研究者詳細 - 大塚　文男

論文 - 大塚　文男

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「哲学カフェ」は医師のどのような能力を涵養するか

小比賀美香子, 松川えり, 徳増一樹, 大塚文男

医学教育 53 ( Suppl. ) 145 - 145 2022年7月

Clinical Characteristics of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Diagnosed in Patients with Long COVID. 査読国際誌

Kazuki Tokumasu, Hiroyuki Honda, Naruhiko Sunada, Yasue Sakurada, Yui Matsuda, Koichiro Yamamoto, Yasuhiro Nakano, Toru Hasegawa, Yukichika Yamamoto, Yuki Otsuka, Hideharu Hagiya, Hitomi Kataoka, Keigo Ueda, Fumio Otsuka

Medicina (Kaunas, Lithuania) 58 ( 7 ) 2022年6月

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 and Objectives: COVID-19 can be serious not only in the acute phase but also after the acute phase and some patients develop ME/CFS. There have been few studies on patients with long COVID in whom ME/CFS was diagnosed by physicians based on standardized criteria after examinations and exclusion diagnosis and not based on only subjective symptoms. The purpose of this study was to elucidate the detailed characteristics of ME/CFS in patients with long COVID. Materials and Methods: A retrospective descriptive study was performed for patients who visited a COVID-19 aftercare clinic established in Okayama University Hospital during the period was from February 2021 to April 2022. Results: Clinical data were obtained from medical records for 281 patients, and 279 patients who met the definition of long COVID were included. The overall prevalence rate of ME/CFS diagnosed by three sets of ME/CFS criteria (Fukuda, Canadian and IOM criteria) was 16.8% (48.9% in male and 51.1% in females). The most frequent symptoms in ME/CFS patients were general fatigue and post-exertional malaise (89.4% of the patients), headache (34.0%), insomnia (23.4%), dysosmia (21.3%) and dysgeusia (19.1%). Dizziness, chest pain, insomnia and headache were characteristic symptoms related to ME/CFS. The male to female ratio in ME/CFS patients was equal in the present study, although ME/CFS was generally more common in women in previous studies. Given that patients with ME/CFS had more severe conditions in the acute phase of COVID-19, the severity of the acute infectious state might be involved in the pathophysiology of ME/CFS. Conclusions: The prevalence rate of ME/CFS and the characteristic sequelae in the long COVID condition were revealed in this study.

DOI： 10.3390/medicina58070850

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Clinical characteristics and outcomes of IgG4-positive marginal zone lymphoma: Systematic scoping review. 査読国際誌

Yoshito Nishimura, Eric Andrew Wien, Midori Filiz Nishimura, Asami Nishikori, Yasuharu Sato, Fumio Otsuka

Pathology international 2022年6月

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）

Immunoglobulin G4 (IgG4)-positive marginal zone lymphoma (MZL) is rare and undefined. It is unclear whether IgG4-positive MZLs have as favorable an outcome as MZLs in general. Also, correlation with IgG4-related disease (IgG4-RD) and IgG4-positive MZLs is unknown. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including"IgG4" and "marginal zone lymphoma" from their inception to February 20, 2022. Twenty-two articles, including six observational studies and 24 cases from 16 case reports and case series, were included. Only one study had a comparative group, and the other five were exploratory observational studies. IgG4-positive MZLs commonly occurred in males (83.3%). It primarily involved ocular adnexa (41.7%) and skin (29.2%). Only 29.2% had concurrent IgG4-RD, and no expiration was noted. While most cases were treated with excision, resection, or clinical observation, 21.7% received rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone as a first-line treatment. This systematic review summarizes the current understanding of the characteristics of IgG4-positive MZLs. While there seems to be IgG4-RD-related and de novo IgG4-positive MZLs, future research needs to clearly define MZL with polyclonal IgG4-positive cells and IgG4-producing lymphoma. Further studies are critical to clarifying long-term prognosis and optimal surveillance planning.

DOI： 10.1111/pin.13251

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「筋痛性脳脊髄炎/慢性疲労症候群(ME/CFS)」岡山大学病院総合内科・総合診療科におけるME/CFS診療

片岡仁美, 大塚勇輝, 本多寛之, 砂田匠彦, 櫻田泰江, 松田祐依, 徳増一樹, 長谷川功, 小比賀美香子, 植田圭吾, 大塚文男

日本疲労学会誌 18 ( 1 ) 37 - 37 2022年6月

Eyelid edema due to Cushing's syndrome 査読国際誌

Koichiro Yamamoto, Kosuke Oka, Kou Hasegawa, Fumio Otsuka

Clinical Case Reports 10 ( 6 ) e05940 2022年6月

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

Cushing's syndrome (CS) shows diverse signs such as centripetal obesity, moon face, and buffalo hump, which can complicate the diagnosis. Facial features including eyelid edema, as an underrecognized sign, can be diagnostic clues for an excess of corticoids in a CS patient.

DOI： 10.1002/ccr3.5940

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ccr3.5940

「筋痛性脳脊髄炎/慢性疲労症候群(ME/CFS)」岡山大学病院総合内科・総合診療科におけるME/CFS診療

片岡仁美, 大塚勇輝, 本多寛之, 砂田匠彦, 櫻田泰江, 松田祐依, 徳増一樹, 長谷川功, 小比賀美香子, 植田圭吾, 大塚文男

日本疲労学会誌 18 ( 1 ) 37 - 37 2022年6月

胸鎖関節炎・頸部膿瘍を契機に診断した2型糖尿病の1例

中本健太, 本多寛之, 平佑貴, 庵谷紘美, 中野靖浩, 長谷川功, 萩谷英大, 小比賀美香子, 片岡仁美, 大塚文男

糖尿病 65 ( 6 ) 337 - 337 2022年6月

維持透析中の2型糖尿病患者に発症したフルニエ壊疽の1例

庵谷紘美, 本多寛之, 平佑貴, 中本健太, 中野靖浩, 長谷川功, 萩谷英大, 小比賀美香子, 片岡仁美, 大塚文男

糖尿病 65 ( 6 ) 337 - 337 2022年6月

医学生の自覚ストレスとコミュニケーションの関連横断研究

徳増一樹, 西村義人, 坂本陽子, 小比賀美香子, 片岡仁美, 大塚文男

日本プライマリ・ケア連合学会学術大会 13回 O - 90 2022年6月

「筋痛性脳脊髄炎/慢性疲労症候群(ME/CFS)」漢方によるlong COVIDの倦怠感への対応

徳増一樹, 植田圭吾, 大塚勇輝, 本多寛之, 砂田匠彦, 櫻田泰江, 松田祐依, 片岡仁美, 大塚文男

日本疲労学会誌 18 ( 1 ) 37 - 37 2022年6月

維持透析中の2型糖尿病患者に発症したフルニエ壊疽の1例

庵谷紘美, 本多寛之, 平佑貴, 中本健太, 中野靖浩, 長谷川功, 萩谷英大, 小比賀美香子, 片岡仁美, 大塚文男

糖尿病 65 ( 6 ) 337 - 337 2022年6月

胸鎖関節炎・頸部膿瘍を契機に診断した2型糖尿病の1例

中本健太, 本多寛之, 平佑貴, 庵谷紘美, 中野靖浩, 長谷川功, 萩谷英大, 小比賀美香子, 片岡仁美, 大塚文男

糖尿病 65 ( 6 ) 337 - 337 2022年6月

Application of Kampo Medicines for Treatment of General Fatigue Due to Long COVID. 査読国際誌

Kazuki Tokumasu, Keigo Ueda, Hiroyuki Honda, Naruhiko Sunada, Yasue Sakurada, Yui Matsuda, Yasuhiro Nakano, Toru Hasegawa, Yuki Otsuka, Mikako Obika, Hideharu Hagiya, Hitomi Kataoka, Fumio Otsuka

Medicina (Kaunas, Lithuania) 58 ( 6 ) 2022年5月

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）

Evidence regarding treatment for the acute phase of COVID-19 has been accumulating, but specific treatment for long COVID/post-COVID-19 condition has not yet been established. Treatment with herbal medicine might be one treatment option for long COVID, but there has been little research on the effectiveness of herbal medicine for long COVID. The aim of this study was to clarify the prescription patterns of Kampo medicines, which are herbal medicines that originated in China and were developed in Japan, for the treatment of general fatigue due to long COVID. A retrospective descriptive study was performed for patients who visited a COVID-19 aftercare clinic established in Okayama University Hospital during the period from Feb 2021 to Dec 2021 with a focus on symptoms accompanying general fatigue and prescriptions of Kampo medicine. Among the clinical data obtained from medical records of 195 patients, clinical data for 102 patients with general fatigue and accompanying symptoms were analyzed. The patients had various symptoms, and the most frequent symptoms accompanying general fatigue were dysosmia, dysgeusia, headache, insomnia, dyspnea, and hair loss. Prescriptions of Kampo medicine accounted for 24.1% of the total prescriptions (n = 609). The most frequently prescribed Kampo medicine was hochuekkito (71.6%) and other prescribed Kampo medicines were tokishakuyakusan, ryokeijutsukanto, juzentaihoto, hangekobokuto, kakkonto, ninjin'yoeito, goreisan, rikkunshito, and keishibukuryogan. Since the pathophysiology of general fatigue after an infectious disease is, in general, considered a qi deficiency in Kampo medicine, treatments with such compensation agents can be the major prescription as a complement for the qi. In conclusion, Kampo medicine can be one of the main pharmacological treatments for long COVID accompanying general fatigue.

DOI： 10.3390/medicina58060730

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Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis 査読国際誌

Daisuke Kametaka, Masaya Iwamuro, Takahide Takahashi, Araki Hirabata, Kenta Hamada, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Takehiro Tanaka, Fumio Otsuka, Yoshiro Kawahara, Hiroyuki Okada

Current Issues in Molecular Biology 44 ( 6 ) 2443 - 2452 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：MDPI AG

Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.

DOI： 10.3390/cimb44060167

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Call for correction: Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: A meta-analysis. 査読国際誌

Hideharu Hagiya, Yuki Otsuka, Fumio Otsuka

Journal of the neurological sciences 436 120232 - 120232 2022年5月

Adrenal and Testicular Tumor Formation Due to 21-Hydroxylase Deficiency. 査読国際誌

Koichiro Yamamoto, Hiroyuki Honda, Fumio Otsuka

The American journal of medicine 135 ( 5 ) e106 2022年5月

Inconsistency of the "Sogo-Shinryo" department in Japanese hospitals. 査読

Yuki Otsuka, Mikako Obika, Fumio Otsuka

Journal of general and family medicine 23 ( 3 ) 201 - 202 2022年5月

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）

The inconsistency of Japanese names of "Sogo-Shinryo" departments is also a greater problem in this country, and we are afraid that it may cause anxiety to patients, residents, and students. As one of the "Sogo-Shinryo" departments in Japan, we want to provide them comprehensive learning environments regardless of the boundaries of academic cliques and societies, and, as a result, relieve them, foster general minds, and build their careers.

DOI： 10.1002/jgf2.522

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Trends in sarcoidosis mortality rate in Japan from 2001 to 2020: A population-based study 査読国際誌

Ko Harada, Hideharu Hagiya, Toshihiro Koyama, Fumio Otsuka

Respiratory Medicine 196 106828 - 106828 2022年5月

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：Elsevier BV

BACKGROUND: The sarcoidosis mortality rate has increased over the years, which contributes to the health care burden. Although epidemiological studies of sarcoidosis mortality in aging societies are essential, none have been published since 1989 in Japan. METHODS: We aimed to investigate the trends in crude and age-adjusted sarcoidosis-associated mortality rates per 1,000,000 population in Japan from 2001 to 2020 using national death certificate data among older adults aged over 50 years. The data were analysed using the joinpoint regression models to estimate long-term trends and average annual percentage changes (AAPCs). RESULTS: A total of 3094 sarcoidosis-associated deaths were recorded from 2001 to 2020 in Japan; women constituted 65.3% of these, with a female:male ratio of 1.89. Nearly 80% of deaths were over the age of 65 years, of which 32% were over the age of 80 years. The trend in crude mortality of those aged ≥80 years markedly increased from 0.81 to 9.68 per 1,000,000 population in men and from 2.38 to 12.87 in women, respectively. The overall age-adjusted sarcoidosis mortality rate increased 2.46-fold during the study period, with an AAPC of 5.1%. CONCLUSIONS: This study revealed that sarcoidosis-associated deaths in Japan have significantly increased over the past two decades, especially among the older population with a female predominance. Given the rising mortality rate and susceptibility of the older population, sarcoidosis will require more attention from health care providers in terms of a multidisciplinary approach to address the specific needs of the older population.

DOI： 10.1016/j.rmed.2022.106828

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甲状腺機能低下症によるPsychosis（Myxedema Psychosis）の臨床的特徴―症例報告と文献レビュー― 査読

山田裕士, 藤原雅樹, 宋龍平, 枝廣暁, 深尾貴志, 酒本真次, 高東祥一朗, 川田清宏, 和迩健太, 山本紘一郎, 大塚文男, 山田了士

精神神経学雑誌 124 ( 5 ) 293 - 299 2022年5月

記述言語：日本語出版者・発行元：(公社)日本精神神経学会

精神症状を呈した甲状腺機能低下症の患者の15%が精神病症状を生じると報告されており,「myxedema psychosis」と呼ばれる.しかし,わが国の精神科領域での報告は数例にとどまり,十分に認知されていない可能性がある.そこで,本症例報告では,精神科におけるmyxedema psychosis鑑別の重要性を改めて強調するため,自験例の詳細な臨床像を記述したうえで,系統的レビューで得られた症状,検査所見,治療経過の特徴を整理して呈示する.症例は50歳代の女性.X-2年に橋本病と診断され,レボチロキシンで治療されていた.X年5月にレボチロキシンを自己中断後,徐々に過敏になり,幻聴に左右されて家を飛びだすようになった.同月末に不安と動悸症状でA病院を受診し,著明な甲状腺機能低下が認められたため,内科に入院した.レボチロキシンを再開し,リスペリドンも開始されたが,精神病症状の改善に乏しく,精査を拒否するため,入院第7病日に当院当科へ転院した.転院時,幻聴は改善していたが,思路障害や焦燥は残存し,甲状腺機能低下も持続していた.脳波検査では徐波が混入しており,髄液検査ではタンパクの軽度高値を認めたことから,橋本脳症の可能性も考えたが,症状が改善傾向であったため,ステロイド投与は保留し,レボチロキシンを増量し経過観察した.すると,転院第7病日までに精神病症状は消失し,転院第16病日に退院した.12月にリスペリドンを中止後も精神病症状の再燃はなかった.X+1年8月にTSHの上昇とともに精神病症状が再発したが,レボチロキシンの増量により速やかに症状は改善した.Myxedema psychosisは甲状腺ホルモン補充により抗精神病薬中止が可能と系統的レビューが示すように,本症例もレボチロキシンの補充で症状は速やかに改善した.Myxedema psychosisは抗精神病薬の中止が可能な予後良好な病態であるため,精神病症状を呈した患者の治療においては,甲状腺機能の評価を行うことが望ましい.(著者抄録)

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Processes of increasing medical residents' intrinsic motivation: a qualitative study. 査読国際誌

Kazuki Tokumasu, Mikako Obika, Haruo Obara, Makoto Kikukawa, Yoshito Nishimura, Fumio Otsuka

International journal of medical education 13 115 - 123 2022年4月

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）

Objectives: This study aimed to determine qualitatively how medical residents develop intrinsic motivation to learn and work in clinical training settings. Methods: This study was a descriptive qualitative study, which is widely used in healthcare research. We conducted a semi-structured interview aimed to explore key participants' in-depth experiences and perspectives regarding intrinsic motivation. The authors interviewed seven postgraduate Japanese medical residents. The transcripts were analyzed using the sequential and thematic qualitative data analysis technique steps for coding and theorization, which entails coding steps from open to selective, writing a storyline using the final selective codes, and offering theories. Results: External stimulations (a self-handle environment and a near-peer role model) triggered the medical residents' cognitive process (gap recognition, awareness, and internalization) to intrinsic motivation. The residents' awareness of autonomy, responsibility, and independence played a vital role in this process. Furthermore, a psychological feeling of competence also reinforced their intrinsic motivation. Positive feedback and approval from attending physicians and patients' gratitude promoted residents' sense of competence. Conclusions: We illustrated a process for increasing medical residents' intrinsic motivation. The intrinsic motivation was triggered by external stimulations (a self-handle environment and a near-peer role model), which caused the cognitive process: gap recognition, awareness of important attitudes as a doctor (autonomy, responsibility, and independence), and internalization. Since the first step of this process was an external factor, there are potential benefits of designing an appropriate training environment for increasing medical residents' intrinsic motivation.

DOI： 10.5116/ijme.6250.1017

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