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栄養不良を呈した維持血液透析患者に対する腎不全用ではなく、一般用アミノ酸溶液を用いた透析時静脈栄養に関する検討 : 多施設共同パイロット試験
Get PDF新潟大学Niigata University博士（医学）Background: Standard amino acid solutions have recently been removed from the contraindications for use in dialysis patients in Japan. However, the details of their safety and efficacy in these patients are still not known. In this study, we investigated the safety and efficacy of intradialytic parenteral nutrition (IDPN) using ENEFLUID® injection containing standard amino acids, glucose, electrolytes, fats, and water-soluble vitamins in maintenance hemodialysis patients with malnutrition. Methods: This clinical trial was designed as a multicenter, prospective, non-randomized, open-label, single-arm, observational pilot study. The participants were patients on maintenance hemodialysis who were in the nutritional high-risk group according to the Nutritional Risk Index for Japanese Hemodialysis Patients. One bag of ENEFLUID® injection was administered during every hemodialysis session for 12 weeks. The primary endpoint was change in serum transthyretin levels between before and after the 12-week period. As safety endpoints, we evaluated changes in body fluid volume and blood biochemical tests, including blood urea nitrogen and electrolytes, as well as blood glucose variability using flash glucose monitoring (FGM). Results: The mean age and body mass index of the 13 participants were 79.0±10.7 years and 18.0±1.7 kg/m2, respectively. No significant changes were observed in nutritional parameters, including serum transthyretin, between before and after the start of the study. After IDPN initiation, there was no obvious fluid overload or significant changes in blood biochemical tests, including electrolytes, and the treatment could be safely continued for 12 weeks. In the FGM analysis, asymptomatic hypoglycemia during hemodialysis was observed at the beginning of the study, but there was a trend toward improvement after 12 weeks (area over the curve<70 mg/dl per dialysis session: 747.5±1333.9 to 21.6±54.3, P=0.09). Conclusions: IDPN using ENEFLUID® injection can be safely continued, although it does not significantly improve markers of nutritional status. It also showed the potential to ameliorate asymptomatic hypoglycemia during hemodialysis sessions. More detailed studies of the improvement in nutritional indicators are needed.Renal Replacement Therapy. 2022, 8, 41.新大院博(医)第1117
長い滞在期から結核を発病し治癒したアジアゾウにおける、抗結核菌蛋白質IgGのモニタリング
Get PDF新潟大学Niigata University博士（医学）Tuberculosis (TB) is fatal in elephants, hence protecting elephants from TB is key not only in the conservation of this endangered animal, but also to prevent TB transmission from elephants to humans. Most human TB cases arise from long-term asymptomatic infections. Significant diagnostic challenges remain in the detection of both infection and disease development from latency in elephants due to their huge bodies. In this study, we assessed cryopreserved sera collected for over 16 years, from the first Japanese treatment case of elephant TB. Semi-quantification of IgG levels to 11 proteins showed high detection levels of 3 proteins, namely ESAT6/CFP10, MPB83 and Ag85B. The level of IgG specific to these 3 antigens was measured longitudinally, revealing high and stable ESAT6/CFP10 IgG levels regardless of onset or treatment. Ag85B-specifc IgG levels were largely responsive to onset or treatment, while those of MPB83 showed intermediate responses. These results suggest that ESAT6/CFP10 is immunodominant in both asymptomatic and symptomatic phases, making it useful in the detection of infection. On the other hand, Ag85B has the potential to be a marker for the prediction of disease onset and in the evaluation of treatment effectiveness in elephants.Scientific Reports. 2022, 12, 4310.新大院博(医)第1134
2020年にミャンマーで発生したSARS-CoV-2流行時の疫学と遺伝学的解析
Get PDF新潟大学Niigata University博士（医学）We aimed to analyze the situation of the first two epidemic waves in Myanmar using the publicly available daily situation of COVID-19 and whole-genome sequencing data of SARS-CoV-2. From March 23 to December 31, 2020, there were 33,917 confirmed cases and 741 deaths in Myanmar (case fatality rate of 2.18%). The first wave in Myanmar from March to July was linked to overseas travel, and then a second wave started from Rakhine State, a western border state, leading to the second wave spreading countrywide in Myanmar from August to December 2020. The estimated effective reproductive number (Rt) nationwide reached 6-8 at the beginning of each wave and gradually decreased as the epidemic spread to the community. The whole-genome analysis of 10 Myanmar SARS-CoV-2 strains together with 31 previously registered strains showed that the first wave was caused by GISAID clade O or PANGOLIN lineage B.6 and the second wave was changed to clade GH or lineage B.1.36.16 with a close genetic relationship with other South Asian strains. Constant monitoring of epidemiological situations combined with SARS-CoV-2 genome analysis is important for adjusting public health measures to mitigate the community transmissions of COVID-19.Viruses. 2022, 14(2), 259.新大院博(医)第1135
慢性疾患のスクリーニングにおける体力スコアの有用性
Get PDF新潟大学Niigata University博士（医学）We developed a new Physical Score (PS) consisting of compre-hensive physical fitness indicators and elucidated the association between the resultant PS and metabolic diseases, i.e., diabetes, hypertension, dyslipidemia, fatty liver, and metabolic syndrome (MetS), among Japanese. Analyzed were 49,850 persons (30,039 men) aged 30 to 69 y who underwent physical fitness tests. Prin-cipal component analysis was performed on the correlation ma-trix of the physical fitness test results (relative grip strength, single-leg balance with eyes closed, and forward bending) according to sex and age. We defined the PS as the first principal component score. A formula was developed for various age groups com-prised of men and women from 30 to 69 years of age from which the PS for each age and sex was calculated. The PS for both men and women was normally distributed with a value of 0 ± 1.15-1.16. Multivariate logistic regression analysis showed that the risk of metabolic diseases increased approximately 1.1 - 1.6 times per each 1-point reduction in the PS. The association between PS and MetS was particularly strong in that a 1-point reduction in the PS increased the risk of MetS by 1.54 times (95% confidence in-terval 1.46 to 1.62) in men and by 1.21 times (1.15 to 1.28) in women. The association between a lower PS and disease risk was stronger in younger men for fatty liver and in older men for MetS. Conversely, in women, the association between a lower PS and disease risk was stronger in older women for fatty liver and in younger women for MetS. For diabetes, hypertension, and dyslipidemia, the change in the impact of PS reductions across age groups was small. The PS is a useful and simple non-invasive tool for screening Japanese people for metabolic diseases.Journal of Sports Science & Medicine. 2023, 22, 98-110.新大院博（医）第1149
Basic research for supporting psychological complications of childhood cancer survivors : An examination of self-disclosure support to promote PTG
Get PDF新潟大学Niigata University博士（保健学）新大院博(保)第50
IoTベースのメンタルヘルスケアシステム構築のための日内心拍変動を用いたフロー測定
Get PDF新潟大学Niigata University博士（工学）Background: With considerable advancements in the field of technology, it is now more convenient and easier to acquire biomedical signals. These signals not only can be used in the evaluation of physical wellness but also may be helpful in the assessment of mental health if applied properly and precisely. With psychological measures to track mental wellness, and searching for relevant physiological parameters to reveal the underlying physiological bases of mental health, it may be possible for individuals to be healthy both physically and mentally in order to achieve full health and high life expectancy in an ageing society. Objectives: This study investigated whether six dispositional psychological measures, Frequency of Flow Experience, Trait-Coping, Self-Image, Self-Awareness, Will for Meaningful Life, and State-Trait Anxiety are associated with physiological parameters of diurnal heart rate rhythm. Psychological measures are evaluated by questionnaires related to the psychological attributes of a person that can be based on either the experienced sampling method or the dispositional method. The dispositional approach, as the main focus of this study, is designed to quantify one's personality with a long-term psychological nature whereas the experienced sampling approach is for short-term measures to quantify the psychological state of a person during specific short activities. These methods have different questionnaires with experienced sampling using nine items for Frequency of Flow Experience while the dispositional method is only containing four items. Methods: The association of four physiological parameters of diurnal heart rate rhythm-24-hour and 12-hour periodic component amplitudes, diurnal heart rate range over a day and autonomic switching rate with six dispositional psychological measures were analyzed. The physiological parameters were extracted using conventional double cosinor rhythmometry and smoothing of splines methods from heart rate data continuously recorded at one-minute intervals by a wrist device. The double cosinor method is a well-known signal processing technique in heart rate variability. The spline method was considered an alternative approach to capture a more detailed trend pattern of the heart rate diurnal change and address the multicollinearity issue in heart rate parameters. The experiment was conducted on 20 healthy Japanese engineers aged 25-60. Four physiological datasets (weekday only, weekday and weekend data each with mean and median values) were used. Results: The dataset containing weekday-only data with median values gave better results. One reason was that median values were generally suitable for small-size sample. The main reason was that circadian rhythm showed a regular pattern on weekdays since participants spent most of their time in desk work or indoor meeting which corresponded to mental activities. However, during the weekends, there were inconsistent patterns heart rate patterns due to extreme physical activities. Therefore, eliminating the effect of extreme physical activities was important for an accurate mental health assessment. The Spearman single regression analysis revealed a significant correlation (p 0.1) of Self-Image with spline-based parameters. The regular single regression analysis revealed a significant correlation of Frequency of Flow Experience, Trait-Coping, and Will for Meaningful Life, a trend of significant correlation of Self-Image, while showing no correlation of Self-Awareness and State-Trait Anxiety with spline-based parameters. The only negative psychological measure; State-Trait Anxiety showed a negative correlation in both Spearman and regular single regression analyses. The regular multiple regression analysis showed a significant correlation of Frequency of Flow Experience, Trait-Coping, and Self-Image, a trend of significant correlation of Will for Meaningful Life, while showing no correlation of Self-Awareness and State-Trait Anxiety with cosinor-based parameters. Principal component analysis extracted one to three orthogonal components with which single component regression analysis showed a significant correlation of Frequency of Flow Experience, Trait-Coping, and Self-Image, a trend of significant correlation of Self-Awareness, Will for Meaningful Life, and State-Trait Anxiety with cosinor-based parameters. Finally, multiple components regression analysis yielded better scores by showing a significant correlation of Frequency of Flow Experience, Trait-Coping, Self-Image, and Will for Meaningful Life, a trend of significant correlation of Self-Awareness, while showing no correlation of State-Trait Anxiety. Generally, cosinor-based physiological parameters gave better scores in regular multiple regression and multiple principal components regression analyses since more heart rate parameters were used to improve the correlation results. Therefore, for regular single regression and Spearman analyses, spline-based heart rate parameters are to be considered as they are a more detailed representation of heart rate change. Conclusion: Dispositional psychological measures were associated with physiological parameters of diurnal heart rate rhythm introduced by this study, representing long-term characteristics of autonomic nervous activity. Integrating such psychological measures and heart rate parameters may lead to a comprehensive understanding of the psychological characteristics of people. The research outcome may be applied to the development of ubiquitous healthcare monitoring systems that integrate both physiological bio-signals and psychological measures.新大院博(工)第543
