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Sublingual immunotherapy decreases the avidity of antigen-specific IgE in patients with Japanese cedar pollinosis
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Postoperative computed tomography findings predict re-drainage cases after early drain removal in pancreaticoduodenectomy
No full textPurpose:
This study aimed to investigate the risk factors for re-drainage in patients with early drain removal after pancreaticoduodenectomy (PD).
Methods:
This study retrospectively analyzed 114 patients who underwent PD and prophylactic drain removal on postoperative day (POD) 4 between January 2012 and March 2021. We analyzed the risk factors for re-drainage according to various factors. Peri-pancreaticojejunostomic fluid collection (PFC) index and pancreatic cross-sectional area (CSA) were evaluated using computed tomography on POD 4. The PFC index was calculated by multiplying the length, width, and height at the maximum aspect.
Results:
Among the 114 patients, 15 (13%) underwent re-drainage due to postoperative pancreatic fistula. Multivariate analysis identified a PFC index ≥ 8.16 cm3 on POD 4 (odds ratio [OR], 20.40, 95%CI 2.38-174.00; p = 0.006) and pancreatic CSA on POD 4 ≥ 3.65 cm2 (OR, 16.40, 95%CI 1.57-171.00; p = 0.020) as independent risk factors for re-drainage.
Conclusion:
A careful decision might be necessary for early drain removal in patients with a PFC index ≥ 8.16 cm3 and pancreatic CSA ≥ 3.65 cm2.journal articl
Ideal body weight-based determination of minimum oral calories beneficial to function and survival in ALS
Get PDFIntroduction:
This study sought to identify the optimal caloric intake to improve function and survival in ALS patients by comparing oral intake per ideal body weight (IBW) and its discrepancy with total energy expenditure (TEE) using the Shimizu formula.
Methods:
A retrospective analysis of 104 ALS patients was conducted, categorizing them based on their average intake during the first week after admission using two primary intake cutoffs: 25 kcal/kgIBW and 30 kcal/kgIBW. The variance between oral intake and TEE was also evaluated using -300 kcal and 0 kcal as reference points.
Results:
Oral caloric intake per IBW and functional decline rate (rs = -0.35, p < 0.001), but the variance from TEE was not significantly correlated (-0.11, p = 0.27). Survival data showed that patients consuming less than 25 kcal/kgIBW had a median survival of 24 months, increasing to 38 months for those consuming between 25-30 kcal/kgIBW and 63 months for those consuming 30 kcal/kgIBW or more. Deviations from the TEE did not significantly affect survival (p = 0.36). Among patients consuming less than their TEE, those consuming less than 25 kcal/kgIBW had a shorter median survival (24 months) compared to their counterparts (46 months) (p = 0.022). Consumption of less than 25 kcal/kgBW emerged as a significant negative predictor of patient outcome, independent of factors such as age, gender or disease progression.
Discussion:
Intakes of 25 kcal/kgIBW or more are correlated with improved ALS outcomes, and larger, multi-regional studies are recommended for deeper insights.journal articl
Visualization of Amyloid Oligomers in the Brain of Patients with Alzheimer's Disease
Get PDFIn the pathogenesis of Alzheimer's disease (AD), highly neurotoxic amyloid-β (Aβ) oligomers appear early, they are thus considered to be deeply involved in the onset of Alzheimer's disease. However, Aβ oligomer visualization is challenging in human tissues due to their multiple forms (e.g., low- and high-molecular-weight oligomers, including protofibrils) as well as their tendency to rapidly change forms and aggregate. In this review, we present two visualization approaches for Aβ oligomers in tissues: an immunohistochemical (using the monoclonal antibody TxCo1 against toxic Aβ oligomer conformers) and imaging mass spectrometry using the small chemical Shiga-Y51 that specifically binds Aβ oligomers. TxCo1 immunohistochemistry revealed Aβ oligomer distributions in postmortem human brains with AD. Using Shiga-Y51, imaging mass spectrometry revealed Aβ oligomer distributions in the brain of a transgenic mouse model for AD. These two methods would potentially contribute to elucidating the pathological mechanisms underlying AD.journal articl
キュウセイキ ビョウイン ニ キンムスル カンゴシ ノ リンリテキ ナヤミ ノ カンレン ヨウイン ノ ケントウ
Get PDF本研究では、倫理的悩みを測定する尺度Nurse Questionnaire (ADULT) scaleをもとに作成した『改訂版 倫理的悩みの尺度－看護師版』を用いて、急性期病院に勤務する看護師の倫理的悩みについて検討した。近畿地方のA県と中部地方のB県にある340床以上の急性期病院22施設に対し研究協力依頼を行い、承諾が得られた6施設に勤務する看護師846名に質問紙調査の依頼を行い、そのうち443部の調査票を回収した（回収率52.4％）。各設問の無効回答率20％以上を除く405部の調査票を有効回答とした（有効回答率 48.1％）。その結果、年齢（F＝6.12，p<0.001）に有意な関係が見られ、「25歳未満」よりも「25歳～30歳未満」、「30歳～35歳未満」、「35歳以上」が倫理的悩みを多く認識し、倫理的悩みのスコア平均値が4.0以上であった項目は【3.患者にとって最良と思えなくても医療を続けてほしいという患者・家族の希望に沿うことがある】と【4.ただ死を先延ばしすることだと感じても救命行為を開始することがある】の主に2つの項目でともに高い値を示した。本研究において、患者家族との倫理的価値の相違から倫理的悩みを多く認識し、年齢の高い看護師は自己の経験より養われた倫理観や価値観を臨床現場に活かそうと模索するなかで、倫理的悩みとしての認識に繋がっていた。これらのことから、看護師への倫理教育では看護倫理のみでなく医療・工学・生命倫理など幅広い分野に基づいた教育が必要であり、臨床看護師への倫理教育のあり方について多くの課題が示唆された。This study examined the ethical concerns of nurses working in acute care hospitals using the "Revised Ethical Concerns Scale - Nurse Edition," which was developed based on the Nurse Questionnaire (ADULT) scale, a scale for measuring ethical concerns. Requests for research cooperation were made to 22 acute care hospitals with 340 or more beds in prefectures A in the Kinki region and B in the Chubu region. 846 nurses working at the 6 facilities that agreed to participate were asked to complete the questionnaire, of which 443 copies were collected (response rate 52.4%). Forty-five copies of the questionnaire were considered valid responses (valid response rate: 48.1%), excluding those with an invalid response rate of 20% or more for each question. The results showed a significant relationship with age (F=6.12, p<0.001), with "25-30 years old," "30-35 years old," and "35 years old or older" identifying more ethical concerns than "under 25 years old," and the items with a mean score of 4.0 or higher for ethical concerns were [3. Sometimes, the patient/family wishes for continued medical care even if it does not seem best for the patient] and [4. Sometimes, life-saving actions are initiated even if the patient/family feels that the action is merely postponing death] were the two main items with high values. In this study, nurses recognized many ethical concerns due to differences in ethical values with patients' families, and older nurses were seeking to apply the ethical views and values nurtured through their own experiences to clinical practice, which led to their recognition as ethical concerns. These findings suggest that ethics education for nurses needs to be based not only on nursing ethics but also on a wide range of fields, including medical, engineering, and bioethics, and that many issues need to be addressed in the education of ethics for clinical nurses.departmental bulletin pape
Autobullectomy with COVID-19 in a patient with chronic obstructive pulmonary disease
Get PDFapplication/pdfA 72-year-old man with chronic obstructive pulmonary disease (COPD) was admitted for coronavirus disease 2019 (COVID-19). He was discharged on day 30; however, he was readmitted 6 days later due to a left lung organizing pneumonia secondary to COVID-19. After methylprednisolone treatment, the patient was discharged on day 15. One year later, computed tomography showed shrinkage of emphysematous lesions, and both total lung capacity measured using computed tomography and fraction of low attenuation volume decreased in the left lung compared to that before COVID-19. Here, we report a rare case of autobullectomy with COVID-19 in a patient with COPD.Journal Articlejournal articl
Thoracic Duct Lymphangiography via the Testicular Parenchyma in a Rabbit Model
Get PDF滋賀医科大学博士（医学）application/pdfThesis or DissertationJournal of Vascular and Interventional Radiology. 2022 Dec;33(12):1543-1547.e1.令和4年度thesi
Bronchus-First Video-Assisted Left Lower Lobectomy for Metastatic Mucinous Carcinoma of the Lung
No full textMucinous lung tumors often develop locoregional recurrence after surgery because tumor cells spread with mucus through the bronchus, worsening the patient prognosis. We suspect that tumor spread is encouraged by intraoperative procedures, such as grasping, pressing, or manipulating the lobes of the lung wherein the tumor is located. When surgeons perform pulmonary resection, they typically avoid these procedures until the bronchus is separated from the healthy lung. We have tried to modify an earlier era technique [5, 6] of posterior bronchus first lung resections for infective conditions and use it for VATS lobectomy for metastatic mucinous carcinoma of the lung in a patient. Our aim was to see if it can reduce loco-regional spread through the airspaces and improve recurrence-free survival. We present the technique in images and a video. A 73-year-old woman was referred to our hospital to treat lung metastasis of the pseudomyxoma peritonei in the left lower lobe. This mucinous tumor was resected by Bronchus-first video-assisted left lower lobectomy, and the patient had no evidence of recurrence at 2 years and 9 months after surgery. There is no evidence yet that bronchus first lobectomy prevents locoregional recurrence by avoiding intraoperative procedures like grasping, pressing, or manipulating of lung which may push the tumor edge forward. We hope that this surgical concept is recognized and that future observational studies will investigate its effect on locoregional recurrence.Journal Articlejournal articl