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Association between human papillomavirus particle production and the severity of recurrent respiratory papillomatosis
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Recurrent respiratory papillomatosis (RRP) has a wide range of severity. We investigate the relationship between human papillomavirus (HPV) particle production and severity of RRP. From September 2005 to June 2021, 68 RRP samples (from 29 patients) were included. HPV type was determined. HPV viral load, physical status, and demographic and clinical characteristics were assessed. Immunohistochemistry (IHC) was performed for p16, Ki-67, L1, and E4. We used NanoSuit- CLEM (correlative light and electron microscopy) and transmission electron microscopy (TEM) to examine the samples. The total number of surgeries in HPV-positive and HPV-negative cases were 3.78 (n=55/68, range:1–16) and 1.30 (n=13/68, range:1–3), respectively (p=0.02). IHC showed that L1 and E4 were correlated and expressed on the tumour surface. NanoSuit-CLEM and TEM revealed HPV particles in L1-positive nuclei. L1 IHC-positive cases had a shorter surgical interval (p<0.01) and more frequent surgeries (p=0.04). P16 IHC, viral load, and physical status were not associated with disease severity. This study visualised HPV particle production in RRP for the first time. Persistent HPV particle infection was associated with severity. We suggest L1 IHC for evaluating RRP severity in addition to the Derkay score.doctoral thesi
Characterization of plasma daptomycin in patients with serum highly glycated albumin and obesity
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Anti-vascular endothelial growth factor (VEGF) therapy for retinopathy of prematurity: five case series
Get PDF抗血管内皮増殖因子（vascular endothelial growth factor : VEGF）療法は，未熟児網膜症（retinopathy of prematurity : ROP）に対する新しい治療法であり，2019年にラニビズマブが抗VEGF薬として初めてROPに対しての適応が承認された．それをうけて当院でもこれまで抗VEGF療法を5例に施行した．
5例とも従来の光凝固療法に比べて短時間で治療が完了し，治療後1週間で病期の改善が得られた．症例1はその後全身状態が増悪しフォローができなかった．症例2,3,4はフォローアップ中に再燃し，症例2は追加の抗VEGF療法を行ったのち光凝固療法も追加した．症例3,4はフォローアップ中に無治療で病勢が改善した．症例5は再燃はなかったものの，正常な網膜血管の伸展が悪かった．
ROPのフォローアップは，治療の時期を逃さないため基本的に1週間毎に行い，徐々に間隔を延ばしていく．抗VEGF療法は光凝固療法に比べ再燃のリスクが高いため，治療後の1週間毎のフォローアップ期間が長く，退院時期の検討にROPの病勢を考慮に入れる必要がある．journal articl
Visualization of domain- and concentration-dependent impact of thrombomodulin on differential regulation of coagulation and fibrinolysis
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Diagnostic value of heart-to-mediastinum ratio in 99mTc-pyrophospate SPECT/CT for transthyretin cardiac amyloidosis
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Postoperative neurological complications in intradural extramedullary tumors: a 10- year experience of a single center
Get PDFBackground: Intradural extramedullary spinal cord tumors (IDEMs) cause neurological symptoms due to compression of the spinal cord and caudal nerves.. The purpose of this study was to investigate the incidence of postoperative neurological complications after surgical resection of IDEM and to identify factors associated with such postoperative neurological complications.
Methods: We retrospectively analyzed 85 patients who underwent tumor resection for IDEM b000000etween 2010 and 2020. We investigated the postoperative worsening of neurological disorders. The patients were divided into two groups: those with and without postoperative neurological complications. Patient demographic characteristics, tumor level, histological type, and surgery-related factors were also compared.
Results: The mean age at the time of surgery was 57.4 years, and histological analysis revealed 45 cases of schwannoma, 34 cases of meningioma, three cases of myxopapillary ependymoma, one case of ependymoma, one case of hemangioblastoma and one case of lipoma. There were five cases (5.8%) of postoperative neurological complications, and four patients improved within 6 months after surgery, and one patient had residual worsening. There were no statistically significant differences in age, sex, tumor location, preoperative modified McCormick Scale grade, histology, tumor occupancy, or whether fixation was performed in the presence or absence of postoperative neurological complications. All four cases of meningioma with postoperative neurological complications had preoperative neuropathy and meningiomas were located in the anterior or lateral thoracic spine.
Conclusions: Neurological complications after surgical resection for IDEM occurred in 5.8% of patients. Meningiomas with postoperative neurological complications located anteriorly or laterally in the thoracic spine
Association between Physical Activity and Mortality in the Japanese General Population with Mild to Moderate Impaired Renal Function: The Jichi Medical School (JMS) Cohort Study
Get PDFBackground: The association between physical activity volume or intensity and mortality in deneral population with impaired renal function is unclear. We assessed these relationships among Japanese residents with impaired renal function.
Methods: We analyzed 638 individuals with estimated creatinine clearance below 60 ml/min in the Jichi Medical School cohort study. Exposures included the daily amount of physical activity converted to the physical activity index (PAI) used in the Framingham study and the activity time for each intensity. Physical activity intensity was classified into sedentary and nonsedentary. Nonsedentary activity was further divided into light-intensity and moderate-to-vigorous physical activity (MVPA). The outcome was mortality. Quartiles of the exposures were created, and hazard ratios (HRs) were calculated using the Cox proportional hazards model.
Results: The mean age of the subjects was 63.3 years, and 72.4% were female. In total, 172 deaths were registered during 11,567 person-years. No significant association was found between PAI and mortality. A significant association was found between long sedentary time and increased mortality (p=0.042). Regarding nonsedentary activity, the HRs (95% confidence intervals [CIs]) for Q2, Q3, and Q4 versus Q1 were 0.85 (0.55–1.31), 0.67 (0.41–1.08), and 0.90 (0.54–1.45), respectively. In the subdivided analysis for light-intensity activity, the HRs (95% CIs) of Q2, Q3, and Q4 versus Q1 were 0.53 (0.33–0.84), 0.51 (0.34–0.82), and 0.57 (0.34–0.96), respectively. No significant association was found between MVPA and mortality.
Conclusions: Nonsedentary activity, especially light-intensity activity, significantly reduced mortality among residents with impaired renal function
Long-term effects of diffuse idiopathic skeletal hyperostosis on physical function: A longitudinal analysis
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）Background: Cross-sectional studies on diffuse idiopathic skeletal hyperostosis have focused on its incidence and related factors. However, the long-term changes caused by the disease remain unclear. This longitudinal cohort study aimed to elucidate the progression of diffuse idiopathic skeletal hyperostosis and its effects on physical function, health-related quality of life, and spinal alignment.
Methods: We recruited 255 older adults (87 men and 168 women; average age, 71.3 years in 2014) who attended local health checkups in 2014 and 2020. Height, body weight, body mass index, blood pressure, grip strength, functional reach, and bone mineral density were measured. The prevalence, location, number of ossified contiguous vertebrae, and spinopelvic parameters were estimated using whole-spine standing radiographs. For health-related quality of life assessment, the Oswestry disability index and EuroQuol-5D were obtained. We performed a 1:1 case-control study with age and sex-matched patients with and without diffuse idiopathic skeletal hyperostosis and analyzed progression over a 6-year period.
Results: In 2014, 39 (15.3%) of 255 patients were diagnosed with diffuse idiopathic skeletal hyperostosis (24 males and 15 females), which occurred more frequently in the elderly and males. In 2020, 12 (4.3%) patients were newly diagnosed with diffuse idiopathic skeletal hyperostosis, and 28 (71.7%) of 39 patients diagnosed in 2014 showed varying degrees of progression. Compared with age- and sex-matched patients without diffuse idiopathic skeletal hyperostosis, patients with the condition had higher body mass index and lumbar bone mineral density, larger sagittal vertical axis, and greater T1-pelvic angle. Changes in physical function and spinal-pelvic parameters during the 6-year period did not differ between the groups.
Conclusions: Over a 6-year period, the prevalence of diffuse idiopathic skeletal hyperostosis increased by 4.3%, and it progressed in 71.7% of patients. However, it had little effect on longitudinal physical function, health-related quality of life, and spinopelvic parameters in older adults
Obstetric admission to intensive care units in Japan: a cohort study using the Japanese Intensive care PAtient Database
Get PDFPurpose: This study aimed to describe the epidemiology and annual trends of obstetric patients using a multicenter intensive care database.
Methods: This multicenter, retrospective cohort study used the Japanese Intensive care PAtient Database (JIPAD). We included obstetric patients registered in the JIPAD between 2015 and 2020. We investigated the proportion of obstetric patients among all patients in the intensive care unit (ICU). We also described the characteristics, procedures, and outcomes of obstetric patients. In addition, the annual trends were examined by nonparametric tests for trends.
Results: Of the 184,705 patients enrolled in the JIPAD, 750 (0.41%) were obstetric patients from 61 facilities. The median age was 34 years, the number of post-emergency surgeries was 450 (60.0%), and the median APACHE III score was 36. Mechanical ventilation was the most common procedure performed in 247 (32.9%) patients. There were five (0.7%) in-hospital deaths. The proportion of obstetric patients in the ICU did not change between 2015 and 2020 (P for trend=0.32). However, there was a trend for a significant decrease in the severity of illness and length of hospital stay on an annual basis between 2015 and 2020. Most patients were admitted to the ICU because of a pregnancy-related disorder postoperatively.
Conclusion: The proportion of obstetric patients was 0.41% of all ICU admissions. The proportion of obstetric patients admitted to the ICU did not change from 2015 to 2020, but the patients’ severity of illness and length of hospital stay significantly decreased over time.journal articl
