論文 - 塚原　宏一

非モザイク型4倍体(92,XXXX)の1例

岡村 朋香, 二口 慧介, 福田 花奈, 佐藤 剛史, 森本 大作, 渡邉 宏和, 鷲尾 洋介, 吉本 順子, 塚原 宏一

日本周産期・新生児医学会雑誌   60 ( Suppl.1 )   P340 - P340   2024年6月

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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新生児の足底のしわの深層学習は,出生後の在胎期間推定の精度を向上させる

森本 大作, 二口 慧介, 福田 花奈, 佐藤 剛史, 岡村 朋香, 渡邉 宏和, 鷲尾 洋介, 吉本 順子, 塚原 宏一

日本周産期・新生児医学会雑誌   60 ( Suppl.1 )   P282 - P282   2024年6月

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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Postnatal longitudinal analysis of serum nitric oxide and eosinophil counts in extremely preterm infants. 査読 国際誌

Hirokazu Watanabe, Yosuke Washio, Kei Tamai, Daisaku Morimoto, Tomoka Okamura, Junko Yoshimoto, Hidehiko Nakanishi, Misao Kageyama, Atsushi Uchiyama, Hirokazu Tsukahara, Satoshi Kusuda

Pediatrics and neonatology   65 ( 3 )   276 - 281   2024年5月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Nitric oxide (NO) may be related to the pathogenesis of several morbidities in extremely preterm infants, including late-onset adrenal insufficiency. However, eosinophilia is observed under pathological conditions with adrenal insufficiency. Therefore, this study explored postnatal changes in NO levels and eosinophil counts in extremely preterm infants with and without morbidities. METHODS: Nineteen extremely preterm infants with a median gestational age of 27.0 weeks and median birth weight of 888 g were enrolled in this study. Serum levels of nitrogen oxides (NOx) and peripheral blood eosinophil counts were measured at birth and every 2 weeks thereafter. Morbidities of the study group were diagnosed using a single criterion. RESULTS: Serum NOx levels (mean ± standard deviation) were 22.5 ± 14.9 μmol/L, 51.2 ± 23.7 μmol/L, 42.4 ± 15.2 μmol/L, and 33.8 ± 9.4 μmol/L at birth and 2, 4, and 6 weeks of age, respectively. The serum NOx level at 2 weeks of age was significantly higher than that at birth and 6 weeks of age. Eosinophil counts, which increase with adrenal insufficiency, were measured simultaneously and were 145 ± 199/μL, 613 ± 625/μL, 466 ± 375/μL, and 292 ± 228/μL at birth and 2, 4, and 6 weeks of age, respectively. These values showed that the eosinophil count was significantly higher at 2 weeks of age than at birth and 6 weeks of age. The serum NOx level of infants without chorioamnionitis was significantly increased at 4 weeks of age, and the eosinophil count of infants with necrotizing enterocolitis was significantly increased at 2 weeks of age. No correlation with the NOx level or eosinophil count was observed in infants with late-onset circulatory collapse. CONCLUSION: The postnatal serum NOx level and eosinophil count were significantly correlated with each other and peaked at 2 weeks of age.

DOI： 10.1016/j.pedneo.2023.08.006

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Delayed diagnostic interval and survival outcomes in pediatric leukemia: A single-center, retrospective study. 査読 国際誌

Kosuke Tamefusa, Motoharu Ochi, Hisashi Ishida, Takahiro Shiwaku, Kiichiro Kanamitsu, Kaori Fujiwara, Yasuhisa Tatebe, Naomi Matsumoto, Kana Washio, Hirokazu Tsukahara

European journal of haematology   112 ( 5 )   714 - 722   2024年5月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Objective

This study primarily focused on the diagnostic interval (DI), defined as the duration from the onset of leukemic symptoms to diagnosis. We investigated whether a prolonged DI is associated with the outcomes of pediatric leukemia.

Methods

We retrospectively collected data of children with newly diagnosed pediatric leukemia at Okayama University Hospital from January 2007 to December 2022. Survival analyses were conducted using Kaplan–Meier methods, and an unadjusted analysis to compare differences in survival was performed using the log‐rank test.

Results

In total, 103 children with leukemia were included in the analysis. The median DI was 20 days (interquartile range, 9.5–33.5 days). A prolonged DI (≥30 days) demonstrated no association with either 5‐year event‐free survival (70.1% for <30 days and 68.3% for ≥30 days, p = .99, log‐rank test) or overall survival (84.7% for <30 days and 89.4% for ≥30 days, p = .85, log‐rank test).

Conclusions

A prolonged DI was not associated with the survival of children with leukemia. If a precise classification of leukemia biology is provided for pediatric patients, a prolonged DI may have little impact on the prognosis of these patients.

DOI： 10.1111/ejh.14162

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Radiological characteristics of skeletal growth in neonates and infants with achondroplasia. 査読 国際誌

Daisuke Miyahara, Kosei Hasegawa, Yuko Ago, Natsuko Futagawa, Hiroyuki Miyahara, Yousuke Higuchi, Kazuki Yamada, Tomonori Tetsunaga, Tadashi Moriwake, Hiroyuki Tanaka, Hirokazu Tsukahara

American journal of medical genetics. Part A   194 ( 5 )   e63525   2024年5月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Achondroplasia (ACH) is the most common form of skeletal dysplasia characterized by a rhizomelic short stature. Radiological skeletal findings in pediatric and adult patients with ACH include short long bones, a relatively longer fibula compared to the tibia, a narrow lumbar interpedicular distance, and a hypoplastic iliac wing. Nonetheless, the characteristics of skeletal growth during the neonatal and infantile periods have scarcely been explored. Therefore, this retrospective study aimed to analyze the radiological skeletal growth during the neonatal and infantile periods in 41 Japanese patients with genetically confirmed ACH. The length of long bones in the upper and lower limbs and the lumbar interpedicular distances at L1 and L4 were measured. These parameters showed significant positive correlations with age. The upper segment-to-lower segment ratio in the lower limbs resembled the data of healthy controls from previous reports. The L1/L4 and fibula/tibia ratios increased with age, suggesting that some representative skeletal phenotypes of ACH were less distinct during the neonatal and infantile periods. In conclusion, for the first time, this study radiologically characterized skeletal growth during the neonatal and infantile periods of patients with genetically confirmed ACH.

DOI： 10.1002/ajmg.a.63525

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Machine Learning to Improve Accuracy of Transcutaneous Bilirubinometry. 査読 国際誌

Daisaku Morimoto, Yosuke Washio, Kana Fukuda, Takeshi Sato, Tomoka Okamura, Hirokazu Watanabe, Junko Yoshimoto, Maki Tanioka, Hirokazu Tsukahara

Neonatology   121 ( 6 )   772 - 779   2024年4月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study aimed to develop models for predicting total serum bilirubin by correcting errors of transcutaneous bilirubin using machine learning based on neonatal biomarkers that could affect spectrophotometric measurements of tissue bilirubin. METHODS: This retrospective study included infants born at our hospital (≥36 weeks old, ≥2,000 g) between January 2020 and December 2022. Infants without a phototherapy history were included. Robust linear regression, gradient boosting tree, and neural networks were used for machine learning models. A neural network, inspired by the structure of the human brain, was designed comprising three layers: input, intermediate, and output. RESULTS: Totally, 683 infants were included. The mean (minimum-maximum) gestational age, birth weight, participant age, total serum bilirubin, and transcutaneous bilirubin were 39.0 (36.0-42.0) weeks, 3,004 (2,004-4,484) g, 2.8 (1-6) days of age, 8.50 (2.67-18.12) mg/dL, and 7.8 (1.1-18.1) mg/dL, respectively. The neural network model had a root mean square error of 1.03 mg/dL and a mean absolute error of 0.80 mg/dL in cross-validation data. These values were 0.37 mg/dL and 0.28 mg/dL, smaller compared to transcutaneous bilirubin, respectively. The 95% limit of agreement between the neural network estimation and total serum bilirubin was -2.01 to 2.01 mg/dL. Unnecessary blood draws could be reduced by up to 78%. CONCLUSION: Using machine learning with transcutaneous bilirubin, total serum bilirubin estimation error was reduced by 25%. This integration could increase accuracy, lessen infant discomfort, and simplify procedures, offering a smart alternative to blood draws by accurately estimating phototherapy thresholds.

DOI： 10.1159/000535970

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Trends in childhood obesity in Japan: A nationwide observational study from 2012 to 2021. 査読 国際誌

Shintaro Fujiwara, Ko Harada, Hideharu Hagiya, Toshihiro Koyama, Kosei Hasegawa, Hirokazu Tsukahara, Fumio Otsuka

Clinical obesity   14 ( 2 )   e12636   2024年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The persistent ascension of childhood obesity on a global scale constitutes a significant quandary. The prevalence of childhood obesity in Japan peaked in the early 2000s and has been reported to have declined since then, but recent data and its trend including the novel coronavirus disease 2019 (COVID-19) pandemic era are not available. Moreover, there is a dearth of studies examining the correlation between the trend in childhood obesity and exercise habits over the past decade. This study aims to examine the changes in the prevalence of obesity, physical fitness, and exercise habits over the past 10 years in Japanese children. We investigated the prevalence of childhood obesity in Japan, using the School Health Statistics Survey data from 2012 to 2021. The dataset has a sample size representative of children nationwide and includes variables for obesity, such as height, weight, and age. Data were classified into groups by sex and age (6-8, 9-11, and 12-14 years age). Children weighing 20% or more of the standard body weight are classified as obese. The annual percentage changes and average annual percentage changes were estimated using the joinpoint regression model. We also examined the trends in the physical fitness test score and exercise time. Average annual percentage changes of boys increased, especially in the 6- to 8-year age group (3.4%-4.6%). For girls, average annual percentage changes had increased in 6- to 8-year (2.5%-4.0%) and 9- to 11-year (0.9%-2.2%) age groups. Since the late 2010s, significantly increasing annual percentage changes were observed in 12- to 14-year age boys (6.7%-8.9%) and girls of many age groups (2.6%-8.6%). The physical fitness test score and exercise time showed decreasing trends since the late 2010s. Childhood obesity may have generally risen in Japan, in the last decade. Encouraging healthy eating and physical activity through school policies and curricula is necessary.

DOI： 10.1111/cob.12636

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「原因不明の小児急性肝炎に関する実態調査(二次調査)」報告

近藤 宏樹, 多屋 馨子, 天羽 清子, 乾 あやの, 笠原 群生, 鈴木 光幸, 田中 孝明, 津川 毅, 別所 一彦, 保科 隆之, 宮入 烈, 虫明 聡太郎, 吉川 哲史, 齋藤 昭彦, 塚原 宏一, 森岡 一朗, 須磨崎 亮, 細矢 光亮, 日本小児科学会予防接種・感染症対策委員会原因不明の小児の急性肝炎対策ワーキンググループ

日本小児科学会雑誌   128 ( 4 )   668 - 680   2024年4月

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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Shear Wave Dispersionによる後期早産児及び正期産新生児の肝臓の粘性の測定

佐藤 剛史, 渡邉 宏和, 二口 慧介, 福田 花奈, 大平 安希子, 森本 大作, 岡村 朋香, 吉本 順子, 鷲尾 洋介, 塚原 宏一

超音波医学   51 ( Suppl. )   S687 - S687   2024年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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A nationwide birth cohort in Japan showed increased risk of early childhood hospitalisation in infants born small for gestational age. 査読 国際誌

Asami Ohyama, Naomi Matsumoto, Kei Tamai, Yosuke Washio, Junko Yoshimoto, Takashi Yorifuji, Hirokazu Tsukahara

Acta paediatrica (Oslo, Norway : 1992)   113 ( 3 )   480 - 485   2024年3月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To examine associations between children being born small for gestational age and childhood hospitalisation following term and preterm births. METHODS: This study included 34 564 children from a nationwide population-based longitudinal survey starting in 2010, comprising 32 603 term births and 1961 preterm births. Children's hospitalisation history was examined during two observational periods, 6-18 and 6-66 months of age. Logistic regression analysis was conducted, adjusting for child and parental confounders, with children born appropriate for gestational age as reference. RESULTS: Children born small for gestational age were more likely to be hospitalised during early childhood than those born appropriate for gestational age. The odds ratio (95% confidence interval) for hospitalisation from 6 to 66 months of age was 1.19 (1.05-1.34) in term children born small for gestational age and 1.47 (1.05-2.06) for preterm children born small for gestational age, compared with those born appropriate for gestational age. The risk of hospitalisation from 6 to 66 months of age in children born small for gestational age was observed for bronchitis/pneumonia. CONCLUSION: We observed the adverse effects of small for gestational age on hospitalisation during early childhood in both term and preterm births, particularly for bronchitis and pneumonia.

DOI： 10.1111/apa.17032

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Successful use of dupilumab for egg-induced eosinophilic gastroenteritis with duodenal ulcer: a pediatric case report and review of literature. 査読 国際誌

Mitsuru Tsuge, Kenji Shigehara, Kazuhiro Uda, Seiji Kawano, Masaya Iwamuro, Yukie Saito, Masato Yashiro, Masanori Ikeda, Hirokazu Tsukahara

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology   19 ( 1 )   103 - 103   2023年12月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Non-esophageal eosinophilic gastrointestinal disorder (non-EoE-EGID) is a rare disease in which eosinophils infiltrate parts of the gastrointestinal tract other than the esophagus; however, the number of patients with non-EoE-EGID has been increasing in recent years. Owing to its chronic course with repeated relapses, it can lead to developmental delays due to malnutrition, especially in pediatric patients. No established treatment exists for non-EoE-EGID, necessitating long-term systemic corticosteroid administration. Although the efficacy of dupilumab, an anti-IL-4/13 receptor monoclonal antibody, for eosinophilic esophagitis, has been reported, only few reports have demonstrated its efficacy in non-EoE EGIDs. CASE PRESENTATION: A 13-year-old boy developed non-EoE-EGID with duodenal ulcers, with chicken eggs as the trigger. He was successfully treated with an egg-free diet, proton pump inhibitors, and leukotriene receptor antagonists. However, at age 15, he developed worsening upper abdominal pain and difficulty eating. Blood analysis revealed eosinophilia; elevated erythrocyte sedimentation rate; and elevated levels of C-reactive protein, total immunoglobulin E, and thymic and activation-regulated chemokines. Upper gastrointestinal endoscopy revealed a duodenal ulcer with marked mucosal eosinophilic infiltration. Gastrointestinal symptoms persisted even after starting systemic steroids, making it difficult to reduce the steroid dose. Subcutaneous injection of dupilumab was initiated because of comorbid atopic dermatitis exacerbation. After 3 months, the gastrointestinal symptoms disappeared, and after 5 months, the duodenal ulcer disappeared and the eosinophil count decreased in the mucosa. Six months later, systemic steroids were discontinued, and the duodenal ulcer remained recurrence-free. The egg challenge test result was negative; therefore, the egg-free diet was discontinued. Blood eosinophil count and serum IL-5, IL-13, and eotaxin-3 levels decreased after dupilumab treatment. The serum levels of IL-5 and eotaxin-3 remained within normal ranges, although the blood eosinophil counts increased again after discontinuation of oral prednisolone. CONCLUSIONS: Suppression of IL-4R/IL-13R-mediated signaling by dupilumab may improve abdominal symptoms and endoscopic and histologic findings in patients with non-EoE-EGID, leading to the discontinuation of systemic steroid administration and tolerance of causative foods.

DOI： 10.1186/s13223-023-00859-3

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Short stature in small-for-gestational-age offspring born to mothers with hypertensive disorders of pregnancy. 査読 国際誌

Sakurako Mishima, Takashi Mitsui, Kazumasa Tani, Jota Maki, Eriko Eto, Kei Hayata, Yosuke Washio, Junko Yoshimoto, Hirokazu Tsukahara, Hisashi Masuyama

Hypertension in pregnancy   42 ( 1 )   2187623 - 2187623   2023年12月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To investigate the incidence and risk factors of small-for-gestational age (SGA) short stature at 2 and 3 years of age in SGA offspring born to women with hypertensive disorders of pregnancy (HDP). METHODS: We examined 226 women with HDP whose respective SGA offspring were delivered. RESULTS: Eighty offspring (41.2%) were diagnosed with SGA short stature. The prematurity before 32 weeks of gestation was the most significant factor for catch-up growth failure. CONCLUSION: In SGA offspring born to women with HDP, SGA short stature incidence was high, and the risk factor was prematurity before 32 weeks of gestation.

DOI： 10.1080/10641955.2023.2187623

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Roles of Oxidative Injury and Nitric Oxide System Derangements in Kawasaki Disease Pathogenesis: A Systematic Review. 査読 国際誌

Mitsuru Tsuge, Kazuhiro Uda, Takahiro Eitoku, Naomi Matsumoto, Takashi Yorifuji, Hirokazu Tsukahara

International journal of molecular sciences   24 ( 20 )   2023年10月

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担当区分：最終著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Kawasaki disease (KD) is an acute febrile vasculitis that occurs mostly in children younger than five years. KD involves multiple intricately connected inflammatory reactions activated by a cytokine cascade. Despite therapeutic advances, coronary artery damage may develop in some patients, who will be at risk of clinical cardiovascular events and even sudden death. The etiology of KD remains unclear; however, it may involve both genetic and environmental factors leading to aberrant inflammatory responses. Given the young age of onset, prenatal or perinatal exposure may be etiologically relevant. Multisystem inflammatory syndrome in children, a post-infectious hyper-inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2, has features that overlap with those of KD. Available evidence indicates that vascular endothelial dysfunction is a critical step in the sequence of events leading to the development of cardiovascular lesions in KD. Oxidative stress and the dysregulation of the nitric oxide (NO) system contribute to the pathogenesis of inflammatory responses related to this disease. This review provides current evidence and concepts highlighting the adverse effects of oxidative injury and NO system derangements on the initiation and progression of KD and potential therapeutic strategies for cardiovascular pathologies in affected children.

DOI： 10.3390/ijms242015450

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造血細胞移植後の肝障害の鑑別にMRIが有用であった輸血後鉄過剰症の2小児例 査読

鷲尾 佳奈, 塩飽 孝宏, 爲房 宏輔, 越智 元春, 石田 悠志, 金光 喜一郎, 藤原 かおり, 塚原 宏一

日本輸血細胞治療学会誌   69 ( 5 )   605 - 609   2023年10月

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担当区分：最終著者   記述言語：日本語   出版者・発行元：一般社団法人 日本輸血・細胞治療学会  

小児がん患者における輸血後鉄過剰症については，海外からは報告が散見される．成人と同様，白血病等における同種造血細胞移植患者において，移植前の血清フェリチン値と合併症の相関等が議論されているが，日本国内からはまだまとまった報告はない．我々は，肝障害を来し，輸血後鉄過剰症と肝移植片対宿主病（GVHD）との鑑別に磁気共鳴画像（MRI）が有用であった2例を経験した．2例とも急性骨髄性白血病であり，肝GVHDとして免疫抑制療法等を行ったにもかかわらず遷延する肝障害を呈していた．高フェリチン血症を認めたためMRI撮像したところ，高度鉄沈着を示唆する所見を呈した．輸血後鉄過剰症として鉄キレート療法を行って肝障害が改善した．小児がん患者において，骨髄抑制期間が長く頻回の輸血を要するような症例では，急性期に臓器障害を伴う輸血後鉄過剰症を示す可能性があるが，治療介入の指針や時期については明らかになっていない．今後日本国内でも大規模な調査が必要と思われる．

DOI： 10.3925/jjtc.69.605

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Epilepsy in Children With Congenital Heart Disease: Risk Factors and Characteristic Presentations. 査読 国際誌

Takashi Shibata, Maiko Kondo, Yosuke Fukushima, Mari Akiyama, Tomoyuki Akiyama, Teruko Morooka, Kenji Baba, Shinichi Ohtsuki, Hirokazu Tsukahara, Shingo Kasahara, Katsuhiro Kobayashi

Pediatric neurology   147   28 - 35   2023年10月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Children with a congenital heart disease (CHD) are at a higher risk of developing epilepsy than the general population, but detailed characteristics of CHD-associated epilepsy have not been clarified. The purposes of this study were to determine the risk factors for developing epilepsy associated with CHD and to elucidate the characteristics of such epilepsy. METHODS: We performed a retrospective cohort study based on medical records of pediatric patients with CHD who were born between January 2006 and December 2016, underwent cardiac surgery at Okayama University Hospital, and were followed up until at least age three years. Multivariate logistic regression analysis was used to determine factors particularly associated with epilepsy occurrence. In patients who developed epilepsy, clinical data on seizure characteristics were further investigated. RESULTS: We collected data from 1024 patients, and 41 (4.0%) developed epilepsy. The presence of underlying disease (odds ratio [OR]: 2.413; 95% confidence interval [CI]: 1.150 to 4.883) and the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score category 2 (OR: 4.373; 95% CI: 1.090 to 29.150) and category 5 (OR: 10.385; 95% CI: 1.717 to 89.016) were significantly related to epilepsy occurrence. Of the 41 patients with epilepsy, 15 (including nine with hypoplastic left heart syndrome) had focal impaired awareness seizures specified as autonomic seizures with vomiting, which tends to escape detection. CONCLUSIONS: We clarified the risk factors for developing epilepsy in children with CHD. We also found that autonomic seizure with vomiting is an important symptom in these children.

DOI： 10.1016/j.pediatrneurol.2023.07.004

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Shear Wave Dispersionによる後期早産児および正期産新生児の肝臓の粘性の測定

佐藤 剛史, 渡邉 宏和, 鈴木 健吾, 福田 花奈, 森本 大作, 岡村 朋香, 鷲尾 洋介, 吉本 順子, 塚原 宏一

日本新生児成育医学会雑誌   35 ( 3 )   545 - 545   2023年10月

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記述言語：日本語   出版者・発行元：(公社)日本新生児成育医学会  

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岡山県の一般小児病棟における神経発達症児への支援に関する実態調査

重安 良恵, 岡田 あゆみ, 田中 知絵, 藤井 智香子, 椙原 彰子, 堀内 真希子, 塚原 宏一

小児心身症研究   ( 29 )   17 - 23   2023年9月

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記述言語：日本語   出版者・発行元：日本小児心身医学会-中国四国地方会  

子どもにとって,入院生活が心理発達面に与える影響は大きい.特に神経発達症児は,環境変化に適応しにくく,新規場面での不安や混乱から検査や治療に支障をきたすことがある.今回,入院中の神経発達症児へ適切な支援を行うため,現状を把握し課題を抽出することを目的に,岡山県内の小児病棟を有する7施設の医師,看護師を対象に質問紙調査を行った.その結果,回答者の97.6%が神経発達症児の入院を経験し,不適応行動に対して様々な対応や工夫を行っていた.一方で,医師の32.1%,看護師の65.3%は適切に対応するための知識不足を認識していた.また,医師・看護師以外の職種が生かされていない,情報共有が難しい,相談する場がないなど,多職種連携の課題が明らかになった.入院中の神経発達症児を支援するためには,神経発達症が専門でない小児科医や看護師が知識を習得し対応スキルの向上を図ること,保護者と情報共有して協力すること,多職種が協力して対応する支援体制の構築が必要だと考えられた.(著者抄録)

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岡山県の一般小児病棟における神経発達症児への支援に関する実態調査

重安 良恵, 岡田 あゆみ, 田中 知絵, 藤井 智香子, 椙原 彰子, 堀内 真希子, 塚原 宏一

小児心身症研究   ( 29 )   17 - 23   2023年9月

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記述言語：日本語   出版者・発行元：日本小児心身医学会-中国四国地方会  

子どもにとって,入院生活が心理発達面に与える影響は大きい.特に神経発達症児は,環境変化に適応しにくく,新規場面での不安や混乱から検査や治療に支障をきたすことがある.今回,入院中の神経発達症児へ適切な支援を行うため,現状を把握し課題を抽出することを目的に,岡山県内の小児病棟を有する7施設の医師,看護師を対象に質問紙調査を行った.その結果,回答者の97.6%が神経発達症児の入院を経験し,不適応行動に対して様々な対応や工夫を行っていた.一方で,医師の32.1%,看護師の65.3%は適切に対応するための知識不足を認識していた.また,医師・看護師以外の職種が生かされていない,情報共有が難しい,相談する場がないなど,多職種連携の課題が明らかになった.入院中の神経発達症児を支援するためには,神経発達症が専門でない小児科医や看護師が知識を習得し対応スキルの向上を図ること,保護者と情報共有して協力すること,多職種が協力して対応する支援体制の構築が必要だと考えられた.(著者抄録)

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A Boy Safely Treated with Tyrosine Kinase Inhibitors for Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia with Osteolysis. 査読

Takahiro Shiwaku, Hisashi Ishida, Yasuhisa Tatebe, Kosuke Tamefusa, Motoharu Ochi, Kaori Fujiwara, Toshihide Kubo, Eiji Nakata, Kana Washio, Hirokazu Tsukahara

Acta medica Okayama   77 ( 4 )   439 - 442   2023年8月

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担当区分：最終著者   記述言語：英語  

A three-year-old boy with Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (Ph+ALL) presented with an osteolytic lesion in his right upper arm. Tyrosine kinase inhibitors (TKIs) such as imatinib and dasatinib are an essential component throughout the course of treatment for Ph+ALL. However, TKIs are reported to affect the bone metabolism. In the treatment course of the current patient, the osteolytic lesion quickly improved despite the continuous use of TKIs, even during the concomitant use of corticosteroids. This suggests that TKIs can be safely given with concomitant corticosteroids to children with Ph+ALL, even when osteolytic lesions are present.

DOI： 10.18926/AMO/65757

PubMed

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Impacts of routine varicella vaccination program and COVID-19 pandemic on varicella and herpes zoster incidence and health resource use among children in Japan. 査読 国際誌

Kazuhiro Uda, Yusuke Okubo, Mitsuru Tsuge, Hirokazu Tsukahara, Isao Miyairi

Vaccine   41 ( 34 )   4958 - 4966   2023年7月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan. MATERIALS AND METHODS: We conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005-2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization. RESULTS: After the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9-56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1-53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2-57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5-67.1]), antiviral use (65.7 % reduction [59.7-70.8]), and healthcare costs (49.1 % [95 %CI, 32.7-61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014. CONCLUSIONS: Varicella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.

DOI： 10.1016/j.vaccine.2023.06.054

PubMed

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