Hiroshi Nonogi

Ehime University, Matuyama, Ehime, Japan

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Publications (302)1418.47 Total impact

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    ABSTRACT: Background Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin, but not non-cardiac origin. Methods and results We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient = 0.22, p = 0.14; OHCA of cardiac origin: r = 0.25, p = 0.09; OHCA of non-cardiac origin: r = −0.002, p = 0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r = 0.47, p < 0.001; OHCA of cardiac origin: r = 0.37, p = 0.01; OHCA of non-cardiac origin: r = 0.28, p = 0.054). Conclusions While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years.
    Journal of Cardiology 07/2015; DOI:10.1016/j.jjcc.2015.06.012 · 2.57 Impact Factor
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    ABSTRACT: Because the initial (on admission) Glasgow Coma Scale (GCS) examination has not been fully evaluated in comatose survivors of cardiac arrest (CA) who receive therapeutic hypothermia (TH), the aim of the present study was to determine any association between the admission GCS motor score and neurologic outcomes in patients with out-of-hospital CA who receive TH.Methods and Results:In the J-PULSE-HYPO study registry, patients with bystander-witnessed CA were eligible for inclusion. Patients were divided into 3 groups based on GCS motor score (1, 2-3, and 4-5) to assess various effects on neurologic outcome. Univariate and multivariate analyses were performed to identify independent predictors of good neurologic outcome at 90 days. Of 452 patients, 302 were enrolled. There was a significant difference among the 3 patient groups with regard to neurologic outcome at 90 days in the univariate analysis. Multiple logistic regression analyses showed that the GCS motor score on admission, age >65 years, bystander cardiopulmonary resuscitation, the time from collapse to return of spontaneous circulation, and pupil size <4 mm were independent predictors of a good neurologic outcome at 90 days in cases of CA (GCS motor score, 4-5: odds ratio, 8.18; 95% confidence interval: 1.90-60.28; P<0.01). GCS motor score is an independent predictor of good neurologic outcome at 90 days in patients sustaining out-of-hospital CA who receive TH.
    Circulation Journal 07/2015; DOI:10.1253/circj.CJ-15-0308 · 3.69 Impact Factor
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    ABSTRACT: Therapeutic hypothermia (TH) is a standard strategy to reduce brain damage in post-cardiac arrest syndrome (PCAS) patients. However, it is unknown whether the target temperature should be adjusted for PCAS patients in different states. Participants in the J-PULSE-Hypo study database were divided into lower (32.0-33.5 °C; Group L) or moderate (34.0-35.0 °C; Group M) temperature groups. Primary outcome was a favourable neurological outcome (proportion of patients with a Glasgow-Pittsburgh Cerebral Performance Category [CPC] of 1-2 on day 30). We compared between the two groups and in subgroups of patients divided by age and resuscitation interval (interval from collapse to return of spontaneous circulation) by propensity score (PS) analysis. Overall, 467 participants were analysed. The proportions of patients with favourable neurological outcomes were as follows (Group L vs. Group M) (OR; Odds ratio): all patients, 64 % (n = 42) vs. 55 % ((n = 424) (PS; OR 1.381 (0.596-3.197)), P = 0.452) and resuscitation interval ≤ 30 min, 88 % (n = 24) vs. 64 % ((n = 281) (PS; OR 7.438 (1.769-31.272)), P = 0.007). PCAS patients with a resuscitation interval of <30 min may be candidates for TH with a target temperature of <34 °C. University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000001935; available at: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000002348&language=J.
    06/2015; 3(1):28. DOI:10.1186/s40560-015-0095-2.
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    Mayuki Aibiki · Osuke Iwata · Hiroshi Nonogi · Kosaku Kinosita · Ken Nagao
    08/2014; 4(3). DOI:10.1089/ther.2014.0011
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    ABSTRACT: Background Prospective cohort studies have shown that seafood consumption is inversely related to fatal coronary heart disease, sudden cardiac death and stroke. We studied whether the kind of seafood consumed in addition to seafood consumption per se is associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin. Methods and results We compared the average consumption of different kinds of seafood and other risk factors to the average incidence of age-adjusted OHCA (660,672 cases of OHCA: 55.2% of cardiac origin and 44.8% of non-cardiac origin) between 2005 and 2010 in the 47 prefectures of Japan. There were many significant correlations between the incidence of age-adjusted OHCA of cardiac origin (ad-OHCA-CO) and the consumption of many kinds of seafood, but not the total consumption of seafood. The consumption of horse mackerel (r = − 0.568, p < 0.0001) and saury (r = 0.607, p < 0.0001) showed the highest negative and positive correlations, respectively, with the age-adjusted incidence of ad-OHCA-CO. Conclusions In Japan, the consumption of different kinds of seafood may be an important factor in OHCA of cardiac origin. Thus, dietary habits with regard to seafood may play a role in OHCA of cardiac origin, however, the question of whether to eat fish in general or instead to eat certain kinds of fish is still unclear.
    03/2014; 2:8–14. DOI:10.1016/j.ijchv.2013.11.002
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    ABSTRACT: Background: We have developed a mobile telemedicine system (MTS) utilizing mobile communications via cellular phones, making it possible to continuously transmit biological information, including 12-lead electrocardiography data, from an ambulance while the patient is being transported to the destination hospital in real time. Purpose: We evaluated whether using an MTS during the transport of acute myocardial infarction patients shortens the interval between arrival at the hospital and balloon inflation to achieve reperfusion (door-to-balloon time). Two hundred eighteen consecutive AMI patients were divided into two groups: 23 patients who had been brought to the hospital in an ambulance equipped with an MTS, and 195 patients who had been brought to the hospital without the use of an MTS. Results: When the MTS group and the non-MTS group were compared, no differences in clinical characteristics , Killip class, incidence of emergency coronary angiography, culprit lesion, or prevalence of multi-vessel disease were seen. No significant differences were seen between the two groups in terms of the incidence of primary percutaneous coronary intervention (PCI), initial angiography findings, or the degree of coronary blood flow after PCI. Regarding outcomes, no differences in the peak creatinine kinase and isozyme MB levels or in-hospital mortality were seen between the two groups. However, the door-to-balloon time was 86 minutes (median times) in the MTS group, which was significantly shorter than the 96 minutes observed in the non-MTS group (P<0.05). Conclusions: We have developed a mobile telemedicine system (MTS) and have shown its efficacy in pre-hospital medical settings.
    01/2014; 20(4):307-313. DOI:10.7793/jcoron.20.13-00011
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    ABSTRACT: Intravenous immunoglobulin (IVIG) therapy has been used to treat several autoimmune or inflammatory diseases. We conducted a clinical trial of immunoglobulin therapy for acute myocarditis. The study consisted of two projects: (1) a comparison of prognosis between patients treated with and those not treated with IVIG in a multi-center study; (2) analyses of inflammatory cytokines and blood cell profiles in a substudy. In (1), 15 patients were treated with IVIG (1-2 g/kg, over 2 days), whereas 26 were untreated. There was a statistically significant difference between the survival curves of the patients treated with IVIG and the survival curves of those not treated with IVIG. There was no significant difference between the IVIG-treated and untreated groups in terms of clinical parameters of the acute and chronic phases. In (2), 10 patients were treated with IVIG and 6 were untreated. In both groups, all of the data except for changes in the fraction of lymphocytes and the fraction of monocytes decreased due to the treatment or during the course. In patients in the IVIG group, the percentage of peripheral eosinophils was decreased and the percentage of peripheral monocytes was increased by this treatment when they were compared with the pretreatment data. Therefore, therapy with IVIG seems to be a promising treatment for acute myocarditis given that it improves the clinical course, which may be due to modulation of inflammatory cytokines and the peripheral leukocyte balance.
    Heart and Vessels 05/2013; 29(3). DOI:10.1007/s00380-013-0368-4 · 2.11 Impact Factor
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    ABSTRACT: MicroRNAs (miRNAs) are endogenous small RNAs that are 18-23 nucleotides long. Recently, plasma miRNAs were reported to be sensitive and specific biomarkers of various pathological conditions. In the present study, we focused on miR-210, which is known to be induced by hypoxia and might therefore be an excellent biomarker for congestive heart failure. Plasma miR-210 levels and expression levels in mononuclear cells and skeletal muscles were elevated in Dahl salt-sensitive rats with heart failure. We also assessed miR-210 expression in patients with heart failure. The miR-210 expression levels in the mononuclear cells of patients with NYHA III and IV heart failure according to the New York Heart Association (NYHA) functional classification system were significantly higher than those with NYHA II heart failure and controls. Although no significant correlation was observed between plasma brain natriuretic peptide (BNP) and plasma miR-210 levels in patients with NYHA II heart failure, patients with an improved BNP profile at the subsequent hospital visit were classified in a subgroup of patients with low plasma miR-210 levels. Plasma miR-210 levels may reflect a mismatch between the pump function of the heart and oxygen demand in the peripheral tissues, and be a new biomarker for chronic heart failure in addition to plasma BNP concentrations.
    Biological & Pharmaceutical Bulletin 01/2013; 36(1):48-54. DOI:10.1248/bpb.b12-00578 · 1.78 Impact Factor
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    ABSTRACT: BACKGROUND: It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression-only cardiopulmonary resuscitation (CPR) or conventional CPR with rescue breathing. METHODS AND RESULTS: A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression-only CPR and conventional CPR with compressions and rescue breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression-only CPR and 870 (63.2%) received conventional CPR. The chest compression-only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03-1.70). CONCLUSIONS: Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay rescuers can witness a sudden collapse and use public-access AEDs.
    Circulation 12/2012; 126(24):2844-2851. DOI:10.1161/CIRCULATIONAHA.112.109504 · 14.95 Impact Factor
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    ABSTRACT: Purpose. The aim of the study was to assess the performance of Airway Scope (AWS) on the first attempt at intubation in manikins by nonexpert physicians. Methods. A randomized crossover trial involving seven scenarios. Participants: residents of a cardiovascular hospital. In group A, the AWS procedure was performed first followed by Machintouch Laryngoscopy (ML), while in group B the ML procedure was performed first and then the AWS. The primary outcome assessed was the success of first intubation attempt in a normal scenario. The secondary outcome assessments were success in six other scenarios, and also elapsed time and dental trauma caused in all scenarios. Results. There were 34 participants. All AWS-assisted intubations were successfully completed, but one ML-assisted intubation failed in the normal scenario (). The outcomes achieved by the AWS in scenarios involving cervical immobilization (), tongue edema (), pharyngeal obstruction (), and jaw trismus () were superior to those obtained with the ML. Conclusions. Use of AWS-assisted intubation in manikin scenarios results in a significantly high intubation success rate on the first attempt by nonexpert physicians. These findings suggest this new device will be useful for nonexpert physicians in emergency situations.
    11/2012; 2012. DOI:10.5402/2012/237949
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    ABSTRACT: BACKGROUND: Little is known about the nationwide trend in the survival of out-of-hospital cardiac arrest (OHCA) in Japan and the differences in incidence and survival by age group and origin of arrest. METHODS AND RESULTS: A nationwide, prospective, population-based observation covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts has been conducted from January 2005 to December 2009. The main outcome measure was one-month survival with favorable neurological outcome. The nationwide trend in OHCA incidence and outcome by age and origin were assessed. Multiple logistic regression analysis for bystander-witnessed OHCA was used to adjust for factors that were potentially associated with favorable neurological outcome. During 5-years, 547,153 overall OHCAs and 169,360 bystander-witnessed OHCAs were enrolled. The annual incidence significantly increased among overall OHCAs and bystander-witnessed OHCAs. Neurologically favorable survival significantly increased from 1.6% (1676/102,737) in 2005 to 2.8% (3280/115,250) in 2009 (P<0.001), from 2.1% (638/30,556) to 4.3% (1558/36,361) (P<0.001), from 9.8% (437/4461) to 20.6% (1215/5906) (P<0.001) among overall OHCA, bystander-witnessed OHCA, and bystander-witnessed ventricular fibrillation OHCA, respectively. Public-access automated external defibrillator use, either bystander-initiated chest compression-only cardiopulmonary resuscitation (CPR) or conventional CPR, and earlier EMS response time were associated with a better neurological outcome. Favorable neurological outcome among adult OHCAs significantly improved, but the outcome among younger children and very elderly did not improve and was dismal irrespective of origin of OHCA. CONCLUSIONS: The nationwide improvements of favorable neurological outcome from OHCA were observed in Japan, and differed by age group and origin of OHCA.
    Circulation 10/2012; 126(24). DOI:10.1161/CIRCULATIONAHA.112.109496 · 14.95 Impact Factor
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    ABSTRACT: To address safety concerns with first-generation drug-eluting stents (DESs), the everolimus-eluting stent (EES) has been developed as a second-generation DES. The study aim was to: (1) demonstrate that use of the EES in Japanese patients is non-inferior to use of the paclitaxel-eluting stent (PES) in US patients; and (2) compare vessel response to the EES in Japanese vs US patients. The SPIRIT III Japan Registry, a prospective single-arm multicenter study was a part of the SPIRIT III global clinical program using harmonization by doing. The primary endpoint was in-segment late loss at 8 months, compared to US PES. A total of 88 subjects were enrolled in the Japan EES group. Angiographic in-segment late loss was significantly less in Japan EES vs US PES (0.15 ± 0.34 mm vs 0.28 ± 0.48 mm, respectively; P=.0185; Pnon-inferio r<.0001), while target vessel failure (TVF; 8.0% vs 9.9%) and major adverse cardiac events (MACE) at 9 months (5.7% vs 8.8%) were not significantly different between the 2 groups. No differences were observed between Japan and US EES populations in terms of late loss, TVF, or MACE. Neointimal volume and postprocedural incomplete stent apposition rate were lower in Japan EES vs US EES/PES. The SPIRIT III Japan Registry met the primary endpoint of lower late loss in the Japan EES group vs the US PES group, with comparable results for EES between the Japanese and US patients.
    The Journal of invasive cardiology 09/2012; 24(9):444-50. · 0.82 Impact Factor
  • Journal of Cardiac Failure 08/2012; 18(8):S77. DOI:10.1016/j.cardfail.2012.06.487 · 3.07 Impact Factor
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    ABSTRACT: Background: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-of-hospital shockable cardiac arrest, there is insufficient evidence that is also applicable for those with out-of-hospital non-shockable cardiac arrest. Methods and Results: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystander-witnessed cardiac arrest, target core temperature of 32-34°C and cooling duration of 12-72h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to-ROSC interval was significantly longer in the non-shockable group than in the shockable group (30min vs. 22min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09-7.24, P=0.84). Conclusions: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short.  (Circ J 2012; 76: 2579-2585).
    Circulation Journal 07/2012; 76(11):2579-2585. DOI:10.1253/circj.CJ-12-0448 · 3.69 Impact Factor
  • Journal of Cardiac Failure 09/2011; 17(9). DOI:10.1016/j.cardfail.2011.06.577 · 3.07 Impact Factor
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    ABSTRACT: CK-MB is an important marker for the diagnosis of acute myocardial infarction (AMI). Since mitochondrial CK (MtCK) is universally present in the blood of healthy individuals, it is known to positively affect the measurement of CK-MB using the immunoinhibition method, causing false-positive results. We performed basic evaluation of ACCURAS AUTO CK-MB MtO, a new reagent containing anti-MtCK antibody that inhibits MtCK activity, and attempted to calculate a cut-off CK-MB level to diagnose AMI. The measurement was performed in samples submitted to the Clinical Laboratory of our center for the measurement of CK-MB. This method was confirmed to have satisfactory basic attributes concerning the reproducibility, linearity, lower detection limit, and effects of interfering substances. When 2886 samples were examined using this and conventional methods, the results of the two methods were correlated in some but not in others. In the samples that showed no correlation, MtCK was demonstrated by isozyme analysis using electrophoresis. The AUC calculated from the ROC curve in AMI patients was 0.912 with this method and 0.861 with the conventional method. The sensitivity and specificity of the new method were higher than those of the conventional method. The cut-off value determined by ROC analysis was 7.7 U/l using the new method and 13.6 U/l using the conventional method, causing an increase in false-positive results compared with the cut off value of 25 U/l widely used for the conventional method to date. However, the cut-off value for the new method that yielded a specificity comparable to 99.1%, which is the specificity of the conventional method using a cut-off value of 25 U/l, was 12 U/l. With a cut-off value of 12 U/l, the sensitivity was improved compared with that employing the conventional method, and both the sensitivity and specificity became comparable to those of the CK-MB mass method. This method is very useful for the accurate measurement of CK-MB activity.
    Rinsho byori. The Japanese journal of clinical pathology 07/2011; 59(7):649-55.
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    ABSTRACT: Little is known about triggers of sudden cardiac arrest. This study aimed to analyze the association of the occurrence of out-of-hospital cardiac arrest (OHCA) with patient activities just before the arrest and ambient temperature as one of the major environmental factors. This prospective, population-based cohort study enrolled all person aged 18 years or older with OHCA of presumed cardiac origin in Osaka Prefecture, Japan, from 2005 through 2007. Patient activities before arrest were divided into six categories: sleeping, bathing, working, exercising, non-specific activities, and unknown. Age-adjusted annual incidence rate of OHCA according to their prior activity and an hourly event rate in each activity by temperature were calculated. Among 19,303 OHCAs, 10,723 were presumed to be of cardiac etiology. The event rate of OHCA was 6.22, 54.49, 1.15, and 10.11 per 10,000,000 population per hour for sleeping, bathing, working, and exercising, respectively. Among patients who suffered OHCA during bathing, the event rate of OHCA per 10,000,000 per hour increased with decreasing temperature from 18.27 (≥25.1°C) to 111.42 (≤5.0°C) (odds ratio [OR] for 1°C increase in temperature, 0.915; 95% confidence interval [CI], 0.907-0.923), while it was almost constant among those who were working (OR for 1°C increase, 0.994; 95% CI, 0.981-1.007) or exercising (OR for 1°C increase, 1.004; 95% CI, 0.971-1.038) before arrest. Both activities before cardiac arrest and ambient temperature were associated with the occurrence of OHCA. Preventive measures against OHCA should be enveloped considering these behavioral and environmental factors.
    Resuscitation 04/2011; 82(8):1008-12. DOI:10.1016/j.resuscitation.2011.03.035 · 3.96 Impact Factor
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61004-8 · 15.34 Impact Factor
  • Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)60282-9 · 15.34 Impact Factor
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    ABSTRACT: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of therapeutic hypothermia (TH) remains unclear. A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6 ± 13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26 min. The target core temperature during TH was 33.9 ± 0.4°C and the mean duration of cooling was 31.5 ± 13.9 h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%. The J-PULSE-HYPO study registry showed a clinical aspect of TH.
    Circulation Journal 04/2011; 75(5):1063-70. DOI:10.1253/circj.CJ-11-0137 · 3.69 Impact Factor

Publication Stats

4k Citations
1,418.47 Total Impact Points


  • 2014
    • Ehime University
      Matuyama, Ehime, Japan
  • 2012–2014
    • Shizuoka General Hospital
      Sizuoka, Shizuoka, Japan
  • 1993–2014
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
  • 1984–2009
    • Kyoto University
      • Department of Cardiovascular Medicine
      Kyoto, Kyoto-fu, Japan
  • 2004
    • Osaka Medical Center for Cancer and Cardiovascular Diseases
      Ōsaka, Ōsaka, Japan
  • 2003
    • Hamamatsu Rosai Hospital
      Hamamatu, Shizuoka, Japan
    • Friedrich Schiller University Jena
      Jena, Thuringia, Germany
  • 2000
    • Shiga University of Medical Science
      Ōtu, Shiga Prefecture, Japan
  • 1994
    • Osaka City General Hospital
      Ōsaka, Ōsaka, Japan
  • 1987–1993
    • University of Zurich
      • Internal Medicine Unit
      Zürich, Zurich, Switzerland
    • Rakuwakai Otowa Hospital
      Kioto, Kyōto, Japan