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脊椎手術におけるMEPでの定電圧刺激を用いた経頭蓋刺激は、定電流刺激よりAnesthetic fadeの影響を受けにくい
Get PDFStudy design: A prospective, within-subject study was conducted. Objective: We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques. Summary of background data: The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade. Methods: We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile). Results: The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time. Conclusion: The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries. Level of evidence: 3.博士（医学）・甲第752号・令和2年9月30日Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.This is a non-final version of an article published in final form in Spine Vol.44 No.21 p.1492-1498 (2019 Nov) (http://dx.doi.org/10.1097/BRS.0000000000003166).
健康な日本人医療従事者における、麻疹・風疹・ムンプス抗体価にワクチン接種が与える影響に関する観察研究
Get PDFGiven the complicated history of Japan's National Immunization Program, a significant proportion of Japanese people including healthcare workers (HCWs) still lack adequate immunity against measles, mumps, and rubella (MMR), resulting in occasional outbreaks. In 2014, the Japanese Society of Infection Prevention and Control (JSIPC) published vaccination guidelines for HCWs. We evaluated antibody titers before and after MMR vaccination in HCWs at the Nara Medical University Hospital, the attainment rate of the target antibody titers defined by the JSIPC guidelines, and the safety of vaccines. We measured MMR antibody titers in HCWs, followed by inoculation with the respective monovalent vaccines and/or trivalent MMR (tMMR) vaccine according to the JSIPC guidelines. Among 467 HCWs evaluated, antibody titers against measles and mumps measured using the IgG-enzyme immunoassay increased from 11.0 [interquartile range (IQR): 8.0-13.6] to 13.7 (IQR: 11.3-16.9; P < 0.001) and from 2.8 (IQR: 2.1-3.5) to 4.8 (IQR: 3.7-5.7; P < 0.001), respectively. By evaluating a logarithmic value of log2(X + 1) converted from an antibody titer X, antibody titers against rubella measured using the hemagglutination assay increased from 3.2 (IQR: 0-4.1) to 6.0 (IQR: 4.6-8.0; P < 0.001). Antibody titer elevated following tMMR vaccination was lower than that following monovalent vaccination in a single dose of the measles-containing, a single dose of the mumps-containing, and two doses of rubella-containing vaccine groups (P = 0.01, 0.01, and <0.001, respectively). After vaccination, 20.0%, 61.5%, and 46.2% of HCWs attained target antibody titers specified by the JSIPC guidelines for measles, rubella, and mumps, respectively. The systemic response in female HCWs who underwent monovalent mumps vaccination was statistically higher than that in others. Although the vaccination program for HCWs according to the JSIPC guidelines caused increased MMR antibody titers, the rates of attaining the target criteria were low.博士（医学）・乙第1476号・令和2年9月30日Copyright: © 2020 Ogawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Hand hygiene behavior of rheumatoid arthritis patients undergoing treatment with biologics.
Get PDF【目的】生物学的製剤の治療が進む中、外来の生物学的製剤（bDMARD）治療中の関節リウマチ（RA）患者は感染徴候が現れやすい。したがって、感染予防行動の管理が重要となる。そこで、bDMARD治療における投与経路別にみたRA患者の手洗い行動の現状を明らかにした。【方法】T病院整形外科外来に通院中の20歳以上のRA女性患者で、bDMARD治療患者58名（点滴群：23名、皮下注射群：35名）を対象とした。調査方法はカルテ転記と質問紙による調査とした。なお、T大学医学部倫理審査委員会の承認をうけ実施した。【結果】両群の平均年齢（点滴群：65.9歳、皮下注射群：62.8歳）、HAQ-DI得点（点滴群：0.85点、皮下注射群：1.03点）は有意な差はなかった。「適切な手洗い行動」が出来ていない割合は皮下注射群（88.6%）の方が有意に多かった（P<0.05）。手指・手関節に変形を有する者で「適切な手洗い行動」が実施出来ていない割合は、皮下注射群（89.7%）の方が有意に多かった。皮下注射のうち、自己注射をしている者（N=11）で手指・手関節に変形を有する者（N=9）のうち、適切な手洗い行動が出来ていない割合は約90%（N=8）であった。【結論】外来のbDMARD治療において皮下注射を受けている患者は、点滴を受けている患者に比べて適切に手洗い行動が出来ていないことが示唆された。このことから、看護師は特に皮下注射をしている患者の手洗い行動を観察し、感染予防行動を随時指導する必要がある。Background: While biologics have led to remission of rheumatoid arthritis (RA), in case symptoms of contagion manifest in RA patients undergoing treatment by biologics, the disease is likely to become severe. Therefore, contagion prevention and management behaviors have become indispensable for outpatients. Purpose: We investigated hand hygiene behavior of outpatients undergoing hypodermic injection (IN) and intravenous drip (IV) treatment with biologics. Methods: The subjects were 58 female RA outpatients over the age of 20 years undergoing treatment with biologics at T hospital. 23 were on IV (IV group: IVG). 35 were on IN (IN group: ING n=35). We conducted interviews with questionnaires and collected information from medical records. All procedures were approved by the Ethics Committee of T University Faculty of Medicine. Result: There were no significant group differences in age (IVG:65.9 vs. ING:62.8). There were no significant group differences in daily activities (IVG:0.85 vs. ING:1.03). There was a significantly higher percentage of subjects who did not practice appropriate hand hygene in the ING group. For patients with metamorphosis of maniphalanx, the percentage of subjects who could not implement appropriate hand hygiene behavior was significantly higher in the ING. For patients with metamorphosis of maniphalanx on self-injection, approximately 90% of subjects were not able to implement appropriate hand hygiene behavior. Conclusion: It is necessary for nurses to notice appropriate hand hygiene behavior in order to help patients manage behaviors for contagion prevention
鏡視下腱板修復術の斜角筋間腕神経叢ブロックにおいて、レボブピバカインにデキサメサゾンを加えると鎮痛時間が延長するのみならず、術後リバウンドペインが減少する。
Get PDFBackground: It has been reported that the addition of dexamethasone to interscalene brachial plexus block (ISBPB) prolongs the duration of the block effect. However, there have been no studies focusing on the effects of dexamethasone on rebound pain after the block effect has worn off. The aim of this study was to investigate the effect on postoperative pain when dexamethasone was added to ISBPB for arthroscopic rotator cuff repair (ARCR). Methods: In this multicenter, single-blinded, and randomized controlled study, 54 patients (33 males, 21 females) who received ARCR were randomly assigned to group L (ISBPB with 20 cc of 0.25% levobupivacaine; 21 patients) or group LD (ISBPB with 20 cc of 0.25% levobupivacaine + 3.3 mg dexamethasone; 33 patients). The primary outcome was the visual analog scale (VAS) for pain after the block effect had worn off. Secondary outcomes were the duration of analgesia, the time to the first request for additional analgesic, the number of additional doses of analgesic, and complications. Results: The VAS scores on postoperative days 0 and 1 were significantly lower in group LD than group L (P = .005, .035). This indicated that the rebound pain was relieved in group LD. After postoperative day 1, there was no significant difference in VAS score (P = .43 and .19 for days 2 and 3, respectively). The duration of analgesia was significantly longer in group LD than group L (P < .001). The time to the first request for additional analgesic was significantly longer in group LD than group L (P < .001). The number of additional doses of analgesic was significantly lower in group LD (P < .001). Conclusion: In ARCR, the addition of dexamethasone to levobupivacaine not only prolongs the duration of ISBPB but also relieves rebound pain after the block effect wears off.博士（医学）・甲第759号・令和2年12月24日Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved
Ring box protein-1 は食道癌の予後不良因子であり、腫瘍の進行と関連している
Get PDFRing box protein-1 (RBX1) is an essential component of the S-phase kinase-associated protein, Cullin and F-box containing ubiquitin ligases. Overexpression of RBX1 has been reported in several cancer types; however, little is known regarding the prognostic value and role of RBX1 in esophageal cancer. The present study examined 120 patients with esophageal cancer (EC) who underwent curative esophagectomy and 61 patients with EC who underwent neoadjuvant combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU; DCF) using immunohistochemistry. All specimens were classified into two groups according to the percentage of RBX1-positive tumor cells. In addition, the impact of RBX1 expression on cancer cell proliferation was analyzed in vitro using a small interfering RNA silencing technique. RBX1 expression levels showed significant differences according to tumor size (P<0.001), tumor depth (P=0.002), lymph node metastasis (P=0.004), pathological stage (P=0.001), lymphatic invasion (P=0.001) and venous invasion (P=0.001). The overall survival (OS) rate in the RBX1 high expression group was significantly lower compared with that in the low group (P=0.004). Multivariate analysis demonstrated that RBX1 status was an independent prognostic factor. RBX1 gene silencing inhibited the proliferation of human EC cells and enhanced the antitumor effect of 5-FU. Among patients who underwent neoadjuvant DCF therapy, the RBX1 high expression group had a significantly lower OS rate compared with that of the RBX1-low group (P<0.001). In conclusion, RBX1 has notable prognostic value, and RBX1 may serve an important function in the tumor progression of EC.博士（医学）・乙第1480号・令和2年12月24日Copyright: © Kunishigeet al. This is an open access article distributed under theterms of CreativeCommons Attribution License(https://creativecommons.org/licenses/by-nc-nd/4.0/)
中鎖脂肪酸と糖質の併用摂取は癌関連骨格筋萎縮から保護する
Get PDFSkeletal muscle volume is associated with prognosis of cancer patients. Maintenance of skeletal muscle is an essential concern in cancer treatment. In nutritional intervention, it is important to focus on differences in metabolism between tumor and skeletal muscle. We examined the influence of oral intake of glucose (0%, 10%, 50%) and 2% medium-chain fatty acid (lauric acid, LAA, C12:0) on tumor growth and skeletal muscle atrophy in mouse peritoneal metastasis models using CT26 mouse colon cancer cells and HT29 human colon cancer cells. After 2 weeks of experimental breeding, skeletal muscle and tumor were removed and analyzed. Glucose intake contributed to prevention of skeletal muscle atrophy in a sugar concentration-dependent way and also promoted tumor growth. LAA ingestion elevated the level of skeletal muscle protein and suppressed tumor growth by inducing tumor-selective oxidative stress production. When a combination of glucose and LAA was ingested, skeletal muscle mass increased and tumor growth was suppressed. Our results confirmed that although glucose is an important nutrient for the prevention of skeletal muscle atrophy, it may also foster tumor growth. However, the ingestion of LAA inhibited tumor growth, and its combination with glucose promoted skeletal muscle integrity and function, without stimulating tumor growth. These findings suggest novel strategies for the prevention of skeletal muscle atrophy.博士（医学）・甲第733号・令和2年3月16日© 2019 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.
This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License(https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes
高齢者の手段的ADL低下に対するスポーツと文化的趣味活動の交互作用－藤原京スタディー
Get PDFBackground: Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown. Methods: We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index). Results: The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004). Conclusions: We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.博士（医学）・乙第1456号・令和2年3月16日© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. 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
原発性胆汁性胆管炎の臨床的予後予測と腸内細菌叢との関連
Get PDFAim: Although some relationships between gut microbiota and liver diseases have been reported, it remains uncertain whether changes in gut microbiota owing to differences in race, food and living environment have similar effects. Response to ursodeoxycholic acid (UDCA) may predict the long-term prognosis of patients with primary biliary cholangitis (PBC); however, little is known about the significance of the gut microbiome in patients with PBC. We elucidated the relationships among clinical profiles, biochemical response to UDCA and gut microbiome composition in patients with PBC. Methods: Fecal samples from 76 patients with PBC treated at our hospital were collected; patients whose UDCA intake period was <1 year were excluded. The microbiome structures of patients were determined using 16S ribosomal RNA gene sequencing and were statistically compared with those of healthy subjects. The structures of patients in the UDCA responder (n = 43) and non-responder (n = 30) groups were compared according to the Nara criteria (reduction rate of gamma-glutamyl transpeptidase, ≥69%, after 1 year). Results: Compared with healthy subjects, bacterial diversity was lower in patients with PBC, with a decreased abundance of the order Clostridiales and increased abundance of Lactobacillales. The UDCA non-responder group had a significantly lower population of the genus Faecalibacterium, known as butyrate-producing beneficial bacteria (P < 0.05), although no significant differences in gender, body mass index, medicated drugs or other serological data were indicated between these two groups. Conclusions: Gut dysbiosis with loss of beneficial Clostridiales commensals was observed in patients with PBC. Decrease in Faecalibacterium abundance might predict the long-term prognosis of patients with PBC.博士（医学）・甲第753号・令和2年9月30日© 2020 The Japan Society of HepatologyThis is the peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/full/10.1111/hepr.13509], which has been published in final form at [https://doi.org/10.1111/hepr.13509
]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
腰部脊柱管狭窄症において、Zurich Claudication Questionnaire とJapanese Orthopaedic Association scoreに、ロコモティブシンドロームを示すカットオフ値が存在する
Get PDFBackground: Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is a LS disorder. The Japanese Orthopaedic Association score (JOA score) and the Zurich Claudication Questionnaire (ZCQ) are international evaluation tools for LSS. However, the relationship between LS and JOA score or ZCQ is unknown. This study aimed to clarify the correlations between LS progression and the values/parameters of the JOA score or ZCQ and to determine the critical cutoff point of the JOA score or ZCQ that indicates LS progression. Methods: We recruited preoperative LSS patients (n = 82). Patients' mean age was 73.4 years. The study participants were evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS), JOA score, and ZCQ (which consists of symptom severity and physical function), and the patients' health-related quality of life was assessed using EuroQoL-5 dimension (EQ-5D) utility values and the EuroQoL-visual analog scale (EQ-VAS). We investigated the correlations between the 25-question GLFS and each clinical variable and evaluated the critical cutoff point of each international evaluation tool to detect LS. Results: There was a statistically significant correlation between 25-question GLFS and each clinical evaluation tool. LSS patients with LS showed significantly worse scores in the evaluation tools than LSS patients without LS. Moreover, we found that critical cutoff points of 17.5 on JOA score, 3.1 on ZCQ-symptom, and 2.3 on ZCQ-function could detect LS. Conclusions: A statistically significant correlation exists between the 25-question GLFS and the JOA score or ZCQ. It might be important to perform decompression surgery for LSS patients before they reach the cutoff values of the several clinical evaluation tools to avoid LS progression. Study design: Clinical prospective case-control study.博士（医学）・乙第1471号・令和2年9月30日© 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved