Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Association of CYP2R1 gene polymorphisms with asthma and COPD in Japanese patients
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
Investigating COVID-19 pandemic effects on acute pancreatitis development －from the perspective of alcohol sales (consumption) in a Japanese regional hospital
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
New Surgical Indication Criterion Combining Ultrasonography and Cytology Findings for Thyroid Nodules
Get PDFThyroid nodules occur frequently, and ultrasonography and cytological examinations are the standard methods for evaluating the characteristics of thyroid nodules and determining the indications for surgery. Although several reports have evaluated the accuracy of ultrasonographic or cytological examinations in detecting malignant thyroid tumors, their accuracy is not high enough, and inadequate diagnosis may cause delayed treatment of malignant tumors. Therefore, we combined the ultrasonographic and cytological findings and established a new surgical criterion to improve the accuracy of the preoperative detection of malignant tumors. The results of ultrasonography and cytological and histological diagnosis of 191 cases of resected thyroid tumors were retrospectively analyzed.
Ultrasonography findings were assessed for microcalcifications, irregular tumor margins, and high intratumoral blood flow; cytological findings were categorized into six types based on the Bethesda classification; and the histological diagnosis was classified into malignant and non-malignant.
Statistical analysis revealed that intratumoral microcalcifications and irregular tumor margins were characteristic ultrasonography features indicating the possibility of malignant tumors (p < 0.05). A combination of ultrasonographic and cytological findings, Bethesda classification V (suspicious for malignancy), VI (malignant), or I-IV with either intratumoral microcalcifications or irregular margins of the tumor, could be used to preoperatively identify malignant tumors with a relatively high accuracy (sensitivity, 93.4%; specificity, 71.0%; area under the curve [AUC], 0.822 [95% confidence interval: 0.753-0.892]). Our new surgical indication showed higher sensitivity and AUC than previous surgical indications based only on the Bethesda classification in cytological examinations.journal articl
Early Mortality after the Initiation of Hemodialysis in Elderly Patients
Get PDFBackground: The early mortality rate is high in elderly patients after hemodialysis initiation, and conservative kidney management (CKM) is introduced as an alternative to renal replacement therapy. Thus, we examined the prognosis of elderly dialysis patients at the Blood Purification Center of Dokkyo Medical University Hospital.
Methods: Among 378 hemodialysis-introduced patients at our hospital from November 2018 to December 2021, we examined the short-term mortality rate in 79 elderly patients of ≥ 80 years of age and analyzed the risk factors from the data at hemodialysis initiation compared to the 298 patients of < 80 years of age.
Results: For dialysis patients of ≥ 80 years of age, the mortality rate was 13% within 3 months (6% under 80), 23% (8%) within 6 months, and 28% (10%) within 12 months. Mortality after 12 months was further increased by up to 40% in patients of ≥ 90 years of age. Data at the time of the initiation of dialysis showed the risk of short-term death in elderly patients with low blood pressure, low body weight, and high hematocrit and potassium levels, and formula to predict the risk of death was proposed with a receiver operating characteristics (ROC) curve area under curve (AUC) of 0.8124.
Conclusion: The early mortality rate within 1 year after the initiation of hemodialysis was high in elderly patients. CKM could be an option in the high-risk patients with declining body weight and albumin levels, and elevated serum potassium and hematocrit.journal articl
A 9-year-old Boy with Summer-type Hypersensitivity Pneumonitis that was Initially Diagnosed as Bronchial Asthma: A Case Report
Get PDFA 9-year-old boy was admitted to hospital for bronchial asthma due to respiratory distress with SpO2 86% under room air and failure of earlier treatment. Diffuse interstitial shadows in the bilateral lung fields were found on chest CT. He was diagnosed with an asthmatic attack, treated with intravenous steroids, and discharged after 2 weeks. One week after discharge, his respiratory status worsened again. In an interview, it was found that he had previously had coughing and dyspnea in the summer, and that he lived in a 50-year-old wooden house. Additionally, restriction of outings due to the COVID-19 pandemic may have increased the duration of antigen exposure at home. On admission, the patient was also found to be positive for anti-Trichosporon asahii antibody. Based on all of this information, he was diagnosed with summer-type hypersensitivity pneumonitis. This case indicates the need for a detailed interview including the living environment, chest CT, and measurement of anti-Trichosporon asahii antibodies for a patient with chronic cough that does not respond to treatment, based on a suspicion of summer-type hypersensitivity pneumonitis.journal articl
Respiratory Arrest due to Muscle Paralysis Caused by Mono, Bis- (Trimethylammoniummethylene Chloride) -Alkyl-Toluene Injection: A Case Report
Get PDFQuaternary ammonium compounds are a large class of permanently charged cationic chemicals used in various consumer and industrial products owing to their antimicrobial properties; mono, bis- (trimethylammoniummethylene chloride) -alkyl-toluene (TAMCA) exhibits bactericidal activity by denaturing the proteins in the bacterial membrane when the cations in its structure are adsorbed to the anionic structure on the bacterial surface. Here, we report the first case of respiratory arrest due to muscle paralysis caused by subcutaneous injection of TAMCA. A 26-year-old man accidently injected with the aforementioned compound, developed respiratory arrest after approximately 1 h. We diagnosed him with TAMCA-related toxicosis. We successfully treated him by ventilatory management followed by tracheal intubation by injecting 10 mL of 1% propofol (100 mg), as he resumed spontaneous breathing the next day, about 15 h following the incident. Subsequently, he developed necrotizing soft tissue and underwent debridement and skin grafting surgery. This case demonstrated that TAMCA erroneous subcutaneous injection or administration into the human body may induce respiratory muscle paralysis thereby necessitating prompt treatment.journal articl
Seasonal variation of risk of stroke mortality in COVID-19 pandemic
Get PDF【目的】 本研究は COVID-19 のパンデミックの中における脳血管疾患死亡リスクの季節変動を明らかにすることを目的とした．
【方法】 インターネット上の「e-Stat 政府統計の総合窓口」に収載されている，2019 年～2022 年の人口動態統計『下巻 死亡 第 3 表 死亡数，死因（死因簡単分類）・性・死亡月別』から死亡年月および男女別に死因簡単分類別（脳血管疾患，くも膜下出血，脳内出血，脳梗塞）の死亡数を収集した．年別・死因別・男女別に 8 月を基準とした各死亡月のリスク比をポワソン回帰分析により算出した．リンク関数は自然対数とした．
【結果】 8 月を基準とした場合の 1 月と 12 月の脳血管疾患死亡のリスク比は，2019 年において，男性で 1.36 （95％信頼区間：1.31-1.42）と 1.19 （1.14-1.24），女性で 1.32 （1.27-1.37）と 1.22 （1.17-1.27）であった．2020 年においては，男性で 1.28 （1.23-1.33）と 1.26 （1.21-1.32），女性で 1.27 （1.22-1.32）と1.25 （1.20-1.31）であった．2021 年においては，男性で 1.30 （1.25-1.36）と 1.23 （1.18-1.28），女性で1.26 （1.21-1.31）と 1.21 （1.16-1.26）であった．2022 年においては，男性で 1.23 （1.18-1.28）と 1.27 （1.22-1.32），女性で 1.20 （1.15-1.25）と 1.23 （1.18-1.28）であった．くも膜下出血，脳内出血，脳梗塞の死亡リスクについても，同様な結果であった．
【結論】 本邦において，脳血管疾患，くも膜下出血，脳内出血，脳梗塞の死亡リスクは，COVID-19のパンデミックの中においても，夏季に比べて冬季が高いことが明らかとなった．適切な暖房の使用の推進等による冬季の脳血管疾患予防が引き続き必要と思われる．departmental bulletin pape
Protein Synthesis Inhibitors Induce the Sodium/Iodide Symporter Expression in Various Human Cancer Cells
Get PDFRadioiodide treatment is often carried out for complete ablation of residual and/or recurrent tumors after total thyroidectomy. Since radioiodide is actively accumulated via the sodium/iodide symporter (NIS), enhancement of its expression is critical to target cancer cells with radioiodide. To investigate if protein synthesis inhibitors induced endogenous NIS expression in human cancer cells, we evaluated the effects of translation inhibitors, cycloheximide (CHX) and homoharringtonine (HHT), on the NIS expression in MCF-7 breast cancer cells, MKN45 gastric cancer cells, and BHP 2-7 papillary thyroid cancer cells. CHX significantly upregulated NIS mRNA expression in MCF-7 cells (up to -397-fold; EC50, -4.9 μg/mL), as well as MKN45 cells (up to 82-fold; EC50, 43.8 μg/mL), but not BHP 2-7 cells. Iodide uptake was also significantly increased (-1.7-fold) in MCF-7 cells. HHT, an anti-leukemic agent, induced NIS expression in MCF-7 cells (up to -38-fold; EC50, 24.6 ng/mL), MKN45 cells (-9-fold; EC50, 256 ng/mL), and BHP 2-7 cells (-100 fold; EC50, 767 ng/mL). The induction of NIS by CHX in MCF-7 cells, as well as that by HHT in MKN45 cells, were susceptible to p38 MAPK inhibition. To our knowledge, this is the first report demonstrating the induction of NIS by protein synthesis inhibitors in human cancer cells. Further elucidation would uncover more specific, and thus less toxic molecular targets for the enhancement of NIS expression, expecting radioiodide therapy with higher efficacy and safety.journal articl