Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Efficacy of a gastric tube insertion guide for insertion of a nasogastric tube: a prospective, randomized controlled clinical study
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Occupational difference in use of heated tobacco products: a cross-sectional analysis of retail workers in Japan
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Incidence of diagnostic errors among unexpectedly hospitalized patients using an automated medical history-taking system with a differential diagnosis generator: retrospective observational study
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Role of liver stiffness measurements in patients who develop hepatocellular carcinoma after clearance of the hepatitis C virus
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Aerosol-generating Procedures in Patients with COVID-19: A Narrative Review
Get PDFSevere acute respiratory syndrome-corona virus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. Transmission of SARS-CoV-2 is thought to be predominantly through respiratory spread of aerosols. Aerosol-generating procedures (AGPs) include various anesthesia or intensive care techniques, such as facemask ventilation, tracheal intubation, tracheal extubation, insertion or removal of the supraglottic airway, tracheostomy, high-flow oxygen delivery, and removal of oropharyngeal or tracheal secretion by suction. AGPs are high at risk of viral infection for the healthcare worker, and special care during airway management would be required as most airway management are closely related to AGPs. Some simulation studies have indicated that facemask ventilation and coughing after extubation may increase the risk of healthcare workers being exposed to a higher concentration of viral aerosols compared to other AGPs. The current state of knowledge indicates that wearing standard personal protective equipment, using an aerosol extractor with a virus filter, choice of tracheal intubation at rapid sequence induction, and video laryngoscope to intubate the trachea have efficacy in protecting healthcare workers from the viral transmission during airway management.journal articl
Ustekinumab as the First Biological Agent for Treatment of Crohn's Disease with Growth Failure and Arrest of Puberty: A Pediatric Case
Get PDFA 14-year-old boy diagnosed with Crohn's disease, complicated by growth failure, arrest of puberty, and perianal abscess, was treated with ustekinumab. We observed improvements in the endoscopic and histological gastrointestinal tract pathology, growth failure, arrest of puberty, and bone mineral density. Crohn's disease can affect both growth and the development of secondary sexual characteristics and bone mineral density; thus, treatment should be selected for both the gastrointestinal tract pathology and the aforementioned factors. Few reports have shown the effectiveness of ustekinumab as the first biological agent for the treatment of pediatric Crohn's disease. In this pediatric case with growth failure and arrest of puberty, ustekinumab as the first biological agent was both effective and safe.journal articl
Evaluation of Polysomnography before and after Treatment Using Polysomnography in Children with Obstructive Sleep Apnea
Get PDFClear diagnostic and treatment standards have not yet been established for pediatric obstructive sleep apnea (OSA), so a considerable number of patients, including those yet undiagnosed, may be left untreated in Japan. However, it is practically impossible to conduct overnight polysomnography (PSG) tests, which are considered useful for diagnosis, for all cases of suspected pediatric OSA because of insufficient manpower in pediatric medical care and detachment of electrodes due to frequent body movements. To clarify the usefulness of surgical treatment for pediatric OSA, a retrospective study was conducted using PSG parameters, including the apnea hypopnea index (AHI) on 32 patients.
Of 144 patients (93 boys, 51 girls, average age at first visit: 9.1 ± 2.9 years, 30 preschool children under seven years old) who were able to undergo PSG, 32 patients with pre- and post-surgery PSG data were included (18 boys, 14 girls, average age at first visit: 8.4 ± 2.4 years, eight preschool children under seven years old). Additionally, eight patients had a pre-treatment body mass index (BMI) of 25 or higher. Allergic diseases such as bronchial asthma and allergic rhinitis were the most common complications (18/32, 56.3%). Comparing post- and pre-surgical PSG parameters, significant decreases were observed for AHI, apnea index (AI), and oxygen desaturation index (ODI); significant increases were observed for stage REM and REM sleep time (p < 0.05).
Despite the limited number of cases, our data suggest that polysomnography is useful in determining the indication of surgical treatment and its efficacy in children with OSA.journal articl
Development of a Young Rat Hyperkalemia Model with Decreased Renal Excretion of Potassium
Get PDFInfants and young children are prone to hyperkalemia caused by decreased renal potassium excretion. However, there are limitations to the use of current hyperkalemia drugs in pediatric patients. To address this issue, we developed a young rat hyperkalemia model by the combined administration of potassium chloride (KCl) and amiloride (Ami) to test new drug candidates for young patients. We administered KCl (2, 3, 4.5, and 6 mEq/kg) and Ami (3 mg/kg) intraperitoneally to five-week-old male Wistar-Imamichi rats and placed them in metabolic cages. After 6 h, blood and urine samples were collected. The combined administration of KCl and Ami increased the serum-potassium concentration compared to the control (2 mEq/kg; 5.2 vs 4.5 mEq/L, P ＝ 0.039, 6 mEq/kg; 6.8 vs 4.1 mEq/L, P = 0.005, n = 5) in a dose-dependent manner. Next, the rats were orally administered furosemide (30 mg/kg, FURO), a known hyperkalemia treatment, or Compound 21 (C21) (10 and 30 mg/kg), an angiotensin II type 2 receptor agonist and candidate drug for hyperkalemia. FURO was administered as a single dose (after 1 h) or as repeated doses (after 1, 3, and 5 h). The serum-potassium concentration was significantly decreased by FURO (single dose; 5.9 vs 6.8 mEq/L, P = 0.017, n = 7, repeated doses; 5.6 vs 6.3 mEq/L, P = 0.021, n = 7). However, C21 did not decrease the serum-potassium concentration compared to the control (6.6 vs 6.8 vs 7.2 mEq/L, P = 0.07). Overall, this model can be used to evaluate the effects of candidate therapeutic drugs for hyperkalemia in school children caused by decreased urinary-potassium excretion.journal articl