研究者詳細 - 大脇　哲洋

講演・口頭発表等 - 大脇　哲洋

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Okumura H., Uchikado Y., Matsumoto M., Omoto I., Sasaki K., Kita Y., Arigami T., Uenosono Y., Nakajo A., Owaki T., Mori S., Ishigami S., Natsugoe S. . Clinical significance of mediastinoscope-assisted transhiatal esophagectomy in patients with esophageal cancer . Langenbeck's Archives of Surgery 2015年8月 Langenbeck's Archives of Surgery

記述言語：日本語

Purpose: Mediastinoscope-assisted transhiatal esophagectomy (MATHE) is a useful surgical procedure in esophageal cancer patients who have limited indications for transthoracic operations due to preoperative complications. Methods: In the last 10 years, 63 patients underwent MATHE at our department. We examined the clinical data of these patients and assessed the indications, postoperative outcomes, and prognostic factors of MATHE. Results: The 5-year overall survival (OS) rate was 53.4 %, and disease-free survival (DFS) rate was 66.0 %. Postoperative complications were observed in 22 cases (34.9 %), and recurrent disease occurred in 17 cases (27.0 %). On univariate analyses of OS, location of the tumor, tumor depth, lymph node metastasis, clinical stage, simultaneous resection of other organs, postoperative pneumonia, and blood loss were significant prognostic factors. On multivariate analyses, location of the tumor and lymph node metastasis were independent prognostic factors of OS. On univariate analyses, location of the tumor, tumor depth, lymph node metastasis, clinical stage, and blood loss were significant prognostic factors of DFS, while on multivariate analyses of DFS, lymph node metastasis and blood loss were independent prognostic factors. Conclusion: MATHE is a useful procedure for the middle to lower thoracic esophageal cancer patients without clinical lymph node metastasis with serious complications who were unable to undergo thoracotomy.

DOI： 10.1007/s00423-015-1330-y

Kita Y., Okumura H., Uchikado Y., Sasaki K., Omoto I., Matsumoto M., Setoyama T., Tanoue K., Mori S., Owaki T., Ishigami S., Ueno S., Kajiya Y., Natsugoe S. . Clinical significance of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography in superficial esophageal squamous cell carcinoma . Annals of Surgical Oncology 2013年5月 Annals of Surgical Oncology

記述言語：日本語

Purpose: To assess the clinical usefulness and significance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in superficial esophageal squamous cell carcinoma (ESCC). Methods: We examined FDG-PET for 80 consecutive patients with superficial ESCC without neoadjuvant treatment. Fifty-seven patients underwent radical esophagectomy, and 23 patients received endoscopic resection. The FDG uptake index was evaluated with clinicopathological findings, and glucose transporter 1 (Glut-1) expression in primary tumors was examined immunohistochemically. Results: The FDG uptake in primary tumors correlated with histology, depth of tumor invasion, lymph node metastasis, lymphatic invasion, vascular invasion, and Glut-1 expression. All patients with more than 4.4 maximum standardized uptake value (SUV max) had deeper invasion of submucosa. Among 16 patients with lymph node metastasis, only two were found to have lymph node metastasis. FDG uptake, depth of tumor invasion, lymph node metastasis, and histology were found to be prognostic factors, and histology was an independent prognostic factor. In FDG uptake-positive patients, depth of tumor invasion and histology were prognostic factors. Conclusions: FDG-PET is useful for diagnosing tumors with deeper invasion of submucosa and is helpful in making decisions regarding endoscopic treatment for superficial ESCC. Patients with FDG uptake-positive disease, deeper invasion of submucosa, poorly differentiated tumor, and poor prognosis should receive multimodal treatment. © 2012 Society of Surgical Oncology.

DOI： 10.1245/s10434-012-2796-2

Ishigami S., Arigami T., Uenosono Y., Okumura H., Kurahara H., Uchikado Y., Setoyama T., Kita Y., Kijima Y., Nishizono Y., Nakajo A., Owaki T., Ueno S., Natsugoe S. . Clinical implications of DLL4 expression in gastric cancer . Journal of Experimental and Clinical Cancer Research 2013年8月 Journal of Experimental and Clinical Cancer Research

記述言語：日本語

Background: Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor neovascular development and angiogenesis during tumor growth. The clinical significance of DLL4 expression in gastric cancer has not been clarified. Methods. Gastric cancer cell lines and 180 gastric cancer patients were enrolled. DLL4 expression in gastric cancer cells and stroma was identified and evaluated immunohistochemically. The association between DLL4 and clinicopathological factors was also assessed. Results: DLL4 expression was identified in the cellular membrane and cytoplasm of gastric cancer cells by immunoblotting and immunohistochemical staining. DLL4 positivity in cancer cells and stroma was found in 88 (48%) and 41 (22%) of the 180 gastric cancer patients respectively. Both cancer and stromal DLL4 expression significantly correlated with more advanced tumor depth, nodal involvement, and lymphatic and venous invasion. A strongly positive association between cancerous and stromal DLL4 expression was identified (p < 0.01). Both cancerous and stromal DLL4 expression were prognostic markers in gastric cancer as determined by univariate analysis. Conclusions: Cancerous and stromal DLL4 expression was found in 48% and 22% in gastric cancer, and significantly affected postoperative clinical outcomes. Cancerous and stromal DLL4 expression may be an effective target of anti-DLL4 treatment in gastric cancer. © 2013 Ishigami et al.; licensee BioMed Central Ltd.

DOI： 10.1186/1756-9966-32-46

Natsugoe S., Matsumoto M., Okumura H., Uchikado Y., Setoyama T., Sasaki K., Sakurai T., Omoto I., Owaki T., Shinchi H., Ueno S., Ishigami S. . Clinical course and outcome after esophagectomy with three-field lymphadenectomy in esophageal cancer . Langenbeck's Archives of Surgery 2010年4月 Langenbeck's Archives of Surgery

記述言語：日本語

Background Esophagectomy with three-field lymphadenectomy has been performed for esophageal cancer. Detailed analysis of cause of death and mode of recurrence is required to determine the need for further adjuvant therapy and follow-up. Materials and methods A total of 208 patients who underwent esophagectomy through right thoracotomy with threefield lymphadenectomy were enrolled into the present study. Mode of first recurrence was divided into four groups: lymph node, hematogenous, mixed, and local recurrence. Results Excluding 16 hospital deaths, the number of deaths and 5-year survival rates were 104 patients and 7.8% for cancer recurrence, 12 patients and 53.8% for second primary cancers in other organs, and 34 patients and 31.0% for causes of death unrelated to carcinoma. In the 104 patients with relapse, 5-year survival rate of patients was 14.3%with lymph node recurrence (n=29), 9.1% with hematogenous recurrence (n=32), 3.1% with mixed recurrence (n=35), and 12.5% with local recurrence (n=8). Conclusion To improve outcomes for esophagectomy with three-field lymphadenectomy, early detection of recurrent disease and regular examination of the entire body for secondary cancer is necessary. © Springer-Verlag 2010.

DOI： 10.1007/s00423-010-0592-7

Kita Y., Nishizono Y., Okumura H., Uchikado Y., Sasaki K., Matsumoto M., Setoyama T., Tanoue K., Omoto I., Mori S., Owaki T., Ishigami S., Nakagawa H., Tanaka F., Mimori K., Mori M., Natsugoe S. . Clinical and biological impact of cyclin-dependent kinase subunit 2 in esophageal squamous cell carcinoma . Oncology Reports 2014年5月 Oncology Reports

記述言語：日本語

Cyclin-dependent kinase subunit 2 (CKS2) is a cyclin-dependent kinase subunit (CKS) family member that participates in cell cycle regulation. Few studies have investigated its involvement in esophageal squamous cell carcinoma (ESCC). The aim of the present study was to assess the clinical significance of CKS2 in ESCC. We used immunohistochemistry to study the clinicopathologic significance of CKS2 protein expression in 121 patients with ESCC. Using real-time reverse transcriptase-polymerase chain reaction (RT-PCR), we examined the expression of CKS2 mRNA in tumors and the corresponding normal esophageal tissues that were obtained from 62 patients. Finally, siRNA-mediated attenuation of CKS2 expression was examined in vitro. CKS2 protein expression was significantly correlated with depth of tumor invasion, clinical stage, lymphatic invasion and distant metastasis (p=0.033, 0.028, 0.041 and 0.009, respectively). CKS2 mRNA expression was higher in cancer tissue than in corresponding normal tissue (p<0.001). Patients with positive-CKS2 protein.

DOI： 10.3892/or.2014.3062

Okumura H., Uchikado Y., Kita Y., Omoto I., Hayashi N., Matsumoto M., Sasaki K., Setoyama T., Arigami T., Uenosono Y., Matsushita D., Desaki R., Noda M., Higo N., Okubo K., Urata M., Yamasaki Y., Owaki T., Ishigami S., Natsugoe S. . Clinical analysis of the diagnosis and treatment of esophageal perforation . Esophagus 2016年4月 Esophagus

記述言語：日本語

Background: Despite recent advances in treatment strategies, the management of esophageal perforation is still problematical and controversial. The purpose of the present study was to evaluate and compare the clinical data, treatment methods, and outcomes of patients with esophageal perforation according to the patients’ systemic condition (shock, systemic inflammatory response syndrome (SIRS), or non-SIRS) on arrival to the hospital. Methods: Twelve patients were treated for an esophageal perforation between 2004 and 2013. Based on the patients’ pretreatment status, the patients were divided into three groups (shock, SIRS, and non-SIRS groups), and their clinical findings, treatment methods, and outcomes were compared. Results: The numbers of patients in the shock, SIRS, and non-SIRS groups were three, three, and six, respectively. There was a difference in etiologies among the three groups as follows: two patients with spontaneous rupture were in the shock group, two patients with tumor perforation were in the SIRS group, four patients with foreign body were in the non-SIRS group, and patients with iatrogenic causes were included in all groups. The treatment procedures included conservative therapy in 4 non-SIRS patients, primary surgical repair in 4 patients (2 SIRS, 2 non-SIRS), resection in one SIRS patient, and conservative treatment with minor surgical approaches or stenting in 3 shock patients. The mortality rate was 0 %. Conclusion: Tailoring the treatment strategy to the systemic condition of patients with esophageal perforation is important. In particular, patients with shock should be treated conservatively with minor surgical approaches, including temporary stent insertion.

DOI： 10.1007/s10388-015-0504-6

Mizuma K., Amitani M., Mizuma M., Kawazu S., Sloan R.A., Ibusuki R., Takezaki T., Owaki T. . Clarifying differences in viewpoints between multiple healthcare professionals during discharge planning assessments when discharging patients from a long-term care hospital to home . Evaluation and Program Planning 2020年10月 Evaluation and Program Planning

記述言語：日本語

Comprehensive discharge planning provided by interprofessional collaboration is critical for discharging patients from hospitals to home. For effective interprofessional discharge planning, the evaluation that clarifies the differences in assessment viewpoints between various healthcare professionals is needed. This study aimed to clarify the assessment viewpoints of multiple healthcare professional groups when discharging patients from a long-term care hospital (LTCH) to home. We reviewed 102 medical records from an LTCH in Japan, extracted descriptions of discharge planning assessments written by 3 doctors, 13 nurses, 3 physical therapists, 13 care workers, and 2 social workers, linked these to the International Classification of Functioning, Disability and Health, and conducted the statistical analysis. Doctors and nurses significantly focused on “Body Functions”. Physical therapists and care workers significantly focused on “Activities and Participation”. Social workers significantly focused on “Environmental Factors”. We also identified the factors less or missing from assessments in the clinical field of the LTCH. Our findings could be contributed as a base of knowledge to foster a better understanding of different healthcare professionals’ assessment viewpoints. The further development of comprehensive discharge planning assessment tools, service programs, and research on discharge planning methods that could contribute to effective interprofessional discharge planning is needed.

DOI： 10.1016/j.evalprogplan.2020.101848

Setoyama T., Natsugoe S., Okumura H., Matsumoto M., Uchikado Y., Ishigami S., Owaki T., Hanazono K., Aikou T. . Circulating tumor cells in blood of esophageal squamous cell carcinoma . Esophagus 2007年3月 Esophagus

有上貴明, 石神純也, 夏越祥次, 奥村浩, 松本正隆, 大脇哲洋, 中野静雄, 高尾尊身, 愛甲孝 . CCR7陽性食道癌の臨床病理学的特徴と臨床的意義 . 日本消化器外科学会雑誌 2003年7月一般社団法人日本消化器外科学会

根路銘安仁, 大脇哲洋, 桑原和代, 新村英士, 嶽崎俊郎 . 鹿児島県における地域枠医学生のキャリア計画時の問題点 . 医学教育 2013年日本医学教育学会

記述言語：日本語

医学部入学定員は平成19年より急速に増加しており多くを地域枠学生が占めている．過去の調査で「医師不足地域での従事」において，専門医取得は大きな要素であった．鹿児島県の地域枠は全国よりも3年間早く開始され来年度から後期研修が開始される．彼らが専門医も取得可能なキャリア計画を提示することは喫緊の課題であり現在の制度情報を元に検討した結果，専門医の取得が困難であった．本問題は鹿児島県だけの問題でなく，数年後全国の医学部の卒業生の約2割が地域枠学生であることを考えると全国的な問題であり，彼らが専門医取得困難である現状は改善しなければならない．そのためには，各方面からの取り組みが必要である．

DOI： 10.11307/mededjapan.44.461

Setoyama T., Natsugoe S., Okumura H., Matsumoto M., Uchikado Y., Ishigami S., Owaki T., Takao S., Aikou T. . Carcinoembryonic antigen messenger RNA expression in blood predicts recurrence in esophageal cancer . Clinical Cancer Research 2006年10月 Clinical Cancer Research

記述言語：日本語

Purpose: The clinical significance of isolated tumor cells (ITC) in blood has not been clearly established, particularly during follow-up in cancer patients. We conducted a longitudinal analysis of the relationship between ITC in blood during follow-up and clinicopathologic findings in patients with esophageal squamous cell carcinoma. Experimental Design: Blood samples obtained from 106 patients were examined by real-time RT-PCR assay targeting carcinoembryonic antigen (CEA) mRNA. Follow-up examination every 3 months after surgery included testing for CEA mRNA and tumor markers, as well as imaging. Results: Thirty-nine (36.8%) patients were positive for CEA mRNA expression. CEA mRNA positivity significantly correlated with tumor depth, lymph node metastasis, stage, and venous invasion. Recurrent disease was found in 34 of 106 (32.1%) cases. CEA mRNA was found in 28 (76.5%) patients experiencing relapse. Of these 28 patients, the number positive of CEA mRNA before detection by imaging, at the same time of detection by imaging, and after detection by imaging was 18 (52.9%), 8 (23.5%), and 2 (5.9%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for CEA mRNA were higher than those for serum CEA or squamous cell carcinoma. Patients positive for CEA mRNA experienced significantly shorter disease-free interval than those with negative CEA mRNA (P < 0.001). According to multivariate analysis, CEA mRNA positivity was an independent factor for disease-free interval. Conclusions: Examination of CEA mRNA in peripheral blood during follow-up is useful for early detection of occult recurrence. We believe that CEA mRNA in blood will be a new marker for recurrence in esophageal squamous cell carcinoma. © 2006 American Association for Cancer Research.

DOI： 10.1158/1078-0432.CCR-06-0637

Ishigami S., Arigami T., Uenosono Y., Matsumoto M., Okumura H., Uchikado Y., Kita Y., Nishizono Y., Maemura K., Kijima Y., Nakajo A., Owaki T., Ueno S., Hokita S., Natsugoe S. . Cancerous HLA class I expression and regulatory T cell infiltration in gastric cancer . Cancer Immunology, Immunotherapy 2012年10月 Cancer Immunology, Immunotherapy

記述言語：日本語

Background Since antitumor immune reactions between tumors and intratumoral immunocytes have been verified in several human tumors, immunological therapeutic strategies must be considered to obtain the proper efficacy of tumor shrinkage under these conditions. Human leukocyte antigen (HLA) class I expression in cancer cells and degree of infiltration of regulatory T cells (Tregs) in the stroma have been regarded as important markers of antitumor immune reactions in the context of independent immunological mechanisms. In the current study, we investigated HLA class I expression and Treg cells infiltration in gastric cancer and discussed the clinical implications of this combinatory analysis in gastric cancer. Patients and methods A total of 141 gastric cancer patients who received R0 gastrectomy at Kagoshima University Hospital were studied. Immunohistochemically, in 141 gastric cancer patients, HLA class I expression and Treg cell infiltration in cancerous tissue were evaluated using HLA class I (EMR8-5) and forkhead box p3 (FOXP3) monoclonal antibodies. The correlation between clinical factors and tumor-infiltrating Treg cells was analyzed. Results HLA class I expression was positively associated with depth of tumor invasion (P\0.05). Infiltration of Foxp3-positive cells did not correlate with any clinicopathological markers. HLA class I expression had no association with Treg cell infiltration (r = 0.04). A better postoperative outcome was associated with fewer numbers of Treg infiltration (P = 0.034). A combination of HLA and Treg analysis may lead to a more accurate prediction of postoperative outcome (P = 0.02). Conclusions Two different antitumor immunological markers, Treg infiltration and HLA class I expression, affected clinicopathological factors in gastric cancer by different mechanisms. Thus, an immunological combination of HLA class I expression and Treg cell infiltration may more accurately predict postoperative outcome. Immunological balance needs to be restored after evaluation of each immunological deficit in gastric cancer. © Springer-Verlag 2012.

DOI： 10.1007/s00262-012-1225-5

Kijima Y., Yoshinaka H., Owaki T., Nozaki T., Hamada T., Yasumoto Y., Aikou T. . Breast cancer with nephrotic syndrome: Report of two cases . Surgery Today 2004年9月 Surgery Today

記述言語：日本語

We report two cases of women found to have breast cancers within a few months of being diagnosed with nephrotic syndrome. Case 1 was a 53-year-old Japanese woman in whom breast cancer was diagnosed 14 months after the onset of nephrotic syndrome. The histological diagnosis was invasive ductal carcinoma with no lymph node metastasis. We performed a modified radical mastectomy, after which the proteinuria and hypoproteinemia resolved almost completely, and the patient has been disease-free for 5 years since. Case 2 was a 61-year-old Japanese woman in whom breast cancer was diagnosed 2 months after the onset of membranous nephropathy. We performed a modified radical mastectomy and the histological diagnosis was invasive ductal carcinoma with marked lymphatic vessel permeation and involvement of five axillary lymph nodes. Proteinuria and hypoproteinemia did not resolve post-operatively and there is a high possibility of remnant or recurrent cancer. To our knowledge, there are only four other reported cases of paraneoplastic membranous nephropathy complicating breast cancer. However, we speculate that the postoperative resolution of nephrotic syndrome might be a measure of cancer control.

DOI： 10.1007/s00595-004-2811-8

KIJIMA YUKO, YOSHINAKA HEIJI, OWAKI TETSUHIRO, NOZAKI TSUYOSHI, HAMADA TOSHIO, YASUMOTO YUICHIRO, AIKOU TAKASHI . Breast Cancer with Nephrotic Syndrome : Report of Two Cases . Surgery Today 2004年9月

Shinden Y, Saho H, Nomoto Y, Nagata A, Minami K, Nakajo A, Akahane T, Hiraki T, Tanimoto A, Owaki T, Kijima Y, Natsugoe S . Breast cancer with an intraductal component that was proven genetically to be metastasis of contralateral breast cancer: a case report. . Surgical case reports 2020年8月

Okumura H., Uchikado Y., Setoyama T., Matsumoto M., Owaki T., Ishigami S., Natsugoe S. . Biomarkers for predicting the response of esophageal squamous cell carcinoma to neoadjuvant chemoradiation therapy . Surgery Today 2014年3月 Surgery Today

記述言語：日本語

This review summarizes and evaluates the literature regarding the biomarkers for predicting the response and/or prognosis of esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiation therapy (CRT). There are seven categories of molecules known to correlate with the response and/or prognosis: tumor suppressors (p53, p21), cell cycle regulators (Cyclin D1, CDC25B, 14-3-3sigma), DNA repair molecules (p53R2, ERCC1), drug resistance proteins [metallothionein (MT)], angiogenic factors (VEGF), molecules involved in cell proliferation/invasion/metastasis (Ki-67, COX-2) and hedgehog signaling molecules (Gli-1). Of the above molecules, the tumor suppressor p53 is expected to be a representative biomarker for predicting the response and prognosis. The cell cycle markers CDC25B and 14-3-3sigma have potential as response biomarkers independent of the p53 status. The DNA repair markers, p53R2 or ERCC1, angiogenic molecule (VEGF), and hedgehog signaling pathway factor Gli-1 also have potential to predict the response and prognosis of ESCC. However, there are still many unanswered questions with regard to predicting the clinical effects of neoadjuvant CRT. © 2013 Springer Japan.

DOI： 10.1007/s00595-013-0580-y

Kheradmand M., Niimura H., Kuwabara K., Nakahata N., Nakamura A., Ogawa S., Mantjoro E.M., Shimatani K., Nerome Y., Owaki T., Kusano K., Takezaki T. . Association of inflammatory gene polymorphisms and conventional risk factors with arterial stiffness by age . Ｊｏｕｒｎａｌ　ｏｆ　Ｅｐｉｄｅｍｉｏｌｏｇｙ 2013年日本疫学会

記述言語：英語

Background: Inflammatory gene polymorphisms are potentially associated with atherosclerosis risk, but their age- related effects are unclear. To investigate the age-related effects of inflammatory gene polymorphisms on arterial stiffness, we conducted cross-sectional and 5-year follow-up studies using the cardio-ankle vascular index (CAVI) as a surrogate marker of arterial stiffness. Methods: We recruited 1850 adults aged 34 to 69 years from the Japanese general population. Inflammatory gene polymorphisms were selected from NF-kB1, CD14, IL-6, IL-10, MCP-1, ICAM-1, and TNF-a. Associations of CAVI with genetic and conventional risk factors were estimated by sex and age group (34-49, 50-59, and 60-69 years) using a general linear model. The association with 5-year change in CAVI was examined longitudinally. Results: Glucose intolerance was associated with high CAVI among women in all age groups, while hypertension was associated with high CAVI among participants in all age groups, except younger women. Mean CAVI for the CD14 CC genotype was lower than those for the TT and CT genotypes (P for trend = 0.005), while the CD14 polymorphism was associated with CAVI only among men aged 34 to 49 years (P = 0.006). No association of the other 6 polymorphisms with CAVI was observed. No association with 5-year change in CAVI was apparent. Conclusions: Inflammatory gene polymorphisms were not associated with arterial stiffness. To confirm these results, further large-scale prospective studies are warranted. © 2013 Motahare Kheradmand et al.

DOI： 10.2188/jea.je20130054

Desaki R., Sawada G., Okumura H., Ikeda R., Tanabe K., Komatsu H., Mimori K., Mori M., Kita Y., Uchikado Y., Arigami T., Uenosono Y., Owaki T., Ishigami S., Natsugoe S. . As a Novel Prognostic Marker, Cysteine/histidine-rich 1 (CYHR1) is a Therapeutic Target in Patients with Esophageal Squamous Cell Carcinoma . Annals of Surgical Oncology 2017年2月 Annals of Surgical Oncology

記述言語：日本語

Background: Cysteine/histidine-rich 1 (CYHR1) was first discovered in a yeast two-hybrid screen with murine galectin-3, and no previous reports have described a relationship between the CYHR1 gene and human cancer. The current study evaluated the role and significance of CYHR1 in esophageal cancer. Methods: The human esophageal squamous cell carcinoma (ESCC) cell line TE-8 and the CYHR1 knock-down cell line TE-8/small interfering (si)-CYHR1 were used for in vitro and in vivo assays. For clinical study, ESCC tissues (n = 104) were used. Results: Compared with parental cells, TE-8/si-CYHR1 cells had suppressed proliferation and invasion activities. In the in vivo assay, the tumors from TE-8 cells treated with si-CYHR1 had abrogated tumorigenicity. In the clinical study, the expression of CYHR1 mRNA was associated with lymph node metastasis and stage and shown to be an independent prognostic factor. Conclusions: As the findings show, CYHR1 may represent not only a valuable prognostic marker but also a therapeutic target for ESCC patients.

DOI： 10.1245/s10434-015-5031-0

Amitani M., Amitani H., Suzuki H., Kawazu S., Mizuma K., Yamaguchi K., Oki T., Nitta H., Sonoda T., Kawano K., Tanaka Y., Uto N., Ibusuki R., Arita R., Takayama S., Mitsuma T., Takezaki T., Asakawa A., Owaki T. . Application of objective structured clinical examination (OSCE) for the evaluation of Kampo medicine training . BMC Medical Education 2022年12月 BMC Medical Education

記述言語：日本語

Background: The purpose of this study was to develop an objective, content-valid, and reliable assessment method for Kampo medicine using an objective structured clinical examination (OSCE) for the assessment of clinical competence in Kampo medicine. Methods: We developed a blueprint followed by a list of 47 assessment items and three task scenarios related to clinical competence in Kampo medicine. An eight-member test committee checked the relevance of the assessment items on a Likert scale. We calculated a content validity index and content validity ratio, and used the Angoff method to set the passing threshold. We trained a total of nine simulated patients with three assigned to each scenario. We conducted an OSCE for 11 candidates with varying medical abilities, and conducted three stations per person, which were evaluated by one evaluator in one room by direct observation. We used video recordings to test the inter-rater reliability of the three raters. We used the test results to verify the reliability of the assessment chart. Results: The inter-rater reliability (intraclass correlation coefficient [2,1]) was 0.973. The reliability of the assessment chart for each scenario (Cronbach’s α) was 0.86, 0.89, and 0.85 for Scenarios 1, 2, and 3, respectively. The reliability of the assessment chart for the whole OSCE (Cronbach’s α) was 0.90. Conclusions: We developed a content-valid new OSCE assessment method for Kampo medicine and obtained high inter-rater and test reliabilities. Our findings suggest that this is one of the most reliable evaluation methods for assessing clinical competence in Kampo medicine.

DOI： 10.1186/s12909-022-03264-3

Arigami T., Okumura H., Matsumoto M., Uchikado Y., Uenosono Y., Kita Y., Owaki T., Mori S., Kurahara H., Kijima Y., Ishigami S., Natsugoe S. . Analysis of the fibrinogen and neutrophil-lymphocyte ratio in esophageal squamous cell carcinoma . Medicine (United States) 2015年10月 Medicine (United States)

記述言語：日本語

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive malignancies in gastrointestinal tract cancers and even patients with early ESCC have a high metastatic potential. Difficulties are associated with clinically predicting tumor progression and prognosis based on conventional tumor markers determined from preoperative blood examinations. The aim of the present study was to measure plasma fibrinogen levels and the neutrophil-lymphocyte ratio (NLR) in blood and compare the clinical impacts of their combined values (fibrinogen and neutrophil-lymphocyte ratio score-F-NLR score) and the modified Glasgow Prognostic Score (mGPS) in patients with ESCC. We classified 238 patients with ESCC based on cut-off values for hyperfibrinogenemia (400 mg/dL) and high NLR (3.0) as F-NLR scores of 2 (both of these hematological abnormalities), 1 (one of these abnormalities), or 0 (neither abnormality). We also categorized patients based on cut-off values for high C-reactive protein (CRP) (0.5 mg/dL) and hypoalbuminemia (3.8 g/dL) as mGPS of 2 (elevated CRP and hypoalbuminemia), 1 (either elevated CRP or hypoalbuminemia), or 0 (neither elevated CRP nor hypoalbuminemia). The F-NLR score correlated with the depth of tumor invasion, lymph node metastasis, lymphovascular invasion, tumor size, and stage (all P0.05). Prognoses among the groups based on the F-NLR score and mGPS significantly differed (all P0.001). A multivariate analysis identified the depth of tumor invasion, lymph node metastasis, and FNLR score as independent prognostic factors (P=0.002, P=0.007, and P=0.037, respectively). The results of the present study showed that the F-NLR score is a promising blood predictor for tumor progression and outcomes in patients with ESCC.

DOI： 10.1097/MD.0000000000001702

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