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Hiroki Umezawa,Yoji Kokura,Satoko Abe,Chieko Suzuki,Akiko Nishida,Yoshie Uchiyama,Keisuke Maeda,Hidetaka Wakabayashi,Ryo Momosaki 대한재활의학회 2019 Annals of Rehabilitation Medicine Vol.43 No.5
Objective To analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown. Methods This retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m2. Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score. Results The final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain. Conclusion Among elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.
Vibration control of membrane structures using multiple dielectric elastomer actuators
Toshiki Hiruta,Hiroki Ishihara,Naoki Hosoya,Shingo Maeda,Itsuro Kajiwara 제어로봇시스템학회 2021 제어로봇시스템학회 국제학술대회 논문집 Vol.2021 No.10
A vibration suppression technique for lightweight and flexible membrane structures is proposed using smart structure technology with a dielectric elastomer actuator (DEA). DEA is a lightweight flexible polynomial material with a large deformation and high response time. Its advantages include easy application to the membrane structures and vibration suppression over a wide frequency band. A non-contact excitation system using a high-power Nd:YAG pulsed laser is used to precisely measure the vibration responses of membrane structures. The system generates a highly reproducible ideal impulse excitation. Active vibration control for membrane structures with DEAs is examined in this study. To improve the vibration control effect, multiple DEAs are applied. These actuators generate vibration control forces simultaneously during the control. Laminated DEAs are fabricated and attached to the membrane surface separately. An experimental setup including a digital control system is constructed with the laser excitation system. To demonstrate the effectiveness of the proposed method, a controller is designed by H∞ control theory with the identified membrane model and vibration control experiments are conducted.
Takamasa Takahashi,Yuji Kaneoka,Atsuyuki Maeda,Yuichi Takayama,Hiroki Aoyama,Takahiro Hosoi,Kazuaki Seita 대한내시경로봇외과학회 2023 Journal of Minimally Invasive Surgery Vol.26 No.2
Purpose: In minimally invasive esophagectomy (MIE), it is important to reduce the rate of anastomotic leakage to ensure its safety. At our institute, the double-ligation method (DLM) has been introduced to insert and fix the anvil of the circular stapler for intracorporeal circular esophagojejunostomy in gastric surgery. We adopted this method for intrathoracic anastomosis (IA) in MIE. The aim of this study was to investigate the safety of IA with DLM in MIE. Methods: In this study, 48 patients diagnosed with primary middle or lower third segment thoracic esophageal carcinoma with clinical stage I, II, III or IV disease were retrospectively evaluated. Postoperative outcomes were assessed. Results: Among the 48 patients, 42 patients underwent laparo-thoracoscopic esophagectomy and IA using a circular stapler with the DLM. The average total operation time and thoracoscopic operation time were 433 and 229 minutes, respectively. The average pursestring suturing time was 4.7 minutes. The rates of anastomotic leakage and stenosis were 2.4% and 14.3%, respectively. The overall incidence of postoperative complications (Clavien- Dindo grade of ≥III) was 16.7%. The average postoperative stay was 16 days. Conclusion: The procedure of IA using a circular stapler with the DLM in MIE was safe and provided a low rate of anastomotic leakage.
( Toshihiko Hata ),( Ken Ueda ),( Hiroshi Maruyama ),( Toshiki Takaya ),( Hiroshi Kuraishi ),( Kenji Maeda ),( Hiroki Tomita ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: In super acute phase after the Great East Japan Earthquake (11 March 2011), Disaster medical association team (DMAT) consisted of emergency physicians acted in disaster areas in the East Coast of Japan. On the other hand, these areas needed chronic care support by general physicians because of the enormous destructions of the medical facilities by the tsunami. So then, the Japanese Red Cross Society had sent disaster emergency outpatient assistance doctors to Isinomaki Red Cross Hospital, was intact because it was moved away from the Pacifi c Ocean three years ago. Methods: Determination of specialism by direct hearing and information from home page of each Red Cross Hospitals. Results: Cumulative 81 medical doctors were 38 internal medicine physicians, trainees 15, emergency physicians 12, surgeon 6, pediatrician 3, orthopedic surgeon 3, anesthesiologist 2, obstetrician 2, from April to August 2011. At fi rst 6 dispatched doctors were resident and did emergency outpatient work in Ishinomaki Red Cross Hospital for 6 days and dipatched. A lot of Cases of pneumonia and bronchial asthma due to debris and rubble by Tsunami were seen. All dispatch doctors corresponded to primary surgery including fractures and trauma, pediatric diseases, and posttraumatic stress disorder due to earthquake itself, tsunami damage, and radiation problem of Fukushima. Conclusions: The role of general physicians is very important in chronic phase of disaster medical assistance. Medical facilities in the area with many earthquakes should be moved apart from the sea in order to avoid the damage of tsunami.
Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Takashi Tamura,Masahiro Itonaga,Takeichi Yoshida,Hiroki Maeda,Hirohito Magari,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun Kato 거트앤리버 소화기연관학회협의회 2016 Gut and Liver Vol.10 No.4
Background/Aims: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Methods: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. Results: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). Conclusions: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.
Takashi Tamura,Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Masahiro Itonaga,Shin-ichi Murata,Kaori Yamamoto,Takeichi Yoshida,Hiroki Maeda,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.4
Background/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone. Methods: Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison. Results: The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06). Conclusions: ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.
Tatematsu, Hidezumi,Miyahara, Ryoji,Shimoyama, Yoshie,Funasaka, Kohei,Ohno, Eizaburou,Nakamura, Masanao,Kawashima, Hiroki,Itoh, Akihiro,Ohmiya, Naoki,Hirooka, Yoshiki,Watanabe, Osamu,Maeda, Osamu,Ando Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.5
Background: A close association between patterns identified by magnifying narrow-band imaging (M-NBI) and histological type has been described. M-NBI patterns were also recently reported to be related to the mucin phenotype; however, detials remain unclear. Materials and Methods: We investigated the cellular differentiation of gastric cancer lesions, along with their mucosal distribution observed by M-NBI. Ninety-seven depressed-type early gastric cancer lesions (74 differentiated and 23 undifferentiated adenocarcinomas) were visualized by M-NBI. Findings were divided into 4 patterns based on abnormal microvascular architecture: a chain loop pattern (CLP), a fine network pattern (FNP), a corkscrew pattern (CSP), and an unclassified pattern. Mucin phenotypes were judged as gastric (G-type), intestinal (I-type), mixed gastric and intestinal (M-type), and null (N-type) based on 4 markers (MAC5AC, MUC6, MUC2, and CD10). The relationship of each pattern of microvascular architecture with organoid differentiation indicated by cancer cell differentiation and its distribution in each histological type of early gastric cancer was investigated. Results: All CLP and FNP lesions were differentiated. The cancer cell distribution showed organoid differentiation in 84.2% (16/19) and 61.1% (22/36) of the two types of lesions, respectively, and there was a significant difference from the unclassified pattern with organoid differentiation (p<0.001). Almost all (94.7%; 18/19) CSP lesions were undifferentiated, and organoid differentiation was observed in 72.2% (13/18). There was a significant difference from the unclassified pattern with organoid differentiation (p<0.05). Conclusions: Cellular differentiation and distribution are associated with microvascular architecture observed by M-NBI.
Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio Kataoka,Eizaburo Ohno,Takuya Ishikawa,Kentaro Yamao,Yasuyuki Mizutani,Tadashi Iida,Hideki Takami,Osamu Maeda,Junpei Yamaguchi,Yukihiro Yokoyama,Tomoki Ebata,Yasuhiro Kodera,Hiroki Kawashima 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1
Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions: Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.