記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1536/ihj.25-105

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担当区分：筆頭著者,　責任著者  

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/ccr3.70168

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm14030817

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Early detection and response to patient deterioration are essential to prevent serious outcomes such as unplanned intensive care unit (ICU) transfers and cardiac arrests. Rapid response systems (RRS) have been implemented globally, leading to a reduction in in-hospital mortality. In high-dependency units (HDUs), where patient monitoring is more frequent than in general wards, but staffing levels are lower than in intensive care units (ICUs), the challenge of identifying deteriorating patients persists. The Early Warning Score System (EWSS), including the National EWS (NEWS) and the artificial intelligence (AI)-based Visensia Safety Index (VSI), offer tools for early detection of patients' exacerbations. This study evaluates the effectiveness of NEWS and VSI in predicting patient deterioration in an HDU in Japan. Methods This single-center retrospective cohort study was conducted at a 344-bed acute care hospital. The study population included patients admitted to the HDU between September 27, 2019, and December 31, 2019. Study outcomes were unexpected ICU admission, endotracheal intubation, de novo use of vasopressors, de novo use of non-invasive positive pressure ventilation (NPPV), cardiac arrest, and the composite outcome (any of these outcomes). The predictive accuracy of the National Early Warning Score (NEWS) and the Visensia Safety Index (VSI) for detecting outcomes within 24 hours from each time point was analyzed. Results A total of 356 patients were included, with a median age of 76 years old (interquartile range (IQR): 64-84) and a median HDU stay of 2.0 days (IQR: 2.0-3.0). Among the 2648 analyzed vital sign sets, the median NEWS score was 5.0 (IQR: 3.0-7.0) and the median VSI score was 1.1 (IQR: 0.7-1.9). Twenty-six patients (7.3%) experienced outcomes. Among these, 13 (3.7%) required unexpected ICU transfers, 6 (1.7%) required endotracheal intubation, 15 (4.2%) required de novo vasopressor use, and 7 (2.0%) required de novo NPPV. NEWS could predict unexpected ICU admissions with good accuracy (the area under the curve (AUC) 0.834), as well as de novo vasopressor use (AUC 0.765) and the composite outcome (AUC 0.701). VSI also demonstrated modest predictive efficacy for unexpected ICU transfers (AUC 0.767), endotracheal intubation (AUC 0.712), and de novo vasopressor use (AUC 0.733). Based on ROC analysis, the appropriate threshold for NEWS ranged between 6.0 and 8.0, and the optimal threshold for VSI was found to be 1.5. Chronologically, NEWS remained stable before the occurrence of outcomes, whereas VSI showed a significant upward trend, suggesting that VSI may be more sensitive to detecting early deterioration. Conclusions In this study, both NEWS and VSI demonstrated modest accuracy in predicting unexpected ICU admission and vasopressor use in an HDU. While NEWS high risk (7≥) is an appropriate cutoff value for detecting adverse outcomes, particularly lowering the VSI cutoff to 1.5, may enhance the identification of high-risk patients.

DOI： 10.7759/cureus.71971

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Adult-onset Still's disease (AOSD) is a rare orphan disease, the diagnosis of which remains challenging. This study aimed to identify additional clues for establishing early diagnosis beyond the existing criteria. Methods A retrospective longitudinal cohort study was conducted at two community hospitals in Japan between March 2012 and December 2022. The clinical characteristics and medical histories of patients with AOSD were extracted from the clinical records. The primary outcome was to identify the key manifestations of AOSD for an early diagnosis beyond the existing criteria. Results Twenty-one patients (mean age, 58 years) were included in the study. Fever was the first symptom in 13 out of 21 patients (62%). Six out of 21 patients (29%) presented with a pruritic rash only, while two out of 21 (10%) initially presented with a sore throat. All patients visited more than one medical institution. The median time to reach a correct diagnosis was 41 days (IQR 19-138). Nineteen out of 20 patients (95%) exhibited a pruritic rash, identified as persistent pruritic linear streaks, with a median duration of 21 days (IQR 12-64) before the diagnosis of AOSD as a cutaneous manifestation. Conclusions Persistent pruritic linear streaks were a key feature in the context of an early diagnosis of AOSD, offering an option for reconsidering and revising the existing classification criteria.

DOI： 10.7759/cureus.62267

PubMed

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

Vitamin C deficiency, also known as scurvy, causes abnormalities in connective tissues and varied symptoms. We describe a patient with putaminal hemorrhage, a very rare presentation of scurvy. A 39-year-old man presented with weakness in the left arm and left leg. Right putaminal hemorrhage was initially diagnosed, and he underwent evacuation of the intracerebral hemorrhage. Scurvy was suspected when repeated physical examinations revealed a bleeding tendency and multiple untreated dental caries, missing teeth, and gingivitis. A diagnosis of scurvy was further supported by the patient's history of smoking, alcohol use disorder, poor diet, and low plasma vitamin C concentration. After receiving oral nutritional supplementation including vitamin C, the bleeding tendency quickly improved. This case highlights the importance of including scurvy in a differential diagnosis for patients with bleeding tendencies, especially those with a poor diet or unknown dietary history. Empirical administration of vitamin C is a reasonable treatment.

DOI： 10.7759/cureus.54777

PubMed

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出版者・発行元：中外医学社  

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記述言語：日本語   出版者・発行元：(株)メディカル・サイエンス・インターナショナル  

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開催年月日： 2024年9月7日 - 2024年9月8日

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2024年6月22日 - 2024年6月23日

記述言語：日本語   会議種別：口頭発表（招待・特別）  

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開催年月日： 2024年3月16日

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2024年3月14日 - 2024年3月16日

記述言語：日本語   会議種別：口頭発表（一般）  

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開催年月日： 2023年6月26日 - 2023年6月27日

記述言語：英語   会議種別：ポスター発表  

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開催年月日： 2023年6月24日 - 2023年6月25日

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開催年月日： 2023年6月

記述言語：日本語  

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開催年月日： 2023年6月

記述言語：日本語  

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開催年月日： 2022年6月25日 - 2022年6月26日

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開催年月日： 2022年2月26日 - 2022年2月27日

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開催年月日： 2022年

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開催年月日： 2021年9月18日 - 2021年9月19日

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開催年月日： 2021年6月26日 - 2021年6月27日

記述言語：英語   会議種別：口頭発表（一般）  

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開催年月日： 2020年9月

記述言語：日本語   会議種別：口頭発表（一般）  

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