研究者詳細 - 大西　浩文

論文 - 大西　浩文

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Prevalence and clinical characteristics of degenerative mitral stenosis

Yasuyuki Ukita, Satoshi Yuda, Hideaki Sugio, Ayaka Yonezawa, Yuka Takayanagi, Hitomi Masuda-Yamamoto, Node Tanaka-Saito, Hirofumi Ohnishi, Tetsuji Miura

JOURNAL OF CARDIOLOGY ( ELSEVIER SCIENCE BV ) 68 ( 3-4 ) 248 - 252 2016年09月 [査読有り]

Background: Degenerative mitral stenosis (DMS) is found in the elderly population. However, there are a few reports regarding the prevalence rate of DMS and, its clinical characteristics. The aim of this study was to determine the relationship between age, gender, and the prevalence rate of DMS. Methods: Patients with DMS and rheumatic mitral stenosis (RMS) were searched retrospectively in consecutive patients who underwent echocardiography from January 2011 to December 2013 in a community hospital. DMS was defined as presence of both turbulent antegrade flow with a mean transmitral pressure gradient (PG) of >= 2 mmHg and mitral annular calcification without restriction of leaflets tip motion. Results: We identified 19 patients (17 female and 2 male) with DMS (0.22%) and 19 patients with RMS in 8683 patients. The prevalence rate of DMS significantly increased with aging, especially in patients >90 years old. There was no significant difference in the prevalence rates of RMS among the age groups. Patients with DMS were older (86 +/- 8 years vs. 73 +/- 10 years, p < 0.01) and had higher rates of hypertension and aortic stenosis, larger left ventricular mass index, and mean PG of aortic valve, smaller aortic valve area, less degree of left atrial dilatation, and lower rate of atrial fibrillation, compared with those values in patients with RMS. Conclusions: DMS is rare (0.22%) and almost exclusively found in females in routine echocardiography. The prevalence of DMS increases with aging to 2.5% in patients >90 years of age, and DMS is often associated with aortic valve stenosis. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Pulmonary vascular resistance estimated by Doppler echocardiography predicts mortality in patients with interstitial lung disease

Kenji Yasui, Satoshi Yuda, Kiyoshi Abe, Atsuko Muranaka, Mitsuo Otsuka, Hirofumi Ohnishi, Akiyoshi Hashimoto, Hiroki Takahashi, Kazufumi Tsuchihashi, Hiroki Takahashi, Satoshi Takahashi, Tetsuji Miura

JOURNAL OF CARDIOLOGY ( ELSEVIER SCIENCE BV ) 68 ( 3-4 ) 300 - 307 2016年09月 [査読有り]

Background: Pulmonary hypertension (PH) is a strong predictor of mortality in patients with interstitial lung disease (ILD). However, patients with ILD often have poor outcomes even in the absence of PH. Pulmonary vascular resistance (PVR) assessed by right heart catheterization is a predictor of mortality in patients with ILD. However, the clinical utility of PVR assessed by Doppler echocardiography (PVRecho) as a predictor of the outcome in patients with ILD remains unclear. The aim of this study was to examine whether PVRecho independently predicts mortality in patients with ILD. Methods: Echocardiographic examinations were performed in 133 consecutively enrolled patients with ILD (age, 67 +/- 9 years; 53% men). Tricuspid annular plane systolic excursion (TAPSE) was measured, and PVRecho was calculated by the following formula: PVRecho = [TRV x 10/time-velocity integral of right ventricular outflow (RVOT-VTI)] + 0.16. Data for parameters of pulmonary functional tests and for serum biomarkers, which were measured within 3 months before or after the echocardiographic examinations, were collected. Results: During a mean follow-up period of 18 +/- 7 months, 13 patients died due to respiratory failure (n = 10), heart failure (n = 1), or unknown causes (n = 2). In univariate analysis, body mass index, idiopathic pulmonary fibrosis, use of an antifibrotic drug (AD), RVOT-VTI, PVRecho, percentage of predicted vital capacity (%VC), percentage of predicted forced expiratory volume in 1 second, and percentage of predicted diffusion capacity of the lungs for carbon monoxide (%DLco), but not TAPSE or serum biomarkers, were significantly associated with mortality. Cox proportional hazard multivariate analysis indicated that %VC [hazard ratio (HR): 0.92, p = 0.001], use of AD (HR: 4.05, p = 0.043), and PVRecho (HR: 3.79, p = 0.029) independently predict mortality in patients with ILD. Replacement of %VC with %DLco in the multivariate analysis did not change the results: %DLco (HR: 0.90, p = 0.001), use of AD (HR: 7.53, p = 0.029), and PVRecho (HR: 3.65, p = 0.020). Conclusions: In addition to parameters of pulmonary function tests and use of AD, increased PVRecho is an independent predictor of mortality in patients with ILD who were evaluated for screening of PH by echocardiography. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Independent Link Between Levels of Proprotein Convertase Subtilisin/Kexin Type 9 and FABP4 in a General Population Without Medication

Masato Furuhashi, Akina Omori, Megumi Matsumoto, Yu Kataoka, Marenao Tanaka, Norihito Moniwa, Hirofumi Ohnishi, Hideaki Yoshida, Shigeyuki Saitoh, Kazuaki Shimamoto, Tetsuji Miura

AMERICAN JOURNAL OF CARDIOLOGY ( EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC ) 118 ( 2 ) 198 - 203 2016年07月 [査読有り]

Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to and degrades the low density lipoprotein (LDL) receptor, leading to hypercholesterolemia and cardiovascular risk. Fatty acid binding protein 4 (FABP4/adipocyte FABP/aP2) is secreted from adipocytes in association with lipolysis, and circulating FABP4 has been reported to act as an adipokine for the development of insulin resistance and atherosclerosis. Elevated serum FABP4 level is associated with obesity, insulin resistance, dyslipidemia, and atherosclerosis. In this study, we examined the association between circulating levels of FABP4 and PCSK9 in a general population. A total of 265 subjects (male/female: 98/167) who were not on medication were recruited from subjects of the Tanno-Sobetsu Study, and concentrations of FABP4 and PCSK9 were measured. The level of FABP4, but not that of PCSK9, showed a gender difference, being higher in women than in men. FABP4 level was independently associated with gender, adiposity, renal dysfunction, and levels of cholesterol and PCSK9. There was a significant and gender different correlation between PCSK9 level and age: negatively in men (r = 0.250, p = 0.013) and positively in women (r = 0.183, p = 0.018). After adjustment of age, gender, and LDL cholesterol level, PCSK9 level was positively and independently correlated with FABP4 concentration. In conclusion, PCSK9 level is differentially regulated by gender during aging. Circulating FABP4 is independently associated with the PCSK9 level, suggesting that elevation of FABP4 level as an adipokine leads to dyslipidemia through increased PCSK9 level and subsequent degradation of the LDL receptor. (C) 2016 Elsevier Inc. All rights reserved.

Double balloon protection during carotid artery stenting for vulnerable carotid stenosis reduces the incidence of new brain lesions

Masahito Nakazaki, Tadashi Nonaka, Akira Takahashi, Yasuyuki Yonemasu, Tatsufumi Nomura, Toshiyuki Onda, Osamu Honda, Yuji Hashimoto, Hirofumi Ohnishi, Masanori Sasaki, Masahiko Daibo, Osamu Honmou

ACTA NEUROCHIRURGICA ( SPRINGER WIEN ) 158 ( 7 ) 1377 - 1386 2016年07月 [査読有り]

The use of distal filter protection alone is associated with a high risk of ischemic complications when vulnerable carotid stenosis is treated by carotid artery stenting (CAS). Double balloon protection, a combination of distal balloon protection and proximal balloon occlusion, can be utilized. We assessed the outcome and complications of the double balloon protection method for vulnerable carotid stenosis. Among 130 patients who underwent CAS from 2009 to 2014, we enrolled the following patients: those whose target lesion was vulnerable as evaluated by MRI, i.e., a signal ratio of plaque to posterior cervical muscle on T1-weighted images before CAS of a parts per thousand yen1.5, and those who underwent diffusion-weighted imaging (DWI) studies within 48 h after the procedure. Ninety patients were enrolled. We investigated DWI findings of the double balloon protection group compared with those of the simple distal balloon protection and distal filter protection groups. Sixty-four patients (71 %) underwent double balloon protection, 15 patients (17 %) simple distal balloon protection, and 11 patients (12 %) distal filter protection. Symptomatic embolic complications and new lesions on DWI after CAS were significantly less common in patients undergoing double balloon protection compared to distal balloon protection or distal filter protection (0 % vs. 20 %, 9 %, P < 0.01, and 30 % vs. 67 %, 82 %, P < 0.01, respectively). Logistic regression analysis also identified the odds ratio of double balloon protection for new lesions on DWI after CAS of 0.23 (95 % confidence interval: 0.07-0.70, P < 0.01) compared to simple distal protections. In the patients who underwent CAS for vulnerable carotid stenosis, double balloon protection was an independent significant factor associated with a reduction in the risk of new lesions on DWI after the procedure compared to conventional distal protections.

Analysis of resources assisting in coping with swallowing difficulties for patients with Parkinson's disease: a cross-sectional study

Aiko Matsushima, Junichi Matsushima, Akihisa Matsumoto, Fumio Moriwaka, Sanae Honma, Kazunori Itoh, Keiko Yamada, Shun Shimohama, Hirofumi Ohnishi, Mitsuru Mori

BMC HEALTH SERVICES RESEARCH ( BIOMED CENTRAL LTD ) 16 276 2016年07月 [査読有り]

Background: Malnutrition induced by swallowing difficulties (SD) impairs the quality of life and gives rise to SD-related costs in Parkinson's disease (PD) patients. With results of a swallowing difficulty questionnaire and data of resources specifically obtained such as SD-related costs, caregivers, and dietary therapies, this study is to suggest statistically supported ideas for improvements in arrangements for how participants cope with SD and maintain general well-being. Methods: We interviewed 237 PD patients. The SD-related costs involved those incurred by the provision of dietary modifications, care oriented foods, alternatives, and supplements. Dietary therapies included rice porridge and commercially available care foods. The relationships between BMI (body mass index) and the severity of SD assumed in this paper as indicators for general well-being and as resources for coping with SD for PD patients were statistically analyzed. Results: A lower BMI was found in participants eating porridge consistency rice (p = 0.003) and eating porridge rice is significantly related to the severity of SD (p < 0.0001) and PD (p = 0.002). The severity of SD increased with age and PD duration (p = 0.035, p = 0.0005). Outlays for dietary modifications are the lowest reported here (p < 0.004) but the number of participants using dietary modifications is the largest among the SD-related items (n = 58). Eating care foods were reported for 11 older participants (p < 0.0001), most female (10/11). No lower BMI was found in participants eating care foods when compared with participants eating ordinary foods. Dietary modifications were performed by caregivers (OR: 6.8, CI: 3.1-15.2, p < 0.0001) and were related to the presence of children (OR: 3.4, CI: 1.2-11.4. p = 0.024). Older participants commonly live with spouses and children. Conclusions: Severe SD is associated with higher costs of coping with SD. A lower BMI is associated with modified foods, mostly eaten to cope with SD. Presence of caregivers and other persons residing with the participants here are related to dietary modifications but not to care food-related costs. Care foods may be effective in preventing malnutrition although the number who are able to cover the added expenses is limited because of the higher prices and shortage of information on the usefulness of care foods.

Combination of type 2 diabetes and smoking increases total cancer mortality in Japanese men using competing risk analysis: the Tanno-Sobetsu study

Hirofumi Ohnishi, Shigeyuki Saitoh, Hiroshi Akasaka, Tetsuaki Furukawa, Mitsuru Mori, Tetsuji Miura

Diabetology International ( Springer Tokyo ) 7 ( 2 ) 167 - 172 2016年06月 [査読有り]

Aims: We assessed the impact of the combination of type 2 diabetes (T2DM) and smoking on total cancer mortality using cohort data of a general Japanese population. Methods: Of 1908 residents who received health checkups in two towns in 1994, 794 males were included as study participants. Smoking status was defined as three categories: never smoker, ex-smoker and current smoker. Individuals with T2DM were defined as individuals with fasting plasma glucose ≥7.0 mmol/l and/or receiving medication for T2DM. Participants were divided into six groups according to T2DM and smoking status: non-DM (NDM) and never smoker, NDM and ex-smoker, NDM and current smoker, DM and never smoker, DM and ex-smoker, and DM and current smoker groups. All participants were followed up for a maximum of 13 years. We calculated the hazard ratio (HR) using Cox’s proportional hazard model and subhazard ratio (SHR) using competing risk regression analyses in each group. Results: During the follow-up period, there were 169 all-cause deaths (62 cancer deaths and 40 CVD deaths). When using Cox regression analysis, HRs were higher in the ex-smoker and current smoker groups than in the never-smoker group, and HRs were also higher in the DM groups than in the NDM groups. When using competing risk analysis, SHRs were almost the same as the HRs of Cox regression analysis (DM and ex-smoker 6.06, DM and current smoker 10.12). Conclusions: The combination of T2DM and smoking is a strong risk factor for total cancer mortality in Japanese men.

Impact of use of angiotensin II receptor blocker on all-cause mortality in hemodialysis patients: prospective cohort study using a propensity-score analysis

Marenao Tanaka, Tomohisa Yamashita, Masayuki Koyama, Norihito Moniwa, Kohei Ohno, Kaneto Mitsumata, Takahito Itoh, Masato Furuhashi, Hirofumi Ohnishi, Hideaki Yoshida, Kazufumi Tsuchihashi, Tetsuji Miura

CLINICAL AND EXPERIMENTAL NEPHROLOGY ( SPRINGER ) 20 ( 3 ) 469 - 478 2016年06月 [査読有り]

It is controversial whether treatment with an angiotensin II receptor blocker (ARB) or a calcium channel blocker (CCB) improves prognosis of hemodialysis (HD) patients. This study was designed as a multicenter prospective cohort study. HD patients (n = 1071) were enrolled from 22 institutes in January 2009 and followed up for 3 years. Patients with missing data, kidney transplantation or retraction of consent during the follow-up period (n = 204) were excluded, and 867 patients contributed to analysis of mortality. Propensity score (PS) for use of ARB and that for CCB was calculated using a multiple logistic regression model. ARB and CCB were prescribed in 45.6 and 54.7 % of patients at enrollment. During the 3-year follow-up period, all-cause mortality and cardiovascular mortality rates were 18.8 and 5.1 %, respectively. Kaplan-Meier curves showed that all-cause and cardiovascular mortality rates were lower in the ARB group than in the non-ARB group, though the mortality rates were similar in the CCB group and non-CCB group. In PS-stratified Cox regression analysis, ARB treatment was associated with 34 and 45 % reduction of all-cause death and cardiovascular death, respectively. In PS matching analysis, ARB treatment was associated with a significant reduction (46 % reduction) in the risk of all-cause death. A significant impact of CCB treatment on all-cause or cardiovascular mortality was not detected in PS analysis. The use of an ARB, but not a CCB, is associated with reduced all-cause and cardiovascular mortalities in patients on HD.

Weight gain and alcohol drinking associations with breast cancer risk in Japanese postmenopausal women - results from the Japan collaborative cohort (JACC) study

Junichi Nitta, Masanori Nojima, Hirofumi Ohnishi, Mitsuru Mori, Kenji Wakai, Sadao Suzuki, Yoshihisa Fujino, Yingsong Lin, Koji Tamakoshi, Akiko Tamakoshi

Asian Pacific Journal of Cancer Prevention ( Asian Pacific Organization for Cancer Prevention ) 17 ( 3 ) 1437 - 1443 2016年04月 [査読有り]

Background: We investigated four factors, height, weight gain since age 20, physical activity, and alcohol drinking, for associations with risk of breast cancer (BC) according to menopausal status, using the latest data of the Japan Collaborative Cohort Study (JACC Study). Materials and Methods: We confined the analysis to 24 areas available of cancer incidence information, excluding women with a previous diagnosis of BC. Baseline data were collected from 38,610 (9,367 premenopausal, and 29,243 postmenopausal) women during 1988 and 1990. The study subjects were followed-up at the end of 2009, and 273 (84 premenopausal, and 189 postmenopausal) cases of BC were newly diagnosed in 501,907 person-years. The Cox model was used to estimate a hazards ratio (HR) and its 95% confidence interval (CI) of BC risk. Results: As a result of the multivariate analysis adjusting for age at baseline survey, age at menarche, number of live births, and, age at first delivery, weight gain since age 20 of 6.7 kg-9.9 kg, and ≥10.0 kg were significantly associated with increased risk for postmenopausal BC (HR=2.48, 95% CI 1.40-4.41, and, HR=2.94, 95% CI 1.84-4.70, respectively). Significantly increased trend of BC risk was also observed in weight gain since age 20 (p for trend, p < 0.001). Amount of ethanol intake per day≥15.0 g was significantly associated with increased risk for postmenopausal BC in the multivariable-adjusted analysis (HR=2.74, 95% CI 1.32-5.70). Conclusions: Higher weight gain in adulthood and larger amounts of ethanol intake were significantly associated with increased risk of BC in Japanese postmenopausal women. None of the investigated factors were significantly associated with BC risk in Japanese premenopausal women.

A Cross-Sectional Study on Socioeconomic Systems Supporting Outpatients With Parkinson's Disease in Japan

Aiko Matsushima, Akihisa Matsumoto, Fumio Moriwaka, Sanae Honma, Kazunori Itoh, Keiko Yamada, Shun Shimohama, Hirofumi Ohnishi, Junichi Matsushima, Mitsuru Mori

JOURNAL OF EPIDEMIOLOGY ( JAPAN EPIDEMIOLOGICAL ASSOC ) 26 ( 4 ) 185 - 190 2016年04月 [査読有り]

Objectives: We conducted a cross-sectional study to evaluate the socioeconomic systems supporting outpatients with Parkinson's disease (PD) in Japan. Methods: The study was performed in 2013 at two private hospitals and one clinic in Hokkaido Prefecture, Japan. A survey was conducted with 248 consecutive PD patients, and the data from 237 PD outpatients were analyzed after excluding 11 patients who did not meet inclusion criteria. Monthly medical and transportation payments as a PD outpatient were selected as outcome variables, and their association with various explanatory variables, such as utilization of support systems for PD outpatients, were evaluated using logistic regression model analysis. Results: After controlling for potential confounding variables, the utilization of the system providing financial aid for treatment for patients with intractable disease was significantly inversely associated with monthly medical payment among PD outpatients (OR 0.46; 95% CI, 0.22-0.95). Experience of hospital admission for PD treatment was significantly positively associated with monthly transportation payment (OR 4.74; 95% CI, 2.18-10.32). Monthly medical payment was also significantly positively associated with monthly transportation payment (OR 4.01; 95% CI, 2.23-7.51). Conclusions: Use of Japanese public financial support systems may be associated with reductions in medical payments for PD outpatients. However, those systems may not have supported transportation payments, and higher transportation payments may be associated with an increased risk of hospitalization.

Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank

Kei Miyata, Hirofumi Ohnishi, Kunihiko Maekawa, Takeshi Mikami, Yukinori Akiyama, Satoshi Iihoshi, Masahiko Wanibuchi, Nobuhiro Mikuni, Shuji Uemura, Katsutoshi Tanno, Eichi Narimatsu, Yasufumi Asai

JOURNAL OF NEUROSURGERY ( AMER ASSOC NEUROLOGICAL SURGEONS ) 124 ( 2 ) 527 - 537 2016年02月 [査読有り]

OBJECTIVE In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. METHODS Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in -hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. RESULTS From each group, 141 patients were extracted using the PS -matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log -rank test using Kaplan -Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional -hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. CONCLUSIONS There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures.

Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

Akira Okayama, Nagako Okuda, Katsuyuki Miura, Tomonori Okamura, Takehito Hayakawa, Hiroshi Akasaka, Hirofumi Ohnishi, Shigeyuki Saitoh, Yusuke Arai, Yutaka Kiyohara, Naoyuki Takashima, Katsushi Yoshita, Akira Fujiyoshi, Maryam Zaid, Takayoshi Ohkubo, Hirotsugu Ueshima

BMJ OPEN ( BMJ PUBLISHING GROUP ) 6 ( 7 ) e011632 2016年 [査読有り]

Objectives: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. Setting: Prospective cohort study. Participants: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. Primary outcome measures: Mortality from total and subtypes of stroke, CVD and all causes. Results: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. Conclusions: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

Does a Reduction in the Glomerular Filtration Rate Increase the Overall Severity of Coronary Artery Stenosis?

Junichi Nishida, Nobuaki Kokubu, Mina Kawamukai, Akiyoshi Hashimoto, Hirofumi Ohnishi, Hidemichi Kouzu, Yoshito Ohnuma, Tohru Hasegawa, Akihito Tsuchida, Tetsuji Miura

INTERNAL MEDICINE ( JAPAN SOC INTERNAL MEDICINE ) 55 ( 8 ) 871 - 877 2016年 [査読有り]

Objective Chronic kidney disease is a risk factor of coronary events, however, its impact on coronary artery stenosis has not yet been clarified with the use of a large database. We examined the association between a reduced glomerular filtration rate (GFR) and the overall severity of coronary stenosis. Methods We enrolled 1,150 patients [mean age, 68 +/- 12 (SD) years; 66.6% men] who consecutively underwent coronary angiography for suspected stable angina pectoris. The overall severity of stenosis in the coronary arteries was assessed by the Gensini score (GS), and its logarithmic values (log-GS) were used for statistical analyses since the GS does not follow a normal distribution. Results The log-GS was significantly larger in men than in women (2.5 +/- 1.5 vs. 1.9 +/- 1.7), while the estimated GFR (eGFR) and comorbidities were comparable between both sexes. A multivariate regression analysis indicated that age, smoking, eGFR, HDL-cholesterol and HbA1c were independent explanatory variables of the log-GS in men, although the eGFR explained only 1.2% of the log-GS variation. In women, the eGFR was not included in the significant explanatory variables shown by the multivariate analysis. However, the sex difference in the regression for the eGFR-log-GS relationship was not statistically significant. Conclusion A reduced eGFR is a significant, but minor, determinant of the overall severity of coronary artery stenosis in men and potentially women.

Factors influencing attitudes toward end-of-life care by care workers at special nursing homes for the elderly: A Cross-sectional study in Japan

山本道代, 大西浩文, 大浦麻絵, 山本武志, 和泉比佐子, 鈴村美和, 森満

札幌医学雑誌 ( 札幌医科大学 ) 84 ( 1-6 ) 27 - 33 2015年12月

Objectives: The purpose of this study was to clarify factors influencing care workers' attitudes toward end-of-life (EOL) care characteristics at special nursing homes (SNHs). Methods: A questionnaire was initially sent to 630 care workers at 19 SNHs in October 2012. Written informed consent was obtained from 253 of these workers (40.2%), who then completed and returned the questionnaires. Participants were asked to reply to questions covering demographic data, work environment, depression status, experiences/education concerning EOL, communication skills, and attitudes toward EOL care. The Japanese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-J) assessment instrument was used in the analysis of the data received. Using the median value of the FATCOD-B-J score, 130 subjects were allocated to the high score (HS) group (FATCOD-B-J?23) and 123 to the low score (LS) group (FATCOD-B-J<23). In the LS group, the odds ratios (ORs) and their 95% confidence intervals (95% CIs) of participants exhibiting relatively negative attitudes toward EOL care were calculated and adjusted for potential confounding factors using multivariate logistic regression model analysis. Results: Length of employment in the facilities of between 5 and 9 years (OR 0.37, 95% CI 0.16-0.87) as well as over 10 years (OR 0.39, 95% CI 0.16-0.96) was significantly associated with a decreased risk of placement in the LS group. Furthermore, moderate (OR 0.44, 95% CI 0.24-0.80) as well as high (OR 0.35, 95%CI 0.17-0.75) communication skills in accepting other opinions, were significantly associated with decreased risk of placement in the LS group. Conclusions: After adjustments for potential confounding variables, results indicated that extended experience as a care worker and higher communication skills in accepting other opinions were significantly associated with a reduced risk of negative attitudes toward EOL care.

Oncological benefit of primary tumor resection with high tie lymph node dissection in unresectable colorectal cancer with synchronous peritoneal metastasis: a propensity score analysis of data from a multi-institute database

Tomohisa Furuhata, Kenji Okita, Toshihiko Nishidate, Koichi Hirata, Hirofumi Ohnishi, Hirotoshi Kobayashi, Kenjiro Kotake, Kenichi Sugihara

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY ( SPRINGER JAPAN KK ) 20 ( 5 ) 922 - 927 2015年10月 [査読有り]

Peritoneal metastasis is recognized as a predictor of poor prognosis in patients with colorectal cancer, and whether surgical intervention for peritoneal metastasis has any clinical benefit has remained controversial. The purposes of this study were to identify prognostic factors in cases of unresectable colorectal cancer with synchronous peritoneal metastasis and to clarify the impacts of primary tumor resection with high tie lymph node dissection. A multi-institutional retrospective analysis was conducted of 579 patients who underwent resection of the primary tumor for unresectable colorectal cancer with peritoneal metastasis between 1991 and 2007. For these 579 patients, clinicopathological variables were analyzed for prognostic significance using Cox proportional hazards model and propensity score analysis to mitigate the selection bias. Multivariate analysis revealed hematogenous metastasis (p < 0.001), histology of the tumor (p = 0.006), postoperative chemotherapy (p < 0.001), and lymph node dissection (p = 0.001) as independent prognostic factors. In the propensity-matched cohort, patients treated with high tie lymph node dissection showed a significantly better overall survival than those with low tie lymph node dissection (median overall survival 13.0 vs. 11.5 months; p = 0.041). It is suggested that primary tumor resection with high tie lymph node dissection favorably affects survival, even in unresectable colorectal cancer with peritoneal metastasis.

Relationship of serum isoflavone, insulin and adiponectin levels with breast cancer risk

Machiko Minatoya, Goro Kutomi, Sumiyo Asakura, Seiko Otokozawa, Yukiko Sugiyama, Hirofumi Ohnishi, Hiroshi Akasaka, Tetsuji Miura, Mitsuru Mori, Koichi Hirata

BREAST CANCER ( SPRINGER JAPAN KK ) 22 ( 5 ) 452 - 461 2015年09月 [査読有り]

Background Obesity is one of the well-known risk factors of breast cancer. Accumulating evidence suggests that adiponectin, an obesity-related hormone, is inversely associated with breast cancer risk, particularly in postmenopausal women. Obesity is also associated with high levels of insulin. In addition, studies have suggested that the soy isoflavones present in the traditional Japanese diet have been associated with decreased risk of breast cancer. However, there is no study that has assessed associations between serum levels of isoflavones, insulin, adiponectin and the risk of breast cancer all together with menopausal status. Methods In a case-control study of 63 histologically confirmed breast cancer patients and 76 controls, serum isoflavone, insulin, and high-molecular-weight (HMW) adiponectin levels and breast cancer risk were examined for their association with breast cancer risk after adjustment for various risk factors. Results Women in the highest tertile of serum HMW adiponectin levels were associated with a statistically significant decreased risk for breast cancer compared with women in the lowest tertile [odds ratio (OR), 0.09; 95 % confidence interval (CI) 0.03-0.33]. This association was observed in postmenopausal women (OR 0.06; 95 % CI 0.01-0.28), but not in premenopausal women. The observed associations were independent of possible effects of insulin, body mass index, and known risk factors for breast cancer. Serum isoflavones and insulin levels were not associated with breast cancer risk. Conclusions This study suggests that high serum HMW adiponectin levels are significantly associated with a decreased risk for breast cancer. Our result support the hypothesis that serum adiponectin may act as a potential biomarker for breast cancer.

Subjective physical and cognitive age among community-dwelling older people aged 75 years and older: differences with chronological age and its associated factors.

Ihira H, Furuna T, Mizumoto A, Makino K, Saitoh S, Ohnishi H, Shimada H, Makizako H

Aging & mental health ( ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD ) 19 ( 8 ) 756 - 761 2015年08月 [査読有り]

Objective: The aim of this cross-sectional study was to determine the associations between self-reported subjective physical and cognitive age, and actual physical and cognitive functions among community-dwelling older people aged 75years and older. Method: The sample comprised 275 older adults aged 75-91years. Two questions were asked regarding subjective age: 'How old do you feel physically?' and 'How old do you feel cognitively?' To assess physical functions, we measured handgrip strength, knee extension strength, standing balance and walking speed. Tests of attention, executive function, processing speed and memory were performed to assess actual cognitive function. Results: Subjective physical and cognitive age was associated with performance on all of the physical and cognitive tests, respectively (p < 0.01). We also found that older adults who reported themselves as feeling older than their chronological age had a slower walking speed and lower scores for word-list memory recall than those who did not report themselves as feeling older than their actual age. Conclusion: These findings suggest that promoting a fast walking speed and good memory function may help to maintain a younger subjective physical and cognitive age in older adults aged 75years and older.

Pneumococcal vaccination reduced the risk of acute otitis media: Cohort study

Junko Hasegawa, Mitsuru Mori, Satoko Showa, Aiko Matsushima, Hirofumi Ohnishi, Takeshi Tsugawa, Yuko Yoto, Hiroyuki Tsutsumi

PEDIATRICS INTERNATIONAL ( WILEY-BLACKWELL ) 57 ( 4 ) 582 - 585 2015年08月 [査読有り]

BackgroundSeven-valent pneumococcal conjugate vaccine (PCV7) was introduced to Japan in 2009, and after that invasive pneumococcal disease has gradually decreased. There are few data, however, on the effectiveness of PCV7 against acute otitis media (AOM) in Japan. MethodsFrom 10 daycare centers in Sapporo, Japan, 614 parents participated in the survey. Each parent reported whether their child subject had received one or more doses of PCV7, and, if so, the exact dates of receiving PCV7 were verified by reviewing their maternal and child health handbooks marked by a pediatrician. AOM was diagnosed by otorhinolaryngologist or pediatrician. Cox's proportional hazard model was used for calculating the hazard ratio (HR) of AOM incidence reduced by PCV7 inoculation. ResultsInoculation of PCV7 significantly reduced the risk of AOM (crude HR, 0.63; 95%CI: 0.50-0.79). Adjusting for potentially confounding variables reduced the risk further (adjusted HR, 0.32; 95%CI: 0.23-0.44). On stratification by subject age on 30 April 2012, PCV7 was significantly associated with a reduced risk of AOM in both infants <3years old, and in children 3years. ConclusionPCV7 is effectiveness in reducing the risk of AOM both in infants <3years old, and in young children 3years in Japan.

Mapping occipital bone thickness using computed tomography for safe screw placement

Tomonori Morita, Tsuneo Takebayashi, Hiroyuki Takashima, Mitsunori Yoshimoto, Kazunori Ida, Katsumasa Tanimoto, Hirofumi Ohnishi, Hiroyoshi Fujiwara, Masateru Nagae, Toshihiko Yamashita

JOURNAL OF NEUROSURGERY-SPINE ( AMER ASSOC NEUROLOGICAL SURGEONS ) 23 ( 2 ) 254 - 258 2015年08月 [査読有り]

OBJECT Safe and effective insertion of occipital bone screws requires morphological analysis of the occipital bone, which is poorly documented in the literature. The authors of this study present morphological data for determining the area of screw placement for optimal internal fixation. METHODS The subjects of this institutional review board approved retrospective study were 105 individuals without head and neck disease who underwent CT imaging at the authors' hospital. There were 55 males and 50 females, with a mean age of 57.1 years (range 20-91 years). Measurements using CT were taken according to a matrix of 55 points following a grid with 1-cm spacing based on the external occipital protuberance (EOP). RESULTS The maximum thickness of the occipital bone was at the level of the EOP at 16.4 mm. Areas with thicknesses > 8 mm were more frequent at the EOP and up to 2 cm in all directions, as well as up to 1 cm in all directions at a height of 1 cm inferiorly, and up to 3 cm from the EOP inferiorly. The male group tended to have a thicker occipital bone than the female group, and the differences were significant around the EOP. The ratio of the trabecular bone to the occipital bone thickness was > 30% in the central region. At positions more than 2 cm laterally, the ratio was < 15%, and the ratio gradually decreased further laterally. CONCLUSIONS Screws that are 8 mm long can be placed in the area extending 2 cm laterally from the EOP at the level of the superior nuchal line and approximately 3 cm inferior to the center. These results suggest that it may be possible to effectively insert a screw over a wider area than the conventional reference range.

The combination of abdominal obesity and high-sensitivity C-reactive protein predicts new-onset hypertension in the general Japanese population: the Tanno-Sobetsu study

Mizue Fujii, Hirofumi Ohnishi, Shigeyuki Saitoh, Hiroshi Akasaka, Tetsuji Miura, Mitsuru Mori

HYPERTENSION RESEARCH ( NATURE PUBLISHING GROUP ) 38 ( 6 ) 426 - 432 2015年06月 [査読有り]

The aim of this study was to examine whether the combination of abdominal obesity and high serum levels of high-sensitivity C-reactive protein (hsCRP) improves the prediction of new-onset hypertension in the general Japanese population. Participants in the Tanno-Sobetsu study, a prospective cohort study, were enrolled. Of 1516 subjects aged 30 years or older in 2002, those with hypertension or abnormal hsCRP levels were excluded, and the remaining 705 subjects were included in the present analyses. Abdominal obesity (AO) and high hsCRP levels were defined by the Japanese criteria of waist circumference and median hsCRP values, respectively. Subjects were followed up on for a maximum of 4.5 years, and the hazard ratio (HR) for new-onset hypertension was calculated using the Cox proportional hazard model. The HR for new-onset hypertension after adjustment for age, sex, fasting plasma glucose, alcohol intake, smoking, treatment for dyslipidemia and high normal blood pressure at baseline was significantly higher in the group with AO and high hsCRP (HR = 1.44, 95% CI: 1.00-2.07) compared with the reference group, a group with no AO and low hsCRP; AO alone or high hsCRP alone was not associated with a significant increase in the HR. Similar trends for the increase in the HR by AO and high hsCRP were observed in separate analyses of men and women, although the differences did not reach statistical significance. Co-presence of AO and a high level of hsCRP is associated with a high risk for new-onset hypertension in the general population.

Physical activity changes in the winter in older persons living in northern Japan: a prospective study

Atsushi Mizumoto, Hikaru Ihira, Keitaro Makino, Shigeyuki Saitoh, Hirofumi Ohnishi, Taketo Furuna

BMC GERIATRICS ( BIOMED CENTRAL LTD ) 15 43 2015年04月 [査読有り]

Background: Physical activity affects physical and mental health, prevents disease, and improves quality of life. However, physical activity also decreases with age in older persons, and is affected by adverse climatic periods. This study examined changes in physical activity during the winter season in older persons (>= 75 years of age) who were living in northern Japan, and evaluated the factors that were associated with this decline. Methods: A total of 201 older persons (83 men and 118 women; mean age, 79.7 +/- 3.8 years) participated in two separate tests that were conducted in November 2012 and February 2013. Physical activity was monitored using the Kenz Lifecorder, and mean step counts and moderate-vigorous physical activity (MVPA) times were calculated over a 1-week period. We also measured body mass index, handgrip strength, normal walking speed, functional capacity, exercise habits, snow-shovelling habits, a change in frequency (between early winter and midwinter) of outdoor excursions, the length of outdoor excursions, social support, and morbidity. Results: In the group that maintained their frequency of outdoor excursions, step counts significantly increased during midwinter compared with early winter (p < 0.01). In the group with a lower frequency of outdoor excursions, MVPA was significantly decreased during midwinter compared with early winter (p < 0.05). After adjusting for other variables, logistic regression analysis showed that weakness (odds ratio [OR]: 2.89, p < 0.05) was independently associated with a decline in step counts. Age (OR: 1.12, p < 0.05) and a change in frequency of outdoor excursions (OR: 0.75, p < 0.01) were independently associated with a decline in MVPA. Conclusions: Older persons should be supported in their attempts to go outdoors during midwinter. They should be provided with intervention programs to increase their physical activity at home.

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