Publications by authors named "Yusuke Watanabe"

474 Publications

Particle Size Distributions in Surgical Smoke Generated by Advanced Energy Devices: A Meaningful Perspective From an Experimental Study in the Time of COVID-19.

Ann Surg 2021 May;273(5):e168-e170

Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Hokkaido, Japan.

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http://dx.doi.org/10.1097/SLA.0000000000004807DOI Listing
May 2021

Deep Learning-based Angiogram Generation Model for Cerebral Angiography without Misregistration Artifacts.

Radiology 2021 Mar 30:203692. Epub 2021 Mar 30.

From the Departments of Diagnostic and Interventional Radiology (D.U., A.Y., S.L.W., H. Tatekawa, H. Takita, T.H., A.S., Y.M.), Neurosurgery (T. Ichinose, H.A., Y.W., T.G.), and Medical Statistics (D.K.), Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; and Department of Radiology, Osaka City University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan (Y.K., T. Ichida).

Background Digital subtraction angiography (DSA) generates an image by subtracting a mask image from a dynamic angiogram. However, patient movement-caused misregistration artifacts can result in unclear DSA images that interrupt procedures. Purpose To train and to validate a deep learning (DL)-based model to produce DSA-like cerebral angiograms directly from dynamic angiograms and then quantitatively and visually evaluate these angiograms for clinical usefulness. Materials and Methods A retrospective model development and validation study was conducted on dynamic and DSA image pairs consecutively collected from January 2019 through April 2019. Angiograms showing misregistration were first separated per patient by two radiologists and sorted into the misregistration test data set. Nonmisregistration angiograms were divided into development and external test data sets at a ratio of 8:1 per patient. The development data set was divided into training and validation data sets at ratio of 3:1 per patient. The DL model was created by using the training data set, tuned with the validation data set, and then evaluated quantitatively with the external test data set and visually with the misregistration test data set. Quantitative evaluations used the peak signal-to-noise ratio (PSNR) and the structural similarity (SSIM) with mixed liner models. Visual evaluation was conducted by using a numerical rating scale. Results The training, validation, nonmisregistration test, and misregistration test data sets included 10 751, 2784, 1346, and 711 paired images collected from 40 patients (mean age, 62 years ± 11 [standard deviation]; 33 women). In the quantitative evaluation, DL-generated angiograms showed a mean PSNR value of 40.2 dB ± 4.05 and a mean SSIM value of 0.97 ± 0.02, indicating high coincidence with the paired DSA images. In the visual evaluation, the median ratings of the DL-generated angiograms were similar to or better than those of the original DSA images for all 24 sequences. Conclusion The deep learning-based model provided clinically useful cerebral angiograms free from clinically significant artifacts directly from dynamic angiograms. Published under a CC BY 4.0 license.
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http://dx.doi.org/10.1148/radiol.2021203692DOI Listing
March 2021

Comparison of Chest CT Grading Systems in Coronavirus Disease 2019 (COVID-19) Pneumonia.

Radiol Cardiothorac Imaging 2020 Dec 5;2(6):e200492. Epub 2020 Nov 5.

Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan (S.I., R.K., Y.N., Y.W., W.G., O.A,); Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, Tokyo, 154-0001, Japan (S.I., A.F.); Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan (M.K.); Department of Radiology, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan (K.S.); Department of Radiology, National Defense Medical College, 3-2, Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan (H.S.); Clinical Research Promotion Center, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan (T.K.); Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Chongno-gu, Seoul 03080, Republic of Korea (S.H.Y.); Department of Respiratory Medicine, Japan Self-Defense Forces Central Hospital, 1-2-24, Ikejiri, Setagaya-ku, Tokyo, 154-0001, Japan (Y.U.); Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan (Y.U.).

Purpose: To compare the performance and interobserver agreement of the COVID-19 Reporting and Data System (CO-RADS), the COVID-19 imaging reporting and data system (COVID-RADS), the RSNA expert consensus statement, and the British Society of Thoracic Imaging (BSTI) guidance statement.

Materials And Methods: In this case-control study, total of 100 symptomatic patients suspected of having COVID-19 were included: 50 patients with COVID-19 (59±17 years, 38 men) and 50 patients without COVID-19 (65±24 years, 30 men). Eight radiologists independently scored chest CT images of the cohort according to each reporting system. The area under the receiver operating characteristic curves (AUC) and interobserver agreements were calculated and statistically compared across the systems.

Results: A total of 800 observations were made for each system. The level of suspicion of COVID-19 correlated with the RT-PCR positive rate except for the "negative for pneumonia" classifications in all the systems (Spearman's coefficient: ρ=1.0, =<.001 for all the systems). Average AUCs were as follows: CO-RADS, 0.84 (95% confidence interval, 0.83-0.85): COVID-RADS, 0.80 (0.78-0.81): the RSNA statement, 0.81 (0.79-0.82): and the BSTI statement, 0.84 (0.812-0.86). Average Cohen's kappa across observers was 0.62 (95% confidence interval, 0.58-0.66), 0.63 (0.58-0.68), 0.63 (0.57-0.69), and 0.61 (0.58-0.64) for CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement, respectively. CO-RADS and the BSTI statement outperformed COVID-RADS and the RSNA statement in diagnostic performance (=.<.05 for all the comparison).

Conclusions: CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement provided reasonable performances and interobserver agreements in reporting CT findings of COVID-19.
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http://dx.doi.org/10.1148/ryct.2020200492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650298PMC
December 2020

Proximal Optimisation Technique Versus Final Kissing Balloon Inflation in Coronary Bifurcation Lesions: the Randomised, Multicenter PROPOT Trial.

EuroIntervention 2021 Mar 30. Epub 2021 Mar 30.

Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.

Background: Clinical implications of proximal optimisation technique (POT) for bifurcation lesions have not been investigated in a randomised controlled trial.

Aims: This study aimed to investigate whether proximal optimisation technique (POT) is superior in terms of stent apposition compared with the conventional kissing balloon technique (KBT) in real-life bifurcation lesions using optical coherence tomography (OCT).

Methods: A total of 120 patients from 15 centres were randomised into two groups: POT followed by side branch dilation or KBT. Finally, 57 and 58 patients in the POT and KBT groups, respectively, were analysed. OCT was performed at baseline, immediately after wire recrossing to the side branch, and at the final procedure.

Results: The primary endpoint was the rate of malapposed struts assessed by the final OCT. The rate of malapposed struts did not differ between the POT and KBT groups (in-stent proximal site: 10.4% vs. 7.7%, p=0.33; bifurcation core: 1.4% vs. 1.1%, p=0.67; core's distal edge: 6.2% vs. 5.3%, p=0.59). More additional treatments were required among the POT group (40.4% vs. 6.9%, p<0.01). At 1-year follow-up, only one patient in each group underwent target lesion revascularisation (2.0% vs. 1.9%).

Conclusions: POT followed by side branch dilation did not show any advantages over conventional KBT in terms of stent apposition, however, the excellent mid-term clinical outcomes were observed in both strategies.
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http://dx.doi.org/10.4244/EIJ-D-20-01386DOI Listing
March 2021

Long-Term Prognostic Value of the Society of Thoracic Surgery Risk Score in Patients Undergoing Transcatheter Aortic Valve Implantation (From the OCEAN-TAVI Registry).

Am J Cardiol 2021 Mar 19. Epub 2021 Mar 19.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

The Society of Thoracic Surgeons (STS) risk model, designed to predict operative mortality after cardiac surgery, is often used for the risk assessment of patients considered for transcatheter aortic valve implantation (TAVI). We investigated the long-term prognostic value of the STS score by utilizing the data of 2588 patients undergoing TAVI from the OCEAN (Optimized CathEter vAlvular iNtervention)-TAVI Japanese multicenter registry. The patients were divided into 3 groups according to their pre-procedural STS score as follows: low-risk (STS score <4%, n = 467 [18%]), intermediate-risk (4%≤ STS score <8%, n = 1200 [46.4%]), and high-risk (8%≤ STS score, n = 921 [35.6%]). Low-risk patients were younger and were more frequently male. The prevalence of most of the comorbidities were higher in high-risk patients, while active cancer was more frequent in low-risk patients (P <0.001).The cumulative 4-year all-cause mortality rates were higher in high-risk patients (49.0%) but comparable in low-risk (22.6%) and intermediate-risk patients (28.7%) (hazard ratio [HR] for intermediate-risk versus low-risk, 1.03; 95% confidence interval [CI], 0.77 to 1.37; P = 0.85; HR for high-risk versus low-risk, 2.27; 95% CI 1.72 to 2.99; P = <0.001). Similarly, the cumulative 4-year cardiovascular mortality rates were higher in high-risk patients (20.5%) but comparable in low-risk (9.9%) and intermediate-risk patients (10.3%) (HR for intermediate-risk versus low-risk, 1.10; 95% CI, 0.68 to 1.77; P = 0.69; HR for high-risk versus low-risk, 2.33; 95% CI 1.48 to 3.67; P = <0.001). After adjustment for several confounders, STS score ≥8% was independently associated with increased long-term mortality (HR, 1.35; 95% CI, 1.08 to 1.68). In conclusion, the risk stratification according to STS score demonstrated an increased risk of long-term mortality after TAVI in high-risk patients, albeit with comparable risks in intermediate- and low-risk patients.
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http://dx.doi.org/10.1016/j.amjcard.2021.03.027DOI Listing
March 2021

Association of serum CCL20 levels with pulmonary vascular involvement and primary biliary cholangitis in patients with systemic sclerosis.

Int J Rheum Dis 2021 Mar 22. Epub 2021 Mar 22.

Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Aim: Systemic sclerosis (SSc) is a chronic autoimmune disease resulting in vasculopathy and fibrosis of the skin and major internal organs. Especially, interstitial lung disease and pulmonary arterial hypertension are the leading causes of mortality. C-C motif ligand 20 (CCL20) is known as a homeostatic and inflammatory chemokine, which is associated with fibrosis and angiogenesis and constantly expressed in organs involved in SSc. Therefore, we investigated the potential contribution of CCL20 to the development of SSc.

Method: We conducted cross-sectional analyses of 67 SSc patients and 20 healthy controls recruited in a single center for 9 years. Serum CCL20 levels were measured by enzyme-linked immunosorbent assay. Statistical analyses were performed with the Mann-Whitney U test, the Kruskal-Wallis test followed by Dunn's multiple comparison test, Fisher's exact probability test and the Spearman's rank correlation coefficient.

Results: SSc patients had significantly higher serum CCL20 levels than healthy controls. In SSc patients, serum CCL20 levels correlated inversely with the percentage of predicated diffusion lung capacity for carbon monoxide and positively with mean pulmonary artery pressure (mPAP). In addition, SSc patients with increased serum CCL20 levels had anti-mitochondrial antibody M2 titer significantly elevated relative to those with normal levels, and SSc patients with asymptomatic primary biliary cholangitis (PBC) possessed higher serum CCL20 levels than those without. Importantly, serum CCL20 levels were associated positively with mPAP values and PBC presence by multivariate regression analysis.

Conclusion: Serum CCL20 levels may be involved in the development of pulmonary vascular involvement leading to pulmonary arterial hypertension and asymptomatic PBC in SSc patients.
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http://dx.doi.org/10.1111/1756-185X.14103DOI Listing
March 2021

Small Left Ventricle and Clinical Outcomes After Transcatheter Aortic Valve Replacement.

J Am Heart Assoc 2021 Apr 20;10(7):e019543. Epub 2021 Mar 20.

Department of Cardiology Keio University School of Medicine Tokyo Japan.

Background In patients undergoing transcatheter aortic valve replacement (TAVR), those with small left ventricle (LV) may have an increased risk of poor outcomes, because small LV is associated with low-flow (LF), left ventricular hypertrophy. However, the impact of small LV on patients undergoing TAVR remains unknown. Methods and Results We examined 2584 patients who underwent TAVR between October 2013 and May 2017 using data from the Japanese multicenter registry. On the basis of the American Society of Echocardiography guidelines, small LV was defined as left ventricular end-diastolic dimension <42.0 mm for men or <37.8 mm for women. The 2-year clinical outcomes were compared between patients with and without small LV using multivariable Cox regression analyses and propensity score matching. Subgroup analyses by LF, left ventricular hypertrophy were performed. Of 2584 patients who underwent TAVR, 466 (18.0%) had small LV. Patients with small LV had smaller body size and less comorbidity, and were more likely to have LF status compared with those without. Small LV was associated with a higher 2-year all-cause (20.8% versus 14.3%; adjusted hazard ratio [HR],1.58 [95% CI, 1.20-2.09]; =0.0013) and cardiovascular mortality (8.8% versus 5.5%; adjusted HR, 1.93 [95% CI, 1.25-2.98]; =0.0028). Propensity score matching analysis showed consistent findings. In subgroup analyses, LF, left ventricular hypertrophy did not interact with small LV. Conclusions Small LV, determined by a simple echocardiographic parameter, was associated with poorer clinical outcomes after TAVR regardless of LF, left ventricular hypertrophy. LV size may be useful for assessing clinical outcomes after TAVR. Registration URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000020423.
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http://dx.doi.org/10.1161/JAHA.120.019543DOI Listing
April 2021

Incidence and predictors of prosthesis-patient mismatch after TAVI using SAPIEN 3 in Asian: differences between the newer and older balloon-expandable valve.

Open Heart 2021 Mar;8(1)

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Background: The balloon-expandable SAPIEN 3 (S3) is superior to the older-generation balloon-expandable SAPIEN XT (XT) in a lower incidence of paravalvular aortic regurgitation, lower complication rates and better survival in transcatheter aortic valve implantation (TAVI). However, prosthesis-patient mismatch (PPM) more frequently occurs in S3 than XT. Further, little information is available on PPM after TAVI using S3 in Asians. This study aims to determine the incidence and predictors of PPM in S3 by focusing on the difference between S3 and XT using data from a Japanese multicentre registry.

Methods: From the Optimised transCathEter vAlvular iNtervention-TAVI (OCEAN-TAVI) registry, 2134 patients undergoing TAVI using S3 or XT were included. PPM was defined as moderate if ≧0.65 but ≦0.85 cm/m or severe if <0.65 cm/m at the indexed effective orifice area by postprocedural echocardiography.

Results: The incidence of moderate and severe PPM in S3 was 13.3% and 1.3%, respectively. The 20 mm transcatheter heart valve (THV) was more frequently used in S3 than XT (7.4% vs 2.4%, p<0.0001). PPM was more frequently observed in S3 than XT (14.7% vs 8.8%, p<0.0001). Multivariate logistic regression analysis revealed S3 predicted PPM (OR 1.92 (95% CI 1.35 to 2.74), p=0.0003). The mutual predictors for PPM between S3 and XT were younger age, larger body surface area, smaller aortic valve area, no balloon postdilatation and the use of 20 mm and 23 mm THV. When comparing 23 mm, 26 mm and 29 mm S3, the ORs of 20 mm S3 were 5.67 (95% CI 2.88 to 11.12), 19.24 (95% CI 8.13 to 46.86) and 51.03 (95% CI 12.28 to 280.77), respectively.

Conclusions: The incidence of PPM after TAVI using S3 was 14.6% overall in this Asian population. PPM was more frequently observed in S3 than XT. A considerable number of patients were treated by the 20 mm S3 in an Asian cohort. The 20 mm THV was identified as a strong predictor for PPM.
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http://dx.doi.org/10.1136/openhrt-2020-001531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978259PMC
March 2021

Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy.

Langenbecks Arch Surg 2021 Mar 15. Epub 2021 Mar 15.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Aim: Isolating the root of the splenic artery (SPA) is a challenging procedure in laparoscopic distal pancreatectomy (LDP). We investigated the usefulness of evaluation of the relationship between the SPA and pancreatic parenchyma using three-dimensional computed tomography (3D-CT).

Methods: In total, 104 patients were evaluated. The relationship between the SPA and pancreatic parenchyma was classified into two types: buried and non-buried. Video clips of 50 patients who underwent LDP requiring isolation of the SPA root were reviewed to determine whether the classification is related to difficulty of LDP.

Results: Of the 50 assessed patients who underwent LDP, the relationship between the SPA and pancreatic parenchyma was the buried type in 30 (60.0%) and non-buried type in 20 (40.0%). The buried type was associated with a significantly longer median operative time than the non-buried type (285.0 vs. 235.5 min, respectively; P < 0.01). The median time required to isolate the SPA in the buried type (25.8 min; range, 4.0-101 min) was significantly longer than that in the non-buried type (7.0 min; range, 1.0-27.0 min) (P < 0.001).

Conclusion: Preoperative 3D-CT around the pancreas is practical for predicting the difficulty of SPA isolation and determining the safety of the procedure.
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http://dx.doi.org/10.1007/s00423-021-02101-3DOI Listing
March 2021

A potential contribution of decreased serum galectin-10 levels to systemic inflammation and pulmonary vascular involvement in systemic sclerosis.

Exp Dermatol 2021 Mar 14. Epub 2021 Mar 14.

Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.

Objective: Galectin-10 (Gal-10) is a key molecule involved in eosinophil-mediated suppression of T-cell immune response. Systemic sclerosis (SSc) is characterized by T helper (Th) 2/Th17 immune response and impaired function of regulatory T cells, but the pathological role of Gal-10 has not been studied so far. Therefore, we investigated the clinical correlation of serum Gal-10 levels in SSc patients.

Methods: Serum Gal-10 levels were determined by enzyme-linked immunosorbent assay in 38 patients with diffuse cutaneous SSc (dcSSc), 30 with limited cutaneous SSc and 20 healthy controls. Clinical correlations of serum Gal-10 levels were examined.

Results: Serum Gal-10 levels were significantly lower in SSc patients than in healthy controls, especially in dcSSc patients, and inversely correlated with skin score, the percentage of predicted diffusion lung capacity for carbon monoxide and estimated right ventricular systolic pressure (RVSP). Furthermore, serum Gal-10 levels had negative correlations with leucocyte counts and inflammatory parameters. Multivariate regression analysis identified C-reactive protein and RVSP as explanatory parameters for serum Gal-10 levels.

Conclusion: Decreased serum Gal-10 levels may reflect the impairment of eosinophil-mediated regulatory system for T-cell immune response in SSc, possibly contributing to pulmonary vascular involvement leading to pulmonary arterial hypertension.
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http://dx.doi.org/10.1111/exd.14320DOI Listing
March 2021

Pyogenic liver abscess caused by Fusobacterium nucleatum with an inflammatory scar in the abdominal cavity.

Clin J Gastroenterol 2021 Apr 6;14(2):617-620. Epub 2021 Mar 6.

Department of Surgery, Hitachiomiya Saiseikai Hospital, Ibaraki, Japan.

Pyogenic liver abscesses generally occur secondary to spread from active infective lesions. We report a rare case of liver abscess in a patient without a clear source of infection. A 19-year-old man was diagnosed as having a liver abscess after investigations when he presented with chief complaints of fever and lethargy. Fusobacterium nucleatum was detected in the pus culture taken from the abscess that was drained. His condition improved with antibacterial treatment. Further examination of the gastrointestinal tract suggested that the infection had tracked through the portal vein from a scar between the rectal sigmoid and the appendix. Laparoscopic adhesiolysis and appendectomy were performed to treat the same. Fusobacterium can be identified early by Gram staining of pus from the liver abscess, which is useful for treatment. In young people with pyogenic liver abscess due to Fusobacterium nucleatum who are not immunocompromised, examination of the gastrointestinal tract should be considered to determine a cause.
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http://dx.doi.org/10.1007/s12328-021-01376-9DOI Listing
April 2021

Calculated plasma volume status and outcomes in patients undergoing transcatheter aortic valve replacement.

ESC Heart Fail 2021 Mar 5. Epub 2021 Mar 5.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Aims: This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR).

Methods And Results: Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All-cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5-13.5%; Q3, PVS 13.5-21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut-off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all-cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high-PVS group regardless of the NYHA class had a higher all-cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all-cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all-cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively].

Conclusions: Plasma volume status is useful for predicting all-cause mortality and HFH after TAVR.
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http://dx.doi.org/10.1002/ehf2.13270DOI Listing
March 2021

Clinical Outcomes of Dialysis Patients Treated with Drug-Eluting Stent for Left Main Distal Bifurcation Lesions.

Cardiorenal Med 2021 Mar 3:1-10. Epub 2021 Mar 3.

Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy.

Aims: We assessed clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) distal bifurcation lesions using drug-eluting stents (DES) in hemodialysis (HD) patients compared to non-HD patients.

Methods And Results: We identified 1,858 consecutive patients who underwent PCI for ULMCA distal bifurcation lesions at 4 high-volume centers in Japan, Italy, and Taiwan between January 2005 and December 2015. Of them, 1,416 patients were treated with DES including 113 HD patients and 1,303 non-HD patients. The primary end point was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction. HD patients were more likely to be younger and have diabetes mellitus, dyslipidemia, peripheral artery disease, lower ejection fraction, and higher EuroSCORE. TLF rate at 3 years was significantly higher in HD group than in non-HD group (adjusted hazard ratio [HR] 2.43 [1.75-3.38], p < 0.001). Cardiac mortality and TLR rate were also significantly higher in HD group than in non-HD group (adjusted HR 3.85 [2.34-6.34], p < 0.001, and HR 2.10 [1.41-3.14], p < 0.001, respectively).

Conclusions: HD was strongly associated with adverse cardiac events after PCI for ULMCA distal bifurcation lesions with DES.
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http://dx.doi.org/10.1159/000510731DOI Listing
March 2021

Tmem100-BAC-EGFP mice to selectively mark and purify embryonic endothelial cells of large caliber arteries in mid-gestational vascular formation.

Genesis 2021 Mar 2:e23416. Epub 2021 Mar 2.

Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.

Embryonic vascular development is achieved through the complex arrays of differentiation, proliferation, migration and mutual interaction of different cell types, and visualization as well as purification of unique cell populations are fundamental in studying its detailed mechanisms using in vivo experimental models. We previously demonstrated that Tmem100 was a novel endothelial gene encoding a small transmembrane protein, and that Tmem100 null mice showed embryonic lethality due to severe impairment of vascular formation. In the present study, we generated an EGFP reporter mouse line using a 216 kb genomic region containing mouse Tmem100 gene. A novel line designated as Tmem100-BAC-EGFP mice precisely recapitulated the Tmem100 expression profile at the mid-gestational stage, which was highly enriched in endothelial cells of large caliber arteries in mouse embryos. FACS experiments demonstrated that Tmem100-BAC-EGFP mice served to selectively purify a specific population of arterial endothelial cells, indicating their usefulness not only for the research concerning Tmem100 expression and function but also for comparative analysis of multiple endothelial cell subgroups in embryonic vascular development.
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http://dx.doi.org/10.1002/dvg.23416DOI Listing
March 2021

Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement.

CJC Open 2021 Feb 3;3(2):142-151. Epub 2020 Oct 3.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Background: Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR).

Methods: We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT.

Results: Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test  = 0.016 and  = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test < 0.001 and  = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88,  = 0.019, and HR: 1.34, 95% CI: 1.03-1.76,  = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29,  = 0.85, and HR: 0.78, 95% CI: 0.60-1.03,  = 0.085, respectively).

Conclusions: CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.
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http://dx.doi.org/10.1016/j.cjco.2020.09.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893200PMC
February 2021

Management of postoperative pancreatic fistula after pancreatoduodenectomy: Analysis of 600 cases of pancreatoduodenectomy patients over a 10-year period at a single institution.

Surgery 2021 Feb 19. Epub 2021 Feb 19.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address:

Background: Although postoperative pancreatic fistula (POPF) is a common and critical complication of pancreatoduodenectomy (PD), effective strategies to prevent POPF have not yet been completely developed. Because appropriate management of POPF is important to reduce the mortality rate after PD, in this study we aimed to evaluate our approach for the management of POPF after PD, including the postoperative course.

Methods: This retrospective study included 605 consecutive patients who underwent PD at our hospital between 2010 and 2020. All patients who developed POPF were first managed conservatively, with drainage tubes placed during surgery retained to manage POPF. In cases wherein conservative treatment was unsuccessful, open drainage, followed by continuous negative pressure and continuous irrigation, was used. For open drainage, the surgical wound was opened bluntly (approximate length, 5 cm) under local anesthesia, and the fluid was directly and completely drained.

Results: The prevalence of POPF of grades B and C was 15.4% (n = 93) and 0.33% (n = 2), respectively. Of these patients, 1 required reoperation, 43 recovered with conservative management only, 47 required open drainage, and 4 required image-guided percutaneous drainage. Postoperative hemorrhage with a pseudoaneurysm was identified in 3 (0.66%) patients. The postoperative in-hospital mortality rate was low (n = 1, 0.16%). The rate of successful POPF management was 98.9%.

Conclusion: Based on our high success rate in POPF management, we consider open drainage to be a safe primary management method for POPF.
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http://dx.doi.org/10.1016/j.surg.2021.01.010DOI Listing
February 2021

Blood Coagulation Changes With or Without Direct Oral Anticoagulant Therapy Following Transcatheter Aortic Valve Implantation.

Am J Cardiol 2021 Feb 20. Epub 2021 Feb 20.

Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.

Thromboembolic events remain clinically unresolved after transcatheter aortic valve implantation (TAVI). The use of direct oral anticoagulant (DOAC) to reduce thrombosis associated with TAVI remains controversial. This study aimed at investigating the periprocedural change in blood coagulation and thrombolysis parameters in 199 patients undergoing transfemoral TAVI. Prothrombin activation fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), soluble fibrin monomer complex (SFMC), and fibrin/fibrinogen degradation product (FDP) levels were measured before and 1 hour after TAVI and 1, 2, and 7 days postoperatively. Of the 199 patients, 49 were treated with DOAC (apixaban in 32, edoxaban in 10, and rivaroxaban in 7). The F1 + 2 and TAT levels immediately increased 1 hour after TAVI and then gradually decreased in both groups. The SFMC level also significantly increased with a peak on day 1. The FDP level gradually increased, peaking on day 2. The values of F1 + 2, TAT, SFMC, and FDP in patients who used DOAC were significantly lower than those who did not use DOAC at 1 hour after TAVI in F1 + 2 (600 [452 to 765] vs 1055 [812 to 1340] pmol/L; p < 0.001), TAT (21.4 [16.2 to 37.0] vs 38.7 [26.4 to 58.7] μg/mL; p < 0.001) and on day 1 in SFMC (18.2 [9.4 to 57.9] vs 113.4 [70.9 to 157.3] μg/mL; p < 0.001) and day 2 in FDP (6.0 [4.7 to 10.0] vs 12.6 [8.2 to 17.4] μg/mL; p < 0.001). Ischemic stroke within 30 days after TAVI occurred in 3 patients (1.5%), who were not treated with DOAC. Coagulation cascade activation was observed after TAVI. DOAC could reduce transient hypercoagulation following TAVI.
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http://dx.doi.org/10.1016/j.amjcard.2021.01.042DOI Listing
February 2021

Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas.

J Neurosurg 2021 Feb 19:1-10. Epub 2021 Feb 19.

Objective: Petroclival meningiomas (PCMs) remain difficult to remove, and radical tumor resection continues to pose a relatively high risk of neurological morbidity in patients with these lesions because of the proximity of the tumor to neurovascular structures. The anterior and posterior combined (APC) transpetrosal approach allows resection of a large petroclival lesion with minimal retraction of the temporal lobe. However, this approach is thought to be complex and time-consuming. The authors simplified this approach by minimizing the petrosectomy and used this method for large PCMs. This retrospective study describes the surgical technique and surgical outcomes of large PCMs.

Methods: Between 2014 and 2019, 23 patients (19 women and 4 men) with benign (WHO grade I) PCMs were treated using the minimal APC (MAPC) transpetrosal approach. The mean age at surgery was 54.0 years (range 37-74 years). The mean tumor diameter was 40.3 mm (range 30-74 mm). The surgical technique consisted of a temporo-suboccipital craniotomy and minimal drilling of the petrous ridge. After opening Meckel's cave and removing the lesion at the prepontine cistern, drilling of the petrous apex with superior mobilization of the trigeminal nerve was performed through the subdural space for further tumor resection around the petrous apex. Finally, the tumor was removed as much as possible.

Results: The mean preoperative and postoperative tumor volumes were 26.8 and 1.3 cm3, respectively. The mean extent of resection was 95.4% (range 62%-100%). Postoperative impairments included facial numbness in 7 patients, trochlear nerve palsy in 3 patients, mild oculomotor nerve palsy in 2 patients, and transient abducens nerve palsy in 1 patient. Preoperative Karnofsky Performance Status was improved in 13 patients, remained stable in 9 patients, and deteriorated in 1 patient.

Conclusions: The MAPC transpetrosal approach provides sufficiently wide exposure of petroclival lesions. Maximal resection via the MAPC transpetrosal approach is a suitable surgical option for the treatment of large PCMs.
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http://dx.doi.org/10.3171/2020.8.JNS202060DOI Listing
February 2021

High mobility group box 1 and angiogenetic growth factor levels in children with central nerve system infections.

J Infect Chemother 2021 Feb 11. Epub 2021 Feb 11.

Department of Pediatrics and Adolescent Medicine, Tokyo Medical University.

Introduction: To clarify the pathology of children with acute encephalopathy and other neurological disorders, the involvement of high-mobility group box 1 (HMGB1), which is a representative of danger-associated molecular patterns, and angiogenesis-related growth factors were investigated.

Patients And Methods: Participants were 12 children with acute encephalopathy (influenza, rotavirus, and others), 7 with bacterial meningitis, and 6 with epilepsy disease (West syndrome). Twenty-four patients with non-central nervous system (CNS) infections as a control group were admitted to our hospital. We examined the levels of HMGB1, platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and other cytokines in the serum and cerebrospinal fluid (CSF) of the subjects.

Results: Serum and CSF HMGB1 levels were significantly higher in the encephalopathy and meningitis groups than in the West syndrome and control groups. CSF HMGB1 levels correlated with those of interleukin-6 and -8. CSF HMGB1 and VEGF levels were correlated, and PDGF showed a positive relationship.

Conclusion: HMGB1 and angiogenesis-related growth factors appear to play pivotal roles in the pathophysiology of CNS infections.
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http://dx.doi.org/10.1016/j.jiac.2021.01.019DOI Listing
February 2021

The Seasonality of Peripheral Venous Catheter-Related Bloodstream Infections.

Infect Dis Ther 2021 Mar 6;10(1):495-506. Epub 2021 Feb 6.

Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.

Introduction: Although the seasonality of infectious diseases has been widely reported, the seasonality of peripheral venous catheter-related bloodstream infection (PV-CRBSI) has not been investigated. This study investigated the seasonality of PV-CRBSI and its relationship with meteorological conditions.

Methods: A retrospective cohort study of PV-CRBSI at Tokyo Medical University Hospital (Tokyo, Japan), from 2009 to 2019, provided the data for descriptive and time series analyses used to evaluate the number of PV-CRBSI cases per 1000 admissions that occurred each month for each causative organism. By performing univariate and multivariate analyses, the researchers investigated the seasonality of cases and the relationships between meteorological conditions, other external factors, and PV-CRBSIs.

Results: This study included a total of 184 PV-CRBSI cases. The mean numbers of PV-CRBSI cases per 1000 admissions caused by all organisms, Bacillus cereus, Gram-positive cocci, and Gram-negative rods were 0.67, 0.15, 0.37, and 0.16 per month, respectively, during the study period. The time series analysis showed that the incidences of PV-CRBSI cases associated with B. cereus and Gram-negative rods were significantly different in the winter/spring from those in the summer/autumn (P < 0.05). The incidence of PV-CRBSI cases caused by B. cereus peaked during summer. The incidence of PV-CRBSI cases caused by B. cereus was significantly positively associated with average monthly temperature, whereas the incidence of PV-CRBSIs caused by Gram-negative rods was significantly negatively associated with average daylight hours.

Conclusion: The incidence of PV-CRBSIs caused by B. cereus showed seasonality, peaking during the summer, and a significant correlation was found between PV-CRBSIs caused by B. cereus and average monthly temperature.
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http://dx.doi.org/10.1007/s40121-021-00407-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954888PMC
March 2021

Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review.

J Hepatobiliary Pancreat Sci 2021 Feb 1. Epub 2021 Feb 1.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Background: Minimally invasive pancreaticoduodenectomy (MIPD) has recently been safely performed by experts, and various methods for resection have been reported. This review summarizes the literature describing surgical approaches for MIPD.

Methods: A systematic literature search of PubMed (MEDLINE) was conducted for studies reporting robotic and laparoscopic pancreaticoduodenectomy; the reference lists of review articles were searched. Of 444 articles yielded, 23 manuscripts describing the surgical approach to dissect around the superior mesenteric artery (SMA), including hand-searched articles, were assessed.

Results: Various approaches to dissect around the SMA have been reported. These approaches were categorized according to the direction toward the SMA when initiating dissection around the SMA: anterior approach (two articles), posterior approach (four articles), right approach (16 articles), and left approach (three articles). Thus, many reports used the right approach. Most articles provided a technical description. Some articles showed the advantage of their method in a comparison study. However, these were single-center retrospective studies with a small sample size.

Conclusions: Various approaches for MIPD have been reported; however, few authors have reported the advantage of their methods compared to other methods. Further discussion is needed to clarify the appropriate surgical approach to the SMA during MIPD.
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http://dx.doi.org/10.1002/jhbp.905DOI Listing
February 2021

4-Dimensional Computed Tomography Detects Early Leaflet Calcification 3 Years After Transcatheter Aortic Valve Replacement.

JACC Cardiovasc Interv 2021 Jan;14(2):e17-e20

Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.jcin.2020.12.003DOI Listing
January 2021

Analysis of Speech Fundamental Frequencies for Different Tasks in Japanese.

J Voice 2021 Jan 14. Epub 2021 Jan 14.

Tokyo Voice Center, International University of Health and Welfare, Tokyo 107-0052, Japan; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Tokyo 107-0052, Japan.

Purpose: Speech fundamental frequency (SFF) assessment is essential for all dysphonia patients to effectively evaluate the therapeutic effects of voice therapy, especially in patients with disturbances in their voice pitch due to mutational dysphonia, Reinke's edema, or as side effects of hormone therapy. A standard method of SFF measurement remains unknown. Speech tasks such as sustained vowel phonation, counting, reading passage, and spontaneous speech have generally been used for SFF measurements. Ideally, spontaneous speech best reflects SFF; however, this task has not yet been clearly defined and is limited with regard to its adaptation to a clinical setting. A reliable task for SFF measurement in Japanese, which corresponds to a speech task that most closely reflects the value that would be observed with typical spontaneous speech, has not been investigated. This study aimed to identify a reliable speech task by measuring the SFF values elicited by different widely used speech tasks in Japanese, and assess its reliability and coefficient of determination (R).

Methods: Sixty healthy volunteers (30 men and 30 women; aged 19-30 years; mean age 22.5 years) were enrolled. All experimental procedures were performed in Japanese. The SFF values for the speech tasks were determined through the voice samples recorded using a Pulse Code Modulation (PCM) recorder. Each task, except spontaneous speech, was repeated five times, and the average fundamental frequency in each task was determined as the SFF. To assess the reliability of the SFF values across daily variations within individual speakers, the SFF measurements were repeated on two different days, separated by at least 1 week.

Results: The SFF values of sustained /a/ phonation, sustained vowel-average, counting, reading passage, and spontaneous speech had excellent reliability, in terms of their reproduction based on intraclass correlation. Significantly high SFF values were observed, in decreasing order, for sustained vowels-average, counting, reading passage, and spontaneous speech in both males and females. The highest R for spontaneous speech was that of reading passage in both males (R = 0.771) and females (R = 0.806) (P < 0.01).

Conclusion: When spontaneous speech was presented as a task most reflective of daily conversation, reading passage was determined to be the reliable task to assess the therapeutic effect of voice therapy in Japanese.
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http://dx.doi.org/10.1016/j.jvoice.2020.12.021DOI Listing
January 2021

Interleukin-1β in peripheral monocytes is associated with seizure frequency in pediatric drug-resistant epilepsy.

J Neuroimmunol 2021 Mar 7;352:577475. Epub 2021 Jan 7.

Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo 160-0023, Japan.

In this study, we assessed circulating immune cells and plasma cytokine levels in 15 pediatric patients with drug-resistant epilepsy (DRE). DRE patients had a significantly higher percentage of CD14 monocytes positive for IL-1β, IL-1 receptor antagonist, IL-6, and TNF-α than controls. Significantly higher intracellular levels of IFN-γ in CD4 T cells and NK cells were also found in DRE patients. The level of IL-1β CD14 monocytes correlated with seizure frequency, and intracellular levels of IFN-γ in NKT-like cells were negatively correlated with the duration of epilepsy. Peripheral immune cells might be involved in the pathogenesis of DRE.
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http://dx.doi.org/10.1016/j.jneuroim.2021.577475DOI Listing
March 2021

Late kidney injury after transcatheter aortic valve replacement.

Am Heart J 2021 Apr 14;234:122-130. Epub 2021 Jan 14.

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.

Background: Information on early to late-phase kidney damage in patients who underwent transcatheter aortic valve replacement (TAVR) is scarce. We aimed to identify the predictive factors for late kidney injury (LKI) at 1-year and patient prognosis beyond 1-year after TAVR.

Methods: We retrospectively reviewed 1,705 patients' data from the Japanese TAVR multicenter registry. Acute kidney injury (AKI) and LKI, defined as an increase of at least 0.3 mg/dL in creatinine level, a relative 50% decrease in kidney function from baseline to 48 hours and 1-year, were evaluated. The patients were categorized into the 4 groups as AKI-/LKI- (n = 1.362), AKI+/LKI- (n = 95), AKI-/LKI+ (n = 199), and AKI+/LKI+ (n = 46).

Results: The cumulative 3-year mortality rates were significantly increased across the four groups (12.5%, 15.8%, 24.6%, 25.8%, P < .001). Multivariate analysis revealed that chronic kidney disease, coronary artery disease, periprocedural AKI, and heart failure-related re-admission within 1-year were significantly associated with LKI. The Cox regression analysis revealed that AKI-/LKI+ and AKI+/LKI+ were independent predictors of increased late mortality beyond 1-year after TAVR (P = .001 and P = .01).

Conclusions: LKI was influenced by adverse cardio-renal events and was associated with increased risks of late mortality beyond 1-year after TAVR.
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http://dx.doi.org/10.1016/j.ahj.2021.01.007DOI Listing
April 2021

Importance of endothelial Hey1 expression for thoracic great vessel development and its distal enhancer for Notch-dependent endothelial transcription.

J Biol Chem 2020 12;295(51):17632-17645

Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan; Graduate School of Medical Sciences, Nara Medical University, Kashihara, Nara, Japan. Electronic address:

Thoracic great vessels such as the aorta and subclavian arteries are formed through dynamic remodeling of embryonic pharyngeal arch arteries (PAAs). Previous work has shown that loss of a basic helix-loop-helix transcription factor Hey1 in mice causes abnormal fourth PAA development and lethal great vessel anomalies resembling congenital malformations in humans. However, how Hey1 mediates vascular formation remains unclear. In this study, we revealed that Hey1 in vascular endothelial cells, but not in smooth muscle cells, played essential roles for PAA development and great vessel morphogenesis in mouse embryos. Tek-Cre-mediated Hey1 deletion in endothelial cells affected endothelial tube formation and smooth muscle differentiation in embryonic fourth PAAs and resulted in interruption of the aortic arch and other great vessel malformations. Cell specificity and signal responsiveness of Hey1 expression were controlled through multiple cis-regulatory regions. We found two distal genomic regions that had enhancer activity in endothelial cells and in the pharyngeal epithelium and somites, respectively. The novel endothelial enhancer was conserved across species and was specific to large-caliber arteries. Its transcriptional activity was regulated by Notch signaling in vitro and in vivo, but not by ALK1 signaling and other transcription factors implicated in endothelial cell specificity. The distal endothelial enhancer was not essential for basal Hey1 expression in mouse embryos but may likely serve for Notch-dependent transcriptional control in endothelial cells together with the proximal regulatory region. These findings help in understanding the significance and regulation of endothelial Hey1 as a mediator of multiple signaling pathways in embryonic vascular formation.
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http://dx.doi.org/10.1074/jbc.RA120.015003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762959PMC
December 2020

Scrub typhus mimicking the clinical course of infectious mononucleosis: a case report.

J Rural Med 2021 Jan 5;16(1):62-66. Epub 2021 Jan 5.

Department of Surgery, Hitachiomiya Saiseikai Hospital, Japan.

Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed. Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface. After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization. We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.
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http://dx.doi.org/10.2185/jrm.2020-037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788302PMC
January 2021

Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis.

Laryngoscope 2021 Jan 9. Epub 2021 Jan 9.

Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan.

Objectives/hypothesis: Vertical locations of vocal fold mucosal lesions (VFMLs) vary along the free edge. As the vertical contact area of vocal folds (VFs) depends on the vocal register, lesions may occur in the contact area of more frequently used vocal registers. This study investigated the cause of location variations by comparing the vertical sites of VFMLs in singers of both sexes with different music genres.

Study Design: Retrospective review.

Methods: Sixty professional classical and rock singers (11 male classical [M-classical], 22 male rock [M-rock], 13 female classical [F-classical], and 14 female rock [F-rock] singers) who underwent microlaryngeal surgery for VF polyps and nodules and their 108 lesions were enrolled. The VF free edge was vertically divided into three equal parts and classified into the following four lesion sites: upper, middle, lower, and multiple sites.

Results: Upper lesions were most common among F-classical singers (73.9%), whereas lower lesions were most common among M-classical (90.0%) and M-rock (60.6%) singers. Among lesions localized to a single site, lower lesions were most common among F-rock singers (37.0%). F-classical singers had significantly more upper lesions than the other groups (P < .001). M-classical singers had significantly more lower lesions than female singers of any genre (P < .001).

Conclusion: Upper lesions were most common among F-classical singers who mostly used the head voice. Lower lesions were most common among singers who mainly used the modal voice. This study suggests that sex, the dominant vocal register used for singing, and mechanical stress on VFs influence the vertical site of VFMLs.

Level Of Evidence: 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29378DOI Listing
January 2021