精神科病院入院患者における身体合併症発症のハイリスク群のスクリーニング

摂食・嚥下機能と排尿機能、肥満度の調査により、身体合併症発症のハイリスク状態の患者をスクリーニングし、実態を把握すると共に、予防的取り組みについて考察することを目的とした。A県内にある公立精神科病院に入院中もしくはデイケアに通所中の精神疾患患者93名のスクリーニングを実施した。反復唾液嚥下テストにおいて、嚥下障害が強く疑われた患者は89名中14名（15.7％）であった。尿排出困難が強く疑われた患者は82名中44名（53.7％）であり、向精神薬の影響が考えられた。肥満者は92名中44名（47.8％）、ウエスト周囲径が男性85cm以上・女性90cm以上だった割合は、85名中64名（75.3％）であり、上半身肥満体型が多いことが示唆された。また、糖尿病が強く疑われる割合は、57名中13名（22.8％）という結果であった

A pragmatic method for electronic medical record-based observational studies: developing an electronic medical records retrieval system for clinical research.

[Objective]The use of electronic medical record (EMR) data is necessary to improve clinical research efficiency. However, it is not easy to identify patients who meet research eligibility criteria and collect the necessary information from EMRs because the data collection process must integrate various techniques, including the development of a data warehouse and translation of eligibility criteria into computable criteria. This research aimed to demonstrate an electronic medical records retrieval system (ERS) and an example of a hospital-based cohort study that identified both patients and exposure with an ERS. We also evaluated the feasibility and usefulness of the method. [Design] The system was developed and evaluated. [Participants] In total, 800 000 cases of clinical information stored in EMRs at our hospital were used. [Primary and secondary outcome measures]The feasibility and usefulness of the ERS, the method to convert text from eligible criteria to computable criteria, and a confirmation method to increase research data accuracy. [Results] To comprehensively and efficiently collect information from patients participating in clinical research, we developed an ERS. To create the ERS database, we designed a multidimensional data model optimised for patient identification. We also devised practical methods to translate narrative eligibility criteria into computable parameters. We applied the system to an actual hospital-based cohort study performed at our hospital and converted the test results into computable criteria. Based on this information, we identified eligible patients and extracted data necessary for confirmation by our investigators and for statistical analyses with our ERS. [Conclusions ]We propose a pragmatic methodology to identify patients from EMRs who meet clinical research eligibility criteria. Our ERS allowed for the efficient collection of information on the eligibility of a given patient, reduced the labour required from the investigators and improved the reliability of the results

Requirement of longer term antiviral therapy in patients with cytomegalovirus anterior uveitis with corneal endothelial cell damage

Yosuke Harada,1,2 Ken Fukuda,1 Asami Nakahira,1 Kentaro Tada,1 Tamaki Sumi,1 Atsuki Fukushima1 1Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku, Japan; 2Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan Background: The aim of the study was to investigate the efficacy of therapy in patients with cytomegalovirus (CMV) anterior uveitis. Patients and methods: We reviewed the records of patients with CMV anterior uveitis who attended our institution between October 2010 and December 2015 and who were confirmed to have CMV DNA in the aqueous humor by polymerase chain reaction analysis. Results: Fourteen immunocompetent patients (10 men and 4 women, total of 17 eyes) were enrolled. The mean ± SD age at the onset of antiviral therapy was 63.1 ± 11.3 years (range, 44–87 years). CMV DNA was not detected in the aqueous humor of 3 patients on initial testing, but it was detected on subsequent analysis. All patients underwent systemic antiviral therapy. Among the patients who were followed up for more than 6 months after starting systemic antiviral therapy, systemic antiviral therapy was successfully terminated in all 4 patients without corneal endothelial loss but had to be continued because of disease recurrence on its termination in 5 of 8 patients (62.5%) with corneal endothelial damage (P = 0.038). Conclusions: Patients with corneal endothelial cell loss are likely to require longer term antiviral therapy than those without endothelial damage. In addition, whereas definitive diagnosis of CMV anterior uveitis requires the detection of CMV DNA in aqueous humor by polymerase chain reaction, one-fifth of patients in the present study tested negative on initial examination. Keywords: cytomegalovirus, anterior uveitis, corneal endothelial cell, polymerase chain reaction, clinical cours

Severity Classification of Conjunctival Hyperaemia by Deep Neural Network Ensembles

Conjunctival hyperaemia is a common clinical ophthalmological finding and can be a symptom of various ocular disorders. Although several severity classification criteria have been proposed, none include objective severity criteria. Neural networks and deep learning have been utilised in ophthalmology, but not for the purpose of classifying the severity of conjunctival hyperaemia objectively. To develop a conjunctival hyperaemia grading software, we used 3700 images as the training data and 923 images as the validation test data. We trained the nine neural network models and validated the performance of these networks. We finally chose the best combination of these networks. The DenseNet201 model was the best individual model. The combination of the DenseNet201, DenseNet121, VGG19, and ResNet50 were the best model. The correlation between the multimodel responses, and the vessel-area occupied was 0.737 (p<0.01). This system could be as accurate and comprehensive as specialists but would be significantly faster and consistent with objective values

Depletion of Thymus-Derived CD4+CD25+ T Cells Abrogates the Suppressive Effects of α-galactosylceramide Treatment on Experimental Allergic Conjunctivitis

Background: We showed previously that α-galactosylceramide (α-GalCer) treatment elevated splenic CD4+ CD25+Foxp3+ T-cell numbers and suppressed the development of experimental allergic conjunctivitis (EC). Here, we investigated whether CD4+CD25+Foxp3+ T cells mediate the suppressive effects of α-GalCer treatment on EC. Methods: To deplete CD4+CD25+Foxp3+ T cells, neonatal mice were thymectomized and intraperitoneally injected with anti-CD25 Ab. At 6 weeks of age, these mice were immunized with ragweed (RW) in aluminum hydroxide. Ten days later, the mice were challenged with RW in eye drops and 24 hours later, the conjunctivas and spleens were harvested for histological and flow cytometric analyses, respectively. α-GalCer or vehicle was injected 2 hours prior to RW challenge. In addition, α-GalCer was injected into thymus-intact EC-developing mice that had not been treated with anti-CD25 Ab. Results: α-GalCer treatment significantly suppressed EC in the thymus-intact mice that had not been treated with anti-CD25 Ab. In contrast, α-GalCer treatment of thymectomized and anti-CD25 Ab-treated mice did not affect the severity of EC or splenic CD4+CD25+Foxp3+ T-cell numbers. However, α-GalCer treatment did significantly increase splenic CD4+CD25+Foxp3+ T-cell numbers in thymectomized mice that had not received anti-CD25 Ab. Conclusions: α-GalCer treatment during the effector phase of EC increased CD4+CD25+Foxp3+ T-cell numbers, which in turn suppressed the development of EC

Interleukin 10 and transforming growth factor β contribute to the development of experimentally induced allergic conjunctivitis in mice during the effector phase

AIM: To investigate the involvement of interleukin (IL)10 and transforming growth factor (TGF) β in the development of experimentally induced allergic conjunctivitis in mice. METHODS: Balb/c mice were actively sensitised with ragweed in alum, and then challenged with ragweed in eye drops after 10 days. 24 h later, the conjunctivas, spleens and blood were collected for histological and cytokine expression analyses, proliferation and cytokine production assays and measurement of immunoglobulin (Ig) levels. Mice developing experimentally induced allergic conjunctivitis were injected intraperitoneally with 200 μg of anti‐IL10 or anti‐TGF β antibodies at 0, 2, 4, 6 and 8 days (induction phase treatment) or 500 μg of antibodies 2 h before ragweed challenge (effector phase treatment). Normal rat IgG was used for control injections. RESULTS: Treatment with either anti‐IL10 or anti‐TGF β antibodies during the induction phase did not affect eosinophil infiltration into the conjunctiva. By contrast, treatment with either antibody during the effector phase suppressed infiltration. During the effector phase, treatment with anti‐TGF β antibody, but not the anti‐IL10 antibody, markedly up regulated proliferation and Th2 cytokine production by splenocytes. IL1α levels in the conjunctiva were reduced after treatment with either antibody; in addition, eotaxin and tumour necrosis factor α levels were reduced after treatment with antibody to TGF β. CONCLUSIONS: IL10 and TGF β do not have immunosuppressive roles in the development of experimentally induced allergic conjunctivitis. Rather, they augment the infiltration of eosinophils into the conjunctiva during the effector phase of experimentally induced allergic conjunctivitis