基本情報
- 所属
- 自治医科大学 医学部総合医学第１講座 教授(兼任)総合診療科 教授
- 学位
- 医学博士(1994年3月 旭川医科大学)FACP(1994年6月 American College of Physicians)
- 連絡先
- hsmdfacp
jichi.ac.jp - ORCID ID
https://orcid.org/0000-0002-5060-9020- J-GLOBAL ID
- 200901030187469907
- Researcher ID
- Y-5081-2019
- researchmap会員ID
- 1000273366
- 外部リンク
経歴
19-
2024年8月 - 現在
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2016年10月 - 2024年6月
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2008年4月 - 2016年9月
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2004年4月 - 2008年3月
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2003年1月 - 2004年3月
学歴
2-
1994年6月 - 1996年3月
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1979年4月 - 1985年3月
受賞
9-
2023年3月
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2019年4月
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2017年4月
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2015年4月
論文
163-
BMC infectious diseases 24(1) 1437-1437 2024年12月18日 査読有り最終著者BACKGROUND: The spleen is a key organ in preventing pneumococcal infection, especially in patients with immunocompromised condition such as those with cancer. Previous studies have shown that a small spleen volume in pneumococcal pneumonia patients is associated with severe disease course. However, it is unknown whether a small spleen increases risk of pneumococcal infection. We investigated the association between spleen volume and risk of pneumococcal infection. METHODS: This study was a retrospective cohort study using a nested case-control design and involved adult patients with malignancy who underwent chest and/or abdominal CT scans from January 1, 2008, to September 30, 2020, at a tertiary care center in Japan. Exclusion criteria comprised patients diagnosed with hepatic cirrhosis, leukemia, lymphoma, and/or post-splenectomy. From the cohort group that met all selection criteria (n = 22475), we identified all incident cases of pneumococcal infection (pneumococcal pneumonia and/or invasive pneumococcal diseases) and matched them with four controls by age, sex, and follow-up duration. Odds ratios (ORs) for the association between spleen volume and pneumococcal infection were estimated using conditional logistic regression models adjusted for body surface area, performance status, Charlson comorbidity index, and metastatic cancer. RESULTS: The median spleen volume was 85.8 (interquartile range, 65.8-120.8) cm3. Over a median follow-up of 4.95 (interquartile range, 1.54-9.25) years, 60 patients were diagnosed with pneumococcal infection (20 with invasive pneumococcal disease and 40 with pneumonia without invasive pneumococcal disease) and matched with 240 controls. Spleen volume reduction (per 10 cm3) did not increase risk of pneumococcal infection in a crude analysis [OR 1.04 (95% CI 0.98-1.11)]. The outcome remained unchanged in the multivariable analysis (OR 1.01 [95% CI 0.95-1.08]). CONCLUSIONS: Small spleen volume did not increase risk of pneumococcal infection in cancer patients.
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Internal Medicine (3478-24) 1-14 2024年7月4日 査読有り責任著者We herein report a 47-year-old man who presented with progressive paraparesis. Imaging revealed a right upper pulmonary nodule, massive bilateral adrenal metastases, thoracolumbar vertebral osteolysis, and subcutaneous nodules. A biopsy of the right buttock nodule revealed a poorly differentiated metastatic carcinoma with high programmed cell death-ligand 1 expression and extensive chromosomal rearrangements. The patient died 10 days after the initiation of pembrolizumab treatment. Autopsy findings confirmed pulmonary pleomorphic carcinoma with extensive metastases. Quantification of chromosomal rearrangements revealed a jump-up mutation from the normal karyotype, followed by a further incremental increase in the degree of deviation.
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Rheumatology 2024年5月2日 査読有りAbstract Objective This study aimed to establish a screening model for differentiating anti-synthetase syndrome (ASS) from other antinuclear antibody (ANA)-associated rheumatic diseases (AARD) using a combination of cytoplasmic and non-cytoplasmic ANA (ncANA) patterns. Methods This retrospective observational study included patients with AARDs such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren's syndrome (SS), mixed connective tissue disease (MCTD), and polymyositis/dermatomyositis (PM/DM) who underwent ANA screening between April 2012 and December 2021. Variables included age, sex, ANA patterns (Cytoplasmic and ncANA), and titers. Logistic regression analysis of Cytoplasmic and ncANA patterns was performed to differentiate ASS from other AARDs. Result The 981 diagnosed cases of AARDs consisted of SS (n = 451), SSc (n = 264), SLE (n = 201), PM/DM (n = 104), MCTD (n = 52), and ASS, including PM/DM (n = 64). Of these, 155 patients had ≥2 overlapping diseases; however, there was no overlap between AARDs and ASS. ASS is more likely to occur when the cytoplasmic titer is positive and the ncANA <320. Receiver operating characteristic (ROC) analysis of the Cytoplasmic and ncANA range revealed an area under the ROC curve (AUC) of 0.885 (95% CI: 0.844 to 0.927). Conclusion It is important to detect cytoplasmic patterns as an ANA screening test for ASS diagnosis, even if the titer is low. Additionally, combining the cytoplasmic and ncANA patterns yields more accurate ASS screening results.
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Cureus Journal of Medical Science 16(3) e56698 2024年3月22日 査読有り最終著者Sanayama H, Namekawa M, Sakiyama Y, et al. (March 22, 2024) Herpes Zoster Ophthalmicus Initially Diagnosed As Cluster Headache, Complicated by Delayed Eruption. Cureus 16(3): e56698. doi:10.7759/cureus.56698
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Cureus Journal of Medical Science 16(3) e55749 2024年3月7日 査読有り最終著者
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Cureus Journal of Medical Science 16(2) e54748 2024年2月23日 査読有り最終著者
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PLOS ONE 19(2) e0290937-e0290937 2024年2月23日 査読有り最終著者Background The coronavirus disease 2019 (COVID-19) pandemic has put a strain on the healthcare system, and sudden changes in disease status during home treatment have become a serious issue. Therefore, prediction of disease severity and allocation of sufficient medical resources, including high-flow nasal cannula (HFNC), to patients in need are important. We aimed to determine risk factors for the need of HFNC use in COVID-19. Methods This was a single-center retrospective observational cohort study including all eligible hospitalized adult patients aged ≥18 years diagnosed with COVID-19 between April 14, 2020 and August 5, 2021 who were treated in the study hospital. The primary outcome is the need for HFNC. Nineteen potential predictive variables, including patient characteristics at hospital admission, were screened using least absolute shrinkage and selection operator and logistic regression to construct a predictive risk score. Accuracy of the risk score was determined using area under the receiver operating characteristic curve. Results The study cohort included 148 patients. The rate of the need for HFNC was 22.9%. Among the 19 potential variables, percutaneous oxygen saturation (SpO2) <92% (odds ratio [OR] 7.50, 95% confidence interval [CI] 2.806–20.82) and IL-6 (OR 1.021, 95% CI 1.010–1.033) were included in developing the risk score, which was termed interleukin (IL)-6-based COVID-19 severity (IBC-S) score. Conclusions The IBC-S score, an easy-to-use risk score based on parameters available at the time of hospital admission, predicted the need for HFNC in patients with COVID-19. The IBC-S score based on interleukin-6 and SpO2 might aid in determining patients who should be transported to a tertiary medical institution or an isolation facility.
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Dialogues in Health 4(100172) 1-7 2024年2月3日 査読有り
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Clinical Infection in Practice 21 100333-100333 2024年1月 査読有り
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Clinical Case Reports 11(6) e7477 2023年6月20日 査読有り責任著者
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Clinical case reports 11(6) e7576 2023年6月19日 査読有り責任著者KEY CLINICAL MESSAGE: With the aging of the population, physicians need to pay more attention to assessing the presence or absence of pelvic fractures and urinary retention associated with urethral injury due to such fractures in the elderly when falling from bicycles. ABSTRACT: Walking ability does not rule out the presence of pelvic fractures. Many geriatric patients are likely to fall off bicycles. Physicians should pay more attention when assessing complications related to urethral trauma caused by pelvic fractures in the elderly after falling from bicycles.
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Biomedicines 11(5) 1403-1403 2023年5月9日 査読有りEarly diagnosis and therapeutic intervention improve the quality of life and prognosis of patients with sarcopenia. The natural polyamines spermine and spermidine are involved in many physiological activities. Therefore, we investigated blood polyamine levels as a potential biomarker for sarcopenia. Subjects were Japanese patients >70 years of age who visited outpatient clinics or resided in nursing homes. Sarcopenia was determined based on muscle mass, muscle strength, and physical performance according to the criteria of the Asian Working Group for Sarcopenia (2019). The analysis included 182 patients (male: 38%, age: 83 [76–90] years). Spermidine levels were higher (p = 0.002) and the spermine/spermidine ratio was lower (p < 0.001) in the sarcopenia group than in the non-sarcopenia group. Polyamine concentration analysis showed that the odds ratios for age and spermidine changed in parallel with sarcopenia progression, and the odds ratio for the spermine/spermidine ratio changed inversely with the degree of sarcopenia progression. Additionally, when the odds ratio was analyzed with spermine/spermidine instead of polyamine concentrations, only for spermine/spermidine, the odds ratio values varied in parallel with the progression of sarcopenia. Based on the present data, we believe that the blood spermine/spermidine ratio may be a diagnostic indicator of risk for sarcopenia.
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Biomedicines 11(3) 746-746 2023年3月1日 査読有りSeveral mechanisms strictly regulate polyamine concentration, and blood polyamines are excreted in urine. This indicates polyamine accumulation in renal dysfunction, and studies have shown increased blood polyamine concentrations in patients with renal failure. Hemodialysis (HD) may compensate for polyamine excretion; however, little is known about polyamine excretion. We measured whole-blood polyamine levels in patients on HD and examined the relationship between polyamine concentrations and indicators associated with health status. Study participants were 59 hemodialysis patients (median age: 70.0 years) at Minami-Uonuma City Hospital and 26 healthy volunteers (median age: 44.5 years). Whole-blood spermidine levels were higher and spermine/spermidine ratio (SPM/SPD) was lower in hemodialysis patients. Hemodialysis showed SPD efflux into the dialysate; however, blood polyamine levels were not altered by hemodialysis and appeared to be minimally excreted. The skeletal muscle mass index (SMI), which was positively correlated with hand grip strength and serum albumin level, was positively correlated with SPM/SPD. Given that sarcopenia and low serum albumin levels are reported risk factors for poor prognosis in HD patients, whole blood SPM/SPD in hemodialysis patients may be a new indicator of the prognosis and health status of HD patients.
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Annals of Internal Medicine: Clinical Cases 2(2) 2023年2月1日 査読有り最終著者
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Journal of General and Family Medicine 2022年11月7日 査読有り最終著者
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American Journal of Case Reports 23 2022年10月3日 査読有り最終著者
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Internal Medicine 61(10) 1629-1629 2022年5月15日 査読有り最終著者
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The Korean journal of internal medicine 2022年5月6日 査読有り最終著者
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International Journal of Infectious Diseases 118(May 2022) 138-140 2022年5月 査読有り最終著者
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Cureus Journal of Medical Science 14(4) e24573 2022年4月28日 査読有り最終著者
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Hypertension Research 45(4) 591-601 2022年4月
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Cureus Journal of Medical Science 14(3) e23498 2022年3月25日 査読有り最終著者
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American Journal of Case Reports 23 2022年2月2日 査読有り最終著者
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Oxford Medical Case Reports 2022(2) 2022年2月1日 査読有り最終著者
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Cureus 14(1) e21622 2022年1月26日 査読有り最終著者
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Internal medicine (Tokyo, Japan) 60(22) 3659-3659 2021年11月15日 査読有り最終著者
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European journal of internal medicine 2021年10月21日 最終著者
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PLOS ONE 16(10) e0257513-e0257513 2021年10月11日 査読有り最終著者<sec id="sec001"> <title>Background</title> Coronavirus disease (COVID-19) is associated with a high mortality rate in older adults; therefore, it is important for medical institutions to take measures to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. This study aimed to assess the risk of SARS-CoV-2 infection among healthcare workers (HCWs) and the effectiveness of infection control measures. </sec> <sec id="sec002"> <title>Methods</title> This study had a cross-sectional component and a prospective cohort component. The cross-sectional component comprised an anti-SARS-CoV-2 antibody survey among HCWs at a medical center in Saitama City, Japan. In the prospective cohort component, HCWs at the same medical center were tested for anti-SARS-CoV-2 antibodies monthly over a 3-month period (May to July 2020) to assess the effectiveness of infection prevention measures, including personal protective equipment use. All participants in the cohort study also participated in the antibody survey. The primary outcome was anti-SARS-CoV-2 antibody (measured using Elecsys® Anti-SARS-CoV-2) positivity based on whether participants were engaged in COVID-19-related medical care. Other risk factors considered included occupational category, age, and sex. </sec> <sec id="sec003"> <title>Results</title> In total, 607 HCWs participated in the antibody survey and 116 doctors and nurses participated in the cohort study. Only one of the 607 participants in the survey tested positive for anti-SARS-CoV-2 antibodies. All participants in the cohort study were anti-SARS-CoV-2 antibody negative at baseline and remained antibody negative. Engaging in the care of COVID-19 patients did not increase the risk of antibody positivity. During the study period, a total of 30 COVID-19 in-patients were treated in the hospital. </sec> <sec id="sec004"> <title>Conclusions</title> The infection control measures in the hospital protected HCWs from nosocomially acquired SARS-CoV-2 infection; thus, HCWs should engage in COVID-19-related medical care with confidence provided that they adhere to infectious disease precautions. </sec>
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Journal of general internal medicine 36(10) 3224-3225 2021年10月 査読有り最終著者
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Journal of General and Family Medicine 2021年8月22日 査読有り最終著者
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Clinical case reports 9(7) e04476 2021年7月 査読有り最終著者In the era of a severely aging population, physicians should pay attention to look for both infective endocarditis and disseminated lesions when blood cultures reveal Staphylococcus warneri, especially in elderly people with valvular heart disease.
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Internal medicine (Tokyo, Japan) 2021年3月29日 査読有り最終著者
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PLOS ONE 16(2) e0246259-e0246259 2021年2月19日 査読有り責任著者The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients with CRP levels ≥40 mg/dL treated in Saitama Medical Center, Japan from 2004 to 2017 were retrieved from medical records. The primary outcome was defined as 72-hour mortality after the final CRP test. Forty-four mortal cases were identified from the 275 enrolled cases. Multivariate logistic regression analysis (MLRA) was performed to explore the parameters relevant for predicting mortality. As an alternative method of prediction, we devised a novel risk predictor, “weighted average of risk scores” (WARS). WARS features the following: (1) selection of candidate risk variables for 72-hour mortality by univariate analyses, (2) determination of C-statistics and cutoff value for each variable in predicting mortality, (3) 0–1 scoring of each risk variable at the cutoff value, and (4) calculation of WARS by weighted addition of the scores with weights assigned according to the C-statistic of each variable. MLRA revealed four risk variables associated with 72-hour mortality—age, albumin, inorganic phosphate, and cardiovascular disease—with a predictability of 0.829 in C-statistics. However, validation by repeated resampling of the 275 records showed that a set of predictive variables selected by MLRA fluctuated occasionally because of the presence of closely associated risk variables and missing data regarding some variables. WARS attained a comparable level of predictability (0.837) by combining the scores for 10 risk variables, including age, albumin, electrolytes, urea, lactate dehydrogenase, and fibrinogen. Several mutually related risk variables are relevant in predicting 72-hour mortality in patients with extremely high CRP levels. Compared to conventional MLRA, WARS exhibited a favorable performance with flexible coverage of many risk variables while allowing for missing data.
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Internal Medicine 60(4) 495-506 2021年2月15日 査読有り最終著者The prevalence of atrial fibrillation (AF) increases with age, as does the proportion of patients with frailty. AF patients with frailty have a higher risk of stroke than those without frailty, and progressive frailty caused by stroke is also associated with a worse prognosis. Despite this, anticoagulant therapy tends to not be used in frail patients because of the risk of falls and bleeding complications. However, some studies have shown that anticoagulant therapy improves the prognosis in patients with frailty. An accurate assessment of the “netclinical-benefits” is needed in patients with frailty, with the aim of improving the prognoses of patients with frailty by selecting those who will benefit from anticoagulant therapy and actively reducing the risk of bleeding. A comprehensive intervention that includes a team of doctors and social resources is required. We herein review the effectiveness and bleeding risk associated with anticoagulant therapy in frail patients investigated in clinical studies.
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Medicine 100(4) e24510-e24510 2021年1月29日 査読有り責任著者The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear. To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions. Retrospective, single-center, case-controlled cross-sectional study. University teaching hospital. Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013. Extremely high RPG (≥500 mg/dl). Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity. A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (−5.142 + 0.901log (CK) −1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%. The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.
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Journal of General and Family Medicine 22(1) 51-52 2021年1月13日 査読有り最終著者A 72‐year‐old woman presented with a 1‐day history of acute throat pain, hoarseness. On cervical ultrasonography (transverse view), the epiglottis was swollen with anterior‐posterior diameter of 3.5 and 3.8 mm at right and left edges, respectively. Laryngeal endoscopy showed marked swelling of the epiglottis, and acute epiglottitis was diagnosed.
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Scientific Reports 11(1) 1-10 2021年1月12日 査読有り責任著者<title>Abstract</title>Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data from medical records of adult patients treated at Saitama Medical Center, Japan, from 2005 to 2019. We conducted a multivariate logistic after adjusting for age, sex, height, weight, body mass index, Brinkman Index, vital signs, biochemical values, updated Charlson Comorbidity Index (CCI) score, CCI components, and underlying causes. A logistic regression model with selected validity risks and higher C-statistic for predicting 72-h mortality was established. During the 15-year period, 428 patients (133 non-survivors and 295 survivors [cases and controls by survival < 72 and ≥ 72 h, respectively]) with AST levels ≥ 3000 U/L were identified. The 72-h mortality rate was 133/428 (31.1%). The model used for predicting 72-h mortality through the assessment of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus levels had a C-statistic value of 0.852 (sensitivity and specificity, 76.6%). The main independent risk factors associated with 72-h mortality among patients with AST levels ≥ 3000 U/L included higher serum values of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus.
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Clinical Case Reports 9(1) 153-157 2021年1月5日 査読有り最終著者Adult‐onset Still's disease may cause intestinal pseudo‐obstruction via a cytokine storm. Early diagnosis and treatment are the key for patient survival before the development of serious complications such as macrophage activation syndrome.
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Modern Rheumatology Case Reports 5(1) 62-68 2021年1月2日 査読有り最終著者A 71-year-old woman with dermatomyositis (DM) received glucocorticoid steroid (GCS) and tacrolimus treatment. Relapse of skin symptoms was observed after tapering the GCS dose, and the patient tested positive for anti-transcriptional intermediary factor-1 gamma (TIF1-γ) antibody. Examinations for malignancy were repeatedly performed. However, no obvious findings indicative of a tumour were observed. Two years after, a retroperitoneal tumour was detected and pathologically diagnosed as poorly differentiated adenocarcinoma. The patient developed intestinal and biliary obstruction and eventually died of sepsis. Herein, we report the presence of anti-TIF1-γ antibodies in a DM patient with cancer of unknown primary site.
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Clinical Case Reports 8(12) 3082-3087 2020年12月18日 査読有り責任著者Physicians must recognize and treat adrenal crisis that may occur with acute viral illnesses such as influenza in women with Sheehan’s syndrome that has been undiagnosed and hence untreated, sometimes for many years, after postpartum hemorrhage.
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Internal medicine (Tokyo, Japan) 60(10) 1621-1625 2020年12月15日 査読有り最終著者Aggregatibacter actinomycetemcomitans, an etiological agent associated with periodontitis, endocarditis, and other infections, has rarely been implicated in spondylitis. A 70-year-old man with aortic valve replacement presented with a 4-month history of lower back pain and was diagnosed with spondylitis. Prolonged incubation of blood cultures and a biopsy yielded A. actinomycetemcomitans. Concurrent infective endocarditis (IE) was probable considering the infectious organism and the patients' prosthetic valve. The patient was treated with ceftriaxone and recovered well. Pyogenic spondylitis with possible concurrent IE may be caused by A. actinomycetemcomitans. Extended incubation and repeated cultures should be considered if HACEK infection is suspected.
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Journal of General and Family Medicine 21(6) 272-273 2020年11月28日 査読有り最終著者A 27-year-old woman complaining of persistent fever and sore throat was consulted. Examination of the laryngopharynx revealed multiple aphthous ulcers in the uvula, arytenoids, epiglottis, and laryngeal pyriform fossa. Crohn's disease was diagnosed by colonoscopy.
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European Journal of Internal Medicine 83 84-85 2020年11月15日 査読有り最終著者A 67-year-old man presented with a 15-year history of chronic urticaria. It was distributed symmetrically on the limb trunk (Fig. 1A and B) without pruritus. No fever or joint pain or headache is observed. He showed no signs of angioedema. He was referred to our hospital for treatment of chronic urticaria. An antihistamine was ineffective. He was diagnosed with mild sensorineural hearing loss. He had no family history of autoinflammatory diseases.
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Journal of General and Family Medicine 21(6) 277-279 2020年11月 査読有り最終著者We present a case of diffuse aspiration bronchiolitis (DAB) with a false‐positive Gaffky score. “Tree‐in‐bud” opacities detected after aspiration should be considered DAB rather than mycobacterial infection.
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Internal medicine (Tokyo, Japan) 60(5) 821-821 2020年9月30日 査読有り最終著者
主要な講演・口頭発表等
106共同研究・競争的資金等の研究課題
6-
日本学術振興会 科学研究費助成事業 基盤研究(C) 2022年4月 - 2026年3月
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地域社会健康科学研究所 2019年4月 - 2022年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2014年4月 - 2020年3月
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公益法人地域社会振興財団 へき地住民の健康増進に関する研究 1997年4月 - 1998年3月
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公益財団法人長寿科学振興財団 海外派遣研究員研究費助成 1994年4月 - 1995年3月