Shiga University of Medical Science Repository BI WAKO / 滋賀医科大学機関リポジトリ
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Outer Media Thickness at False Lumen and Secondary Aortic Dilatation After Acute Aortic Dissection.
No full textpdfBackground:
This study measured the outer media thickness (OMT) at the false lumen by using microscopic images of specimens collected intraoperatively and assessed the impact of OMT on secondary dilatation of the downstream aorta.Methods:
Of 238 patients undergoing surgical procedures for acute type A dissection between 2007 and 2016, 129 patients fulfilled the inclusion criteria for this study: DeBakey type I dissection with a patent false lumen, histopathologic examination of full-thickness aortic wall, and at least 1 follow-up computed tomographic scan at more than 3 months after surgical procedures. On average, 5.1 scans were obtained per patient, and median follow-up was 4.3 years.Results:
Considerable variation was observed in OMT (median, 0.21 mm; range, 0.04-0.51 mm). The aortic diameter growth rate was inversely correlated with the OMT, and in the lowest tertile of OMT the aortic diameter dilated significantly faster in the first year than later and faster than in the other tertiles. Multivariable Fine-Gray analysis, with death as the competing risk, identified OMT as an independent variable for aortic-related events. Patients with OMT of 0.04 to 0.15 mm had a 3.54-fold higher risk of aortic-related events and those with 0.16 to 0.31 mm had a 1.56-fold higher risk of aortic-related events than did patients with OMT of 0.32 to 0.51 mm. Multivariable Cox regression analyses revealed OMT of 0.04 to 0.15 mm as an independent variable for all-cause mortality.Conclusions:
In patients with DeBakey type I aortic dissection with a patent false lumen, the growth rate of the distal residual dissecting aorta was inversely correlated with the OMT. The risk of aortic-related events was significantly higher in patients with OMT of 0.04 to 0.15 mm.Journal Articlejournal articl
How Does E-mail-Delivered Cognitive Behavioral Therapy Work for Young Adults (18–28 Years) with Insomnia? Mediators of Changes in Insomnia, Depression, Anxiety, and Stress.
Get PDFpdfThis study examined whether cognitive behavioral therapy (CBT) for insomnia (CBT-I) improved insomnia severity, by changing sleep-related mediating factors. It also examined whether an improvement in insomnia led to enhanced mental health. This study was a secondary analysis of a randomized controlled trial of e-mail-delivered CBT-I for young adults with insomnia. The participants were randomized to either CBT-I or self-monitoring. The mental health-related measures were depression, anxiety, and stress. The sleep-related mediating factors were sleep hygiene practices, dysfunctional beliefs, sleep reactivity, and pre-sleep arousal. A total of 41 participants, who completed all the sessions (71% females; mean age 19.71 ± 1.98 years), were included in the analysis. The hierarchical multiple regression analysis showed that 53% of the variance in the improvements in insomnia severity was explained by the treatment group (β = −0.53; ΔR2 = 0.25; p < 0.01) and the changes in sleep reactivity (β = 0.39; ΔR2 = 0.28; p < 0.05). Moreover, the mediation analysis showed that the reductions in depression and stress were explained by the changes in insomnia severity; however, anxiety symptoms were not reduced. CBT-I for young adults suggested that sleep reactivity is a significant mediator that reduces insomnia severity, and that the alleviation and prevention of depression and stress would occur with the improvement in insomnia.Journal Articlejournal articl
Ustekinumab trough levels predicting laboratory and endoscopic remission in patients with Crohn's disease
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Optimal concentration of ustekinumab (UST) predicting endoscopic remission has not been fully investigated in Crohn's disease (CD). We aimed to identify the optimal UST trough levels predicting clinical, laboratory and endoscopic remission in CD patients.Methods:
Twenty-eight patients with CD were enrolled and investigated (27 patients by enteroscopy and 1 by colonoscopy). The endoscopic activity was assessed using the scoring system that applied the Rutgeerts score to observed intestine. Serum UST trough levels and anti-UST antibodies (AUAs) levels were determined by in-house immunoassays.Results:
Endoscopic activity was negatively correlated with serum UST trough levels (Spearman's rank correlation coefficient (ρ) = - 0.66, P = 0.0001) and serum albumin levels (ρ = - 0.60, P = 0.0007). The endoscopic activity was positively and significantly correlated with CRP (ρ = 0.59, P = 0.0009) and ESR (ρ = 0.44, P = 0.033). There was no significant association between the endoscopic score and AUA levels and/or Crohn's disease activity index (CDAI). Serum UST trough levels and albumin levels were significantly higher in the endoscopic remission group (scores of 0 and 1) than in the non-endoscopic remission group (UST trough, mean 3.3 vs. 1.8 μg/mL). No significant difference was observed in AUAs between the endoscopic remission and non-remission groups. Receiver operation curve (ROC) analysis revealed that the optimal cutoff value of UST trough levels predicting normal CRP and serum albumin levels was 1.7 μg/mL for each, and the optimal cutoff value predicting endoscopic remission was 2.0 μg/mL (AUC: 0.80, 95% CI 0.64-0.96).Conclusion:
Achievement of endoscopic remission requires higher UST trough levels than required for normalization of CRP and serum albumin levels.Journal Articlejournal articl
R-R interval-based sleep apnea screening by a recurrent neural network in a large clinical polysomnography dataset.
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Easily detecting patients with undiagnosed sleep apnea syndrome (SAS) requires a home-use SAS screening system. In this study, we validate a previously developed SAS screening methodology using a large clinical polysomnography (PSG) dataset (N = 938).Methods:
We combined R-R interval (RRI) and long short-term memory (LSTM), a type of recurrent neural networks, and created a model to discriminate respiratory conditions using the training dataset (N = 468). Its performance was validated using the validation dataset (N = 470).Results:
Our method screened patients with severe SAS (apnea hypopnea index; AHI ≥ 30) with an area under the curve (AUC) of 0.92, a sensitivity of 0.80, and a specificity of 0.84. In addition, the model screened patients with moderate/severe SAS (AHI ≥ 15) with an AUC of 0.89, a sensitivity of 0.75, and a specificity of 0.87.Conclusions:
Our method achieved high screening performance when applied to a large clinical dataset.Significance:
Our method can help realize an easy-to-use SAS screening system because RRI data can be easily measured with a wearable heart rate sensor. It has been validated on a large dataset including subjects with various backgrounds and is expected to perform well in real-world clinical practice.Journal Articlejournal articl
Kinematic and Electrophysiological Characteristics of Pedal Operation by Elderly Drivers during Emergency Braking
Get PDF滋賀医科大学博士（医学）pdfAge-related decline in lower limb motor control may cause errors in pedal operation when driving a car. This study aimed to clarify the kinematics and electrophysiological characteristics of the pedal-switching operation associated with emergency braking in the case of elderly drivers. The participants in this study consisted of 11 young drivers and 10 elderly drivers. An experimental pedal was used, and the muscle activity and kinematic data during braking action were analyzed using the light from a light-emitting diode installed in the front as a trigger. The results showed that elderly drivers took the same time from viewing the visual stimulus to releasing the accelerator pedal as younger drivers, but took longer to switch to the brake pedal. The elderly drivers had higher soleus muscle activity throughout the process, from accelerator release to brake contact; furthermore, the rectus femoris activity was delayed, and the simultaneous activity between the rectus femoris and biceps femoris was low. Furthermore, elderly drivers tended to have low hip adduction velocity and tended to switch pedals by hip internal rotation. Thus, the alteration in joint movements and muscle activity of elderly drivers can reduce their pedal operability and may be related to the occurrence of pedal errors.Thesis or Dissertation令和3年度doctoral thesi
Enhancement of antitumor immune response by radiation therapy combined with dual immune checkpoint inhibitor in a metastatic model of HER2-positive murine tumor
Get PDFpdfPurpose:
Treatments for metastatic human epidermal growth factor receptor 2 (HER2)-positive tumors are improving but remain inadequate. We investigated activating antitumor immune response by combining radiation therapy with immune checkpoint inhibitors using mouse tumors overexpressing HER2, a pivotal driver oncogenic antigen, to develop new immunotherapies for metastatic HER2-positive tumors.Materials and methods:
NT2.5 cells were inoculated into the two mammary fat pads of FVB/N mice, which were divided into four groups: no treatment (Non), anti-PD-1 and anti-CTLA4 antibodies (P1C4), irradiation of the large tumor (Rad), and combination (R + P1C4) groups. Tumor growth, immunostaining of tumor-infiltrating lymphocytes, and the proportion of HER2-tumor antigen-specific CD8-positive T cells in the spleen and tumor-infiltrating lymphocytes were analyzed.Results:
In the Rad group, unirradiated and irradiated tumors shrank after treatment. Besides the directly irradiated tumors, the unirradiated tumors in the R + P1C4 group shrank the most. In the unirradiated tumors, CD8-positive T cells and FOXP3-positive T cells accumulated significantly more in the R + P1C4 group than in the P1C4 and the Rad groups (all p < 0.001). CD4-positive helper T cells accumulated significantly more in the R + P1C4 group than in the Rad group (p < 0.05), but this was not significantly different from the P1C4 group. HER2-specific CD8-positive T cells in the spleen and tumor-infiltrating lymphocytes were significantly increased in the R + P1C4 group compared to the P1C4 and Rad groups (all p < 0.0001).Conclusion:
Irradiation of HER2-positive tumors induced an antitumor immune effect against the unirradiated tumor, which was enhanced by the combined use of immune checkpoint inhibitors and was mediated by enhanced recruitment of HER2-tumor antigen-specific cytotoxic T lymphocytes at the tumor site in an HER2-positive mouse tumor model. Harnessing the distant antitumor immune response induced by the combination of radiation therapy and immune checkpoint inhibitors could be a promising treatment strategy for metastatic HER2-positive tumors.Journal Articlejournal articl
Severity of Placental Abruption in Restrained Pregnant Vehicle Drivers: Correct Seat Belt Use Confirmed by Finite Element Model Analysis
Get PDFapplication/pdfDespite wearing a seat belt, pregnant drivers often suffer from negative fetal outcomes in the event of motor accidents. In order to maintain the safety of pregnant drivers and their fetuses, we assessed the severity of placental abruption caused by motor vehicle collisions using computer simulations. We employed a validated pregnant finite element model to determine the area of placental abruption. We investigated frontal vehicle collisions with a speed of 40 km/h or less involving restrained pregnant drivers with a gestational age of 30 weeks. For a crash speed of 40 km/h, the placental abruption area was 7.0% with a correctly positioned lap belt across the lower abdomen; it was 36.3% with the belt positioned at the umbilicus. The area of placental abruption depended on collision speed, but we found that with a correctly positioned belt it likely would not lead to negative fetal outcomes. We examined the effects on placental abruptions of reconfiguring seat belt width and force limiter setting. A wider lap belt and lower force limiter setting reduced the area of placental abruption to 3.5% and 1.1%, respectively; however, they allowed more forward movement upon collision. A 2.5 kN force limiter setting may be appropriate with respect to both forward movement and reduced placental abruption area. This study confirmed the importance of correctly using seat belts for pregnant drivers. It provides valuable evidence about improving safety equipment settings.Journal Articlejournal articl
Electroconvulsive Therapy Anesthesia Without Raising the Convulsive Threshold With Dexmedetomidine and Remifentanil.
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Clinical short-term outcomes of two stage operation of esophagectomy with ileocolic reconstruction for esophageal cancer
Get PDFpdf【背景】
食道切除術では胃管再建が第一選択とされることが多いが、胃管再建が困難な場合は小腸、結腸などを用いる．食道切除回結腸再建は侵襲が高く、ハイリスク症例においては二期分割手術が選択されることがある．【対象と方法】2017年1月から2021年8月に施行した二期分割食道切除回結腸再建例8例の短期治療成績を検証した．【結果】
男性 7 例、女性 1例、年齢中央値69（58-79）歳．臨床病期はI :3例、II:1例、III 期: 4例．胃管再建困難の理由は、胃癌合併4例、胃切除既往1例、食道胃接合部癌3例．一期目手術から二期目手術までの期間は中央値で33日（28-49）．手術時間、出血量の中央値は、一期目で390分（269-613）、184ml（72-584）、二期目で270分（233-401）、324 ml（50-1648）であった．術後合併症として、一期目手術で反回神経麻痺、二期目手術で肺炎をそれぞれ1例（12.5%）に認めた．縫合不全は認めなかった．再建術後経口摂取開始日中央値は7日（5-10）で、術後在院日数中央値は再建術後23日(16-39)であった．【結語】二期分割手術は手術侵襲の軽減を図ることが可能であり、回結腸再建におけるハイリスク症例に対して術後合併症の減少に寄与する可能性があり、手術適応拡大にもつながる可能性があると考えられた．Background:
Esophageal reconstruction by ileocolic interposition for esophageal cancer is highly invasive. We evaluated the two-stage operation by ileocolic reconstruction for high-risk esophageal cancer patients.Method:
We investigated the clinical outcomes in 8 patients who underwent the two-stage operation by ileocolic reconstruction at our hospital between January 2017 and August 2021. Results: Of the 8 patients investigated, 7 were men. Median patient age was 69 (range 58–79) years, the median intraoperative blood loss was 184 (72-584) ml at first and 324 (50-1648) ml at second operation. The median operation time was 390 (269-613) min at first and 270 (233-401) min at second operation. The following postoperative complications were observed: 1 (12.5%) case of recurrent nerve palsy at first operation; 1 (12.5%) case of pneumonia, 1 (12.5%) case of wound infection, and 0 (0%) cases of anastomotic leakage at second operation.Conclusions:
The two-stage operation by ileocolic reconstruction is safe and feasible. The two-stage operation would lead to expand the indication of operation for high-risk esophageal cancer patients.Departmental Bulletin Paperdepartmental bulletin pape
Investigation of the prognostic predictive value of serum lipid profiles in amyotrophic lateral sclerosis: roles of sex and hypermetabolism.
Get PDFThe prognostic predictive value of lipid profiling in amyotrophic lateral sclerosis (ALS) remains unclear. Here, we aimed to clarify the value of the levels of serum lipids, including high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG), for predicting the prognosis in ALS. This was a single-center retrospective study of 78 patients with ALS. The serum lipid profiles at the first hospital visit after symptom onset were analyzed to determine the correlations of lipids with survival and physical parameters, including nutritional, respiratory, and metabolic conditions. The cutoff level for high HDL was defined as the third quartile, while that of low LDL and TG, as the first quartile. Hypermetabolism was defined as the ratio of resting energy expenditure to lean soft tissue mass ≥ 38 kcal/kg. High HDL was an independent factor for poor prognosis in all patients (hazards ratio [HR]: 9.87, p < 0.001) in the Cox proportional hazard model, including %vital capacity and the monthly decline rate in body mass index and the Revised Amyotrophic Lateral Functional Rating Scale score from symptom onset to diagnosis. Low LDL was a factor for poor prognosis (HR: 6.59, p = 0.017) only in women. Moreover, subgroup analyses with log-rank tests revealed that the prognostic predictive value of high HDL was evident only in the presence of hypermetabolism (p = 0.005). High HDL predicts poor prognosis in all patients, whereas low LDL, only in women. Hypermetabolism and high HDL synergistically augment the negative effect on prognosis.journal articl