Updated on 2022/07/20

写真a

 
NISHIDA Kazuki
 
Organization
Nagoya University Hospital Assistant professor of hospital
Title
Assistant professor of hospital
External link

Degree 2

  1. Doctor of Philosophy (Medical Science) ( 2022.3   Nagoya University ) 

  2. M.D. ( 2014.3   Nagoya University ) 

Research Areas 1

  1. Life Science / Hygiene and public health (non-laboratory)  / Biostatistics

Research History 1

  1. Nagoya University   Nagoya University Hospital   Assistant professor of hospital

    2020.4

 

Papers 43

  1. Predictive factors for massive hemorrhage in women with retained products of conception: a prospective study.

    Sonehara R, Nakamura T, Iwase A, Nishida K, Takikawa S, Murakami M, Yoshita S, Muraoka A, Miyake N, Nakanishi N, Osuka S, Goto M, Kajiyama H

    Scientific reports   Vol. 12 ( 1 ) page: 11859   2022.7

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    DOI: 10.1038/s41598-022-15564-1

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  2. Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis Reviewed

    Daisuke Hasegawa, Ryota Sato, Narut Prasitlumkum, Kazuki Nishida

    Journal of Intensive Care Medicine   Vol. 37 ( 7 ) page: 908 - 916   2022.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:{SAGE} Publications  

    <jats:sec><jats:title>Objective</jats:title><jats:p> The aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of premorbid beta-blockers on mortality in patients with sepsis. </jats:p></jats:sec><jats:sec><jats:title>Data Sources</jats:title><jats:p> We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for eligible studies. The protocol was registered at the PROSPERO (CRD42021256813). </jats:p></jats:sec><jats:sec><jats:title>Study Selection</jats:title><jats:p> Two authors independently evaluated the following inclusion criteria: (1) randomized controlled trials, cohort studies, cross-sectional studies; (2) patients with sepsis aged ≥18 years, and (3) premorbid beta-blocker use. </jats:p></jats:sec><jats:sec><jats:title>Data Extraction</jats:title><jats:p> Two authors extracted the patients’ characteristics and outcomes independently. All analyses were performed using the random-effects models. The primary outcome was short-term mortality, defined as mortality within 30 days, in-hospital or intensive care unit mortality. </jats:p></jats:sec><jats:sec><jats:title>Data Synthesis</jats:title><jats:p> Ten studies (n = 24 748 patients) were included. The pooled odds ratio (OR) of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% confidence interval [CI], 0.69-1.04; P = .12; I<jats:sup>2</jats:sup> = 50%). Five studies reported an adjusted OR of short-term mortality. The pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P &lt; .001; I<jats:sup>2</jats:sup> = 0%). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Premorbid beta-blockers were associated with a lower short-term mortality in patients with sepsis. </jats:p></jats:sec>

    DOI: 10.1177/08850666211052926

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  3. Prediction of Prehospital Change of the Cardiac Rhythm From Nonshockable to Shockable in Out-of-Hospital Patients With Cardiac Arrest: A Post Hoc Analysis of a Nationwide, Multicenter, Prospective Registry. International journal

    Ryo Emoto, Mitsuaki Nishikimi, Muhammad Shoaib, Kei Hayashida, Kazuki Nishida, Kazuya Kikutani, Shinichiro Ohshimo, Shigeyuki Matsui, Nobuaki Shime, Taku Iwami

    Journal of the American Heart Association   Vol. 11 ( 12 ) page: e025048   2022.6

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    Background Predicting a spontaneous rhythm change from nonshockable to shockable before hospital arrival in patients with out-of-hospital cardiac arrest can help emergency medical services develop better strategies for prehospital treatment. The aim of this study was to identify predictors of spontaneous rhythm change before hospital arrival in patients with out-of-hospital cardiac arrest and develop a predictive scoring system. Methods and Results We retrospectively reviewed data of eligible patients with out-of-hospital cardiac arrest with an initial nonshockable rhythm registered in a nationwide registry between June 2014 and December 2017. We performed a multivariable analysis using a Cox proportional hazards model to identify predictors of a spontaneous rhythm change, and a ridge regression model for predicting it. The data of 25 804 patients were analyzed (derivation cohort, n=17 743; validation cohort, n=8061). The rhythm change event rate was 4.1% (724/17 743) in the derivation cohort, and 4.0% (326/8061) in the validation cohorts. Age, sex, presence of a witness, initial rhythm, chest compression by a bystander, shock with an automated external defibrillator by a bystander, and cause of the cardiac arrest were all found to be independently associated with spontaneous rhythm change before hospital arrival. Based on this finding, we developed and validated the Rhythm Change Before Hospital Arrival for Nonshockable score. The Harrell's concordance index values of the score were 0.71 and 0.67 in the internal and external validations, respectively. Conclusions Seven factors were identified as predictors of a spontaneous rhythm change from nonshockable to shockable before hospital arrival. We developed and validated a score to predict rhythm change before hospital arrival.

    DOI: 10.1161/JAHA.121.025048

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  4. Meflin-positive cancer-associated fibroblasts enhance tumor response to immune checkpoint blockade Reviewed

    Yuki Miyai, Daisuke Sugiyama, Tetsunari Hase, Naoya Asai, Tetsuro Taki, Kazuki Nishida, Takayuki Fukui, Toyofumi Fengshi Chen-Yoshikawa, Hiroki Kobayashi, Shinji Mii, Yukihiro Shiraki, Yoshinori Hasegawa, Hiroyoshi Nishikawa, Yuichi Ando, Masahide Takahashi, Atsushi Enomoto

    Life Science Alliance   Vol. 5 ( 6 )   2022.6

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    DOI: 10.26508/lsa.202101230

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  5. Impact of Serum Zinc Level and Oral Zinc Supplementation on Clinical Outcomes in Patients Undergoing Infrainguinal Bypass for Chronic Limb-Threatening Ischemia. Reviewed

    Akio Kodama, Kimihiro Komori, Akio Koyama, Tomohiro Sato, Shuta Ikeda, Takuya Tsuruoka, Yohei Kawai, Kiyoaki Niimi, Masayuki Sugimoto, Hiroshi Banno, Kazuki Nishida

    Circulation journal : official journal of the Japanese Circulation Society   Vol. 86 ( 6 ) page: 995 - 1006   2022.5

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    BACKGROUND: Zinc (Zn) has been reported to play an important role in wound healing (WH). Nevertheless, the effect of Zn in chronic limb-threatening ischemia (CLTI) patients is unclear. This study investigated the effect of Zn on the clinical outcomes of CLTI patients undergoing bypass surgery.Methods and Results:This study reviewed 111 consecutive patients who underwent an infrainguinal bypass from 2012 to 2020. Patients with Zn deficiency (serum Zn level <60 μg/dL) received oral Zn supplementation and maintained a normal level until WH. This study aimed to explore: (1) the effect of Zn deficiency; and (2) Zn supplementation in Zn-deficient patients on the clinical outcomes of this cohort. Patients with Zn deficiency, Zn supplementation, and no Zn supplementation despite Zn deficiency accounted for 48, 21, and 42 patients, respectively. (1) Zn deficiency was associated with WH (HR, 0.47; 95% CI, 0.29-0.78: P=0.003), major adverse limb events (MALE) (HR, 2.53; 95% CI, 1.26-5.09: P=0.009), and major amputation or death (HR, 3.17; 95% CI, 1.51-6.63: P=0.002). (2) Zn supplementation was positively related to WH (HR, 2.30; 95% CI, 1.21-4.34: P=0.011). This result was confirmed using propensity score matching (HR, 2.24; 95% CI, 1.02-4.87: P=0.043). CONCLUSIONS: The current study revealed that Zn level was associated with clinical outcomes in CLTI patients after bypass surgery. Oral Zn supplementation could improve WH in these patients.

    DOI: 10.1253/circj.CJ-21-0832

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  6. Hyaluronan in articular cartilage: analysis of hip osteoarthritis and osteonecrosis of femoral head. International journal

    Jiarui Zhang, Yoshihiro Nishida, Hiroshi Koike, Kan Ito, Lisheng Zhuo, Kazuki Nishida, Koji Kimata, Kunihiro Ikuta, Tomohisa Sakai, Hiroshi Urakawa, Taisuke Seki, Shiro Imagama

    Journal of orthopaedic research : official publication of the Orthopaedic Research Society     2022.5

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    Hyaluronan (HA) plays crucial roles in the maintenance of high-quality cartilage extracellular matrix. Several studies have reported the HA in synovial fluid in patients with osteoarthritis (OA), but few have described the changes of HA in articular cartilage of OA or idiopathic osteonecrosis of femoral head (ONFH). KIAA1199 was recently reported to have strong hyaluronidase activity. The aim of this study was to clarify the HA metabolism in OA and ONFH, particularly the involvement of KIAA1199. Immunohistochemical analysis of KIAA1199 and HA deposition was performed for human OA (n=10), ONFH (n=10), and control cartilage (n=7). The concentration and molecular weight of HA were determined by competitive HA ELISA and Chromatography, respectively. Regarding HA metabolism related molecules, HAS1, HAS2, HAS3, HYAL1, HYAL2, and KIAA1199 gene expression was assessed by RT-PCR. Histological analysis showed the overexpression of KIAA1199 in OA cartilage, which was accompanied by decreased HABP staining compared with ONFH and control. Little KIAA1199 expression was observed in cartilage at the collapsed area of ONFH, which was accompanied by a slight decrease in HABP staining. The mRNA expression of HAS2 and KIAA1199 was up-regulated in OA cartilage, while the mRNA expression of genes related to HA catabolism in ONFH cartilage showed mostly a downward trend. The MW of HA in OA cartilage increased while that in ONFH cartilage decreased. HA metabolism in ONFH is suggested to be generally indolent, and is activated in OA including high expression of KIAA1199. Interestingly, MW of HA in OA cartilage was not reduced. This article is protected by copyright. All rights reserved.

    DOI: 10.1002/jor.25364

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  7. Comment on: Favourable complete remission of anti-OJ antibody-positive myositis after lung cancer resection. Reviewed International journal

    Yoshinao Muro, Kazuki Nishida, Yuta Yamashita, Haruka Koizumi, Takuya Takeichi, Minoru Satoh, Masashi Akiyama

    Rheumatology (Oxford, England)     2022.3

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    DOI: 10.1093/rheumatology/keac170

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  8. Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water-pressure method. Reviewed International journal

    Yoshihisa Takada, Takashi Hirose, Kazuki Nishida, Naomi Kakushima, Kazuhiro Furukawa, Satoshi Furune, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami, Hiroki Kawashima, Mitsuhiro Fujishiro

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   Vol. 34 ( 3 ) page: 526 - 534   2022.3

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    OBJECTIVES: Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP-ESD) has been developed with a decreased rate of perforation. However, details about perioperative adverse events of WP-ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP-ESD. METHODS: A chart-based retrospective analysis was performed on 43 patients who underwent duodenal WP-ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP-ESD until six weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases. RESULTS: In WP-ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) ≧17ml/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was the significant factor in univariate analysis (P=0.027). Significant difference was observed in the frequency of fecal incontinence between WP-ESD and conventional ESD (28% vs 0%, P<0.001), but no difference was observed in oral regurgitation or aspiration pneumonia. CONCLUSIONS: Intraoperative fecal incontinence is a unique adverse event of WP-ESD related to the infusion speed. WP-ESD was not a risk of oral regurgitation, but we should be aware of the risk in large tumor cases.

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  9. Preoperative docetaxel, cisplatin, and fluorouracil treatment with pegfilgrastim on day 7 for patients with esophageal cancer: A phase II study. Reviewed International journal

    Osamu Maeda, Masahide Fukaya, Masahiko Koike, Kazushi Miyata, Mitsuro Kanda, Kazuki Nishida, Masahiko Ando, Yasuhiro Kodera, Yuichi Ando

    Asia-Pacific journal of clinical oncology     2022.1

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    AIMS: The docetaxel and cisplatin plus 5-fluorouracil (5-FU) (DCF) regimen is expected to be superior to cisplatin plus 5-FU for the preoperative treatment of esophageal cancer. However, a high risk of adverse effects, including febrile neutropenia (FN), has been reported. To evaluate the effectiveness and safety of DCF with prophylactic pegfilgrastim, we conducted a phase II study. METHODS: The regimen consisted of intravenous administration of docetaxel (70 mg/m2 per day) and cisplatin (70 mg/m2 per day) on day 1 and a continuous infusion of 5-FU (750 mg/m2 per day) on days 1-5. A single 3.6-mg dose of pegfilgrastim was given as a subcutaneous injection on day 7 of each cycle. This regimen was repeated every 3 weeks for a maximum of three cycles. The primary endpoint was the grade-2/3 histopathological response rate. RESULTS: Thirty-seven eligible patients were enrolled and received DCF. Thirty-four patients underwent esophagectomy. Two patients received chemoradiotherapy or radiotherapy without surgery. One patient withdrew consent and ended his hospital visit. One patient received additional radiotherapy before surgery. Histopathological responses of grade 3, grade 2, grade 1b, and grade 1a were observed in two (5.4%), 14 (37.8%), 10 (27.0%), and seven (18.9%) patients, respectively, and the primary endpoint was met. Of the 37 eligible patients, 11 (29.7%) developed FN in the first cycle. CONCLUSIONS: Since the histopathological responses were as expected, DCF with prophylactic pegfilgrastim is considered to be effective as preoperative chemotherapy. However, the prophylactic use of pegfilgrastim on day 7 was insufficient to prevent FN.

    DOI: 10.1111/ajco.13755

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  10. Evaluation of lower extremity gait analysis using Kinect V2® tracking system. International journal

    Takuya Usami, Kazuki Nishida, Hirotaka Iguchi, Taro Okumura, Hiroaki Sakai, Ruido Ida, Mitsuya Horiba, Shuuto Kashima, Kento Sahashi, Hayato Asai, Yuko Nagaya, Hideki Murakami, Yoshino Ueki, Gen Kuroyanagi

    SICOT-J   Vol. 8   page: 27 - 27   2022

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    INTRODUCTION: Microsoft Kinect V2® (Kinect) is a peripheral device of Xbox® and acquires information such as depth, posture, and skeleton definition. In this study, we investigated whether Kinect can be used for human gait analysis. METHODS: Ten healthy volunteers walked 20 trials, and each walk was recorded by a Kinect and infrared- and marker-based-motion capture system. Pearson's correlation and overall agreement with a method of meta-analysis of Pearson's correlation coefficient were used to assess the reliability of each parameter, including gait velocity, gait cycle time, step length, hip and knee joint angle, ground contact time of foot, and max ankle velocity. Hip and knee angles in one gait cycle were calculated in Kinect and motion capture groups. RESULTS: The coefficients of correlation for gait velocity (r = 0.92), step length (r = 0.81) were regarded as strong reliability. Gait cycle time (r = 0.65), minimum flexion angle of hip joint (r = 0.68) were regarded as moderate reliability. The maximum flexion angle of the hip joint (r = 0.43) and maximum flexion angle of the knee joint (r = 0.54) were regarded as fair reliability. Minimum flexion angle of knee joint (r = 0.23), ground contact time of foot (r = 0.23), and maximum ankle velocity (r = 0.22) were regarded as poor reliability. The method of meta-analysis revealed that participants with small hip and knee flexion angles tended to have poor correlations in maximum flexion angle of hip and knee joints. Similar trajectories of hip and knee angles were observed in Kinect and motion capture groups. CONCLUSIONS: Our results strongly suggest that Kinect could be a reliable device for evaluating gait parameters, including gait velocity, gait cycle time, step length, minimum flexion angle of the hip joint, and maximum flexion angle of the knee joint.

    DOI: 10.1051/sicotj/2022027

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  11. Effect of IV High-Dose Vitamin C on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Reviewed International journal

    Ryota Sato, Daisuke Hasegawa, Narut Prasitlumkum, Miki Ueoka, Kazuki Nishida, Kunihiko Takahashi, Michitaka Nasu, Siddharth Dugar

    Critical care medicine   Vol. 49 ( 12 ) page: 2121 - 2130   2021.12

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Ovid Technologies (Wolters Kluwer Health)  

    OBJECTIVES: The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to investigate whether IV high-dose vitamin C improves the short-term mortality of patients with sepsis. DESIGN: This study is a systematic review and meta-analysis of randomized controlled trials. We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for randomized controlled trials that met inclusion criteria. The protocol was registered at the University hospital Medical Information Network Clinical Trials Registry (UMIN000040528). All analyses were presented with the use of random-effects models. The primary outcome was short-term mortality defined as 28-day, 30-day, or in-hospital mortality. PATIENTS: Two authors independently evaluated the following eligibility criteria: 1) randomized controlled trial, 2) patients with sepsis aged ≥18 years, and 3) received intravenous high-dose vitamin C in addition to standard of care, or standard of care alone. Then, two authors independently extracted the selected patient and study characteristics and outcomes from studies that met above eligibility criteria. MEASUREMENTS AND MAIN RESULTS: Eleven randomized controlled trials (n = 1,737 patients) were included in this meta-analysis. High-dose IV vitamin C was not associated with a significantly lower short-term mortality (risk ratio, 0.88; 95% CI, 0.73-1.06; p = 0.18; I2 = 29%) but was associated with a significantly shorter duration of vasopressor use (standardized mean difference, -0.35; 95% CI, -0.63 to -0.07; p < 0.01; I2 = 80%) and a significantly greater decline in the Sequential Organ Failure Assessment score at 72-96 hours (standardized mean difference, -0.20; 95% CI, -0.32 to -0.08; p < 0.01; I2 = 16%). One study reported significant association with hypernatremia, but adverse effects were rare, and high-dose vitamin C is deemed relatively safe. CONCLUSIONS: In this meta-analysis, the use of IV high-dose vitamin C in patients with sepsis was not associated with lower short-term mortality although it was associated with significantly shorter duration of vasopressor use and greater decline in the Sequential Organ Failure Assessment score at 72-96 hours.

    DOI: 10.1097/CCM.0000000000005263

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  12. Prevalence of pulmonary embolism in patients with acute exacerbations of COPD: A systematic review and meta-analysis Reviewed

    Ryota Sato, Daisuke Hasegawa, Kazuki Nishida, Kunihiko Takahashi, Mary Schleicher, Neal Chaisson

    The American Journal of Emergency Medicine   Vol. 50   page: 606 - 617   2021.12

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    DOI: 10.1016/j.ajem.2021.09.041

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  13. The rCAST score is useful for estimating the neurological prognosis in pediatric patients with post-cardiac arrest syndrome before ICU admission: External validation study using a nationwide prospective registry. Reviewed International journal

    Yuma Yasuda, Mitsuaki Nishikimi, Kota Matsui, Atsushi Numaguchi, Kazuki Nishida, Ryo Emoto, Shigeyuki Matsui, Naoyuki Matsuda

    Resuscitation   Vol. 168   page: 103 - 109   2021.11

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    INTRODUCTION: The objective of this cohort study was to investigate whether the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (rCAST), which we previously developed as a prognostic score for adult patients with post-cardiac arrest syndrome (PCAS), is also applicable to pediatric patients. METHODS: Pediatric PCAS patients were included from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM). We validated the predictive accuracy of the rCAST for the neurological outcomes at 30 and 90 days. We also evaluated the probability of a good neurological outcome in each of the three specified severity categories based on the rCAST (low severity: ≤5.5; moderate severity: 6.0-14.0; high severity: ≥14.5). RESULTS: Among the 737 pediatric patients with OHCA, the data of 179 pediatric PCAS patients in whom return of spontaneous circulation was achieved were analyzed. The areas under the curve (AUC) of the rCAST for predicting the neurological outcomes at 30 days and 90 days were 0.95 (95% CI: 0.90-0.99) and 0.96 (0.91-1.00), respectively. The proportions of patients with a good neurological outcome at 30 days were 100% (12/12) in the low severity group, 36.1% (13/36) in the moderate severity group, and 2.3% (3/131) in the high severity group. CONCLUSIONS: The AUC of the rCAST for pediatric PCAS patients was found to be greater than 0.9 in the external validation, which corresponds to excellent predictive accuracy. There was no patient with good neurological outcome among the patients with more than 17.0 points (extremely high severity group).

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  14. Hypofibrinogenemia can be estimated by the predictive formula in aortic surgery Reviewed

    Nishi, Toshihiko, Mutsuga, Masato, Akita, Toshiaki, Narita, Yuji, Fujimoto, Kazuro, Tokuda, Yoshiyuki, Nishida, Kazuki, Matsui, Shigeyuki, Nishiwaki, Kimitoshi, Usui, Akihiko

    General Thoracic and Cardiovascular Surgery   Vol. 69 ( 10 ) page: 1376 - 1382   2021.10

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    OBJECTIVE: Aortic surgery often causes massive bleeding due to hypofibrinogenemia. Predicting hypofibrinogenemia is useful for developing a hemostasis strategy, including preparing for blood transfusion. We made a formula for predicting the serum fibrinogen level (SFL) at the termination of cardiopulmonary bypass (CPB) in aortic surgery and examined its validity. METHODS: We performed a retrospective observational study that consisted of 267 patients (group A) who underwent aortic surgery from July 2013 to December 2016 and made a formula for predicting the SFL at the termination of CPB in group A by a multiple linear regression analysis. The validity of this formula was then examined in another 60 patients (group B) who underwent aortic surgery from January 2017 to December 2017. RESULTS: We developed the following predictive formula: SFL at the termination of CPB (mg/dL) = 14.7 + 0.44 × preoperative SFL (mg/dL) + (- 0.14) × CPB time (min) + 0.64 × preoperative body weight (kg) + (- 17.3) × lateral thoracotomy (Yes/No, Yes: 1, No: 0). In group B, the predictive formula proved to be statistically valid in group B (R2 = 0.531, p < 0.001). CONCLUSION: The SFL at the termination of CPB in aortic surgery can be predicted by the preoperative SFL, body weight, CPB time and surgical approach. The predictive formula is useful for developing a hemostasis strategy, including preparing for blood transfusion.

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  15. Clinical impact of visually assessed right ventricular dysfunction in patients with septic shock. Reviewed International journal

    Hiroaki Hiraiwa, Daisuke Kasugai, Masayuki Ozaki, Yukari Goto, Naruhiro Jingushi, Michiko Higashi, Kazuki Nishida, Toru Kondo, Kenji Furusawa, Ryota Morimoto, Takahiro Okumura, Naoyuki Matsuda, Shigeyuki Matsui, Toyoaki Murohara

    Scientific reports   Vol. 11 ( 1 ) page: 18823 - 18823   2021.9

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    We retrospectively analyzed data from the Medical Information Mart for Intensive Care-III critical care database to determine whether visually-assessed right ventricular (RV) dysfunction was associated with clinical outcomes in septic shock patients. Associations between visually-assessed RV dysfunction by echocardiography and in-hospital mortality, lethal arrhythmia, and hemodynamic indicators to determine the prognostic value of RV dysfunction in patients with septic shock were analyzed. Propensity score analysis showed RV dysfunction was associated with increased risk of in-hospital death in patients with septic shock (adjusted odds ratio [OR] 2.15; 95% confidence interval [CI] 1.99-2.32; P < 0.001). In multivariate logistic regression analysis, RV dysfunction was associated with in-hospital death (OR 2.19; 95% CI 1.91-2.53; P < 0.001), lethal arrhythmia (OR 2.19; 95% CI 1.34-3.57; P < 0.001), and tendency for increased blood lactate levels (OR 1.31; 95% CI 1.14-1.50; P < 0.001) independent of left ventricular (LV) dysfunction. RV dysfunction was associated with lower cardiac output, pulmonary artery pressure index, and RV stroke work index. In patients with septic shock, visually-assessed RV dysfunction was associated with in-hospital mortality, lethal arrhythmia, and circulatory insufficiency independent of LV dysfunction. Visual assessment of RV dysfunction using echocardiography might help to identify the short-term prognosis of patients with septic shock by reflecting hemodynamic status.

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  16. Outcome Related to Level of Targeted Temperature Management in Postcardiac Arrest Syndrome of Low, Moderate, and High Severities: A Nationwide Multicenter Prospective Registry. Reviewed International journal

    Mitsuaki Nishikimi, Takayuki Ogura, Kazuki Nishida, Kei Hayashida, Ryo Emoto, Shigeyuki Matsui, Naoyuki Matsuda, Taku Iwami

    Critical care medicine   Vol. 49 ( 8 ) page: e741 - e750   2021.8

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    OBJECTIVES: The optimal target temperature during targeted temperature management for patients after cardiac arrest remains under debate. The aim of this study was to evaluate the association between targeted temperature management at lower target temperatures and the neurologic outcomes among patients classified by the severity of postcardiac arrest syndrome. DESIGN: A multicenter observational study from the out-of-hospital cardiac arrest registry of the Japanese Association for Acute Medicine, which is a nationwide prospective registry of out-of-hospital cardiac arrest patients. SETTING: A total of 125 critical care medical centers or hospitals with an emergency care department across Japan. PATIENTS: A total of 1,111 out-of-hospital cardiac arrest patients who had received targeted temperature management. MEASUREMENTS AND MAIN RESULTS: We divided all 1,111 postcardiac arrest syndrome patients treated with targeted temperature management into two groups: those who received targeted temperature management at a lower target temperature (33-34°C) and those who received targeted temperature management at a higher target temperature (35-36°C). In regard to classification of the patients, we divided the patients into three categories of severity (low, moderate, and high severities) using the risk classification tool, post-Cardiac Arrest Syndrome for Therapeutic hypothermia, which was previously validated. The primary outcome was the percentage of patients with a good neurologic outcome at 30 days, and the secondary outcome was the survival rate at 30 days. Multivariate analysis showed that targeted temperature management at 33-34°C was significantly associated with a good neurologic outcome and survival at 30 days in the moderate severity (odds ratio, 1.70 [95% CI, 1.03-2.83] and 1.90 [95% CI, 1.15-3.16], respectively), but not in the patients of low or high severity (pinteraction = 0.033). Propensity score analysis also showed that targeted temperature management at 33-34°C was associated with a good neurologic outcome in the moderate-severity group (p = 0.022). CONCLUSIONS: Targeted temperature management at 33-34°C was associated with a significantly higher rate of a good neurologic outcome in the moderate-severity postcardiac arrest syndrome group, but not in the low- or high-severity group.

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  17. Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis. Reviewed International journal

    Daisuke Kasugai, Masayuki Ozaki, Kazuki Nishida, Yukari Goto, Kunihiko Takahashi, Shigeyuki Matsui, Naoyuki Matsuda

    Scientific reports   Vol. 11 ( 1 ) page: 14033 - 14033   2021.7

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    In sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet counts. To estimate the impact of relative platelet reductions and absolute platelet counts on sepsis outcomes. A multicenter retrospective observational study was performed using the eICU Collaborative Research Database, comprising 335 intensive care units (ICUs) in the United States. Patients with sepsis and an ICU stay > 2 days were included. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were evaluated. Overall, 26,176 patients were included. Multivariate mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent from the resultant absolute platelet counts. The adjusted odds ratio (OR) [95% confidence intervals (CI)] for in-hospital mortality was 1.28[1.23-1.32], 1.86[1.75-1.97], 2.99[2.66-3.36], and 6.05[4.40-8.31] for 20-40%, 40-60%, 60-80%, and > 80% reductions, respectively, when compared with a < 20% decrease in platelets (P < 0.001 for each). In the multivariate logistic regression analysis, platelet reductions ≥ 11% and platelet counts ≤ 100,000/μL on day 2 were associated with high coagulopathy-related complications (OR [95%CI], 2.03 and 1.18; P < 0.001 and P < 0.001), while only platelet reduction was associated with thromboembolic complications (OR [95%CI], 1.43 [1.03-1.98], P < 0.001). The magnitude of platelet reductions represent mortality risk and provides a better signature of coagulopathies in sepsis; therefore, it is a plausible criterion for sepsis-associated coagulopathies.

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  18. Usefulness of Respiratory Mechanics and Laboratory Parameter Trends as Markers of Early Treatment Success in Mechanically Ventilated Severe Coronavirus Disease: A Single-Center Pilot Study Reviewed International journal

    Daisuke Kasugai, Masayuki Ozaki, Kazuki Nishida, hiroaki hiraiwa, Naruhiro Jingushi, Atsushi Numaguchi, Norihito Omote, Yuichiro Shindo, Yukari Goto

    Journal of Clinical Medicine   Vol. 10 ( 11 ) page: 2513 - 2513   2021.6

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    Whether a patient with severe coronavirus disease (COVID-19) will be successfully liberated from mechanical ventilation (MV) early is important in the COVID-19 pandemic. This study aimed to characterize the time course of parameters and outcomes of severe COVID-19 in relation to the timing of liberation from MV. This retrospective, single-center, observational study was performed using data from mechanically ventilated COVID-19 patients admitted to the ICU between 1 March 2020 and 15 December 2020. Early liberation from ventilation (EL group) was defined as successful extubation within 10 days of MV. The trends of respiratory mechanics and laboratory data were visualized and compared between the EL and prolonged MV (PMV) groups using smoothing spline and linear mixed effect models. Of 52 admitted patients, 31 mechanically ventilated COVID-19 patients were included (EL group, 20 (69%); PMV group, 11 (31%)). The patients' median age was 71 years. While in-hospital mortality was low (6%), activities of daily living (ADL) at the time of hospital discharge were significantly impaired in the PMV group compared to the EL group (mean Barthel index (range): 30 (7.5-95) versus 2.5 (0-22.5), p = 0.048). The trends in respiratory compliance were different between patients in the EL and PMV groups. An increasing trend in the ventilatory ratio during MV until approximately 2 weeks was observed in both groups. The interaction between daily change and earlier liberation was significant in the trajectory of the thrombin-antithrombin complex, antithrombin 3, fibrinogen, C-reactive protein, lymphocyte, and positive end-expiratory pressure (PEEP) values. The indicator of physiological dead space increases during MV. The trajectory of markers of the hypercoagulation status, inflammation, and PEEP were significantly different depending on the timing of liberation from MV. These findings may provide insight into the pathophysiology of COVID-19 during treatment in the critical care setting.

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  19. The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation: A systematic review and meta-analysis Reviewed International journal

    Sato, Ryota, Hasegawa, Daisuke, Hamahata, Natsumi T., Narala, Swetha, Nishida, Kazuki, Takahashi, Kunihiko, Sempokuya, Tomoki, Daoud, Ehab G.

    Journal of Critical Care   Vol. 63   page: 124 - 132   2021.6

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    PURPOSE: The predictive value of airway occlusion pressure at 100 milliseconds (P0.1) on weaning outcome has been controversial. We performed a meta-analysis to investigate the predictive value of P0.1 on successful weaning from mechanical ventilation. MATERIALS AND METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, and two authors independently screened articles. The pooled sensitivity, specificity and the summary receiver operating characteristic (sROC) curve were estimated. Diagnostic odds ratio (DOR) was calculated using meta-regression analysis. RESULTS: We included 12 prospective observational studies (n = 1089 patients). Analyses of sROC curves showed the area under the curve of 0.81 (95% confidence interval (CI): 0.77 to 0.84) for P0.1. The pooled sensitivity and specificity were 86% (95% CI, 72 to 94%) and 58% (95% CI, 37% to 76%) with substantial heterogeneity respectively. DOR was 20.09 (p = 0.019, 95%CI: 1.63-247.15). After filling the missing data using the trim-and-fill method to adjust publication bias, DOR was 36.23 (p = 0.002, 95%CI: 3.56-372.41). CONCLUSION: This meta-analysis suggests that P0.1 is a useful tool to predict successful weaning. To determine clinical utility, a large prospective study investigating the sensitivity and specificity of P0.1 on weaning outcomes from mechanical ventilation is warranted.

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  20. Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Reviewed International journal

    Daisuke Hasegawa, Ryota Sato, Narut Prasitlumkum, Kazuki Nishida, Kunihiko Takahashi, Tomoaki Yatabe, Osamu Nishida

    Chest   Vol. 159 ( 6 ) page: 2289 - 2300   2021.6

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    BACKGROUND: Historically, β-blockers have been considered to be relatively contraindicated for septic shock because they may cause cardiac suppression. On the other hand, there is an increasing interest in the use of β-blockers for treating patients with sepsis with persistent tachycardia despite initial resuscitation. RESEARCH QUESTION: Do ultrashort-acting β-blockers such as esmolol and landiolol improve mortality in patients with sepsis with persistent tachycardia despite initial resuscitation? STUDY DESIGN AND METHODS: This was a systematic review and meta-analysis. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with esmolol or landiolol. We updated our search on April 20, 2020. Two independent reviewers assessed whether titles and abstracts met the following eligibility criteria: (1) RCT, (2) patients with sepsis and septic shock ≥ 18 years of age, and (3) treatment with either esmolol/landiolol or placebo/no interventions. Two authors independently extracted selected patient and study characteristics and outcomes. The results of all analyses are presented using random effect models. RESULTS: Seven RCTs with a pooled sample size of 613 patients were included. Of these, six RCTs with 572 patients reported 28-day mortality. Esmolol or landiolol use in patients with sepsis and septic shock was significantly associated with lower 28-day mortality (risk ratio, 0.68; 95% CI, 0.54-0.85; P < .001). Unimportant heterogeneity was observed (I2 = 31%). The absolute risk reduction and number of patients to be treated to prevent one death were 18.2% and 5.5, respectively. INTERPRETATION: The use of ultrashort-acting β-blockers such as esmolol and landiolol in patients with sepsis with persistent tachycardia despite initial resuscitation was associated with significantly lower 28-day mortality. TRIAL REGISTRY: UMIN Clinical Trials Registry; No.: UMIN000040174; URL: https://www.umin.ac.jp/ctr/index.htm.

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  21. Banding with lesser trochanter fragment using nonabsorbable tape in trochanteric femoral fractures Reviewed International journal

    Takuya Usami, Naoya Takada, Kazuki Nishida, Hiroaki Sakai, Hidetoshi Iwata, Isato Sekiya, Yoshino Ueki, Hideki Murakami, Gen Kuroyanagi

    SICOT-J   Vol. 7   page: 33 - 33   2021.5

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    INTRODUCTION: Trochanteric femoral fracture is one of the most common fractures in the elderly. Trochanteric femoral fracture with involvement of the lesser trochanter is considered unstable and recognized as having a poor prognosis. However, fixation of lesser trochanter fragment is scarce because of technical difficulties. In this study, we reported the simple surgical procedure and the effect of using nonabsorbable tape in lesser trochanter fixation. METHODS: From January 2014 to December 2017, 114 patients treated with proximal intramedullary nailing for trochanteric fractures with the lesser trochanter fragment were reviewed. Among patients enrolled in this study, 73 were followed up until radiographic bone union, of which 26 were treated with lesser trochanter fragment banding (group B) and 47 without banding (group N). Radiographs and/or computed tomography images were used to evaluate bone union of the lesser trochanter fragment at three months postoperatively. RESULTS: The bone union of the lesser trochanter fragment was achieved in 24 cases (92%) in group B and 30 cases (64%) in group N. Compared with group N, group B showed a significantly increased number of mild and moderate deformities but decreased number of severe deformity and nonunion (P < 0.001). Postoperative complications were not observed in both groups. CONCLUSIONS: From the viewpoint of increasing lesser trochanteric bone union ratio, fixation of the lesser trochanter fragment using nonabsorbable tape in the treatment of trochanteric fractures could be an effective procedure.

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  22. Failure of non-invasive respiratory support after 6 hours from initiation is associated with ICU mortality Reviewed International journal

    Nishikimi, M., Nishida, K., Shindo, Y., Shoaib, M., Kasugai, D., Yasuda, Y., Higashi, M., Numaguchi, A., Yamamoto, T., Matsui, S., Matsuda, N.

    PLoS ONE   Vol. 16 ( 4 ) page: e0251030   2021

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    A previous study has shown that late failure (> 48 hours) of high-flow nasal cannula (HFNC) was associated with intensive care unit (ICU) mortality. The aim of this study was to investigate whether failure of non-invasive respiratory support, including HFNC and non-invasive positive pressure ventilation (NPPV), was also associated with the risk of mortality even if it occurs in the earlier phase. We retrospectively analyzed 59 intubated patients for acute respiratory failure due to lung diseases between April 2014 and June 2018. We divided the patients into 2 groups according to the time from starting non-invasive ventilatory support until their intubation: ≤ 6 hours failure and > 6 hours failure group. We evaluated the differences in the ICU mortality between these two groups. The multivariate logistic regression analysis showed the highest mortality in the > 6 hours failure group as compared to the ≤ 6 hours failure group, with a statistically significant difference (p < 0.01). It was also associated with a statistically significant increased 30-day mortality and decreased ventilator weaning rate. The ICU mortality in patients with acute respiratory failure caused by lung diseases was increased if the time until failure of HFNC and NPPV was more than 6 hours.

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  23. Endocytoscopy Is Useful for the Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors. Reviewed International journal

    Takashi Hirose, Naomi Kakushima, Kazuhiro Furukawa, Satoshi Furune, Eri Ishikawa, Tsunaki Sawada, Keiko Maeda, Takeshi Yamamura, Takuya Ishikawa, Eizaburo Ohno, Masanao Nakamura, Kazuki Nishida, Takio Yokoi, Hiroki Kawashima, Mitsuhiro Fujishiro

    Digestion   Vol. 102 ( 6 ) page: 895 - 902   2021

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    INTRODUCTION: Endoscopic criteria for the diagnosis of superficial nonampullary duodenal epithelial tumors (SNADETs) are lacking. The aim of this study was to explore the usefulness of endocytoscopy (ECS) in the duodenum. METHODS: A total of 77 ECS images stained by methylene blue and 58 images with double staining of methylene blue and crystal violet were obtained from 20 patients. Images were classified into 3 grades based on nuclear and villi atypia: EC A, B, and C. Diagnostic performance of ECS classification to predict histology and interobserver agreement was evaluated. The performance was compared between staining methods and ×520 or ×936 zoom. RESULTS: With methylene blue staining, high rates of accuracy, sensitivity, specificity, and positive predictive value (PPV) over 90% were achieved for tumor and nontumor diagnosis as assessed by EC A versus EC B. High rates of accuracy, sensitivity, PPV, and negative predictive value over 90% were achieved for the differentiation between the diagnosis of the Vienna category 3 and 4/5 as assessed by EC B versus C. The accuracy rate of interpreting ECS images with ×936 zoom among 10 endoscopists was 82%, and the interobserver agreement rate was 0.803 (Kendall's coefficient of concordance). In the ×936 zoom group, methylene blue staining was significantly associated with higher accuracy rate (odds ratio 1.76 [1.06-2.92], p value 0.0297). No benefit was observed by double staining. CONCLUSIONS: ECS diagnosis with methylene blue provides a high accuracy rate and good interobserver agreement to predict histology of SNADETs.

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  24. Maximum Norepinephrine Dosage Within 24 Hours as an Indicator of Refractory Septic Shock: A Retrospective Study Reviewed International journal

    Kasugai, Daisuke, Hirakawa, Akihiko, Ozaki, Masuyuki, Nishida, Kazuki, Ikeda, Takao, Takahashi, Kunihiko, Matsui, Shigeyuki, Uenishi, Norimichi

    Journal of Intensive Care Medicine   Vol. 35 ( 11 ) page: 1285 - 1289   2020.11

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    BACKGROUND: The management of refractory septic shock remains a major challenge in critical care and its early indicators are not fully understood. We hypothesized that the maximum norepinephrine dosage within 24 hours of intensive care unit (ICU) admission may be a useful indicator of early mortality in patients with septic shock. METHODS: In this retrospective single-center observational study, patients with septic shock admitted to the emergency ICU of an academic medical center between April 2011 and March 2017 were included. Individuals with cardiac arrest and those with do-not-resuscitate orders before admission were excluded. We analyzed if the maximum norepinephrine dosage within 24 hours of ICU admission (MD24) was associated with 7-day mortality. RESULTS: Among 152 patients with septic shock, 20 (15%) did not survive by day 7. The receiver operating characteristic curve analysis for predicting 7-day mortality revealed a cutoff of MD24 of 0.6 μg/kg/min (sensitivity 47%, specificity 93%). In the multivariable regression analysis, a higher MD24 was significantly associated with 7-day mortality (odds ratio: 7.20; 95% confidence interval [CI]: 2.02-25.7; P = .002) but not with 30-day mortality. Using the inverse probability of treatment weighting method in a propensity scoring analysis, a higher MD24 was significantly associated with 7-day (hazard ratio [HR]: 8.9; 95% CI: 3.2-25.0; P < .001) and 30-day mortality (HR: 2.7; 95% CI: 1.2-5.8; P = .012). CONCLUSIONS: An MD24 ≥0.6 μg/kg/min was significantly associated with 7-day mortality in patients with septic shock and may therefore be a useful indicator of refractory septic shock.

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  25. Impact of Blood Type O on Mortality of Sepsis Patients: A Multicenter Retrospective Observational Study Reviewed International journal

    Hasegawa, Daisuke, Nishida, Kazuki, Kawaji, Takahiro, Hara, Yoshitaka, Shimomura, Yasuyo, Moriyama, Kazuhiro, Niimi, Daisuke, Kuriyama, Naohide, Shintani, Ayumi, Komura, Hidefumi, Nishida, Osamu

    Diagnostics   Vol. 10 ( 10 ) page: 826 - 826   2020.10

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    ABO blood groups have been implicated as potential risk factors for various diseases. However, no study has investigated the association between sepsis mortality and ABO blood types. We aimed to evaluate the impact of these blood types on mortality in patients with sepsis and septic shock. This retrospective observational study was conducted at two general hospitals in Japan. Patients diagnosed with sepsis or septic shock were included and divided into four groups based on blood type (O, A, B, and AB). The association between type O vs. other types and 28- and 90-day mortalities was evaluated using multivariate logistic regression analysis adjusted for age, sex, and Sequential (Sepsis-related) Organ Failure Assessment score. This study included 415 patients, of whom 131 (31.6%), 171 (41.2%), 81 (19.5%), and 32 (7.7%) had type O, A, B, and AB, respectively. Blood type O was not associated with 28-day (odds ratio: 1.7 p = 0.08) or 90-day mortality (odds ratio: 1.53, p = 0.091). However, type O was significantly associated with higher 90-day mortality (odds ratio: 3.26, p = 0.009) in patients with septic shock. The role of ABO blood type in risk stratification for septic shock and the mechanisms that potentially affect the prognosis of sepsis patients need further investigation.

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  26. Comparative Analysis of Three Machine-Learning Techniques and Conventional Techniques for Predicting Sepsis-Induced Coagulopathy Progression Reviewed International journal

    Hasegawa, Daisuke, Yamakawa, Kazuma, Nishida, Kazuki, Okada, Naoki, Murao, Shuhei, Nishida, Osamu

    Journal of Clinical Medicine   Vol. 9 ( 7 ) page: 2113 - 2113   2020.7

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    Sepsis-induced coagulopathy has poor prognosis; however, there is no established tool for predicting it. We aimed to create predictive models for coagulopathy progression using machine-learning techniques to evaluate predictive accuracies of machine-learning and conventional techniques. A post-hoc subgroup analysis was conducted based on the Japan Septic Disseminated Intravascular Coagulation retrospective study. We used the International Society on Thrombosis and Haemostasis disseminated intravascular coagulation (DIC) score to calculate the ΔDIC score as ((DIC score on Day 3) - (DIC score on Day 1)). The primary outcome was to determine whether the predictive accuracy of ΔDIC was more than 0. The secondary outcome was the actual predictive accuracy of ΔDIC (predicted ΔDIC-real ΔDIC). We used the machine-learning methods, such as random forests (RF), support vector machines (SVM), and neural networks (NN); their predictive accuracies were compared with those of conventional methods. In total, 1017 patients were included. Regarding DIC progression, predictive accuracy of the multiple linear regression, RF, SVM, and NN models was 63.7%, 67.0%, 64.4%, and 59.8%, respectively. The difference between predicted ΔDIC and real ΔDIC was 2.05, 1.54, 2.24, and 1.77 for the multiple linear regression, RF, SVM, and NN models, respectively. RF had the highest predictive accuracy.

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  27. EFFECT OF SUSTAINED HIGH-EFFICIENCY DAILY DIAFILTRATION USING A MEDIATOR-ADSORBING MEMBRANE ON 28-DAY MORTALITY IN SEPTIC SHOCK PATIENTS Reviewed International journal

    Hasegawa Daisuke, Nishida Kazuki, Kasugai Daisuke, Kawaji Takahiro, Moriyama Kazuhiro, Nishida Osamu

    SHOCK   Vol. 53   page: 31 - 32   2020.6

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  28. High-flow nasal cannula therapy for acute respiratory failure in patients with interstitial pneumonia: a retrospective observational study Reviewed

    Omote, Norihito, Matsuda, Naoyuki, Hashimoto, Naozumi, Nishida, Kazuki, Sakamoto, Koji, Ando, Akira, Nakahara, Yoshio, Nishikimi, Mitsuaki, Higashi, Michiko, Matsu, Shigeyuki, Hasegawa, Yoshinori

    Nagoya Journal of Medical Science   Vol. 82 ( 2 ) page: 301 - 313   2020.5

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    High-flow nasal cannula (HFNC) oxygen is a therapy that has demonstrated survival benefits in acute respiratory failure (ARF). However, the role of HFNC in ARF due to interstitial pneumonia (IP) is unknown. The aim of this study was to compare the effects of HFNC therapy and non-invasive positive pressure ventilation (NPPV) in ARF due to IP. This retrospective observational study included 32 patients with ARF due to IP who were treated with HFNC (n = 13) or NPPV (n = 19). The clinical characteristics, intubation rate and 30-day mortality were analyzed and compared between the HFNC group and the NPPV group. Predictors of 30-day mortality were evaluated using a logistic regression model. HFNC group showed higher mean arterial blood pressure (median 92 mmHg; HFNC group vs 74 mmHg; NPPV group) and lower APACHEII score (median 22; HFNC group vs 27; NPPV group) than NPPV group. There was no significant difference in the intubation rate at day 30 between the HFNC group and the NPPV group (8% vs 37%: p = 0.069); the mortality rate at 30 days was 23% and 63%, respectively. HFNC therapy was a significant determinant of 30-day mortality in univariate analysis, and was confirmed to be an independent significant determinant of 30-day mortality in multivariate analysis (odds ratio, 0.148; 95% confidence interval, 0.025-0.880; p = 0.036). Our findings suggest that HFNC therapy can be a possible option for respiratory management in ARF due to IP. The results observed here warrant further investigation of HFNC therapy in randomized control trials.

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  29. Relationship Between Serum Norepinephrine Levels at ICU Admission and the Risk of ICU-Acquired Delirium: Secondary Analysis of the Melatonin Evaluation of Lowered Inflammation of ICU Trial. Reviewed International journal

    Yuma Yasuda, Mitsuaki Nishikimi, Kazuki Nishida, Kunihiko Takahashi, Atsushi Numaguchi, Michiko Higashi, Shigeyuki Matsui, Naoyuki Matsuda

    Critical care explorations   Vol. 2 ( 2 ) page: e0082   2020.2

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    Abnormal secretion of catecholamines is well known to cause delirium. In particular, disturbances of catecholamine balance can cause ICU-acquired delirium. The aim of this study was to evaluate the association between the serum levels of catecholamines and the risk of occurrence of ICU-acquired delirium separately in patients who had/had not received exogenous catecholamines before ICU admission. Design:A secondary analysis of the data of 81 patients enrolled in our previous randomized clinical trial. Setting:ICU of an academic hospital. Patients:ICU patients in whom the serum levels of catecholamines were measured at ICU admission. Interventions:None. Measurements and Main Results:We evaluated the association between the serum levels of catecholamines measured at ICU admission and the risk of ICU-acquired delirium separately in patients who had received exogenous catecholamines at ICU admission (Ex[+] group) and those who had not received exogenous catecholamines (Ex[-] group). The serum levels of norepinephrine measured at ICU admission were significantly associated with the risk of ICU-acquired delirium in the Ex(-) group (odds ratio, 2.58; 95% CI, 1.02-6.52; p = 0.046), but not in the Ex(+) group (odds ratio, 1.02; 95% CI, 0.88-1.18; p = 0.823). Furthermore, there was a statistically significant interaction effect between the serum levels of norepinephrine and the use/nonuse of exogenous catecholamines at ICU admission in relation to the risk of occurrence of ICU-acquired delirium (p interaction = 0.017). Conclusions:The serum levels of norepinephrine measured at admission were associated with the risk of occurrence of ICU-acquired delirium in patients who had not received exogenous catecholamines at ICU admission, whereas no such association was observed in those who had received exogenous catecholamines previously. Thus, the association between the serum levels of catecholamines measured at admission and the risk of ICU-acquired delirium differed between patients who had/had not received exogenous catecholamines at ICU admission.

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  30. Galapagosization of sepsis management in Japan: a nationwide survey of current practices Reviewed International journal

    Yamakawa, Kazuma, Hasegawa, Daisuke, Yasuda, Hideto, Sakamoto, So, Nishida, Kazuki, Yatabe, Tomoaki, Egi, Moritoki, Ogura, Hiroshi, Nishida, Osamu

    Acute Medicine & Surgery   Vol. 7 ( 1 ) page: e561   2020

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  31. EFFECT OF SUSTAINED HIGH-EFFICIENCY DAILY DIAFILTRATION USING A MEDIATOR-ADSORBING MEMBRANE ON 28-DAY MORTALITY IN SEPTIC SHOCK PATIENTS

    Hasegawa, Daisuke, Nishida, Kazuki, Kasugai, Daisuke, Kawaji, Takahiro, Moriyama, Kazuhiro, Nishida, Osamu

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  32. Clinical Frailty Scale Score Before ICU Admission Is Associated With Mobility Disability in Septic Patients Receiving Early Rehabilitation. Reviewed International journal

    Hiroki Nakajima, Mitsuaki Nishikimi, Miho Shimizu, Kazuhiro Hayashi, Takayuki Inoue, Kazuki Nishida, Kunihiko Takahashi, Shigeyuki Matsui, Yoshihiro Nishida, Naoyuki Matsuda

    Critical care explorations   Vol. 1 ( 12 ) page: e0066   2019.12

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    To clarify the relationship between mobility disability at the time of discharge from the ICU and clinical factors evaluated at ICU admission in septic patients. Design: A single-center, retrospective, observational study. Setting: Ten-bed, the emergency and medical ICU. Patients: We analyzed the data of septic patients who were admitted to our ICU between September 2012 and September 2016 and received early rehabilitation. Interventions: None. Measurements and Main Results: The patients were categorized into two groups based on their scores on the ICU mobility scale at the time of discharge from the ICU: the mobility disability group (ICU mobility scale score < 9) and the no mobility disability group (ICU mobility scale score ≥ 9). Of the 110 eligible patients, 63 met the inclusion criteria; of these, 46 patients (73%) were classified into the mobility disability group, and 17 patients (27%) were classified into the no mobility disability group. The age (median, 72 vs 64 yr; p = 0.024), prevalence of patients with clinical frailty scale scores of greater than or equal to 5 (54% vs 12%; p = 0.003), Sequential Organ Failure Assessment score (median, 9.0 vs 6.0; p = 0.006) and rate of vasopressin use (26% vs 0%; p = 0.026) were significantly higher in the mobility disability group as compared with the no mobility disability group. Among the candidate variables for which values recorded before/at the time of ICU admission were available, the clinical frailty scale score was identified as the only independent, statistically significant predictor of mobility disability at ICU discharge (odds ratio, 7.77; 95% CI, 1.37-44.21; p = 0.021). The positive predictive value and negative predictive value of clinical frailty scale scores greater than or equal to 5 for mobility disability at ICU discharge were 92.6% and 41.7%, respectively. Conclusions: The clinical frailty scale score was associated with increased mobility disability at ICU discharge in septic patients receiving early rehabilitation.

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  33. Clinical features and treatment outcome of desmoid-type fibromatosis: based on a bone and soft tissue tumor registry in Japan Reviewed

    Nishida, Yoshihiro, Kawai, Akira, Toguchida, Junya, Ogose, Akira, Ae, Keisuke, Kunisada, Toshiyuki, Matsumoto, Yoshihiro, Matsunobu, Tomoya, Takahashi, Kunihiko, Nishida, Kazuki, Ozaki, Toshifumi

    International Journal of Clinical Oncology   Vol. 24 ( 11 ) page: 1498 - 1505   2019.11

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    BACKGROUND: Treatment modality of desmoid-type fibromatosis (DF) has changed from surgery with a wide surgical margin to conservative treatment. In this study, tumor characteristics of DF, transition of the treatment modality, and clinical outcome of surgical treatment were analyzed based on data obtained from the bone and soft tissue tumor registry established in Japan. METHODS: Data were collected as registration data and follow-up data. Five hundred and thirty registered cases of DF were identified, including 223 cases with follow-up data with or without surgical treatment. RESULTS: The number of registered patients increased gradually. The frequency of surgical treatment was gradually reduced year by year. The 3-year local recurrence free survival (LRFS) was 77.7%, with tumor location and size tending to correlate with LRFS. Interestingly, there was no significant difference in LRFS between wide and marginal margin (P = 0.34). CONCLUSIONS: The treatment modality has shifted from surgical to conservative treatment, with risk factors for surgical treatment similar to those noted in previous studies. The National registry system is crucial for a rare disease such as DF, and in the future, a population based registry system should be established to better comprehend the actual status of DF.

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  34. Steeper Macular Curvature in Eyes With Non-Highly Myopic Retinitis Pigmentosa Reviewed International journal

    Komori, Shiori, Ueno, Shinji, Ito, Yasuki, Sayo, Akira, Meinert, Monika, Kominami, Taro, Inooka, Daiki, Kitagawa, Masahiro, Nishida, Kazuki, Takahashi, Kunihiko, Matsui, Shigeyuki, Terasaki, Hiroko

    Investigative Ophthalmology & Visual Science   Vol. 60 ( 8 ) page: 3135 - 3141   2019.7

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    Purpose: A posterior staphyloma has been reported to be present in some eyes with retinitis pigmentosa (RP), and the purpose of this study was to determine the macular curvature of non-highly myopic RP eyes. Methods: This was a retrospective, observational study. The medical charts of the right eyes of 143 patients with RP and 60 controls whose axial length ranged from 21.5 mm to 26.0 mm were reviewed. The mean curvature of Bruch's membrane within 6 mm of the central macula obtained from the horizontal optical coherence tomographic images were evaluated as the mean macular curvature index (MMCI). The relationships between the MMCI and other clinical factors were assessed. Results: The mean MMCI of RP patients (-13.73 ± 9.63 × 10-5 μm-1) was significantly lower than that of the controls (-6.63 ± 5.63 × 10-5 μm-1). This indicated a deeper concave shape of the macula in RP eyes (P < 0.001). The MMCI was significantly correlated with the age (r = 0.20; P = 0.016) and the axial length (r = -0.24; P = 0.004). Further analysis suggested a nonlinear effect of the ellipsoid zone width on the macular curvature in the RP eyes. Conclusions: There is a high incidence of steeper macular curvatures even in non-highly myopic RP eyes, and the steepness was also affected by the degree of photoreceptor degeneration.

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  35. External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management Reviewed International journal

    Nishikimi, Mitsuaki, Ogura, Takayuki, Nishida, Kazuki, Takahashi, Kunihiko, Nakamura, Mitsunobu, Matsui, Shigeyuki, Matsuda, Naoyuki, Iwami, Taku

    Resuscitation   Vol. 140   page: 135 - 141   2019.7

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    INTRODUCTION: There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score" (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it. METHODS: For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33-36 °C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days. RESULTS: Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95% CI: 0.92-0.98) and 0.47 (0.40-0.55) for the low (rCAST: ≤5.5), 0.62 (0.56-0.68) and 0.48 (0.40-0.55) for the moderate (rCAST: 6.0-14.0), and 0.57 (0.51-0.63) and 0.95 (0.91-0.98) for the high severity category (rCAST: ≥14.5). CONCLUSIONS: The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.

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  36. Differential effect of lactate in predicting mortality in septic patients with or without disseminated intravascular coagulation: a multicenter, retrospective, observational study (vol 7, 2, 2019) Reviewed International journal

    Hasegawa, Daisuke, Nishida, Kazuki, Hara, Yoshitaka

    Journal of Intensive Care   Vol. 7 ( 1 ) page: 2 - 2   2019

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    Background: We examined whether high lactate level in septic patients was associated with 90-day mortality based on the patients' disseminated intravascular coagulation (DIC) status. Methods: We conducted a multicenter, retrospective, observational study of patients admitted to the intensive care unit (ICU) with a suspicion of severe infection and diagnosed with sepsis. Regression analyses were performed to estimate the interaction effect between DIC status and the lactate level. Then, the association between the lactate level and 90-day mortality was assessed in the DIC and non-DIC subgroups. Results: The data of 415 patients were analyzed. We found a significant interaction between DIC status and the lactate level for predicting 90-day mortality (p interaction = 0.04). Therefore, we performed a subgroup analysis and found that high lactate concentration was significantly associated with 90-day mortality in the DIC group (odds ratio = 2.31, p = 0.039) but not in the non-DIC group. Conclusions: In patients with DIC, a high lactate level significantly predicted 90-day mortality; no such association was found in the non-DIC group. Thus, DIC status may serve as a possible effect modifier of lactate level in predicting mortality in patients with sepsis.

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  37. Timing of administration of epinephrine predicts the responsiveness to epinephrine in norepinephrine-refractory septic shock: a retrospective study Reviewed

    Kasugai, Daisuke, Nishikimi, Mitsuaki, Nishida, Kazuki, Higashi, Michiko, Yamamoto, Takanori, Numaguchi, Atsushi, Takahashi, Kunihiko, Matsui, Shigeyuki, Matsuda, Naoyuki

    Journal of Intensive Care   Vol. 7 ( 1 ) page: 20 - 20   2019

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    Background:Currently, the appropriate method of management of patients with refractory septic shock remains unclear. This study aimed to evaluate the factors associated with response to epinephrine in norepinephrine-refractory septic shock. Methods:A retrospective single-center observational study was performed using data from adult patients (≥ 18 years old) admitted to our emergency and medical intensive care unit (ICU) from January 2014 to December 2017 who had received epinephrine to treat norepinephrine-refractory septic shock. The response was considered positive if there was increase in mean arterial pressure of 10 mmHg or decrease in arterial lactate level 3 h after epinephrine administration. Results:Forty-one patients were included: 24 responders (59%) and 17 non-responders (41%). Responders showed higher rate of survival from shock (92% vs. 18%; P < 0.001), and 28-day survival (83% vs. 18%; P < 0.001). In multivariable analysis, time of epinephrine administration after ICU admission (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.27-0.87; P = 0.011) and SOFA score (OR 0.19; 95% CI 0.04-0.88; P = 0.034) were associated with epinephrine response. Time of epinephrine administration was also significantly associated with survival from shock (OR 0.42; P = 0.005) and 28-day survival (OR 0.14; P = 0.006), while SOFA score did not. Using inverse probability of treatment weighing (IPTW) adjustment of propensity score, epinephrine administration later than 24 h after ICU admission was associated with poor response (OR 0.07; 95% CI 0.02-0.21; P < 0.001). Conclusions:Early administration of epinephrine after ICU admission (i.e., within 24 h) is associated with better hemodynamic status in patients with refractory septic shock.

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  38. Differential Effects of Mild Therapeutic Hypothermia Against Normothermia for Post-Cardiac Arrest Syndrome According to the Severity Scale

    Nishikimi, Mitsuaki, Ogura, Takayuki, Nishida, Kazuki, Iwami, Taku

    Circulation     2019

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  39. Treatment of patients with sepsis in a closed intensive care unit is associated with improved survival: a nationwide observational study in Japan. Reviewed International journal

    Takayuki Ogura, Yoshihiko Nakamura, Kunihiko Takahashi, Kazuki Nishida, Daisuke Kobashi, Shigeyuki Matsui

    Journal of intensive care   Vol. 6 ( 1 ) page: 57 - 57   2018.9

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    Background: The aim of this study is to investigate the association between treatment in a closed ICU and survival at discharge in patients with sepsis. Methods: This is a post hoc analysis utilizing data from the Japan Septic Disseminated Intravascular Coagulation study, including data from patients with sepsis from 2011 to 2013. Multiple logistic regression analysis was used to estimate the association between ICU policy and survival at discharge, and propensity score matching analysis was performed including the same covariates as a sensitivity analysis. Multiple linear regression analysis for the length of ICU stay in surviving patients was also performed with adjustments for the same covariates. Results: Two thousand four hundred ninety-five patients were analyzed. The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 22 [17-29], the median Sequential Organ Failure Assessment (SOFA) score was 9 [7-12], and the overall mortality was 33%. There were 979 patients treated in 17 open ICUs and 1516 patients in 18 closed ICUs. In comparison, the APACHE II score and SOFA scores were significantly higher in patients in closed ICUs (closed vs open = 23 [18-29] vs 21 [16-28]; p < .001, 9 [7-13] vs 9 [6-12]; p = 0.004). There was no difference in the unadjusted mortality (closed vs open; 33.1% vs 33.2%), but in multiple logistic regression analysis, treatment in a closed ICU is significantly associated with survival at discharge (odds ratio = 1.59, 95% CI [1.276-1.827], p = .001). The sensitivity analysis (702 pairs of the matching) showed a significantly higher survival rate in the closed ICU (71.8% vs 65.2%, p = 0.011). The length of ICU stay of patients in closed ICUs was significantly shorter (20% less). Conclusion: This Japanese nationwide analysis of patients with sepsis shows a significant association between treatment in a closed ICU and survival at discharge, and a 20% decrease in ICU stay.

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  40. Differential effect of mild therapeutic hypothermia depending on the findings of hypoxic encephalopathy on early CT images in patients with post-cardiac arrest syndrome. Reviewed International journal

    Mitsuaki Nishikimi, Takayuki Ogura, Kazuki Nishida, Kunihiko Takahashi, Kenji Fukaya, Keibun Liu, Mitsunobu Nakamura, Shigeyuki Matsui, Naoyuki Matsuda

    Resuscitation   Vol. 128   page: 11 - 15   2018.7

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    INTRODUCTION: The aim of this study was to evaluate the differential effects of mild therapeutic hypothermia (MTH) in post-cardiac arrest syndrome (PCAS) patients depending on the presence/absence of hypoxic encephalopathy (HE) in the early brain CT images obtained before the initiation of MTH. METHODS: We conducted a retrospective review of the data of a total of 129 patients with PCAS who were treated by MTH (34 °C) or normothermia treatment (NT) (35 °C or 36 °C), and had undergone brain CT examination prior to the initiation of these treatments. We divided the subjects into 4 groups, namely, the HE(-)/MTH, HE(-)/NT, HE(+)/MTH, and HE(+)/NT groups, for evaluating the interaction effect between the two variables. Then, we compared the neurological outcomes between the HE(-)/MTH and HE(-)/NT groups by multivariate logistic analysis. Good outcome was defined as a Cerebral Performance Category score of ≤2 at 30 days. RESULTS: The percentages of subjects with a good outcome in the HE(-)/MTH and HE(-)/NT group were 68.9% (42/61) and 36.1% (13/36), respectively (p = .003), while those in the HE(+)/MTH and HE(+)/NT groups were lower, at 7.4% (2/27) and 20.0% (1/5), respectively (p = .410), suggesting a statistically significant interaction effect between the two variables (pinteraction = 0.002). In the HE(-) group, MTH was associated with a higher odds ratio of a good outcome as compared to NT (OR 6.80, 95% CI 1.19-38.96, p = .031). CONCLUSIONS: The effect of MTH in patients with PCAS differed depending on the presence/absence of evidence of HE on the early CT images.

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  41. Global overexpression of divalent metal transporter 1 delays crocidolite-induced mesothelial carcinogenesis in male mice Reviewed International journal

    Funahashi, Satomi, Okazaki, Yasumasa, Nishiyama, Takahiro, Ohyoshi, Hidekazu, Yasui, Hiroyuki, Nishida, Kazuki, Matsui, Shigeyuki, Toyokuni, Shinya

    Free Radical Research   Vol. 52 ( 9 ) page: 1030 - 1039   2018

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    Exposure to asbestos fiber is central to mesothelial carcinogenesis, for which iron overload in or near mesothelial cells is a key pathogenic mechanism. Alternatively, iron chelation therapy with deferasirox or regular phlebotomy was significantly preventive against crocidolite-induced mesothelial carcinogenesis in rats. However, the role of iron transporters during asbestos-induced carcinogenesis remains elusive. Here, we studied the role of divalent metal transporter 1 (DMT1; Slc11a2), which is a Fe(II) transporter, that is present not only on the apical plasma membrane of duodenal cells but also on the lysosomal membrane of every cell, in crocidolite-induced mesothelial carcinogenesis using DMT1 transgenic (DMT1Tg) mice. DMT1Tg mice show mucosal block of iron absorption without cancer susceptibility under normal diet. We unexpectedly found that superoxide production was significantly decreased upon stimulation with crocidolite both in neutrophils and macrophages of DMT1Tg mice, and the macrophage surface revealed higher iron content 1 h after contact with crocidolite. Intraperitoneal injection of 3 mg crocidolite ultimately induced malignant mesothelioma in ∼50% of both wild-type and DMT1Tg mice (23/47 and 14/28, respectively); this effect was marginally (p = 0.069) delayed in DMT1Tg mice, promoting survival. The promotional effect of nitrilotriacetic acid was limited, and the liver showed significantly higher iron content both in DMT1Tg mice and after crocidolite exposure. The results indicate that global DMT1 overexpression causes decreased superoxide generation upon stimulation in inflammatory cells, which presumably delayed the promotional stage of crocidolite-induced mesothelial carcinogenesis. DMT1Tg mice with low-stamina inflammatory cells may be helpful to evaluate the involvement of inflammation in various pathologies.

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  42. Longitudinal study of visual field changes determined by Humphrey Field Analyzer 10-2 in patients with Retinitis Pigmentosa. Reviewed International journal

    Akira Sayo, Shinji Ueno, Taro Kominami, Kazuki Nishida, Daiki Inooka, Ayami Nakanishi, Shunsuke Yasuda, Satoshi Okado, Kunihiko Takahashi, Shigeyuki Matsui, Hiroko Terasaki

    Scientific reports   Vol. 7 ( 1 ) page: 16383 - 16383   2017.11

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    The aim of this study is to determine the progress of the visual field defects obtained by the Humphrey Field Analyzer 10-2 program (HFA 10-2) in patients with retinitis pigmentosa (RP). The medical records of 45 eyes of 45 RP patients who had at least 3 visual field tests were reviewed. Linear mixed models were used to follow the changes of the mean deviation and the average sensitivity of 4, 12, and 20 points in three concentric squares, designated as S4, S12, and S20. The median follow-up time was 3.86 years [range: 1.93 to 9.86, IQR (Interquartile range): 3.01 to 4.93]. The median number of the visual field tests was 3 (range: 3 to 15, IQR: 3 to 4). The mean change of the MD was -0.46 dB/year (-5.80%/year). When the patients were grouped by the average initial MD, the less advanced group had slower progressions than the more advanced group in S4, S12, and S20. These results should be useful in understanding the pathological changes of RP in the central visual field.

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  43. Risk Classification of Post-Cardiac Arrest Syndrome Based on the CAST: Is Targeted Temperature Management at 34 degrees C Recommended in the Moderate-Risk Group?

    Nishikimi, Mitsuaki, Ogura, Takayuki, Nishida, Kazuki, Liu, Keibun, Nakamura, Mitsunobu, Sakamoto, Tetsuya, Matsuda, Naoyuki

    Circulation     2017

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MISC 7

  1. Weekly point-prevalence surveillanceを用いた医療関連感染対策の有効性評価

    豊留 有香, 西田 一貴, 井口 光孝, 森岡 悠, 手塚 宜行, 岡 圭輔, 矢田 吉城, 長田 ゆかり, 安立 なぎさ, 八木 哲也

    日本環境感染学会総会プログラム・抄録集   Vol. 36回   page: 274 - 274   2021.9

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  2. Microsoft Xbox Kinect V2を用いた歩行解析の信頼性評価

    宇佐美 琢也, 黒柳 元, 西田 一貴, 鹿島 崇人, 堀場 充哉, 佐橋 健斗, 浅井 勇人, 坂井 宏章, 井口 普敬, 植木 美乃, 村上 英樹

    日本整形外科学会雑誌   Vol. 95 ( 8 ) page: S1836 - S1836   2021.8

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  3. 大腿骨転子部骨折手術において小転子締結は骨癒合に影響するか 小転子骨癒合形態の後ろ向き比較研究

    宇佐美 琢也, 高田 直也, 西田 一貴, 林 義一, 柴田 芳宏, 勝田 康裕, 生田 憲史, 柴田 淳, 岩田 英敏, 稲本 捷悟, 太田 恭平, 関谷 勇人

    日本整形外科学会雑誌   Vol. 94 ( 3 ) page: S815 - S815   2020.3

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  4. 機械学習を用いた敗血症患者のDIC進展予測モデル

    長谷川大祐, 西田一貴, 西田修

    日本血栓止血学会学術標準化委員会シンポジウム   Vol. 14th   2020

  5. 医学統計はじめの一歩

    西田 一貴

    日本急性血液浄化学会雑誌   Vol. 9 ( Suppl. ) page: 111 - 111   2018.9

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  6. 蘇生後脳症に対する軽度低体温療法のCT像による有効性の検討

    錦見 満暁, 小倉 崇以, 西田 一貴, 中村 光伸, 劉 啓文, 徳山 秀樹, 松田 直之

    日本救急医学会雑誌   Vol. 28 ( 9 ) page: 622 - 622   2017.9

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  7. 救急外来で中枢性めまいをとらえるために 中枢性めまいの予測スコアの検討

    松本 奈々, 西田 一貴, 長谷川 義高, 宇佐美 琢也, 横山 大輔, 川出 洋平, 越山 彩香, 須網 和也, 稲本 捷悟

    日本農村医学会雑誌   Vol. 66 ( 3 ) page: 284 - 284   2017.9

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KAKENHI (Grants-in-Aid for Scientific Research) 3

  1. 膵癌早期診断を目的とした、IPMNの病変及び周囲背景膵における遺伝子変異解析

    Grant number:22K08010  2022.4 - 2025.3

    科学研究費助成事業  基盤研究(C)

    大野 栄三郎, 石川 卓哉, 加藤 あす香, 川嶋 啓揮, 西田 一貴, 飯田 忠, 水谷 泰之

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    膵癌早期診断は喫緊の課題であるが、未だに高リスク群の絞り込みは不十分である。膵管内乳頭粘液性腫瘍(IPMN)は自身の悪性化に加え、通常型膵癌が高頻度に発生すると報告されている。本研究では、サーベイランス中の膵嚢胞症例中、手術例(膵癌または悪性IPMN疑い)における、切除病変の遺伝子変異プロファイルと周囲正常膵実質内の膵管上皮内腫瘍性病変(PanIN)の発症頻度および背景膵実質内膵管上皮における遺伝子変異プロファイルを同時に解析し、IPMN症例における膵管癌発生の超高リスク群の特徴を解明する。更にその結果を蓄積された臨床情報、画像情報、血液検体と対比し、膵発癌予測の新規バイオマーカーを探索する。

  2. ビッグデータと凝固プロファイリングによる敗血症性凝固障害主要メカニズムの解明

    Grant number:22K09180  2022.4 - 2025.3

    科学研究費助成事業  基盤研究(C)

    春日井 大介, 西田 一貴

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    本研究では敗血症性凝固障害発症・重症化のリスク因子の解明及び重症化に寄与する主要メカニズムを明らかにする。国内外の2つの大規模なデータベースを利用して、敗血症性凝固障害の発症・重症化予測因子を明らかにし、機械学習により凝固障害の重症化を予測する精度の高いモデルを構築する。次に、、包括的凝固機能プロファイル測定を活用した主要な凝固障害のフェノタイプ毎のモニタリング方法を探索的に明らかにする。

  3. 人工呼吸器離脱のタイミングにおけるP0.1の有効性:診断メタアナリシスによる検討

    Grant number:20K23222  2020.9 - 2022.3

    日本学術振興会  科学研究費助成事業  研究活動スタート支援

    西田 一貴

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    Grant amount:\2860000 ( Direct Cost: \2200000 、 Indirect Cost:\660000 )

    重症呼吸不全では、人工呼吸器による治療が必須である。人工呼吸器の治療期間が適切でない場合、人工呼吸器装着による合併症のリスクが増えるが、人工呼吸器の離脱(ウイニング)の可否を予測する指標はまだ確立されていない。100ミリ秒の気道閉塞圧(P0.1)は人工呼吸器の治療下で容易に取得することができ、ウイニングの予測指標になりうるかどうか、いくつか検討されてきた。本研究では、ウイニングに対するP0.1の診断能力をメタアナリシスにより統合し、最適な閾値について提案することで、人工呼吸器の治療成績の向上に貢献したい。
    重症呼吸不全では、人工呼吸器による治療が必須である。人工呼吸器の治療期間が適切でない場合、人工呼吸器装着による合併症のリスクが増えるが、人工呼吸器の離脱(ウイニング)の可否を予測する正確な指標はまだ確立されていない。100ミリ秒の気道閉塞圧(P0.1)は人工呼吸器の治療下で容易に取得することができ、ウイニングの予測指標になりうるかどうか、いくつか検討されてきた。しかし、先行研究では各研究ごとにP0.1の閾値は異なるため、診断能力についての統一的な見解が得られていない。また、実臨床での運用、および後続の臨床研究に大きく活用されるためには、最適な閾値が決定されることが望ましい。本研究では、ウイニングに対するP0.1の診断能力をメタアナリシスにより統合し、最適な閾値について提案するのが目標である。
    <BR>
    昨年度までの成果としては、ウイニングに対するP0.1の有効性について検討した先行文献の抽出を行い、異質性の評価を行い、診断メタアナリシスを実施した。最適な閾値については未確定であるものの、検査の診断パワーを表現する指標として陽性尤度比と陰性尤度比との比で定義できる診断オッズ比を算出した。これにより、P0.1はウイニングの可否について有意に診断能力がある、という結果が得られたため、先ずはこの成果について学術専門誌に研究論文として投稿した。ウイニングの可否の判別におけるP0.1の有効性は人工呼吸器の治療成績の向上に寄与するエビデンスの一つになると期待される。
    P0.1はウイニングの可否に対して有意に診断能力がある、というメタアナリシスの結果を学術専門誌に研究論文として出版することができた。一方で、診断能力の言及だけでは、臨床現場への実用は難しい側面もある。最適な閾値が設定されることで後続の臨床研究に組み入れやすくなる。よって今年度は最適な閾値についての検討を深めたい。閾値を求める統計的な方法論はいくつか提案されており、今回の研究に合致するものを適用するか、もしくは新たな手法を提案したいと考えている。
    本研究の得られている成果に基づき、最適な閾値についての方法論の評価および実際への適用についてさらなる検討を行い、論文投稿を目指す。

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