Faculty Profiles - IMAIZUMI Takahiro

Papers - IMAIZUMI Takahiro

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Unveiling the Patterns of Water Diuresis in Profound Hyponatremia Management in Intensive Care Unit Settings

Nagase K., Imaizumi T., Nagase F.N., Iwasaki K., Ito Y., Nakamura Y., Ikai H., Yamamoto M., Murai Y., Yokoyama-Kokuryo W., Takizawa N., Shimizu H., Fujita Y., Watanabe T.

Kidney360 2024

Publisher：Kidney360

Background:Hyponatremia treatment guidelines recommend avoiding excessive increases in serum sodium concentration (s[Na]) to prevent osmotic demyelination syndrome. Although an unexpected rise in s[Na] has been attributed to water diuresis during the treatment of hyponatremia, clinical courses of water diuresis are unclear. We conducted this study to investigate the clinical characteristics of water diuresis during profound hyponatremia management.Methods:In this retrospective observational study, we examined patients with profound hyponatremia (s[Na] ≤120 mEq/L) admitted to the intensive care unit of a Japanese hospital. The manifestation of water diuresis was defined as a urine volume ≥2 ml/kg/h and a urinary sodium plus potassium concentration (u[Na+K]) ≤50 mEq/L. We analyzed changes in urine volume and u[Na+K] over time for patients experiencing water diuresis. This analysis employed a mixed-effects model with spline terms for time, and the results are graphically presented.Results:Among 47 eligible patients, 30 (64%) met the criteria for water diuresis. The etiologies of hyponatremia were drug-related hyponatremia (n=10; 33%), primary polydipsia (n=8; 27%), hypovolemic hyponatremia (n=7; 23%), syndrome of inappropriate secretion of antidiuresis (n=7; 23%), and acute heart failure (n=1; 3%). Among patients with water diuresis, 27 (90%) experienced the manifestation of water diuresis within 24 hours after the start of correction. The increased urine volume and decreased u[Na+K] levels began several hours before the peak manifestation of water diuresis. Within 6 hours after the manifestation of water diuresis, 29 patients (97%) received electrolyte-free infusions and 14 (47%) received desmopressin. One patient (3%) with water diuresis experienced overcorrection.Conclusions:Water diuresis is common during the treatment for profound hyponatremia and typically occurs within the first 24 hours, preceded by changes in urinary characteristics. Early detection and prompt response to water diuresis through urine monitoring during the early periods of hyponatremia treatment may be effective for managing water diuresis.

DOI： 10.34067/KID.0000000000000535

Association between reduced left ventricular ejection fraction and peritoneal dialysis related peritonitis: a single center retrospective cohort study in Japan

Yamaguchi, M; Obayashi, T; Kobayashi, N; Izumi, N; Nagai, M; Nobata, H; Asai, A; Kamiya, K; Sugiyama, H; Kinashi, H; Banno, S; Ando, M; Imaizumi, T; Kubo, Y; Katsuno, T; Ishimoto, T; Ito, Y

SCIENTIFIC REPORTS Vol. 13 ( 1 ) page： 22697 2023.12

Language：English Publisher：Scientific Reports

We present a single-center retrospective analysis of 228 Japanese patients with peritoneal dialysis, in which we examined whether reduced left ventricular ejection fraction (LVEF) is a risk factor for peritonitis development. Time-dependent multivariable-adjusted Cox proportional hazards models revealed that reduced LVEF (LVEF < 50% vs. preserved LVEF ≥ 50%, hazard ratio (HR) 2.10; 95% confidence interval (CI) 1.16–3.82) was associated with peritonitis. Qualitatively, similar associations with reduced LVEF (< 50%) were observed for enteric peritonitis (adjusted HR 7.68; 95% CI 2.51–23.5) but not for non-enteric peritonitis (adjusted HR 1.15; 95% CI 0.54–2.44). Reduced LVEF is associated with a significantly higher risk of subsequent peritonitis, particularly enteric peritonitis. These results indicate that patients with reduced LVEF may be at risk of enteric peritonitis from bowel sources caused by intestinal involvement due to cardiac dysfunction.

DOI： 10.1038/s41598-023-49744-4

In-Hospital Fall Risk Prediction by Objective Measurement of Lower Extremity Function in a High-Risk Population

Tanaka, S; Imaizumi, T; Morohashi, A; Sato, K; Shibata, A; Fukuta, A; Nakagawa, R; Nagaya, M; Nishida, Y; Hara, K; Katsuno, M; Suzuki, Y; Nagao, Y

JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION Vol. 24 ( 12 ) page： 1861 - 1867.e2 2023.12

Language：English Publisher：Journal of the American Medical Directors Association

Objectives: Limited data exist regarding association between physical performance and in-hospital falls. This study was performed to investigate the association between physical performance and in-hospital falls in a high-risk population. Design: Retrospective cohort study. Setting and Participants: The study population consisted of 1200 consecutive patients with a median age of 74 years (50.8% men) admitted to a ward with high incidence rates of falls, primarily in the departments of geriatrics and neurology, in a university hospital between January 2019 and December 2021. Methods: Short Physical Performance Battery (SPPB) was measured after treatment in the acute phase. As the primary end point of the study, the incidence of in-hospital falls was examined prospectively based on data from mandatory standardized incident report forms and electronic patient records. Results: SPPB assessment was performed at a median of 3 days after admission, and the study population had a median SPPB score of 3 points. Falls occurred in 101 patients (8.4%) over a median hospital stay of 15 days. SPPB score showed a significant inverse association with the incidence of in-hospital falls after adjusting for possible confounders (adjusted odds ratio for each 1-point decrease in SPPB: 1.19, 95% CI 1.10-1.28; P < .001), and an SPPB score ≤6 was significantly associated with increased risk of in-hospital falls. Inclusion of SPPB with previously identified risk factors significantly increased the area under the curve for in-hospital falls (0.683 vs. 0.740, P = .003). Conclusion and Implications: This study demonstrated an inverse association of SPPB score with risk of in-hospital falls in a high-risk population and showed that SPPB assessment is useful for accurate risk stratification in a hospital setting.

DOI： 10.1016/j.jamda.2023.07.020

Association between serum iron markers, iron supplementation and cardiovascular morbidity in pre-dialysis chronic kidney disease.

Hasegawa T, Imaizumi T, Hamano T, Murotani K, Fujii N, Komaba H, Ando M, Maruyama S, Nangaku M, Nitta K, Hirakata H, Isaka Y, Wada T, Fukagawa M

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association Vol. 38 ( 12 ) page： 2713 - 2722 2023.11

Language：English Publisher：Nephrology Dialysis Transplantation

Background: The optimal range of serum iron markers and usefulness of iron supplementation are uncertain in patients with pre-dialysis chronic kidney disease (CKD). We investigated the association between serum iron indices and risk of cardiovascular disease (CVD) events and the effectiveness of iron supplementation using Chronic Kidney Disease Japan Cohort data. Methods: We included 1416 patients ages 20-75 years with pre-dialysis CKD. The tested exposures were serum transferrin saturation and serum ferritin levels and the outcome measures were any cardiovascular event. Fine-Gray subdistribution hazard models were used to examine the association between serum iron indices and time to events. The multivariable fractional polynomial interaction approach was used to evaluate whether serum iron indices were effect modifiers of the association between iron supplementation and cardiovascular events. Results: The overall incidence rate of CVD events for a median of 4.12 years was 26.7 events/1000 person-years. Patients with serum transferrin saturation <20% demonstrated an increased risk of CVD [subdistribution hazard ratio (HR) 2.13] and congestive heart failure (subdistribution HR 2.42). The magnitude of reduction in CVD risk with iron supplementation was greater in patients with lower transferrin saturations (P =. 042). Conclusions: Maintaining transferrin saturation >20% and adequate iron supplementation may effectively reduce the risk of CVD events in patients with pre-dialysis CKD.

DOI： 10.1093/ndt/gfad096

Risk factors for cefmetazole-non-susceptible bacteremia in acute cholangitis.

Onishi K, Morioka H, Imaizumi T, Tsuchimoto D, Nishio M, Komiyama T

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2023.11

Language：English Publisher：Journal of Infection and Chemotherapy

Introduction: Cefmetazole (CMZ), an antibiotic with limited international distribution, is recommended by the Tokyo Guidelines 2018 (TG18) for non-severe cases of acute cholangitis (AC). However, the risk factors for CMZ-non-susceptible (CMZ-NS) bacteremia in AC remain unclear. Here, we aimed to investigate the risk factors for CMZ-NS bacteremia and evaluate mortality in patients with AC. Methods: This single-center, retrospective, observational study included all patients diagnosed with definite bacteremic AC, based on TG18, from April 2019 to March 2023. Risk factors for CMZ-NS bacteremia were analyzed by univariate, and age- and sex-adjusted, logistic regression analyses. Mortality was compared by cause of obstruction, CMZ-susceptible/CMZ-NS bacteremia, and initial treatment. Results: In total, 165 patients were enrolled. CMZ-NS bacteremia was diagnosed in 46 (27.9 %) patients. Histories of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy were identified as significant factors associated with the risk of CMZ-NS bacteremia. Thirteen patients died within 30 days of hospital admission. The mortality of patients with AC and malignant biliary obstruction was statistically higher than that of patients with bile duct stones. No patients with AC and bile duct stones died in the group with CMZ-NS bacteremia and inappropriate initial antibiotics. Conclusions: In AC, a history of diabetes mellitus, hepato-biliary-pancreatic cancer, malignant biliary obstruction, and endoscopic sphincterotomy are associated with an increased risk of CMZ-NS bacteremia. Therefore, the choice of empiric therapy for AC should be based on the etiology and patient background, rather than on the severity.

DOI： 10.1016/j.jiac.2023.11.015

Modification effects of albuminuria on the association between kidney function and development of anemia in diabetes.

Okada A, Yamaguchi S, Imaizumi T, Oba K, Kurakawa KI, Yamauchi T, Kadowaki T, Nangaku M

The Journal of clinical endocrinology and metabolism 2023.11

特集血液浄化法に応じた食と栄養 4.長時間血液透析(2)今日から実践可能な,透析患者の低栄養への根本的対策

菱田学, 岡崎雅樹, 西堀暢浩, 今泉貴広, 金田史香, 丸山彰一

臨床透析 Vol. 39 ( 12 ) page： 1397 - 1404 2023.11

Lower Parathyroid Hormone Levels Are Associated with Lower Risk of Fractures in Japanese Hemodialysis Patients: A Nationwide Cohort Study

Komaba, H; Imaizumi, T; Hamano, T; Fujii, N; Abe, M; Hanafusa, N; Fukagawa, M

JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Vol. 34 ( 11 ) page： 125 - 125 2023.11

The impact of hospital volume on the prognosis of patients with cardiogenic shock requiring mechanical circulatory support

Araki, T; Kondo, T; Imaizumi, T; Sumita, Y; Nakai, M; Tanaka, A; Okumura, T; Yang, M; Butt, J; Petrie, M; Murohara, T

EUROPEAN HEART JOURNAL Vol. 44 2023.11

The Goal of Intraoperative Blood Loss in Major Hepatobiliary Resection for Perihilar Cholangiocarcinoma Saving Patients From a Heavy Complication Burden

Kawakatsu, S; Mizuno, T; Yamaguchi, J; Watanabe, N; Onoe, S; Sunagawa, M; Baba, T; Igami, T; Yokoyama, Y; Imaizumi, T; Ebata, T

ANNALS OF SURGERY Vol. 278 ( 5 ) page： E1035 - E1040 2023.11

Language：English Publisher：Annals of Surgery

Objective: To determine the goal of intraoperative blood loss in hepatectomy for perihilar cholangiocarcinoma. Background: Although massive bleeding can negatively affect the postoperative course, the target value of intraoperative bleeding to reduce its adverse impact is unknown. Methods: Patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2010 and 2019 were included. Intraoperative blood loss was adjusted for body weight [adjusted blood loss (aBL)], and the overall postoperative complications were evaluated by the comprehensive complication index (CCI). The impact of aBL on CCI was assessed by the restricted cubic spline regression. Results: A total of 425 patients were included. The median aBL was 17.8 (interquartile range, 11.8-26.3) mL/kg, and the CCI was 40.6 (33.7-49.5). Sixty-three (14.8%) patients had an aBL<10 mL/kg, nearly half (45.4%) of the patients were in the range of 10 ≤aBL<20 mL/kg, and 37 (8.7%) patients had an aBL >40 mL/kg. The spline regression analysis showed a nonlinear incremental association between aBL and CCI; CCI remained flat with an aBL under 10 mL/kg; increased significantly with an aBL ranging from 10 to 20 mL/kg; grew gradually with an aBL over 20 mL/kg. These inflection points of 10 and 20 mL/kg were almost consistent with the cutoff values identified by the recursive partitioning technique. After adjusting for other risk factors for the postoperative course, the spline regression identified a similar model. Conclusions: aBL had a nonlinear aggravating effect on CCI after hepatectomy for perihilar cholangiocarcinoma. The primary goal of aBL should be <10 mL/kg to minimize CCI.

DOI： 10.1097/SLA.0000000000005869

Renal pathology in adult and paediatric population of Japan: review of the Japan renal biopsy registry database from 2007 to 2017

Goto, K; Imaizumi, T; Hamada, R; Ishikura, K; Kosugi, T; Narita, I; Sugiyama, H; Shimizu, A; Yokoyama, H; Sato, H; Mauryama, S

JOURNAL OF NEPHROLOGY Vol. 36 ( 8 ) page： 2257 - 2267 2023.11

Language：English Publisher：Journal of Nephrology

Background: The Japan Renal Biopsy Registry (J-RBR), a nationwide, web-based, registry system, started in 2007. This study aimed to summarise the epidemiology of biopsy-diagnosed kidney disease in Japan over 10 years. Methods: We analysed the J-RBR database, from 2007 to 2017. Patients’ clinical data collected at the time of biopsy and histopathological diagnoses were used for epidemiological and clinicopathologic analyses. Results: The predominant renal biopsy diagnoses were immunoglobulin A nephropathy (39.2%), lupus nephritis (6.5%) and minimal change disease (6.0%) in younger adults (19–64 years), and membranous nephropathy (17.4%), antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis (13.0%), and immunoglobulin A nephropathy (12.5%) in older adults (≥ 65 years). The percentages of patients diagnosed with membranoproliferative glomerulonephritis and immunoglobulin A nephropathy decreased, whereas those with immunoglobulin A vasculitis and diabetic nephropathy increased over the decade. In paediatric patients (< 19 years), immunoglobulin A nephropathy (36.1%), minimal change disease (17.6%), and immunoglobulin A vasculitis (8.6%) were the predominant diagnoses. The percentage of patients diagnosed with immunoglobulin A vasculitis increased over the decade. Based on the sex distribution, minimal change disease and membranous nephropathy were predominant in men aged < 20 and > 40 years, respectively, whereas immunoglobulin A vasculitis and antineutrophil cytoplasmic antibody-associated vasculitis or anti-glomerular basement membrane glomerulonephritis were predominant in women in their 20s and 30s and aged < 50 years, respectively. Immunoglobulin A nephropathy was predominant in men at most ages and in women in their 20s to 40s. Conclusions: This study describes the distribution and changes in kidney biopsy diagnoses over 10 years in Japan and paves the way for future research on kidney diseases in adults and children. Graphical abstract: [Figure not available: see fulltext.].

DOI： 10.1007/s40620-023-01687-9

A Japanese retrospective study of non-tuberculous mycobacterial infection in children, adolescents, and young adult patients with hematologic-oncologic diseases.

Tsumura Y, Muramatsu H, Tetsuka N, Imaizumi T, Sato K, Inoue K, Motomura Y, Cho Y, Yamashita D, Sajiki D, Maemura R, Yamamori A, Imaya M, Wakamatsu M, Narita K, Kataoka S, Hamada M, Taniguchi R, Nishikawa E, Narita A, Nishio N, Kojima S, Hoshino Y, Takahashi Y

Haematologica 2023.10

Regional Variation in Hemoglobin Distribution Among Individuals With CKD: the ISN International Network of CKD Cohorts

Canney, M; Induruwage, D; Tang, ML; de Pinho, NA; Er, L; Zhao, YS; Djurdjev, O; Ahn, YH; Behnisch, R; Calice-Silva, V; Chesnaye, NC; de Borst, MH; Dember, LM; Dionne, J; Ebert, N; Eder, S; Fenton, A; Fukagawa, M; Furth, SL; Hoy, WE; Imaizumi, T; Jager, KJ; Jha, V; Kang, HG; Kitiyakara, C; Mayer, G; Oh, KH; Onu, U; Pecoits-Filho, R; Reichel, H; Richards, A; Schaefer, F; Schaeffner, E; Scheppach, JB; Sola, L; Ulasi, I; Wang, JW; Yadav, AK; Zhang, JZ; Feldman, H; Taal, MW; Stengel, B; Levin, A

KIDNEY INTERNATIONAL REPORTS Vol. 8 ( 10 ) page： 2056 - 2067 2023.10

Language：English Publisher：Kidney International Reports

Introduction: Despite recognized geographic and sex-based differences in hemoglobin in the general population, these factors are typically ignored in patients with chronic kidney disease (CKD) in whom a single therapeutic range for hemoglobin is recommended. We sought to compare the distribution of hemoglobin across international nondialysis CKD populations and evaluate predictors of hemoglobin. Methods: In this cross-sectional study, hemoglobin distribution was evaluated in each cohort overall and stratified by sex and estimated glomerular filtration rate (eGFR). Relationships between candidate predictors and hemoglobin were assessed from linear regression models in each cohort. Estimates were subsequently pooled in a random effects model. Results: A total of 58,613 participants from 21 adult cohorts (median eGFR range of 17–49 ml/min) and 3 pediatric cohorts (median eGFR range of 26–45 ml/min) were included with broad geographic representation. Hemoglobin values varied substantially among the cohorts, overall and within eGFR categories, with particularly low mean hemoglobin observed in women from Asian and African cohorts. Across the eGFR range, women had a lower hemoglobin compared to men, even at an eGFR of 15 ml/min (mean difference 5.3 g/l, 95% confidence interval [CI] 3.7–6.9). Lower eGFR, female sex, older age, lower body mass index, and diabetic kidney disease were all independent predictors of a lower hemoglobin value; however, this only explained a minority of variance (R2 7%–44% across cohorts). Conclusion: There are substantial regional differences in hemoglobin distribution among individuals with CKD, and the majority of variance is unexplained by demographics, eGFR, or comorbidities. These findings call for a renewed interest in improving our understanding of hemoglobin determinants in specific CKD populations.

DOI： 10.1016/j.ekir.2023.07.032

Reasons and risk factors for discontinuation of treatment with any biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: A long-term observational study

Terabe, K; Takahashi, N; Asai, S; Hirano, Y; Kanayama, Y; Yabe, Y; Oguchi, T; Fujibayashi, T; Ishikawa, H; Hanabayashi, M; Hattori, Y; Suzuki, M; Kishimoto, K; Ohashi, Y; Imaizumi, T; Imagama, S; Kojima, T

MODERN RHEUMATOLOGY Vol. 33 ( 5 ) page： 891 - 898 2023.8

Language：English Publisher：Modern Rheumatology

Objectives: Patients with rheumatoid arthritis (RA) usually switch to a second biological disease-modifying antirheumatic drugs (bDMARDs) when the first has proven to be ineffective, although some may discontinue bDMARDs treatment altogether. We investigated the total rate of bDMARDs retention and the risk of bDMARDs discontinuation in patients with RA. Methods: The study included 564 patients with RA who started bDMARDs treatment before 2008 (<65 years old, n = 413; ≥65, n = 151). The primary outcome was the incidence of bDMARDs discontinuation due to adverse events (AEs). Risk factors were examined using Fine and Gray regression models. Results: Among 564 patients, 74 had discontinued bDMARDs treatment due to AEs. Male sex and Steinbrocker class 3-4 were more frequent, while rheumatoid factor and concomitant methotrexate treatment were less frequent, in those aged ≥65 years than in those aged <65 years, respectively. The subdistribution hazard ratio for discontinuation was significantly higher in the ≥65 group than in the <65 years group (hazard ratio = 3.53, 95% confidence interval = 2.07-6.03). Lack of concomitant treatment with MTX was risk factor for discontinuation in patients ≥65 years. Advanced Steinbrocker class was a risk factor in patients <65 years. Conclusions: Older patients are at higher risk of discontinuing bDMARDs treatment due to AEs than younger patients.

DOI： 10.1093/mr/roac090

Association of kidney function with cancer incidence and its influence on cancer risk of smoking: The Japan Multi-Institutional Collaborative Cohort Study

Kurasawa, S; Imaizumi, T; Maruyama, S; Tanaka, K; Kubo, Y; Nagayoshi, M; Ikezaki, H; Suzuki, S; Koyama, T; Koriyama, C; Kadota, A; Katsuura-Kamano, S; Kuriki, K; Wakai, K; Matsuo, K

INTERNATIONAL JOURNAL OF CANCER Vol. 153 ( 4 ) page： 732 - 741 2023.8

Language：English Publisher：International Journal of Cancer

The association between kidney function and cancer incidence is inconsistent among previous reports, and data on the Japanese population are lacking. It is unknown whether kidney function modifies the cancer risk of other factors. We aimed to evaluate the association of estimated glomerular filtration rate (eGFR) with cancer incidence and mortality in 55 242 participants (median age, 57 years; 55% women) from the Japan Multi-Institutional Collaborative Cohort Study. We also investigated differences in cancer risk factors between individuals with and without kidney dysfunction. During a median 9.3-year follow-up period, 4278 (7.7%) subjects developed cancer. Moderately low and high eGFRs were associated with higher cancer incidence; compared with eGFR of 60-74 ml/min/1.73 m2, the adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) for eGFRs of ≥90, 75-89, 45-59, 30-44 and 10-29 ml/min/1.73 m2 were 1.18 (1.07-1.29), 1.09 (1.01-1.17), 0.93 (0.83-1.04), 1.36 (1.00-1.84) and 1.12 (0.55-2.26), respectively. High eGFR was associated with higher cancer mortality, while low eGFR was not; the adjusted subdistribution HRs (95% CIs) for eGFRs of ≥90 and 75-89 ml/min/1.73 m2 were 1.58 (1.29-1.94) and 1.27 (1.08-1.50), respectively. Subgroup analyses of participants with eGFRs ≥60 and <60 ml/min/1.73 m2 revealed elevated cancer risks of smoking and family history of cancer in those with eGFR <60 ml/min/1.73 m2, with significant interactions. Our findings suggest that the relationship between eGFR and cancer incidence was U-shaped. Only high eGFR was associated with cancer mortality. Kidney dysfunction enhanced cancer risk from smoking.

DOI： 10.1002/ijc.34554

Clinical Efficiency of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Aneurysm: Comparison with the Conventional Method

Ishikawa, K; Izumi, T; Nishihori, M; Imaizumi, T; Goto, S; Suzuki, K; Yokoyama, K; Kanamori, F; Uda, K; Araki, Y; Saito, R

CLINICAL NEURORADIOLOGY Vol. 33 ( 4 ) page： 1143 - 1150 2023.7

Language：English Publisher：Clinical Neuroradiology

Purpose: Artificial intelligence (AI)-based three-dimensional angiography (3D-A) was reported to demonstrate visualization of cerebral vasculature equivalent to that of three-dimensional digital subtraction angiography (3D-DSA). However, the applicability and efficacy of the AI-based 3D‑A algorithm have not yet been investigated for 3D-DSA micro imaging. In this study, we evaluated the usefulness of the AI-based 3D‑A in 3D-DSA micro imaging. Materials and Methods: The 3D-DSA micro datasets of 20 consecutive patients with cerebral aneurysm (CA) were reconstructed with 3D-DSA and 3D‑A. Three reviewers compared 3D-DSA and 3D‑A in terms of qualitative parameters (degrees of visualization of CA and the anterior choroidal artery [AChA]) and quantitative parameters (aneurysm diameter, neck diameter, parent vessel diameter, and visible length of AChA). Results: Qualitative evaluation of diagnostic potential revealed that visualization of CA and the proximal to middle parts of the AChA with 3D‑A was equal to that with conventional 3D-DSA; in contrast, visualization of the distal part of the AChA was lower with 3D‑A than with 3D-DSA. Further, regarding quantitative evaluation, the aneurysm diameter, neck diameter, and parent vessel diameter were comparable between 3D‑A and 3D-DSA; in contrast, the visible length of the AChA was lower with 3D‑A than with 3D-DSA. Conclusions: The AI-based 3D‑A technique is feasible and evaluable visualization of cerebral vasculature with respect to quantitative and qualitative parameters in 3D-DSA micro imaging. However, the 3D‑A technique offers lower visualization of such as the distal portion of the AChA than 3D-DSA.

DOI： 10.1007/s00062-023-01325-8

Relationship between the volume of cases and in-hospital mortality in patients with cardiogenic shock receiving short-term mechanical circulatory support

Araki, T; Kondo, T; Imaizumi, T; Sumita, Y; Nakai, M; Tanaka, A; Okumura, T; Yang, MM; Butt, JH; Petrie, MC; Murohara, T

AMERICAN HEART JOURNAL Vol. 261 page： 109 - 123 2023.7

Language：English Publisher：American Heart Journal

Background: We examined the relationship between annual case volume at each hospital and outcome in cardiogenic shock (CS) patients receiving mechanical circulatory support (MCS) devices. Methods: This cross-sectional study used the Japanese nationwide database to identify patients receiving short-term MCS for CS between April 2012 and March 2020. Of 65,837 patients, 3 subcohorts were created; the intra-aortic balloon pump (IABP) alone (n = 48,643), the extracorporeal membrane oxygenation (ECMO) (n = 16,871), and the Impella cohorts (n = 696). Results: The median annual case volume was 13.5 (7.4-22.1) in the IABP alone cohort, 6.4 (3.4-11.0) in the ECMO cohort, and 7.5 (4.0-10.7) in the Impella cohort. The highest quintile for the volume of cases in the IABP alone and ECMO had the lowest in-hospital mortality (IABP alone, 25.1% in quintile 1 vs 15.2% in quintile 5; ECMO, 73.7% in quintile 1 in 67.4% in quintile 5). Adjusted ORs for in-hospital mortality decreased as case volume increased (IABP alone, 0.63 [0.58-0.68] in quintile 5; ECMO, 0.73 [0.65-0.82] in quintile 5, with the lowest quintile as reference) but did not decrease significantly in the Impella (0.90 [0.58-1.39] in tertile 3, with the lowest tertile as reference). In the continuous models with the case volume as a continuous variable, adjusted ORs for in-hospital mortality decreased to 28 IABP cases/year and 12 ECMO cases/year. They did not decrease or became almost flat above that. Conclusions: Higher volumes of IABP and ECMO are associated with a lower mortality. There is an upper limit to the decline. Centralizing patients with refractory CS in a particular hospital might improve patient outcomes in each region.

DOI： 10.1016/j.ahj.2023.03.017

Number of calcified aortic valve leaflets: natural history and prognostic value in patients undergoing haemodialysis

Kurasawa, S; Okazaki, M; Imaizumi, T; Kondo, T; Hishida, M; Nishibori, N; Takeda, Y; Kasuga, H; Maruyama, S

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING Vol. 24 ( 7 ) page： 909 - 920 2023.6

Language：English Publisher：European Heart Journal Cardiovascular Imaging

Aims: Aortic valve calcification in aortic sclerosis, a precursor of aortic stenosis (AS), is not always present in all three leaflets; how calcification develops in each leaflet is unknown. We aimed to investigate the natural history of calcification development in each aortic valve leaflet and the prognostic value of the number of calcified leaflets. Methods and results: In a retrospective multicentre cohort study of patients undergoing haemodialysis without AS, we observed calcification development in each aortic valve leaflet using echocardiography. We investigated the association between the number of calcified leaflets and AS development and mortality using time-to-event analysis. Among the 1507 patients (mean age, 66 years; 66% male) included in the longitudinal echocardiography analysis, 709 (47%) had aortic sclerosis at baseline: one-leaflet calcified, 370 (52%); two-leaflet calcified, 215 (30%); and three-leaflet calcified, 124 (17%). The median time for one calcified leaflet increase was 3-4 years, and 251 (17%) patients developed AS during a median 3.2-year follow-up. The increased number of calcified aortic valve leaflets was associated with developing AS; compared with that of one-leaflet calcified, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of two- and three-leaflet calcified were 2.12 (1.49-3.00) and 4.43 (3.01-6.52), respectively; the aHR (95% CI) per one calcified leaflet increase was 2.24 (1.96-2.55). It was also associated with all-cause mortality; the aHR (95% CI) per one calcified leaflet increase was 1.18 (1.08-1.27). Conclusion: The number of calcified aortic valve leaflets strongly predicted AS development and even mortality in patients undergoing haemodialysis, suggesting the usefulness of assessing calcification for each valve leaflet separately using echocardiography.

DOI： 10.1093/ehjci/jead020

Association Between Physician Empathy and Difficult Patient Encounters: a Cross-Sectional Study

Tamura, H; Shikino, K; Sogai, D; Yokokawa, D; Uchida, S; Li, Y; Yanagita, Y; Yamauchi, Y; Kojima, J; Ishizuka, K; Tsukamoto, T; Noda, K; Uehara, T; Imaizumi, T; Kataoka, H; Ikusaka, M

JOURNAL OF GENERAL INTERNAL MEDICINE Vol. 38 ( 8 ) page： 1843 - 1847 2023.6

Language：English Publisher：Journal of General Internal Medicine

Background: Physicians frequently experience patients as difficult. Our study explores whether more empathetic physicians experience fewer patient encounters as difficult. Objective: To investigate the association between physician empathy and difficult patient encounters (DPEs). Design: Cross-sectional study. Participants: Participants were 18 generalist physicians with 3–8 years of experience. The investigation was conducted from August–September 2018 and April–May 2019 at six healthcare facilities. Main Measures: Based on the Jefferson Scale of Empathy (JSE) scores, we classified physicians into low and high empathy groups. The physicians completed the Difficult Doctor-Patient Relationship Questionnaire-10 (DDPRQ-10) after each patient visit. Scores ≥ 31 on the DDPRQ-10 indicated DPEs. We implemented multilevel mixed-effects logistic regression models to examine the association between physicians’ empathy and DPE, adjusting for patient-level covariates (age, sex, history of mental disorders) and with physician-level clustering. Key Results: The median JSE score was 114 (range: 96–126), and physicians with JSE scores 96–113 and 114–126 were assigned to low and high empathy groups, respectively (n = 8 and 10 each); 240 and 344 patients were examined by physicians in the low and high empathy groups, respectively. Among low empathy physicians, 23% of encounters were considered difficulty, compared to 11% among high empathy groups (OR: 0.37; 95% CI = 0.19–0.72, p = 0.004). JSE scores and DDPRQ-10 scores were negatively correlated (r = −0.22, p < 0.01). Conclusion: Empathetic physicians were less likely to experience encounters as difficult. Empathy appears to be an important component of physician perception of encounter difficulty.

DOI： 10.1007/s11606-022-07936-0

Photoperiodic flowering in<i> Arabidopsis</i> : Multilayered regulatory mechanisms of CONSTANS and the florigen FLOWERING LOCUS T

Takagi, H; Hempton, AK; Imaizumi, T

PLANT COMMUNICATIONS Vol. 4 ( 3 ) page： 100552 2023.5

Language：English Publisher：Plant Communications

The timing of flowering affects the success of sexual reproduction. This developmental event also determines crop yield, biomass, and longevity. Therefore, this mechanism has been targeted for improvement along with crop domestication. The underlying mechanisms of flowering are highly conserved in angiosperms. Central to these mechanisms is how environmental and endogenous conditions control transcriptional regulation of the FLOWERING LOCUS T (FT) gene, which initiates floral development under long-day conditions in Arabidopsis. Since the identification of FT as florigen, efforts have been made to understand the regulatory mechanisms of FT expression. Although many transcriptional regulators have been shown to directly influence FT, the question of how they coordinately control the spatiotemporal expression patterns of FT still requires further investigation. Among FT regulators, CONSTANS (CO) is the primary one whose protein stability is tightly controlled by phosphorylation and ubiquitination/proteasome-mediated mechanisms. In addition, various CO interaction partners, some of them previously identified as FT transcriptional regulators, positively or negatively modulate CO protein activity. The FT promoter possesses several transcriptional regulatory “blocks,” highly conserved regions among Brassicaceae plants. Different transcription factors bind to specific blocks and affect FT expression, often causing topological changes in FT chromatin structure, such as the formation of DNA loops. We discuss the current understanding of the regulation of FT expression mainly in Arabidopsis and propose future directions related to this topic.

DOI： 10.1016/j.xplc.2023.100552

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