著者

Miyuki Shimizu Kensuke Kinoshita Kazuya Hattori Yoshio Ota Takao Kanai Hiroyuki Kobayashi Yasuharu Tokuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.10, pp.1207-1210, 2012 (Released:2012-05-15)

参考文献数

7

被引用文献数

7 25 2

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Objective Dehydration is a common condition and frequent cause of hospitalization in older people, despite the caregiver's high attention in attempt to avoid its occurrence. In this study, various physical signs were examined as clinical signs of dehydration in elderly. Methods A prospective observational study was conducted in an acute care teaching hospital. Consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Dehydration was defined as a calculated serum osmolality above 295 mOsm/L. The patients diagnosed as dehydrated or not dehydrated were observed for physical signs of dehydration. Data of blood and urine chemistry analysis were also compared between the two groups. Results A total of 27 elderly patients admitted with acute medical conditions were included in this study. For the physical signs, dry axilla had moderate sensitivity (44%) and excellent specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). For laboratory data, the mean concentrations of serum sodium of the dehydrated group (146 mEq/L) was significantly higher (p<0.01) than those of the non-dehydrated group (134 mEq/L). Conclusion Physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. The evaluation of the axillary moisture could help assess dehydration as well as laboratory data analysis such as serum sodium concentration.

著者

TAKENORI INOMATA JAEMYOUNG SUNG ALAN YEE AKIRA MURAKAMI YUICHI OKUMURA KEN NAGINO KENTA FUJIO YASUTSUGU AKASAKI AKIE MIDORIKAWA-INOMATA ATSUKO EGUCHI KEIICHI FUJIMOTO TIANXIANG HUANG YUKI MOROOKA MARIA MIURA HURRAMHON SHOKIROVA KUNIHIKO HIROSAWA MIZU OHNO HIROYUKI KOBAYASHI

出版者

The Juntendo Medical Society

雑誌

順天堂醫事雑誌 (ISSN:21879737)

巻号頁・発行日

pp.JMJ22-0032-R, (Released:2023-01-26)

参考文献数

63

被引用文献数

1

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During the 5th Science, Technology, and Innovation Basic Plan, the Japanese government proposed a novel societal concept -Society 5.0- that promoted a healthcare system characterized by its capability to provide unintrusive, predictive, longitudinal care through the integration of cyber and physical space. The role of Society 5.0 in managing our quality of vision will become more important in the modern digitalized and aging society, both of which are known risk factors for developing dry eye. Dry eye is the most common ocular surface disease encountered in Japan with symptoms including increased dryness, eye discomfort, and decreased visual acuity. Owing to its complexity, implementation of P4 (predictive, preventive, personalized, participatory) medicine in managing dry eye requires a comprehensive understanding of its pathology, as well as a strategy to visualize and stratify its risk factors. Using DryEyeRhythm®, a mobile health (mHealth) smartphone software (app), we established a route to collect holistic medical big data on dry eye, such as the subjective symptoms and lifestyle data for each individual. The studies to date aided in determining the risk factors for severe dry eye, the association between major depressive disorder and dry eye exacerbation, eye drop treatment adherence, app-based stratification algorithms based on symptomology, blink detection biosensoring as a dry eye-related digital phenotype, and effectiveness of app-based dry eye diagnosis support compared to traditional methods. These results contribute to elucidating disease pathophysiology and promoting preventive and effective measures to counteract dry eye through mHealth.

著者

Hiroyuki Yamaguchi Hiroyuki Kobayashi Kazuya Nagasaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.4, pp.595, 2020-02-15 (Released:2020-02-15)

参考文献数

1

被引用文献数

1

著者

TAKENORI INOMATA JAEMYOUNG SUNG ALAN YEE AKIRA MURAKAMI YUICHI OKUMURA KEN NAGINO KENTA FUJIO YASUTSUGU AKASAKI AKIE MIDORIKAWA-INOMATA ATSUKO EGUCHI KEIICHI FUJIMOTO TIANXIANG HUANG YUKI MOROOKA MARIA MIURA HURRAMHON SHOKIROVA KUNIHIKO HIROSAWA MIZU OHNO HIROYUKI KOBAYASHI

出版者

The Juntendo Medical Society

雑誌

順天堂醫事雑誌 (ISSN:21879737)

巻号頁・発行日

vol.69, no.1, pp.2-13, 2023 (Released:2023-02-28)

参考文献数

63

被引用文献数

1

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During the 5th Science, Technology, and Innovation Basic Plan, the Japanese government proposed a novel societal concept -Society 5.0- that promoted a healthcare system characterized by its capability to provide unintrusive, predictive, longitudinal care through the integration of cyber and physical space. The role of Society 5.0 in managing our quality of vision will become more important in the modern digitalized and aging society, both of which are known risk factors for developing dry eye. Dry eye is the most common ocular surface disease encountered in Japan with symptoms including increased dryness, eye discomfort, and decreased visual acuity. Owing to its complexity, implementation of P4 (predictive, preventive, personalized, participatory) medicine in managing dry eye requires a comprehensive understanding of its pathology, as well as a strategy to visualize and stratify its risk factors. Using DryEyeRhythm®, a mobile health (mHealth) smartphone software (app), we established a route to collect holistic medical big data on dry eye, such as the subjective symptoms and lifestyle data for each individual. The studies to date aided in determining the risk factors for severe dry eye, the association between major depressive disorder and dry eye exacerbation, eye drop treatment adherence, app-based stratification algorithms based on symptomology, blink detection biosensoring as a dry eye-related digital phenotype, and effectiveness of app-based dry eye diagnosis support compared to traditional methods. These results contribute to elucidating disease pathophysiology and promoting preventive and effective measures to counteract dry eye through mHealth.

著者

Shun Yonezaki Kazuya Nagasaki Hiroyuki Yamaguchi Hiroyuki Kobayashi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.5, pp.743-747, 2022-03-01 (Released:2022-03-01)

参考文献数

16

被引用文献数

2

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TAFRO syndrome is a systemic inflammatory disorder resembling multicentric Castleman disease; it is characterized by thrombocytopenia, anasarca, a fever, reticulin fibrosis, and organomegaly. Involvement of the adrenal glands, including adrenal infarction, hemorrhaging, and adrenomegaly, has recently been reported in several cases and been considered a characteristic early-stage symptom. We herein report a case of TAFRO syndrome initially presenting with bilateral adrenal infarctions and review the literature on TAFRO syndrome related to adrenal involvement. This case suggests that adrenal abnormalities as an early clinical feature of TAFRO syndrome may be useful for the early diagnosis.

著者

Shigeru YAMAGUCHI Hiroaki MOTEGI Yukitomo ISHI Michinari OKAMOTO Ryosuke SAWAYA Hiroyuki KOBAYASHI Shunsuke TERASAKA Kiyohiro HOUKIN

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.oa.2020-0308, (Released:2021-03-04)

参考文献数

29

被引用文献数

5

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Bevacizumab (BEV) is a key anti-angiogenic agent used in the treatment for recurrent glioblastoma multiforme (GBM). The aim of this study was to investigate whether cytoreductive surgery prior to treatment with BEV contributes to prolongation of survival for patients with recurrent GBM. We retrospectively analyzed the treatment outcomes of 124 patients with recurrent GBM who were initially treated with the Stupp protocol between 2006 and 2019. Given that BEV has only been available in Japan since 2013, we grouped the patients into two groups according to the time of first recurrence: the pre-BEV group (N = 51) included patients who had recurrence before BEV approval, and the BEV group (N = 73) included patients with recurrence after BEV approval. The overall survival after first recurrence (OS-R) was analyzed according to the treatment strategy. Among 124 patients, 27 patients (19.4%) received cytoreductive surgery. There were nine cases in the pre-BEV group and 18 cases in the BEV group. Although the mean extent of resection for both groups was almost equal, OS-R was significantly different. The median OS-R was 8.1 m in the pre-BEV group and 16.3 m in the BEV group (P = 0.007). Multivariate analysis revealed that the unavailability of BEV postoperatively (P = 0.03) and decreasing performance status by surgery (P = 0.01) were significant poor prognostic factors for survival after surgery. With the advent of BEV, cytoreductive surgery might provide superior survival benefit at the time of GBM recurrence, especially in cases where surgery can be performed without deteriorating the patient’s condition.

著者

TOMOHIRO NAKAMURA RYO KAKIGI NORIKO ICHINOSEKI-SEKINE TAKAMASA TSUZUKI HIROYUKI KOBAYASHI KAZUHIKO SAKUMA HISASHI NAITO

出版者

The Juntendo Medical Society

雑誌

順天堂醫事雑誌 (ISSN:21879737)

巻号頁・発行日

pp.JMJ19-OA08, (Released:2019-09-25)

参考文献数

21

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Objective: Alpha-actinin (ACTN) 3 R577X polymorphisms have three genotypes: RR, RX and XX. Only RR and RX genotypes express ACTN3 protein in type II fibers. The purpose of this study was to clarify whether there are differences in ACTN3 protein expression levels and myosin heavy chain (MyHC) composition between RR and RX genotypes in Japanese college-level male sprinters.Materials and Methods: Forty-three Japanese college-level male sprinters participated in this study. Subjects were genotyped for ACTN3 R577X using a real-time polymerase chain reaction assay. Furthermore, muscle biopsies from the vastus lateralis muscle were obtained from a subset of subjects who had R allele and gave their consent (4 RR and 9 RX). ACTN3 protein expression levels were assessed by western blotting. MyHC composition was determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis.Results: There was no difference in 100-m sprint performance among RR, RX and XX genotypes in all 43 subjects. In 13 biopsy-sampled subjects, there was also no difference in 100-m sprint performance between RR and RX and ACTN3 protein expression levels tended to be higher in RR genotype than in RX genotype. Although there were no differences in the proportion of type I and II MyHC isoforms between both genotypes, RR genotype had a significantly higher proportion of type IIx MyHC isoform and a significantly lower proportion of type IIa MyHC isoform than RX genotype.Conclusions: ACTN3 protein expression levels and the proportion of type IIx MyHC isoform are higher in RR genotype compared with RX genotype in Japanese college-level male sprinters.

著者

Tomoharu Suzuki Yasuharu Tokuda Hiroyuki Kobayashi

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8769-16, (Released:2017-09-06)

参考文献数

7

被引用文献数

8

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Yellow nail syndrome (YNS) is characterized by yellowish nails, lymphedema, sinusitis, and pulmonary involvement and can be triggered by various underlying conditions, such as sinusitis or titanium exposure from an artificial joint or dental implant. Since YNS is potentially treatable, its timely diagnosis is important. The authors recently experienced a case of YNS in a patient who developed sinusitis, yellowish nails, bilateral edema of the extremities, and subclinical rheumatoid arthritis after the implantation of a cardiac pacemaker made from titanium. This case may be the first report of YNS induced by a titanium cardiac pacemaker.

著者

Aya Sawa Toshikazu Abe Miyoko Omoto Kazuya Fujihara Hiroyuki Kobayashi Yasuharu Tokuda

出版者

日本プライマリ・ケア連合学会

雑誌

General Medicine (ISSN:13460072)

巻号頁・発行日

vol.14, no.1, pp.72-75, 2013 (Released:2013-07-05)

参考文献数

12

被引用文献数

1

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Metformin is widely prescribed for patients with type 2 diabetes mellitus (DM). Its use for patients with type 1 has been considered a contraindication because of possible adverse effects such as lactic acidosis. However, metformin has been recently used with insulin therapy to reduce insulin-dose requirements in Type 1 DM.An 81-year-old Japanese woman with type 1 DM was treated with insulin and metformin. She was admitted to our hospital due to altered mental state and hypotensive shock via a referral from her primary care physician. The patient had severe lactic acidosis and acute kidney injury with hyperkalemia with the suspected cause being the use of metformin. She was treated successfully with hemodialysis (HD).Although the independent predictive factor of mortality due to metformin-associated lactic acidosis is a prothrombin time (PT) activity of less than 50% in 24 hours, we recommend that HD should be performed for a patient with severe lactic acidosis even if the initial PT activity is normal.