Journal of Nippon Medical School最新文献

Background: Perioperative prophylactic antimicrobials are re-administered at intervals of twice their half-life. However, the actual concentrations of antimicrobial agents and the degree of elevation remain unelucidated.

Methods: This prospective cohort study was conducted at a single tertiary care center. Serum concentrations were evaluated in patients who underwent hepatobiliary-pancreatic surgery between April 2019 and December 2020 and received an additional dose of flomoxef (FMOX) every 3 h or 5 h during the surgical procedure based on their renal function.

Results: Among the 31 participants, 25 and six received FMOX every 3 h and 5 h, respectively. Analysis based on renal function revealed median FMOX concentrations of 9.88 mg/L and 9.85 mg/L (p = 0.09) for patients with creatinine clearance (Ccr) >60 mL/min and 14.26 mg/L and 20.03 mg/L (p = 0.02) for the patients with Ccr ≤60 mL/min at 3 h and 6 h, respectively, with notable elevation at Ccr ≤60 mL/min. Moreover, the serum FMOX concentration at 6 h for the 3-h dosing patients with Ccr ≤60 mL/min was significantly higher than the concentration at 5 h for the 5-h dosing patients with Ccr ≤60 mL/min (20.03 mg/L vs. 12.85 mg/L, p = 0.04). Although serum concentrations at 3-h and 6-h intervals did not differ significantly in patients with Ccr ≥60 mL/min, these significantly increased in patients with Ccr <60 mL/min.

Conclusions: Administering FMOX every 3 h when Ccr is ≥60 mL/min and every 5 h when Ccr is <60 mL/min are appropriate.

Background: Role-playing is a key learning method in genetic counseling education, with facilitators playing a crucial role. Although facilitator training exists in other fields, it lacks a structured framework in the context of genetic counseling. Identifying the factors contributing to facilitator success can improve the quality of education. This study aims to examine the key factors associated with successful experiences as genetic counseling facilitators.

Methods: An anonymous cross-sectional survey was conducted in September 2023 among 356 members of the Japanese Association of Certified Genetic Counselors.

Results: A total of 106 responses (29.7%) were collected, with 45 participants (42.4%) possessing facilitator experience. Logistic regression analysis identified prior learning experiences (OR = 10.02, 95% CI: 1.07-93.7) and confidence as a facilitator (OR = 25.94, 95% CI: 2.27-295.96) as significant factors for successful facilitation. Prior learning experiences correlated with observing inappropriate facilitation (OR = 6.39, 95% CI: 1.25-32.76). Confidence was linked to both skill improvement opportunities (OR = 14.30, 95% CI: 1.41-145.14) and inappropriate facilitation (OR = 9.65, 95% CI: 1.67-55.67).

Conclusion: Successful facilitator experiences were associated with prior learning and confidence. Inappropriate facilitation played an indirect role in facilitator success. Enhancing confidence through learning opportunities and exposure to facilitation challenges is crucial for facilitator development.

Background: Diagnosis of bone metastases would be hastened if they could be detected on plain radiographs obtained at the first visit to an orthopedic surgeon. However, lesions are often undetectable on plain radiography. Bone metastasis is diagnosed at the first visit in only a few patients, and diagnosis is delayed in many cases. We investigated the diagnostic performance of plain radiography that used a new image processing method, Dynamic Visualization II (DV), to diagnose bone metastases.

Methods: We enrolled 29 patients with symptomatic pelvic bone metastases who visited our hospital between April 2018 and March 2021. The evaluation images were created by processing the original plain radiography data with the default settings for DV (Presets 1-4). Processing with Preset 1 resulted in an image converted to conventional film parameters, whereas Presets 2-4 utilized different DV processing methods. The readers were six orthopedic trainees, and the reading time was 30 seconds per image. The rate of correct answers for images processed with Preset 1 was compared to the rates for those processed with the other presets. Additionally, the rate of correct answers was analyzed in relation to clinical variables.

Results: The correct answer rate was significantly higher for Preset 3 (43.7%) and Preset 4 (42.5%) than for Preset 1 (28.7%). Correct answer rates for Presets 3 and 4 were significantly higher for elderly patients, male patients, patients with innominate bone lesions, patients with osteolytic bone metastases, and patients with a normal body weight.

Conclusions: Image processing by DV improved diagnosis of bone metastases by plain radiography. DV might hasten diagnosis of bone metastases and help prevent associated complications.

Background: We evaluated the effects of drug therapy on T lymphocyte subsets and their associations with recurrent chronic bronchitis (CB) attacks.

Methods: A total of 162 CB patients treated from April 2020 to April 2021 were selected. All patients underwent anti-infective, cough-relieving, and phlegm-eliminating treatment, as detailed in Clinical Pathway for Chronic Bronchitis. They were divided into a recurrent attack group (n=95) and a non-recurrent attack group (n=67). Changes in T lymphocyte subsets at different time points of treatment and their associations with the number of attacks were analyzed. Associated factors were analyzed in a multivariate logistic regression model, and their predictive value was validated using a nomogram prediction model and receiver operating characteristic (ROC) curves.

Results: The number of attacks at 1 year after treatment was positively correlated with CD8⁺ and negatively correlated with CD3⁺, CD4⁺, and CD4⁺/CD8⁺. A history of smoking, CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ were independent risk factors for recurrent attacks. The nomogram prediction model showed that the total risk value corresponding to smoking history, low CD3⁺, CD4⁺, and CD4⁺/CD8⁺, and elevated CD8⁺ was 0.86, and the concordance index and area under the ROC curve of the model was 0.896 (95% CI: 0.782-0.997, P<0.05) and 0.816 (95% CI: 0.803-0.847, P<0.001), respectively. There was an association between T lymphocyte subsets and recurrent attacks before and after treatment of CB.

Conclusions: Low CD3⁺, CD4⁺/CD8⁺ and CD4⁺, elevated CD8⁺, and smoking history were risk factors for recurrent attack.

Background: Information is limited on the incidence and risk factors for further serious conditions after an in-hospital fall. Using data from the incident-accident reports, we assessed the incidence and risk factors for subsequent adverse events (SAEs) among outpatients after in-hospital falls.

Methods: Incident-accident reports from April 2017 to March 2024 at Nippon Medical School Tama Nagayama Hospital were reviewed to identify outpatient falls. Data on patient characteristics and fall-related details were collected. Multivariable logistic regression analysis was performed to identify risk factors for SAEs.

Results: We analyzed data from 118 outpatients with in-hospital falls (mean age: 76.4±11.7 years; male: 56.8%): 39 (33.1%) experienced SAEs, including 5 fractures (4.2%), 13 functional disorders (11.0%), 17 surgical procedures (14.4%), and 17 admissions (14.4%). Multivariable analysis showed that males had a significantly higher odds ratio (OR) for SAEs than females, even after adjusting for age (OR, 2.80; 95% CI, 1.21-6.48; P=0.016). For each SAE, the floor of the fall, number of previous falls, and site of the fall were significantly associated with a subsequent fracture, functional disorder, and surgical procedure after an in-hospital fall, respectively.

Conclusions: The incidence rate of SAEs among outpatients with in-hospital falls was 33.1%. Male sex was the only significant risk factor for SAEs, and factors contributing to individual SAE types were distinct. To prevent further adverse outcomes after in-hospital falls, medical staff should pay more attention to patients with these risk factors.

The principles of hyperbaric oxygen therapy (HBOT) have been known since ancient times. Empirical knowledge regarding relief of decompression sickness (DCS) symptoms in divers re-entering a pressurized environment was reported as early as 4,500 BC. DCS was recognized as a disease after deep diving became possible because of diving helmets. DCS also occurs in high-pressure dry workspaces (caissons) developed to construct bridges and tunnels. After the discovery of oxygen in the 18th century, its administration was found to be beneficial in treating conditions that developed after rapid decompression, and HBOT is now established as a part of recompression therapy. This review describes the indications for HBOT in Japan and its effectiveness, as indicated by the author's experience with HBOT in the Department of Emergency Room and General Medicine at Nippon Medical School.

Background: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage to the left insula may result in constipation. We investigated the association between constipation and left-sided insular infarction in patients with acute stroke.

Methods: We retrospectively analyzed data from consecutive patients who received a diagnosis of acute infarction in the middle cerebral artery territory between January 2015 and December 2018. Constipation was defined as bowel movements less often than three times a week or a prescription for laxatives within 2 weeks of stroke onset. Clinical characteristics and factors associated with constipation were evaluated.

Results: Among 892 patients (mean age, 75 [66-82] years; male, 566 [63.5%]), 301 (32.8%) had constipation. Infarction involving the insula (57.7% vs. 25.1%) and left-sided infarction (62.5% vs. 46.4%) were more frequent in patients with constipation than in those without constipation. In multivariable analysis, infarction involving the insula (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.57-3.36; P<0.001), left-sided infarction (aOR, 1.93; 95% CI, 1.40-2.64; P<0.001), and baseline National Institutes of Health Stroke Score (aOR, 1.04; 95% CI, 1.01-1.06; P<0.001) were associated with constipation. The incidence of constipation was highest in cases of left-sided infarction with insular involvement (69.2%).

Conclusions: Left-sided infarction, infarction involving the insular cortex, and baseline National Institutes of Health Stroke Score were identified as independent factors associated with constipation in patients with acute stroke.

Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perinatal consequences. We report the detailed clinical course of a neonate born from a mother with DKA caused by fulminant T1DM. The male neonate weighed 3,024 grams and was born at 36 weeks of gestation. The patient's mother had an uneventful pregnancy until she visited the hospital on the day of delivery with headache, nausea, and decreased fetal movement. The APGAR score of the neonate was 8/8, but he was transferred to our hospital for further evaluation because umbilical cord blood gas analysis showed unexplained acidosis (pH = 6.92). We were later informed that the mother was diagnosed as having DKA due to fulminant T1DM after the neonate was born. On admission, laboratory testing of the neonate revealed hypoglycemia, hyperinsulinemia, and hyperkalemia, all of which were induced by the mother's metabolic condition. Intravenous glucose supplementation resolved the neonate's metabolic derangement, and he was discharged on day 10. He showed no neurological abnormalities, but magnetic resonance imaging showed lesions indicating hypoglycemic encephalopathy. Maternal fulminant T1DM and DKA should be considered in neonates with severe metabolic acidosis. Even a neonate who is asymptomatic at birth may rapidly develop severe disease.