Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Investigation of the Predictors of Dysphagia in Cardiovascular Patients Treated with Invasive and Non-invasive Mechanical Ventilation
Get PDFObjectives: To examine the predictors of prolonged dysphagia at discharge in cardiovascular patients treated with invasive and non-invasive mechanical ventilation (MV).
Methods: Inpatients with dysphagia and cardiovascular disease treated with MV at Japanese Red Cross Ashikaga Hospital were evaluated between April 2019 and August 2022 in this retrospective observational study. Age, sex, ambulatory ability, Geriatric Nutritional Risk Index (GNRI), primary heart disease, Charlson Comorbidity Index, invasive or non-invasive MV, Sequential Organ Failure Assessment, duration of MV, days from the withdrawal of MV to the start of rehabilitation, Functional Oral Intake Scale (FOIS) at the start of rehabilitation and at discharge, length of hospital stay, training time per day, pneumonia after the start of rehabilitation, and death during hospitalization were surveyed. To assess the predictors of death and dysphagia at discharge, univariate comparisons and Firth's logistic regression analyses were performed.
Results: Ten of the 128 patients died, and 71 patients had dysphagia at discharge. Lower FOIS scores (P = 0.04), less training time per day (P < 0.01), and pneumonia (P = 0.02) were significantly associated with death in univariate comparisons. Ambulatory ability (odds ratio = 0.09; 95% confidence interval = 0.01-1.48, P = 0.04) and the nutritional risk assessed by GNRI (odds ratio = 1.84; 95% confidence interval = 1.20-2.81, P < 0.01) were the independent predictors of dysphagia at discharge in Firth's logistic regression analysis.
Conclusions: Ambulatory ability and GNRI are valuable as the predictors of prolonged dysphagia at discharge in cardiovascular patients treated with MV.journal articl
Changes and Possible Risk Factors in the Prevalence of Allergic Rhinitis among Children in Ulaanbaatar, Mongolia from 2009 to 2021
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
Survey of Health Literacy Among Japanese Outpatients with Mental Illness
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
Relationship between Increased ba-PWV Values and Body Composition in Patients with Type 2 Diabetes Mellitus
Get PDFBackground: Reduced lower limb circumference in patients with type 2 diabetes mellitus (T2DM) could be a useful screening tool for arteriosclerosis. The objective of this study was to clarify the relationship between lower limb circumference and body composition measures, muscle strength, patient characteristics, and the progression of arteriosclerosis in patients with T2DM.
Methods: We included 114 patients receiving outpatient care for T2DM, assessed body composition, muscle strength indicators, patient characteristics, clinical diabetic neuropathy status, and examined their brachialankle pulse wave velocity (ba-PWV) measurements using multiple regression analysis.
Results: The ba-PWV severity levels were classified at 1400 cm/s, 1650 cm/s, and 1963 cm/s to investigate their associations with the patients' attributes using logistic regression analysis. Body mass index (BMI), HbA1c levels, abnormal ankle reflex, and the percentage ratio of the circumference at the tibial tuberosity to the maximum circumference of the lower leg (TRSC%: Circumferential diameter of tibial rough surface/Circumferential diameter of tibia, at the calf at the proximal 26% of the fibula) were the independent variables in the multiple regression analysis, with ba-PWV as the dependent variable. In the logistic regression analysis of ba-PWV categorized at 1400 cm/s, which is considered an index of arteriosclerosis, BMI was the independent variable. When divided by 1963 cm/s, which is considered a mortality risk index, BMI, abnormal ankle reflex, and TRSC% were the independent variables.
Conclusion: Arteriosclerosis in patients with T2DM is associated with a decrease in lower limb circumference. TRSC% was independently associated with severe arteriosclerosis.journal articl
Therapeutic Effects of Dotinurad and Febuxostat in Chronic Kidney Disease Patients with Hyperuricemia
Get PDF慢性腎臓病（CKD）患者は血清尿酸値が高いことが多く，高尿酸血症は腎不全や脳心血管病の危険因子となる．腎機能が低下している場合，高尿酸血症治療薬として尿酸排泄促進薬は効果的ではなく，尿酸生成抑制薬であるアロプリノール（ALP）も副作用に注意を要するが，フェブキソスタット（FBX）などの非プリン系キサンチンオキシダーゼ阻害薬が腎不全患者にも用いられるようになり，選択的尿酸再吸収阻害薬であるドチヌラド（DTN）も導入されている．本研究では，CKDを合併する高尿酸血症に対するDTNおよびFBXの治療効果を比較した．
高尿酸血症を呈するCKD患者19例にDTN 0.5, 1, 2 mgあるいはFBX 10, 20, 40 mgを3-6か月ずつ投与する無作為交差試験を行った．各治療期終了時に血液・尿検査を行い，腎障害や心血管系危険因子を評価した．
血清尿酸値はDTN投与期とFBX投与期で同等であり（5.5 vs 5.1 mg/dL），推算糸球体濾過 （eGFR）＜45 mL/分/1.73 m2の症例においても有意差はなかった（5.5 vs 4.9 mg/dL）．血圧（121/79 vs 123/78 mmHg）や血清脂質，ヘモグロビンA1c（6.1 vs 6.2％）にDTNとFBXで有意差はなく，および血清クレアチニン（1.14 vs 1.16 mg/dL）や尿中アルブミン排泄（219 vs 179 mg/gCr）にもDTN投与期とFBX投与期で有意な違いは認められなかった．血漿BNP（48 vs 55 pg/mL）や血清高感度CRP（1.60 vs 1.41 mg/L）および酸化ストレスのマーカー（酸化LDL 94 vs 102 U/L, 活性酸素代謝物 339 vs 354 U.CARR）にも有意差はなかった．
CKD患者の高尿酸血症に対し，DTNはCKDステージG3bにおいても血清尿酸値を下げるのに効果的であり，心血管系危険因子に対する影響もFBXと同等であると考えられる．Patients with chronic kidney disease（CKD）are at high risk for developing cardiovascular diseases and hyperuricemia is associated with the progression of renal dysfunction and the incidence of cardiovascular events. In this study, we compared the effects of dotinurad（DTN）, a novel selective urate reabsorption inhibitor, and febuxostat（FBX）, a non-purine xanthine oxidase inhibitor, on cardiovascular risk profile in CKD patients. Nineteen CKD patients were given DTN （0.5, 1, 2 mg/day） or FBX （10, 20, 40 mg/day） for 3-6 months in a random crossover manner, and the indices of cardiovascular risk were evaluated at the end of each treatment period. Hypouricemic effect was not significantly different between DTN and FBX （5.5 vs 5.1 mg/dL） even in subgroup subjects with glomerular filtration rate （eGFR）＜45 mL/min/1.73 m2（5.5 vs 4.9 mg/dL）There were no significant differences in blood pressure, hemoglobin A1c and serum lipids. Indices Indices of renal injury such as eGFR （51.9 vs 50.8 mL/min/ 1.73 m 2） and albuminuria （219 vs 179 mg/gCr） did not significantly differ between DTN and FBX. Significant differences were not observed in circulating markers of oxidative stress （oxidized LDL 94 vs 102 U/L, reactive oxygen metabolites 339 vs 354 U.CARR）or inflammation （high-sensitivity CRP 1.60 vs 1.41 mg/L）. Plasma brain natriuretic peptide did not show a significant difference between the two treatment periods （48 vs 55 pg/mL）. It is suggested that DTN has comparable hypouricemic effect to xanthine oxidase inhibitors even in stage G3b CKD patients and the effects on cardiovascular risk profile is also comparable to xanthine oxidase inhibitors.journal articl
Practice of Home Medical Care Carried Out by a Community-based University Hospital
Get PDFOur hospital, a 923-bed capacity university hospital located in a large city, is responsible for both advanced acute medical care and regional medical support. Many patients are highly dependent on medical care, and a home medical care department was established in 2018 to provide medical care not only during hospitalization but also at home. Doctors in our general medicine department concurrently work in the home medical department. We report on progress achieved within five years in which we have been working with nursing staff and clerical workers. For inpatients or outpatients at our hospital, we consider not only physical factors, such as diseases and comorbidities, but also various situations, such as recuperation environment and the need for nursing care. Additionally, doctors in the general medicine department conduct regular home visits during the day based on requests from the main department, which provides emergency care at night and on holidays. Home-visit nursing has been practiced for a long time and has played a role in returning unstable patients to a stable condition immediately after discharge from the hospital. Even though our facility is a university hospital, we have the flexibility to go out to the community, and as a medical education institution, medical students and initial resident physicians accompany us to experience home medical care; this will contribute to human resource development that will support future medical care.journal articl