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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）doctoral医学系研究科thesi
Why we need to assess nutritional and physical status in dialysis patients?
Get PDF長期の腎不全状態により，透析患者の身体ではさまざまな生理学的変化が起こるが，とくに低栄養，サルコペニア，フレイルは重大な転帰に直結する病態である．これら病態は保存期腎不全から高率に存在し，透析導入とともに急速に進行し，透析患者の日常生活活動度や生活の質，さらには入院や死亡リスクを上昇させる．そのため，透析導入の時点から定期的に栄養および身体機能をスクリーニングし，リスクを認めた時点から早期介入することが求められる．journal articl
Critical considerations, including overfitting in regression models and confounding in study designs for delirium follow-up
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Role of hepcidin upregulation and proteolytic cleavage of ferroportin 1 in hepatitis C virus-induced iron accumulation
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Patency of separate tube grafts for intercostal artery reconstruction: Size and length matter
Get PDFObjectives. Low patency is a major concern when using separate tube grafts for intercostal artery reconstruction. We aimed to elucidate the optimal size and length of grafts from the patency and computational fluid dynamics.
Methods. The patency, size, and length of separate tube grafts were evaluated in 41 patients. Computational fluid dynamics simulation was performed in a model derived from a patient with a patent 12-mm graft of 15mm in length, with 2 simulation models with a smaller (8-mm) or longer (30-mm) graft.
Results. A total of 49 grafts were used for intercostal artery reconstruction. There was 1 in-hospital death and 2 spinal cord injuries. The patency rate, which could be evaluated in 46 grafts, was 63% (29/46). It was 71% (24/34) in thoracoabdominal aortic replacement and 42% (5/12) in descending aortic replacement. Among 14 patients in whom all grafts were occluded, no patients developed spinal cord injury. All grafts longer than 25mm were occluded (n=5). Eight- and 10-mm grafts showed better patency than 12-mm grafts in thoracoabdominal aortic replacement (p=0.008), when grafts were shorter than 25mm. Computational fluid dynamics simulation revealed vortical flow within the 12-mm graft, which did not reach the intercostal orifice, while helical flow was maintained throughout the cardiac cycle within the 8-mm graft.
Conclusions. Eight- and 10-mm grafts seemed better than 12-mm grafts, and grafts should be kept shorter than 25mm. Computational fluid dynamics simulation may shed light on the issue of optimal intercostal artery reconstruction technique.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）dotoral医学系研究科Background: Stem cells from human exfoliated deciduous teeth (SHED) are a mesenchymal stem cell type and have recently attracted attention for their high proliferative rate, multipotency, and immunosuppressive properties. However, SHED have not yet been investigated for anticancer properties. We therefore investigated whether SHED can be used as a treatment modality, particularly for anti-glioma therapy. Methods: In vitro, we examined the mobility of SHED and their ability to migrate towards glioma-conditioned medium and specific growth factors secreted by malignant gliomas. In vivo, we transplanted SHED into the left hemisphere of nude mice that had been previously implanted with human malignant glioma U87 cells into the right hemisphere. We assessed whether SHED had tumorigenic potential. Results: SHED exhibited strong migration ability towards malignant glioma in both in vitro and in vivo assays. In vitro, SHED migrated towards glioma-conditioned medium and specific growth factors such as stem cell factor, platelet-derived growth factor BB, CX-C motif chemokine ligand 12, and vascular endothelial growth factor. SHED were accumulated around tumor cells in the contralateral hemisphere 1 week after transplantation. Moreover, SHED remained in the brains of nude mice 150 days after transplantation. Finally, we verified that SHED had no malignant transformation or engraftment of SHED in the mouse brain. Conclusions: Our findings indicate that SHED can potentially be applied to track malignant glioma.doctoral thesi
Effects of bowel training and defecation posture on chronic constipation in older adults with dementia: A randomized controlled trial
Get PDF浜松医科大学博士（医学）dotoral医学系研究科INTRODUCTION: Chronic constipation (CC), which can cause behavioral and psychiatric symptoms of dementia (BPSDs) and related caregiver distress, is common in older adults admitted to care facilities with dementia. This study aimed to examine the effect of defecation care on CC and related problems.
METHODS: This study compared bowel training and a defecation posture intervention (intervention group) with general care (control group) as treatment for CC among older adults with dementia in six long-term care facilities. The primary outcomes were the number of spontaneous bowel movements (SBMs) and complete SBMs (CSBMs). The secondary outcomes were Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), Constipation Scoring System (CSS), constipation symptoms, and Neuropsychiatric Inventory Nursing Home Version (NPI-NH) scores. The differences were analyzed using two-way analysis of variance with repeated measures.
RESULTS: The data of 30 (14 intervention, 16 control group) patients were analyzed. Weekly mean CSBMs increased from 0.53 times at baseline to 1.58 times at eight weeks in the intervention group compared with a change from 0.56 to 0.43 times in the control group (interaction p<0.001). PAC-QOL, CSS, BPSD, and caregiver distress scores showed significant improvement after eight weeks of defecation care intervention. CONCLUSION: Defecation care, including bowel training and appropriate defecation posture, is effective for CC among older adults with dementia, improving patient mental health, and reducing the burden on caregivers.doctoral thesi
Preoperative prognostic nutritional index as a predictive factor for medical complication after cervical posterior decompression surgery: a multicenter study
Get PDF浜松医科大学博士（医学）dotoral医学系研究科Study design: Retrospective longitudinal cohort study. Objective: To investigate postoperative medical complications in patients with malnutrition after cervical posterior surgery. Methods: A total of 256 patients were participated and divided into PNI<50 group (group L) or PNI≥50 (group H). Patient data, preoperative laboratory data, surgical data, hospitalization data, JOA score, complication data were measured. Results: Group L and group H were 127 and 129 patients, each PNI was L: 44.8±4.3, H: 54.6±4.0, P<0.01. There was significant difference in mean age (L: 72.2 years vs H: 64.8 years, P<0.01), BMI (23.1 vs 24.7, P<0.01), serum albumin (L: 3.9±0.4 g/dl vs H: 4.4±0.3 g/dl, P<0.01), total lymphocyte count (L: 1.3±0.5 10³/μL vs H: 2.1±0.7 103/μL, P<0.01), hospital stay (L: 25.0 days vs H: 18.8 days, P<0.05), discharge to home (87.5% vs 57.5%, P<0.01), delirium (L: 15.9% vs H: 3.9%, P<0.01), medical complications (L: 25.2% vs H: 7.0%, P<0.01), pre- and post- operative JOA score (L: 11.3±2.8 vs H: 12.4±2.6, P<0.01; L: 13.3±3.0 vs H: 14.1±2.4, P=0.02). Multiple logistic regression analysis showed that significant risk factors for medical complications were PNI<50 (P=0.024, odds ratio [OR] 2.746, 95% confidence interval [CI] 1.143–6.600) and age (P=0.005, odds ratio [OR] 1.064, 95% confidence interval [CI] 1.020–1.111). Conclusion: Medical complications are significantly higher in patients with PNI<50 and higher age. The results showed that PNI is a good indicator for perioperative medical complications in cervical posterior surgery. Improvement of preoperative nutritional status is important to avoid medical complications.doctoral thesi
Development and validation of the optimal circumferential resection margin in pathological T3 esophageal cancer: A multicenter retrospective study
Get PDF浜松医科大学博士（医学）dotoral医学系研究科Background: The clinical significance of circumferential resection margin (CRM) in esophageal squamous cell carcinoma (ESCC) remains unclear. Optimal CRM for predicting the recurrence of pathological T3 ESCC was investigated.
Methods: Seventy-three patients were retrospectively investigated in the development cohort. Patients were divided into CRM-negative and CRM-positive groups, and clinicopathological factors and survival outcomes were compared between the groups. The cut-off value was validated in another validation cohort (n=99).
Results: Receiver operating characteristic analysis in the development cohort showed the cut-off value of CRM was 600 μm. In the validation cohort, patients in the CRM-positive group showed a significantly higher rate of locoregional recurrence (p = 0.006) and worse recurrence-free survival (RFS) (p<0.001) than those in the CRM-negative group. Multivariate analysis identified positive CRM as an independent predictive factor for poor RFS (hazard ratio, 2.695; 95% confidence interval, 1.492–4.867; p=0.001). The predictive value of our criteria of positive CRM for RFS was higher than that of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) criteria. Stratified analysis in the neoadjuvant chemotherapy groups also revealed that the rate of locoregional recurrence was higher in the CRM-positive group than in the CRM-negative group both in the pathological N0 and N1–3 subgroups.
Conclusions: CRM of 600 μm can be the optimal cut-off value rather than the RCP and CAP criteria for predicting locoregional recurrence after esophagectomy. These results may support the impact of perioperative locoregional control of locally advanced ESCC.doctoral thesi