2021年度博士論文 http://hdl.handle.net/10564/3938 2026-04-09T04:01:36Z 2026-04-09T04:01:36Z Kogeichi, Yohei Motoyama, Yasushi Takeshima, Yasuhiro Matsuda, Ryosuke Tamura, Kentaro Nishimura, Fumihiko Yamada, Shuichi Nakagawa, Ichiro Park, Young-Su Fukushima, Hidetada Nakase, Hiroyuki http://hdl.handle.net/10564/4031 2022-06-01T16:30:11Z 2022-05-31T15:00:00Z

タイトル: Efficacy of autogenous bone grafts preserved in 80% ethanol solution for preventing surgical site infection after cranioplasty: A retrospective cohort study. 著者: Kogeichi, Yohei; Motoyama, Yasushi; Takeshima, Yasuhiro; Matsuda, Ryosuke; Tamura, Kentaro; Nishimura, Fumihiko; Yamada, Shuichi; Nakagawa, Ichiro; Park, Young-Su; Fukushima, Hidetada; Nakase, Hiroyuki 抄録: Background: Surgical site infection (SSI) is common following cranioplasty after decompressive craniectomy (DC). The aim of this study was to assess the risk of SSI following cranioplasty in terms of the preservation method of autogenous bone graft (ABG), comparing preservation in 80% ethanol versus the standard method of subcutaneous ABG preservation. Material and methods: The patients who underwent cranioplasty using ABGs after DC between 2008 and 2019 were retrospectively reviewed. SSIs were compared between patients whose ABG was preserved in 80% ethanol (group A) and those whose ABG was preserved subcutaneously (group B) using inverse probability of treatment weighting (IPTW) based on propensity scores to balance measurable confounders including elderly age, sex, expanded polytetrafluoroethylene, stroke, interval to cranioplasty, and diabetes mellitus. Results: Total number of 127 patients consisted of 56 in group A and 71 in group B. SSI after cranioplasty occurred in five patients each in groups A and B (8.9% vs. 7%, p = 0.748). IPTW analysis demonstrated that preservation in 80% ethanol was associated with a lower risk of SSI (odds ratio: 0.239, 95％ confidence interval: 0.0615–0.927, p = 0.039). Conclusion: The simple and less-invasive method of preserving ABGs in 80% ethanol for cranioplasty after DC might be potentially safe from an SSI perspective. 内容記述: 博士（医学）・乙第1526号・令和4年3月15日; © 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND licens(https://creativecommons.org/licenses/by-nc-nd/4.0/).

2022-05-31T15:00:00Z Sang-Tae, Lee Tanaka, Shinobu Yamazaki, Masaharu Inoue, Takashi Kasahara, Kei http://hdl.handle.net/10564/4030 2022-06-01T16:30:10Z 2021-11-29T15:00:00Z

タイトル: The impact of toxigenic culture on antimicrobial prescriptions for Clostridioides difficile infection: The role of diagnostic stewardship. 著者: Sang-Tae, Lee; Tanaka, Shinobu; Yamazaki, Masaharu; Inoue, Takashi; Kasahara, Kei 抄録: Introduction : Toxigenic culture has been recommended as a sensitivity enhancement option for testing Clostridioides difficile infections (CDI). However, no studies have evaluated whether toxigenic culture impacts clinical decisions such as CDI treatment. Methods : At Nara Medical University Hospital, simultaneous testing of glutamate dehydrogenase antigen (A) and toxin A/B (T) by immunochromatography has been conducted since November 2013. Furthermore, toxigenic culture (C) has been adopted since April 2018. Therefore, patients tested for CD were divided into two groups: pre-period from April 2014 to March 2018 and post-period from April 2018 to March 2021. Patient data were retrospectively examined. Results : The study included 1262 and 1023 cases in the pre- and post-periods, respectively. A significant reduction in A+T+ cases could be observed with 64 (5.1 %) and 28 (2.7%) in the pre- and post-periods (P = 0.005), respectively. Of the 104 A+T- cases undergoing toxigenic culture in the post-period, 54 (51.9 %) were A+T-C+. The antimicrobial administration ratio for the A+T-C+ cases (68.5 %) was lower than that for the A+T+ patients (90.6 and 82.1 %, P = 0.014 and P = 0.417, in the pre- and post-periods, respectively), and was not significantly different from that of the A+T-patients (64.2 and 64.1 % in the pre- and post-periods, respectively) or from that of the A+ T-C-patients (64 %). Conclusion : This study showed that toxigenic culture does not necessarily affect the antibiotic administration ratio or duration. A coordinated approach under diagnostic stewardship for improved reporting and interpretation of toxigenic cultures would be necessary. 内容記述: 博士（医学）・乙第1525号・令和4年3月15日

2021-11-29T15:00:00Z Matsumura, Yachiyo Yamanaka, Toshiaki Murai, Takayuki Fujita, Nobuya Kitahara, Tadashi http://hdl.handle.net/10564/4029 2022-06-01T16:30:09Z 2022-07-31T15:00:00Z

タイトル: Orthostatic hemodynamics in the vertebral artery and blood pressure in patients with orthostatic dizziness/vertigo. 著者: Matsumura, Yachiyo; Yamanaka, Toshiaki; Murai, Takayuki; Fujita, Nobuya; Kitahara, Tadashi 抄録: Objectives: Orthostatic dizziness/vertigo (ODV) is a common symptom and is believed to occur due to the cerebral hypoperfusion caused by orthostatic hypotension (OH). However, the detailed mechanism underlying ODV onset is poorly understood. The vertebral artery (VA) mainly supplies blood to the central vestibular system; therefore, the orthostatic decrease of VA blood flow could possibly lead to ODV. This study investigated the orthostatic blood pressure and VA hemodynamics in ODV patients to elucidate the hemodynamic mechanism underlying ODV onset. Furthermore, the influence of orthostatic hypotension (OH) on VA hemodynamics was examined because OH is probably the most common cause of ODV. Methods: This study included 181 patients with ODV and 73 control patients without ODV. All subjects underwent an active standing test to measure the extracranial Doppler (ECD) sonography spectrum of the VA and blood pressure (BP). VA blood flow velocity and BP were simultaneously measured for each patient in the supine static position and then in the upright standing positions following 3 min of standing. We investigated the orthostatic change in the average of flow velocity in bilateral VAs (VAFV) and BP for ODV patients compared with the control patients. Result: VAFV in ODV patients was significantly reduced when standing up compared with the control patients. In the ODV patients, there was no difference in orthostatic decrease in VAFV between patients those with OH and without OH. However, the VAFV in the standing position was significantly lower in patients with OH than without OH. In cases with OH, the ODV patients exhibited a greater decrease in VAFV compared with the control patients, but this was not statistically significant. In the absence of OH, a significantly greater orthostatic decrease in VAFV was observed in ODV patients compared with the controls. Conclusion: Our findings suggest that the orthostatic decrease of VA blood flow is deeply involved in the hemodynamic mechanism underlying ODV onset and is possibly associated with OH and other etiologies. 内容記述: 博士（医学）・乙第1524号・令和4年3月15日; © 2021 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.

2022-07-31T15:00:00Z Nishikawa, Daisuke Wada, Yoshiro Shiozaki, Tomoyuki Shugyo, Masayuki Ito, Taeko Ota, Ichiro Kitahara, Tadashi http://hdl.handle.net/10564/4028 2022-05-26T16:30:12Z 2021-05-31T15:00:00Z

タイトル: Patients with vertigo/dizziness of unknown origin during follow-ups by general otolaryngologists at outpatient town clinic. 著者: Nishikawa, Daisuke; Wada, Yoshiro; Shiozaki, Tomoyuki; Shugyo, Masayuki; Ito, Taeko; Ota, Ichiro; Kitahara, Tadashi 抄録: Objectives: The purpose of this study was to access the contribution of vertigo/dizziness-related patients' interview and examinations during short-term hospitalization in determining the accurate final diagnosis of vertigo/dizziness of unknown origin. Methods: We reviewed 1905 successive vertigo/dizziness patients at the Vertigo/Dizziness Center of Nara Medical University, who were introduced from general otolaryngologists at outpatient town clinic from May 2014 to April 2020. However, 244 patients were diagnosed with vertigo/dizziness of unknown origin (244/1905; 12.8%). Of these patients, 240 were hospitalized and underwent various examinations, including caloric test (C-test), video head impulse test (vHIT), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), inner ear magnetic resonance imaging (ieMRI), Schellong test (S-test), and self-rating questionnaires of depression score (SDS). Results: According to the examination data, together with interviewed vertigo/dizziness characteristics and daily changeable nystagmus findings, the final diagnoses were as follows: benign paroxysmal positional vertigo (BPPV: 107/240; 44.6%), orthostatic dysregulation (OD: 56/240; 23.3%), vestibular peripheral disease (VPD: 25/240; 10.4%), vestibular migraine (VM: 14/240; 5.8%), Meniere's disease (MD: 12/240; 5.0%), gravity perception disturbance (GPD: 10/240; 4.2%), psychogenic vertigo (Psycho: 10/240; 4.2%), and unknown (Unknown: 6/240; 2.5%). Supporting factors of final diagnosis was seen in gender, evoked dizziness, and positional nystagmus as BPPV; in evoked dizziness, S-test, and hypertension as OD; in evoked dizziness, head shaking after nystagmus, C-test, and vHIT as VPD; in gender, headache, and S-test as VM; in ear fullness and ieMRI as MD; in gender, evoked dizziness, and SVV as GPD; and in SDS as Psycho. To sum up, the ratios of Unknown were significantly reduced by this short-term hospitalization (244/1905→6/240). Conclusions: The answer lists for vertigo/dizziness of unknown origin obtained in the present study may be helpful for future general otolaryngologists at outpatient town clinic to better attain an accurate final iagnosis. 内容記述: 博士（医学）・乙第1523号・令和4年3月15日; © 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.

2021-05-31T15:00:00Z