Faculty Profiles - IMAIZUMI Takahiro

Papers - IMAIZUMI Takahiro

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All-cause and cardiovascular mortality in patients undergoing hemodialysis with aortic sclerosis and mild-to-moderate aortic stenosis: A cohort study

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

ATHEROSCLEROSIS Vol. 331 page： 12 - 19 2021.8

Language：English Publisher：Atherosclerosis

Background and aims: Mild-to-moderate aortic stenosis (AS) and aortic sclerosis, a precursor of AS, are associated with mortality in the general population; however, their association in patients undergoing hemodialysis with higher morbidity of AS is unknown. Thus, we investigated the mortality of aortic sclerosis and mild-to-moderate AS in patients undergoing hemodialysis. Methods: This was a retrospective multicenter cohort study of consecutive patients undergoing hemodialysis at nine dialysis facilities who underwent screening echocardiography between January 2008 and December 2019. We investigated the mortality of patients with aortic sclerosis or mild-to-moderate AS using multivariable Cox proportional hazards regression. Results: Among 1,878 patients undergoing hemodialysis, those with normal aortic valves, aortic sclerosis, mild AS, moderate AS, severe AS, and prosthetic aortic valves were 844 (45%), 793 (42%), 161 (8.6%), 38 (2.0%), 11 (0.6%), and 31 (1.7%), respectively. After excluding patients with severe AS and prosthetic aortic valves, we performed comparative analysis on 1,836 patients (mean age, 67 years; 66% male). In a median follow-up of 3.6 years, crude death rates (per 100 person-years) were 5.2, 10.6, and 13.0 in patients with normal aortic valves, aortic sclerosis, and mild-to-moderate AS, respectively. Compared with normal aortic valves, both aortic sclerosis and mild-to-moderate AS were associated with all-cause and cardiovascular death: adjusted hazard ratios (95% confidence intervals) were 1.36 (1.13–1.65) and 1.36 (1.02–1.80) for all-cause death; and 1.52 (1.06–2.17) and 1.74 (1.04–2.92) for cardiovascular death, respectively. Conclusions: Aortic sclerosis and mild-to-moderate AS were independent risk factors for all-cause and cardiovascular death in patients undergoing hemodialysis.

DOI： 10.1016/j.atherosclerosis.2021.06.910

High urinary glucose is associated with improved renal prognosis in patients with diabetes mellitus

Itano, Y; Sobajima, H; Ohashi, N; Shibata, T; Fujiya, A; Nagata, T; Ando, M; Imaizumi, T; Kubo, Y; Ozeki, T; Katsuno, T; Kato, S; Yasuda, Y; Maruyama, S

JOURNAL OF DIABETES INVESTIGATION Vol. 12 ( 6 ) page： 998 - 1006 2021.6

Language：English Publisher：Journal of Diabetes Investigation

Aims/Introduction: The relationship between renal function and urinary glucose is poorly understood in diabetes patients who are not using sodium–glucose cotransporter 2 inhibitors. This study aimed to investigate the association of urinary glucose excretion with renal function prognosis in such patients. Materials and Methods: This retrospective cohort study included 1,172 patients with type 1 or 2 diabetes mellitus. Patients were recruited and data were collected between 1 January 2007 and 31 December 2011; follow-up data were collected until 30 June 2015. The primary outcome was set as a 30% decline in estimated glomerular filtration rate relative to baseline. The relationship between this outcome and urinary glucose was investigated using Cox proportional hazards model. For analysis, patients were categorized into two groups: urinary glucose <5 g/day or ≥5 g/day. Interaction terms were analyzed. Results: Multivariate analysis showed that the prognosis of renal function was significantly better in patients with high urinary glucose (≥5 g/day; adjusted hazard ratio 0.58, 95% confidence interval 0.35–0.96; P = 0.034). Significant interactions were observed between high urinary glucose and male sex (hazard ratio 0.33, 95% confidence interval 0.14–0.74; P = 0.007), and between high urinary glucose and longer duration of diabetes (≥10 years; hazard ratio 0.25, 95% confidence interval 0.11–0.58; P = 0.001). Conclusions: The present study suggests that high urinary glucose is associated with prognosis in diabetes patients not taking sodium–glucose cotransporter 2 inhibitors. Measurement of 24-h urinary glucose excretion might have clinical utility for predicting renal prognosis.

DOI： 10.1111/jdi.13428

Cardiovascular disease history and β-blocker prescription patterns among Japanese and American patients with CKD: a cross-sectional study of the CRIC and CKD-JAC studies

Imaizumi, T; Hamano, T; Fujii, N; Huang, J; Xie, DW; Ricardo, AC; He, J; Soliman, EZ; Kusek, JW; Nessel, L; Yang, W; Maruyama, S; Fukagawa, M; Feldman, HI

HYPERTENSION RESEARCH Vol. 44 ( 6 ) page： 700 - 710 2021.6

Language：English Publisher：Hypertension Research

Cardiovascular disease (CVD) is a major complication in individuals with chronic kidney disease (CKD). In Japan, the incidence of CVD among persons with CKD is lower than that in the United States. Although various classes of antihypertensive agents are prescribed to prevent CVD, the proportion varies between the United States and Japan. Until now, few studies have compared clinical practices and CVD prevalence among patients with CKD in the United States vs. Japan. In this study, we performed a cross-sectional comparison of the prevalence of CVD and the prescription of β-blockers at study entry to the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study and the Chronic Renal Insufficiency Cohort (CRIC) Study. The mean patient age was 58.2 and 60.3 years, the mean estimated glomerular filtration rate (eGFR) was 42.8 and 28.9 (mL/min/1.73 m2), and the median urinary albumin:creatinine ratio was 51.9 and 485.9 (mg/g) among 3939 participants in the CRIC Study and 2966 participants in the CKD-JAC Study, respectively. The prevalence of any CVD according to a self-report (CRIC Study) was 33%, while that according to a medical chart review (CKD-JAC Study) was 24%. These findings were consistent across eGFR levels. Prescriptions for β-blockers differed between the CRIC and CKD-JAC Studies (49% and 20%, respectively). The odds ratios for the association of any history of CVD and β-blocker prescription were 3.0 [2.6–3.5] in the CRIC Study and 2.0 [1.6–2.5] in the CKD-JAC Study (P < 0.001 for the interaction). In conclusion, the prevalence of CVD and treatment with β-blockers were higher in the CRIC Study across eGFR levels.

DOI： 10.1038/s41440-020-00608-8

Postoperative computed tomography assessment of anteromedial cortex reduction is a predictor for reoperation after intramedullary nail fixation for pertrochanteric fractures.

Yamamoto N, Imaizumi T, Noda T, Inoue T, Kawasaki K, Ozaki T

European journal of trauma and emergency surgery : official publication of the European Trauma Society 2021.5

Predictive factors for the development of leukemia in patients with transient abnormal myelopoiesis and Down syndrome

Yamato, G; Deguchi, T; Terui, K; Toki, T; Watanabe, T; Imaizumi, T; Hama, A; Iwamoto, S; Hasegawa, D; Ueda, T; Yokosuka, T; Tanaka, S; Yanagisawa, R; Koh, K; Saito, AM; Horibe, K; Hayashi, Y; Adachi, S; Mizutani, S; Taga, T; Ito, E; Watanabe, K; Muramatsu, H

LEUKEMIA Vol. 35 ( 5 ) page： 1480 - 1484 2021.5

DOSE-RESPONSE RELATIONSHIP BETWEEN ALCOHOL CONSUMPTION AND THE RISK OF DEVELOPING CKD: RETROSPECTIVE COHORT STUDY

Hashimoto, Y; Imaizumi, T; Hori, A; Kato, S; Yasuda, Y; Maruyama, S

NEPHROLOGY DIALYSIS TRANSPLANTATION Vol. 36 2021.5

Glucocorticoid treatment is associated with ICU-acquired hypernatremia: a nested case-control study

Imaizumi, T; Nakatochi, M; Fujita, Y; Yamamoto, R; Watanabe, K; Maekawa, M; Yamawaka, T; Katsuno, T; Maruyama, S

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 25 ( 2 ) page： 131 - 139 2021.2

Language：English Publisher：Clinical and Experimental Nephrology

Background: Hypernatremia is a major electrolyte disorder associated with death among critically ill patients. Glucocorticoid therapy may cause hypernatremia in refractory septic shock patients, but the association between glucocorticoid and intensive care unit (ICU)-acquired hypernatremia (IAH) remains unclear. The aim of this study was to clarify whether glucocorticoid administration was associated with IAH. Methods: This was a nested case–control study using data from an established cohort including 121 IAH cases identified from 1756 patients who were admitted to ICU in a tertiary care facility in Japan. We included patients who were admitted with a normal range of serum sodium concentrations (130–149 mEq/L) from January 1, 2013 to December 31, 2015 and remained in ICU for ≥ 2 days. Hypernatremia was defined as serum sodium concentration ≥ 150 mEq/L. Each case was matched to one control. Results: Multivariable conditional logistic regression revealed high-dose glucocorticoid {odds ratio (OR), 4.15 [95% confidence interval (CI) 1.29–13.4]}, acute kidney injury (AKI) [OR, 2.72 (95% CI 1.31–5.62)], and osmotic diuretics [OR, 3.44 (95% CI 1.41–8.39)] to be significantly associated with IAH. The contents and amounts of fluid infusion were not significantly associated with IAH. There were also significant duration–response effects between duration of glucocorticoid use and IAH; however, pulse glucocorticoid administration was not associated with IAH. Conclusion: In this nested case–control study, we demonstrated a significant association between IAH and high-dose glucocorticoid with significant duration–response effects. Serum sodium concentrations should be monitored carefully in critically ill patients administered prolonged high-dose glucocorticoid.

DOI： 10.1007/s10157-020-01967-9

The ISN/RPS 2016 classification predicts renal prognosis in patients with first-onset class III/IV lupus nephritis

Hachiya, A; Karasawa, M; Imaizumi, T; Kato, N; Katsuno, T; Ishimoto, T; Kosugi, T; Tsuboi, N; Maruyama, S

SCIENTIFIC REPORTS Vol. 11 ( 1 ) page： 1525 2021.1

Language：English Publisher：Scientific Reports

Lupus nephritis (LN) is a life-threatening complication of systemic lupus erythematosus. The 2003 pathological classification of LN was revised in 2016; it quantitatively evaluates the interstitium in addition to the glomeruli. We performed a retrospective multi-centre cohort study and investigated the utility of the 2016 classification—including the activity index (AI), chronicity index (CI), and each pathological component to predict complete remission or renal function decline, defined as 1.5-fold increase in serum creatinine levels—and compare with that of the 2003 classification. Ninety-one consecutive adult patients with first-onset class III/IV LN who were newly prescribed any immunosuppressants were enrolled and followed up for a median of 51 months from January 2004. Cox regression analysis demonstrated the subclasses based on the 2003 classification, which mainly evaluate glomerular lesions, were not associated with clinical outcomes. After adjustments for estimated glomerular filtration rate and urinary protein levels, higher CI and higher interstitial fibrosis and lower hyaline deposit scores were associated with renal functional decline. Similarly, higher CI and interstitial inflammation scores were associated with failure to achieve complete remission. Therefore, the 2016 classification can predict the clinical outcomes more precisely than the 2003 classification.

DOI： 10.1038/s41598-020-78972-1

Validity of "One-size-fits-all" Approaches for the National Health Screening and Education Program: A Large-scale Cohort Study of Corporate Insurance Beneficiaries

Kikuchi Kyoko, Imaizumi Takahiro, Ando Masahiko, Kato Sawako, Kondo Takaaki, Honda Hiroyuki, Yoshida Yasuko, Maruyama Shoichi

Internal Medicine Vol. 60 ( 11 ) page： 1681 - 1689 2021

Language：English Publisher：The Japanese Society of Internal Medicine

<p><b>Objective </b>Metabolic syndrome represents a unified condition of atherosclerotic diseases caused by abdominal obesity. The aims of this study were to examine the applicability of the prevalent fixed cut-off values of the abdominal circumference (AC) and body mass index (BMI) to age and gender groups and to identify suitable lifestyle modification factors. </p><p><b>Methods </b>We defined an outcome as having ≥ 2 risk components that are necessary to diagnose metabolic syndrome and examined the cross-sectional association of the AC and BMI with the outcome. We also assessed the effects of time-updated lifestyle information on metabolic traits using longitudinal data. </p><p><b>Patients </b> We enrolled 22,953 beneficiaries of a corporate health insurance scheme who underwent annual health examinations between January 2004 and December 2014. </p><p><b>Results </b>The AC [per 5-cm increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.12-1.24] and BMI (OR 1.10, 95% CI 1.07-1.13) were significantly associated with the outcome, adjusted for age, gender, current smoking status, drinking habits, and other lifestyle information. The association between the outcome and AC was modified by gender (p for interaction = 0.033), and the association between the outcome and BMI was modified by age group (p for interaction = 0.049). In the longitudinal analysis, current smoking, drinking habits, and unhealthy eating habits were associated with an increased AC and BMI, whereas regular physical activity was associated with a decreased AC and BMI. </p><p><b>Conclusion </b>We showed that the association between the AC or BMI and metabolic syndrome was modified by gender or age group. Further studies will be needed to customize the national health screening and education programs. </p>

DOI： 10.2169/internalmedicine.5515-20

Prompt prediction of fibrinogen concentration during cardiopulmonary bypass: a pilot study

Tamura, T; Imaizumi, T; Kubo, Y; Waters, JH; Nishiwaki, K

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 82 ( 4 ) page： 623 - 630 2020.11

Language：English Publisher：Nagoya Journal of Medical Science

Platelet Mapping can measure both the degree of platelet inhibition and fibrinogen activation, was not originally designed to measure fibrinogen concentration. Traditional laboratory fibrinogen concentration testing requires around 60 minutes; however, fibrinogen activation only takes 10 minutes, and is indicated as maximum amplitude of activator f. If Platelet Mapping can predict fibrinogen concentration during cardiopulmonary bypass, this could facilitate rapid hemostasis management. The aim of this study was to verify whether fibrinogen concentration could be predicted using Platelet Mapping results. Thus, a pilot study was conducted to evaluate this concept during cardiopulmonary bypass. This prospective, observational pilot study investigated 15- to 90-year-old patients who underwent cardiac or aortic surgery from August 2019 to September 2019. Twenty-one patients enrolled in this study, and 43 blood samples were obtained for both fibrinogen activation measurements using Platelet Mapping and traditional laboratory-based tests, respectively. Correlations between results were analyzed using linear regression and the receiver operating characteristic curve. Correlation by Pearson's correlation analysis indicates a significant relationship (correlation coefficient of r = 0.91), and a receiver operating characteristic curve indicated that sensitivity, specificity, and receiver operating characteristic area were 100% (95% confidence interval, 75.3-100%), 93.8% (79.2-99.2%), and 0.995 (0.984-1.00), respectively. Our results indicate a strong correlation between fibrinogen activation and serum fibrinogen concentration. The maximum amplitude of activator f can estimate low fibrinogen concentration faster than traditional methods; this method quickly provides important information for anesthesia and hemostatic management in cardiac surgery.

DOI： 10.18999/nagjms.82.4.623

URINARY CD11B AND CD163 REFLECT GLOMERULAR LEUKOCYTE ACCUMULATIONS IN ANCA-ASSOCIATED GLOMERULONEPHRITIS

Tsuboi, N; Yokoe, Y; Kitagawa, A; Karasawa, M; Imaizumi, T; Ozeki, T; Takayuki, K; Maruyama, S

NEPHROLOGY Vol. 25 page： 35 - 36 2020.10

Additional prognostic value of toe-brachial index beyond ankle-brachial index in hemodialysis patients

Hishida, M; Imaizumi, T; Menez, S; Okazaki, M; Akiyama, S; Kasuga, H; Ishigami, J; Maruyama, S; Matsushita, K

BMC NEPHROLOGY Vol. 21 ( 1 ) page： 353 2020.8

Language：English Publisher：BMC Nephrology

Background: Ankle-brachial index (ABI), the first-line diagnostic test for peripheral artery disease, can be falsely elevated when ankle arteries are incompressible, showing a J-shaped association with mortality. In this situation, toe-brachial index (TBI) is the recommended test. However, whether TBI provides additional prognostic information beyond ABI in patients on hemodialysis is unknown. Methods: In this retrospective cohort study of 247 Japanese prevalent hemodialysis patients (mean age 66.8 [SD 11.6] years), we evaluated mortality (116 deaths over a median follow-up of 5.2 years) related to quartiles of ABI and TBI, as well as three categories of low ABI (≤0.9), normal/high ABI (> 0.9) + low TBI (≤0.6), and normal/high ABI + normal TBI (> 0.6) using multivariable Cox models. Results: ABI showed a J-shaped association with mortality (adjusted hazard ratio 2.72 [95% CI, 1.52-4.88] in the lowest quartile and 1.59 [95% CI, 0.87-2.90] in the highest quartile vs. the second highest). Lower TBI showed a potentially dose-response association with mortality (e.g., adjusted hazard ratios 2.63 [95% CI, 1.36-5.12] and 2.89 [95% CI, 1.49-5.61] in the lowest two quartiles vs. the highest). When three categories by both ABI and TBI were analyzed, those with low ABI (≤0.9) experienced the highest risk followed by normal/high ABI (> 0.9) + low TBI (≤0.6). Among patients with normal/high ABI (> 0.9), the increased mortality risk in individuals with low TBI (≤0.6) compared to those with normal TBI (> 0.6) were significant (adjusted hazard ratio 1.84 [95% CI, 1.12-3.02]). Conclusions: Lower TBI was independently associated with mortality in patients on hemodialysis and has the potential to classify mortality risk in patients with normal/high ABI. Our results support the importance of evaluating TBI in addition to ABI in this clinical population.

DOI： 10.1186/s12882-020-01991-7

Impact of old age on the association between in-center extended-hours hemodialysis and mortality in patients on incident hemodialysis

Okazaki, M; Inaguma, D; Imaizumi, T; Hishida, M; Kurasawa, S; Kubo, Y; Kato, S; Yasuda, Y; Katsuno, T; Kaneda, F; Maruyama, S

PLOS ONE Vol. 15 ( 7 ) page： e0235900 2020.7

Language：English Publisher：PLoS ONE

With the global problem of aging, it has become more difficult to improve the prognosis of older dialysis patients. Extended-hours hemodialysis offers longer treatment time compared to conventional hemodialysis regimen and provides favorable metabolic status, hemodynamic stability, and increased dietary intake. Despite prior studies reporting that in-center extended-hours hemodialysis can reduce the mortality rate, the treatment impact on elderly patients remains unclear. Therefore, we examined the association between extended-hours hemodialysis compared to conventional hemodialysis and all-cause mortality. Survival analyses using Cox proportional hazard model with multivariable adjustments and propensityscore based method were performed to compare mortality risk between 198 consecutive patients who started in-center extended-hours hemodialysis (Extended-HD) and 1407 consecutive patients who initiated conventional hemodialysis. The median age was 67.1 years in the Extended-HD group and 70.7 years in the conventional hemodialysis group. Extended-HD was associated with lower all-cause mortality in overall patients and the subgroup >70 years (adjusted hazard ratios of 0.60 [95% CI, 0.39-0.91] and 0.35 [95% CI, 0.18-0.69], respectively). There was a significant interaction between age >70 years and Extended-HD. In conclusion, extended-hours hemodialysis was associated with a lower mortality rate, especially in elderly patients. Copyright:

DOI： 10.1371/journal.pone.0235900

Survival Benefit of Maintained or Increased Body Mass Index in Patients Undergoing Extended-Hours Hemodialysis Without Dietary Restrictions

Hishida, M; Imaizumi, T; Nishiyama, T; Okazaki, M; Kaihan, AB; Kato, S; Kubo, Y; Ando, M; Kaneda, H; Maruyama, S

JOURNAL OF RENAL NUTRITION Vol. 30 ( 2 ) page： 154 - 162 2020.3

Language：English Publisher：Journal of Renal Nutrition

Objective: Low body mass index (BMI) is a potential risk factor for mortality in patients on maintenance hemodialysis. This suggests the usefulness of BMI as a prognostic factor and implies the importance of nutritional status, inflammation, and oxidative stress, all of which affect BMI. We aimed to evaluate BMI changes over time and the mortality risk in patients undergoing a novel combination therapy consisting of an extended-hours hemodialysis protocol without dietary restrictions, which enabled sufficient nutrition. Design and Methods: This is a retrospective cohort study. Patients were divided into 2 groups based on BMI change (ΔBMI < 0, ΔBMI ≥ 0) between the 3rd and 12th month after transfer to the clinic. We studied the associations of BMI changes with all-cause mortality. Further subgroup analyses were performed using Cox models. We finally studied 187 patients who were receiving the combined therapy. The main outcome measure was all-cause mortality of the study group. Results: The median (interquartile range) follow-up time was 4.9 (3.0-8.6) years. Overall, 138 patients were in the ΔBMI ≥ 0 group. As per unadjusted and adjusted Cox models, maintained or increased BMI during this period was associated with hazard ratios of 0.45 (confidence interval 0.23-0.87, P <.05) and 0.35 (confidence interval 0.17-0.75, P <.01) for all-cause mortality, respectively. In the same group, maintained or increased BMI was found to be significantly associated with decreased mortality in female, older, and nondiabetic patients. The data indicated that diabetic status could have a modifying effect on the association between variation in BMI and mortality (P =.006). Conclusions: Extended-hours hemodialysis without dietary restrictions led to a beneficial effect of maintenance or increase in BMI, especially in females, patients aged ≥65 years, and those without diabetic nephropathy, which could lead to prolonged survival.

DOI： 10.1053/j.jrn.2019.06.002

Effectiveness of Lifestyle Intervention Using the Internet of Things System for Individuals with Early Type 2 Diabetes Mellitus

Kato Sawako, Ando Masahiko, Honda Hiroyuki, Yoshida Yasuko, Imaizumi Takahiro, Yamamoto Naoki, Maruyama Shoichi

Internal Medicine Vol. 59 ( 1 ) page： 45 - 53 2020

Language：English Publisher：The Japanese Society of Internal Medicine

<p><b>Objective </b>Exercise therapy is used for glycemic control in type 2 diabetes mellitus (T2DM). We evaluated the effects of intensive health guidance using the Internet of things (IoT) among Japanese company workers with early T2DM. </p><p><b>Methods </b>Fifty-three men (mean age: 54 years) with glycated hemoglobin (HbA1c) levels of >6.5% were enrolled in a 6-month exercise therapy program between August 2016 and January 2017. They used activity meters, scales, and sphygmomanometers connected to the Internet by Bluetooth. These devices automatically and continuously recorded daily information, and the participants simultaneously received health guidance from a public health nurse twice a month. </p><p><b>Results </b>The number of daily steps significantly increased, whereas the amount of physical activity increased but was not significant. The mean decrease (±SD) in HbA1c levels after 3 and 6 months was estimated to be -0.40% (±0.45, p<0.0001) and -0.19% (±0.55, p=0.033), respectively, by a linear mixed model that included baseline HbA1c levels and age as covariates. The program failed to improve the body mass index and blood pressure of the participants. The percentage of active stage (action and maintenance stage) in stage of health behavior significantly increased from 48% to 68% (p=0.011). </p><p><b>Conclusion </b>Intensive lifestyle intervention using a wearable monitoring system and remote health guidance improved diabetic control in middle-aged company workers. </p>

DOI： 10.2169/internalmedicine.3150-19

Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

Yamauchi, Y; Shiga, T; Shikino, K; Uechi, T; Koyama, Y; Shimozawa, N; Hiraoka, E; Funakoshi, H; Mizobe, M; Imaizumi, T; Ikusaka, M

BMC MEDICAL EDUCATION Vol. 19 ( 1 ) page： 461 2019.12

Language：English Publisher：BMC Medical Education

Background: Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians' negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians' decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. Methods: A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). Results: A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p < 0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p < 0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. Conclusions: Additional background information on past medical history of schizophrenia increased physicians' mistakes in decision making. Patients' psychiatric backgrounds should not bias physicians' decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

DOI： 10.1186/s12909-019-1897-z

Circulating levels of CD34<SUP>+</SUP> cells predict longterm cardiovascular outcomes in patients on maintenance hemodialysis

Kaihan, AB; Hishida, M; Imaizumi, T; Okazaki, M; Kaihan, AN; Katsuno, T; Taguchi, A; Yasuda, Y; Tsuboi, N; Kosugi, T; Maruyama, S

PLOS ONE Vol. 14 ( 10 ) page： e0223390 2019.10

Language：English Publisher：PLoS ONE

CD34+ cells maintain vascular homeostasis and predict cardiovascular outcomes. We previously evaluated the association of CD34+ cells with cardiovascular disease (CVD) events over 23 months, but long-term CVD outcomes in relation to levels of CD34+ cells in patients on maintenance hemodialysis are unclear. Herein, we analyzed the long-term predictive potential levels of CD34+ cells for CVD outcomes and all-cause mortality. Between March 2005 and May 2005, we enrolled 215 patients on maintenance hemodialysis at Nagoya Kyoritsu Hospital and followed them up to 12.8 years. According to the CD34+ cell counts, patients were classified into the lowest, medium, and highest tertiles. Levels of CD34+ cells were analyzed in association with four-point major adverse CV events (MACEs), CVD death, and all-cause mortality. In univariate analysis age, smoking habit, lower geriatric nutrition risk index, lower calcium × phosphate product, and lower intact parathyroid hormone were significantly associated with the lowest tertile. Whereas, in multivariate analysis, age and smoking habit were significantly associated with the lowest tertile. Among 139 (64.7%) patients who died during a mean follow-up period of 8.0 years, 39 (28.1%) patients died from CVD. Patients in the lowest tertile had a significantly lower survival rate than those in the medium and highest tertiles (p . 0.001). Using multivariable analyses, the lowest tertile was significantly associated with four-point MACEs (hazard ratio 1.80, p = 0.023) and CVD death (hazard ratio 2.50, p = 0.011). In conclusion, our long-term observational study revealed that a low level of CD34+ cells in the circulation predicts CVD outcomes among patients on maintenance hemodialysis.

DOI： 10.1371/journal.pone.0223390

External validation of the quick Sequential Organ Failure Assessment score for mortality and bacteraemia risk evaluation in Japanese patients undergoing haemodialysis: a retrospective multicentre cohort study

Nishiwaki, H; Sasaki, S; Hasegawa, T; Sasai, F; Kawarazaki, H; Minatoguchi, S; Uchida, D; Koitabashi, K; Ozeki, T; Koiwa, F; Furusho, M; Nomura, A; Shimizu, H; Ryuge, A; Imaizumi, T; Murasawa, M; Raita, Y; Saka, Y; Yazawa, M; Terashita, M; Suzuki, Y; Fujita, Y; Murakami, M; Maruta, Y; Oikawa, M; Saito, H; Mizukami, A; Omiya, S; Shibagaki, Y

BMJ OPEN Vol. 9 ( 7 ) 2019.8

Clinical impact of endocapillary proliferation with modified cutoff points in IgA nephropathy patients

Kaihan, AB; Yasuda, Y; Imaizumi, T; Inagaki, K; Ozeki, T; Hishida, M; Katsuno, T; Tsuboi, N; Maruyama, S

PLOS ONE Vol. 14 ( 3 ) page： e0214414 2019.3

Language：English Publisher：PLoS ONE

Predictive values of mesangial proliferation (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), and crescents (C) among 19 validation studies of the Oxford Classification of IgA nephropathy (IgAN) were discrepant, especially in Asian patients. These validation studies indicate that cutoffs of MESC score in the Oxford Classification may not be generalizable. Thus, we aimed to improve the clinical value of MESC scores by modifying the cutoff points. A total of 104 patients with IgAN were diagnosed from 2001 to 2012 vai renal biopsy and retrospectively evaluated at Nagoya University Hospital. The cutoff point for modified (M´E´S´C´) was determined using the receiver operating characteristic curve in association with renal outcome in the training cohort. Clinical values of the Oxford MESTC vs M´E´S´C´ cutoff points were analyzed using Kaplan-Meier and Cox regression in association with poor renal outcome in the validation and the entire cohort. Of 104 patients, 12.5% reached poor renal outcome over a median of 6.25 [4.16–9.61] years of follow-up. The modified cutoffs were defined as 40%, 10%, 20%, and 5% in the glomeruli for M´E´S´, and C´ respectively. In univariate analysis, E´, S ´, and T were significantly associated with poor renal outcome, whereas Oxford MESC, M´, and C´ in the training and validation cohort were not associated with poor renal outcome. Using multivariate analysis in the presence of estimated glomerular filtration rate (eGFR), only E´ was a significant predictive factor for poor renal outcome. The E´ with modified cutoff point of 10% significantly improved predictive value for poor renal outcome in IgAN. Therefore, the clinical value of modified cutoff points for M´E´S´C´ scores should be validated with various cohort studies in different regions.

DOI： 10.1371/journal.pone.0214414

Spontaneous remission of giant cell arteritis: possible association with a preceding acute respiratory infection and seropositivity to <i>Chlamydia pneumoniae</i> antibodies

Maekawa, M; Iwadate, T; Watanabe, K; Yamamoto, R; Imaizumi, T; Yamakawa, T

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 81 ( 1 ) page： 151 - 158 2019.2

Language：English Publisher：Nagoya Journal of Medical Science

Recent epidemiological or immunopathological studies demonstrate the possible association between giant cell arteritis and infectious agents including Chlamydia pneumoniae. A 62-year-old Japanese man with type 1 diabetes mellitus developed biopsy-proven giant cell arteritis after acute upper respiratory infection. Serological examination indicated concurrent re-infection with C. pneumoniae. Clinical manifestations of the vasculitis subsided within a month without any immunosuppressive therapy, and no relapse was observed for the following 12 months. The natural history of this disease is unclear and spontaneous remission is rarely reported. The self-limiting nature of the infection could contribute to this phenomenon.

DOI： 10.18999/nagjms.81.1.151

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