研究内容

敗血症性播種性血管内凝固症における予後予測因子としてのProtein C活性の検討

重症感染症では高率に播種性血管内凝固（Disseminated intravascular coagulation, DIC）を合併し、その予後は不良である。重症感染症患者の予後予測因子としてはAPACHEIIスコアが開発されているが、スコア算出は煩雑であり、より簡便な予測因子が望まれる。近年、Antithrombin（AT）値が重症感染症において有意に低下し、生命予後の予測因子になることは広く知られるようになり、APACHEIIスコアの代替指標となり得ることが期待されている。我々は、感染性DICではProtein C（PC）値もAT値同様に低下することに着目した。本研究では、感染性DIC患者においてPC値が予後予測因子となり得るか検討する。

救急外来における向精神薬大量服薬患者の予後予測因子の検討

救急外来には、向精神薬の大量服薬患者が多数搬送されてくる。これらの患者の多くは年齢が若く、軽症であり、入院を要しないことが多いが、中には誤嚥性肺炎や薬物中毒症状を呈し、ICU等で入院管理を要することもある。救急外来で、これら患者の重症度を簡便に見分ける方法はなく、これらの患者の入院振り分けは担当医の勘に頼っているのが現状である。本研究の目的は、救急車のプレホスピタルレコードを用いて患者のバイタルサインや意識状態から、大量向精神薬服薬患者の予後を予測する方法を開発することにある。

心停止蘇生後のストレス反応・炎症反応・血糖値の検討

心停止後蘇生患者で、蘇生直後のストレス反応マーカー及び血糖値と生命予後の関係を調査し、予後因子を明らかにする。

妊娠糖尿病の病態解析

妊娠糖尿病はたとえ糖尿病の程度が軽度であっても巨大児など、周産期の様々な合併症のリスクとなる。また一方、妊娠糖尿病と診断された女性は将来の2型糖尿病発症のハイリスク群でもある。本研究では、妊娠糖尿病診断の時点でインスリン治療の必要性および将来の2型糖尿病発症について、予測が可能であるか検討する。

抗GAD抗体陽性妊娠糖尿病患者のフォローアップ研究

妊娠糖尿病患者の6.2%（24/385例）で抗GAD抗体などの膵島関連自己抗体が陽性であること、その中の50%（12例）で1型糖尿病が発症したこと、またその発症時期は5年以内が91.6%であったことが海外から報告された。抗GAD抗体陽性妊娠糖尿病患者は1型糖尿病発症の高リスク群と考えられるが、本邦における同様の報告は見当たらない。本研究は、抗GAD抗体陽性娠糖尿病患者の1型糖尿病発症率および糖代謝病態の変化を調査する目的とした、当科受診歴のある妊娠糖尿病患者を対象とした前向き観察研究である。

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• One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance
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• Impaired balance is related to the progression of diabetic complications in both young and older adults
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• Low glucose induces mitochondrial reactive oxygen species via fatty acid oxidation in bovine aortic endothelial cells
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• New glycemic targets for patients with diabetes from the Japan Diabetes Society
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• Hyperglycemia Induces Cellular Hypoxia through Production of Mitochondrial ROS Followed by Suppression of Aquaporin-1
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• Involvement of advanced glycation end-products in ‘hyperglycemic memory’
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  Journal of diabetes investigation. 2016;7(3):297-9

• Measurement of small fibre pain threshold values for the early detection of diabetic polyneuropathy
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• Coexistence of resistance to thyroid hormone and papillary thyroid carcinoma
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• Acetate alters expression of genes involved in beige adipogenesis in 3T3-L1 cells and obese KK-Ay mice
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• New glycemic targets for patients with diabetes from the Japan Diabetes Society
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• Mitochondrial reactive oxygen species in the pathogenesis of early diabetic nephropathy
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• Statins meditate anti-atherosclerotic action in smooth muscle cells by peroxisome proliferator-activated receptor-gamma activation
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• Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room
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• Prevalence of metabolic syndrome in stroke patients: a prospective multicenter study in Japan
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• What is the role of soluble cytokine receptors in adult T-cell leukemia/lymphoma?
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• Effect of blood transfusion on supportive therapy of elderly patients at Kumamoto, Japan as compared with Khon Kaen, Thailand
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• A lack of cellular senescence, formation of microenvironment, and role of soluble CD30 in development of adult T-cell leukemia/lymphoma
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• Clinical Value of Serum Soluble CD30 Levels in Adult T-Cell Leukemia/Lymphoma
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  Journal of Hematology and Thromboembolic Disease 2014;2:167–175

• Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive ATL: a randomized phase II study
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• Serum soluble CD25 and CD30 levels as a biomarker in adult T-cell leukemia/lymphoma patients undergoing allogeneic hematopoietic stem cell transplantation
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• Human Retroviruses and Soluble CD30 Levels of Patients
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• Soluble CD30 and peripheral blood or pulmonary involvement of adult T-cell leukemia/lymphoma
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• Mutualism among HTLV-1-infected different type of cells or among other virus-infected cells
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• CD30+ Cells in Lung of Indolent Type Adult T-Cell Leukemia/Lymphoma and Elevated Serum Levels of Soluble CD30 Associated with Acute Crisis and Relapse of Disease
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• The EPOS-CC score: an integration of independent, tumor- and patient-associated risk factors to predict 5-year overall survival following colorectal cancer surgery
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• Preliminary study of surgical audit for overall survival following gastric cancer resection
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• Value of general surgical risk models for predicting postoperative morbidity and mortality in pancreatic resections for pancreatobiliary carcinomas
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• Evaluation of modified Estimation of Physiologic Ability and Surgical Stress in patients undergoing surgery for choledochocystolithiasis
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• The development and validation of the Calculation of post-Operative Risk in Emergency Surgery (CORES) model
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• Effect of Eritoran, an Antagonist of MD2-TLR4, on Mortality in Patienta With Severe Sepsis
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• Risk factors for catheter-related bloodstream infections in adult hospitalized patients - Multicenter cohort study
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• Quality of Gastric Cancer Care in Designated Cancer Care Hospitals in Japan
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• Value of general surgical risk models for predicting postoperative liver failure and mortality following liver surgery
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• Defucosylated Anti-CCR4 Monoclonal Antibody (KW-0761) for Relapsed Adult T-Cell Leukemia-Lymphoma: A Multicenter Phase II Study
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• Evaluation of modified Estimation of Physiologic Ability and Surgical Stress (mE-PASS) in gastric carcinoma surgery
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• Evaluation of modified Estimation of Physiologic Ability and Surgical Stress (mE-PSS) in colorectal carcinoma surgery
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• Evaluation of Estimation of Physiologic Ability and Surgical Stress to predict in-hospital mortality in cardiac surgery
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• Prediction of anastomotic leak and its prognosis in digestive surgery
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• A multicenter prospective study of surgical audit systems
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• Timing of the appearance of early hypodense computed tomography signs in patients with middle cerebral artery/internal carotid artery embolism
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• Maximal sterile barrier precautions do not reduce catheter-related blood stream infections in general surgery units: a multi-institutional randomized controlled trial
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• Efficacy of vasopressin administration in the resuscitation of out-of-hospital cardiopulmonary arrest patients
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• New prediction rule for mortality in acute mesenteric ischemia
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