1
|
Akimoto T, Kobayashi T, Maita H, Hirano T. Tele-education by an orthopedic specialist increased the confidence in orthopedics of a general practitioner at a rural solo-practice clinic. J Rural Med 2024; 19:40-43. [PMID: 38196802 PMCID: PMC10773997 DOI: 10.2185/jrm.2023-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: General practitioners in rural clinics are required to deal with musculoskeletal problems, but they often lack the confidence. We aim to confirm changes in their confidence in orthopedic practices after using tele-education. Materials and Methods: We conducted tele-education in orthopedic practices from June 1, 2022, to November 30, 2022. Using a teleconference system, the first author, an orthopedic specialist, provided tele-education training to an independent general practitioner in a rural clinic. We adopted a 7-point Likert scale to assess the general practitioner's confidence levels. In pre- and post-research, the counts and confidence levels in the scale were assessed for 18 types of orthopedic practices each month. Furthermore, we interviewed the general practitioner to examine the factors influencing their confidence. Results: The confidence levels increased for all measurement items. The most experienced orthopedic practice was "Advising on daily care for musculoskeletal problems", with confidence levels increasing from 3 to 6. The least experienced orthopedic practice was "Manipulative reduction of radial head subluxation", with confidence levels increasing from 4 to 5. The factors that influenced the change in confidence levels were regular feedback and unrestricted availability of consultations. Conclusion: Tele-education in orthopedics may enhance general practitioners' confidence in orthopedic practices.
Collapse
Affiliation(s)
- Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Japan
| | - Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Japan
| | - Takahiro Hirano
- General Medicine, Hirosaki University Graduate School of Medicine, Japan
| |
Collapse
|
2
|
Tomizawa K, Hojo H, Zhou Y, Oyoshi H, Fujisawa T, Kageyama SI, Nakamura M, Hirata H, Motegi A, Zenda S, Akimoto T. Compensatory Enlargement of the Liver after Proton Beam Therapy for Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e346. [PMID: 37785203 DOI: 10.1016/j.ijrobp.2023.06.2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Charged particle therapy (CPT) has been applied as a safe and effective treatment option for hepatocellular carcinoma (HCC). Although most HCC patients have cirrhosis, favorable treatment outcome has been achieved with CPT preserving liver function. After proton beam therapy (PBT) for patients with HCC, the liver volume in the non-irradiated area is often enlarged. Here, we evaluated whether enlargement of the non-irradiated liver affects preserving hepatic function and prognosis in HCC patients treated with PBT. MATERIALS/METHODS Among consecutive patients with HCC treated with PBT between April 2011 and July 2017, we retrospectively identified patients who fulfilled the following criteria: (i) receiving PBT to the right hepatic lobe, (ii) the left lateral segment was not irradiated, (iii) no local treatment was performed for liver within 12 months after PBT, and (iv) the albumin-bilirubin (ALBI) score was evaluable at 12 months after PBT. The left lateral segment was defined as the non-irradiated region and measured by contrast-enhanced CT just before and 3 months after PBT. ALBI scores just before and 12 months after PBT were compared to evaluate changes of hepatic function. Overall survival rate was estimated using the Kaplan-Meier method, and differences in survival between subgroups were examined using the log-rank test. The ALBI scores were compared using the Wilcoxon signed-rank test. RESULTS We identified 40 patients (male/female = 32/8). The median age at the start date of PBT was 72 (range, 54-87) years. The prescribed dose was 66.0-76.0 Gy (relative biological effectiveness) delivered in 10-38 fractions. The median follow-up was 61 (range, 12-126) months. The 5-year overall survival rates were 79.0% (95% CI: 60.4-100.0%) in the larger enlargement group (n = 16, enlarged volume of non-irradiated region 3 months after PBT ≥75 cm3) and 53.7% (95% CI: 36.0-79.9%) in the smaller enlargement group (n = 24, as above, <75 cm3), respectively (p = 0.21). The median ALBI scores just before and 12 months after PBT were -3.14 (95% CI: -3.22- (-2.53)) and -2.74 (95% CI: -3.07- (-2.42)) in the larger enlargement group (p = 0.09), and -2.91 (95% CI: -3.15- (-2.40)) and -2.59 (95% CI: -2.74- (-2.12)) in the smaller enlargement group (p = 0.006), respectively. CONCLUSION Our study suggests that larger enlargement of the non-irradiated liver after PBT is related to well-preserved liver function at 1 year and modestly associated with a favorable prognosis.
Collapse
Affiliation(s)
- K Tomizawa
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Hojo
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Y Zhou
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Oyoshi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - T Fujisawa
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S I Kageyama
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - M Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H Hirata
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - A Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
3
|
Motegi K, Motegi A, Kano K, Yamashita N, Hirotaki K, Oyoshi H, Ariji T, Tachibana H, Akimoto T. Feasibility Study of Robust Treatment Planning in VMAT for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e699. [PMID: 37786049 DOI: 10.1016/j.ijrobp.2023.06.2183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In general, patient positional uncertainty is considered by adding a geometrically expanded margin to clinical target volume (CTV) in photon radiation therapy. However, this method may not be suitable because image-guided radiotherapy is available. In intensity modulated proton beam therapy, robust treatment planning is currently common to take patient positional uncertainty into account in optimization rather than in margins. The purpose of this study is to assess the feasibility of clinical implementation of the method in volumetric modulated arc therapy (VMAT) for head and neck cancer. We quantitatively evaluated whether the plans with the robust optimization (Robust plans) can adequately cover CTV against patients' positional uncertainties and body shape change throughout a treatment course. MATERIALS/METHODS Ten head and neck cancer patients were chosen, who were treated with PTV-based VMAT plans in our hospital between 2021.5-2022.4. RayStation V10A (RaySearch Laboratories, Stockholm, Sweden) was used for the robust optimization, which was applied to the CTVs with patient positional uncertainty of 5 mm in the 6-axis direction. Dose prescribed to the high- and low-risk CTVs were to 70 and 56 Gy in 35 fractions, respectively. To create the patients' CT images with residual set-up errors and body shape change at the treatment, pseudo simulation-CT images were created by deformable image registration with CBCT and simulation-CT. Dose distribution at the treatment was re-calculated by applying the plan to the pseudo simulation-CT images. The variation of D98 for the high-risk CTV from the time of treatment planning was evaluated on a weekly basis. For comparison, planning target volume (PTV) -based plans (5 mm margin circumference) were created and a similar evaluation was performed. RESULTS D98 for the high-risk CTV varied between -3∼2% in the robust plan and between -5∼1% in the PTV-based plan during the treatment course. There was no significant difference in the amount of D98 variation between the two plans by t-test, except for one case with hypopharyngeal cancer. In this case, D98 for the high-risk CTV varied within ±1% with the PTV-based plan, whereas the value decreased up to 3% with the robust plan (p < 0.05). This case often had a residual setup error of approximately 5 mm at the sites related to the pitch rotation of head, suggesting that the dose distribution for the robust plan was affected by non-rigid positional errors. Patient weight loss during the treatment period was -3.5±2.4 kg, showing a weak correlation (r = -0.33) with the variation in D98 for the high-risk CTV. CONCLUSION The robust treatment planning exhibits comparable CTV coverage to the conventional PTV-based planning against positional uncertainty and body shape change throughout a treatment period. In order to overcome set-up baseline shift by the non-rigid positional errors, re-planning should be recommended. Further planning studies will be conducted to promote clinical implementation of the method.
Collapse
Affiliation(s)
- K Motegi
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - A Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - K Kano
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - N Yamashita
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - K Hirotaki
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Oyoshi
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - T Ariji
- Department of Radiology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Tachibana
- Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, Kashiwa, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
4
|
Hirano T, Kobayashi T, Maita H, Akimoto T, Kato H. Utilization of and barriers to a telemedicine system at a rural general hospital in Japan: a mixed methods study. J Rural Med 2023; 18:226-232. [PMID: 37854513 PMCID: PMC10579925 DOI: 10.2185/jrm.2023-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 10/20/2023] Open
Abstract
Objective The initial and operational costs of telemedicine are major barriers to its adoption. We aimed to investigate and identify the barriers to adopting a telemedicine system in a Japanese rural general hospital without incurring setup and operational costs. Materials and Methods Our study was conducted between May and August 2018, and included six general practitioners working at a rural general hospital. We extracted data collected from messages (date and time, sender and recipient, and counts and contents of messages) and conducted semi-structured interviews, which were then analyzed using quantitative and qualitative methods. Results We quantitatively analyzed the total counted of the 179 messages. The total counts recorded for each physician were 56 (A), 20 (B), 3 (C), 74 (D), 5 (E), and 21 (F). The mean monthly counts were 2.17 (May), 8.50 (June), 11.50 (July), and 7.67 (August). Interview data from the six physicians yielded 13 codes that included various points of dissatisfaction acting as barriers to using our system, which we grouped into mental and physical barriers. Mental barriers included suspicion of carrying, feelings of isolation, and loss, whereas physical barriers included portability, user authentication, internet speed, group chat system, notice, search image, typing, chat system, print facility, and limited function. Conclusion The representative barriers to introducing a telemedicine system at a rural general hospital in Japan without initial and running costs could be classified as feelings of isolation and suspicion of carrying (mental barriers); and notice, portability, and user authentication (physical barriers). Continued investigation in this area is warranted, and solutions to these barriers could improve the shortage of medical staff in the context of declining birth rates and aging populations in Japan.
Collapse
Affiliation(s)
- Takahiro Hirano
- General Medicine, Hirosaki University Graduate School of
Medicine, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of
Medicine and Hospital, Japan
| | - Hiroki Maita
- Development of Community Healthcare, Hirosaki University
Graduate School of Medicine, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of
Medicine and Hospital, Japan
| | - Hiroyuki Kato
- General Medicine, Hirosaki University Graduate School of
Medicine, Japan
- Department of General Medicine, Hirosaki University School of
Medicine and Hospital, Japan
- Development of Community Healthcare, Hirosaki University
Graduate School of Medicine, Japan
| |
Collapse
|
5
|
Kato M, Sasaki S, Mori W, Kohmaru M, Akimoto T, Hayakawa E, Soma S, Arai Y, Matsubara NS, Nakazawa S, Sueyasu T, Hirakawa H, Motomura H, Sumiyoshi I, Ochi Y, Watanabe J, Hoshi K, Kadoya K, Ihara H, Hou J, Togo S, Takahashi K. Nintedanib administration after the onset of acute exacerbation of interstitial lung disease in the real world. Sci Rep 2023; 13:12528. [PMID: 37532874 PMCID: PMC10397323 DOI: 10.1038/s41598-023-39101-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
Nintedanib reduces the decline in forced vital capacity and extends the time to the first acute exacerbation of interstitial lung disease (AE-ILD). However, the effect of additional nintedanib administration after AE-ILD onset is unknown. This study aimed to investigate the efficacy and safety of nintedanib administration after AE-ILD development. We retrospectively collected the data of 33 patients who developed AE-ILD between April 2014 and January 2022. Eleven patients who received nintedanib after AE-ILD development and the remaining who did not were classified into the N and No-N groups, respectively. The survival time in the N group tended to be longer than that in the No-N group. The generalized Wilcoxson test revealed that the cumulative mortality at 90 days from AE-ILD onset was significantly lower in the N group. The time to subsequent AE-ILD development was significantly longer in the N group than that in the No-N group. The incidence of adverse gastrointestinal effects and liver dysfunction in the N group was 9-18%. Treatment without nintedanib after AE-ILD development and the ratio of arterial oxygen partial pressure to fractional inspired oxygen were significant independent prognostic factors in the multivariate analysis. Thus, nintedanib administration may be a treatment option for AE-ILD.
Collapse
Affiliation(s)
- Motoyasu Kato
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Shinichi Sasaki
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Wataru Mori
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Makiko Kohmaru
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takashi Akimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Eri Hayakawa
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Soichiro Soma
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yuta Arai
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Naho Sakamoto Matsubara
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shun Nakazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Haruki Hirakawa
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Hiroaki Motomura
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Issei Sumiyoshi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Yusuke Ochi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Junko Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuaki Hoshi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kotaro Kadoya
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Hiroaki Ihara
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Jia Hou
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shinsaku Togo
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| |
Collapse
|
6
|
Maita H, Kobayashi T, Akimoto T, Ota S, Sakuraba H, Kato H. Takayasu arteritis presenting with fever of unknown origin and bilateral carotid artery tenderness: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190493. [PMID: 37539356 PMCID: PMC10395173 DOI: 10.1177/2050313x231190493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023] Open
Abstract
A 51-year-old otherwise healthy woman was referred to our hospital with a fever of unknown origin, liver dysfunction, and anemia. One month prior, she had persistent and spontaneous anterior neck pain, with no exacerbation during swallowing or neck movements. Physical examination revealed no pharyngeal or tonsillar abnormalities, heart murmur, arthritis, skin rash, or lymphadenopathy, except for mild bilateral common carotid artery tenderness at the level of the thyroid cartilage. Blood tests showed nonspecific chronic inflammatory findings, anemia, and liver damage, whereas blood cultures, viral antibodies, interferon-γ release assay, and antibodies specific for any collagen disease showed negative results. Echocardiography and computed tomography without contrast of the neck, chest, abdomen, and pelvis showed no apparent abnormalities. She was subsequently diagnosed with Takayasu arteritis using positron emission tomography. Identifying a characteristic history of bilateral carotid artery tenderness and subsequent positron emission tomography can be useful for diagnosing Takayasu arteritis.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Shinji Ota
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| |
Collapse
|
7
|
Maita H, Kobayashi T, Akimoto T, Hirano T, Osawa H, Kato H. Evaluation of simulation-based ultrasound education using a bladder simulator for medical students in Japan: a prospective observational study. J Med Ultrason (2001) 2023; 50:73-80. [PMID: 36445651 PMCID: PMC9892112 DOI: 10.1007/s10396-022-01269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE This study aimed to investigate the usefulness of ultrasound education for medical students using a bladder simulator. METHODS This prospective observational study included volunteer fifth- and sixth-year medical students. An intravesical urine volume measurement simulator and a pocket-sized hand-held ultrasound device were used. The ultrasound education comprised pre-learning, briefing, simulation, debriefing, and learning summary. The simulation consisted of two tests: bladder simulator cube evaluation and scenario-based clinical application. A self-rated confidence score of 0-10 points along with reasons for the scores was recorded before and after the ultrasound education. RESULTS Twelve participants (median age, 23 years; female, 75%) met the inclusion criteria and were examined. Participants' bladder simulator cube evaluation and scenario-based clinical application test results were good, and the educational difficulty level was appropriate. The mean confidence scores for main unit operation, probe control, image acquisition, image evaluation and clinical application before the ultrasound education were 1.0, 1.8, 1.3, 0.8 and 0.1 points, respectively. The mean confidence scores after the ultrasound education were 5.8, 5.9, 5.4, 5.5 and 5.1, respectively, with significant increases for all items (p < 0.01). The positive impression categories that affected confidence scores after ultrasound education were related to device operation, image acquisition, image evaluation, clinical application and learning. CONCLUSION Ultrasound education using a bladder simulator increases confidence scores by imparting competencies related to device operation, image acquisition, image evaluation and clinical application, and it improves students' learning impression. This is a useful method for introductory ultrasound education for medical students.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi, Aomori, 036-8562, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 Hon-Cho, Hirosaki-Shi, Aomori, 036-8563, Japan.
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 Hon-Cho, Hirosaki-Shi, Aomori, 036-8563, Japan
| | - Takahiro Hirano
- General Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi, Aomori, 036-8562, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 Hon-Cho, Hirosaki-Shi, Aomori, 036-8563, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi, Aomori, 036-8562, Japan
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 Hon-Cho, Hirosaki-Shi, Aomori, 036-8563, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki-Shi, Aomori, 036-8562, Japan
| |
Collapse
|
8
|
Oyoshi H, Hirata H, Hirano Y, Zenda S, Fujisawa T, Nakamura M, Hojo H, Motegi A, Kageyama S, Akimoto T. Prognosis after Whole-Brain Radiotherapy for Leptomeningeal Metastasis in Patients with Lung Adenocarcinoma with or without EGFR/ALK Alterations. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Inada M, Nishimura Y, Ishikura S, Ishikawa K, Murakami N, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Minemura T, Shimizu H, Hiraoka M. The Organs-at-Risk Dose Constraints in Head and Neck Intensity Modulated Radiation Therapy Using Data from a Multi-Institutional Clinical Trial (JCOG1015A1). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
10
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Pseudo-fever caused by predictive electronic thermometers: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221129772. [PMID: 36225225 PMCID: PMC9548687 DOI: 10.1177/2050313x221129772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
A 33-year-old man was referred to our hospital with chief complaints of fever, dizziness, and headache. Although he had recurring fever and dizziness for 7 months, neurological examination, magnetic resonance imaging, computed tomography, electrocardiograms, and blood tests were normal. He was diagnosed with functional hyperthermia, cervical vertigo, and tension headache and was treated with oral medication and physical therapy. After treatment, the dizziness and headache resolved; however, the fever and anxiety did not. During follow-up, he noticed differing results from different electronic thermometers. The physician decided to use an accurate analog thermometer, a gallium thermometer, in combination with the other thermometers. The results differed significantly among the thermometers, and the electronic thermometer readings were found to be inappropriately high. The physician made a diagnosis of pseudo-fever, and the patient recognized that the gallium thermometer's results were the most accurate reflection of his physical condition, resolving his anxiety.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan,Hiroki Maita, Development of Community Healthcare, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan,Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan,General Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| |
Collapse
|
11
|
Maita H, Kobayashi T, Akimoto T, Matsuoka F, Funakoshi S, Osawa H, Kato H. Clinical diagnosis of seasonal influenza by physicians: a retrospective observational study. BMJ Open 2022; 12:e055910. [PMID: 35868823 PMCID: PMC9315920 DOI: 10.1136/bmjopen-2021-055910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To elucidate the diagnostic accuracy of pretest probability of influenza (%) by physicians and the factors affecting the clinical diagnosis. DESIGN Retrospective, single-centre observational study. SETTING A community primary care clinic in Japan. PARTICIPANTS The participants were recruited from a database of studies conducted during the influenza season from December 2017 to April 2019. PRIMARY OUTCOME MEASURE Sensitivity and specificity of the physician's clinical diagnosis of influenza recorded in the medical record as pretest probability. RESULTS A total of 335 patients (median age, 31 years; male, 66.6%) were analysed in this study. The area under the curve (AUC) of the physician's pretest probability was 0.77. At a cut-off value of 30%, the sensitivity and negative likelihood ratio were 92.0% (95% CI 86.7 to 95.7) and 0.19 (95% CI 0.11 to 0.33), respectively. At a cut-off value of 80%, the specificity and positive likelihood ratio were 90.8% (95% CI 85.4 to 94.6) and 4.01 (95% CI 2.41 to 6.66), respectively. The AUCs of patients who had and had not taken any medications before visiting the clinic were 0.77 (95% CI 0.69 to 0.85) and 0.78 (95% CI 0.71 to 0.84), respectively. The AUCs of patients with type A and B influenza were 0.78 (95% CI 0.72 to 0.84) and 0.76 (95% CI 0.70 to 0.82), respectively. The AUCs of vaccinated and unvaccinated patients were 0.80 (95% CI 0.72 to 0.88) and 0.76 (95% CI 0.63 to 0.89), respectively. The AUC for patients less than 12 hours after onset was 0.69 (95% CI 0.51 to 0.88), and that for patients aged younger than 6 years was 0.69 (95% CI 0.49 to 0.88). CONCLUSIONS The physician's pretest probability of influenza (%) may be useful for both definitive and exclusionary diagnoses within the limits of our study.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan
| | - Fumihiko Matsuoka
- Rokkasho Center for Community and Family Medicine, Rokkasho, Aomori, Japan
| | - Shigeki Funakoshi
- Rokkasho Center for Community and Family Medicine, Rokkasho, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Hirosaki, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| |
Collapse
|
12
|
Nanjo Y, Okuma T, Kuroda Y, Hayakawa E, Shibayama K, Akimoto T, Murashima R, Kanamori K, Tsutsumi T, Suzuki Y, Namba Y, Makino F, Nagashima O, Sasaki S, Takahashi K. Multiple Types of Taste Disorders among Patients with COVID-19. Intern Med 2022; 61:2127-2134. [PMID: 35527025 PMCID: PMC9381347 DOI: 10.2169/internalmedicine.9065-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Based on the increasing incidence of smell and taste dysfunction among coronavirus disease 2019 (COVID-19) patients, such issues have been considered an early symptom of infection. However, few studies have investigated the type of taste components that are most frequently affected in COVID-19 patients. This study investigated the difference in frequencies of the types of taste component disorders among hospitalized COVID-19 patients. Methods In this retrospective, single-center, observational study, patients' background characteristics, clinical course, laboratory and radiological findings, and details on taste and/or smell disorders were collected and analyzed from medical records. Patients A total of 227 COVID-19 patients were enrolled, among whom 92 (40.5%) complained of taste disorders. Results Multiple types of taste disorders (hypogeusia/ageusia and hypersensitivity, or hypersensitivity and changing tastes) were reported in 10 patients. In particular, 23 patients reported hypersensitivity to at least 1 type of taste, and 2 patients complained of a bitter taste on consuming sweet foods. Impairment of all taste components was found in 48 patients (52.2%). The most frequent taste disorder was salty taste disorder (81 patients, 89.0%). Hypersensitivity to salty taste was most frequently observed (19 patients, 20.9%). Conclusion Patients with COVID-19 develop multiple types of taste disorders, among which salty taste disorder was the most frequent, with many patients developing hypersensitivity to salty taste. As smell and taste are subjective senses, further studies with the combined use of objective examinations will be required to confirm the findings.
Collapse
Affiliation(s)
- Yuta Nanjo
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Tomoko Okuma
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yumi Kuroda
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Eri Hayakawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Kohei Shibayama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takashi Akimoto
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Ryoko Murashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Koichiro Kanamori
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yohei Suzuki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Fumihiko Makino
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Osamu Nagashima
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Shinichi Sasaki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| |
Collapse
|
13
|
Maita H, Kobayashi T, Akimoto T, Matsuoka F, Osawa H, Kato H. Factors associated with children's seasonal influenza diagnosis by their guardians: a prospective observational study in Japan. J Prim Health Care 2022; 14:29-36. [PMID: 35417328 DOI: 10.1071/hc21135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Children's influenza diagnosis by their guardians has been reported to be highly accurate, but clinical factors that improve the reliability of a guardian's diagnosis are unclear. Aim To determine the accuracy of guardians' influenza diagnosis of their children, investigate clinical factors that improve the diagnostic accuracy, and determine the additional clinical value of the guardian's diagnosis. Methods A prospective observational study was conducted at a primary care clinic in Japan from December 2017 to April 2019. Pre-examination checklists completed by guardians accompanying children aged Results A total of 112 patient pairs of child (median age, 6 years) and guardian (mother, 81.2%; father, 16.1%; grandmother, 1.8%; other, 0.9%) were included in the analysis. The AUC for guardians' influenza diagnosis was higher in mothers (0.72), as well as pairs with children with a history of influenza (0.72), guardians who were aware of the influenza epidemic (0.71), and unvaccinated children (0.76), than in other guardians. After multivariate analysis, the AUC increased significantly from 0.79 to 0.85. Discussion Guardians' influenza diagnosis for their children was highly accurate. We identified factors that improve the accuracy of the guardians' diagnosis and demonstrated that the guardians' diagnosis can support physicians' diagnostic accuracy.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | | | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan; and Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| |
Collapse
|
14
|
Akimoto T, Kobayashi T, Maita H, Osawa H, Kato H. Non‐convulsive epilepsy with acute‐onset and short‐lasting repeated fatigue attacks: A case of 30‐year‐old man. J Gen Fam Med 2022; 23:275-277. [PMID: 35800643 PMCID: PMC9249925 DOI: 10.1002/jgf2.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022] Open
Abstract
A 30‐year‐old man was referred to our department because of repeated acute‐onset and short‐lasting fatigue attacks, which occurred from 3 months before the referral. He had no abnormal findings in blood tests, electrocardiogram (including 24‐ h monitoring), or head MRI (including angiography). His vital signs were unremarkable, and his physical examination revealed no abnormal findings. Detailed history‐taking with closed‐ended questions revealed the occurrence of tingling sensation from the right fingers as the aura before his attacks. Electroencephalography was performed, which revealed focal epilepsy. Levetiracetam resolved his symptoms. Physicians could consider non‐convulsive epilepsy as a potential cause of repeated acute‐onset and short‐lasting fatigue attacks of unknown etiology after underlying conditions, such as metabolic diseases, have been ruled out.
Collapse
Affiliation(s)
- Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroyuki Kato
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
- General Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
| |
Collapse
|
15
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Functional hyperthermia caused by obstructive sleep apnea syndrome: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221123308. [PMID: 36119663 PMCID: PMC9478686 DOI: 10.1177/2050313x221123308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
A 47-year-old farm worker with diabetes mellitus, dyslipidemia, and hyperuricemia was referred to our hospital for a 3-month history of fever and malaise. He had no respiratory tract or abdominal symptoms, skin rashes, or joint pain. There was no change to his regular medication or pesticide exposure. Blood tests and echocardiography revealed no abnormalities. Whole-body computed tomography revealed a fatty liver; however, non-alcoholic steatohepatitis was excluded. We diagnosed the patient with functional hyperthermia. He had a history of snoring and weight gain, and we suspected the obstructive sleep apnea syndrome to be a stressor. Polysomnography revealed severe obstructive sleep apnea syndrome with an apnea–hypopnea index of 44.5. Continuous positive airway pressure was introduced; the axillary temperature decreased gradually and malaise was resolved. Functional hyperthermia should be considered a cause of fever with a negative inflammatory response. Obstructive sleep apnea syndrome can be a stressor for functional hyperthermia, which can be improved by interventions.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| |
Collapse
|
16
|
Nishino K, Akimoto T, Mitsuoka H, Terajima Y, Arai Y, Masui Y, Mimori T, Koike K, Takahashi K, Sekiya M. A Case of Tuberculosis-related Cerebral Venous Sinus Thrombosis and Pulmonary Thromboembolism Successfully Treated with Edoxaban. Respir Med Case Rep 2022; 39:101736. [PMID: 36133419 PMCID: PMC9483779 DOI: 10.1016/j.rmcr.2022.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old woman was admitted to the hospital with complaints of headache and vomiting. Radiological examinations revealed cerebral sinus venous thromboses, pulmonary thromboembolism, and cavities in the left upper lung. Pulmonary tuberculosis was diagnosed based on sputum and gastric aspirate culture. Heparin followed by warfarin was administered. Anti-tuberculosis agents including rifampicin were also initiated. Since the effect of warfarin did not reach the therapeutic level because of interaction with rifampicin, edoxaban was administered and thromboses were ameliorated. This report illustrates rare thrombotic complications in a TB-induced hypercoagulable state and the potential benefits and safety of edoxaban in combination with rifampicin.
Collapse
|
17
|
Akimoto T, Kobayashi T, Maita H, Osawa H, Kato H. A case of Raynaud's phenomenon of toes induced by whole‐body warm stimulation. J Gen Fam Med 2021; 23:113-115. [PMID: 35261861 PMCID: PMC8888806 DOI: 10.1002/jgf2.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/23/2022] Open
Abstract
Raynaud's phenomenon, induced by cold stimulation and emotional stress, is also induced by whole‐body warm stimulation. A 74‐year‐old man was referred to our department because of nocturnal toe pain from 2 years prior and immediate color change of the toes from 1 year prior when submerging himself into a warm bath. Physical examination and blood tests revealed no abnormal findings suggestive of secondary Raynaud's phenomenon. Two years later, the signs and symptoms persisted. When physicians confirm Reynaud's phenomenon, they should check for the possibility of secondary Reynaud's phenomenon. Additional research on Reynaud's phenomenon induced by warm stimulation is needed.
Collapse
Affiliation(s)
- Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
| | - Hiroyuki Kato
- Department of General Medicine Hirosaki University School of Medicine and Hospital Hirosaki Japan
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Hirosaki Japan
- General Medicine Hirosaki University Graduate School of Medicine Hirosaki Japan
| |
Collapse
|
18
|
Yamanaka H, Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Diagnostic accuracy of pocket-sized ultrasound for aspiration pneumonia in elderly patients without heart failure: A prospective observational study. Geriatr Gerontol Int 2021; 21:1118-1124. [PMID: 34647413 PMCID: PMC9293111 DOI: 10.1111/ggi.14293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022]
Abstract
Aim To investigate the diagnostic accuracy of pocket‐sized ultrasound (PsUS) for aspiration pneumonia in elderly patients without heart failure. Methods This prospective observational study included patients with aspiration pneumonia. PsUS was performed in six areas (bilateral chest, four dorsal areas) by an independent examiner, blinded to the computed tomography (CT) results as a reference standard. Patients with heart failure were excluded. Results PsUS findings of 34 patients (median age, 87.5 years) and 204 areas were analyzed. Three or more B‐lines (comet tail artifacts) were strongly suggestive (positive likelihood ratio [LR+] 17.302) of consolidation on CT (CT‐consolidation, subpleural hypoechoic area with tissue‐like echostructure) or pleural change on CT. Consolidation on US (US‐consolidation) was suggestive of CT‐consolidation or pleural changes on CT (LR+ 6.453). Pleural effusion on US was strongly suggestive (LR+ 10.989) of CT‐consolidation or pleural change on CT. Absence of either three or more B‐lines, US‐consolidation, or US pleural effusion could not rule out CT‐consolidation or pleural change on CT (negative likelihood ratio [LR−] 0.482‐0.683). However, absence of all three findings could rule out abnormal CT findings (LR− 0.230). Chest radiograph findings proved difficult to confirm or exclude CT‐consolidation or pleural changes on CT (LR+ 1.584, LR− 0.489); when combined with PsUS findings, LR− improved to 0.124. Conclusions Three or more B‐lines or US‐consolidation on PsUS in elderly patients with aspiration pneumonia without heart failure suggested CT‐consolidation or pleural changes on CT. When both PsUS and chest radiograph findings were negative, CT‐consolidation and pleural change could be excluded. Geriatr Gerontol Int 2021; 21: 1118–1124.
Collapse
Affiliation(s)
- Harumitsu Yamanaka
- General Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan.,Fujishiro-Kensei Hospital, Aomori, Japan
| | - Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Aomori, Japan
| | - Hiroyuki Kato
- General Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan.,Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan.,Department of General Medicine, Hirosaki University School of Medicine & Hospital, Aomori, Japan
| |
Collapse
|
19
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Severe edema and blood blisters of the lower extremities caused by sitagliptin, a dipeptidyl peptidase‐4 inhibitor. J Gen Fam Med 2021; 23:124-125. [PMID: 35261865 PMCID: PMC8888802 DOI: 10.1002/jgf2.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroyuki Kato
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
- General Medicine Hirosaki University Graduate School of Medicine Aomori Japan
| |
Collapse
|
20
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. A case of juvenile myoclonic epilepsy in which a disease‐specific question led to the diagnosis. J Gen Fam Med 2021; 23:107-109. [PMID: 35261859 PMCID: PMC8888799 DOI: 10.1002/jgf2.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
A 17‐year‐old female patient presented to our hospital with repeated transient loss of consciousness lasting less than 10 min. After regaining consciousness, she experienced no disorientation, confusion, tongue‐biting, or incontinence. Physical findings, blood tests, electrocardiogram, and echocardiogram showed no obvious abnormalities. On being asked whether she had experienced sudden rapid body movements, she answered “yes.” Therefore, we suspected juvenile myoclonic epilepsy (JME) and obtained an electroencephalogram, which showed diffuse bilateral bursts of spike‐and‐wave complexes, confirming the diagnosis. In adolescent patients with transient loss of consciousness, myoclonic jerks should be actively confirmed for the diagnosis of JME.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroyuki Kato
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| |
Collapse
|
21
|
Fujisawa T, Motegi A, Zenda S, Hojo H, Nakamura M, Hirano Y, Hirata H, Vijay Parshuram R, Matsuura K, Shinozaki T, Hayashi R, Akimoto T. PO-1007 Radiotherapy with delayed accelerated hyperfractionated boost for node negative hypopharynx cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Hasui K, Kato H. An undiagnosed patient with skin rash, polyarthritis, and edema responding to low-dose colchicine: A case report. SAGE Open Med Case Rep 2021; 9:2050313X211024508. [PMID: 34178350 PMCID: PMC8202317 DOI: 10.1177/2050313x211024508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
A 54-year-old man was referred to our hospital with painful rashes on the extremities. He also developed polyarthritis and pitting pedal edema. Blood tests showed no specific autoantibodies and were negative for human leukocyte antigens B51, B15, and B27. Lower extremity venous ultrasonography and computed tomography angiography showed no vascular disorders. Skin biopsy showed no evidence of thrombosis or vasculitis. Direct fluorescence antibody analysis showed no antibody or complement deposition. Joint ultrasonography showed mild synovial thickening and/or synovial effusion in the extremities. Non-steroidal anti-inflammatory drugs and topical steroids were administered, followed by oral steroids. However, the signs and symptoms did not improve. Oral steroids were discontinued, and colchicine (0.5 mg/day) was administered. Thereafter, the symptoms of arthritis improved, and no skin rash developed. In potentially inflammatory conditions with skin rash, edema, and polyarthritis that are difficult to diagnose, low-dose colchicine administration may be considered for prompt relief of symptoms.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Graduate School of Medicine & University Hospital, Hirosaki University, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Graduate School of Medicine & University Hospital, Hirosaki University, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Graduate School of Medicine & University Hospital, Hirosaki University, Aomori, Japan
| | - Keisuke Hasui
- Department of Community Medical Support, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Graduate School of Medicine, Hirosaki University, Aomori, Japan.,Department of General Medicine, Graduate School of Medicine & University Hospital, Hirosaki University, Aomori, Japan.,Department of General Medicine, Graduate School of Medicine, Hirosaki University, Aomori, Japan
| |
Collapse
|
23
|
Tokumaru S, Ohnishi K, Harada H, Wada H, Nakamura N, Arimura T, Iwata H, Sato Y, Tamamura H, Ogino H, Ogino T, Akimoto T, Okimoto T, Kikuchi Y, Murayama S, Sakurai H. Clinical Outcomes of Proton Beam Therapy for Stage I Lung Cancer in Patients with Interstitial Pneumonia: A Multi-Institutional Retrospective Study in Japan. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Okumura M, Hojo H, Nakamura N, Zenda S, Motegi A, Nakamura M, Hirano Y, Kageyama S, Raturi V, Akimoto T. PO-1261: Radiation pneumonitis after palliative radiotherapy in patients with interstitial lung disease. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Maebayashi T, Mizowaki T, Nakamura K, Nakamura K, Inaba K, Asakura H, Iwata H, Wada H, Itasaka S, Sakaguchi M, Jingu K, Akiba T, Tomita N, Imagumbai T, Shimamoto S, Yamazaki T, Yorozu A, Akimoto T. Outcomes Of Radiation Therapy For Clinically Node-Positive Prostate Cancer: Surveillance Study Of The Japanese Radiation Oncology Study Group (JROSG). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Kubo Y, Ito K, Sone M, Nagasawa H, Onishi Y, Umakoshi N, Hasegawa T, Akimoto T, Kusumoto M. Diagnostic Value of Model-Based Iterative Reconstruction Combined with a Metal Artifact Reduction Algorithm during CT of the Oral Cavity. AJNR Am J Neuroradiol 2020; 41:2132-2138. [PMID: 32972957 DOI: 10.3174/ajnr.a6767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/07/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Metal artifacts reduce the quality of CT images and increase the difficulty of interpretation. This study compared the ability of model-based iterative reconstruction and hybrid iterative reconstruction to improve CT image quality in patients with metallic dental artifacts when both techniques were combined with a metal artifact reduction algorithm. MATERIALS AND METHODS This retrospective clinical study included 40 patients (men, 31; women, 9; mean age, 62.9 ± 12.3 years) with oral and oropharyngeal cancer who had metallic dental fillings or implants and underwent contrast-enhanced ultra-high-resolution CT of the neck. Axial CT images were reconstructed using hybrid iterative reconstruction and model-based iterative reconstruction, and the metal artifact reduction algorithm was applied to all images. Finally, hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithm data were obtained. In the quantitative analysis, SDs were measured in ROIs over the apex of the tongue (metal artifacts) and nuchal muscle (no metal artifacts) and were used to calculate the metal artifact indexes. In a qualitative analysis, 3 radiologists blinded to the patients' conditions assessed the image-quality scores of metal artifact reduction and structural depictions. RESULTS Hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithms yielded significantly different metal artifact indexes of 82.2 and 73.6, respectively (95% CI, 2.6-14.7; P < .01). The latter algorithms resulted in significant reduction in metal artifacts and significantly improved structural depictions(P < .01). CONCLUSIONS Model-based iterative reconstruction + metal artifact reduction algorithms significantly reduced the artifacts and improved the image quality of structural depictions on neck CT images.
Collapse
Affiliation(s)
- Y Kubo
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan .,Department of Cancer Medicine (Y.K., T.A.), Jikei University Graduate School of Medicine, Tokyo, Japan
| | - K Ito
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - M Sone
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - H Nagasawa
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - Y Onishi
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - N Umakoshi
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - T Hasegawa
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| | - T Akimoto
- Department of Cancer Medicine (Y.K., T.A.), Jikei University Graduate School of Medicine, Tokyo, Japan.,Division of Radiation Oncology and Particle Therapy (T.A.), National Cancer Center Hospital East, Kashiwa, Japan
| | - M Kusumoto
- From the Department of Diagnostic Radiology (Y.K., K.I., M.S., H.N., Y.O., N.U., T.H., M.K.), National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
27
|
Yokota T, Ota Y, Fujii H, Kodaira T, Shimokawa M, Nakashima T, Monden N, Homma A, Ueda S, Akimoto T. 960P A real-world clinical outcomes and prognostic factors in Japanese patients with recurrent or metastatic squamous cell carcinoma of head and neck treated with chemotherapy plus cetuximab: A prospective observation study (JROSG12-2). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
28
|
Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. Vestibular migraine without headache treated with lomerizine: A 35-year-old woman undiagnosed for 10 years. J Gen Fam Med 2020; 21:140-142. [PMID: 32742903 PMCID: PMC7388671 DOI: 10.1002/jgf2.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 11/23/2022] Open
Abstract
A 35-year-old woman presented with recurrent vertigo without headache, which had persisted for 10 years. Detailed medical history revealed that she experienced hearing loss, tinnitus, nausea, photophobia, phonophobia, and slight discomfort in the head during vertigo attacks, which often led to absence from work. Based on the diagnostic criteria of the International Classification of Headache Disorders, third edition, she was diagnosed with vestibular migraine and was prescribed lomerizine, as prophylaxis. Her symptoms markedly improved, enabling her to go to work. Accurate diagnosis and treatment are important for improving the quality of life of patients, since vestibular migraine is commonly underdiagnosed.
Collapse
Affiliation(s)
- Hiroki Maita
- Development of Community HealthcareHirosaki University Graduate School of MedicineAomoriJapan
- General MedicineHirosaki University Graduate School of MedicineAomoriJapan
| | - Tadashi Kobayashi
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Takashi Akimoto
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Hiroshi Osawa
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| | - Hiroyuki Kato
- Development of Community HealthcareHirosaki University Graduate School of MedicineAomoriJapan
- General MedicineHirosaki University Graduate School of MedicineAomoriJapan
- Department of General MedicineHirosaki University School of Medicine & HospitalAomoriJapan
| |
Collapse
|
29
|
Akimoto T, Kobayashi T, Maita H, Osawa H, Kato H. Initial assessment of femoral proximal fracture and acute hip arthritis using pocket-sized ultrasound: a prospective observational study in a primary care setting in Japan. BMC Musculoskelet Disord 2020; 21:291. [PMID: 32393287 PMCID: PMC7216341 DOI: 10.1186/s12891-020-03326-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/04/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Acute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders. METHODS In this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging. RESULTS Our study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97. CONCLUSIONS Negative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.
Collapse
Affiliation(s)
- Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 hon-cho, Hirosaki-shi, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, 53 hon-cho, Hirosaki-shi, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 hon-cho, Hirosaki-shi, Aomori, Japan
| | - Hiroki Maita
- General Medicine, Hirosaki University Graduate School of Medicine, 53 hon-cho, Hirosaki-shi, Aomori, Japan
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, 53 hon-cho, Hirosaki-shi, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 hon-cho, Hirosaki-shi, Aomori, Japan
| | - Hiroyuki Kato
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, 53 hon-cho, Hirosaki-shi, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, 53 hon-cho, Hirosaki-shi, Aomori, Japan
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, 53 hon-cho, Hirosaki-shi, Aomori, Japan
| |
Collapse
|
30
|
Kodaira T, Kagami Y, Shibata T, Shikama N, Nishimura Y, Ishikura S, Nakamura K, Saito Y, Matsumoto Y, Teshima T, Ito Y, Akimoto T, Nakata K, Toshiyasu T, Nakagawa K, Nagata Y, Nishimura T, Uno T, Kataoka M, Yorozu A, Hiraoka M. Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701). Ann Oncol 2019; 29:992-997. [PMID: 29401241 DOI: 10.1093/annonc/mdy036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background We assessed the non-inferiority of accelerated fractionation (AF) (2.4 Gy/fraction) compared with standard fractionation (SF) (2 Gy/fraction) regarding progression-free survival (PFS) in patients with T1-2N0M0 glottic cancer (GC). Patients and methods In this multi-institutional, randomized, phase III trial, patients were enrolled from 32 Japanese institutions. Key inclusion criteria were GC T1-2N0M0, age 20-80, Eastern Cooperative Oncology Group performance status of 0-1, and adequate organ function. Patients were randomly assigned to receive either SF of 66-70 Gy (33-35 fractions), or AF of 60-64.8 Gy (25-27 fractions). The primary end point was the proportion of 3-year PFS. The planned sample size was 360 with a non-inferiority margin of 5%. Results Between 2007 and 2013, 370 patients were randomized (184/186 to SF/AF). Three-year PFS was 79.9% (95% confidence interval [CI] 73.4-85.4) for SF and 81.7% (95% CI 75.4-87.0) for AF (difference 1.8%, 91% CI-5.1% to 8.8%; one-sided P = 0.047 > 0.045). The cumulative incidences of local failure at 3 years for SF/AF were 15.9%/10.3%. No significant difference was observed in 3-year overall survival (OS) between SF and AF. Grade 3 or 4 acute and late toxicities developed in 22 (12.4%)/21 (11.5%) and 2 (1.1%)/1 (0.5%) in the SF/AF arms. Conclusion Although the non-inferiority of AF was not confirmed statistically, the similar efficacy and toxicity of AF compared with SF, as well as the practical convenience of its fewer treatment sessions, suggest the potential of AF as a treatment option for early GC. Clinical trials registration UMIN Clinical Trial Registry, number UMIN000000819.
Collapse
Affiliation(s)
- T Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Y Kagami
- Department of Radiation Oncology, Showa University, Tokyo, Japan
| | - T Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - N Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Y Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - S Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - K Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Y Saito
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Y Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - T Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Y Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - T Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - K Nakata
- Department of Radiology, Sapporo Medical University, Sapporo, Japan
| | - T Toshiyasu
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - K Nakagawa
- Department of Radiology, Tokyo University, Tokyo, Japan
| | - Y Nagata
- Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan
| | - T Nishimura
- Department of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - T Uno
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - M Kataoka
- Department of Radiation Oncology, Shikoku Cancer Center, Matsuyama, Japan
| | - A Yorozu
- Department of Radiology, Tokyo Medical Center, Tokyo, Japan
| | - M Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | | |
Collapse
|
31
|
Nakamura N, Zenda S, Motegi A, Arahira S, Hayashi R, Tahara M, Oyoshi H, Ariji T, Hojo H, Nakamura M, Parshuram R, Okumura M, Akimoto T. The Interval between Initial Surgery and Regional Recurrence May be a Predictive Factor of Local Recurrence in Patients with Oral Cavity Cancer Who Receive Postoperative Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Nozaki M, Kagami Y, Takahashi M, Machida R, Shibata T, Ito Y, Nishimura Y, Kawaguchi Y, Saito Y, Nagata Y, Matsumoto Y, Akimoto T, Hoiraoka M. EP-1276 A Comparison of Breast Cosmetic Evaluation Methods in Hypofractionated Whole Breast Irradiation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
33
|
Kawaguchi Y, Nozaki M, Kagami Y, Shibata T, Nakamura K, Ito Y, Nishimura Y, Saito Y, Nagata Y, Matsumo Y, Akimoto T, Nishimura T, Uno T, Tsujino K, Kataoka M, Kodaira T, Shiraishi K, Inoue K, Isohashi F, Hiraoka M. A Multicenter Single-Arm Confirmatory Trial on Hypofractionated Whole-breast Irradiation after Breast-Conserving Surgery. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Nishimura Y, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Ishikawa K, Shimizu H, Minemura T, Ishikura S, Shibata T, Nakamura K, Shibata T, Hiraoka M. A Phase II Study of Two-Step Intensity Modulated Radiation Therapy (IMRT) with Chemotherapy for Loco-Regionally Advanced Nasopharyngeal Cancer (NPC) (JCOG1015). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Imamura Y, Kiyota N, Akimoto T, Ogawa G, Eba J, Minami S, Hasegawa Y, Iwae S, Monden N, Matsuura K, Fujii H, Onozawa Y, Homma A, Hayashi R, Tahara M. Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: A supplementary analysis of a phase II trial (JCOG0706S1). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Sugi H, Akimoto T, Chaen S. WITHDRAWN: Basic Properties of ATP-Induced Myosin Head Movement in Hydrated Myosin Filaments, Studied Using the Gas Environmental Chamber. Micron 2018; 113:48-60. [PMID: 30008439 DOI: 10.1016/j.micron.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Affiliation(s)
- H Sugi
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan.
| | - T Akimoto
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan
| | - S Chaen
- Department of Integrated Sciences in Physics and Biology, College of Humanities and Sciences, Nihon University, Tokyo, Japan
| |
Collapse
|
37
|
Sugi H, Akimoto T, Chaen S. Basic properties of ATP-induced myosin head movement in hydrated myosin filaments, studied using the gas environmental chamber. Micron 2018; 112:15-25. [PMID: 29902615 DOI: 10.1016/j.micron.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
Although more than 50 years have passed since the monumental discovery of Huxley and Hanson that muscle contraction results from relative sliding between actin and myosin filaments, coupled with ATP hydrolysis, the mechanism underlying the filament sliding still remains to be a mystery. It is generally believed that the myofilament sliding is caused by cyclic attachment-detachment between myosin heads in myosin filaments and myosin-binding sites in actin filaments. Attempts to prove the myosin head movement using techniques of X-ray diffraction and chemical probes attached to myosin heads have failed to obtain clear results because of the asynchronous nature of myosin head movement. Using the gas environmental chamber (EC) attached to an electron microscope, we succeeded in recording myosin head movement in hydrated myosin filaments, coupled with ATP hydrolysis with the following results: (1)In the absence of actin filaments, myosin heads fluctuate around a definite neutral position, so that their time-averaged position remains unchanged; (2) On ATP application, myosin heads bind with ATP to be in the charged-up state, M-ADP-Pi, and perform a recovery stroke in the direction away from the myosin filament central bare zone and stay in the post-recovery stroke position; (3) In the actin-myosin filament mixture, myosin heads form rigor linkages with actin, and bind with applied ATP to be in the charged-up state, M-ADP-Pi, and perform a power stroke in the direction towards the myosin filament bare zone, while releasing ADP and Pi to stay in the post-power stroke position; (4) In both recovery and power strokes, myosin heads in the non charged-up state return to the neutral position. These results indicate that the charged-up myosin heads decide their direction of movement without being guided by actin filaments.
Collapse
Affiliation(s)
- H Sugi
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan.
| | - T Akimoto
- Department of Physiology, School of Medicine, Teikyo University, Tokyo, Japan
| | - S Chaen
- Department of Integrated Sciences in Physics and Biology, College of Humanities and Sciences, Nihon University, Tokyo, Japan
| |
Collapse
|
38
|
Nakamura M, Onozawa M, Motegi A, Hojo H, Zenda S, Nakamura N, Udagawa H, Kirita K, Matsumoto S, Umemura S, Yoh K, Niho S, Goto K, Akimoto T. P3.14-001 Impact of PCI on Prognosis of LD-SCLC Through Pattern of Brain Metastases as a First Recurrence Site. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Ono A, Takahashi T, Niho S, Yoshida T, Akimoto T, Sakamaki K, Seto T, Nishio M, Yamamoto N, Hida T, Okamoto H, Kurata T, Satouchi M, Goto K, Yamanaka T, Ohe Y. MA 17.06 Safety Data from Randomized Phase II Study of CDDP+S-1 vs CDDP+PEM Combined with TRT for Locally Advanced Non-Squamous NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Ohnishi K, Harada H, Nakamura N, Tokumaru S, Wada H, Arimura T, Iwata H, Sato Y, Sekino Y, Tamamura H, Mizoe J, Ogino T, Ishikawa H, Kikuchi Y, Okimoto T, Murayama S, Akimoto T, Sakurai H. P2.05-005 Proton Beam Therapy for Early Stage Lung Cancer: A Multi-Institutional Retrospective Study in Japan. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Okuda T, Maruyama M, Akimoto T, Ohno Y, Haseba T. S21-3THE ROLE OF CLASS III ALCOHOL DEHYDROGENASE (ADH3) IN ALCOHOL-RELATED DISORDER ON LIVER AND BONE. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx075.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Nakamura N, Kawamori J, Takahashi O, Shikama N, Sekiguchi K, Takahashi T, Kato S, Ogita M, Haga C, Ito R, Nishimura K, Yamano T, Yoshida K, Motegi A, Akimoto T. Palliative Radiation Therapy for Breast Cancer With Skin Invasion: A Multi-institutional Prospective Observational Study. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
Ishibashi N, Soejima T, Kawaguchi H, Oguchi M, Sasai K, Hasegawa M, Isobe K, Ejima Y, Ito H, Imai M, Kasuya T, Shimoda E, Akimoto T. National Survey of Japan for Myeloablative Total Body Irradiation Prior to Hematopoietic Stem Cell Transplantation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Niho S, Yoshida T, Akimoto T, Sakamaki K, Takahashi T, Seto T, Nishio M, Yamamoto N, Hida T, Okamoto H, Kurata T, Satouchi M, Goto K, Yamanaka T, Ohe Y. Safety data from randomized phase II study of cisplatin (CDDP)+S-1 versus CDDP+pemetrexed (PEM) combined with thoracic radiotherapy (TRT) for locally advanced non-squamous (non-sq) non-small cell lung cancer (NSCLC): SPECTRA study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx379.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
45
|
Akamatsu H, Nakamura K, Ebara T, Inaba K, Itasaka S, Jingu K, Kosaka Y, Murai T, Nagata K, Soejima T, Takahashi S, Toyoda T, Toyoshima S, Nemoto K, Akimoto T. EP-1366: Radiotherapy aimed at functional preservation in patients with small cell carcinoma of the bladder. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Nozaki M, Kagami Y, Shibata T, Nakamura K, Ito Y, Nishimura Y, Kawaguchi Y, Saito Y, Nagata Y, Matsumoto Y, Akimoto T, Nishimura T, Uno T, Tsujino K, Kataoka M, Kodaira T, Shiraishi K, Inoue K, Isohashi F, Hiraoka M, Karasawa K, Izumi S, Sakurai H. EP-1156: A clinical trial on hypofractionated whole breast irradiation after breast-conserving surgery. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31592-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Nakamura N, Hotta K, Zenda S, Tachibana H, Onozawa M, Arahira S, Toshima M, Motegi A, Hojo H, Hirano Y, Kibe Y, Akimoto T. Radiological Changes After Proton Beam Therapy for Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Nishimura Y, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saitoh J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Ishikawa K, Shimizu H, Minemura T, Ishikura S, Shibata T, Nakamura K, Shibata T, Hiraoka M. A Phase II Study of Intensity Modulated Radiation Therapy (IMRT) with Chemotherapy for Locoregionally Advanced Nasopharyngeal Cancer (NPC) (JCOG1015): Acute Toxicity and Treatment Compliance. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
49
|
Hojo H, Domae T, Hotta K, Kohno R, Motegi A, Hirano Y, Onozawa M, Toshima M, Zenda S, Nakamura N, Kibe Y, Arahira S, Tsuchihara K, Akimoto T. Evaluation of Cellular Response to Proton Beam in Esophageal Cancer Cell Lines. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
50
|
Akimoto T, Zenda S, Nakamura N, Demizu Y, Okimoto T, Murayama S, Mizumoto M, Sakurai H, Nakamura T, Kikuchi Y, Yamamoto K, Shirato H, Onoe T. A Retrospective Multi-institutional Study of Proton Beam Therapy for Head and Neck Cancer With Non-Squamous Cell Histologies. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|