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再発膠芽腫における放射線治療の生物学的線量評価 : 2Gy等価線量換算値(EQD2)による検討
Get PDFThe standard treatment for glioblastoma is surgery followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy. A total dose of 60 Gy given in 2 Gy fractions (fr) with the concurrent and adjuvant TMZ has been recommended; however, local recurrences are frequent and the prognosis remains very poor. In this study, the equivalent dose in 2Gy fr (EQD2) in the recurrent site of glioblastoma was assessed to evaluate the biological effect of RT on glioblastoma considering that α/β ratios might vary from 1 to 10 Gy. Recurrences were found in gross tumor volume (GTV) areas in all 11 patients, and 8 of them also showed recurrence in clinical target volume (CTV). Differences in EQD2 according to α/β ratios were relatively small in high-dose areas around 60 Gy; however, low-dose areas often showed significant differences of EQD2 according to the α/β ratios. In patients that received 60 Gy in 2 Gy fr, EQD2 was less than the original physical dose and became smaller as the α/β ratio became smaller. The comparison of the dose distribution of EQD2 and dose volume histogram (DVH) of EQD2 between α/β ratios 1 and 10 suggested that little difference was found in relatively high-dose areas but a significant difference was found in lowdose areas. In contrast, if the fraction size was larger than 2 Gy, EQD2 was
greater than the original physical dose and it became larger as the α/β ratio became smaller. In conclusion, this study showed that the standard RT 60 Gy in 2 Gy fr is insufficient for glioblastoma, and it suggested that biological effects might differ significantly according to each fraction size of radiation and α/β ratio of the linear quadratic (LQ) model.博士（医学）・甲第838号・令和4年3月15
COVID-19パンデミックが慢性疼痛患者の痛みの強さ、心理状態、運動習慣に与えた短期間での影響
Get PDFPurpose: The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain. Methods: This study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic. Results: Of the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02). Conclusion: The effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term. Clinical trail registration: UMIN000043174.博士（医学）・甲第839号・令和4年3月15日© Japanese Society of Anesthesiologists 2021.This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00540-021-02992-y.発行元が定める登録猶予期間終了の後、本文を登録予定（2022.12
Comprehensive analysis of bacterial flora involved in postmortem alcohol production.
Get PDFIn forensic autopsies, postmortem microbial ethanol production makes it difficult to estimate the amount of antemortem alcohol consumption. 1-propanol, which is produced simultaneously with ethanol, has been used as an indicator of postmortem ethanol production. However, it becomes increasingly clear that postmortem ethanol production can occur without 1-propanol production. Therefore, the use of 1-propanol as an indicator of postmortem ethanol production is getting awkward to use and the identification of bacteria accompanied with ethanol production is required to elucidate the mechanism of postmortem ethanol production. In this study, we measured the blood alcohol concentration and analyzed the bacterial flora using the 16SrRNA (16S) gene region by next-generation sequencing to identify the bacteria involved in postmortem alcohol production. The bacterial flora analysis of 88 samples identified 1065 bacterial genera. Wed ivided the 88 samples into 3 groups as follows: Group Ⅰ(n=27); ethanol (-) and 1-propanol (-), Group Ⅱ (n=21); ethanol (+) and 1-propanol (-), and Group Ⅲ (n=40); ethanol (+) and 1-propanol (+). The bacterial content was compared among groups using Linear Discrimination Analysis Effect Size (LEfSe) and 16S copies. The total 16S copies was significantly larger in groups Ⅱ and Ⅲ than in group Ⅰ, demonstrating that postmortem alcohol production is more likely to occur as the bacterial content increases. In the blood of decomposed corpses, anaerobic bacteria such as Proteus and Vagococcus were involved in ethanol production, while Morganella, Peptoniphilus, Anaerosalibacter, and Tissierella were involved in 1-propanol production as well as ethanol production. This study demonstrated that the postmortem alcohol production depended on the amount and type of bacteria. This is the first study that analyzed the relationship between bacterial flora and alcohol production in cadaveric blood. These results may be applicable to the estimation of antemortem ethanol consumption in the practical forensic examination.法医解剖における血中エタノール濃度測定において、微生物によるエタノールの死後産生が生前の飲酒の有無や飲酒量の推定を困難にしている。これまで、エタノールの死後産生の有無は同時に産生される1-プロパノールが指標とされてきたが、近年、1-プロパノール産生を伴わないエタノール産生も見受けられ、1-プロパノールを指標とすることが問題視されている。したがって、エタノールおよび1-プロパノールの死後産生の機序を解明する上で、死後産生アルコールに関与する細菌の同定が必要である。本研究では、解剖時に採取した心臓血を用いて、血中アルコール濃度測定と次世代シーケンサーによる16SrRNA(16S)遺伝子領域を用いた細菌叢解析(メタ16S解析)を行い、死体血における細菌叢とアルコールの産生との関係性を検討した。88試料の細菌叢解析により1,065の細菌属が同定された。I群(n=27):エタノール(-)かつ1-プロパノール(-)、II群(n=21):エタノール(+)かつ1-プロパノール(-)、III群(n=40):エタノール(+)かつ1-プロパノール(+)に分け、LEfSe解析および16Sコピー数に基づく群間比較を行った。総16Sコピー数はI群と比較してII、III群が有意に多く、アルコールの死後産生は細菌量が多いほど起こりやすいことが示された。腐敗死体の血液では、Proteus、Vagococcusなどの嫌気性菌がエタノール産生に関与し、Peptoniphilus、Morganella、Anaerosalibacter、Tissierellaがエタノール産生と同時に1-プロパノールの産生に関与していると推察された。以上から、アルコールの死後産生が細菌の量や種類に依存することが明らかとなった。本研究は、死体血における細菌叢とアルコール産生の関係を分析する最初の試みである。法医実務上、生前の飲酒量の推定への応用が期待される。博士（医学）・乙第1519号・令和4年3月15日発行元である日本法医病理学会の許諾を得て登録（2022年4月12日付）日本法医病理学会HP内ジャーナルページ（※本文は会員限定）: http://houibyouri.kenkyuukai.jp/special/?id=3009
術後機能障害の関連因子の検討 : 前向きコホート研究
Get PDFPurpose: Preoperative prediction of functional status after surgery is essential when practicing patient-centered medicine. We aimed to evaluate the incidence and factors associated with postoperative functional disability or all-cause mortality. Secondarily, we sought to describe the trajectory of disability in this population. Methods: Adults aged ≥ 55 yr who underwent elective noncardiac surgery under general anesthesia in a tertiary care hospital were followed up one year after surgery. Pre- and intraoperative factors associated with a composite outcome of postoperative functional disability or all-cause mortality were assessed using a multiple logistic regression. The sequential changes in the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score were described and stratified by surgical invasiveness. Results: Of the 2,921 patients included, 293 experienced postoperative functional disability (10.0%; 95% confidence interval [CI], 8.9 to 11.1) and 124 died (4.2%; 95% CI, 3.5 to 5.0). In a multiple regression model, the potentially modifiable risk factors, body mass index ≥ 30 kg·m-2 and poor preoperative nutritional status, were significantly associated with the primary composite outcome, as well as nonmodifiable factors such as age, preoperative comorbidities, and blood loss volume. Changes in the 12-item WHODAS 2.0 disability score varied between different levels of surgical invasiveness and types of surgery. Conclusion: Within one year after surgery, one in ten patients experienced postoperative functional disability and one in 20 died. We identified potentially modifiable factors (obesity, poor nutritional status) associated with these adverse outcomes. Study registration: University Hospital Medical Information Network (UMIN000021671); registered 31 December 2015.博士（医学）・甲第844号・令和4年6月29日© Canadian Anesthesiologists' Society 2022.This is a post-peer-review, pre-copyedit version of an article published in Canadian journal of anaesthesia. The final authenticated version is available online at: https://doi.org/10.1007/s12630-022-02247-8
Utility of Near-infrared spectroscopy in child and adolescent psychiatry
No full text近赤外線スペクトロスコピィ (near-infrared spectroscopy:NIRS)は、非侵襲的な近赤外光を用い、脳内のヘモグロビン変化を多点で測定することで画像化する方法である。NIRSは、安全性が高く、簡便に測定でき、自然な姿勢での測定が可能であることから、安全性や非侵襲性がより求められる小児期を対象とした研究においては有用である。本学児童青年精神医学グループは、NIRS研究に先駆的に、精力的に取り組んできた。本稿では、それらの研究を概括するとともに、今後のNIRS研究の方向性、臨床への応用について検討した
