Faculty Profiles - OTSUKA Fumio

Antibiotic literacy among Japanese medical students. International journal

Hideharu Hagiya, Hideo Ino, Kazuki Tokumasu, Hiroko Ogawa, Tomoko Miyoshi, Kanako Ochi, Fumio Otsuka

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 26 ( 10 ) 1107 - 1109 2020.10

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER

Antimicrobial resistance (AMR) is an urgent global issue. After the AMR action plan was introduced in 2016, a study on antibiotic literacy (i.e., awareness, knowledge, and attitude relating to antimicrobial use) among clinicians and lay people was conducted in Japan. However, no studies have hitherto targeted medical students who are expected to have a high level of antibiotic literacy. The present study was conducted between September 2019 and February 2020, enrolling undergraduate students at Okayama University Medical School. We collected data using a paper-based questionnaire form with 11 questions about antibiotic literacy. The response rate was 93.8% (661/705 students). Overall, 92.6% of the students knew that antibiotics inhibit the growth of bacteria. Student reporting that antibiotics could treat the common cold accounted for 77.0% (Year 1), 50.9% (Year 2), 48.2% (Year 3), 49.1% (Year 4), 23.8% (Year 5), and 26.2% (Year 6). Only 43 (6.5%) had heard about the AMR action plan. The study data suggested that medical students' level of literacy on antimicrobial use should be further enhanced to address AMR and promote antimicrobial stewardship.

DOI： 10.1016/j.jiac.2020.06.021

A nationwide trend analysis in the incidence and mortality of Creutzfeldt-Jakob disease in Japan between 2005 and 2014. International journal

Yoshito Nishimura, Ko Harada, Toshihiro Koyama, Hideharu Hagiya, Fumio Otsuka

Scientific reports 10 ( 1 ) 15509 - 15509 2020.9

Language：English Publishing type：Research paper (scientific journal) Publisher：NATURE RESEARCH

In the era of hyper-ageing, Creutzfeldt-Jakob disease (CJD) can become more prevalent as an important cause of dementia. This study aimed to evaluate the trends in crude and age-adjusted CJD-associated mortality and incidence rates in Japan using national vital statistics data on CJD-associated deaths among individuals aged over 50 years, as well as the government-funded nationwide CJD surveillance data (pertaining to the years 2005-2014) in Japan. The data were analysed using the Joinpoint Regression Program to estimate the long-term trends and average annual percentage changes (AAPCs). Overall, the AAPCs of age-adjusted CJD-associated mortality rates rose significantly over the study period (3.2%; 95% confidence interval [CI] 1.4-5.1%). The AAPC of the age-adjusted incidence rates also increased (overall 6.4%; 95% CI 4.7-8.1%). The CJD-associated increases in the mortality and incidence rates were especially prominent among adults over the age of 70 years. Given this trend in aging of population, the disease burden of CJD will continue to increase in severity. Our findings thus recommend that policymakers be aware of the importance of CJD and focus on preparing to address the increasing prevalence of dementia.

DOI： 10.1038/s41598-020-72519-0

Hashimoto's thyroiditis and primary thyroid lymphoma. International journal

Y Otsuka, M Yasuda, K Tokumasu, K Hasegawa, F Otsuka

QJM : monthly journal of the Association of Physicians 0 ( 0 ) 691 - 692 2020.9

Bilateral massive empyema with bronchopleural fistula. International journal

Ko Harada, Hideharu Hagiya, Fumio Otsuka

Postgraduate medical journal 96 ( 1139 ) 573 - 573 2020.9

Hepatic encephalopathy due to extrahepatic portosystemic shunt. International journal

Yosuke Sazumi, Yoshito Nishimura, Yuki Otsuka, Yuki Mizuta, Yasuhiro Nakano, Hiroyuki Sakae, Fumio Otsuka

Clinical case reports 8 ( 9 ) 1852 - 1853 2020.9

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY

Clinicians should recognize extrahepatic portosystemic shunt as a cause of refractory or intermittent hepatic encephalopathy. Treatment strategies should be individualized according to patients' anatomic and hemodynamic status.

DOI： 10.1002/ccr3.2986

Calcinosis Cutis. International journal

Ko Harada, Ei Miyasaka, Fumio Otsuka

The American journal of medicine 133 ( 9 ) e528-e529 - E529 2020.9

A rare case of oncocytic adrenocortical carcinoma clinically presented as an incidentaloma.

Ko Harada, Miho Yasuda, Yasuhiro Nakano, Kazuhiro Yoshida, Yuzo Umeda, Takahito Yagi, Yuto Yamazaki, Hironobu Sasano, Fumio Otsuka

Endocrine journal 67 ( 8 ) 883 - 888 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN ENDOCRINE SOC

Adrenocortical carcinoma (ACC) is a rare aggressive tumor originating from adrenocortical parenchymal cells and its incidence is approximately 1 per million population per year. An oncocytic ACC is a recently identified entity among the several known histopathological variants of ACC, which is characterized by oncocytic cells, and only a few cases in the available literature have reported this tumor. In contrast to conventional ACCs, oncocytic ACCs usually manifest as solitary lesions presenting in adults without any sex predilection. We report a case of a 70-year-old Japanese man who presented with an incidentally discovered retroperitoneal mass without any evidence of excessive corticosteroid secretion. Laboratory and imaging studies, as well as transgastric endoscopic ultrasound-guided fine needle aspiration failed to establish a definitive diagnosis. Thus, the patient underwent surgical resection of the left-sided peritoneal tumor. Weiss score was positive in 6/9 points and the tumor met two major criteria of the Lin-Weiss-Bisceglia (LWB) system leading to a diagnosis of an oncocytic variant of ACC. Based on our findings in this patient, we conclude that a combination of the Weiss and LWB criteria is required to determine the malignant potential of oncocytic adrenal tumors because ACCs and oncocytomas could be frequently indistinguishable. Careful histopathological examination is pivotal in confirming the oncocytic component in the lesion and hence definitive diagnosis of ACCs.

DOI： 10.1507/endocrj.EJ20-0024

Multiple Deep-seated Dentofacial Abscesses Caused by Multidrug-resistant Viridans Group Streptococci.

Shinnosuke Fukushima, Hideharu Hagiya, Yuki Mizuta, Yasuhiro Nakano, Masahiro Takahara, Kayo Okamoto, Yuko Hayashi, Kiyoshi Yamada, Kou Hasegawa, Fumio Otsuka

Internal medicine (Tokyo, Japan) 59 ( 16 ) 2067 - 2070 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

Odontogenic infections, generally caused by dental caries and periodontal disease, can result in fatal illness. We herein report a 71-year-old Japanese woman with type 2 diabetes and hemodialysis who suffered from multiple dentofacial abscesses mainly caused by multidrug-resistant Streptococcus oralis. She complained of pain and swelling of her face, with an extraoral fistula from the left cheek. Following 3 surgical debridement procedures and partial mandibulectomy, in addition to 12 weeks of antimicrobial therapy, the multiple dentofacial abscesses were ameliorated. A combination of surgical and antimicrobial treatments following an early diagnosis is essential for reducing further complications.

DOI： 10.2169/internalmedicine.4283-20

Coronary Spastic Angina Induced by Adrenal Insufficiency.

Yuki Otsuka, Ko Harada, Miho Yasuda, Yasuhiro Nakano, Kou Hasegawa, Fumio Otsuka

Internal medicine (Tokyo, Japan) 59 ( 15 ) 1873 - 1877 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

Adrenal insufficiency patients are treated with glucocorticoid replacement therapy. However, mimicking the in vivo circadian rhythm of cortisol levels is challenging, and suboptimal replacement increases the risk of mortality from cardiovascular disease. We herein report a case of coronary spastic angina (CSA) with simultaneous low early-morning serum cortisol levels in a patient undergoing corticosteroid replacement therapy for primary adrenal insufficiency. Steroid therapy is reportedly effective for refractory angina, but underlying adrenal deficiency has never been revealed. Our case intimates the probable risk of CSA as a complication of relative adrenal insufficiency and highlights the effectiveness of dexamethasone in these patients.

DOI： 10.2169/internalmedicine.4337-19

Mycobacterium chelonae bloodstream infection induced by osteomyelitis of toe: A case report. International journal

Yayoi Ueda, Kazuki Tokumasu, Hideharu Hagiya, Koji Iio, Takumi Fujimori, Ayaka Kakehi, Mami Okura, Hiroshi Minabe, Fumio Otsuka

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 26 ( 8 ) 843 - 846 2020.8

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER

Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.

DOI： 10.1016/j.jiac.2020.03.004

Invasive non-typeable Haemophilus influenzae infection due to endometritis associated with adenomyosis. International journal

Yoshito Nishimura, Hideharu Hagiya, Kaoru Kawano, Yuya Yokota, Kosuke Oka, Koji Iio, Kou Hasegawa, Mikako Obika, Tomoko Haruma, Sawako Ono, Hisashi Masuyama, Fumio Otsuka

BMC infectious diseases 20 ( 1 ) 521 - 521 2020.7

Language：English Publishing type：Research paper (scientific journal) Publisher：BMC

BACKGROUND: The widespread administration of the Haemophilus influenzae type b vaccine has led to the predominance of non-typable H. influenzae (NTHi). However, the occurrence of invasive NTHi infection based on gynecologic diseases is still rare. CASE PRESENTATION: A 51-year-old Japanese woman with a history of adenomyoma presented with fever. Blood cultures and a vaginal discharge culture were positive with NTHi. With the high uptake in the uterus with 67Ga scintigraphy, she was diagnosed with invasive NTHi infection. In addition to antibiotic administrations, a total hysterectomy was performed. The pathological analysis found microabscess formations in adenomyosis. CONCLUSIONS: Although NTHi bacteremia consequent to a microabscess in adenomyosis is rare, this case emphasizes the need to consider the uterus as a potential source of infection in patients with underlying gynecological diseases, including an invasive NTHi infection with no known primary focus.

DOI： 10.1186/s12879-020-05193-2

Clinical and biochemical characteristics of patients having general symptoms with increased serum IgG4. International journal

Kou Hasegawa, Yoshihisa Hanayama, Mikako Obika, Tomoko Miyoshi, Hiroko Ogawa, Eisei Kondo, Hitomi Kataoka, Yasuharu Sato, Fumio Otsuka

Modern rheumatology 30 ( 4 ) 721 - 728 2020.7

Language：English Publishing type：Research paper (scientific journal) Publisher：TAYLOR & FRANCIS LTD

Objective: To differentiate patients with IgG4-related diseases (RD) from patients with other hyper IgG4 conditions who visit general medicine department.Methods: Fifty-six patients with high serum IgG4 levels (>135 mg/dL) were classified into three groups based on the final diagnosis: definite and possible IgG4-RD and others. Clinical and laboratory characteristics of the three groups of patients were retrospectively analyzed.Results: Major manifestations were renal dysfunction and general malaise, while thirst was the most frequent symptom in the definite group, in which submandibular glands and lymph nodes were likely to be affected. Biopsy of minor salivary glands was the least diagnostic for IgG4-RD despite the high frequency of biopsy. In the definite group, serum levels of IgG4 and IgG, IgG4/IgG ratio and basophil number were increased, while serum levels of CRP, IgA and complements were decreased. A negative correlation between serum levels of IgG4 and IgM was found in the definite group.Conclusion: The results indicated that in patients with renal dysfunction, malaise, thirst or weight loss, measurements of the levels of basophils, immunoglobulins and complements are helpful for diagnosing IgG4-RD. Considering distribution of affected tissues and localization of diagnostic biopsies, physical examination and laboratory workup are required for early diagnosis.

DOI： 10.1080/14397595.2019.1642291

Vision loss, tractional retinal detachment, and profound anemia due to rectal carcinoma. International journal

Akira Yamamoto, Yoshito Nishimura, Mikako Obika, Yuki Morizane, Fumio Otsuka

Clinical case reports 8 ( 7 ) 1304 - 1305 2020.7

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY

Profound anemia can cause severe proliferative retinopathy and tractional retinal detachment; therefore, it is important to closely investigate the cause of anemia. Endoscopy and computed tomography are valuable tools for this purpose.

DOI： 10.1002/ccr3.2833

Macromolecules detected in highly increased serum luteinizing hormone

K Ogura-Ochi, K Itoshima, Y Kamada, F Otsuka

J. Endocrinol. Invest. 856 - 866 2020.6

X-linked Hypophosphatemia (XLH) Mimicking Rheumatic Disease. Reviewed

Ryosuke Takase, Yasuhiro Nakano, Kosei Hasegawa, Fumio Otsuka

Internal medicine (Tokyo, Japan) 59 ( 9 ) 1233 - 1234 2020.5

Rigid Ears and Hyperpigmentation in Addison's Disease. International journal

Ko Harada, Fumio Otsuka

The American journal of medicine 133 ( 5 ) e192 2020.5

An Endoscopic Biopsy Specimen Contains Adequate Lymphocytes for Flow Cytometric Analysis of Light Chain Expression in the Gastrointestinal Mucosa. International journal

Masaya Iwamuro, Katsunori Matsueda, Takahide Takahashi, Sizuma Omote, Takehiro Tanaka, Daisuke Ennishi, Fumio Otsuka, Tadashi Yoshino, Hiroyuki Okada

Annals of clinical and laboratory science 50 ( 3 ) 348 - 353 2020.5

Language：English Publishing type：Research paper (scientific journal) Publisher：ASSOC CLINICAL SCIENTISTS

OBJECTIVE: Flow cytometry has not been widely used in routine clinical practice for the diagnosis of gastrointestinal lymphoma; this is mainly because of the absence of an appropriate protocol. Here, we established a protocol for flow cytometric analysis of a single biopsy specimen from the gastrointestinal mucosa and investigated its sensitivity and specificity. DESIGN: In this prospective study, we enrolled patients with previously diagnosed gastrointestinal lymphoma and patients with gastrointestinal lesions that were suspected to be lymphoma. RESULTS: Overall, 15 patients with gastric extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (N=8), duodenal follicular lymphoma (grade 1; N=5), and benign lymphoid hyperplasia (ileum, N=1, and rectum, N=1) were included in this study. Of these, lymphocytes were isolated from 14 patients (93.3%). There were 200,000-1,500,000 viable cells per patient. Biopsy specimens from 10 out of the 12 patients with lymphoma were positive for light chain restriction; the two patients with benign lymphoid hyperplasia showed negative results. CONCLUSIONS: An adequate number of lymphocytes for flow cytometry could be isolated from a single specimen of endoscopic mucosal biopsy from 93.3% of the patients. Overall, the sensitivity of flow cytometric analysis of light chain expression for the diagnosis of B-cell lymphoma was 83.3%, and the specificity was 100%. Although further investigation is required as the sample size of the present study was small, our study suggests a potential option for diagnosing B-cell lymphoma in the gastrointestinal mucosa.