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Keiko Fujisawa,
Naoto Katakami,
Hideaki Kaneto,
Toyoko Naka,
Mitsuyoshi Takahara, Fumie Sakamoto,
Yoko Irie,
Kazuyuki Miyashita,
Fumiyo Kubo,
Tetsuyuki Yasuda,
Taka-Aki Matsuoka,
Iichiro Shimomura
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ABSTRACT: It is still controversial whether circulating soluble form of receptor for AGE (sRAGE) is associated with atherosclerosis in diabetic patients. In this study, we enrolled 276 Japanese type 2 diabetic subjects without history of cardiovascular disease (CVD), assessed their baseline clinical and biochemical data including serum sRAGE levels, and prospectively evaluated the association between these parameters and CVD events. The median follow-up period was 5.6 years and there were 25 new CVD events. The tertile analysis showed that the risk for CVD events was higher as serum sRAGE levels were increased (p for trend = 0.046). A multivariate Cox proportional hazards regression analysis revealed that serum sRAGE levels were independently associated with CVD (HR per 1SD = 1.59, 95% CI 1.04-2.45, p = 0.034), even after adjusting for conventional coronary risk factors. In summary, elevated sRAGE levels were associated with the increased risk of CVD in Japanese type 2 diabetic subjects.
Atherosclerosis 01/2013; · 3.79 Impact Factor
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Naoto Katakami,
Hideaki Kaneto, Fumie Sakamoto,
Mitsuyoshi Takahara,
Yoko Irie,
Keiko Fujisawa,
Kazuyuki Miyashita,
Tetsuyuki Yasuda,
Taka-Aki Matsuoka,
Kazutomi Yoshiuchi,
Ken'ya Sakamoto,
Akio Kuroda,
Munehide Matsuhisa,
Keisuke Kosugi,
Iichiro Shimomura
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ABSTRACT: AIMS: Pentraxin3 (PTX3), a recently discovered inflammatory mediator, is produced abundantly in various cells in atherosclerotic lesions, and therefore, its plasma level could reflect local inflammation at the site of atherosclerotic lesion. The present study evaluated whether plasma PTX3 levels are associated with subclinical atherosclerosis in young subjects with type 1 diabetes. METHODS: Plasma PTX3 levels, urinary albumin excretion, diabetic retinopathy, and carotid intima-media thickness (IMT) were examined in 78 Japanese type 1 diabetic patients (30 men and 48 women, aged 28.5±5.3 years (±SD), duration of diabetes 19.7±6.5 years). RESULTS: There was statistically significant association between plasma PTX3 levels and Max-IMT (r=0.363, p=0.001). A stepwise multivariate regression analysis including conventional coronary risk factors as independent variables revealed that plasma PTX3 levels (β=0.389, p<0.001), duration of diabetes (β=0.256, p=0.035), and serum triglyceride levels (β=0.371, p<0.001) were independent determinants of Max-IMT. In addition, plasma PTX3 levels was an independent determinant of urinary albumin excretion, an indicator of diabetic nephropathy (β=0.258, p=0.018). However, there was no significant association between plasma PTX3 levels and diabetic retinopathy. CONCLUSIONS: Increased levels of plasma PTX3 are associated with accelerated atherosclerotic change and increased albuminuria in young patients with type 1 diabetes.
Diabetes research and clinical practice 12/2012; · 2.16 Impact Factor
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Akio Kuroda,
Tetsuyuki Yasuda,
Mitsuyoshi Takahara, Fumie Sakamoto,
Ryuichi Kasami,
Kazuyuki Miyashita,
Sumiko Yoshida,
Eri Kondo,
Ken-Ichi Aihara,
Itsuro Endo,
Taka-Aki Matsuoka,
Hideaki Kaneto,
Toshio Matsumoto,
Iichiro Shimomura,
Munehide Matsuhisa
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ABSTRACT: Abstract Background: To optimize insulin dose using insulin pump, basal and bolus insulin doses are widely calculated from total daily insulin dose (TDD). It is recommended that total daily basal insulin dose (TBD) is 50% of TDD and that the carbohydrate-to-insulin ratio (CIR) equals 500 divided by TDD. We recently reported that basal insulin requirement is approximately 30% of TDD. We therefore investigated CIR after adjustment of the proper basal insulin rate. Subjects and Methods: Forty-five Japanese patients with type 1 diabetes were investigated during several weeks of hospitalization. The patients were served standard diabetes meals (25-30 kcal/kg of ideal body weight). Each meal omission was done to confirm basal insulin rate. Target blood glucose level was set at 100 and 150 mg/dL before and 2 h after each meal, respectively. After the basal insulin rate was fixed and target blood glucose levels were achieved, TBD, CIR, TDD, and their products were determined. Results: Mean (±SD) blood glucose levels before and 2 h after meals were 121±47 and 150±61 mg/dL, respectively. TDD was 31.5±9.0 U, and TBD was 27.0±6.5% of TDD. CIR×TDD of breakfast was significantly lower than those of lunch and supper (288±73 vs. 408±92 and 387±83, respectively; P<0.01). Conclusions: CIR has diurnal variance and is estimated from the formula CIR=300/TDD at breakfast or CIR=400/TDD at lunch and supper in type 1 diabetes patients. These results indicate that the insulin dose has been underestimated by using previously established calculations.
Diabetes Technology & Therapeutics 11/2012; 14(11):1077-80. · 1.93 Impact Factor
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Tetsuyuki Yasuda,
Yasuyuki Okamoto,
Noboru Hamada,
Kazuyuki Miyashita,
Mitsuyoshi Takahara, Fumie Sakamoto,
Takeshi Miyatsuka,
Tetsuhiro Kitamura,
Naoto Katakami,
Dan Kawamori,
Michio Otsuki,
Taka-Aki Matsuoka,
Hideaki Kaneto,
Iichiro Shimomura
Endocrine 09/2012; · 1.42 Impact Factor
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ABSTRACT: YKL-40 is a marker of inflammation and endothelial dysfunction, both of which play important roles in the progression of diabetic complications. However, little information has been obtained about serum YKL-40 levels in type 1 diabetic patients. We evaluated YKL-40 levels and its association with diabetic micro- and macroandgiopathy in 131 young Japanese type 1 diabetic patients without advanced diabetic complications (aged 24.7±5.9 years) and 97 age- and gender-matched healthy controls. YKL-40 levels were significantly elevated in type 1 diabetic patients than in healthy controls (median (range) 46.4 (20.3-136.7) and 52.3 (21.4-274.1) ng/ml, respectively, p = 0.006). There was a significant positive association between YKL-40 levels and urinary albumin creatinine ratio (UACR) (r = 0.226, p = 0.013). Furthermore, a multivariate regression analysis demonstrated that YKL-40 levels were a determinant of UACR independently of conventional risk factors. In addition, YKL-40 levels were significantly higher in participants with diabetic retinopathy compared to those without it (median (range) 55.5 (23.3-274.1) and 50.3 (21.4-237.4) ng/ml, respectively, p = 0.039). Serum YKL-40 levels were elevated in type 1 diabetic patients and associated with increasing level of albuminuria. YKL-40 could be a predictor to assess the risk of diabetic microangiopathy in the early stage in type 1 diabetic patients.
Endocrine Journal 09/2012; · 2.03 Impact Factor
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Tetsuyuki Yasuda,
Yasuyuki Okamoto,
Noboru Hamada,
Kazuyuki Miyashita,
Mitsuyoshi Takahara, Fumie Sakamoto,
Takeshi Miyatsuka,
Tetsuhiro Kitamura,
Naoto Katakami,
Dan Kawamori,
Michio Otsuki,
Taka-Aki Matsuoka,
Hideaki Kaneto,
Iichiro Shimomura
Endocrine 05/2012; · 1.42 Impact Factor
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ABSTRACT: To examine whether diabetic duration and insulin use are independently associated with the prognosis of critical limb ischemia (CLI) after endovascular therapy.
We recruited 312 Japanese patients who underwent endovascular therapy for CLI. The outcome measures were major amputation and mortality. Cox proportional hazards regression analyses were performed.
The prevalence of diabetes mellitus (DM) was 69%, and 47% of the DM population were treated with insulin. DM patients with insulin use had hemoglobin A1c (HbA1c) of 7.5 ± 1.3% and diabetic duration of 21 ± 11 years, whereas those without insulin use had HbA1c of 6.6 ± 1.4% and diabetic duration of 19 ± 11 years. Follow-up period was 93 ± 72 weeks; 55 patients underwent major amputations and 102 died. Diabetic duration and insulin use had significant associations with major amputation in each univariate model, with an unadjusted hazard ratio (HR) and 95% confidence interval (CI) of 1.019 [1.000, 1.039] in one-year increments and 2.321 [1.368, 3.938], respectively. In the multivariate model, however, diabetic duration and insulin use were not significantly associated with limb prognosis, as HbA1c level was, with an adjusted HR [95% CI] of 1.332 [1.114, 1.593] in 1% increment. Mortality had no statistical association with any of these DM-related variables.
Diabetic duration and insulin use were not independent risk factors for the prognosis of CLI after endovascular therapy.
Journal of atherosclerosis and thrombosis 11/2011; 18(12):1102-9. · 2.69 Impact Factor
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Tetsuyuki Yasuda,
Hideaki Kaneto,
Akio Kuroda,
Tsunehiko Yamamoto,
Mitsuyoshi Takahara,
Toyoko Naka,
Kazuyuki Miyashita,
Keiko Fujisawa, Fumie Sakamoto,
Naoto Katakami,
Taka-Aki Matsuoka,
Iichiro Shimomura
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ABSTRACT: We examined a possible association between subclinical hypothyroidism and albuminuria in 159 people with type 2 diabetes. Patients with subclinical hypothyroidism had significantly higher levels of urinary albumin-to-creatinine ratio (UACR) than those with euthyroidism. Multivariate logistic regression analyses demonstrated that serum TSH level was an independent risk factor of albuminuria.
Diabetes research and clinical practice 09/2011; 94(3):e75-7. · 2.16 Impact Factor
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Akio Kuroda,
Hideaki Kaneto,
Tetsuyuki Yasuda,
Munehide Matsuhisa,
Kazuyuki Miyashita,
Noritaka Fujiki,
Keiko Fujisawa,
Tsunehiko Yamamoto,
Mitsuyoshi Takahara, Fumie Sakamoto,
Taka-Aki Matsuoka,
Iichiro Shimomura
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ABSTRACT: To investigate the basal insulin requirement in total daily insulin dose in Japanese type 1 diabetic patients who use the insulin pump.
The basal insulin requirement in 35 type 1 diabetic patients without detectable C-peptide using the insulin pump (Paradigm 712) was investigated during 2-3 weeks of hospitalization. The patients were served diabetic diets of 25-30 kcal/kg ideal body weight. Each meal omission was done to confirm stable blood glucose levels within 30 mg/dL variance until the next meal. Target blood glucose level was set at 100 mg/dL before each meal and 150 mg/dL at 2 h after each meal.
Total daily insulin dose was 31.6 ± 8.5 units, and total basal insulin requirement was 8.7 ± 2.9 units, which was 27.7 ± 6.9% of the total daily dose.
Basal insulin requirement is ~30% of the total daily dose in Japanese type 1 diabetic patients who use the insulin pump.
Diabetes care 03/2011; 34(5):1089-90. · 8.09 Impact Factor
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Naoto Katakami,
Hideaki Kaneto,
Takeshi Osonoi,
Miyoko Saitou,
Mitsuyoshi Takahara, Fumie Sakamoto,
Kaoru Yamamoto,
Tetsuyuki Yasuda,
Taka-Aki Matsuoka,
Munehide Matsuhisa,
Yoshimitsu Yamasaki,
Iichiro Shimomura
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ABSTRACT: It is indicated that total/HDL cholesterol and LDL/HDL cholesterol ratios have more predictive power for cardiovascular disease compared to classic lipid parameters. However, there have been few reports about the usefulness of these indices for the assessment of early stage atherosclerosis in Japanese type 2 diabetic subjects.
We examined the relation between various lipid parameters and carotid atherosclerosis in 934 type 2 diabetic subjects without apparent atherosclerotic diseases (males, 71.7%; age, 59.6 ± 10.5 years (mean ± SD)). Serum concentrations of total cholesterol (TC), HDL cholesterol (HDL-C), and triglyceride were measured. LDL cholesterol (LDL-C) level was calculated using the Friedewald formula. The presence of carotid plaque and intima-media thickness (IMT) were evaluated by ultrasonography.
A stepwise multivariate regression analysis demonstrated that HDL-C (β = -0.110, p<0.001), TC/HDL-C (β = 0.132, p < 0.001) and LDL-C/HDL-C ratios (β = 0.132, p < 0.001) were independent determinants of IMT even after adjustment of other conventional risk factors. However, there was no significant correlation between IMT and TC, triglyceride, LDL-C, and non-HDL-C levels. TC/HDL-C and LDL-C/HDL-C ratios and non-HDL-C levels were significantly higher, but HDL-C levels were significantly lower in patients with carotid plaque than those without it (p < 0.05). There was no significant difference between the groups regarding TC, LDL-C, and triglyceride levels. Furthermore, TC/HDL-C (OR; 1.34, p < 0.001) and LDL-C/HDL-C (OR; 1.54, p < 0.001) ratios showed a positive and linear relationship with the prevalence of carotid plaque, whether covariates were adjusted or not.
TC/HDL-C and LDL-C/HDL-C ratios are useful as a tool to assess the risk of early stage atherosclerosis in Japanese type 2 diabetic patients.
Atherosclerosis 02/2011; 214(2):442-7. · 3.79 Impact Factor
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ABSTRACT: We analyzed time series data to investigate factors that contributed to the gradual decrease and eventual eradication of methicillin-resistant Staphylococcus aureus (MRSA) from our neonatal intensive care unit (NICU).
A multivariate adjusted autoregressive integrated moving average (ARIMA) model was used for time series analyses of monthly MRSA incidence density rates and their predictors in the NICU from July 2003 to July 2009.
Based on our ARIMA (0,1,1), which is a nonseasonal and nonstationary moving average model, the monthly pooled mean of the amount of alcohol-based hand sanitizer used for 1 patient per day (lag time, 0 month; P = .011) was the only factor significantly associated with the MRSA incidence density rates. MRSA colonization pressure, patient-to-nurse ratios, and bed occupancy rates were not associated with MRSA acquisition in the NICU. Active surveillance, which had been practiced since the late 1980s, alone was not sufficient to control the spread of MRSA until it was accompanied by enhanced hand hygiene.
Increasing the use of alcohol-based hand sanitizers by improving accessibility and providing periodic hand hygiene training sessions to health care workers is strongly recommended for decreasing the risk of MRSA acquisition among neonates in NICU settings.
American journal of infection control 04/2010; 38(7):529-34. · 3.01 Impact Factor
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ABSTRACT: We compared the performance of two commercial toxin detection kits, C. difficile toxin A/B (C. difficile TOX A/B II test; TOX A/B II) and C. difficile toxin A (Uniquick), for (i) detection using highly purified toxin A solution; (ii) cross-reactivity using culture supernatants of toxin A-positive and B-positive C. difficile, toxin A-negative and B-positive C. difficile, and toxin A-negative and B-negative C. difficile strains and other bacteria; and (iii) sensitivity and specificity using clinical specimens. Results indicated that TOX A/B II detected toxin A at concentrations of 0.35 ng/mL and Uniquick at concentrations of 0.7 ng/mL. Uniquick performance was specific for detecting toxin A alone, while TOX A/B II detected toxin A/B specifically. Kit performance was then evaluated using 99 fecal specimens--43 specimens from patients with toxin B-positive C. difficile and 56 from those without. Sensitivity of TOX A/B II vs Uniquick was 95.3% vs 76.7%, specificity 98.2% vs 98.2%, positive predictive 97.6% vs 97.1%, and negative predictive value 96.5% vs 84.6%. Findings thus indicate that TOX A/B II is a more suitable diagnostic aid for CDAD than Uniquick because it correlates well with toxin B-positive C. difficile culture results. Stool culture for C. difficile is also required, however.
Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 09/2009; 83(5):513-8.
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Tetsuyuki Yasuda,
Munehide Matsuhisa,
Noritaka Fujiki, Fumie Sakamoto,
Mayumi Tsuji,
Noriko Fujisawa,
Masato Kimura,
Rieko Ishibashi,
Hideaki Kaneto,
Yoshimitsu Yamasaki,
Takao Watarai,
Eiichi Imano
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ABSTRACT: Metabolic syndrome has been revealed to be a major risk factor for cardiovascular disease (CVD) and early mortality in non-diabetic and diabetic patients. In 2005, the International Diabetes Federation (IDF) and the Examination Committee of Criteria for Diagnosis of Metabolic Syndrome in Japan published new definitions of metabolic syndrome in which central obesity was an indispensable factor. However, the significance of this new definition to CVD in type 2 diabetes has not yet been clarified. A cross-sectional study was conducted with 294 Japanese type 2 diabetic patients without known cardiovascular disease to evaluate the association between metabolic syndrome defined by this new definition and carotid atherosclerosis, and the significance of central obesity for the prediction of the development of carotid atherosclerosis. In a multivariate regression analysis, metabolic syndrome but not central obesity was significantly associated with carotid intima-media thickness (IMT) independent of known cardiovascular risk factors (p<0.05). In addition, whereas carotid IMT was significantly increased according to the increase in the number of components of metabolic syndrome, it was not significantly different between the groups with the same number of components of metabolic syndrome with or without central obesity. These findings suggest that the prediction of the development of carotid atherosclerosis in Japanese type 2 diabetic patients could be improved by the assessment of aggregation of components of metabolic syndrome rather than with or without metabolic syndrome by this new definition.
Endocrine Journal 12/2007; 54(5):695-702. · 2.03 Impact Factor
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Fumie Sakamoto
Nippon rinsho. Japanese journal of clinical medicine 03/2007; 65 Suppl 2 Pt. 1:653-6.
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ABSTRACT: A 48-year-old woman suffering from hematuria was admitted to our hospital due to conscious disturbance. She had lower abdominal phantom tumor, anemia, renal dysfunction, hyperglycemia, metabolic acidosis and electrolyte abnormalities. Because of pelvocaliceal dilatation noted on abdominal ultrasonography, we first diagnosed her as having postrenal failure. With massive blood clots and gas emission from her urethra upon attempting cystoscopy, the remarkable expansion of the urinary bladder and a three-layered structure of gas, urine and complex of blood and debris inside her urinary bladder noted on abdominal CT scan, as well as the increased white blood cell count, we finally concluded our diagnosis as emphysematous cystitis.
Internal Medicine 05/2004; 43(4):315-8. · 0.94 Impact Factor
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