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  • 1
    In: Cardiology, S. Karger AG, Vol. 122, No. 1 ( 2012), p. 12-19
    Abstract: 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 Despite recent advances in cardiovascular surgery, hyperbilirubinemia after heart valve surgery occurs often and the mechanism is not well clarified. We evaluated the incidence and nature of postoperative hyperbilirubinemia in heart valve surgery patients to analyze its risk factors and to identify its clinical significance for associated morbidity and mortality. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We investigated 334 consecutive patients who underwent heart valve surgery. Postoperative hyperbilirubinemia was defined as total serum bilirubin concentration greater than 3 mg/dl at any postoperative measurement point. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Postoperative hyperbilirubinemia developed in 63 patients (19.0%) and was associated with greater in-hospital mortality (15.9 vs. 1.5%, p 〈 0.01). Univariate analysis revealed congestive heart failure history, cardiogenic shock, infective endocarditis, preoperative liver dysfunction, longer cardiopulmonary bypass time and transfusion as significantly related to postoperative hyperbilirubinemia. In multivariate analysis, preoperative liver dysfunction [odds ratio (OR) 6.5, p 〈 0.05] and longer cardiopulmonary bypass time (OR 1.007, p 〈 0.01) were independent predictors. In postoperative hyperbilirubinemia patients, preoperative New York Heart Association status and history of heart failure were associated with outcome. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Postoperative hyperbilirubinemia remains common in patients undergoing heart valve surgery and is associated with a high rate of in-hospital mortality. For patients with heart failure or liver dysfunction, meticulous operative management is required to reduce cardiopulmonary bypass time and transfusion.
    Type of Medium: Online Resource
    ISSN: 0008-6312 , 1421-9751
    RVK:
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482041-9
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  • 2
    In: Digestion, S. Karger AG
    Abstract: Introduction: Submucosal invasion is a core hallmark of early gastric cancer (EGC) with poor prognosis. However, the molecular mechanism of the progression from intramucosal gastric cancer (IMGC) to early submucosal-invasive gastric cancer (SMGC) is not fully understood. The objective of this study was to identify genes and pathways involved in the submucosal invasion in EGC using comprehensive gene expression analysis. Methods: Gene expression profiling was performed for eight cases of IMGC and eight cases of early SMGC with submucosal invasion ≥500 μm. To validate the findings of gene expression analysis and to examine the gene expression pattern in tissues, immunohistochemical (IHC) staining was performed for 50 cases of IMGC and SMGC each. Results: Gene expression analysis demonstrated that the expression levels of small intestine-specific genes were significantly decreased in SMGC. Among them, defensin alpha 5 (DEFA5) was the most downregulated gene in SMGC, which was further validated in SMGC tissues by IHC staining. Gene set enrichment analysis showed a strong association between SMGC, the JAK-STAT signaling pathway, and the upregulation of STAT3-activating cytokines. The expression of phosphorylated STAT3 was significant in the nucleus of tumor cells in SMGC tissues but not in areas expressing DEFA5. Conclusion: The results of this study strongly suggest that the downregulation of DEFA5 and the activation of STAT3 play a significant role in the submucosal invasion of EGC.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    RVK:
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    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1482218-0
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  • 3
    In: European Neurology, S. Karger AG, Vol. 70, No. 5-6 ( 2013), p. 304-307
    Abstract: 〈 b 〉 〈 i 〉 Aim: 〈 /i 〉 〈 /b 〉 Patients with gynecological neoplasms often suffer ischemic stroke. This study aimed to clarify the underlying mechanisms of ischemic stroke in patients with gynecological tract tumors. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively reviewed 6 patients with gynecologic tumors and hypercoagulability who were being treated for acute ischemic stroke between 2006 and 2012. Diffusion-weighted magnetic resonance imaging (DW-MRI), cardiovascular risk factors including plasma D-dimer levels, and histologic examination of the patients' solid tumors were performed. All 6 patients underwent transesophageal echocardiography (TEE) for nonbacterial thrombotic endocarditis (NBTE) and paradoxical embolism. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 All 6 patients showed elevated plasma D-dimer levels. In 1 patient, paradoxical embolism was diagnosed. In the remaining 5 patients, DW-MRI scans showed numerous lesions in multiple vascular territories, and in 4 of these 5 patients, TEE demonstrated vegetations on the mitral valve, leading to the diagnosis of NBTE. Interestingly, 2 of these 4 patients had benign uterine tumors, whereas the other 2 had ovarian cancer. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 NBTE was the main etiology for ischemic stroke in patients with gynecologic tract tumors and coagulopathy. Both malignant and benign tumors of the gynecologic tract can cause NBTE.
    Type of Medium: Online Resource
    ISSN: 0014-3022 , 1421-9913
    RVK:
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482237-4
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  • 4
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 24, No. 1 ( 2007), p. 35-42
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 There is epidemiological evidence that increased carotid intima-media thickness (IMT) is a predictor of cardiovascular disease (CVD) events. However, the significance of carotid IMT in high-risk patients in whom risk factors are managed clinically has not been adequately investigated. The purpose of this study was to determine the usefulness of carotid IMT measurement in such patients. 〈 i 〉 Methods: 〈 /i 〉 The study comprised 900 outpatients with cardiovascular risk factors or established atherosclerosis. Carotid IMT was calculated as the mean bilateral IMT of the common carotid artery, bifurcation, and internal carotid artery. Baseline vascular risk factors, medications, and history of CVD were recorded at the time of enrollment. The incidence of CVD events was determined prospectively. 〈 i 〉 Results: 〈 /i 〉 During a mean follow-up period of 2.6 years, there were 64 CVD events. The relative risk (RR) of a CVD event increased with increased IMT. Association between CVD events and carotid IMT was significant after adjustment for risk factors and history of CVD, showing an increased risk per IMT tertile from the middle tertile (RR, 2.5; 95% confidence interval [CI]: 1.0–6.3) to the highest (RR, 3.6; 95% CI: 1.4–9.0). When patients with a history of CVD were excluded (n = 574), the predictive value of IMT was significant even after adjustment for risk factors (hazard ratio per 1 SD IMT increase was 1.57 [95% CI: 1.11–2.20] ). 〈 i 〉 Conclusions: 〈 /i 〉 Carotid IMT is an independent predictor of vascular events in high-risk patients in whom risk factors are managed clinically.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482069-9
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  • 5
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 38, No. 5 ( 2014), p. 354-361
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Although the echolucent plaque in carotid stenosis is associated with future ischemic stroke, the predictive value of echogenicity in small and medium size carotid plaques on vascular events has not been thoroughly examined. Thus, we prospectively tested the hypothesis that plaque echogenicity of carotid atheroma can predict the future total cardiovascular events in patients with vascular risk factors. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Ultrasound assessment of carotid intima-media complex thickness (IMT) and plaque echogenicity using integrated backscatter (IBS) analysis was performed in 596 patients aged 40 or more, with any history of vascular events or with at least 1 risk factor, who were enrolled between 2001 and 2006 in the Osaka Follow-up Study for Carotid Atherosclerosis, part 2 (OSACA2). We followed the incidence of total cardiovascular events including cerebrovascular events, coronary heart disease (CHD), and peripheral artery disease (PAD) for 6.4 years. We divided the patients into two groups according to the IBS index above (echorich plaques) and under (echolucent plaque) the median value, and calculated the hazard ratios (HR) of the echolucent group compared with the echogenic group in the risk of cardiovascular events. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among 596 patients, carotid stenosis was found only in 87 patients. During the follow-up period, we observed 121 cardiovascular events including 63 cerebrovascular events, 45 CHD cases, and 13 PAD cases. The patients with incident cardiovascular events had larger plaque thickness and lower IBS index than those without incident vascular events. The relative risk of vascular events for echolucent versus echorich plaques was 1.45 (95% confidence interval [CI] 0.99-2.13, p = 0.058) after adjustment for risk factors and plaque thickness. In patients with plaque size above the median value ( 〉 2.1 mm), the relative risk of vascular events for echolucent plaques was 1.72 (95% CI 1.06-2.85, p = 0.029), but this association was not observed in patients with plaque size 〈 2.0 mm. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The association between echogenicity of carotid plaque and incident vascular events is dependent on the plaque size. Echolucent medium-to-large plaques, but not small plaques, are associated with the risk of future total cardiovascular events. This finding suggests that measurement of echolucency in medium-to-large carotid plaques may improve selection of patients at high risk for total vascular events.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1482069-9
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  • 6
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 27, No. 1 ( 2009), p. 91-98
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Recent studies revealed that inflammation contributes to plaque instability. Cyclo-oxygenase (COX)-2 is one of the key enzymes in plaque inflammation. We examined the relation between a polymorphism in the COX-2 gene and carotid plaque echogenicity in patients with high risk of cerebrovascular disease to evaluate the involvement of COX-2 in plaque instability. 〈 i 〉 Methods: 〈 /i 〉 The study comprised 469 individuals with carotid atherosclerotic plaques. We quantified the echogenicity of the largest plaque in each participant by integrated backscatter analysis. The –765G 〉 C variant of the COX-2 gene was genotyped by restriction enzyme fragment length polymorphism analysis. Urinary 6-keto prostaglandin F 〈 sub 〉 1 〈 /sub 〉 〈 sub 〉 α 〈 /sub 〉 levels and flow-mediated dilation were measured in 25 participants from the –765GC genotype group and 25 matched participants from the –765GG genotype group. 〈 i 〉 Results: 〈 /i 〉 The carotid plaque echogenicity in the variant genotype group (n = 44) was lower than that in the –765GG genotype group (n = 425, p = 0.017). The association remained significant when we controlled for atherosclerotic risk factors, plaque thickness and serum levels of interleukin-6 (p = 0.027). The level of urinary 6-keto prostaglandin F 〈 sub 〉 1 〈 /sub 〉 〈 sub 〉 α 〈 /sub 〉 and flow-mediated dilation in the variant genotype group was significantly lower than that in the –765GG genotype group. 〈 i 〉 Conclusions: 〈 /i 〉 The –765G 〉 C variant of COX-2 was associated with reduced carotid plaque echogenicity in Japanese. Diminished COX-2 activity in the endothelium may contribute to plaque instability.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1482069-9
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  • 7
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 35, No. 2 ( 2013), p. 155-162
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Acute brain infarction affects the timing and regimen of cardiac surgery in patients with infective endocarditis (IE). We aimed to identify preoperative brain MRI characteristics, incidence, and related factors for acute ischemic lesions in left-sided IE patients undergoing cardiac surgery. Furthermore, we investigated whether preoperative acute ischemic lesions are associated with postoperative neurological complications in IE patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively reviewed consecutive patients with a definite left-sided IE who underwent cardiac surgery in 6 university-affiliated hospitals from January 2004 to November 2011. Preoperative brain MRI evaluations were systematically performed on all patients without contraindications, regardless of neurological complications, with the aim of preventing perioperative complications. Patients were included if diffusion-weighted imaging and fluid-attenuated inversion recovery sequences were performed within 14 days after diagnosis. Associations between acute ischemic lesions and related factors were analyzed. Neurological complications within 30 days after surgery were evaluated for postoperative outcome analyses. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 139 consecutive patients with left-sided IE who underwent cardiac surgery, 85 patients were evaluated in this study. The mean age was 58 ± 16 years, and 22 patients (26%) were women. Preoperative MRI revealed acute ischemic lesions in 47 patients (55%), and 19 of these patients developed neurological symptoms. Among the patients with ischemic lesions, 24 (60%) had small lesions ( 〈 10 mm), 36 (77%) had multiple lesions, and 30 (64%) had lesions in multiple vascular territories. Compared to patients without ischemic lesions, patients with acute ischemic lesions were older and had significantly higher white blood cell counts and plasma C-reactive protein (CRP) levels, but lower hemoglobin levels. Logistic regression analyses showed that the white blood cell count and plasma CRP level were independently associated with acute ischemic lesions [adjusted OR per 1-SD increase were 2.21 (95% CI: 1.23-4.35) and 2.33 (95% CI: 1.27-4.96), respectively]. Three patients developed postoperative neurological complications, but preoperative acute ischemic lesions and postoperative complications were not associated. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Preoperative MRI detected a high incidence of asymptomatic ischemic lesions in IE patients. Acute ischemic lesions were often small, multiple, and located in multiple vascular territories. Inflammatory reactions may play an important role in the development of ischemic lesions in IE patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
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  • 8
    In: Digestion, S. Karger AG, Vol. 103, No. 6 ( 2022), p. 411-420
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 〈 i 〉 Helicobacter pylori 〈 /i 〉 eradication is expected to significantly change the prevalence of Barrett’s esophagus (BE). However, few reports on this relationship exist. We analyzed the risk factors of BE using the current consensus on length of BE considering 〈 i 〉 H. pylori 〈 /i 〉 infection status. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analyzed 10,122 individuals (5,962 men; mean age = 52.9 ± 9.9 years) who had undergone esophagogastroduodenoscopy as part of a medical checkup. Correlations among factors including 〈 i 〉 H. pylori 〈 /i 〉 infectious status, endoscopic findings, and BE ≥1 cm were analyzed. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Prevalence of BE, long-segment BE, and esophageal adenocarcinoma was 22.5%, 0.014%, and 0%, respectively. Logistic regression analysis showed that the risk factors for BE were hiatal hernia (odds ratio [OR]: 2.89 [2.59–3.24] ), female sex (OR: 0.52 [0.46–0.59]), social drinking (OR:0.77 [0.68–0.87] ), 〈 i 〉 H. pylori 〈 /i 〉 eradication therapy (OR: 1.34 [1.19–1.51]), proton pump inhibitor (PPI) use (OR: 1.52 [1.18–1.96] ), bile reflux (OR: 1.18 [1.04–1.33]), age ≥50 years (OR: 1.13 [1.02–1.26] ), and nonsteroidal anti-inflammatory drug (NSAID) use (OR: 1.29 [1.02–1.62]). Although reflux esophagitis (RE) was more common in 〈 i 〉 H. pylori 〈 /i 〉 -negative patients (17.2%) than in those after 〈 i 〉 H. pylori 〈 /i 〉 eradication therapy (11.8%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.00001), the latter was correlated with BE, disputing RE as a strong risk factor for BE. Therefore, we conducted a subgroup analysis; most of the risk factors except for PPI use ( 〈 i 〉 p 〈 /i 〉 = 0.75), H2-receptor antagonist use ( 〈 i 〉 p 〈 /i 〉 = 0.078), and atrophic gastritis absence ( 〈 i 〉 p 〈 /i 〉 = 0.72) were positively correlated with BE after 〈 i 〉 H. pylori 〈 /i 〉 eradication therapy compared with 〈 i 〉 H. pylori 〈 /i 〉 -negative status. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 〈 i 〉 H. pylori 〈 /i 〉 eradication, bile reflux, PPI use, and NSAID use were risk factors for BE along with hiatal hernia, male sex, and older age.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    RVK:
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    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1482218-0
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  • 9
    In: Digestion, S. Karger AG, Vol. 98, No. 4 ( 2018), p. 201-208
    Abstract: Background/Aims: Gastroesophageal reflux disease (GERD)-related disorders of systemic sclerosis (SSc) patients have not been adequately investigated. Methods: Sixty-six SSc patients (5 males and 61 females; 56.6 ± 14.6 years old) who underwent esophagogastroduodenoscopy were analyzed on the basis of 16 background factors. They were additionally compared with 116 matched non-SSc subjects controlling age, sex, and use of proton pump inhibitors (PPIs). Results: The mean disease duration of 66 patients was 5.1 ± 8.1 years, and their breakdown was as follows: 53 (80.3%) with GERD, 38 (57.6%) with GERD-related symptoms, and 20 (30.3%) with reflux esophagitis (RE; LA-A: 10, LA-B: 5, LA-C: 4, LA-D: 1). Use of PPI (p = 0.0455), complication of interstitial lung disease (p = 0.0242), and history of cyclophosphamide therapy (p = 0.0184) denoted significant association with GERD-related symptoms. Older age (p = 0.0211) was significantly associated with RE. None of GERD-related disorders showed any difference between 37 diffuse cutaneous SSc and 29 limited cutaneous SSc patients. The matched analysis indicated that SSc patients had higher prevalence of GERD (p  〈 0.0001), GERD-related symptoms (p = 0.0034), and RE (p = 0.0002). Conclusion: SSc patients tend to have worse GERD symptoms and severer RE. However, most SSc-associated factors did not show significant association with GERD-related disorders, indicating the difficulty in predicting GERD-related disorders among SSc patients.
    Type of Medium: Online Resource
    ISSN: 0012-2823 , 1421-9867
    RVK:
    RVK:
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1482218-0
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