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991.
Yukio Tsugihashi MD MPH Naoki Kakudate DDS PhD MPH Yoko Yokoyama MPH PhD Yosuke Yamamoto MD PhD Hiroki Mishina MD MPH Norio Fukumori MD Fumiaki Nakamura MD Misa Takegami RN MPH PhD Shinya Ohno MPH Takafumi Wakita MA Kazuhiro Watanabe PhD Takuhiro Yamaguchi PhD Shunichi Fukuhara MD DMSc FACP 《Journal of evaluation in clinical practice》2013,19(2):250-255
Rationale, aims and objectives We developed a novel Internet‐based blended learning programme that allows busy health care professionals to attain core competency in clinical research. This study details the educational strategies and learning outcomes of the programme. Method This study was conducted at Kyoto University and seven satellite campuses from September 2009 to March 2010. A total of 176 health care professionals who had never attempted to attain core competency in clinical research were enrolled. The participants were supplied with a novel programme comprising the following four strategies: online live lectures at seven satellite campuses, short examinations after each lecture, an Internet‐based feedback system and an end‐of‐course examination. We assessed the proportion of attendance at the lectures as the main outcome. In addition, we evaluated interaction via the feedback system and scores for end‐of‐course examination. Results Of the 176 participants, 134 (76%) reported working more than 40 hours per week. The mean proportion of attendance over all 23 lectures was 82%. A total of 156 (89%) participants attended more than 60% of all lectures and were eligible for the end‐of‐course examination. A total of the participants accessed the feedback system 3564 times and asked 284 questions. No statistically significant differences were noted in the end‐of‐course scores among medical doctors, pharmacists, registered nurses and other occupations. Conclusions We developed an Internet‐based blended learning programme providing core competency in clinical research. Most busy health care professionals completed the programme successfully. In addition, the participants could attain the core competency effectively, regardless of their occupation. 相似文献
992.
993.
Jumpei Akahane Atsuhito Ushiki Makoto Kosaka Yuichi Ikuyama Akemi Matsuo Tsutomu Hachiya Fumiaki Yoshiike Shigeru Koyama Masayuki Hanaoka 《Journal of infection and chemotherapy》2021,27(5):707-714
IntroductionThere is an increasing incidence of Pneumocystis pneumonia (PcP) among individuals without human immunodeficiency virus (HIV) infection (non-HIV PcP). However, prognostic factors for patients with non-HIV PcP have not been identified. Moreover, A-DROP (for classifying the severity of community-acquired pneumonia) or the blood urea nitrogen-to-serum albumin ratio (BUN/Alb), which is reported to be a predictor of mortality of community-acquired pneumonia, has not been established as an efficient prognostic factor in patients with non-HIV PcP. In this study, we analyzed the prognostic factors for non-HIV PcP and evaluated the prognostic ability of A-DROP and the BUN/Alb ratio.MethodsThis retrospective study involved a chart review of the medical records of 102 patients diagnosed with non-HIV PcP between January 2003 and May 2019 at five medical facilities.ResultsOverall, 102 patients were involved in this study. The 30-day mortality rate for non-HIV PcP was 20.5% in this study population. Compared with survivors, non-survivors had significantly lower serum albumin levels and significantly higher age, corticosteroid dosage at the PcP onset, alveolar–arterial oxygen gradient, A-DROP score, lactate dehydrogenase levels, blood urea nitrogen levels, and BUN/Alb ratio. Multivariate analysis showed that a high BUN/Alb ratio at treatment initiation was significantly associated with 30-day mortality risk. The receiver operating characteristic curves showed that A-DROP score had the highest prognostic ability in estimating 30-day mortality.ConclusionsIn patients with non-HIV PcP, a high BUN/Alb ratio is an independent prognostic predictor of mortality risk, and A-DROP is useful for classifying the severity. 相似文献
994.
Matsushita T Hasegawa M Shirasaki F Fujimoto M Yamazaki H Sato S Takehara K 《Dermatology (Basel, Switzerland)》2008,216(1):64-67
Graft-versus-host disease (GVHD) is a frequent complication occurring after allogenic hematopoietic stem cell transplantation and is divided into acute and chronic type. Cutaneous involvement is the most frequent manifestation of acute GVHD, with maculopapular exanthema and perifollicular papular lesions. We describe the first case to develop acute cutaneous GVHD mimicking psoriasis vulgaris shortly after allogenic peripheral blood stem cell transplantation. The patient's rash resembled psoriasis vulgaris and showed histologic features of both psoriasis and acute GVHD. Despite various immunosuppressant therapies, the skin lesion was drug-resistant. Therefore, we administered psoralen-UVA (PUVA) therapy and achieved the desired therapeutic effect. As far as we know, this is the first case of psoriasiform skin eruption as a manifestation of acute GVHD. 相似文献
995.
Shinwa Tanaka Takashi Toyonaga Yoshiko Ohara Tetsuya Yoshizaki Fumiaki Kawara Tsukasa Ishida Namiko Hoshi Yoshinori Morita Takeshi Azuma 《World journal of gastroenterology : WJG》2015,21(10):3121-3126
Endoscopic submucosal dissection(ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms.The rate of adverse events,such as perforation,has been decreasing with the improvement of devices and techniques.In this paper,we report a case of esophageal cancer that had a diverticulum under cancerous epithelium.The diverticulum was not detected during preoperative examination,and led to perforation during the ESD procedure.Our case shows that,although rare,some diverticula can exist underneath the mucosal surface without obvious depression.If there is any sign of hidden diverticula during ESD,surgeons should proceed with caution or,depending on the case,the procedure should be discontinued to avoid adverse events. 相似文献
996.
Kazuto Tsuboi Nobuo Omura Fumiaki Yano Masato Hoshino Se-Ryung Yamamoto Shunsuke Akimoto Takahiro Masuda Hideyuki Kashiwagi Katsuhiko Yanaga 《World journal of gastroenterology : WJG》2015,21(38):10830-10839
In general,the treatment methods for esophageal achalasia are largely classified into four groups,including drug therapy using nitrite or a calcium channel blocker,botulinum toxin injection,endoscopic therapy such as endoscopic balloon dilation,and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913,but the most common approach has changed from openchest surgery to laparoscopic surgery. Currently,the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy,to thoracoscopic surgery,and to laparoscopic surgery,the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux,but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently,a new endoscopic approach,peroral endoscopic myotomy(POEM),has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia. 相似文献
997.
998.
Cyclin D1 plays important roles in esophageal squamous cell carcinoma (ESCC) cases by amplification of the 11q13.3 locus. FBXO31 is a subunit of the SCF ubiquitin ligase, which targets cyclin D1 for degradation. In this study, we clarified the clinical significance of FBXO31 and characterized the association between cyclin D1 and FBXO31 in ESCC cases. Total RNA was extracted from tumor tissues obtained from 68 ESCC patients who underwent surgical resection. FBXO31 expression levels were determined by quantitative RT-PCR, and both FBXO31 and cyclin D1 protein expression and localization were evaluated by immunohistochemistry (IHC). Furthermore, using CGH and gene expression array data of another subset, we validated the association between cyclin D1 genomic amplification and FBXO31 expression levels. Higher FBXO31 expression levels significantly correlated with depth of tumor invasion and clinical stage (P<0.05). In addition, the FBXO31 high expression group showed a significantly poorer prognosis than the low expression group (P<0.001). Multivariate analysis indicated that FBXO31 expression was an independent prognostic factor [relative risk (RR): 1.79, confidence interval (CI): 1.14-3.01, P=0.01]. Using IHC, concordant expression was observed between cyclin D1 and FBXO31 in the nucleus and cytoplasm, respectively. CGH array indicated that cases having cyclin D1 with increased copy number were significantly associated with elevated FBXO31 expression levels (P<0.05). FBXO31 could be a novel and robust prognostic marker for ESCC. 相似文献
999.
We describe a 19-year-old woman with onset of epileptic seizure, and a small mural nodule and multicystic lesions with severe
brain edema located in the right frontal lobe. At surgery, the tumor and a clear margin was removed, and symptoms improved
postoperatively. Extended local radiotherapy (60 Gy) was performed. Histopathological examination revealed oligodendroglioma-like
tumor cells with a perinuclear halo. The tumor cells extended processes toward CD34-positive proliferating vessels, which
resemble a basement membrane. These proliferating vessels formed a tumor membrane so that there was a clear margin between
the tumor and brain tissue. Tumor cells were positive for epithelial membrane antigen in a dot-like pattern. MIB-1 staining
index was 50.6%. Electron microscopy showed cilia and zipper-like junctions, and anaplastic clear-cell ependymoma grade III
was diagnosed. A characteristic of the case was formation of a tumor membrane by proliferating tumor blood vessels. Fluorescence
in situ hybridization showed 1p/19q deletions, and the concentration of erythropoietin in the cyst fluid was abnormally high,
at 1,859.4 mIU/ml. Erythropoietin and erythropoietin receptors were verified with immunohistochemical staining. 相似文献
1000.
Tadao Okada Fumiaki Sasaki Kazutosi Cho Tomoo Itoh Satoru Todo 《Journal of pediatric surgery》2010,45(6):e11
Localized myopathy of the muscular layers may be an important factor contributing to segmental dilatation of the intestine (SDI). Only one report has described SDI of the jejunum in a neonate showing no abnormality of the interstitial cells of Cajal (ICC). The present report describes the very rare case of a neonatal girl with segmental dilatation of the distal duodenum and proximal jejunum with irregular arrangements of Auerbach's plexus and ICC and the successful surgical treatment of SDI. We review the literature on this type of relationship between abnormality of ICC and SDI and discuss the clinical features of this complication. Furthermore, the possible neuropathic cause of SDI complicated with disorders of ICC was explored in this report. 相似文献