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せん妄の遷延化に関連する因子についての後方視研究
Get PDFBackground: It has been reported that delirium causes various problems. Many researchers have reported the risk factors associated with the onset of delirium; however, there are few reports focused on persistent delirium. This study aimed to identify the risk factors associated with persistent delirium. Methods: A total of 573 patients hospitalised in Nara Prefecture General Medical Centre from October 2014 through September 2017 who were referred to the psychiatry consultation service were included in this study. Persistent delirium was defined as delirium lasting for 14 days or more. A retrospective study was carried out based on the patients' records. The relationship between various background factors and persistent delirium was statistically analysed. Results: Of the 573 hospitalised patients, 295 were diagnosed as having delirium. Forty-six patients with persistent delirium and 181 patients with nonpersistent delirium were included in this study. Multivariable logistic regression analyses revealed that male gender, opioid analgesics use, non-opioid analgesics use, and low serum sodium were significantly and independently associated with persistent delirium. Ramelteon or trazodone was used significantly more in persistent delirium, although each use was not significant. Conclusion: This is the first study to reveal that male gender and use of analgesics were associated with persistent delirium in general hospital. However, as this is a case-control study and may contain bias, future cohort studies and intervention studies are needed. It is also necessary to investigate the relevance of the 'degree of pain' behind the use of analgesics.博士（医学）・乙第1516号・令和3年12月21日© 2021 Japanese Psychogeriatric Society.This is the peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/10.1111/psyg.12655], which has been published in final form at [https://doi.org/10.1111/psyg.12655]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited
日本人の免疫性血栓性血小板減少性紫斑病患者における不十分な血漿交換は致死的な転帰と強く相関する
Get PDFPlasma exchange (PEX) using fresh frozen plasma has considerably reduced the mortality rate in patients with immune-mediated thrombotic thrombocytopenic purpura (iTTP). However, some patients still do not survive even with treatment, but little information is available regarding which treatment these patients received. This study was conducted to obtain this information in 240 patients who met the current iTTP diagnostic criteria and completed at least 30 days of follow-up except for deceased cases. These patients were divided into three groups: survivors (n = 195), TTP-related deaths (n = 32), and other cause of death (n = 13). In the TTP-related death group, 26 of 32 patients experienced sudden death, mostly following radical hypotension and bradycardia. The median follow-up time after admission was 5.0 days, and the median number of PEX sessions was 2.5. Nine patients underwent autopsy and had cardiac microvascular thrombi in arterioles. Levels of lactate dehydrogenase, total bilirubin, serum creatinine, and D-dimer were significantly higher in the TTP-related death group than in the survivors group. Frequent PEX (> 20 sessions) was not associated with TTP-related death. In the acute phase of iTTP, patients with substantial organ damage caused by microthrombi have a greater mortality risk, even after just a few PEX sessions.博士（医学）・乙第1518号・令和3年12月21日© Japanese Society of Hematology 2021.The version of record of this article, first published in International journal of hematology, is available online at Publisher’s website: http://dx.doi.org/10.1007/s12185-021-03197-5.発行元が定める登録猶予期間終了の後、本文を登録予定（2022.10
I軸とII軸を並存する自殺企図患者に対するアサーティブケースマネージメントによる介入の効果：無作為化比較試験の二次解析
Get PDFBackground: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. Methods: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. Results: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). Conclusions: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.博士（医学）・乙第1503号・令和3年3月15日© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
Clinical and demographic characteristics of the use of seclusion and restraint in NMU Psychiatric Institute (NMU-PI).
Get PDFBackground: Seclusion/restraint are interventions legally permitted for use in psychiatry practice to man-age a person’s behavior. Nara Medical University Psychiatric Institute (NMU-PI) functions as a local core hospital providing medical care services across all ages. Thus, we accept a wide range of patients, from those with psychiatric disorders in acute and/or resistant cases, to those who need to receive advanced physical treatment comorbided with psychiatric disorders. Previous studies on seclusion/restraint use have been reported from around the world. However, no substantial studies on seclusion/restraint use under such a singular situation have been reported at least in Japan. The purpose of this study was to examine the frequency of seclusion/restraint in NMU-PI and to analyze which variables may have significantly influence the use of this procedure. Materials and methods: The data from 2014 to 2018 were retrieved from the medical records of patients who underwent seclusion/restraint interventions during this period in NMU-PI. The analyzed data included age, gender, psychiatric diagnosis, the number of seclusion/restraint and its duration, reasons led to seclusion/restraint, days of hospital stay and psychiatric severity of patients with dementia and psychotic disorders. Results: Consistent with the national survey named '630 survey', the number of the secluded/restrained patients became increasing yearly in NMU-PI. During the observation period, 89 subjects (20.8%) and 41 subjects (9.6%) underwent seclusion and restraint interventions, respectively. In addition, median days of seclusion/restaint were 32 and 27 days, respectively. A large proportion were secluded/restrained due to hurting others with psychomotor agitation, followed by prevention of injury and/or treatment of physical comorbidity. Patients diagnosed with schizophrenia (ICD-10, F2) were the most secluded, whereas patients diagnosed with dementia (F0) were the most restrained. The duration of restraint was significantly longer in male, and patients with F0. Total Neuro-psychiatric Inventory (NPI) score was significantly higher in restrained patients with F0 than in those who were not. Total Brief Psychiatric Rating Scale (BPRS) score in patients with F2 was positively correlated with the length of seclusion/restraint in patients with F2, whereas total NPI score in patients with F0 was not correlated with the length of coercive interventions. Finaly, the duration of seclusion was significantly correlated with the length of hospital stay. Conclusions: The present study provided the first real evidence of the current status of seclusion/restraint at the level of university hospital in Japan. Given the potentialy negative effects of these practices, further studies using larger samples and a wide range of quantitative outcome measures are required to identify the crucial factors of seclusion/restraint in all psychiatric diagnoses in NMU-PI.博士（医学）・乙第1504号・令和3年3月15日発行元である科学評論社の許諾を得て登録（2021年7月28日付）ジャーナル公式サイト（科学評論社HP内）：https://www.kahyo.com/product/detail/SE20201
Effects of hyperbaric oxygen on recovery from fatigue and sleep after playing golf.
No full text高圧酸素療法(hyperbaric oxygen therapy:HBOT)療法はPTSDなどへの有効性が示され、精神疾患への効果が期待されている。ゴルフは年齢を問わず競技可能で、認知症への治療効果が明らかになるなど精神疾患への有用性が検討されている。本研究はHBOTがゴルフ競技後の疲労と睡眠に与える効果を検討した。疲労、睡眠は、CFS(Chalder Fatigue Scale Japanese-version)・RAS(Roken Arousal Scale)・OSA(obstructive sleep apnea)睡眠調査票により評価した。CFSの合計点、RASの眠気、緊張、注意集中困難、意欲減退、全般的活性、リラックス、起床時眠気、疲労回復、及びOSA睡眠調査票の起床時眠気、疲労において対照群とHBO群間で有意な差を認め、HBOTがゴルフ競技後の疲労と睡眠に効果的であることが示された。博士（医学）・乙第1505号・令和3年3月15日発行元である世論時報社の許諾を得て登録（2021年7月27日付）ジャーナル公式サイト（世論時報社HP内）：https://seronjihou.com/最新精神医学25巻6号
日本の百寿者及び非百寿者における死亡前1年間に発生する医療費の比較
Get PDFImportance: Although research has shown that centenarians tend to experience shorter periods of serious illness compared with other age groups, few studies have focused on the medical expenditures of centenarians as a potential indicator of the scale of medical resources used in their last year of life. Objective: To compare Japanese centenarians' and noncentenarians' monthly medical expenditures during the year before death according to age and sex. Design, setting, and participants: This retrospective cohort study used linked national health and long-term care insurance data collected from April 2013 to March 2018 in Nara Prefecture, Japan, for residents aged 75 years or older who were insured under the Medical Care System for older adults and died between April 2014 and March 2018. Data were analyzed from April 2013 to March 2018. Exposures: Age of 100 years or older (centenarians) vs 75 to 99 years (noncentenarians). Main outcomes and measures: The numbers of unique inpatients and outpatients and medical expenditures related to decedents' hospitalization and outpatient care were extracted and analyzed based on sex and age group. The Jonckheere-Terpstra test was used to identify trends in unadjusted medical expenditures by age group, and generalized estimating equations were used to estimate monthly median expenditures by age group with adjustment for comorbidity burden and functional status. Results: Of 34 317 patients aged 75 to 109 years (16 202 men [47.2%] and 18 115 women [52.8%]) who died between April 2014 and March 2018, 872 (2.5%) were aged 100 to 104 years (131 men [15.0%] and 741 women [85.0%]) and 78 (0.2%) were aged 105 to 109 years (fewer than 10 were men). The analysis of unadjusted medical expenditures in the last year of life showed a significant trend of lower expenditures for the older age groups; the median adjusted total expenditures during the 30 days before death by age group were 4884-5894 (IQR, 8536) for 80 to 84 years, 3676-4205 (IQR, 5914) for 90 to 94 years, 2626-2898 (IQR, 3835) for 100 to 104 years, and 1938-$3527) for 105 to 109 years. The proportion of inpatients among all patients in the year before death also decreased with increasing age: 4311 of all 4551 patients aged 75 to 79 years (94.7%); 43 of all 78 patients aged 105 to 109 years (55.1%); 2831 of 2956 men aged 75 to 79 years (95.8%); 50.0% of men aged 105 to 109 years (the number is not reported owing to the small sample size); 1480 of 1595 women aged 75 to 79 years (92.8%); and 55.7% of women aged 105 to 109 years (the number of women is not reported to prevent back-calculation of the number of men). Specifically, 274 of 872 patients aged 100 to 104 years (31.4%) and 35 of 78 patients aged 105 to 109 years (44.9%) had not been admitted to a hospital in the year before death. Conclusions and relevance: This cohort study found that medical expenditures in the last year of life tended to be lower for centenarians than for noncentenarians aged 75 years or older in Japan. The proportion of inpatients also decreased with increasing age. These findings may inform future health care services coverage and policies for centenarians.博士（医学）・甲第801号・令和3年12月21日© 2021 Nakanishi Y. et al.JAMA Network Open.
Open Access: This is an open access article distributed under the terms of the CC-BY License(https://creativecommons.org/licenses/by/4.0/)
エスジーエルティー2阻害薬（カナグリフロジン）およびジペプチジルペプチダーゼ４阻害薬（テネリグリプチン）との併用療法は非糖尿病ラットモデルにおける非アルコール性脂肪肝炎の進行を抑制する
Get PDFHepatocellular carcinoma (HCC) is the strongest independent predictor of mortality in non-alcoholic steatohepatitis (NASH)-related cirrhosis. The effects and mechanisms of combination of sodium-dependent glucose cotransporter inhibitor and canagliflozin (CA) and dipeptidyl peptidase-4 inhibitor and teneligliptin (TE) on non-diabetic NASH progression were examined. CA and TE suppressed choline-deficient, L-amino acid-defined diet-induced hepatic fibrogenesis and carcinogenesis. CA alone or with TE significantly decreased proinflammatory cytokine expression. CA and TE significantly attenuated hepatic lipid peroxidation. In vitro studies showed that TE alone or with CA inhibited cell proliferation and TGF-β1 and α1 (I)-procollagen mRNA expression in Ac-HSCs. CA+TE inhibited liver fibrogenesis by attenuating hepatic lipid peroxidation and inflammation and by inhibiting Ac-HSC proliferation with concomitant attenuation of hepatic lipid peroxidation. Moreover, CA+TE suppressed in vivo angiogenesis and oxidative DNA damage. CA or CA+TE inhibited HCC cells and human umbilical vein endothelial cell (HUVEC) proliferation. CA+TE suppressed vascular endothelial growth factor expression and promoted increased E-cadherin expression in HUVECs. CA+TE potentially exerts synergistic effects on hepatocarcinogenesis prevention by suppressing HCC cell proliferation and angiogenesis and concomitantly reducing oxidative stress and by inhibiting angiogenesis with attenuation of oxidative stress. CA+TE showed chemopreventive effects on NASH progression compared with single agent in non-diabetic rat model of NASH, concurrent with Ac-HSC and HCC cell proliferation, angiogenesis oxidative stress, and inflammation. Both agents are widely, safely used in clinical practice; combined treatment may represent a potential strategy against NASH.博士（医学）・甲第765号・令和3年3月15日© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)