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

Objectives: The present study aimed to elucidate the characteristics of long COVID patients with headaches. Methods: A single-center retrospective observational study was performed for long COVID outpatients who visited our hospital from 12 February 2021 to 30 November 2022. Results: A total of 482 long COVID patients, after excluding 6, were divided into two groups: the Headache group of patients with complaints of headache (113 patients: 23.4%) and the remaining Headache-free group. Patients in the Headache group were younger (median age: 37 years) than patients in the Headache-free group (42 years), while the ratio of females (56%) in the Headache group was nearly the same as that in the Headache-free group (54%). The proportion of patients in the Headache group who were infected in the Omicron-dominant phase (61%) was larger than the proportions of patients infected in the Delta (24%) and preceding (15%) phases, and that trend was significantly different from the trend in the Headache-free group. The duration before the first visit for long COVID was shorter in the Headache group (71 days) than in the Headache-free group (84 days). The proportions of patients in the Headache group with comorbid symptoms, including general fatigue (76.1%), insomnia (36.3%), dizziness (16.8%), fever (9.7%), and chest pain (5.3%) were larger than the proportions of patients in the Headache-free group, whereas blood biochemical data were not significantly different between the two groups. Interestingly, patients in the Headache group had significant deteriorations of scores indicating depression and scores for quality of life and general fatigue. In multivariate analysis, headache, insomnia, dizziness, lethargy, and numbness were shown to be involved in the quality of life (QOL) of long COVID patients. Conclusions: The manifestation of headaches related to long COVID was found to have a significant impact on social and psychological activities. Alleviation of headaches should be a priority for the effective treatment of long COVID.

DOI： 10.3390/jcm12103533

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

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

OBJECTIVES: The aim of this study was to determine the characteristics of hypozincemia in long COVID patients. METHODS: This study was a single-center retrospective observational study for outpatients who visited the long COVID clinic established in a university hospital during the period from 15 February 2021 to 28 February 2022. Characteristics of patients with a serum zinc concentration lower than 70 μg/dL (10.7 μmol/L) were compared with characteristics of patients with normozincemia. RESULTS: In a total of 194 patients with long COVID after excluding 32 patients, hypozincemia was detected in 43 patients (22.2%) including 16 male patients (37.2%) and 27 female patients (62.8%). Among various parameters including the background characteristics of the patients and medical histories, the patients with hypozincemia were significantly older than the patients with normozincemia (median age: 50 vs. 39 years). A significant negative correlation was found between serum zinc concentrations and age in male patients (R = -0.39; p < 0.01) but not in female patients. In addition, there was no significant correlation between serum zinc levels and inflammatory markers. General fatigue was the most frequent symptom in both male patients with hypozincemia (9 out of 16: 56.3%) and female patients with hypozincemia (8 out of 27: 29.6%). Patients with severe hypozincemia (serum zinc level lower than 60 μg/dL) had major complaints of dysosmia and dysgeusia, which were more frequent complaints than general fatigue. CONCLUSIONS: The most frequent symptom in long COVID patients with hypozincemia was general fatigue. Serum zinc levels should be measured in long COVID patients with general fatigue, particularly in male patients.

DOI： 10.3390/jcm12052062

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

More and more studies investigate medical students’ empathy using the Jefferson Scale of Empathy (JSE). However, no norm data or cutoff scores of the JSE for Japanese medical students are available. This study therefore explored Japanese norm data and tentative cutoff scores for the Japanese translation of the JSE-medical student version (JSE-S) using 11 years of data obtained from matriculants from a medical school in Japan.

Methods

Participants were 1,216 students (836 men and 380 women) who matriculated at a medical school in Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants prior to the start of the program. Data were summarized using descriptive statistics and statistical tests were performed to show the norm data and tentative cutoff scores for male and female students separately.

Results

The score distributions of the JSE-S were moderately skewed and leptokurtic for the entire sample, with indices -0.75 and 4.78, respectively. The mean score (standard deviation) for all participants was 110.8 (11.8). Women had a significantly higher mean score (112.6) than men (110.0; p &lt; 0.01). The effect size estimate of gender difference was 0.22, indicating a small effect size. The low and high cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.

Conclusions

This study provides JSE-S norm data and tentative cutoff scores for Japanese medical school matriculants, which would be helpful in identifying those who may need further training to enhance their empathy.

DOI： 10.1186/s12909-022-03977-5

researchmap

Other Link： https://link.springer.com/article/10.1186/s12909-022-03977-5/fulltext.html

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

BACKGROUND: Excessive psychological stress in medical students affects their mental health and causes problems such as burnout and depression. Furthermore, changes in the learning environment to online learning due to the COVID-19 pandemic have had a psychological effect on medical students. However, the relationships between medical students' perceived stress and different methods of communication, including in-person and online communication, remain unclear. The purpose of this study was to investigate the differences in stress perception of medical students depending on in-person communication and online communication during the COVID-19 pandemic. METHODS: This study was a cross-sectional study conducted from September to October in 2020. All of the students of Okayama University School of Medicine were asked to participate in a questionnaire survey. The explanatory variables were the frequency and length of communications with others (by in-person or online communication), empathy, and lifestyle. The main outcome measure was perceived stress. Subgroup analysis was conducted for students who preferred to be by themselves and students who preferred to study together and interact with other people. Univariate analysis and multivariate multiple regression analysis were conducted. Gender and grade, which have been shown to be associated with stress in previous studies, were used as covariates for multiple regression analysis. RESULTS: Valid responses to the questionnaire survey were received from 211 (29.4%) of the 717 students. There was no significant association between perceived stress and online communication, but the number of people with which students had in-person communication (1-2 people compared to 0 as a control, regression coefficient [B] = -4.4, 95% confidence interval [CI]; -7.8, -1.1, more than 10 people, B = -12, 95% CI: -18, -5.8) and the length of communication (more than 120 min, B = -4.5, 95% CI: -8.1, -0.92) were associated with a reduction in perceived stress. In subgroup analysis, the number of people with in-person communication and the length of communication had significant associations with stress reduction even in the group of students who had a preference for being by themselves. CONCLUSION: In-person communications rather than online communications were associated with a lower level of perceived stress. In subgroup analysis, this trend was statistically significant in the group of students who had a preference for being by themselves.

DOI： 10.3390/ijerph20021579

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Endocrine Society  

DOI： 10.1210/jendso/bvac162

PubMed

researchmap

Other Link： https://academic.oup.com/jes/article-pdf/7/1/bvac162/47154587/bvac162.pdf

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

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

Symptoms of long COVID are complex and long-lasting, and endocrine dysfunction might be involved in the underlying mechanisms. In this study, to clarify the hormonal characteristics of long COVID patients, laboratory data for patients who visited the outpatient clinic for long COVID were evaluated. A retrospective analysis was performed for patients who visited Okayama University Hospital during the period from Feb 2021 to Dec 2021 with focus on the interrelationships between major symptoms and endocrine data. Information and laboratory data were obtained from medical records for 186 patients. The patients had various symptoms, and the most frequent symptoms were general malaise, dysosmia/dysgeusia, hair loss, headache, dyspnea, and sleeplessness. Patients who were suffering from fatigue and dysosmia/dysgeusia were younger, while hair loss was more frequent in older and female patients. As for the characteristics of patients suffering from general fatigue, the scores of depression and fatigue were positively correlated with serum levels of cortisol and free thyroxin (FT4), respectively. Also, patients suffering from general fatigue had lower levels of serum growth hormone and higher levels of serum FT4, while patients with dysosmia/dysgeusia had a significantly lower level of serum cortisol. Serum thyrotropin (TSH) levels were higher and the ratios of FT4/TSH were lower in the initially severe cases, suggesting occult hypothyroidism. In addition, the ratios of plasma adrenocorticotropin to serum cortisol were decreased in patients with relatively high titers of serum SARS-CoV-2 antibody. Thus, hormonal changes seem to be, at least in part, involved in the persistent symptoms of long COVID.

DOI： 10.1507/endocrj.EJ22-0093

Web of Science

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

researchmap

Language：Japanese   Publisher：日本疲労学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：日本疲労学会  

researchmap

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

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

Web of Science

Scopus

PubMed

researchmap

Language：English   Publisher：WILEY  

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

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT JOURNAL MEDICAL EDUCATION-IJML  

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

Web of Science

Scopus

PubMed

researchmap

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

Calcimimetic treatment has been reported to be effective for primary hyperparathyroidism (PHPT). Nine elderly PHPT patients who had been treated with calcimimetics were retrospectively analyzed. It was found that calcimimetics can reduce elevated serum calcium levels in elderly PHPT patients with low femoral DEXA %YAM and low urinary cAMP levels.

DOI： 10.1002/ccr3.5713

Web of Science

PubMed

researchmap

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ccr3.5713

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本感染症学会  

researchmap

Language：Japanese   Publisher：The Japanese Association for Infectious Diseases  

The global pandemic of Novel Coronavirus Disease (COVID-19) has highlighted the importance of clinicians having universal knowledge and skills in infection prevention. Herein, we report the results of a questionnaire survey regarding mandatory training in infectious diseases (ID) in a Japanese residency program. The questionnaire collected information on the gender, post-graduate year, and the necessity and feasibility of, and expectation from the program. Responses were obtained from 127 respondents (74 residents [58.3%] and 53 fellows [41.7%] ). The majority (98.4%) indicated that ID training during a residency program is important, and that its importance was augmented by the COVID-19 pandemic. Notably, 66.1% of the respondents agreed with the need for mandatory ID training; however, 21.3% pointed out the possibility of not being able to receive adequate training in the current programs. To prepare and confront a future ID crisis, it may be time to discuss mandatory ID training in clinical residency programs.

DOI： 10.11150/kansenshogakuzasshi.96.61

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00276&link_issn=&doc_id=20220406400006&doc_link_id=1390010292792199424&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390010292792199424&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Subclinical hypothyroidism (SCH) is diagnosed when serum thyrotropin (TSH) is elevated despite a normal thyroxine level and is known to increase the risk of metabolic disorders. This study was conducted to identify potential laboratory markers suspicious for latent SCH. We retrospectively reviewed 958 outpatients in whom thyroid functions had been examined. Eighty-five (9.1%) of the 939 analyzed subjects had SCH (73% females). In the SCH group, median serum TSH and FT4 levels were 5.04 μU/ml and 1.19 ng/dl, respectively, and auto-thyroid antibodies were detected in 53.8% of patients. SCH group patients were significantly older than patients in the euthyroid group, while there was no intergroup difference in BMI. However, 56.5% of the SCH patients were asymptomatic. In the SCH group, serum aspartate aminotransferase and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher, and the estimated glomerular filtration rate (eGFR) was significantly lower than in the euthyroid group. Among patients less than 65 years of age, SCH patients tended to have lower eGFR and higher LDL-C than euthyroid patients. Age-dependent reductions of red blood cells and serum albumin were more prominent in the SCH than the euthyroid group. Biochemical changes with aging are useful as potential clues for suspecting latent SCH.

DOI： 10.18926/AMO/63203

Web of Science

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

researchmap

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

INTRODUCTION: The emergence of the novel coronavirus disease of 2019 (COVID-19) has led to huge disruptions in the medical field and society. The significance of training and education for experts has been increasingly acknowledged in Japan, where the number of infectious disease (ID) specialists is reportedly insufficient. In this paper, we report the results of a web-based survey that was conducted to reveal the ways in which the COVID-19 pandemic has influenced medical students' awareness of ID specialists and future career choices. METHOD: This cross-sectional descriptive study was conducted in March 2021 and targeted 717 medical students belonging to Medical School of Okayama University, Japan. The questionnaire consisted of four questions meant to assess students' knowledge and future intentions of becoming ID specialists. RESULTS: We obtained 328 eligible questionnaires (response rate: 45.7%). Of 227 (69.2%) students who were aware of ID specialists, 99 (43.6%) answered that they came to know about them only after the pandemic, 12 (3.7%) answered that their interest in being an ID specialist arose during the pandemic, while 36 (11.0%) responded that they would rather not become ID specialists. At the time of the survey, 5 students (1.5%) were aiming to become ID specialists. CONCLUSION: We observed a very low rate of interest to be an ID specialist among medical students. The experience of the pandemic does not seem to have influenced Japanese medical students to choose ID as a specialty for their careers. Continuous efforts to increase the number of ID specialists are necessary in Japan as a countermeasure against the coming pandemic.

DOI： 10.1371/journal.pone.0267587

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

新型コロナウイルス感染症対策の一環として,「新型コロナウイルス感染症対応従事者慰労金交付事業」が実施されたが,その影響・有効性に関するデータは乏しい。2021年4月26日〜5月31日に,岡山県・香川県・広島県の医療機関に勤務する職員を対象にウェブ・アンケートによる横断調査を実施した。1001名からの回答において,慰労金受給率は95.8%であり,59.5%は本事業に満足したと回答した。職種別満足度は,医師(60.8%),メディカルスタッフ(63.9%)に比べて看護職(46.3%)で低かった(p<0.001)。医療機関内職員のみならず,救急隊員,保健所職員,高齢者介護施設の職員も慰労金が支払われるべき業種として高率に理解を得た。慰労金交付事業は,医療従事者等の外的モチベーションとして概ね機能したと考えられるが,給付金額や対象者の選定に関しては検討の余地がある。(著者抄録)

researchmap

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

Introduction The long-term clinical course, prognosis, and optimal management of symptoms and conditions after the acute phase of coronavirus disease 2019 (COVID-19) remain to be elucidated. The purpose of this study was to clarify the characteristics of patients referred to a COVID-19 aftercare (CAC) clinic established at a tertiary academic hospital in Japan. Methods This study was a descriptive case series study. All patients who visited the CAC clinic between February 15 and September 17 in 2021 were included. Patients' background, chief complaints, and clinical courses after the onset of COVID-19 were described. Results A total of 87 Japanese patients (median age, 40.0 years; interquartile range [IQR], 26.5-53.0 years; 52.9% women) were referred to the CAC clinic. The median interval between the onset of COVID-19 and the visit to the clinic was 79.0 (IQR, 52.5-112.0) days. Referral sources were hospitals (36 patients), clinics (47 patients), a local healthcare center (3 patients), and other (1 patient). The most common chief complaint was general fatigue (50.4%) followed by dysosmia (28.7%), dysgeusia (26.4%), hair loss (18.4%), headache (17.2%), dyspnea (16.1%), and dyssomnia (13.1%). Respiratory symptoms were common in the early stages of the disease but were less common as the chief complaints when visiting the clinic. On the other hand, neurological, psychiatric, and extremity symptoms were predominant one month after the onset of COVID-19. Conclusions Regardless of the severity in the acute phase, patients visiting our CAC clinic suffered from a variety of symptoms. General physicians skilled in using a comprehensive approach would be optimal to see patients with such complex symptoms.

DOI： 10.7759/cureus.18568

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

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

Objectives Vitamin D deficiency, which is common worldwide, increases the risks of falls and fractures and can lead to increased morbidity and mortality. However, the clinical utility and relevance of vitamin D activation remain unknown. The aim of the present study was to clarify the clinical usefulness of serum 1,25-dihydroxyvitamin D (1,25D)/25-hydroxyvitamin D (25D) ratio for assessment of the extent of bone metabolism. Methods We retrospectively screened data for 87 patients whose serum 1,25D and 25D levels were measured. Eight patients who were taking vitamin D preparations were excluded, and data for 79 patients (33 males and 46 females) were analyzed. Since menopausal status can be associated with serum vitamin D level, we divided the patients by gender and divided the female patients into two groups at the age of 50 years. Results The median serum 1,25D/25D ratio was significantly lower in males than in females, with the most considerable difference in all males [4.1 (interquartile range: 2.3-5.8) × 10-3] versus elderly females (aged ≧50 years) [7.9 (3.3-10.1) × 10-3). Main disorders were endocrine (30.6%), inflammatory (18.5%), and bone-related (16.7%) disorders. The ratios of serum 1,25D/25D had significant negative correlations with femoral dual-energy X-ray absorptiometry % young adult mean (DEXA %YAM) (R=-0.35) and lumbar DEXA %YAM (R=-0.32). Significant correlations were found between the 1,25D/25D ratio and serum levels of inorganic phosphate (iP), parathyroid hormone, and alkaline phosphatase (ALP). The 1,25D/25D ratio had gender-specific characteristics: the ratio was significantly correlated with age in males (R=-0.49), while it was significantly correlated with BMI in females (R=0.34). Conclusions The results of this study suggested that vitamin D activity is negatively correlated with bone mineral density, being reduced in aged males but enhanced in obese females.

DOI： 10.7759/cureus.18070

Web of Science

PubMed

researchmap

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

OBJECTIVE: Urinary free cortisol (UFC) is a reliable marker to avoid cortisol fluctuation and the effects of binding proteins. However, UFC levels are affected by fluid intake and urine volume, and the normal levels range widely. METHODS: To discover the utility of the ratio of urinary cortisol to aldosterone excretions, 246 patients in whom daily excretions of UFC and aldosterone (UAC) were measured were retrospectively analyzed. RESULTS: The UFC/UAC ratio showed significant positive and negative correlations with the levels of serum cortisol (R=0.287) and aldosterone (R=-0.762), respectively. The UFC/UAC ratio increased with aging in female patients, while it was not altered by the level of BMI in either gender. Markers for metabolic and inflammatory status, including hemoglobin A1c (R=0.327), albumin (R=-0.331), C-reactive protein (R=0.317), ferritin (R=0.473), and D-dimer (R=0.569), showed correlations with the ratio of UFC/UAC that were more significant than the correlations with the serum level of cortisol or UFC alone. Of note, the UFC/UAC ratio was shown to be an indicator for the risk of diabetes (AUC: 0.765), hypoalbuminemia (0.839), hyper-CRPemia (0.748), and thrombophilia (0.824), in which the cut-off levels of the UFC/UAC ratio were around 12. CONCLUSION: The UFC/UAC ratio is a variable for detecting metabolic and inflammatory complications related to adrenocortical dysfunction.

Web of Science

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

researchmap

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

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) mainly affects young adults and can have a potential impact on social functioning. As this syndrome is associated with endothelial dysfunction, the heart can be damaged via ischemia due to endothelial damage. This might potentially lead to heart failure, which accounts for approximately 20% of deaths among patients with ME/CFS. While cardiac ischemia is thought be a pathophysiologically important manifestation of this syndrome, this is not yet reported. Herein, we present a case of a young female with newly diagnosed vasospastic or microvascular angina and concurrent exacerbation of ME/CFS severity. Her anginal symptoms, including exertional chest pain and transient chest discomfort, mimicked those of ME/CFS but were relieved after the administration of a calcium channel blocker. We emphasize the possibility of concurrent angina and exacerbation of ME/CFS and the importance of detecting cardiac ischemia to avoid unfavorable outcomes.

DOI： 10.3390/diagnostics11030460

Web of Science

Scopus

PubMed

researchmap

Language：English   Publisher：JMIR PUBLICATIONS, INC  

BACKGROUND: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students' distress during the pandemic. OBJECTIVE: This study aimed to provide details on how medical students have been affected by the pandemic. METHODS: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. The survey included questions about how the participants' mental status had changed from before to after the Japanese nationwide state of emergency (SOE). RESULTS: Out of 717 medical students, 473 (66.0%) participated in the study. In total, 29.8% (141/473) of the students reported concerns about the shift toward online education, mostly because they thought online education would be ineffective compared with in-person learning. The participants' subjective mental health status significantly worsened after the SOE was lifted (P<.001). Those who had concerns about a shift toward online education had higher odds of having generalized anxiety and being depressed (odds ratio [OR] 1.97, 95% CI 1.19-3.28) as did those who said they would request food aid (OR 1.99, 95% CI 1.16-3.44) and mental health care resources (OR 3.56, 95% CI 2.07-6.15). CONCLUSIONS: Given our findings, the sudden shift to online education might have overwhelmed medical students. Thus, we recommend that educators inform learners that online learning is not inferior to in-person learning, which could attenuate potential depression and anxiety.

DOI： 10.2196/25232

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

To determine the clinical characteristics of low androgen status in adult males with diabetes, we retrospectively analyzed the medical records of patients with type 2 diabetes mellitus in whom serum free testosterone (FT) levels were examined for 1 year. Among the 46 patients (56 ± 1.5 years old), decreases in serum FT levels to < 8.5 pg/ml (indicating the occurrence of late-onset hypogonadism [LOH]) were detected in 18 (39%). The per-centages of patients with low FT levels were high in the ≥ 50 years age group (83%), the HbA1c < 7% group (67%), and the 25 ≤ BMI < 30 kg/m2 group (56%). The serum FT levels tended to decrease age-dependently. The level of HbA1c was significantly correlated with the Heinemann Aging Male Symptoms (AMS) score (R = 0.47). The low-FT group had decreased levels of hemoglobin. Of note, the serum FSH level (R = -0.32) was negatively correlated with the serum FT level, whereas the serum TSH level (R = 0.36) was positively correlated with the serum FT level. Collectively, these results revealed that many diabetic males may have low FT levels and that the AMS score is related to the HbA1c level. A slightly anemic condition, thyroid dysfunction, and obesity (class 1) might be involved in LOH in middle-aged diabetic males.

DOI： 10.18926/AMO/61424

Web of Science

Scopus

PubMed

researchmap

Language：English   Publisher：BMJ PUBLISHING GROUP  

DOI： 10.1136/postgradmedj-2020-139562

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Influenza potentially has a high mortality rate when it affects the elderly. We aimed to examine the differences in clinical manifestations in patients with influenza according to their age. This multicenter prospective study was performed in six medical institutions in Okayama and Kagawa prefectures (Japan). Between December 1, 2019 and March 31, 2020, we collected data on adult patients diagnosed with influenza type A, who were strat-ified into younger (20-49 years), middle-aged (50-64 years), and older groups (≥ 65 years). We compared the presence or absence of fever, respiratory symptoms, and extrapulmonary symptoms according to age group. In total, 203 patients (113, younger; 51, middle-aged; and 39, older) were eligible for the analysis. The maxi-mum body temperature and temperature at first physician visit in the older group were significantly lower than those in the younger group. The incidence of respiratory symptoms was not different among the three groups. Chills, muscle pain, and arthralgia as systemic symptoms were noted significantly more frequently in the younger (80.9%) and middle-aged (75.5%) groups than in the older group (51.3%) (p = 0.002). Fever and sys-temic symptoms were less likely to appear in older patients, possibly resulting in the delaying of hospital visits among older adults.

DOI： 10.18926/AMO/62769

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Anorexia nervosa (AN) is occasionally complicated with hypoglycemic coma, which may cause sudden death by unknown mechanisms. We present the case of a 36-year-old woman with recurrent comas and a nineteen-year history of AN. She was found in a coma with remarkable hypoglycemia (28 mg/dL). Her BMI was 11.1 kg/m2. Endocrine workup revealed extremely low serum levels of glucagon, IGF-I and insulin. Asymptomatic hypoglycemia occurred with liver injury in the refeeding process. An aberrant glucose metabolism due to liver damage might have been involved in her susceptibility to hypoglycemia. This case suggests a possible mechanism of hypoglycemic coma in AN.

DOI： 10.18926/AMO/62776

Web of Science

Scopus

PubMed

researchmap

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

Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.

DOI： 10.1371/journal.pone.0259633

Scopus

PubMed

researchmap

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

OBJECTIVE: Insulin-like growth factor-1 (IGF-1) is an anabolic hormone, the levels of which decline with age. The present study aimed to determine the impact of age-related declines in serum IGF-1 levels on various physiological processes. DESIGN: We retrospectively reviewed the medical records of patients whose serum IGF-1 levels were estimated in our department, and assessed the relationships between serum IGF-1 levels and various physiological parameters. RESULTS: A total of 427 patients with a mean (± standard deviation) age of 52.8 (± 17.1) years were included in the analysis. The levels of serum IGF-1 showed significant positive correlation with those of hemoglobin and hematocrit, and negative correlation with the presence of inflammatory and fibrin-related markers including C-reactive protein (CRP) and procalcitonin (PCT), and D-dimer and fibrin degradation products (FDP). These tendencies persisted after exclusion of patients with pituitary disease. CONCLUSIONS: In this study population of diverse diseases and backgrounds, a decline in serum IGF-1 levels with age was associated with an increase in inflammatory and fibrin-related markers. This may explain the correlation between low serum IGF-1 levels and an increased risk of cardiovascular events. Our findings suggest that serum IGF-1 is a clinically relevant marker of cardiovascular risk, particularly in males.

DOI： 10.1080/13685538.2019.1657083

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Alkaline phosphatase (ALP) is an enzyme that is expressed in a variety of tissues. Among the isoforms of ALP, bone-specific alkaline phosphatase (BAP) is used as a marker for evaluating bone metabolism. We investigated the clinical usefulness of the ratio of serum BAP to total ALP for the diagnosis of various disorders in general practice. We retrospectively analyzed the cases of 107 Japanese patients whose serum BAP levels were exam-ined, focusing on clinical characteristics. We observed that the BAP/ALP ratios of the patients with fever and those with inflammatory diseases were significantly lower than the ratios of other patient groups. The BAP/ALP ratios of the patients with osteoporosis and those with metabolic bone diseases were higher than those of the patients with other conditions. The BAP/ALP ratio was found to be negatively correlated with age, a cor-relation that has not been found in other ethnicities. The serum BAP/ALP ratio was inversely correlated with serum CRP levels but was positively correlated with serum albumin levels and hemoglobin concentrations. Collectively, our results suggest that the BAP/ALP ratio could be a useful predictor for important geriatric con-ditions seen in general practice.

DOI： 10.18926/AMO/61205

Web of Science

PubMed

researchmap

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

PURPOSE: The aim of the present study was to determine how age-related decreases in serum dehydroepiandrosterone sulfate (DHEAS) levels affect various physiological processes. METHODS: We retrospectively reviewed the medical records of patients in whom serum DHEAS levels were measured in our department and assessed the relationships between serum DHEAS levels and various patient characteristics. RESULTS: Among the 149 patients included in our analysis (mean age: 52.7 ± 17.6 years, range: 15-84 years), 54 (36.2%) were men. Serum DHEAS levels inversely correlated with age in men (R = -0.810, p < .01) and to a lesser extent in women (R = -0.391, p < .01). Of note, there were significant positive associations between DHEAS levels and hemoglobin (R = 0.317, p ≤ .01) and hematocrit (R = 0.324, p ≤ .01) levels, which were observed in men, but not in women. CONCLUSIONS: Our study suggests that reduced DHEAS secretion inhibits erythropoietic activity in aging men, perhaps owing to the erythropoietic androgenic actions of DHEAS. Importantly, it suggests that the age-associated decline in DHEAS secretion might decrease erythropoietic activity in aging men. It is also possible that the adrenal cortex, the source of DHEAS, is dysfunctional in anemic men.

DOI： 10.1080/13685538.2019.1592151

Web of Science

Scopus

PubMed

researchmap

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

Septic pulmonary embolism (SPE) is a rare yet serious infectious disorder with nonspecific clinical findings due to microorganism-containing emboli disseminating from extrapulmonary infectious foci. It is unknown whether a positive blood culture correlates with a worse clinical outcome. We compared the clinical and microbiologic characteristics of patients with SPE divided into the culture-positive group and the culture-negative one. This study was a retrospective observational study of the patients diagnosed with SPE and treated in an academic hospital from April 2010 to May 2020. We identified six culture-positive and four culture-negative patients with SPE during the study period. The culture-positive group had significantly longer periods of hospitalization (median: 75 days, range: 45-125 days) than the culture-negative group (median: 14.5 days, range: 3-43 days) (p < 0.05), as well as significantly elevated serum C-reactive protein and procalcitonin. Patients with culture-negative SPE more commonly had odontogenic infections as the primary infectious foci. Our study highlights the importance of giving extra attention to SPE patients who have a positive blood culture, as they may have worse clinical outcomes. Physicians need to collaborate with dentists when faced with patients with culture-negative SPE, since they may have primary odontogenic infections.

DOI： 10.3390/pathogens9120995

Web of Science

Scopus

PubMed

researchmap

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

The prognosis of systemic amyloid light chain (AL) amyloidosis is generally poor, hence requiring chemotherapy or hematopoietic stem cell transplantation, while the prognosis of localized AL amyloidosis without an abnormal monoclonal immunoglobulin light chain is good. Localized AL amyloidosis has been previously reported to be observed in pulmonary, urinary tract, gastrointestinal, oropharyngeal, and laryngeal sites. However, only a few cases of localized lymph node AL amyloidosis have so far been reported. We herein present a case of localized lymph node AL amyloidosis that could possibly be misdiagnosed as systematic AL amyloidosis.

DOI： 10.2169/internalmedicine.4651-20

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

To clarify the relevance of prolactin (PRL) to clinical parameters in patients who visited our general medicine department, medical records of 353 patients in whom serum PRL levels were measured during the period from 2016 to 2018 were retrospectively reviewed. Data for 140 patients (M/F: 42/98) were analyzed after excluding patients lacking detailed records and patients taking dopaminergic agents. Median serum PRL levels were significantly lower in males than females: 6.5 ng/ml (IQR: 4.2-10.3) versus 8.1 ng/ml (5.9-12.9), respectively. Pain and general fatigue were the major symptoms at the first visit, and past histories of hypertension and dyslipidemia were frequent. Male patients with relatively high PRL levels (≥ 10 ng/ml) had significantly lower levels of serum albumin and significantly higher levels of serum LDH than those with low PRL (< 10 ng/ml). There were significant correlations of male PRL level with the erythrocyte sedimentation rate (R=0.62), serum LDH level (R=0.39) and serum albumin level (R=-0.52), while the level of serum CRP (R=0.33) showed an insignificant but weak positive correlation with PRL level. Collectively, these results show that PRL levels had gender-specific relevance to various clinical factors, with PRL levels in males being significantly related to inflammatory status.

DOI： 10.18926/AMO/60797

Web of Science

PubMed

researchmap

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

Web of Science

Scopus

PubMed

researchmap

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

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

Web of Science

PubMed

researchmap

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

Web of Science

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

A relationship between diabetes and depression is apparent. To clarify the clinical relevance of diabetic patients' gastroesophageal symptoms to their psychological status, we retrospectively analyzed the data from a Selfrating Depression Scale (SDS) and a Frequency Scale for Symptoms of Gastroesophageal reflux disease (FSSG) among 143 type 2 diabetic patients who visited a general medicine department. Among the 45 Japanese patients enrolled, the group with relatively high SDS scores (≥ 36) showed higher (FSSG) dysmotility symptom scores versus the low-SDS (< 36) group, although the 2 groups' characteristics and laboratory data were not significantly different. Positive correlations of postprandial plasma glucose (PPG) levels with FSSG scores (R=0.321, p<0.05), particularly with reflux scores (R=0.455, p<0.01) were revealed. PPG and HbA1c levels were not correlated with SDS scores. The patients' SDS scores were significantly correlated with their FSSG scores (R=0.41, p<0.01), suggesting that depressive status is linked to GERD-related manifestations. Considering that the patients' PPG levels were correlated with GERD-related symptoms, diabetic patients' blood glucose levels are associated with depressive status. Collectively, key symptoms related to GERD and glucose level values would be helpful.

DOI： 10.18926/AMO/57950

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

To clarify the potential relevance of patients' chief complaints at a general medicine department to their self-rating depression scale (SDS) and frequency scale for symptoms of gastroesophageal reflux disease (GERD) (FSSG) scores, we analyzed data of 478 patients who visited our general medicine department. The chief complaints (553 symptoms of 447 patients) were categorized into major symptom-based groups: respiratory (31%), circulatory (3%), gastrointestinal (GI) tract (26%), neurology (8%), orthopedic and skin (10%), and systemic (22%) symptoms. The SDS score tended to be higher in females and younger patients. The FSSG score did not differ by gender but was higher in younger patients. The patients receiving social welfare had higher SDS and FSSG scores. A close inter-relationship between the FSSG (including both degrees of reflux and dysmotility) and SDS was observed in all patients. Although the averages of the SDS and FSSG scores were not significantly different among the symptom-based categories, we observed significantly positive correlations between the FSSG and SDS in each category, suggesting that depressive status may be closely related to GERD-related symptoms regardless of the patients' chief complaints. An initial checkup of patients' psychological condition and/or GERD-like symptoms could help screen for latent disorders in outpatients with uncertain complaints.

DOI： 10.18926/AMO/57711

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Osteoporosis increases the risk of bone fractures. It is diagnosed based on an individual's bone mineral density (BMD) or a fracture without trauma. BMD is usually measured by the dual energy X-ray absorptiometry (DXA) method. Here we investigated factors for the earliest possible prediction of decreased BMD by examining the relationships between patients' BMD values and changes in the patients' physical and laboratory values. We retrospectively reviewed the medical records of 149 patients who visited our department in 2014-2015 for a variety of reasons and underwent an area BMD examination by DXA. We analyzed the relationships between decreasing BMD and the patients' gender, age, body mass index (BMI), medical background, hemoglobin, electrolytes, and thyroid function. Thirty-nine of the patients were diagnosed with osteoporosis based on their T-scores. An adjusted analysis showed that female gender, aging, and increased serum calcium level were significantly related to decreasing femoral BMD, whereas high BMI was associated with an increase in femoral BMD. Collectively the results indicate that for the early detection of low BMD, it is important for general-practice physicians to consider conducting a BMD checkup when treating female and elderly patients with a low BMI and/or elevated serum calcium level.

DOI： 10.18926/AMO/57370

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT JOURNAL MEDICAL EDUCATION-IJML  

Objectives: We explore the prevalence and characteristics of burnout among Japanese resident physicians and identifies factors associated with burnout. Methods: A cross-sectional study was conducted three times between April 2017 and March 2018 at a Japanese teaching hospital. Resident physicians were invited to answer an online survey that included existing valid instruments related to burnout, depression, and empathy. Demographic, background, occupational, and socioeconomic data were also collected. Participants were prompted to report the average daily work hours and the specialty they wish to pursue. Results: Overall, 39/76 (51%), 27/76 (36%), and 21/76 (28%) resident physicians responded to surveys in April 2017, October 2017, and March 2018, respectively. The percentages of participants with burnout for surveys in April 2017, October 2017, and March 2018 were 7/39 (18%), 6/27 (22%), and 7/21 (33.3%). Emotional exhaustion (EE) was the only burnout component strongly correlated with the severity of depression (r = .615, p < .001; r = .706, p < .001; r = .601, p < .01). EE and depersonalization (DP) had no significant correlation with average daily working hours (β = .156, p = .343 for EE; β = .061, p = .711 for DP). Conclusions: The results suggest that capping working hours alone may not be effective in reducing burnout in Japanese resident physicians. Medical educators might need to consider not only working hours but also individual job quality and satisfaction to address burnout. Future studies may need to incorporate qualitative methods to explore the characteristics of burnout.

DOI： 10.5116/ijme.5caf.53ad

Web of Science

PubMed

researchmap

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

We herein report a teenage girl who had been taking oral contraceptive pills for three months and complained of left lower abdominal pain that had continued for two months. A physical examination indicated anterior cutaneous nerve entrapment syndrome (ACNES), although no abnormality was found in various biochemical and imaging examinations. The pain was only transiently ameliorated by trigger-point injection, and neurectomy surgery was eventually effective. Sex steroids can be involved in the progress of local tissue edema causing ACNES. ACNES should be considered in cases of abdominal pain in patients taking oral contraceptives.

DOI： 10.2169/internalmedicine.1361-18

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

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

BACKGROUND: Simulation-based learning plays an important role in contemporary medical education, although there are problems providing tutors. Peer-assisted learning has begun being formally adopted in medical education. Although it is considered useful for simulation-based learning, its effectiveness remains unclear. This study was designed to compare the effect of simulation-based learning with that of traditional lectures conducted by postgraduate-year (PGY)-II residents on PGY-I residents. METHODS: This study was conducted at Okayama University Hospital over three years, for one week each year, before residents entered clinical practice. The study enrolled 76 PGY-I residents, who were randomized into two groups: simulation and lecture groups. PGY-II residents volunteered to conduct simulations and lectures. Knowledge evaluation was performed using pre- and post-tests, and self-evaluation of competence and behaviour-change and program evaluations were conducted using questionnaires. RESULTS: In both groups, knowledge test scores were found to improve significantly, and the score difference between pre- and post-tests in both the groups was not significant. Self-evaluation of competence and behaviour-change was found to be higher in the simulation group than the lecture group. The trainees in the simulation group valued the program and the PGY-II residents as teaching staff more than those in the lecture group. CONCLUSIONS: The combination of simulation-based learning and peer-assisted learning led by PGY-II residents is potentially more effective in improving the postgraduate education of PGY-I residents than the combination of lecture and peer-assisted learning.

DOI： 10.1186/s12909-019-1509-y

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

To clarify potential relationships between chief complaints of patients and laboratory data with a focus on aging-related changes, we retrospectively analyzed the data of 843 patients who visited a general medicine department for the first time. Their chief complaints were classified into 8 major symptoms: visceral pain, somatic pain, fever, cough, dizziness, fatigue, appetite loss, and edema. We compared the laboratory data obtained from the patients with complaints with the data of symptom-free (control) patients. The serum sodium and potassium levels in the fever group were decreased compared to those in the control group. In the fever group, the serum sodium level was inversely correlated with age. The ratio of serum urea nitrogen to creatinine (UN/Cr) was increased in the appetite-loss group. There were significant age-dependent increases in the UN/Cr ratio in the appetite-loss and edema groups. Of note, serum levels of free thyroxin were lower in the dizziness group compared to the control group. In addition, the free thyroxin level was inversely correlated with age in the dizziness group but not in the asymptomatic control group. Collectively, the results indicated that osmolality-related laboratory data are strongly associated with individual primary symptoms at the first visit regardless of the final diagnosis. The consideration of age-dependent changes of these markers is helpful for diagnosing latent disorders based on various primary symptoms.

DOI： 10.18926/AMO/56372

Web of Science

PubMed

researchmap

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

The aim of this study was to determine the relationships between free testosterone (FT) level and parameters including laboratory data and data from questionnaires and to determine symptoms leading to the detection of late onset hypogonadism (LOH). We retrospectively reviewed medical records of patients in whom serum FT was measured in our hospital. Aging Male Symptoms (AMS) score, self-rating depression scale (SDS) and frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) score were used for questionnaires. A total of 205 patients were included in the analysis (55.2 ± 15.6 years of age, mean ± SD). Among them, 119 patients (58.0%) had an FT level of less than 8.5 pg/mL, which fulfills the diagnostic criterion of LOH syndrome according to the clinical practice manual for LOH in Japan. It was revealed that FSSG score was inversely correlated to serum FT levels (r = -0.3395, p < 0.001), although SDS and AMS scales did not show significant correlations to FT levels. Our study revealed a high prevalence of LOH syndrome among patients in whom the majority complained of general symptoms. Although GERD symptoms are generally not considered to be typical symptoms of LOH, our study indicates that those symptoms might be clues for the detection of LOH.

DOI： 10.1507/endocrj.EJ18-0187

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

We retrospectively analyzed the cases of 148 febrile patients whose body temperature (BT) was ≥ 37.5°C at our hospital. We categorized them into seven groups; those with bacterial and viral infection, nonspecific inflammation, neoplasm, connective tissue disease (CTD), drug-induced disease, and unidentified causes. Our analysis revealed that the patient's BT at the 1st visit (BT-1st visit) and highest BT during the febrile period (BT-max) differed significantly among all categories except neoplasm. The greatest difference between BT-1st visit and BT-max was highest in the CTD group (1.5°C). Positive correlations of heart rate and C-reactive protein (CRP) level with BT-max and a negative correlation between serum sodium level with BT-max were uncovered. The serum thyroid-stimulating hormone (TSH) level and the ratio of TSH/free thyroxine were negatively correlated with BT-max, especially in the viral infection group, suggesting the existence of occult thyrotoxicosis in accord with a febrile condition, possibly leading to febrile tachycardia. A febrile gap between BT-1st visit and BT-max (except in the neoplasm group) was shown, in which BT-max was correlated with thyroid function. Clinicians should recognize the fluctuation of BT when diagnosing febrile patients, and tachycardia in such febrile patients may be, at least in part, associated with subclinical thyroid dysfunction.

DOI： 10.18926/AMO/56242

Web of Science

PubMed

researchmap

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

We herein report a case of central diabetes insipidus complicated with thyroid storm. A middle-aged woman who was receiving treatment for Graves' disease suddenly complained of polydipsia, polyuria and general fatigue. Laboratory tests showed hyperthyroidism, hypernatremia, hypoosmolar urine and a decreased plasma vasopressin level. The occurrence of central diabetes insipidus with hyperthyroidism was revealed on the basis of pituitary magnetic resonance imaging, a water deprivation test and a desmopressin test. The clinical co-existence of diabetes insipidus and hyperthyroidism is very rare; however, the complication should be considered when hypernatremia and/or dehydration progress in patients with Graves's disease as a common autoimmune-related etiology.

DOI： 10.2169/internalmedicine.0063-17

Web of Science

PubMed

researchmap

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

The aim of this study was to determine the relationships between free testostemne (FT) level and parameters including laboratory data and data from questionnaires and to determine symptoms leading to the detection of late onset hypogonadism (LOH). We retrospectively reviewed medical records of patients in whom serum FT was measured in our hospital. Aging Male Symptoms (AMS) score, self-rating depression scale (SDS) and frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) score were used for questionnaires. A total of 205 patients were included in the analysis (55.2 +/- 15.6 years of age, mean +/- SD). Among them, 119 patients (58.0%) had an FT level of less than 8.5 pg/mL, which fulfills the diagnostic criterion of LOH syndrome according to the clinical practice manual for LOH in Japan. It was revealed that FSSG score was inversely correlated to serum FT levels (r = -0.3395, p < 0.001), although SDS and AMS scales did not show significant correlations to FT levels. Our study revealed a high prevalence of LOH syndrome among patients in whom the majority complained of general symptoms. Although GERD symptoms are generally not considered to be typical symptoms of LOH, our study indicates that those symptoms might be clues for the detection of LOH.

DOI： 10.1507/endocrj.EJ18-0187

Web of Science

researchmap

Language：Japanese   Publisher：日本病院総合診療医学会  

症例は発熱とコーヒー残渣様嘔吐を呈した75歳女性。糖尿病、腎後性腎不全、腎盂腎炎および菌血症、肺血栓塞栓症、深部静脈血栓症などの多数の基礎疾患を有していた。上部消化管内視鏡検査では下部食道に全周性の潰瘍を認めたほか、十二指腸にも広範な潰瘍がみられ、急性食道粘膜病変および十二指腸潰瘍と診断した。絶食とし酸分泌抑制薬と胃粘膜保護薬を投与するとともに基礎疾患の治療を行ったところ、食道および十二指腸の潰瘍は急速に改善した。(著者抄録)

CiNii Article

J-GLOBAL

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2017072974

Language：Japanese   Publisher：Japan Society for Medical Education  

<p>Introduction: In Japan, the number of female physicians is increasing rapidly. The importance of education focused on career development and the work-life balance is increasingly being recognized.</p><p>Methods: In February 2008, we sent a questionnaire regarding the working status and life events to 1,374 female physicians who graduated from Okayama University Medical School or who were working at university-affiliated hospitals and facilities at the time of the investigation.</p><p>Results: Of the 376 respondents (26.8% response rate), we analyzed 360 respondents whose specialty is clinical medicine. Among them, 75.9% (n=269) of female physicians have partners, 70.2% (n=233) have children, and most of the female physicians experience these life events from age of 25-29 years. Although 82.1% (n=216) regarded the timing of their marriage as appropriate, 65.2% (n=144) regarded it as appropriate about having first child. Of the 174 respondents who returned to clinical work, 32.2% (n=56) returned to the same position as a full-time worker, and 27.6% (n=48) changed their position from full-time to part-time. Important factors to return to work easily, 〈understanding from their supervisors〉, 〈support from their family〉, and an appropriate amount of work were the top three reasons.</p><p></p><p>Discussion: It is important to educate medical students about career development based on the life stage and work-life balance for gender equality in medicine.</p>

DOI： 10.11307/mededjapan.47.2_111

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016270204

Language：Japanese   Publisher：南山堂  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016074594

Language：English  

CiNii Article

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016156775

Language：English  

researchmap

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

Background: Japanese medical student education lacks emphasis on teaching clinical reasoning skills. To partially remedy this situation, we developed a prototypic web-based module for tutors to teach clinical reasoning. We report the medical students' opinions of this module.Methods: Twenty-four students from two Japanese medical universities were randomly assigned to the two tutored virtual classrooms, each classroom with six students, or to the self-study group, 12 students, after taking the Internetbased Sequential Question and Answer pretest. After four weeks, each of the 24 students took the Sequential Question and Answer posttest. The entire 24 students answered a questionnaire about the Sequential Question and Answer tests; all 12 tutored students answered a questionnaire about the web-based tutored module.Results: Although both tutored and self-study Sequential Question and Answer posttest scores increased, the increases of the tutored group's posttest compared to the self-study posttest group were not statistically significant (p = 0.066).Ninety-two percent of the students rated the Sequential Question and Answer tests as an improved way to learn case presentation and clinical reasoning. Moreover, 79% of students felt that the Sequential Question and Answer tests were an effective way to learn clinical information. The tutored students rated the web-based tutored seminars as an 'excellent to fair' method to learn clinical reasoning using a five-point 'excellent to poor' scale.Conclusions: We developed a prototypic web-based module for tutors to teach clinical reasoning to medical students. The students' opinion supported the modular components of the web-based seminar format, Sequential Question and Answer test, and the tutoring syllabus as an effective way to improve learning clinical reasoning, case presentation, and medical information. Students also suggested refinements of the prototypic module.

Web of Science

researchmap

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

Background: At present clinical reasoning skills are not systematically taught in Japanese medical universities. We developed a prototypic preliminary module for clinical tutors to introduce clinical reasoning to Japanese medical students. We hypothesized that tutored medical students would outperform self-study students.Method: Using the web-based Sequential Question and Answer test that rewarded history and differential diagnosis as proxies for clinical reasoning, we compared the pre and posttest scores of 12 randomized fifth grade tutored students at two universities during four tutor-led 1.5-hour web-based seminars using a structured syllabus to 12 randomized self-study students.Results: The tutored and self-study groups' pretest scores were statistically similar at about 40 out of 100 weighted correct points. The tutored students' posttest scores were 62 points, significantly greater (p = 0.007) than the pretest mean 42 points, compared to the self-study students' posttest scores of 52 points, significantly greater (p = 0.012) than pretest mean 40 points. The difference between the two posttest groups was of borderline statistical significance (p = 0.08).Conclusions: We successfully assessed a prototypic module for tutors to introduce clinical reasoning to Japanese medical students. The tutored students achieved higher scores than the self-study students. Further research is needed to exploit the potential of our modular clinical reasoning system.

DOI： 10.14442/general.16.13

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

The aim of this study was to clarify the factors associated with the remission and/or regression of microalbuminuria in Japanese patients with type 2 diabetes mellitus. We retrospectively analyzed the data of 130 patients with type 2 diabetes mellitus with microalbuminuria for 2-6 years (3.39 +/- 1.31 years). Remission was defined as improving from microalbuminuria to normoalbuminuria using the albumin/creatinine ratio (ACR), and regression of microalbuminuria was defined as a decrease in ACR of 50% or more from baseline. Progression of microalbuminuria was defined as progressing from microalbuminuria to overt proteinuria during the follow-up period. Among 130 patients with type 2 diabetes mellitus with microalbuminuria, 57 and 13 patients were defined as having remission and regression, respectively, while 26 patients progressed to overt proteinuria. Sex (female), higher HDL cholesterol and lower HbAlc were determinant factors associated with remission/regression of microalbuminuria by logistic regression analysis. Lower systolic blood pressure (SBP) was also correlated with remission/regression, but not at a significant level. These results suggest that proper control of blood glucose, BP and lipid profiles may be associated with remission and/or regression of type 2 diabetes mellitus with microalbuminuria in clinical practice.

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT JOURNAL MEDICAL EDUCATION-IJML  

OBJECTIVE: We report the preliminary development of a unique Web-based instrument for assessing and teaching knowledge and developing clinical thinking called the "Sequential Questions and Answers" (SQA) test. Included in this feasibility report are physicians' answers to the Sequential Questions and Answers pre- and posttests and their brief questionnaire replies. METHODS: The authors refined the SQA test case scenario for content, ease of modifications of case scenarios, test uploading and answer retrieval. Eleven geographically distant physicians evaluated the SQA test, taking the pretest and posttest within two weeks. These physicians completed a brief questionnaire about the SQA test. RESULTS: Eleven physicians completed the SQA pre- and posttest; all answers were downloaded for analysis. They reported the ease of website login and navigating within the test module together with many helpful suggestions. Their average posttest score gain was 53% (p=0.012). CONCLUSIONS: We report the successful launch of a unique Web-based instrument referred to as the Sequential Questions and Answers test. This distinctive test combines teaching organization of the clinical narrative into an assessment tool that promotes acquiring medical knowledge and clinical thinking. We successfully demonstrated the feasibility of geographically distant physicians to access the SQA instrument. The physicians' helpful suggestions will be added to future SQA test versions. Medical schools might explore the integration of this multi-language-capable SQA assessment and teaching instrument into their undergraduate medical curriculum.

DOI： 10.5116/ijme.52a7.7280

Web of Science

PubMed

researchmap

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

The aim of this study was to clarify the factors associated with the remission and/or regression of microalbuminuria in Japanese patients with type 2 diabetes mellitus. We retrospectively analyzed the data of 130 patients with type 2 diabetes mellitus with microalbuminuria for 2-6 years (3.39±1.31 years). Remission was defined as improving from microalbuminuria to normoalbuminuria using the albumin/creatinine ratio (ACR), and regression of microalbuminuria was defined as a decrease in ACR of 50% or more from baseline. Progression of microalbuminuria was defined as progressing from microalbuminuria to overt proteinuria during the follow-up period. Among 130 patients with type 2 diabetes mellitus with microalbuminuria, 57 and 13 patients were defined as having remission and regression, respectively, while 26 patients progressed to overt proteinuria. Sex (female), higher HDL cholesterol and lower HbA1c were determinant factors associated with remission/regression of microalbuminuria by logistic regression analysis. Lower systolic blood pressure (SBP) was also correlated with remission/regression, but not at a significant level. These results suggest that proper control of blood glucose, BP and lipid profiles may be associated with remission and/or regression of type 2 diabetes mellitus with microalbuminuria in clinical practice.

PubMed

researchmap

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

BACKGROUND: The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar). METHODS: The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students' verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking. RESULTS: The most basic level of verbal simple responses accounted for a majority (85%) of the total students' verbal comments. Only 15% of the students' comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students' verbal response time for the four sessions with the male instructor was 6.9%; total mean students' verbal response time for the four sessions with the female instructor was 19% (p < 0.05). CONCLUSIONS: This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.

DOI： 10.1186/1472-6920-13-156

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title>
<sec>
<title>Background</title>
The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar).


</sec>
<sec>
<title>Methods</title>
The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students’ verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking.


</sec>
<sec>
<title>Results</title>
The most basic level of verbal simple responses accounted for a majority (85%) of the total students’ verbal comments. Only 15% of the students’ comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students’ verbal response time for the four sessions with the male instructor was 6.9%; total mean students’ verbal response time for the four sessions with the female instructor was 19% (p &lt; 0.05).


</sec>
<sec>
<title>Conclusions</title>
This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.


</sec>

DOI： 10.1186/1472-6920-13-156

researchmap

Other Link： http://link.springer.com/article/10.1186/1472-6920-13-156/fulltext.html

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

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver function tests results, after the commonly investigated causes have been excluded, and frequently coexists with type 2 diabetes mellitus (T2DM) because the conditions have common risk factors. As both T2DM and NAFLD are related to adverse outcomes of the other, diagnosis and valuation of fatty liver is an important part of the management of diabetes. Although noninvasive methods, such as biomarkers, panel markers, and imaging, may support a diagnostic evaluation of NAFLD patients, accurate histopathological findings cannot be achieved without a liver biopsy. As it is important to know whether steatohepatitis and liver fibrosis are present for the management of NAFLD, liver biopsy remains the gold standard for NAFLD diagnosis and evaluation. Therefore, new investigations of the pathogenesis of NAFLD are necessary to develop useful biomarkers that could provide a reliable noninvasive alternative to liver biopsy.

DOI： 10.1155/2012/145754

Web of Science

PubMed

researchmap

Language：English   Publisher：AMER ASSOC CLINICAL ENDOCRINOLOGISTS  

DOI： 10.4158/EP09312.CO

Web of Science

researchmap

Language：English   Publisher：AMER DIABETES ASSOC  

Web of Science

researchmap

Language：English   Publisher：AMER DIABETES ASSOC  

Web of Science

researchmap

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Aims: To prospectively study whether occult hepatitis B virus (HBV) infection can promote the development of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related chronic liver disease. In addition, to evaluate the difference among HBV DNA-negative patients and patients with high and low HBV copy numbers. Methods: A total of 167 patients with HCV-related chronic liver disease without HBV surface antigen ( HBsAg) were studied. HBV DNA in liver tissue was determined using polymerase chain reaction (PCR). Results: HBV DNA was detected in 9 of 167 patients (5.4%) by single PCR and in 25 patients (15.0%) by nested PCR. HCC developed in 12 of 167 patients (7.2%). Ten of 142 HBV DNA-negative patients (7.0%) and 2 of 9 patients with a high HBV copy number (22.2%) developed HCC, whereas none of 16 patients with a low HBV copy number developed HCC. The incidence rate of HCC in patients with a high HBV copy number was significantly higher than in HBV DNA-negative patients and patients with low HBV copy number. Conclusion: A high amount of HBV DNA in liver tissue of HBsAg-negative patients with HCV-related liver disease might be associated with HCC development. Copyright (c) 2008 S. Karger AG, Basel.

DOI： 10.1159/000121363

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

AIMS: To prospectively study whether occult hepatitis B virus (HBV) infection can promote the development of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related chronic liver disease. In addition, to evaluate the difference among HBV DNA-negative patients and patients with high and low HBV copy numbers. METHODS: A total of 167 patients with HCV-related chronic liver disease without HBV surface antigen (HBsAg) were studied. HBV DNA in liver tissue was determined using polymerase chain reaction (PCR). RESULTS: HBV DNA was detected in 9 of 167 patients (5.4%) by single PCR and in 25 patients (15.0%) by nested PCR. HCC developed in 12 of 167 patients (7.2%). Ten of 142 HBV DNA-negative patients (7.0%) and 2 of 9 patients with a high HBV copy number (22.2%) developed HCC, whereas none of 16 patients with a low HBV copy number developed HCC. The incidence rate of HCC in patients with a high HBV copy number was significantly higher than in HBV DNA-negative patients and patients with low HBV copy number. CONCLUSION: A high amount of HBV DNA in liver tissue of HBsAg-negative patients with HCV-related liver disease might be associated with HCC development.

DOI： 10.1159/000121363

Web of Science

PubMed

researchmap

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

AIM: This study was performed to determine the prevalence and distribution of hepatitis C virus (HCV) genotypes in Myanmar. METHODS: A total of 1333 peripheral blood samples were collected from four different border cities of Myanmar. The anti-HCV antibody-positive serum samples were identified. HCV was genotyped by reverse transcriptase polymerase chain reaction, direct DNA sequencing and phylogenetic analysis on the partial core genome. RESULTS: The overall prevalence of HCV infection was 11.6% (154/1333). Regionally, it was 13.5% (47/349) in the north-eastern city, 12.8% (64/501) in the north-western city, 4.2% (16/380) in the southern city and 26.2% (27/103) in the western city. HCV was genotyped in 145/154 (94.2%) samples. Genotype 6 was the most prevalent genotype in this study (71/145, 49%), followed by genotype 3 (57/145, 39.3%), genotype 1 (16/145, 11%), and genotype 2 (1/145, 0.7%). Genotype 6 was mostly found in the northern cities and genotype 3 in the southern and western cities of Myanmar. Multiple HCV genotypes/subtypes were successfully characterized as 1a, 1b, 2a, 3a, 3b, 6m, 6n, and a new 6 subtype. Among them, subtype 6n was the most predominant subtype (38.6%), followed by subtype 3b (29.7%), 3a (9.6%), 6m (9%), 1b (6.9%), 1a (4.1%), new 6 subtype (1.4%) and 2a (0.7%). Subtype 6n was more widely distributed in the northern cities whereas subtype 3b was more common in the western city. The newly discovered genotype 6 subtype was from the northern cities. CONCLUSIONS: The results indicate there are regional differences of HCV genotype distribution in Myanmar. There is a distinct geographic variation from other South-East Asian countries in terms of the existence of the new genotype 6 subtype.

DOI： 10.1111/j.1872-034X.2007.00053.x

Web of Science

PubMed

researchmap

Language：English  

researchmap

Language：English   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Previously, using phylogenetic analysis of NS5b sequences, we found that three type 6 variant subgroups (M6-1, M6-2 and M6-3) exist in Myanmar. According to the new nomenclature of hepatitis C, M6-1 and M6-2 belong to subtypes 6m and 6n, respectively, but M6-3 is unassigned. In this study, we sequenced and phylogenetically analyzed the core region of these type 6 variant subgroups. Serum samples assigned as 6m or 6n by NS5b sequence were also identified as 6 m or 6n by core region analysis. The M6-3 (sample name MYAN-3E-3) remained unassigned to a subgroup based on its core region analysis. The findings of this study suggest that either the core region or the NS5b region can be analyzed for HCV subtype classification.

Web of Science

Scopus

PubMed

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1429203996

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

CiNii Books

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本東洋医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：診断と治療社  

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：The Japanese Society of Internal Medicine  

DOI： 10.2169/naika.110.486

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2021162863

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：遠見書房  

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2021210732

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：日本疲労学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)ライフ・サイエンス  

高齢者診療においては、疾患分野別(臓器別)なアプローチ以外に、老年医学としてのアプローチを積極的に取り入れる必要がある。医療面接においての情報収集以外に、高齢者総合機能評価(CGA)による評価や、患者家族からの意見や看護師、介護士、ケアマネジャーなどの多職種からの情報も取り入れ、問題点の評価・診療計画・介入に当たってはコメディカルと相談・協力して行うことが望ましい。とりわけ総合診療において、老年医学は重要な位置づけにあり、医学生・若手医師に対して老年医学の実践を通じてその大切さを発信し、老年医学に対する興味を育てていく必要がある。(著者抄録)

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ◎夏は清涼飲料水を多飲する機会が多いため,清涼飲料水ケトーシスの発症に注意する.◎高齢者は自覚症状に乏しく,口渇感の訴えも少ないため,夏は高齢者の高浸透圧高血糖状態(HHS)進展リスクが高まる.◎夏の糖尿病ケトアシドーシス(DKA),HHS発症予防のため,シックデイルールを活用する.

DOI： 10.11477/mf.1402227081

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1402226749

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1402226763

J-GLOBAL

researchmap

Language：Japanese   Publisher：診断と治療社  

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：The Japanese Society of Internal Medicine  

DOI： 10.2169/naika.109.1155

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：Japan Society for Medical Education  

DOI： 10.11307/mededjapan.51.3_279

CiNii Article

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1402226217

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1402226218

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(株)羊土社  

＜Point＞●診断困難症例への考え方:直感的思考と分析的思考、そして除外診断の重要性を理解しよう●他診療科との協力は、鑑別診断のためなのか、検査目的なのか、治療介入が必要なのか、目的を明確に伝える●「症例くん」と「PINACO」は、同様の症例を検索するのに便利●それでも診断がつかないときでも、患者の気持ちに寄り添い、患者への説明を十分に行う(著者抄録)

J-GLOBAL

researchmap

Language：Japanese   Publisher：間脳・下垂体・副腎系研究会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

researchmap

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：間脳・下垂体・副腎系研究会  

40歳代男性。他院で頭蓋咽頭腫に対する腫瘍摘出開頭術を受けるも、2ヵ月後、腰痛と39℃台の発熱が出現したため再入院となった。髄液培養にてAcinetobacterが検出され、細菌性髄膜炎として抗生剤加療されたが、解熱せず、当院へ転院となった。当初、本症例は細菌性髄膜炎として薬剤をMEPMからABPC/SBTに変更し対処した。だが、奏効はせず、腰痛精査のため行った脊椎CTにてTh7/8・L4/5に骨破壊像が認められ、更にL4/5の椎体培養からCandida albicansが検出され、Candida椎体炎と診断した。診断後は抗真菌薬を併用したが効果は得られず、頭部MRIを行ったところ、髄膜炎が示唆され、髄液異常の原因は化学性髄膜炎と考えられた。治療は副腎不全に対する補充療法の継続ほか、汎下垂体機能症に対してはヒドロコルチゾン投与を行った。9ヵ月後の外来検査ではMRI-FLAIRの高信号は消失し、髄液所見は改善傾向にあった。

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：Okayama Medical Association  

DOI： 10.4044/joma.130.167

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Language：Japanese   Publisher：Okayama Medical Association  

DOI： 10.4044/joma.130.25

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Other Link： http://ousar.lib.okayama-u.ac.jp/56058

Language：Japanese   Publisher：メディカル・サイエンス・インターナショナル  

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2018300964

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本社会薬学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：診断と治療社  

＜Headline＞ 1 更年期障害の要因として、「内分泌学的要因」「環境要因」「心理的要因」の三つがあり、これらの要因は通常複雑に絡み合っている。2 更年期障害の診療において、対話は重要であり、対話から要因を探るだけでなく、対話自体が治療のひとつとなりうる。3 更年期障害の症状は、自律神経失調症状、精神的症状、その他の3種類に分けられる。4 更年期障害の治療法は、薬物療法としてホルモン補充療法(HRT)、漢方療法、向精神薬などが、非薬物療法としてカウンセリングや、心理療法などがある。5 漢方療法では、婦人科三大処方である、当帰芍薬散、加味逍遙散、桂枝茯苓丸などを中心に用い、まずは陰陽、虚実で使い分ける。(著者抄録)

CiNii Article

CiNii Books

J-GLOBAL

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2017283176

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：間脳・下垂体・副腎系研究会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：メディカル・サイエンス・インターナショナル  

CiNii Article

CiNii Books

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内分泌学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：エム・イー振興協会 ; 1975-  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2014243061

Language：Japanese   Publisher：(株)医学書院  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：日本医学教育学会  

DOI： 10.11307/mededjapan.45.5_363

CiNii Article

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本女性医学学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本医学教育学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

J-GLOBAL

researchmap