咳嗽音を用いた新しい咳嗽力評価法の提案

広島大学(Hiroshima University)博士(工学)Doctor of Engineeringdoctora

Participación de las familias en la educación infantil latinoamericana

El presente estudio se concibió como un punto de partida para comprender la situación actual en América Latina, revisando y analizando la información existente en la región, tanto en el ámbito de las políticas como de las prácticas educativas. Este documento ofrece una sistematización de la información recopilada, a través de un análisis documental y la aplicación de un cuestionario a instituciones latinoamericanas que trabajan en los temas objeto de este estudio. Se presenta una primera mirada de ámbito regional sobre la situación actual de la participación y educación de los padres. Este documento se estructura en tres partes. En la primera se entrega un marco conceptual; en la segunda se realiza un análisis de la situación de la participación y educación de los padres y madres en América Latina, y en la tercera se ofrece una serie de conclusiones y recomendaciones para avanzar en el tema que nos ocupa. El primer capítulo explícita someramente los objetivos y metodología del estudio. El segundo, establece la relación entre infancia y familia desde una perspectiva conceptual del conocimiento existente en el ámbito mundial y en América Latina. En ese contexto se analizan las concepciones de infancia, familia y educación de la primera infancia, la influencia de la familia y sus pautas de crianza respecto de los niños y niñas y los cambios acaecidos en las familia en América Latina, mostrándose al final del acápite la importancia de la participación de los padres y madres en la educación de sus hijos. El tercer capítulo entrega cuatro tipos de antecedentes: aquellos relativos al concepto teórico de participación; los aportes de los diferentes tipos de participación al adulto y a los niños; los desafíos pedagógicos que implica la relación entre familia y escuela; y el tipo de conocimiento que se está difundiendo actualmente a través de una red especializada en temas de investigación y educación. En el cuarto capítulo se analizan las políticas, normativas y programas desde la perspectiva de la participación y educación familiar. El análisis se basa en tres tipos de documentos: acuerdos internacionales referidos a la educación e infancia; marcos políticos de los países de América Latina, y programas que se están desarrollando en diferentes países de la región. El análisis considera las siguientes perspectivas: concepción de familia que subyace en los programas; tipos y modalidades de participación; actores involucrados y sus roles; estrategias utilizadas; elementos que obstaculizan y facilitan su desarrollo, y la evaluación de los programas. El documento finaliza con una serie de conclusiones y recomendaciones que pueden ser de utilidad para orientar el debate y avanzar en el desarrollo de políticas y programas

Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study

Elevated erythropoietin (EPO) levels have been reported to predict poor survival in various populations including diabetic patients. However, data regarding its impact on renal outcomes are scarce. We conducted a single-center, prospective cohort study of 339 type 2 diabetic patients with anemia. The primary outcome was the estimated glomerular filtration rate (eGFR) slope for two years. We performed multiple linear regression and restricted cubic spline analyses to assess the association of serum EPO levels with the renal outcome. Chronic kidney disease (CKD) was defined as eGFR 30 mg/g creatinine. Median baseline EPO and eGFR level were 14.4 IU/L and 53 mL/min/1.73 m2, respectively. Inappropriately low EPO levels were observed in 73% of anemic patients and 59% of anemic patients even without CKD, suggesting that EPO deficiency precedes the onset of CKD in diabetes mellitus. Multivariable analysis revealed that iron status and hemoglobin levels were major determinants of EPO levels. Median eGFR slope was −1.3 mL/min/1.73 m2/year. We found that low EPO levels, but not low hemoglobin levels, were associated with a faster decline in eGFR, independent of clinically relevant factors. The eGFR decline was steeper, particularly when the EPO level was below the upper limit of normal. Lower EPO concentrations were associated with rapid eGFR decline, especially in patients with iron deficiency (P for interaction = 0.01). Relative EPO deficiency should be considered as a culprit in anemia of unknown etiology in diabetic patients, even those without CKD. Low EPO levels, especially when accompanied by poor iron status, are predictive of rapid loss of renal function.Fujita Y., Doi Y., Hamano T., et al. Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study. Scientific Reports 9, 14871 (2019); https://doi.org/10.1038/s41598-019-51207-8

Application of PDT for Uterine Cervical Cancer

We have been performing PDT using Excimer Dye Laser (EDL) or YAG-OPO laser, a type of low power laser, both of which have a considerably higher degree of tissue penetration even when compared to PDT using Argon Dye Laser (ADL)

Dynapenia and sarcopenia diabetes

Aims/Introduction: The present study aimed to clarify the prevalence and clinical characteristics of sarcopenia and dynapenia, which are muscle weakness with and without low muscle mass, respectively, in Japanese patients with type 1 diabetes mellitus and type 2 diabetes mellitus. Materials and Methods: This cross-sectional study enrolled 1,328 participants with type 1 diabetes (n = 177), type 2 diabetes (n = 645) and without diabetes (n = 506). Sarcopenia was defined as a low grip strength and slow gait speed with low skeletal muscle mass index, whereas dynapenia was defined as low strengths of grip and knee extension with a normal skeletal muscle mass index. Participants without sarcopenia and dynapenia were defined as robust. Results: Among participants aged ≥65 years, sarcopenia and dynapenia were observed in 12.2% and 0.5% of individuals without diabetes, 42.9% and 11.4% of type 1 diabetes patients, and 20.9% and 13.9% of type 2 diabetes patients. In both type 1 diabetes and type 2 diabetes patients, sarcopenic patients were significantly older and thinner, and showed a significantly higher rate of diabetic neuropathy than robust patients. In patients with type 1 diabetes and type 2 diabetes, dynapenic patients were older, and showed a higher rate of diabetic neuropathy and lower estimated glomerular filtration rate than robust patients. Patients complicated with sarcopenia and dynapenia showed a significantly lower physical quality of life and higher rate of incidental falls than robust patients. Conclusions: Sarcopenia and dynapenia were more frequent in patients with type 1 diabetes and type 2 diabetes than in individuals without diabetes, which might contribute to their impaired quality of life and incidental falls

Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy

Background: We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. Methods: Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. Results: The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. Conclusions: Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care

A case report on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia

症例は難治性潰瘍性口内炎を契機に判明した急性リンパ性白血病の 1 例である．患者は 60 歳台，女性．下口唇に難治性潰瘍を認め紹介となった．血液検査にて汎血球減少を認めたため，血液疾患を疑った．骨髄検査にて，Ph 染色体陰性急性 B 細胞性リンパ性白血病と診断され，初診の 4 日後からステロイド療法が開始された．なお，下口唇生検の病理組織には明らかな白血病細胞の浸潤は認めなかった．口腔症状が白血病の初発症状となることがあり，これを主訴に受診した白血病患者を早期診断することは大変重要である．しかし，口腔病変の原因は多彩であり，さまざまな科が対応することが多く，各科が連携して診療にあたることが重要と考える．We herein report a case on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia. The female patient in her 60s showed refractory ulcer on her lower lip ; and the referral was made. Since pancytopenia was found by a blood test, hematologic disease was suspected. Bone marrow examination presented the diagnosis of Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia. Based on this diagnosis, steroid therapy had been initiated from four days after the first visit. On biopsy of lower lip, the pathological tissue did not show obvious infiltration of leukemia cells. Since oral manifestation may sometimes be an initial symptom of leukemia, an early diagnosis on leukemia patient with main complaint of oral symptom is critically important. Oral lesions, however, have various causes, and it thus often requires care of various clinical department. Based on this, it is considered to be important to implement treatment with cooperation among each clinical department