Epub 2021 Jan 22.

Institute for Chemical Research, Kyoto University, Uji, Kyoto, Japan.

Multielement rare earth (R)-transition metal (T) intermetallics are arguably the next generation of high-performance permanent magnetic materials for future applications in energy-saving and renewable energy technologies. Pseudobinary SmFeN and (R,Zr)(Fe,Co,Ti) (R = Nd, Sm) compounds have the highest potential to meet current demands for rare-earth-element-lean permanent magnets (PMs) with ultra-large energy product and operating temperatures up to 200°C. However, the synthesis of these materials, especially in the mesoscopic scale for maximizing the maximum energy product ( ), remains a great challenge. Nonequilibrium processes are apparently used to overcome the phase-stabilization challenge in preparing the R-T intermetallics but have limited control of the material's microstructure. More radical bottom-up nanoparticle approaches based on chemical synthesis have also been explored, owing to their potential to achieve the desired composition, structure, size, and shape. While a great achievement has been made for the SmFeN, progress in the synthesis of (R,Zr)(Fe,Co,Ti) magnetic mesoscopic particles (MMPs) and R-T/T exchange-coupled nanocomposites (NCMs) with substantial coercivity ( ) and remanence ( , respectively, remains marginal.
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http://dx.doi.org/10.1080/14686996.2020.1862630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833049PMC
January 2021

Transformations of Ionic Nanocrystals via Full and Partial Ion Exchange Reactions.

Acc Chem Res 2021 Feb 3;54(4):765-775. Epub 2021 Feb 3.

Institute for Chemical Research, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan.

ConspectusElaborate chemical synthesis methods allow the production of various types of inorganic nanocrystals (NCs) with uniform shape and size distributions. Many single-step synthesis approaches, such as the reduction of metal ions, the decomposition of metal complexes, double replacement reactions, and hydrolysis, have been adapted to promote the generation of monodisperse metal and ionic NCs. However, the question has become, how can we synthesize NCs with thermodynamically metastable phases or very complex structures? The transformation of already-synthesized NCs via elemental substitutions, such as ion exchange reactions for ionic NCs and galvanic replacement reactions for metal NCs, can overcome the difficulties facing conventional one-step syntheses. In particular, NC ion exchange reactions have been studied with numerous combinations of foreign ions and ionic NCs with various shapes. They have been investigated extensively because the reactions proceed under relatively mild conditions thanks to the large surface-to-volume ratio of the NCs relative to their bulk form. The functionality of the resulting ionic NCs, including semiconducting and plasmonic properties, can be easily tuned in a wide range, from the visible to near-infrared. Because anions generally have much larger ionic radii than cations within the frameworks of NCs, the cation exchange reactions proceed much faster than the anion exchange reactions. For ionic NCs above a critical size, the anion framework remains intact, and the original shape of the parent NCs is retained throughout the cation exchange reaction. In contrast, the anion exchange reaction often provides the new NCs with unique structures, such as hollow or anisotropically phase-segregated assemblies.This Account focuses on the full and partial ion exchange reactions involving ionic NCs, which have been thoroughly investigated by our group and others while highlighting important aspects such as the preservation of appearance and dimensions. First, we discuss how each type of ion exchange reaction progresses to understand the morphologies and crystal structures of their final products. This discussion is supported by emphasizing important examples, which help to explore the formation of NCs with thermodynamically metastable phases and complex structures, and other significant features of the ion exchange reactions leading to structure-specific functions. As a special case, we examine how the shape-dependent anionic framework (surface anion sublattice and stacking pattern) of polyhedral CuO NCs determines the crystalline structure of the anion-exchanged products of hollow CuS NCs. In addition, we review the characteristic anion exchange behavior of metal halide perovskite NCs observed in our laboratory and other laboratories. Finally, a general outline of the transformation of NCs via ion exchange reactions and future prospects in this field are provided.
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http://dx.doi.org/10.1021/acs.accounts.0c00701DOI Listing
February 2021

Clinical features of large vessel vasculitis (LVV): Elderly-onset versus young-onset.

Mod Rheumatol 2021 Feb 22:1-6. Epub 2021 Feb 22.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.

Objectives: We compared large vessel vasculitis (LVV) clinical features between age groups.

Methods: We retrospectively examined clinical features and therapies in 41 LVV patients at our hospital from January 2010 to March 2020. We compared two patient groups, elderly (≥50 years) and young (<50 years).

Results: Of all patients, 29 were elderly and 12 were young. In the younger group, upper extremity symptoms ( <.05), bruits ( <.01), and cardiovascular complications ( <.01) were more common. Of the elderly group, 7 (24%) met classification criteria for giant cell arteritis while none of the younger group met these criteria; however, 10 (83%) of the younger group and 3 (10%) of the elderly group met the ACR classification criteria for Takayasu arteritis ( <.01). In the elderly group, 16 patients (66%) met no criteria ( <.01). There were no significant differences in laboratory findings but imaging showed a significantly higher incidence of head and neck artery lesions in the younger group ( <.05). The younger group was more likely to receive additional tocilizumab ( <.01) and cardiovascular complications were more likely to occur in younger patients ( < .01).

Conclusion: LVV clinical features differed between elderly- and young-age-onset groups.
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http://dx.doi.org/10.1080/14397595.2021.1878622DOI Listing
February 2021

Impact of Sarcopenia on Erectile Function after Nerve-Sparing Robot-Assisted Radical Prostatectomy.

World J Mens Health 2020 Nov 16. Epub 2020 Nov 16.

Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

Purpose: To determine the impact of sarcopenia on erectile functional outcomes after a nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) using patient-reported validated questionnaires.

Materials And Methods: In this retrospective study, RARP was performed on 841 patients at Okayama University Hospital, of which 132 underwent NS RARP. Erectile functional outcomes were assessed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the Expanded Prostate Cancer Index Composite before and 1, 3, 6, and 12 months after surgery. Automated measurement of skeletal muscle at L3 was achieved using volume analyzer software and normalizing for height (cm²/m²) to calculate skeletal muscle index (SMI). Patients who had an IIEF-5≤4 comprised the group with erectile dysfunction (ED), and those with an IIEF-5≤5 made up the non-ED group.

Results: This study enrolled 95 patients of median age 65 years with a preoperative IIEF-5 of 16. There were no significant differences between patients with and without sarcopenia among those with preoperative IIEF-5. Postoperatively, in the ED group, SMI and preoperative IIEF-5 were significantly lower than in the non-ED group. Multiple linear regression analysis revealed that (1) both SMI and preoperative IIEF-5 were independent predictors of ED, and (2) sarcopenia and preoperative IIEF-5 were predictors of ED at 12 months after NS RARP.

Conclusions: Patients with sarcopenia can have worse erectile functional outcomes after NS RARP. Sarcopenia and a lower preoperative IIEF-5 score may be predictive of postoperative ED.
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http://dx.doi.org/10.5534/wjmh.200036DOI Listing
November 2020

Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Chest 2021 Jan 9. Epub 2021 Jan 9.

Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan. Electronic address:

Background: Historically, β-blockers have been considered to be relatively contraindicated for septic shock because they may cause cardiac suppression. On the other hand, there is an increasing interest in the use of β-blockers for treating patients with sepsis with persistent tachycardia despite initial resuscitation.

Research Question: Do ultrashort-acting β-blockers such as esmolol and landiolol improve mortality in patients with sepsis with persistent tachycardia despite initial resuscitation?

Study Design And Methods: This was a systematic review and meta-analysis. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with esmolol or landiolol. We updated our search on April 20, 2020. Two independent reviewers assessed whether titles and abstracts met the following eligibility criteria: (1) RCT, (2) patients with sepsis and septic shock ≥ 18 years of age, and (3) treatment with either esmolol/landiolol or placebo/no interventions. Two authors independently extracted selected patient and study characteristics and outcomes. The results of all analyses are presented using random effect models.

Results: Seven RCTs with a pooled sample size of 613 patients were included. Of these, six RCTs with 572 patients reported 28-day mortality. Esmolol or landiolol use in patients with sepsis and septic shock was significantly associated with lower 28-day mortality (risk ratio, 0.68; 95% CI, 0.54-0.85; P < .001). Unimportant heterogeneity was observed (I = 31%). The absolute risk reduction and number of patients to be treated to prevent one death were 18.2% and 5.5, respectively.

Interpretation: The use of ultrashort-acting β-blockers such as esmolol and landiolol in patients with sepsis with persistent tachycardia despite initial resuscitation was associated with significantly lower 28-day mortality.

Trial Registry: UMIN Clinical Trials Registry; No.: UMIN000040174; URL: https://www.umin.ac.jp/ctr/index.htm.
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http://dx.doi.org/10.1016/j.chest.2021.01.009DOI Listing
January 2021

Temporal trends in coronary intervention strategies and the impact on one-year clinical events: data from a Japanese multi-center real-world cohort study.

Cardiovasc Interv Ther 2021 Jan 9. Epub 2021 Jan 9.

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.

Percutaneous coronary intervention (PCI) has significantly advanced over the last 40 years, but it is not clear whether there have been any changes in prognosis in recent years. The Kumamoto Intervention Conference Study Real-World Registry is a multi-center registry that enrolls consecutive patients undergoing PCI in 17 centers in Kyushu, Japan. To elucidate the clinical impact of recent changes in treatment strategies, 8841 consecutive participants (historical PCI: n = 4038, enrolled between January 2013 and December 2014, and current PCI: n = 4803, between January 2015 and March 2017) with 1-year follow-up data were analyzed. The incidences of major adverse cardiovascular and other clinical events were comparable between historical PCI and current PCI, even though complex lesions were more frequent during the more recent period. During this period, the use of radial approaches, drug eluting stents, and coronary imaging was greater. The use of prasugrel was more frequent (P < 0.001) during the time periods. Comparable event rates were associated with the use of clopidogrel (52.7%) and prasugrel (47.3%). In the sub-analysis for acute coronary syndrome (n = 5047), similar clinical event rates were recorded for historical and current PCI. Although the lesions to be treated are becoming more severe and complex, equivalent clinical outcomes have been maintained in recent years, possibly due to advances in the devices and medication used.
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http://dx.doi.org/10.1007/s12928-020-00752-5DOI Listing
January 2021

Blood-Nerve Barrier (BNB) Pathology in Diabetic Peripheral Neuropathy and In Vitro Human BNB Model.

Int J Mol Sci 2020 Dec 23;22(1). Epub 2020 Dec 23.

Department of Neurology and Clinical Neuroscience, Graduate School of Medicine, Yamaguchi University, Yamaguchi 753-8511, Japan.

In diabetic peripheral neuropathy (DPN), metabolic disorder by hyperglycemia progresses in peripheral nerves. In addition to the direct damage to peripheral neural axons, the homeostatic mechanism of peripheral nerves is disrupted by dysfunction of the blood-nerve barrier (BNB) and Schwann cells. The disruption of the BNB, which is a crucial factor in DPN development and exacerbation, causes axonal degeneration via various pathways. Although many reports revealed that hyperglycemia and other important factors, such as dyslipidemia-induced dysfunction of Schwann cells, contributed to DPN, the molecular mechanisms underlying BNB disruption have not been sufficiently elucidated, mainly because of the lack of in vitro studies owing to difficulties in establishing human cell lines from vascular endothelial cells and pericytes that form the BNB. We have developed, for the first time, temperature-sensitive immortalized cell lines of vascular endothelial cells and pericytes originating from the BNB of human sciatic nerves, and we have elucidated the disruption to the BNB mainly in response to advanced glycation end products in DPN. Recently, we succeeded in developing an in vitro BNB model to reflect the anatomical characteristics of the BNB using cell sheet engineering, and we established immortalized cell lines originating from the human BNB. In this article, we review the pathologic evidence of the pathology of DPN in terms of BNB disruption, and we introduce the current in vitro BNB models.
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http://dx.doi.org/10.3390/ijms22010062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793499PMC
December 2020

IL-1RA in the supernatant of QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold Plus is useful for discriminating active tuberculosis from latent infection.

J Infect Chemother 2021 Apr 11;27(4):617-624. Epub 2020 Dec 11.

Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.

Introduction: The new-generation QuantiFERON (QFT)-TB Gold Plus (QFT-Plus) is expected to be useful because it includes a new peptide that is supposed to induce a CD8 T cell response. There is a need for a new marker with sensitivity higher than that of the conventional IFN-γ release assays owing to false-negative results in the latter. This study aimed to compare cytokines in QFT-plus and QuantiFERON-Gold In-Tube (QFT-GIT) supernatants to discriminate between active tuberculosis and latent tuberculosis infection (LTBI).

Methods: A cross-sectional study was conducted at Tokyo National Hospital, wherein 21 LTBI patients and age and sex-matched active TB patients were randomly selected. The levels of various cytokines were measured and compared using the MAGPIX System, and receiver operating characteristic (ROC) curves were generated.

Results: IL-1RA, IFN-γ, CXCL10/IP-10, and CCL4/MIP-1β levels were higher in the active TB group than in the LTBI group in QFT-GIT antigen (GIT Ag) tubes. In QFT-plus tubes, IL-1RA was higher in TB1 and TB2 tubes, while CCL2/MCP-1 was higher only in TB2 tubes. In Nil tubes, CCL5/RANTES, TNF-α, PDGF-BB, and IL-2 levels were significantly higher in the active TB group. IL-1RA in GIT Ag tubes showed the highest area under the curve of 0.8367. The sensitivity and specificity of IL-1RA were 66.7% (95% confidence interval [CI]: 43.0-85.4) and 90.5% (95% CI: 69.6-98.8), respectively, which were the highest among the cytokines.

Conclusions: IL-1RA level in the QFT-GIT supernatant can be a good marker for discriminating active TB from LTBI.
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http://dx.doi.org/10.1016/j.jiac.2020.11.023DOI Listing
April 2021

[Neuromuscular Disorders in the Oldest-Old].

Authors:
Ryota Sato

Brain Nerve 2020 Dec;72(12):1319-1330

Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.

Age-related changes in physical function are attracting attention in Japan. Sarcopenia is known as the loss of skeletal muscle mass and strength in the elderly. Secondary sarcopenia due to neuromuscular disorders should be considered in patients with sarcopenia. Providing appropriate medical care for patients with neuromuscular disorders will extend healthy life expectancy. In this review, previous studies on age-related changes in the neuromuscular system were summarized and the common neuromuscular disorders in the oldest-old were reviewed.
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http://dx.doi.org/10.11477/mf.1416201689DOI Listing
December 2020

Sight-Threatening Graves' Ophthalmopathy during the Third Trimester of Pregnancy: A Case Report.

Tohoku J Exp Med 2020 12;252(4):321-327

Department of Endocrinology and Metabolism, National Hospital Organization Sendai Medical Center.

Dysthyroid optic neuropathy is a severe manifestation of Graves' ophthalmopathy that can result in permanent vision loss. We report a 37-year-old pregnant woman with Graves' ophthalmopathy which was deteriorated to dysthyroid optic neuropathy in the third trimester of pregnancy. Diplopia, bilateral eye lid retraction, lid edema and proptosis were observed in the 29th week of gestation. Thyroid-stimulating hormone (TSH) level was decreased with a normal level of free triiodothyronine (FT3) and an upper normal level of free thyroxine (FT4). Anti-TSH receptor antibodies (16.2 IU/L, reference range < 2.0 IU/L) and thyroid stimulating antibody (4,443%, reference range < 120%) were positive. Magnetic resonance imaging (MRI) demonstrated a significant enlargement of the extraocular muscles with a high signal intensity on T2-weighted image. She was diagnosed as Graves' ophthalmopathy and subclinical hyperthyroidism, and followed without treatment. In the 34th week of gestation, the symptom of color vision abnormality appeared, suggesting dysthyroid optic neuropathy. She delivered a female infant during the 36th week of gestation. Four days after delivery, she had a spontaneous orbital pain. MRI showed that the extraocular muscles were more enlarged than the findings in the 29th week of gestation. FT3 and FT4 levels were mildly elevated. Dysthyroid optic neuropathy was diagnosed. She was treated with methylprednisolone pulse therapy and retrobulbar injections of betamethasone valerate, and the ocular symptoms improved. The present case shows that the glucocorticoid therapy performed one week after delivery is effective against Graves' ophthalmopathy which was deteriorated to dysthyroid optic neuropathy during the third trimester of pregnancy.
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http://dx.doi.org/10.1620/tjem.252.321DOI Listing
December 2020

The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation: A systematic review and meta-analysis.

J Crit Care 2021 Jun 30;63:124-132. Epub 2020 Sep 30.

Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Department of Critical Care Medicine, Kuakini Medical Center, Honolulu, HI, USA.

Purpose: The predictive value of airway occlusion pressure at 100 milliseconds (P0.1) on weaning outcome has been controversial. We performed a meta-analysis to investigate the predictive value of P0.1 on successful weaning from mechanical ventilation.

Materials And Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, and two authors independently screened articles. The pooled sensitivity, specificity and the summary receiver operating characteristic (sROC) curve were estimated. Diagnostic odds ratio (DOR) was calculated using meta-regression analysis.

Results: We included 12 prospective observational studies (n = 1089 patients). Analyses of sROC curves showed the area under the curve of 0.81 (95% confidence interval (CI): 0.77 to 0.84) for P0.1. The pooled sensitivity and specificity were 86% (95% CI, 72 to 94%) and 58% (95% CI, 37% to 76%) with substantial heterogeneity respectively. DOR was 20.09 (p = 0.019, 95%CI: 1.63-247.15). After filling the missing data using the trim-and-fill method to adjust publication bias, DOR was 36.23 (p = 0.002, 95%CI: 3.56-372.41).

Conclusion: This meta-analysis suggests that P0.1 is a useful tool to predict successful weaning. To determine clinical utility, a large prospective study investigating the sensitivity and specificity of P0.1 on weaning outcomes from mechanical ventilation is warranted.
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http://dx.doi.org/10.1016/j.jcrc.2020.09.030DOI Listing
June 2021

Identification of a herpes simplex virus 1 gene encoding neurovirulence factor by chemical proteomics.

Nat Commun 2020 09 29;11(1):4894. Epub 2020 Sep 29.

Division of Molecular Virology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, 108-8639, Japan.

Identification of the complete set of translated genes of viruses is important to understand viral replication and pathogenesis as well as for therapeutic approaches to control viral infection. Here, we use chemical proteomics, integrating bio-orthogonal non-canonical amino acid tagging and high-resolution mass spectrometry, to characterize the newly synthesized herpes simplex virus 1 (HSV-1) proteome in infected cells. In these infected cells, host cellular protein synthesis is shut-off, increasing the chance to preferentially detect viral proteomes. We identify nine previously cryptic orphan protein coding sequences whose translated products are expressed in HSV-1-infected cells. Functional characterization of one identified protein, designated piUL49, shows that it is critical for HSV-1 neurovirulence in vivo by regulating the activity of virally encoded dUTPase, a key enzyme that maintains accurate DNA replication. Our results demonstrate that cryptic orphan protein coding genes of HSV-1, and probably other large DNA viruses, remain to be identified.
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http://dx.doi.org/10.1038/s41467-020-18718-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524712PMC
September 2020

Air-stable Pd(0) catalyst bearing dual phosphine ligands: a detailed evaluation of air stability and catalytic property in cross-coupling reactions.

Dalton Trans 2020 Sep;49(36):12814-12819

Tsukuba Research Center for Energy Materials Science (TREMS), Graduate School of Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Ibaraki 305-8573, Japan.

We have synthesised an air-stable Pd(0) catalyst bearing donor and acceptor phosphine ligands (Complex 1). This study revealed the long-term air stability and catalytic property of Complex 1 as a catalyst for cross-coupling reactions, where it was stable in air for eight months. DFT calculations revealed that the acceptor ligands in Complex 1 decreased the HOMO energy level, which provided the observed air stability. Complex 1 successfully served as a catalyst for direct C-H arylation reactions and Suzuki-Miyaura cross-coupling reactions, and catalysed the reaction of a relatively inactive substrate, 2-chrolopyridine, which could not be achieved by conventional, air-stable Pd(0) catalysts. Isolating the intermediates of the coupling reactions revealed that each intermediate possessed the donor ligand (PCy3), which was determined to be responsible for imparting the high catalytic activity exhibited by Complex 1.
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http://dx.doi.org/10.1039/d0dt02744hDOI Listing
September 2020

Go with the flow-clinical importance of flow curves during mechanical ventilation: A narrative review.

Can J Respir Ther 2020 22;56:11-20. Epub 2020 Jul 22.

Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.

Most clinicians pay attention to tidal volume and airway pressures and their curves during mechanical ventilation. On the other hand, inspiratory-expiratory flow curves also provide a plethora of information, but much less attention is paid to them. Flow curves chronologically show the velocity and direction of inspiration and expiration and are influenced by the respiratory mechanics, the patient's effort, and the mode of ventilation and its settings. When the ventilator setting does not synchronize with the patient's respiratory pattern, the patient can easily have worsening breathing effort, patient-ventilator asynchrony, which can lead to prolonged ventilator support or lung injury. The information provided by the flow curves during mechanical ventilation, such as respiratory mechanics, the patient's effort, and patient-ventilator interactions, are very helpful when adjusting the ventilator setting. If clinicians can monitor and assess the flow curves information appropriately, it can be a useful diagnostic and therapeutic tool at the bedside. There may be association between inspiratory effort and flow, and this may further guide us, especially in the weaning process and when patients are not synchronizing with the ventilator. In this review, we try to gather information about "flow" that is scattered around in the literature and textbooks in one place. We will summarize the different flow waveforms utilized in commonly used ventilator modes with their advantages and disadvantages, information gained by the flow curves (i.e., flow-time, flow-volume, and flow-pressure), how to detect and manage asynchronies, and some ideas for future uses. Flow waveforms shapes and patterns are very beneficial for the management of patients undergoing mechanical ventilatory support. Attention to those waveforms can potentially improve patient outcomes. Clinicians should be familiar with this information and how to act upon them.
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http://dx.doi.org/10.29390/cjrt-2020-002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427988PMC
July 2020

The impact of cell maturation and tissue microenvironments on the expression of endosomal Toll-like receptors in monocytes and macrophages.

Int Immunol 2020 11;32(12):785-798

Division of Innate Immunity, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Shirokanedai, Minato-ku, Tokyo, Japan.

Toll-like receptors (TLRs) impact myeloid cell responsiveness to environmental cues such as pathogen components and metabolites. Although TLR protein expression in monocytes and tissue macrophages is thought to be optimized for microenvironments in each tissue, a comprehensive study has not been reported. We here examined protein expression of endogenous TLRs in tissue-resident myeloid cells. Neutrophils in peripheral blood, spleen, liver and lung expressed TLR2, TLR4 and TLR5 in all tissues. Ly6C+ MHC II‒ classical monocytes mature into Ly6C‒ MHC II+ monocyte-derived dendritic cells (moDCs) or Ly6C‒ MHC II‒ patrolling monocytes. These subsets were found in all the tissues studied. TLR2 and TLR4 were displayed on all of these subsets, regardless of location. In contrast, expression of endosomal TLRs did vary with tissues and subsets. moDCs expressed TLR9, but much less TLR7. In contrast, TLR7, not TLR3 or TLR9, was highly expressed in classical and patrolling monocytes. Tissue macrophages such as red pulp macrophages in the spleen, Kupffer cells in the liver, microglia in the brain, alveolar macrophages in the lung and adipose tissue macrophages all expressed TLR2, TLR4 and TLR3. TLR7 was also expressed in these tissue macrophages except Kupffer cells in the liver. TLR9 expression in tissue macrophages was much lower or hard to detect. These results suggest that expression of endosomal TLRs in myeloid cells is influenced by their differentiation status and tissue-specific microenvironments.
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http://dx.doi.org/10.1093/intimm/dxaa055DOI Listing
November 2020

Extensive Loss of Myocardium due to Lymphocytic Fulminant Myocarditis: An Autopsy Case Report of a Patient with Persistent Cardiac Arrest for 25 Days.

Intern Med 2020 Dec 12;59(24):3171-3175. Epub 2020 Aug 12.

Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Japan.

We herein report the histological findings of a patient who had progressed to persistent cardiac arrest for 25 days due to lymphocytic fulminant myocarditis despite mechanical circulatory support (MCS). There were few residual cardiomyocytes, and extensive replacement fibrosis was present. Therefore, improvement of the cardiac function for this patient was considered improbable. Further research is warranted to improve predictions for the recovery of the cardiac function and optimize MCS strategies for patients with fulminant myocarditis.
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http://dx.doi.org/10.2169/internalmedicine.5137-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807115PMC
December 2020

Therapeutic Plasma Exchange Improved Pregnancy-associated Thrombotic Microangiopathy but not the Pregnancy Outcome in Patient with Systemic Lupus Erythematosus.

Intern Med 2020 Dec 12;59(24):3235-3238. Epub 2020 Aug 12.

Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan.

Thrombotic microangiopathy (TMA) is a rare but life-threatening complication of systemic lupus erythematosus (SLE) and is associated with adverse pregnancy outcomes. We herein report a 30-year-old pregnant woman with SLE complicated by TMA. Because her condition was unresponsive to initial corticosteroid and fresh-frozen plasma infusion treatment, we attempted plasma exchange (PE). Although thrombocytopenia and microangiopathic hemolytic anemia gradually improved, fetal death was confirmed at 23 weeks of gestation. This case suggests that PE is an effective therapeutic option but might be insufficient to maintain pregnancy in patients with SLE complicated by TMA.
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http://dx.doi.org/10.2169/internalmedicine.4655-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807106PMC
December 2020

Comparison of QuantiFERON-TB Gold Plus, QuantiFERON-TB Gold In-Tube, and T-SPOT.TB among patients with tuberculosis.

J Infect Chemother 2020 Nov 19;26(11):1205-1212. Epub 2020 Jul 19.

Asthma Allergy and Rheumatology Center, National Hospital Organization Tokyo National Hospital. Electronic address:

Objectives: This study evaluated the efficacy of the following interferon (IFN)-γ release assays (IGRAs): QuantiFERON-TB Gold Plus (QFT-Plus), QFT-Gold In-Tube (QFT-GIT), and T-SPOT. TB (T-SPOT) with the quantitative values of IFN-γ response.

Methods: Blood samples were collected from patients with active tuberculosis (TB), latent TB infection (LTBI), individuals with previous TB infection, and healthy volunteers enrolled between May 2017 and June 2018.

Results: IGRAs results were analyzed in 175 subjects (76 had active TB, 14 had LTBI, 35 had prior TB infection, and 50 were healthy). QFT-Plus and QFT-GIT revealed equal efficacy for IFN-γ values, and the IFN-γ response in QFTs tended to increase with the spot counts in T-SPOT, with similar high sensitivities (approximately 90%) in the active TB group. The test concordance of two of three IGRAs was optimal among all subjects (κ coefficients: 0.82-0.96). Additionally, the median quantitative values of IFN-γ with QFT-Plus and QFT-GIT were higher in the active TB group than in the LTBI and previous TB groups.

Conclusion: Three IGRAs showed equivalent efficacy with high sensitivities and higher IFN-γ response in active TB group than that in non-active TB group.
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http://dx.doi.org/10.1016/j.jiac.2020.06.019DOI Listing
November 2020

Venoarterial Extracorporeal Membranous Oxygenation: Treatment Option for Sepsis-Induced Cardiogenic Shock? A Systematic Review.

Crit Care Med 2020 08;48(8):e722-e729

Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.

Objectives: Clinicians often encounter adult patients with septic shock who fail to respond to fluid therapy and vasopressors. There is an increasing interest in venoarterial extracorporeal membranous oxygenation in the treatment of patients with septic shock, but its outcomes and safety remain unclear. The aim of this study is to describe in-hospital mortality and complication rate in adult patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation, and to identify patients who may potentially benefit from venoarterial extracorporeal membranous oxygenation.

Data Sources: The protocol for this systematic review was registered at International Prospective Register of Systematic Reviews (CRD42018098848). We searched MEDLINE, Embase, and Igaku Chuo Zasshi for studies of any design in which patients with septic shock were treated with venoarterial extracorporeal membranous oxygenation. Our search was updated on October 6, 2019.

Study Selection: Two independent reviewers assessed whether titles and abstracts met the eligibility criteria. Studies were included when patients met the following criteria: 1) age 18 years old or older; 2) septic shock; and 3) treated with venoarterial extracorporeal membranous oxygenation as hemodynamic support. When there were disagreements between reviewers, the full text was reviewed, and discussion was continued until a consensus was reached.

Data Extraction: Two authors independently extracted the selected patient and study characteristics and outcomes.

Data Synthesis: A total of 6,457 studies were screened. Six retrospective studies were included. The in-hospital mortality rate of patients with septic shock who underwent venoarterial extracorporeal membranous oxygenation was 76.7% (188/245). Four studies provided cardiac function with left ventricular ejection fraction and/or cardiac index. In two of these four studies where median left ventricular ejection fraction and cardiac index were 16.0% and 1.3 L/min/m and median left ventricular ejection fraction and mean cardiac index were 30.0% and 2.4 L/min/m, respectively, the in-hospital mortalities were markedly lower (14.8% and 28.6%, respectively) than the other two studies (78.1% and 91.5%, respectively) that included populations with median left ventricular ejection fraction of 25.0% and mean cardiac index of 2.1 L/min/m. Complications were reported in five studies (39 events/174 cases), hemorrhage (22 events/174 cases) being the most common.

Conclusions: Venoarterial extracorporeal membranous oxygenation remains a controversial treatment strategy in septic shock. The reported in-hospital mortality rates in patients with sepsis-induced cardiogenic shock who underwent venoarterial extracorporeal membranous oxygenation were quite inconsistent. There is a need for well-designed studies to assess the benefit and safety of venoarterial extracorporeal membranous oxygenation in patients with sepsis-induced cardiogenic shock.
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http://dx.doi.org/10.1097/CCM.0000000000004432DOI Listing
August 2020

Long-Term Prognosis of Patients with Myocardial Infarction Type 1 and Type 2 with and without Involvement of Coronary Vasospasm.

J Clin Med 2020 Jun 2;9(6). Epub 2020 Jun 2.

Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan.

While prognoses in relation to myocardial infarction (MI) type have been elucidated in past reports, the results were not consistent, perhaps due to occurrence of Type 2 MI with CVS and its mortality. The Japanese registry of acute Myocardial Infarction diagnosed by Universal Definition (J-MINUET) is a prospective multicenter registry in Japan. In contrast to thromboembolic event-related Type 1 myocardial infarction (MI), clinical features of Type 2 MI, including coronary vasospasm (CVS), are varied due to the heterogeneous nature of its development. To elucidate the MI type-related all-cause mortality, 2989 consecutive patients with AMI were stratified as Type 1 MI, Type 2 MI with CVS, and Type 2 MI with non-CVS. Most patients ( = 2834; 94.8%) were classified as Type 1 MI and 155 patients (5.2%) were classified as Type 2 MI. Of the Type 2 MI patients, 87 (56% of Type 2 MI) were diagnosed as MI with CVS. Although the 3-year mortality was comparable between Type 1 and Type 2 MI patients, significant differences were observed between Type 2 MI with CVS and with non-CVS (3.4% and 22.1%, < 0.001). Among Japanese patients with AMI, mortality rates between Type 1 MI and Type 2 MI are comparable, but further stratification of Type 2 MI (with or without CVS) may be useful in predicting the prognosis of patients with Type 2 MI.
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http://dx.doi.org/10.3390/jcm9061686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356040PMC
June 2020

IgG Fc sialylation is regulated during the germinal center reaction following immunization with different adjuvants.

J Allergy Clin Immunol 2020 09 21;146(3):652-666.e11. Epub 2020 May 21.

Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

Background: Effector functions of IgG Abs are regulated by their Fc N-glycosylation pattern. IgG Fc glycans that lack galactose and terminal sialic acid residues correlate with the severity of inflammatory (auto)immune disorders and have also been linked to protection against viral infection and discussed in the context of vaccine-induced protection. In contrast, sialylated IgG Abs have shown immunosuppressive effects.

Objective: We sought to investigate IgG glycosylation programming during the germinal center (GC) reaction following immunization of mice with a foreign protein antigen and different adjuvants.

Methods: Mice were analyzed for GC T-cell, B-cell, and plasma cell responses, as well as for antigen-specific serum IgG subclass titers and Fc glycosylation patterns.

Results: Different adjuvants induce distinct IgG GC B-cell responses with specific transcriptomes and expression levels of the α2,6-sialyltransferase responsible for IgG sialylation that correspond to distinct serum IgG Fc glycosylation patterns. Low IgG Fc sialylation programming in GC B cells was overall highly dependent on the Foxp3 follicular helper T (T) cell-inducing cytokine IL-6, here in particular induced by water-in-oil adjuvants and Mycobacterium tuberculosis. Furthermore, low IgG Fc sialylation programming was dependent on adjuvants that induced IL-27 receptor-dependent IFN-γ T cells, IL-6/IL-23-dependent IL-17A T cells, and high ratios of T cells to Foxp3 follicular regulatory T cells. Here, the 2 latter were dependent on M tuberculosis and its cord factor.

Conclusion: This study's findings regarding adjuvant-dependent GC responses and IgG glycosylation programming may aid in the development of novel vaccination strategies to induce IgG Abs with both high affinity and defined Fc glycosylation patterns in the GC.
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http://dx.doi.org/10.1016/j.jaci.2020.04.059DOI Listing
September 2020

Natural Y-shaped radial artery graft bypass for a complex middle cerebral artery aneurysm: A case report.

J Stroke Cerebrovasc Dis 2020 Jul 8;29(7):104853. Epub 2020 May 8.

Department of Neurosurgery, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan. Electronic address:

Giant thrombosed middle cerebral artery (MCA) aneurysms are difficult to treat and sometimes require complex revascularization using allografts. We describe a technical method using revascularization with a natural Y-shaped graft that provides a normal variation for a complex MCA aneurysm. A 65-year-old man with a giant thrombosed MCA aneurysm presented with right hemiparesis and aphasia. The patient had a history of clipping surgery for the ipsilateral side of the MCA aneurysm 25 years before, and a de novo aneurysm developed over the previous 18 years. For the giant thrombosed aneurysm, trapping and revascularization were performed. A natural radial artery Y-graft was used as the graft and anastomosed to both M2 trunks. The symptoms improved after surgery, and the patient was discharged 3 weeks later. This is the first report of a double-barrel bypass using a natural Y-graft. This method attained a normal variation, and the flow of the Y-graft was physiological. For the radical cure of giant thrombosed MCA aneurysms, multiple revascularizations might be required. With this natural Y-graft, complex transpositions could be avoided.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104853DOI Listing
July 2020

Correlation between lumbar skeletal muscle size and urinary incontinence after radical prostatectomy.

Low Urin Tract Symptoms 2020 Sep 6;12(3):245-252. Epub 2020 May 6.

Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

Objectives: Urinary incontinence is a major concern after radical prostatectomy because it can decrease quality of life. The aim of the present study was to explore the effect of preoperative skeletal muscle on urinary quality of life after robot-assisted radical prostatectomy.

Methods: A total of 762 patients underwent robot-assisted radical prostatectomy. Longitudinal health-related quality of life was evaluated using the Expanded Prostate Cancer Index Composite instrument. The skeletal muscle area at the level of the third lumbar vertebra was assessed preoperatively by computed tomography and was standardized to height to obtain the skeletal muscle index. Reduced skeletal muscle size (RSMS) was defined as a skeletal muscle index ≤ 53 or ≤ 43 cm /m in patients with a body mass index (BMI) ≥25 or < 25, respectively.

Results: A total of 301 patients were included in this study, of whom 91 were classified as having RSMS (30.2%). Non-RSMS patients exhibited better urinary function at 12 months (P = .012) and better urinary continence recovery at 2 weeks and 12 months (P = .033 and P = .014, respectively) after prostatectomy compared with RSMS patients. Univariate and multivariate analyses identified preoperative RSMS as a significant and independent predictor of urinary incontinence (odds ratio = 1.77, P = .028).

Conclusions: Patients with RSMS had a lower urinary quality of life compared with non-RSMS patients after robot-assisted radical prostatectomy, and RSMS, independent of age or BMI, was predictive of postoperative urinary incontinence.
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http://dx.doi.org/10.1111/luts.12312DOI Listing
September 2020

Reduction of Optical Gain Threshold in CsPbI Nanocrystals Achieved by Generation of Asymmetric Hot-Biexcitons.

Nano Lett 2020 May 4;20(5):3905-3910. Epub 2020 May 4.

Institute for Chemical Research, Kyoto University, Uji, Kyoto 611-0011, Japan.

Lead halide perovskite nanocrystals (NCs) are a class of promising light-emitting materials and have been considered as gain media in lasers. Strong exciton-exciton interactions in NCs cause an energy shift of the lowest optical transition and affect the optical gain threshold. Here, we clarify the dynamics of exciton-exciton interactions in highly photoexcited CsPbI NCs by double-pump transient absorption spectroscopy. This method provides control over the population of each excited state by varying the time interval between the two pump pulses. We find that the band-edge energy shift induced by the formation of asymmetric hot-biexcitons (comprising one ground-state exciton and one hot exciton) is smaller than that induced by hot excitons and hot biexcitons in the ensemble. We demonstrate that the generation of asymmetric hot-biexcitons reduces the optical gain threshold in the CsPbI NC ensemble.
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http://dx.doi.org/10.1021/acs.nanolett.0c01079DOI Listing
May 2020

Effect of A-Site Cation on Photoluminescence Spectra of Single Lead Bromide Perovskite Nanocrystals.

Nano Lett 2020 May 29;20(5):4022-4028. Epub 2020 Apr 29.

Institute for Chemical Research, Kyoto University, Uji, Kyoto 611-0011, Japan.

Lead halide perovskite (APbX) nanocrystals exhibit photoluminescence (PL) with both wide wavelength tunability and high quantum efficiency. While the Pb-X octahedra mainly determines the near-band-edge optical properties and the A-site cation affects the structural stability, the role of the A-site cation in determining the optical properties is still unclear. Here, we report the PL properties of three types of lead bromide perovskite APbBr nanocrystals with different cations [A = HC(NH), CHNH, and Cs], as revealed by single-dot spectroscopy, and discuss the influence of the A-site cation on the PL spectrum. The nanocrystal size dependences of the PL energy and lifetime show no large variation with the species of the A-site cation. We find that the size of the A-site cation determines the coupling strength between electrons and longitudinal-optical phonons in the nanocrystal and thus affects the PL spectral shape, especially the low-energy tail.
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http://dx.doi.org/10.1021/acs.nanolett.0c01417DOI Listing
May 2020

[A case of novel WDR45 mutation with beta-propeller protein-associated neurodegeneration (BPAN) presenting asymmetrical extrapyramidal signs].

Rinsho Shinkeigaku 2020 May 18;60(5):317-320. Epub 2020 Apr 18.

Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.

Beta-propeller protein-associated neurodegeneration (BPAN) is categorized in Neurodegeneration with brain iron accumulation. The clinical feature of BPAN is global developmental delay in early childhood, followed rapid progression of cognitive disfunction and parkinsonism in adulthood. This case was pointed out intellectual disability at the age of 9, followed left dominant progressive parkinsonism from the age of 31. Brain MRI showed the T-weighted signal hyperintensity of the substantia nigra with a central band of hypointensity and the T star weighted image hypointensity of substantia nigra and globus pallidus presenting dominant at right side. DAT SPECT also showed specific binding ratio decreased dominant in right side. She was diagnosed BPAN based on her genetic test revealing a novel mutation (c.411dupT) in WDR45. No studies reported detailed parkinsonism like laterality in BPAN. This case indicates the left dominant parkinsonism was caused by right dominant iron deposition to substantia nigra and globus pallidus in view of MRI findings and DAT SPECT.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001324DOI Listing
May 2020