研究者総覧

堀 大治郎 (ホリ ダイジロウ)

  • 総合医学第2講座 助教
メールアドレス: dougskgh05gmail.com
Last Updated :2020/07/29

研究者情報

学位

    堀 大治郎

J-Global ID

研究活動情報

論文

  • Hori D, Okamura H, Yamamoto T, Nishi S, Yuri K, Kimura N, Yamaguchi A, Adachi H
    Interactive cardiovascular and thoracic surgery 24 6 944 - 950 2017年06月 [査読有り][通常論文]
     
    OBJECTIVES: With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm. METHODS: Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared. RESULTS: Seventy percent (n = 47) needing endovascular repair underwent fenestrated stent graft and 30% (n = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P < 0.001). Intensive care unit stay (1 vs 3 days, P < 0.001), hospital stay (11 vs 17 days, P < 0.001) and surgical time (208 vs 390 min, P < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P = 0.40). Mid-term survival (P < 0.001) and freedom from reintervention (P = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison (n = 58) demonstrated that survival was better in the open surgery group (P = 0.011); no significant difference was seen in the reintervention rate (P = 0.28). CONCLUSIONS: Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.
  • Hori D, Dunkerly-Eyring B, Nomura Y, Biswas D, Steppan J, Henao-Mejia J, Adachi H, Santhanam L, Berkowitz DE, Steenbergen C, Flavell RA, Das S
    PloS one 12 3 e0174108  2017年03月 [査読有り][通常論文]
     
    Background Endothelial dysfunction and arterial stiffening play major roles in cardiovascular diseases. The critical role for the miR-181 family in vascular inflammation has been documented. Here we tested whether the miR-181 family can influence the pathogenesis of hypertension and vascular stiffening. Methods and results qPCR data showed a significant decrease in miR-181b expression in the aorta of the older mice. Eight miR-181a1/b1(-/-) mice and wild types (C57BL6J: WT) were followed weekly for pulse wave velocity (PWV) and blood pressure measurements. After 20 weeks, the mice were tested for endothelial function and aortic modulus. There was a progressive increase in PWV and higher systolic blood pressure in miR-181a1/b1(-/-) mice compared with WTs. At 21 weeks, aortic modulus was significantly greater in the miR-181a1/b1(-/-) group, and serum TGF-beta was found to be elevated at this time. A luciferase reporter assay confirmed miR181b targets TGF-beta i (TGF-beta induced) in the aortic VSMCs. In contrast, wire myography revealed unaltered endothelial function along with higher nitric oxide production in the miR181a1/ b1(-/-) group. Cultured VECs and VSMCs from the mouse aorta showed more secreted TGF-beta in VSMCs of the miR-181a1/b1(-/-) group; whereas, no change was observed from VECs. Circulating levels of angiotensin II were similar in both groups. Treatment with losartan (0.6 g/L) prevented the increase in PWV, blood pressure, and vascular stiffness in miR181a1/ b1(-/-) mice. Immunohistochemistry and western blot for p-SMAD2/3 validated the inhibitory effect of losartan on TGF-beta signaling in miR-181a1/b1(-/-) mice. Conclusions Decreased miR-181b with aging plays a critical role in ECM remodeling by removing the brake on the TGF-beta, pSMAD2/3 pathway.
  • Jochen Steppan, Yehudit Bergman, Kayla Viegas, Dinani Armstrong, Siqi Tan, Huilei Wang, Sean Melucci, Daijiro Hori, Sung Yong Park, Sebastian F. Barreto, Abraham Isak, Sandeep Jandu, Nicholas Flavahan, Mark Butlin, Steven S. An, Alberto Avolio, Dan E. Berkowitz, Marc K. Halushka, Lakshmi Santhanam
    JOURNAL OF THE AMERICAN HEART ASSOCIATION 6 2 2017年02月 [査読有り][通常論文]
     
    Background-The structural elements of the vascular wall, namely, extracellular matrix and smooth muscle cells (SMCs), contribute to the overall stiffness of the vessel. In this study, we examined the crosslinking-dependent and crosslinking-independent roles of tissue transglutaminase (TG2) in vascular function and stiffness. Methods and Results-SMCs were isolated from the aortae of TG2-/- and wild-type (WT) mice. Cell adhesion was examined by using electrical cell-substrate impedance sensing and PicoGreen assay. Cell motility was examined using a Boyden chamber assay. Cell proliferation was examined by electrical cell-substrate impedance sensing and EdU incorporation assays. Cell micromechanics were studied using magnetic torsion cytometry and spontaneous nanobead tracer motions. Aortic mechanics were examined by tensile testing. Vasoreactivity was studied by wire myography. SMCs from TG2-/- mice had delayed adhesion, reduced motility, and accelerated de-adhesion and proliferation rates compared with those from WT. TG2-/- SMCs were stiffer and displayed fewer cytoskeletal remodeling events than WT. Collagen assembly was delayed in TG2-/- SMCs and recovered with adenoviral transduction of TG2. Aortic rings from TG2-/- mice were less stiff than those from WT; stiffness was partly recovered by incubation with guinea pig liver TG2 independent of crosslinking function. TG2-/- rings showed augmented response to phenylephrine-mediated vasoconstriction when compared with WT. In human coronary arteries, vascular media and plaque, high abundance of fibronectin expression, and colocalization with TG2 were observed. Conclusions-TG2 modulates vascular function/tone by altering SMC contractility independent of its crosslinking function and contributes to vascular stiffness by regulating SMC proliferation and matrix remodeling.
  • D. Hori, N. M. Katz, D. M. Fine, M. Ono, V. M. Barodka, L. C. Lester, G. Yenokyan, C. W. Hogue
    BRITISH JOURNAL OF ANAESTHESIA 117 6 733 - 740 2016年12月 [査読有り][通常論文]
     
    Background. While urine flow rate <= 0.5 ml kg(-1) h(-1) is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI). The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI. Methods. Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification. Adjusted risk factors associated with AKI and urine flow rate were assessed. Results. Patients with AKI [n=149 (29.5%)] had lower urine flow rate than those without AKI (P<0.001). The relationship between urine flow and AKI risk was non-linear, with an inflection point at 1.5 ml kg(-1) h(-1). Among patients with urine flow <1.5 ml kg(-1) h(-1), every 0.5 ml kg(-1) h(-1) higher urine flow reduced the adjusted risk of AKI by 26% (95% CI 13-37; P<0.001). Urine flow rate during CPB was independently associated with the risk for AKI. Age up to 80 years and preoperative diuretic use were inversely associated with urine flow rate; mean arterial pressure on CPB (when <87 mmHg) and CPB flow were positively associated with urine flow rate. Conclusions. Urine flow rate during CPB <1.5 ml kg(-1)h(-1) identifies patients at risk for cardiac surgery-associated AKI. Careful monitoring of urine flow rate and optimizing mean arterial pressure and CPB flow might be a means to ensure renal perfusion during CPB.
  • Niranjana Natarajan, Daijiro Hori, Sheila Flavahan, Jochen Steppan, Nicholas A. Flavahan, Dan E. Berkowitz, Jennifer L. Pluznick
    PHYSIOLOGICAL GENOMICS 48 11 826 - 834 2016年11月 [査読有り][通常論文]
     
    Short chain fatty acid (SCFA) metabolites are byproducts of gut microbial metabolism that are known to affect host physiology via host G proteincoupled receptor (GPCRs). We previously showed that an acute SCFA bolus decreases blood pressure (BP) in anesthetized mice, an effect mediated primarily via Gpr41. In this study, our aims were to identify the cellular localization of Gpr41 and to determine its role in BP regulation. We localized Gpr41 to the vascular endothelium using RT-PCR: Gpr41 is detected in intact vessels (with endothelium) but is absent from denuded vessels (without endothelium). Furthermore, using pressure myography we confirmed that SCFAs dilate resistance vessels in an endothelium-dependent manner. Since we previously found that Gpr41 mediates a hypotensive response to acute SCFA administration, we hypothesized that Gpr41 knockout (KO) mice would be hypertensive. Here, we report that Gpr41 KO mice have isolated systolic hypertension compared with wild-type (WT) mice; diastolic BP was not different between WT and KO. Older Gpr41 KO mice also exhibited elevated pulse wave velocity, consistent with a phenotype of systolic hypertension; however, there was no increase in ex vivo aorta stiffness (measured by mechanical tensile testing). Plasma renin concentrations were also similar in KO and WT mice. The systolic hypertension in Gpr41 KO is not salt sensitive, as it is not significantly altered on either a high-or low-salt diet. In sum, these studies suggest that endothelial Gpr41 lowers baseline BP, likely by decreasing active vascular tone without altering passive characteristics of the blood vessels, and that Gpr41 KO mice have hypertension of a vascular origin.
  • Daijiro Hori, Laura Max, Andrew Laflam, Charles Brown, Karin J. Neufeld, Hideo Adachi, Christopher Sciortino, John V. Conte, Duke E. Cameron, Charles W. Hogue, Kaushik Mandal
    JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 30 3 606 - 612 2016年06月 [査読有り][通常論文]
     
    Objective: The aim of this study was to evaluate whether excursions of blood pressure from the optimal mean arterial pressure during and after cardiac surgery are associated with postoperative delirium identified using a structured examination. Design: Prospective, observational study. Setting: University hospital. Participants: The study included 110 patients undergoing cardiac surgery. Interventions: Patients were monitored using ultrasound tagged near-infrared spectroscopy to assess optimal mean arterial pressure by cerebral blood flow autoregulation monitoring during cardiopulmonary bypass and the first 3 hours in the intensive care unit. Measurements and Main Results: The patients were tested preoperatively and on postoperative days 1 to 3 with the Confusion Assessment Method or Confusion Assessment Method for the Intensive Care Unit, the Delirium Rating Scale-Revised-98, and the Mini Mental State Examination. Summative presence of delirium on postoperative days 1 through 3, as defined by the consensus panel following Diagnostic and Statistical Manual of Mental Disorders-IV-TR criteria, was the primary outcome. Delirium occurred in 47 (42.7%) patients. There were no differences in blood pressure excursions above and below optimal mean arterial pressure between patients with and without summative presence of delirium. Secondary analysis showed blood pressure excursions above the optimal mean arterial pressure to be higher in patients with delirium (mean SD, 33.2 +/- 26.51 mmHgxh v 23.4 +/- 16.13 mmHgxh; p = 0.031) and positively correlated with the Delirium Rating Scale score on postoperative day 2 (r = 0.27, p = 0.011). Conclusions: Summative presence of delirium was not associated with perioperative blood pressure excursions; but on secondary exploratory analysis, excursions above the optimal mean arterial pressure were associated with the incidence and severity of delirium on postoperative day 2. (C) 2016 Elsevier Inc. All rights reserved.
  • Hori D, Hogue CW
    The Annals of thoracic surgery 101 5 2027  2016年05月 [査読有り][通常論文]
  • Daijiro Hori, Charles Hogue, Hideo Adachi, Laura Max, Joel Price, Christopher Sciortino, Kenton Zehr, John Conte, Duke Cameron, Kaushik Mandal
    INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY 22 4 445 - 451 2016年04月 [査読有り][通常論文]
     
    OBJECTIVES: Perioperative blood pressure management by targeting individualized optimal blood pressure, determined by cerebral blood flow autoregulation monitoring, may ensure sufficient renal perfusion. The purpose of this study was to evaluate changes in the optimal blood pressure for individual patients, determined during cardiopulmonary bypass (CPB) and during early postoperative period in intensive care unit (ICU). A secondary aim was to examine if excursions below optimal blood pressure in the ICU are associated with risk of cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS: One hundred and ten patients undergoing cardiac surgery had cerebral blood flow monitored with a novel technology using ultrasound tagged near infrared spectroscopy (UT-NIRS) during CPB and in the first 3 h after surgery in the ICU. The correlation flow index (CFx) was calculated as a moving, linear correlation coefficient between cerebral flow index measured using UT-NIRS and mean arterial pressure (MAP). Optimal blood pressure was defined as the MAP with the lowest CFx. Changes in optimal blood pressure in the perioperative period were observed and the association of blood pressure excursions (magnitude and duration) below the optimal blood pressure [area under the curve (AUC) < OptMAP mmHgxh] with incidence of CSA-AKI (defined using Kidney Disease: Improving Global Outcomes criteria) was examined. RESULTS: Optimal blood pressure during early ICU stay and CPB was correlated (r = 0.46, P < 0.0001), but was significantly higher in the ICU compared with during CPB (75 +/- 8.7 vs 71 +/- 10.3 mmHg, P = 0.0002). Thirty patients (27.3%) developed CSA-AKI within 48 h after the surgery. AUC < OptMAP was associated with CSA-AKI during CPB [median, 13.27 mmHgxh, interquartile range (IQR), 4.63-20.14 vs median, 6.05 mmHgxh, IQR 3.03-12.40, P = 0.008], and in the ICU (13.72 mmHgxh, IQR 5.09-25.54 vs 5.65 mmHgxh, IQR 1.71-13.07, P = 0.022). CONCLUSIONS: Optimal blood pressure during CPB and in the ICU was correlated. Excursions below optimal blood pressure (AUC < OptMAP mmHgXh) during perioperative period are associated with CSA-AKI. Individualized blood pressure management based on cerebral autoregulation monitoring during the perioperative period may help improve CSA-AKI-related outcomes.
  • Hori D, Ono M, Adachi H, Hogue CW
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49 1 281 - 287 2016年01月 [査読有り][通常論文]
     
    OBJECTIVES: Combined carotid artery endarterectomy (CEA) and coronary artery bypass grafting surgery is considered to reduce longterm stroke risk for patients with severe carotid artery stenosis. The benefits of CEA for improving cerebral perfusion during subsequent cardiopulmonary bypass (CPB) are unclear. The purpose of this pilot study was to assess cerebral autoregulation and cerebral oximetry in patients undergoing combined CEA and cardiac surgery with those undergoing cardiac surgery without significant carotid artery stenosis or with uncorrected stenosis. METHODS: Cerebral autoregulation was monitored continuously in 257 patients with the cerebral oximetry index (COx). COx represents a moving Pearson's correlation coefficient between low-frequency changes in regional cerebral oxygen saturation (rScO(2)) and mean arterial pressure that has been validated in previous investigations. Impaired autoregulation was defined as a value of COx >= 0.3. RESULTS: Nineteen patients had prior CEA, 8 underwent combined CEA and cardiac surgery, 8 had uncorrected stenosis >70% and 197 had stenosis <50%. Combined, patients with stenosis >70% had a higher COx before CPB compared with those with stenosis <50% (median, 0.26, 25th percentile and 75th percentile [p25-p75], 0.18-0.33 vs 0.18, p25-p75, 0.07-0.27, respectively, P = 0.054). Patients who underwent combined CEA and cardiac surgery had a higher COx before surgery compared with those with prior CEA (P = 0.027) and stenosis <50% (P = 0.026). There were no differences in average COx or rScO(2) during CPB in patients undergoing combined CEA and cardiac surgery compared with those with prior CEA (P = 0.53, 0.27) and those with stenosis <50% (P = 0.71, 0.19), respectively. During CPB, patients with uncorrected stenosis had an average COx of 0.36 (p25-p75, 0.28-0.56) indicating cerebral autoregulation impairment, and lower rScO(2) compared with patients with prior CEA (P = 0.006) and stenosis <50% (P = 0.005). CONCLUSIONS: While higher at baseline, patients undergoing CEA immediately before cardiac surgery had COx and rScO(2) measurements during CPB similar to those with non-significant stenosis in contrast to those patients with uncorrected stenosis who had evidence of impaired autoregulation and lower rScO(2). These preliminary results suggest the potential utility of COx, possibly for complimenting patient selection for CEA as well as for individual patient management during surgery.
  • T. Rappold, A. Laflam, D. Hori, C. Brown, J. Brandt, C. D. Mintz, F. Sieber, A. Gottschalk, G. Yenokyan, A. Everett, C. W. Hogue
    BRITISH JOURNAL OF ANAESTHESIA 116 1 83 - 89 2016年01月 [査読有り][通常論文]
     
    Background: Postoperative cognitive dysfunction (POCD) is common after non-cardiac surgery, but the mechanism is unclear. We hypothesized that decrements in cognition 1 month after non-cardiac surgery would be associated with evidence of brain injury detected by elevation of plasma concentrations of S100 beta, neuron-specific enolase (NSE), and/or the brain-specific protein glial fibrillary acid protein (GFAP). Methods: One hundred and forty-nine patients undergoing shoulder surgery underwent neuropsychological testing before and then 1 month after surgery. Plasma was collected before and after anaesthesia. We determined the relationship between plasma biomarker concentrations and individual neuropsychological test results and a composite cognitive functioning score (mean Z-score). Results: POCD (>=-1.5 SD decrement in Z-score from baseline) was present in 10.1% of patients 1 month after surgery. There was a negative relationship between higher plasma GFAP concentrations and lower postoperative composite Z-scores {estimated slope=-0.14 [95% confidence interval (CI) -0.24 to -0.04], P=0.005} and change from baseline in postoperative scores on the Rey Complex Figure Test copy trial (P=0.021), delayed recall trial (P=0.010), and the Symbol Digit Modalities Test (P=0.004) after adjustment for age, sex, history of hypertension and diabetes. A similar relationship was not observed with S100 beta or NSE concentrations. Conclusions: Decline in cognition 1 month after shoulder surgery is associated with brain cellular injury as demonstrated by elevated plasma GFAP concentrations.
  • Jochen Steppan, Gautam Sikka, Daijiro Hori, Daniel Nyhan, Dan E. Berkowitz, Allan Gottschalk, Viachaslau Barodka
    HYPERTENSION RESEARCH 39 1 27 - 38 2016年01月 [査読有り][通常論文]
     
    Pulse wave velocity (PWV) and pulse pressure (PP) are blood pressure (BP)-dependent surrogates for vascular stiffness. Considering that there are no clinically useful markers for arterial stiffness that are BP-independent, our objective was to identify novel indices of arterial stiffness and compare them with previously described markers. PWV and PP were measured in young and old male Fisher rats and in young and old male spontaneously hypertensive rats (SHR) over a wide range of BPs. The BP dependence of these and several other indices of vascular stiffness were evaluated. An index incorporating PWV and PP was also constructed. Both PWV and PP increase in a non-linear manner with rising BP for both strains of animals (Fisher and SHRs). Age markedly changes the relationship between PWV or PP and BP. The previously described Ambulatory Arterial Stiffness Index (AASI) was able to differentiate between young and old vasculature, whereas the Cardio-Ankle Vascular Index (CAVI) did not reliably differentiate between the two. The novel Arterial Stiffness Index (ASI) differentiated stiffer from more compliant vasculature. Considering the limitations of the currently available indices of arterial stiffness, we propose a novel index of intrinsic arterial stiffness, the ASI, which is robust over a range of BPs and allows one to distinguish between compliant and stiff vasculature in both Fisher rats and SHRs. Further studies are necessary to validate this index in other settings.
  • Daijiro Hori, Charles W. Hogue, Ashish Shah, Charles Brown, Karin J. Neufeld, John V. Conte, Joel Price, Christopher Sciortino, Laura Max, Andrew Laflam, Hideo Adachi, Duke E. Cameron, Kaushik Mandal
    ANESTHESIA AND ANALGESIA 121 5 1187 - 1193 2015年11月 [査読有り][通常論文]
     
    BACKGROUND: Individualizing mean arterial blood pressure (MAP) based on cerebral blood flow (CBF) autoregulation monitoring during cardiopulmonary bypass (CPB) holds promise as a strategy to optimize organ perfusion. The purpose of this study was to evaluate the accuracy of cerebral autoregulation monitoring using microcirculatory flow measured with innovative ultrasound-tagged near-infrared spectroscopy (UT-NIRS) noninvasive technology compared with transcranial Doppler (TCD). METHODS: Sixty-four patients undergoing CPB were monitored with TCD and UT-NIRS (CerOx). The mean velocity index (Mx) was calculated as a moving, linear correlation coefficient between slow waves of TCD-measured CBF velocity and MAP. The cerebral flow velocity index (CFVx) was calculated as a similar coefficient between slow waves of cerebral flow index measured using UT-NIRS and MAP. When MAP is outside the autoregulation range, Mx is progressively more positive. Optimal blood pressure was defined as the MAP with the lowest Mx and CFVx. The right- and left-sided optimal MAP values were averaged to define the individual optimal MAP and were the variables used for analysis. RESULTS: The Mx for the left side was 0.31 0.17 and for the right side was 0.32 +/- 0.17. The mean CFVx for the left side was 0.33 +/- 0.19 and for the right side was 0.35 +/- 0.19. Time-averaged Mx and CFVx during CPB had a statistically significant among-subject correlation (r = 0.39; 95% confidence interval [CI], 0.22-0.53; P < 0.001) but had only a modest agreement within subjects (bias 0.03 +/- 0.20; 95% prediction interval for the difference between Mx and CFVx, -0.37 to 0.42). The MAP with the lowest Mx and CFVx (optimal blood pressure) was correlated (r = 0.71; 95% CI, 0.56-0.81; P < 0.0001) and was in modest within-subject agreement (bias -2.85 +/- 8.54; 95% limits of agreement for MAP predicted by Mx and CFVx, -19.60 to 13.89). Coherence between ipsilateral middle CBF velocity and cerebral flow index values averaged 0.61 +/- 0.07 (95% CI, 0.59-0.63). CONCLUSIONS: There was a statistically significant correlation and agreement between CBF autoregulation monitored by CerOx compared with TCD-based Mx.
  • Daijiro Hori, Allen D. Everett, Jennifer K. Lee, Masahiro Ono, Charles H. Brown, Ashish S. Shah, Kaushik Mandal, Joel E. Price, Laeben C. Lester, Charles W. Hogue
    ANNALS OF THORACIC SURGERY 100 4 1353 - 1359 2015年10月 [査読有り][通常論文]
     
    Background. Rewarming from hypothermia during cardiopulmonary bypass (CPB) may compromise cerebral oxygen balance, potentially resulting in cerebral ischemia. The purpose of this study was to evaluate whether CPB rewarming rate is associated with cerebral ischemia assessed by the release of the brain injury biomarker glial fibrillary acidic protein (GFAP). Methods. Blood samples were collected from 152 patients after anesthesia induction and after CPB for the measurement of plasma GFAP levels. Nasal temperatures were recorded every 15 min. A multivariate estimation model for postoperative plasma GFAP level was determined that included the baseline GFAP levels, rewarming rate, CPB duration, and patient age. Results. The mean rewarming rate during CPB was 0.21 degrees +/- 0.11 degrees C/min; the maximal temperature was 36.5 degrees +/- 1.0 degrees C (range, 33.1 degrees C to 38.0 degrees C). Plasma GFAP levels increased after compared with before CPB (median, 0.022 ng/mL versus 0.035 ng/mL; p < 0.001). Rewarming rate (p = 0.001), but not maximal temperature (p = 0.77), was associated with higher plasma GFAP levels after CPB. In the adjusted estimation model, rewarming rate was positively associated with postoperative plasma log GFAP levels (coefficient, 0.261; 95% confidence intervals, 0.132 to 0.390; p < 0.001). Six patients (3.9%) experienced a postoperative stroke. Rewarming rate was higher (0.3 degrees +/- 0.09 degrees C/min versus 0.2 degrees +/- 0.11 degrees C/min; p = 0.049) in the patients with stroke compared with those without a stroke. Conclusions. Rewarming rate during CPB was correlated with evidence of brain cellular injury documented with plasma GFAP levels. Modifying current practices of patient rewarming might provide a strategy to reduce the frequency of neurologic complications after cardiac surgery. (C) 2015 by The Society of Thoracic Surgeons
  • Daijiro Hori, Masahiro Ono, Thomas E. Rappold, John V. Conte, Ashish S. Shah, Duke E. Cameron, Hideo Adachi, Allen D. Everett, Charles W. Hogue
    ANNALS OF THORACIC SURGERY 100 2 487 - 494 2015年08月 [査読有り][通常論文]
     
    Background. Individualizing blood pressure targets could improve organ perfusion compared with current practices. In this study we assess whether hypotension defined by cerebral autoregulation monitoring vs standard definitions is associated with elevation in the brain-specific injury biomarker glial fibrillary acidic protein plasma levels (GFAP). Methods. Plasma GFAP levels were measured in 121 patients undergoing cardiac operations after anesthesia induction, at the conclusion of the operation, and on postoperative day 1. Cerebral autoregulation was monitored during the operation with the cerebral oximetry index, which correlates low-frequency changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation. Blood pressure was recorded every 15 minutes in the intensive care unit. Hypotension was defined based on autoregulation data as an MAP below the optimal MAP (MAP at the lowest cerebral oximetry index) and based on standard definitions (systolic blood pressure decrement >20%, >30% from baseline, or <100 mm Hg, or both). Results. MAP (mean +/- standard deviation) in the intensive care unit was 74 +/- 7.3 mm Hg; optimal MAP was 78 +/- 12.8 mm Hg (p = 0.008). The incidence of hypotension varied from 22% to 37% based on standard definitions but occurred in 54% of patients based on the cerebral oximetry index (p < 0.001). There was no relationship between standard definitions of hypotension and plasma GFAP levels, but MAP of less than optimal was positively related with postoperative day 1 GFAP levels (coefficient, 1.77; 95% confidence interval, 1.27 to 2.48; p = 0.001) after adjusting for GFAP levels at the conclusion of the operation and low cardiac output syndrome. Conclusions. Individualizing blood pressure management using cerebral autoregulation monitoring may better ensure brain perfusion than current practice. (C) 2015 by The Society of Thoracic Surgeons
  • Deepesh Pandey, Daijiro Hori, Jae Hyung Kim, Yehudit Bergman, Dan E. Berkowitz, Lewis H. Romer
    JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY 81 18 - 22 2015年04月 [査読有り][通常論文]
     
    Emerging evidence strongly supports a role for HDAC2 in the transcriptional regulation of endothelial genes and vascular function. We have recently demonstrated that HDAC2 reciprocally regulates the transcription of Arginase2, which is itself a critical modulator of endothelial function via eNOS. Moreover HDAC2 levels are decreased in response to the atherogenic stimulus OxLDL via a mechanism that is apparently dependent upon proteasomal degradation. NEDDylation is a post-translational protein modification that is tightly linked to ubiquitination and thereby protein degradation. We propose that changes in NEDDylation may modulate vascular endothelial function in part through alterations in the proteasomal degradation of HDAC2. In HAEC, OxLDL exposure augmented global protein NEDDylation. Pre-incubation of mouse aortic rings with the NEDDylation activating enzyme inhibitor, MLN4924, prevented OxLDL-induced endothelial dysfunction. In HAEC, MLN enhanced HDAC2 abundance, decreased expression and activity of Arginase2, and blocked OxLDL-mediated reduction of HDAC2. Additionally, HDAC2 was shown to be a substrate for NEDD8 conjugation and this interaction was potentiated by OxLDL. Further, HDAC2 levels were reciprocally regulated by ectopic expression of NEDD8 and the de-NEDDylating enzyme SENP8. Our findings indicate that the observed improvement in endothelial dysfunction with inhibition of NEDDylation activating enzyme is likely due to an HDAC2-dependent decrease in Arginase2. NEDDylation activating enzyme may therefore be a novel target in endothelial dysfunction and atherogenesis. (C) 2015 Elsevier Ltd. All rights reserved.
  • Guangshuo Zhu, Dieter Groneberg, Gautam Sikka, Daijiro Hori, Mark J. Ranek, Taishi Nakamura, Eiki Takimoto, Nazareno Paolocci, Dan E. Berkowitz, Andreas Friebe, David A. Kass
    HYPERTENSION 65 2 385 - U290 2015年02月 [査読有り][通常論文]
     
    Nitroxyl (HNO), the reduced and protonated form of nitric oxide (NO.), confers unique physiological effects including vasorelaxation and enhanced cardiac contractility. These features have spawned current pharmaceutical development of HNO donors as heart failure therapeutics. HNO interacts with selective redox sensitive cysteines to effect signaling but is also proposed to activate soluble guanylate cyclase (sGC) in vitro to induce vasodilation and potentially enhance contractility. Here, we tested whether sGC stimulation is required for these HNO effects in vivo and if HNO also modifies a redox-sensitive cysteine (C42) in protein kinase G-1 alpha to control vasorelaxation. Intact mice and isolated arteries lacking the sGC-beta subunit (sGCKO, results in full sGC deficiency) or expressing solely a redox-dead C42S mutant protein kinase G-1 alpha were exposed to the pure HNO donor, CXL-1020. CXL-1020 induced dose-dependent systemic vasodilation while increasing contractility in controls; however, vasodilator effects were absent in sGCKO mice whereas contractility response remained. The CXL-1020 dose reversing 50% of preconstricted force in aortic rings was approximate to 400-fold greater in sGCKO than controls. Cyclic-GMP and cAMP levels were unaltered in myocardium exposed to CXL-1020, despite its inotropic-vasodilator activity. In protein kinase G-1 alpha(C42S) mice, CXL-1020 induced identical vasorelaxation in vivo and in isolated aortic and mesenteric vessels as in littermate controls. In both groups, dilation was near fully blocked by pharmacologically inhibiting sGC. Thus, sGC and cGMP-dependent signaling are necessary and sufficient for HNO-induced vasodilation in vivo but are not required for positive inotropic action. Redox modulation of protein kinase G-1 alpha is not a mechanism for HNO-mediated vasodilation.
  • Gautam Sikka, G. Patrick Hussmann, Deepesh Pandey, Suyi Cao, Daijiro Hori, Jong Taek Park, Jochen Steppan, Jae Hyung Kim, Viachaslau Barodka, Allen C. Myers, Lakshmi Santhanam, Daniel Nyhan, Marc K. Halushka, Raymond C. Koehler, Solomon H. Snyder, Larissa A. Shimoda, Dan E. Berkowitz
    PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 111 50 17977 - 17982 2014年12月 [査読有り][通常論文]
     
    Melanopsin (opsin4; Opn4), a non-image-forming opsin, has been linked to a number of behavioral responses to light, including circadian photo-entrainment, light suppression of activity in nocturnal animals, and alertness in diurnal animals. We report a physiological role for Opn4 in regulating blood vessel function, particularly in the context of photorelaxation. Using PCR, we demonstrate that Opn4 (a classic G protein-coupled receptor) is expressed in blood vessels. Force-tension myography demonstrates that vessels from Opn4(-/-) mice fail to display photorelaxation, which is also inhibited by an Opn4-specific small-molecule inhibitor. The vasorelaxation is wavelength-specific, with a maximal response at similar to 430-460 nm. Photorelaxation does not involve endothelial-, nitric oxide-, carbon monoxide-, or cytochrome p450-derived vasoactive prostanoid signaling but is associated with vascular hyperpolarization, as shown by intracellular membrane potential measurements. Signaling is both soluble guanylyl cyclase-and phosphodiesterase 6-dependent but protein kinase G-independent. beta-Adrenergic receptor kinase 1 (beta ARK 1 or GRK2) mediates desensitization of photorelaxation, which is greatly reduced by GRK2 inhibitors. Blue light (455 nM) regulates tail artery vasoreactivity ex vivo and tail blood blood flow in vivo, supporting a potential physiological role for this signaling system. This endogenous opsin-mediated, light-activated molecular switch for vasorelaxation might be harnessed for therapy in diseases in which altered vasoreactivity is a significant pathophysiologic contributor.
  • D. Hori, C. Brown, M. Ono, T. Rappold, F. Sieber, A. Gottschalk, K. J. Neufeld, R. Gottesman, H. Adachi, C. W. Hogue
    BRITISH JOURNAL OF ANAESTHESIA 113 6 1009 - 1017 2014年12月 [査読有り][通常論文]
     
    Background. Mean arterial pressure (MAP) below the lower limit of cerebral autoregulation during cardiopulmonary bypass (CPB) is associated with complications after cardiac surgery. However, simply raising empiric MAP targets during CPB might result in MAP above the upper limit of autoregulation (ULA), causing cerebral hyperperfusion in some patients and predisposing them to cerebral dysfunction after surgery. We hypothesized that MAP above an ULA during CPB is associated with postoperative delirium. Methods. Autoregulation during CPB was monitored continuously in 491 patients with the cerebral oximetry index (COx) in this prospective observational study. COx represents Pearson's correlation coefficient between low-frequency changes in regional cerebral oxygen saturation (measured with near-infrared spectroscopy) and MAP. Delirium was defined throughout the postoperative hospitalization based on clinical detection with prospectively defined methods. Results. Delirium was observed in 45 (9.2%) patients. Mechanical ventilation for >48 h [odds ratio (OR), 3.94; 95% confidence interval (CI), 1.72-9.031 preoperative antidepressant use (OR, 3.0; 95% CI, 1.29-6.96), prior stroke (OR, 2.79; 95% CI, 1.12-6.96), congestive heart failure (OR, 2.68; 95% CI, 1.28-5.62), the product of the magnitude and duration of MAP above an ULA (mm Hg h; OR, 1.09; 95% CI, 1.03-1.15), and age (per year of age; OR, 1.01; 95% CI, 1.01-1.07) were independently associated with postoperative delirium. Conclusions. Excursions of MAP above the upper limit of cerebral autoregulation during CPB are associated with risk for delirium. Optimizing MAP during CPB to remain within the cerebral autoregulation range might reduce risk of delirium.
  • Daijiro Hori, Kenichiro Noguchi, Yohei Nomura, Hiroyuki Tanaka
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 20 836 - 838 2014年 [査読有り][通常論文]
     
    We report on a successful configuration strategy of extracorporeal membrane oxygenation (ECMO) in two consecutive cases of acute lung injury. A 60-year-old woman with Streptococcus pneumoniae infection and a 22-year-old man with hemothorax were admitted to our hospital with failing lungs. Although treatment with a ventilator was started, oxygenation could not be maintained. ECMO with a femoro-femoral circuit was performed, which showed a slight improvement in oxygenation. However, not enough oxygen support was provided. To minimize the venous mixture at the right atrium, we added venous drainage from the right jugular vein which resulted in better oxygenation and patient survival.
  • Daijiro Hori, Koichi Yuri, Satoshi Nishi, Harunobu Matsumoto, Atsushi Yamaguchi, Hideo Adachi
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 20 805 - 808 2014年 [査読有り][通常論文]
     
    A 70-year-old woman with a medical history of descending aorta replacement for chronic type B aortic dissection 12 years prior was admitted to our hospital with sudden back pain and hemoptysis. The patient was diagnosed with ruptured residual dissected thoracic aortic aneurysm and underwent emergent endovascular treatment. Two TAG thoracic endoprosthesis of different sizes were used to accommodate the discrepancy in size of the true lumen, resulting in a successful closure of the entry tear and hemostasis, without any damage to the intima. Computed tomography performed 3 months after surgery revealed successful remodeling of the remaining aorta. Thoracic endovascular aortic replacement may be considered as an option in the treatment of chronic dissected aortic aneurysm, achieving not only entry closure but possibly remodeling, as well.
  • Yuri K, Yokoi Y, Yamaguchi A, Hori D, Adachi K, Adachi H
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 44 4 760 - 767 2013年10月 [査読有り][通常論文]
  • Hori D, Noguchi K, Nomura Y, Tanaka H
    Asian cardiovascular & thoracic annals 21 5 608 - 611 2013年10月 [査読有り][通常論文]
  • Hori D, Noguchi K, Nomura Y, Tanaka H
    Asian cardiovascular & thoracic annals 21 5 615 - 617 2013年10月 [査読有り][通常論文]
  • Daijiro Hori, Kenichiro Noguchi, Yohei Nomura, Alan Lefor, Hiroyuki Tanaka
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 19 3 234 - 238 2013年06月 [査読有り][通常論文]
     
    An 82-year-old-man with a previous history of atrial fibrillation was admitted with acute limb ischemia. Emergent embolectomy was performed, but after the operation, the patient suffered from recurrent ischemic pain. Peripheral angiography revealed thrombosis of the distal popliteal artery due to pre-existing peripheral arterial occlusive disease. Bypass surgery of the popliteal artery and posterior tibial artery was then performed. Although peripheral blood flow was restored after the operation, he suffered from compartment syndrome the next day. The patient was treated with an emergent bed-side fasciotomy using a small incision, achieving full recovery of blood flow to the distal artery. The wound closed secondarily without surgical closure. In a patient with peripheral arterial occlusive disease, fasciotomy should be performed at a lower compartment pressure due to a lack of peripheral perfusion pressure. Emergent small incision fasciotomy was effective in this patient with an acute compartment syndrome and an ischemic limb.
  • Daijiro Hori, Koichi Yuri, Kenichiro Noguchi, Yohei Nomura, Hiroyuki Tanaka
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 18 6 536 - 539 2012年12月 [査読有り][通常論文]
     
    A 68 year old man was admitted to our hospital with dysphagia and back pain. Contrasted computed tomography showed "Shaggy aorta" forming a saccular descending aortic aneurysm with edematous esophagus. Low density area in the intramuscular layer of the esophagus suggested the possibility of connection between the esophagus and the aneurysm. The patient underwent endovascular treatment of the aneurysm. The postoperative course was uneventful, and the patient was discharged from the hospital with improvement in his symptoms. Although there are reports suggesting endovascular treatment as a contraindication for shaggy aorta due to risk of embolization, it may be considered as an option for a patient who is in need of surgical treatment.
  • Daijiro Hori, Kenichiro Noguchi, Yohei Nomura, Alan Lefor, Hiroyuki Tanaka
    ANNALS OF THORACIC SURGERY 94 2 641 - 643 2012年08月 [査読有り][通常論文]
     
    A 68-year-old man with a history of coronary artery bypass graft surgery was admitted for ascending aorta replacement. Preoperative coronary computed tomography angiography revealed occlusion of the three coronary arteries. Perfusion of all three coronary vessels was achieved using a T-graft from the right gastroepiploic and radial arteries, which were anastomosed to the right coronary artery and posterolateral artery, respectively. The patient underwent ascending aorta replacement, with hyperkalemia and hypothermia for myocardial protection. Systemic hyperkalemia was useful to maintain cardiac arrest and also to monitor effective perfusion of the myocardium through the bypass grafts. (Ann Thorac Surg 2012;94:641-3) (c) 2012 by The Society of Thoracic Surgeons
  • Kenichiro Noguchi, Daijiro Hori, Yohei Nomura, Hiroyuki Tanaka
    INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY 14 6 900 - 902 2012年06月 [査読有り][通常論文]
     
    We present the case of a 60-year old man who complained of severe dysphagia caused by a double aortic arch (DAA) with a right-sided descending thoracic aorta. The left-sided aortic arch had a compressive segment located between the left subclavian artery and the descending thoracic aorta. Using left third thoracotomy, the segment, which caused compression of the oesophagus, was ligated and divided. After the operation, the patient was completely relieved of his symptoms. We concluded that the removal of the compressive portion of the left aortic arch and the ligation of the ligamentum arteriosum are the only treatment measures needed in such cases.
  • Hori D, Noguchi K, Yamaguchi A, Adachi H
    General thoracic and cardiovascular surgery 60 6 381 - 385 2012年06月 [査読有り][通常論文]
  • Daijiro Hori, Kenichiro Noguchi, Yohei Nomura, Hiroyuki Tanaka
    ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY 18 3 262 - 265 2012年06月 [査読有り][通常論文]
     
    A 62-year-old man with a medical history of aortic valve replacement was referred to our hospital with high-grade fever. Blood culture was positive for Streptococcus dysgalactiae, and the echocardiogram showed edematous aortic annulus, suggesting a perivalvular abscess. Treatment with antibiotics was started, which showed progressive improvement. The echocardiogram at 2 weeks after admission showed progression of the perivalvular abscess, resulting in the formation of a perivalvular pseudoaneruysm, which revealed rapid enlargement. The patient underwent surgical resection of a 20-mm pseudoaneurysm, originating from the right and left coronary cusp. Complete resection of the infective tissue was performed, and an aortic root replacement was done. This case highlights that a frequent follow-up should be performed in case of perivalvular abscess, because of the risk of pseudoaneurysm formation, which may cause a life-threatening outcome.
  • Hori D, Yuri K, Nemoto K, Yamaguchi A, Adachi H
    General thoracic and cardiovascular surgery 60 5 308 - 311 2012年05月 [査読有り][通常論文]
  • Yuri K, Yamaguchi A, Hori D, Shiraishi M, Nagano H, Tamura A, Noguchi K, Naito K, Nemoto K, Adachi H
    Annals of vascular diseases 5 1 15 - 20 2012年 [査読有り][通常論文]
  • Noguchi K, Hori D, Nomura Y, Tanaka H
    Annals of vascular diseases 5 1 78 - 81 2012年 [査読有り][通常論文]
  • Noguchi K, Hori D, Nomura Y, Tanaka H
    Annals of vascular diseases 5 3 376 - 380 2012年 [査読有り][通常論文]
  • Daijiro Hori, Koichi Yuri, Kazunari Nemoto, Atsushi Yamaguchi, Hideo Adachi
    SURGERY TODAY 40 12 1169 - 1172 2010年12月 [査読有り][通常論文]
     
    A 77-year-old man with an infrarenal abdominal aortic aneurysm was referred with a complex medical history including pancreatitis, chronic renal failure, atrial fibrillation, and a cerebral infarction. He also had a history of atherosclerosis obliterans, treated with a vascular bypass using an 8-mm prosthetic graft 9 years previously. His complicated anatomy, including a small access route and a large common iliac artery, suggested usage of Powerlink, a bifurcated stent graft through the previously placed graft, as an access route. The patient was discharged from the hospital with a type III endoleak, which was completely resolved 5 months after discharge.
  • Hori D, Tanaka M, Kohinata T, Kimura C, Naito K, Yamaguchi A, Adachi H
    General thoracic and cardiovascular surgery 58 6 283 - 286 2010年06月 [査読有り][通常論文]
  • Hori D, Tanaka M, Yamaguchi A, Adachi H
    General thoracic and cardiovascular surgery 58 5 255 - 259 2010年05月 [査読有り][通常論文]
  • Yuri K, Yamaguchi A, Hori D, Nemoto K, Kawaguchi S, Yokoi Y, Shigematsu H, Adachi H
    Annals of vascular diseases 3 3 228 - 231 2010年 [査読有り][通常論文]
  • Hori D, Tanaka M, Yamaguchi A, Adachi H
    Asian cardiovascular & thoracic annals 17 6 640 - 642 2009年12月 [査読有り][通常論文]
  • Hori D, Endo S, Tsubochi H, Nokubi M, Sohara Y
    General thoracic and cardiovascular surgery 56 9 468 - 471 2008年09月 [査読有り][通常論文]
  • Hori D, Tanaka M, Yamaguchi A, Adachi H, Ino T
    General thoracic and cardiovascular surgery 56 8 424 - 426 2008年08月 [査読有り][通常論文]
  • [Hemoptysis one year after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax: report of a case].
    Hori D, Endo S, Tsubochi H, Miwa C, Watanabe Y, Koyama S, Matsuura K, Nokubi M, Sohara Y
    Kyobu geka. The Japanese journal of thoracic surgery 61 4 340 - 343 2008年04月 [査読有り][通常論文]
  • [Hemolysis after ascending and arch replacement of the aorta; report of a case].
    Hori D, Kawahito K, Tanaka M, Nagano H
    Kyobu geka. The Japanese journal of thoracic surgery 60 12 1103 - 1106 2007年11月 [査読有り][通常論文]

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