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Occupancy rate of pedicle screw below 80% is a risk factor for upper instrumented vertebral fracture following adult spinal deformity surgery
Get PDFStudy Design: Single-center retrospective study
Objective: To clarify whether an occupancy rate of pedicle screw (ORPS) <80% in an upper instrumented vertebra (UIV) is a risk factor for UIV fracture (UIVF).
Summary of Background data: The ratio of the length of the pedicle screw to the anteroposterior diameter of the vertebral body at the UIV is defined as ORPS. Previous studies showed that the stress on the UIV is most reduced when ORPS is >80%. However, it remains unclear whether these results are clinically valid.
Methods: A total of 297 patients who had undergone adult spinal deformity surgery were included in the study. UIVF incidence was assessed and a logistic regression analysis was conducted to uncover the risk factors for UIVF. The group with an ORPS ≥80% and <80% was defined as the H (n=198) and L (n=99) group, respectively.
Results: The mean age of both groups was 69 years. The average ORPS in the L and H groups was 70% and 85%, respectively. The incidence of UIVF was 30% in group L and 15% in group H (P<0.01). Additionally, the 99 patients in group H were subdivided into two groups, according to whether the screws penetrated the anterior wall of the vertebral body: 68 patients had no penetration (group U), while it was present in 31 patients (group B). A total of 10% and 26% of the patients in the U and B groups, respectively, experienced 1 UIVF (P<0.05). Logistic regression analysis of possible UIVF risk factors revealed an odds ratio of 3.9 for ORPS <80% (P=0.007, 95% confidence interval 1.4-10.5).
Conclusion: To reduce UIVF, screw length should be set with a target ORPS of 80% or higher. If the screw is long enough to penetrate the anterior wall of the vertebral body, the risk of UIVF is greater.journal articl
Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: a prospective cohort study
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Pros and cons of neurally adjusted ventilation assist (NAVA) in extremely low birth weight infants: four case reports
Get PDF横隔膜電気的活動（electrical activity of the diaphragm : Edi）を利用した神経調節補助換気（neurally adjusted ventilatory assist : NAVA）は，同調性が改善された新しい呼吸器モードである．従来の呼吸器モードと比較して慢性肺疾患の進行予防に期待が高まっている．今回，当院で経験したNAVAの功罪に関して示唆に富む超低出生体重児4例を報告する．1症例目では，NAVAの使用により呼吸器条件の緩和が進み，抜管後もNIV-NAVAを使用したことで呼吸状態の安定を保つことができた．2症例目では，抜管後の呼吸状態の増悪時に非侵襲的神経調節補助換気（noninvasive-NAVA : NIV-NAVA）を使用したことで再挿管を回避することができた．3症例目では，抜管後の努力呼吸が予想されたためNIV-NAVAの使用により呼吸状態の増悪を予防することができた．4症例目では，Ediカテーテル留置に伴う胃壁損傷のため胃出血を来した．NAVA および NIV-NAVAは超低出生体重児の呼吸管理に有用と考えられるが，Ediカテーテル留置に伴う消化管損傷などの合併症に注意を払う必要がある．journal articl
Migration capacity of stem cells from human exfoliated deciduous teeth towards glioma
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Correction by the skin-to-chest wall distance in near-infrared spectroscopy and assessment of breast cancer responses to neoadjuvant chemotherapy
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
The delivery outcome of pregnant women infected with novel coronavirus (COVID-19) in city hospital
Get PDF当院でのCOVID-19感染妊婦の分娩対応を後方視的に検討した。
2021年9月から2022年12月までのCOVID-19感染妊婦（COVID-19群）の分娩件数は22例であり、それ以外の通常対応を行った妊婦（通常対応群）は263例であった。COVID-19群は基本的に全例帝王切開とし、児はNICU入院とした。妊婦の背景について、年齢、妊娠週数、分娩歴の有無については有意差を認めなかったが、COVID-19群でワクチン接種歴なしの割合、帝王切開率が有意に高かった。分娩予後については産後2週間、1か月のエジンバラ産後うつ病スコア（EPDS）に関して有意差は認めなかった一方で、経腟分娩を含めた検討ではCOVID-19群で有意に分娩時出血量が多く、入院期間も延長していた。新生児予後については出生時体重、Apgar score、呼吸障害、新生児低血糖の発生率で有意差を認めなかった。
COVID-19ワクチンは先行研究でも妊娠中の感染予防効果が示されている。COVID-19群では帝王切開率が高いため分娩時出血量の増加、入院期間の延長を認めた。COVID-19適応のみで帝王切開を行うことは妊婦に負担を強いている可能性がある。妊娠中のCOVID-19感染を予防するためにワクチン接種勧奨を含めた啓蒙が必要である。COVID-19感染妊婦も通常妊婦と同様の対応ができるように環境を整える必要がある。This is a retrospective case-control study of COVID-19-infected and normal pregnant women admitted in our hospital between September 2021 and December 2022. There were 22 deliveries with COVID-19 (COVID-19 group) and 263 deliveries without COVID-19 (usual care group). The COVID-19 group women basically had caesarean sections and all babies in COVID-19 group were hospitalized in NICU. No significant differences were observed in the background of pregnant women between the COVID-19 group and usual care group in terms of age, number of weeks of gestation, or obstetric history. The likelihood of COVID-19 group to have no history of vaccination was significantly high. Moreover, the caesarean section rate was significantly high in the COVID-19 group. There were no significant differences in Edinburgh postpartum depression score (EPDS) at 2 weeks and 1 month postpartum between the two groups. The COVID-19 group had significantly high instance of hemorrhage at delivery and experience long hospital stays. The neonates had no COVID-19 infection, and there were no significant differences in body weight, Apgar score, frequency of neonates’ respiratory distress and hypoglycemia between the two groups neonates. The current situation in which only caesarean sections are performed for COVID-19 infections may be burdensome for pregnant women. Therefore, awareness and recommendation of vaccination need to be raised to prevent COVID-19 infection during pregnancy, and the environment needs to be improved so that COVID-19-infected pregnant women can be treated in the same way as those without COVID-19.journal articl
A predictive model for acute exacerbation of idiopathic interstitial pneumonias
Get PDF令和6年度 浜松医科大学優秀論文賞：最優秀論文賞
受賞者：柄山 正人Background
Acute exacerbation of idiopathic interstitial pneumonias (AE-IIPs) induces permanent pulmonary dysfunction and is potentially lethal. The unpredictable occurrence of AE-IIPs remains an important clinical issue in the management of IIPs.
Methods
In this multicentre, retrospective, observational study, a predictive score for AE-IIPs was designed using clinical factors based on multivariate Fine–Gray analysis in patients with IIPs.
Results
Based on multivariate Fine–Gray analysis in an exploratory cohort of 487 patients with IIPs, the predictive score for AE-IIPs was determined as follows: 1 point each was added for honeycombing on high-resolution computed tomography (H), age >75 years (A) and lactate dehydrogenase level >222 U·L−1 (L); the total score ranged from 0 to 3 (HAL score). The HAL score discriminated the risk of AE-IIPs with a C-index of 0.62 (95% CI 0.56–0.67); this discrimination was verified in a validation cohort of 402 patients with IIPs with a C-index of 0.67 (95% CI 0.60–0.73). In a combined cohort, the estimated
cumulative risks for AE-IIPs at 1, 2, 3, 5 and 10 years were 1.9%, 3.5%, 5.1%, 7.7% and 12.9%, respectively, in the total score 0 group; 4.7%, 8.3%, 12.0%, 17.7% and 28.4%, respectively, in the total score 1 group; and 8.0%, 14.2%, 19.7%, 28.7% and 43.0%, respectively, in the total score ⩾2 group. Subgroup analysis revealed that the HAL score was applicable to patients with and without idiopathic pulmonary fibrosis.
Conclusions
The HAL score discriminated the risk of AE-IIPs and could aid in the management of IIPs.journal articl
Association between plasma xanthine oxidoreductase activity and in-hospital outcomes in patients with stable coronary artery disease after percutaneous coronary intervention
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Astrocytic NKCC1 inhibits seizures by buffering Cl− and antagonizing neuronal NKCC1 at GABAergic synapses
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Pure somatic pathogenic variation profiles for patients with serrated polyposis syndrome: a case series
Get PDF浜松医科大学博士（医学）dotoral医学系研究科Objective: The serrated pathway is a distinct genetic/epigenetic mechanism of the adenoma-carcinoma sequence in colorectal carcinogenesis. Although many groups have reported the genetic-phenotypic correlation of serrated lesions (SLs), previous studies regarding the serrated pathway were conducted on patients with SLs that have different germline and environmental genetic backgrounds. We aimed to compare pure somatic genetic profiles among SLs within identical patient with SPS.
Results: We analyzed SLs from one patient with SPS (Case #1) and compared DNA variant profiles using targeted DNA multigene panels via NGS among the patient’s hyperplastic polyp (HP), three sessile serrated lesions (SSLs), and one traditional serrated adenoma (TSA), and separately analyzed three SSLs and one tubular adenoma (TA) within another patient with SPS (Case #2). In two patients, known pathogenic variant of BRAF (c.1799 T > A, p.Val600Glu) was observed in one TSA and one SSL in Case #1, and in three SSLs within Case #2. The pure somatic pathogenic variant BRAF (c.1799 T > A, p.Val600Glu) among SLs with identical germline genetic background supports its importance as a strong contributor for SLs.doctoral thesi