Hitomi Tomita

Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure

Central aortic blood pressure (BP), obtained from radial arterial waveform using the transfer function method (TFM), has been shown to have prognostic value independently of brachial BP. In this study, the relationship between peripheral systolic BP (SBP) and aortic SBP was evaluated. We further investigated whether TFM-derived aortic SBP can be estimated by information obtained from the radial waveform. The radial waveform was analysed to obtain the first peak of radial SBP (SBP1), second peak of radial SBP (SBP2), radial augmentation index (AI) (radial (SBP2−DBP)/(SBP1−DBP) × 100 and aortic SBP and AI using TFM in 233 subjects in the supine position. Measurements were repeated after changing position to the prone position. The constructed equation was validated in 149 community residents with different backgrounds. Radial SBP2 was closer to TFM-derived aortic SBP compared with brachial SBP. TFM-derived aortic SBP was approximated by the equation: aortic SBP=18.9—radial SBP2−0.03 × HR—0.214 × radial AI (r2=0.992). The equation was also applicable to predicting aortic SBP in the prone position as well as in different populations (mean difference between predicted aortic SBP and TFM-derived aortic SBP: −0.01±1.34 and 1.05±1.47 mm Hg, respectively). Radial arterial waveform analysis can be used for estimation of TFM-derived aortic SBP.

Blood Pressure Is the Main Determinant of the Reflection Wave in Patients with Type 2 Diabetes

Augmentation index (AI), the ratio of augmented pressure by the reflection pressure wave to the pulse pressure (PP), is an index of arterial stiffness and central blood pressure (BP). Although type 2 diabetes mellitus (DM) is a major risk factor for atherosclerosis, there is controversy with respect to how DM affects AI. In the present study, we investigated possible determinants of AI in 194 type 2 DM patients (mean age 67±9 years). AI was measured in the left radial artery using an automated tonometric method. In a simple correlation analysis, AI showed a positive association with age, and a negative association with body height, body weight, waist circumference, heart rate (HR), plasma glucose, and HbA1c. Women had significantly higher AI than men. Stepwise regression analysis revealed that mean BP (MBP) (β=0.260, p<0.001), HR (β=−0.550, p<0.001) and body height (β=−0.217, p<0.001) were independent determinants of radial AI. Similarly, the second peak of systolic BP (SBP2), an index of central aortic systolic BP (SBP), showed a positive association with age, BMI, waist circumference, MBP and AI, and a negative association with body height. In a separate analysis performed in diabetic patients with treated hypertension (n=123), again, only MBP, HR and body height were significant determinants of radial AI. There was no difference in radial AI and SBP2 among the classes of antihypertensive drugs used. These findings indicate that tight BP control would be effective in reducing the reflection wave and aortic BP, which could independently relate to cardiovascular disease in type 2 diabetic patients.

Usefulness of cervical computed tomography and magnetic resonance imaging for rapid diagnosis of crowned dens syndrome: A case report and review of the literature

Highlights • We report a patient with crowned dens syndrome dramatically improved following treatment with nonsteroidal anti-inflammatory medication.• This condition should be considered in the differential diagnosis of a possible etiology for fever, headache and cervical pain of unknown origin.• The rapid diagnosis of crowned dense syndrome using CT and MRI can prevent invasive, expensive and useless investigations.• It was very interesting that the soft tissue surrounding the odontoid process was hyperintense on MR T2-weighted imaging with fat suppression.• This is the first report of making reference to MRI findings of crowned dens syndrome.

Predictors of functional status in Japanese community-dwelling older persons during a 2-year follow up

Aims:  To clarify baseline sociodemographic and health characteristics that predict subsequent functional outcome in community‐dwelling Japanese older persons.

Efficacy of Early Superficial Temporal Artery–Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke

BACKGROUND We investigated the efficacy of early superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. MATERIALS AND METHODS Nine consecutive patients who underwent early STA-MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA-MCA double anastomoses. RESULTS Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA-MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. CONCLUSIONS Early STA-MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage.