切迫早産母体への出生前ステロイド投与は早産児の甲状腺機能を成熟させる

京都大学新制・論文博士博士(医学)乙第13439号論医博第2238号新制||医||1054(附属図書館)(主査)教授 万代 昌紀, 教授 小杉 眞司, 教授 稲垣 暢也学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDFA

Effect of electrical activity of the diaphragm waveform patterns on SpO₂ for extremely preterm infants ventilated with neurally adjusted ventilatory assist

[Objective] This study aimed to evaluate the association between electrical activity of the diaphragm (Edi) waveform patterns and peripheral oxygen saturation (SpO2) in extremely preterm infants who are ventilated with neurally adjusted ventilatory assist (NAVA). [Study Design] We conducted a retrospective cohort study at a level III neonatal intensive care unit. Extremely preterm infants born at our hospital between November 2019 and November 2020 and ventilated with NAVA were included. We collected Edi waveform data and classified them into four Edi waveform patterns, including the phasic pattern, central apnea pattern, irregular low-voltage pattern, and tonic burst pattern. We analyzed the Edi waveform pattern for the first 15 h of collectable data in each patient. To investigate the association between Edi waveform patterns and SpO2, we analyzed the dataset every 5 min as one data unit. We compared the proportion of each waveform pattern between the desaturation (Desat [+]) and non-desaturation (Desat [–]) groups. [Results] We analyzed collected data for 105 h (1260 data units). The proportion of the phasic pattern in the Desat (+) group was significantly lower than that in the Desat (–) group (p < .001). However, the proportions of the central apnea, irregular low-voltage, and tonic burst patterns in the Desat (+) group were significantly higher than those in the Desat (–) group (all p < .05). [Conclusion] Our results indicate that proportions of Edi waveform patterns have an effect on desaturation of SpO2 in extremely preterm infants who are ventilated with NAVA

Effect of doxapram on the electrical activity of the diaphragm waveform pattern of preterm infants

[Objective] This study aimed to evaluate the change in the waveform pattern of the electrical activity of the diaphragm (Edi) following the administration of doxapram in extremely preterm infants ventilated with neurally adjusted ventilatory assist (NAVA). [Study Design] We conducted this retrospective cohort study in our neonatal intensive care unit between November 2019 and September 2021. The study participants were extremely preterm infants under the gestational age of 28 weeks who were ventilated with NAVA and administered doxapram. We collected the data of the Edi waveform pattern and calculated the proportion. To analyze the change in the proportion of the Edi waveform pattern, we compared the proportion of the data for 1 h before and after doxapram administration. [Results] Ten extremely preterm infants were included. Almost all the patients’ respiratory condition improved after doxapram administration. The ventilatory parameters—Edi peak, Edi minimum, peak inspiratory pressure, time in backup ventilation, and number of switches to backup ventilation—did not change significantly. However, the proportion of phasic pattern significantly increased (before: 46% vs. after: 72%; p < 0.05), whereas the central apnea pattern significantly decreased after doxapram administration (before: 31% vs. after: 8.3%; p < 0.05). The proportion of irregular low-voltage patterns tended to decrease, albeit with no significant changes. [Conclusion] Our results indicated that the proportion of Edi waveform patterns changed following doxapram administration. Edi waveform pattern analysis could be a sensitive indicator of effect with other intervention for respiratory conditions

EGFR mutation and ALK fusion-positive non-small cell lung cancer: a multicenter prospective cohort study in Nagano Prefecture, Japan

Introduction. We prospectively examined current clinical practices in patients with inoperable epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) fusion-positive (EGFR+ and ALK+, respectively) non-small cell lung cancer (NSCLC) in Nagano Prefecture, Japan.  Material and methods. The study population consisted of newly diagnosed patients with inoperable EGFR+ and ALK+ NSCLC in 14 hospitals in Nagano between May 2016 and March 2019. Both initial and subsequent treatment decisions were made at the discretion of the attending physician.  Results. A total of 281 patients with EGFR+ NSCLC (mean age, 74 years, 59.1% female) and 26 patients with ALK+ NSCLC (mean age, 66 years, 53.8% female) were included in the study. The study population consisted of 148/107/29/20/3 cases with performance status 0/1/2/3/4 and 6/2/31/194/75 cases with clinical stage I/II/III/IV/recurrence, respectively. First-line therapy with tyrosine kinase inhibitors was performed in 259 (92.2%) and 22 (84.6%) patients with EGFR+ and ALK+ NSCLC, respectively. The median overall survival rate was 41.2 months (95% CI 36.8–45.6 months) with EGFR+. It was not reached with ALK+ .  Conclusions. This observational analysis represents a valuable resource for evaluating the outcomes of treatment in patients with NSCLC

Combination Chemotherapy with Doxorubicin, Vincristine, Cyclophosphamide, and Platinum Compounds for Advanced Thymic Carcinoma

This is a non-final version of an article published in final form in JOURNAL OF THORACIC ONCOLOGY. 6(12):2130-2134 (2011).信州大学博士(医学)・学位論文・平成23年3月31日授与（甲第903号)・吾妻俊彦Introduction: Thymic carcinoma is a rare epithelial neoplasm that tends to be aggressive and metastasize widely. The optimal chemotherapy for unresectable advanced thymic carcinoma has not yet been established because of its rare occurrence. The purpose of this study was to evaluate the efficacy and tolerability of combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds for advanced thymic carcinoma. Methods: A retrospective analysis of 34 patients with untreated and unresectable thymic carcinoma who received chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds between 1996 and 2010 was conducted. Twenty-nine patients were treated with a combination of cisplatin (50 mg/m(2)) and doxorubicin (40 mg/m(2)) on day 1, vincristine (0.6 mg/m(2)) on day 3, and cyclophosphamide (700 mg/m(2)) on day 4. Five patients were treated with carboplatin (area under the curve of 3.0 minutes center dot mg/ml) instead of cisplatin. Results: The responses of all 34 patients to the current regimen were assessed. The median number of treatment cycles for the present chemotherapy was 4. The overall response rate and disease control rate were 50.0% and 88.2%, respectively. The median survival was 21.3 months (95% confidence interval [CI], 15.0-37.2 months), and the 1-year and 3-year survival rates were 72.7% (95% CI, 56.8-88.6%) and 34.4% (95% CI, 16.2-52.6%), respectively. The most common adverse event was leukopenia/neutropenia, and nonhematological toxicities were mild. Conclusions: Combination chemotherapy with doxorubicin, vincristine, cyclophosphamide, and platinum compounds is an effective and well-tolerated treatment for unresectable advanced thymic carcinoma.Articlejournal articl