Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Serum Vitamin D Binding Protein in Asthma-Chronic Obstructive Pulmonary Disease Overlap and the Individual Diseases
Full text linkVitamin D binding protein (VDBP) has been shown to influence asthma and chronic obstructive pulmonary disease (COPD), but its specific effects are unclear. Moreover, serum VDBP has not been investigated in asthma-COPD overlap (ACO). In this study, we compared serum concentrations of VDBP among 252 participants (63 patients with ACO, 70 with bronchial asthma, 69 with COPD, and 50 healthy donors). We also analyzed correlations of blood VDBP concentration with smoking, serum immunoglobin E, peripheral blood eosinophil and neutrophil counts, serum calcium, serum 25-hydroxyvitamin D3, respiratory function (FEV1: forced expiratory volume in 1 s), and fractional exhaled nitric oxide in ACO, bronchial asthma, and COPD. Serum VDBP concentrations were significantly lower in the healthy donors compared with the ACO, bronchial asthma, and COPD groups (all p < 0.05), but did not differ significantly among ACO, bronchial asthma, and COPD. Analysis of correlations of various parameters with serum VDBP concentration showed a negative correlation with smoking history (pack-years) (r = -0.266, p = 0.037) and a positive correlation with FEV1 (r = 0.267, p = 0.036) for ACO, but no correlation between serum VDBP and smoking history or FEV1 for bronchial asthma or COPD. A positive correlation between serum VDBP and peripheral blood eosinophil count was found for COPD alone (r = 0.279, p = 0.039). These results suggest that VDBP influences smoking-related respiratory dysfunction in ACO and peripheral blood eosinophil count in COPD.journal articl
Combining the FIB-4 Index with the aMAP Score to Enhance Prediction of Liver Carcinogenesis in HCV-SVR Patients
Full text linkBackground and aim:
The background of liver carcinogenesis has shifted from viral hepatitis to sustained virological response (SVR) of hepatitis C virus (HCV) due to the advent of direct-acting antiviral agents (DAAs). The aMAP score is useful for predicting liver carcinogenesis in HCV-SVR patients, but limitations remain, particularly in medium- and high-risk groups. This study aimed to identify the best factor to combine with the aMAP score to improve predictive accuracy.
Methods:
We reviewed 286 patients who achieved HCV-SVR. Patients were divided into two groups based on cancer development. Clinical characteristics at 12 weeks post-SVR were compared using the paired Wilcoxon test, and the cut-off values for liver carcinogenesis were determined using the receiver-operating characteristic (ROC) curve. Patients were classified by the aMAP scores as follows: less than 50 for low-risk, 50 to 59 for medium-risk, more than 60 for high-risk for liver carcinogenesis.
Results:
After excluding 30 patients due to insufficient follow-up, 256 patients were analyzed. During the observation period, 13 patients (5.1%) developed hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT), α-fetoprotein, platelet count, shear wave velocity, and the FIB-4 index were identified as promising factors for combination with the aMAP score. The combination of the FIB-4 index (cut-off value 2.57) with the aMAP score was optimal for predicting liver carcinogenesis, increasing the HCC occurrence rate in medium-and high-risk groups compared to that in high-risk group of the aMAP score alone (13.6%, 12/88 vs. 9.2%, 11/119).
Conclusions:
The FIB-4 index is the best factor to combine with the aMAP score for predicting liver carcinogenesis after HCV-SVR, especially in medium- and high-risk groups (aMAP score more than 50).journal articl
Interaction of Ganglion Plexi during Atrial Fibrillation Ablation in a Patient with Mirror-image Dextrocardia -Remarkable Vagal Responses during Hotballoon Ablation-
Full text linkThe ganglion plexi (GPs) location and vagal response during ablation are not well understood in dextrocardia patients. A 75-year old female with dextrocardia underwent pulmonary vein isolation (PVI) using hot-balloon ablation for atrial fibrillation. A vagal response occurred during the left-superior PV ablation, which was suspected due to neural interactions between the atrial GPs and sinus node. 3D-CT revealed the existence of epicardial adipose tissue (EAT) at the PV antrum and an EAT volume reduction after the PVI. In the present case, the neural location and GP connections consisted of a normal anatomy except for being on the opposite side.journal articl
A Case of Liver Injury as an Immune-related Adverse Event in Squamous Cell Carcinoma of the Lung with Successful Life-saving Treatment
Full text linkA patient with lung squamous cell carcinoma, cT4N3M1c (OSS), Stage IVB developed Grade 4 hepatic impairment after 2 cycles of carboplatin + paclitaxel + nivolumab + ipilimumab as first-line chemotherapy. Clinically, an immune-related adverse event (irAE) was suspected and pulse therapy with 1 g methylprednisolone for 3 days was administered twice, followed by prednisolone 100 mg/day and mycophenolate mofetil 2000 mg/day, resolving the hepatic impairment. Immune checkpoint inhibitors can cause severe irAEs, as in the present case where cytotoxic chemotherapy combined with anti-PD-1 and anti-CTLA-4 antibodies caused Grade 4 irAE liver injury, which was successfully treated with steroids and immunosuppressants.journal articl
Long-term Effect of Oral Semaglutide on Glycemic Control: An Extended Observational Study over Two Years from Baseline
Full text linkThe aim of this study is to investigate the long-term effect of oral semaglutide on glycemic control. The effect on glycemic control of switching from a DPP4 inhibitor to oral semaglutide was examined in an extended period of 2 years from baseline in patients (n = 18) from a previous study. Average HbA1c and GA were significantly decreased by oral semaglutide after 2 years compared to baseline. There were no significant differences in each level among measurement time points of 4 months and 1, 1.5 and 2 years. These results show that the effect of oral semaglutide on glycemic control is maintained over a 2-year period.journal articl
Trends and Challenges in Measurement and Evaluation Methods for Medical Safety Culture
Full text link【目的】 日本では1999 年～2000 年に起こった医療事故が契機となり，医療の安全性への関心が高まり，様々な取り組みがなされてきている．組織が安全文化を醸成するためには，安全文化の現状把握と「見える化」が重要である．本稿では日本の医療機関に適用可能な評価法を紹介し，医療安全文化に関する評価法の動向を示すことを目的とした．
【方法】 2000 年1 月～2024 年9 月までの医学中央雑誌で「医療安全」，「医療事故防止」，「組織の文化」，「評価法」等のキーワードで検索し，医療安全文化に関する測定評価法を開発・使用している研究報告を抜粋した．
【結果】 検索された17 の論文の内容を検討して，使用・引用頻度が高いHospital Survey on Patient Safety Culture の日本語版，医療安全文化構成要因尺度，患者安全のための医療事故防止行動自己評価尺度，Patient Safety Climate Scale（患者安全風土尺度）に，救急部門に特化したEmergency Department Safety Questionnaire を加えて，医療安全の構成要素や測定法的特性を比較した．信頼性ではどの測定評価法も良好な内的整合性を認めていたが，安定性の報告は少なく，妥当性では因子的妥当性の報告がほとんどで，それ以外の妥当性の報告は乏しかった．これらは中規模以上の医療施設でのデータに基づいて報告されていた．
【結論】 現行の医療安全文化の測定評価ツールは一定の心理測定法的特性を有しているが，医療施設の70％を占める小規模の医療施設での測定や少人数の職種の施設間比較を可能とするような評価法の開発が望まれる．Objective：In Japan, the medical accidents that occurred in 1999 and 2000 triggered a growing interest in medical safety, and various efforts have been made to address this issue. In order for an organization to develop a safety culture, it is important to understand and “visualize” the current status of the safety culture. The purpose of this article is to introduce assessment methods applicable to medical institutions in Japan, and to describe trends and issues in assessment tools related to medical safety culture.
Methods：We searched the Ichushi Web, a Japanese medical database maintained by the Japan Medical Abstracts Society, from January 2000 to September 2024 using keywords such as “medical safety, ”“ medical accident prevention, ”“ organizational culture, ” and “evaluation methods, ” and selected research reports that developed and used assessment tools related to medical safety culture.
Results：The contents of the 17 articles retrieved were reviewed to identify the most frequently used and cited tools. We selected the Japanese version of the Hospital Survey on Patient Safety Culture, the Medical Safety Culture Component Scale, the Self-Evaluation Scale of Medical Accident Prevention Behaviors with Aim of Ensuring Patient Safety, and the Patient Safety Climate Scale, along with the Emergency Department Safety Questionnaire, which is specialized for emergency departments. As to the scale reliability, these assessment tools showed good internal consistency, but few reports were available concerning test-retest reliability. As to the validity, their factorial validity was reported but few reports of other aspects of validity. These reports were based on data obtained from a medium-sized or larger medical facility.
Conclusion：Although current tools for evaluating medical safety culture have certain psychometric properties, it is desirable to develop evaluation methods that will enable in small medical facilities, which account for 70％ of all medical facilities, and inter-facility comparison of workers.departmental bulletin pape