基本情報
- 所属
- 自治医科大学 附属さいたま医療センター/ 医学部総合医学第1講座 教授
- 学位
- 医学博士(東京大学)
- J-GLOBAL ID
- 200901000408616016
- researchmap会員ID
- 6000003282
研究キーワード
1研究分野
1論文
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Cardiovascular intervention and therapeutics 2025年2月28日
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Cardiovascular intervention and therapeutics 2025年2月22日The clinical outcomes of percutaneous coronary intervention (PCI) in patients with dialysis are still worse compared with those without dialysis. Among patients with dialysis, those who started dialysis due to diabetic nephropathy (DMN) may have a worse prognosis than those who started dialysis due to non-DMN. This retrospective study aimed to compare the clinical outcomes in dialysis patients who underwent PCI between with and without long-term dialysis due to DMN. We included 303 dialysis patients with PCI. The length of dialysis at the time of PCI was used to stratify the study patients. Patients with DMN and the length of dialysis ≥ 3 years were defined as the long-DMN group (n = 117), and the others were defined as the other group (n = 186). The primary endpoint was the incidence of major adverse cardiac events (MACE), which was defined as a composite of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, and ischemia-driven target vessel revascularization. A total of 165 MACE were observed with the median follow-up of 568 days. The Kaplan-Meier curves showed that MACE was more frequently observed in the long-DMN group than in the other group (p = 0.005). In the multivariate Cox hazard model, long-DMN was significantly associated with MACE (hazard ratio 1.483, 95% confidence interval 1.075-2.046, p = 0.016) after controlling for multiple confounding factors. Among patients with dialysis, the combination of DMN and a long history of dialysis is closely associated with poor clinical outcomes. These patients should be carefully followed up by both cardiologists and nephrologists.
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Cardiovascular intervention and therapeutics 2025年2月3日Percutaneous coronary intervention has been developed for patients with coronary artery disease. Calcified lesions are recognized as an unsolved issue where many clinical devices have evolved and some disappeared. Understanding intracoronary imaging of the calcified lesions can help operators to make decisions during the procedure. There are several potential stories of progression of calcification, although a precise mechanism of progression of calcification remains unknown. In the process of a large calcification, it is histologically believed that lipid is replaced by calcification. This process can be observed by intracoronary imaging devices, i.e., intravascular ultrasound and optical coherence tomography. Calcified nodule is a unique type of calcifications. Among the calcified lesions, especially calcified nodule has serious clinical outcomes such as target lesion revascularization (TLR) with stent under-expansion. Additionally, in-stent calcified nodule is a distinctive type of restenosis pattern after stenting to calcified nodule, leading to malignant cycle of repeated TLR. Recently, calcified nodule is divided into two types based on the surface irregularity: (1) eruptive and (2) non-eruptive calcified nodule. Eruptive calcified nodule has higher rate of target vessel revascularization than non-eruptive calcified nodule despite greater stent expansion in eruptive calcified nodule. It is thought that there are differences of component such as the amount of fibrin and the size of calcific nodules between both, although it is common for both to include calcific nodules and fibrin. Histopathological understanding calcified nodule can be helpful to choose the treatment devices during the procedure in the area where there is no correct answer.
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Cardiovascular intervention and therapeutics 2025年1月24日
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European Heart Journal - Digital Health 6(2) 209-217 2025年1月16日Abstract Aims Delayed diagnosis of pulmonary hypertension (PH) is a known cause of poor patient prognosis. We aimed to develop an artificial intelligence (AI) model, using ensemble learning method to detect PH using electrocardiography (ECG), chest X-ray (CXR), and brain natriuretic peptide (BNP), facilitating accurate detection and prompting further examinations. Methods and results We developed a convolutional neural network model using ECG data to predict PH, labelled by ECG from seven institutions. Logistic regression was used for the BNP prediction model. We referenced a CXR deep learning model using ResNet18. Outputs from each of the three models were integrated into a three-layer fully connected multimodal model. Ten cardiologists participated in an interpretation test, detecting PH from patients’ ECG, CXR, and BNP data both with and without the ensemble learning model. The area under the receiver operating characteristic curves of the ECG, CXR, BNP, and ensemble learning model were 0.818 [95% confidence interval (CI), 0.808–0.828], 0.823 (95% CI, 0.780–0.866), 0.724 (95% CI, 0.668–0.780), and 0.872 (95% CI, 0.829–0.915). Cardiologists’ average accuracy rates were 65.0 ± 4.7% for test without AI model and 74.0 ± 2.7% for test with AI model, a statistically significant improvement (P < 0.01). Conclusion Our ensemble learning model improved doctors’ accuracy in detecting PH from ECG, CXR, and BNP examinations. This suggests that earlier and more accurate PH diagnosis is possible, potentially improving patient prognosis.
MISC
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糖尿病 52(12) 935-939 2009年12月冠動脈疾患は欧米人糖尿病患者では死因の第1位であるが,日本人糖尿病患者では第3位と,欧米人と比較して冠動脈イベントリスクが低い可能性がある.糖尿病網膜症の重症度は冠動脈疾患リスクと比例することが海外の疫学調査よりわかっており,糖尿病網膜症患者は糖尿病患者のなかでも冠動脈イベントリスクが高いサブグループである.さらに,冠動脈疾患に関して未診断の糖尿病網膜症患者の約20.25%は冠動脈狭窄病変を合併していることが判明している.(著者抄録)
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日本心臓病学会誌 =Journal of cardiology. Japanese edition 3(2) 113-117 2009年3月15日
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Circulation journal : official journal of the Japanese Circulation Society 73 555-555 2009年3月1日
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Circulation journal : official journal of the Japanese Circulation Society 73 695-695 2009年3月1日
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Circulation journal : official journal of the Japanese Circulation Society 73 466-466 2009年3月1日
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PROGRESS IN BIOPHYSICS & MOLECULAR BIOLOGY 97(2-3) 282-297 2008年6月Mechano-electrical feedback (MEF) has mainly been studied in isolated single cardiomyocytes using the microelectrode and micropipette techniques, but information regarding its dynamic aspects at the cellular level is limited due to the technical difficulties associated with manipulating single cells and maintaining stable attachment of these devices. To overcome such difficulties, we have combined two experimental methods, namely a carbon fiber technique to hold single myocytes and a ratiometric fluorescence measurement technique to monitor Ca2+ transients or membrane potentials. Following an overview of the experimental technique for stretching myocytes, the results for single rat ventricular myocytes under axial stretching are presented. Ca2+ transients were influenced by the loading conditions and involvement of myofilaments was suspected in regulatory mechanism. Membrane potential measurements during dynamic axial stretching revealed that the action potential duration was prolonged when the stretch was applied during the late phase of twitch contraction, and that depolarization of the resting membrane potential depended on the phase, amplitude and speed of the applied stretch. The amplitude may also modulate the ion selectivity of stretch-activated channels. This combination of the carbon fiber technique with fluorescence measurement could represent a powerful tool for clarifying MEF at the cellular level. (c) 2008 Published by Elsevier Ltd.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 51(10) A268-A268 2008年3月
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Japanese Journal of Gastroenterological Surgery 41(2) 269-274 2008年Drug-eluting coronary stents (DES) incorporating an eluting antiproliferative agent are commonly used to treat coronary heart disease. While DES reduce the rate of coronary artery restenosis, they have a higher incidence of late thrombosis compared to bare metal stents. Patients are maintained on dual antiplatelet therapy with aspirin and thienopyridine. If the patient suffers from digestive cancer after DES implantation, antiplatelet therapy is temporarily halted, and replaced by heparin administration to avoid perioperative bleeding risk. No evidence exists, to our knowledge is that this drug substitution is safe. We report two successfully treated and one unsuccessfully treated case of gastric cancer involving DES implantation. We review the literature and propose anticoagulation treatment guidelines for DES patients undergoing surgery. ©2008 The Japanese Society of Gastroenterological Surgery.
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Circulation journal : official journal of the Japanese Circulation Society 71 868-868 2007年4月20日
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日本外科学会雑誌 108 267-267 2007年3月10日
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Circulation journal : official journal of the Japanese Circulation Society 71 118-118 2007年3月1日
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Circulation journal : official journal of the Japanese Circulation Society 71 659-660 2007年3月1日
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 49(9) 195A-195A 2007年3月
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Circulation journal : official journal of the Japanese Circulation Society 70 1137-1137 2006年10月20日
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Circulation journal : official journal of the Japanese Circulation Society 66 135-135 2002年3月31日
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Circulation journal : official journal of the Japanese Circulation Society 66 386-386 2002年3月31日
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Circulation journal : official journal of the Japanese Circulation Society 66 440-440 2002年3月31日
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Japanese circulation journal 65 721-721 2001年10月20日
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Japanese circulation journal 64 175-175 2000年3月1日
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Radioisotopes 48(6) 431-432 1999年6月虚血性心疾患は冠動脈に硬化が生じ惹起されるさまざまな病態であるが, 狭窄・閉塞部位をバルーンで機械的に拡張する経皮経管冠動脈形成術 (peraitaneous transluminal coronary angioplasty, PTCA) は20年来大きな役割を果たし発展してきた。しかし, 一度拡張を行った部位に数か月後30-60%の症例で起きる再狭窄という問題が大きな限界となっていた。これに対し筒状・網状のステントという金属を植え込んで血管内腔を確保する技術で20-30%程度に再狭窄率を減少させることが明らかにされてきたが, ステント部位にも再狭窄が生じ, さらに問題が複雑化すること (ステント内再狭窄in-stent restenosis) も指摘されてきた。それらの問題の克服のためこれまでにさまざま方法が模索されてきている。刃付きバルーンなど新たなメカニカルなアプローチ, 薬物療法, さらに遺伝子治療などが試みられているがそれぞれ十分な効果をあげている, あるいはあげうると言い難いのが現状である。そこで細胞増殖抑制効果のためケロイド治療などに治療効果が確立されている放射線照射療法を冠動脈治療に応用する試みが欧米でなされ, 臨床試験の成積も発表されその有用性への期待が高まっている。
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Japanese circulation journal 63(1) 431-431 1999年3月1日
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Japanese circulation journal 63(1) 106-106 1999年3月1日
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Japanese circulation journal 62 333-333 1998年2月28日
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Japanese circulation journal 62 36-36 1998年2月28日
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Japanese circulation journal 62 122-122 1998年2月28日
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Japanese circulation journal 60 95-95 1996年2月20日
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Japanese circulation journal 58(7) 577-577 1994年6月20日
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Japanese circulation journal 58(7) 498-498 1994年6月20日
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