救急救命士におけるマッキントッシュ型喉頭鏡の臨床経験がビデオ喉頭鏡を用いた気管挿管技能に及ぼす影響

内容の要旨 , 審査の要旨広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Primary Tracheal Malignant Lymphoma Detected during a Regular Checkup in an Asbestos Dust-Exposed Smoker

Primary tracheal malignant lymphoma is a rare disease;only 30 cases have been reported to date. A 73-year-old Japanese man with a history of asbestos exposure was undergoing biannual chest computed tomography (CT) twice a year as a routine procedure for those previously exposed to asbestos. He had been smoking since the age of 32. In September 2010, chest CT during this regular checkup revealed a polypoid lesion in his trachea and pleural plaques, which were suspected to be caused by asbestos. Bronchoscopy performed in October revealed a polypoid lesion with granules and nodules in the trachea. A diagnosis of non-Hodgkin lymphoma (NHL) and extranodal marginal-zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) was confirmed by histological analysis of the biopsy specimens. To our knowledge, this is the first case of primary tracheal lymphoma associated with a history of asbestos exposure. Several reports have documented no correlation between asbestos and malignant lymphoma. In addition, the correlation between smoking and NHL is weak. Although we cannot exclude the possibility of a simple coincidence of asbestos, smoking, and tracheal lymphoma, this case suggests that asbestos and smoking might have multiplicative effects in the development or progression of tracheal lymphoma

Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis

BACKGROUND: To improve quality of life (QOL) in patients with multiple sclerosis (MS), it is important to decrease disability and prevent relapse. The aim of this study was to examine the causal and mutual relationships contributing to QOL in Japanese patients with MS, develop path diagrams, and explore interventions with the potential to improve patient QOL. METHODS: Data of 163 Japanese MS patients were obtained using the Functional Assessment of MS (FAMS) and Nottingham Adjustment Scale-Japanese version (NAS-J) tests, as well as four additional factors that affect QOL (employment status, change of income, availability of disease information, and communication with medical staff). Data were then used in structural equation modeling to develop path diagrams for factors contributing to QOL. RESULTS: The Expanded Disability Status Scale (EDSS) score had a significant effect on the total FAMS score. Although EDSS negatively affected the FAMS symptom score, NAS-J subscale scores of anxiety/depression and acceptance were positively related to the FAMS symptom score. Changes in employment status after MS onset negatively affected all NAS-J scores. Knowledge of disease information improved the total NAS-J score, which in turn improved many FAMS subscale scores. Communication with doctors and nurses directly and positively affected some FAMS subscale scores. CONCLUSIONS: Disability and change in employment status decrease patient QOL. However, the present findings suggest that other factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL

Virtual Human Generative Model: Masked Modeling Approach for Learning Human Characteristics

Identifying the relationship between healthcare attributes, lifestyles, and personality is vital for understanding and improving physical and mental conditions. Machine learning approaches are promising for modeling their relationships and offering actionable suggestions. In this paper, we propose Virtual Human Generative Model (VHGM), a machine learning model for estimating attributes about healthcare, lifestyles, and personalities. VHGM is a deep generative model trained with masked modeling to learn the joint distribution of attributes conditioned on known ones. Using heterogeneous tabular datasets, VHGM learns more than 1,800 attributes efficiently. We numerically evaluate the performance of VHGM and its training techniques. As a proof-of-concept of VHGM, we present several applications demonstrating user scenarios, such as virtual measurements of healthcare attributes and hypothesis verifications of lifestyles.Comment: 14 pages, 4 figure

視野左方偏倚が線分二等分試験に及ぼす影響 : Head Mounted Displayを用いた若年健常者に対する検討

Objective: The purpose of this study was to verify the effect on spatial perception in healthy young subjects of an unconscious leftward optical shift created by a head-mounted display (HMD) with an offset camera. Methods: We recruited 40 healthy right-handed adults who were divided into four groups according to the hand used in the tests and the visual direction displayed by the HMD (centered or 10° left). Each of the four groups (n = 10) undertook line bisection tasks across four combinations of variables: using a finger/stick or a mouse to point at a touch panel located 60 or 120 cm away from the subject. Results: According to the results, regardless of the hand used, when the index finger or a stick was used (reaching condition), the line bisection point was displaced significantly to the left of the center. Additionally, a major left-displacement trend was observed in the short-distance reaching task, which did not require the use of a stick. In contrast, the long-distance task required a stick to be used, and the left displacements were all smaller than those for the short-distance tasks that used the index finger. Conclusion: This finding may be explained by the subjects having sufficient experience coordinating hand and eye movements in the condition where they used their dominant hand and reached with their own arms without using a stick.東京都立大学学位論文甲第1160号　副論

Chemoradiotherapy with 3-weekly CDDP 80 mg/m2 for head and neck squamous cell carcinoma: 5-year survival data from a phase 2 study

ObjectiveThe global standard for chemoradiation therapy (CCRT) for head and neck squamous cell carcinoma is cisplatin 100 mg/m2 administered once every three weeks, although cisplatin 80 mg/m2 is also widely used as an alternative treatment to reduce adverse events in Japan. We aimed to assess the long-term survival outcomes and late adverse events associated with CCRT with a 3-weekly cisplatin dose of 80 mg/m2.MethodsA phase 2 study on CCRT with a 3-weekly cisplatin dose of 80 mg/m2 was performed in 47 patients between April 2015 and December 2016 at four centers in Japan. Survival outcomes and late adverse events at 5 years after this phase 2 trial were investigated.ResultsThe median follow-up period was 61 months. The 5-year progression-free survival/overall survival of all 47 patients was 66.0%/76.6%, while that of patients with stage III, IV disease (UICC) was 65.6%/71.9%. Seventeen patients (36%) experienced dysphagia as a late adverse event. Univariate and multivariate analyses revealed a significant association between acute mucositis/low body mass index (BMI) during CCRT and late dysphagia.ConclusionThe survival outcomes of CCRT with a 3-weekly cisplatin dose of 80 mg/m2 may be comparable to the previously reported dose of 100 mg/m2. Acute mucositis and low BMI at CCRT were risk factors for late dysphagia, indicating the importance of managing these conditions during CCRT to prevent late adverse events. Caution and care for acute mucositis and swallowing training in patients with low BMI may be important for preventing late-stage dysphagia

Analysis of abnormal posture in patients with Parkinson's disease using a computational model considering muscle tones

Patients with Parkinson's disease (PD) exhibit distinct abnormal postures, including neck-down, stooped postures, and Pisa syndrome, collectively termed “abnormal posture” henceforth. In the previous study, when assuming an upright stance, patients with PD exhibit heightened instability in contrast to healthy individuals with disturbance, implying that abnormal postures serve as compensatory mechanisms to mitigate sway during static standing. However, limited studies have explored the relationship between abnormal posture and sway in the context of static standing. Increased muscle tone (i.e., constant muscle activity against the gravity) has been proposed as an underlying reason for abnormal postures. Therefore, this study aimed to investigate the following hypothesis: abnormal posture with increased muscle tone leads to a smaller sway compared with that in other postures, including normal upright standing, under the sway minimization criterion. To investigate the hypothesis, we assessed the sway in multiple postures, which is determined by joint angles, including cases with bended hip joints. Our approach involved conducting forward dynamics simulations using a computational model comprising a musculoskeletal model and a neural controller model. The neural controller model proposed integrates two types of control mechanisms: feedforward control (representing muscle tone as a vector) and feedback control using proprioceptive and vestibular sensory information. An optimization was performed to determine the posture of the musculoskeletal model and the accompanied parameters of the neural controller model for each of the given muscle tone vector to minimize sway. The optimized postures to minimize sway for the optimal muscle tone vector of patients with PD were compared to the actual postures observed in these patients. The results revealed that on average, the joint-angle differences between these postures was <4°, which was less than one-tenth of the typical joint range of motion. These results suggest that patients with PD exhibit less sway in the abnormal posture than in other postures. Thus, adopting an abnormal posture with increased muscle tone can potentially serve as a valid strategy for minimizing sway in patients with PD