研究者詳細 - 津川　毅

論文 - 津川　毅

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原因不明の小児急性肝炎に関する実態調査(一次調査)報告書

近藤宏樹, 多屋馨子, 天羽清子, 乾あやの, 笠原群生, 鈴木光幸, 田中孝明, 津川毅, 別所一彦, 保科隆之, 宮入烈, 虫明聡太郎, 吉川哲史, 齋藤昭彦, 塚原宏一, 森岡一朗, 須磨崎亮, 細矢光亮, 日本小児科学会予防接種・感染症対策委員会原因不明の小児の急性肝炎対策ワーキンググループ

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 127 ( 7 ) 1033 - 1038 2023年07月

2022年より欧米から「原因不明の小児急性肝炎」について多くの報告があがるようになり、アデノウイルスや新型コロナウイルス感染症(COVID-19)流行との関連が疑われている。これまで本邦では小児の急性肝炎のサーベイランスが行われていないことから、今回、日本小児科学会会員が所属する全国の病院小児科責任者を対象に、2017年1月～2022年6月までの期間における同疾患の実態について質問紙調査を行い、947名より回答を得た。その結果、COVID-19流行前の報告数は2017年260名、2018年257名、2019年243名で、COVID-19流行中の報告数は2020年164名、2021年192名、2022年1～6月で113名と、COVID-19流行中の方が少ない傾向がみられた。COVID-19流行前は0歳および1～4歳群の症例数が他の年齢群と比較して多い傾向がみられたが、流行中はこれらの年齢群で減少が著明であった。地域別では、COVID-19流行前・流行後ともに、京都府・愛知県・福島県からの報告が多かった。

小児科医に潜在するワクチン忌避(Vaccine Hesitancy)に対する教育プログラム

勝田友博, 天羽清子, 荒木かほる, 石和田稔彦, 大宜見力, 神谷元, 越田理恵, 高野智子, 津川毅, 富樫篤生, 中野貴司, 西村直子, 野崎昌俊, 菱木はるか, 保科隆之, 細矢光亮, 前田明彦, 水野由美, 宮入烈, 宮崎雅仁, 吉川哲史, 和田泰三, 岩田敏, 尾内一信, 岡田賢司, 岡部信彦, 是松聖悟, 清水直樹, 菅秀, 宮崎千明, 森内浩幸, 大城誠, 藤岡雅司, 森岡一朗, 塚原宏一, 齋藤昭彦, 多屋馨子, 日本小児科学会予防接種・感染症対策委員会

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 127 ( 5 ) 787 - 794 2023年05月

予防接種後有害事象(AEFI)および予防接種ストレス関連反応(ISRR)に関連する動画講義視聴が小児科医の予防接種に対する知識、態度、自信、役割認識、自己効力感、行動に与える影響を調査した。介入前評価(pre study)に回答した日本小児科学会会員368名をA群とB群に分けてA群にのみオンラインでISRRに関する約20分間の動画講義を配布し、pre studyから約1ヵ月後にA群・B群に介入後評価(Post study)を行った。Post studyの回答者A群74名、B群95名を対象に動画講義視聴による介入効果について検討した。その結果、AEFIおよびISRRに関連する調査によってA群・B群の知識レベルが向上したが、予防接種に対する態度、自信、役割認識、自己効力感、実際の接種行動に与える影響は限定的であった。

交通外傷を契機に発症した甲状腺クリーゼの女児例

下村遼太郎, 石井玲, 高尾魁, 萩原絢哉, 北田文華, 千葉充将, 津川毅

臨床小児医学 ( (財)小児愛育協会 ) 70 ( 1-6 ) 51 - 56 2023年03月 [査読有り]

担当区分：最終著者

甲状腺クリーゼ(thyroid storm;TS)は,何らかの誘因によりコントロール不良の甲状腺中毒症が増悪し,甲状腺ホルモン過剰への代償不全から多臓器不全に至る病態である。致死率は10%を超え,早期の介入が求められる。誘因として抗甲状腺薬のアドヒアランス不良,感染症,手術や外傷などのストレスがあるが,交通外傷に続発した報告は少ない。今回,われわれは交通外傷を契機に発症したTSの女児例を経験した。症例は13歳女児,交通外傷で当院救急部へ搬送され,顔面頸部を含む多発骨折に対して緊急手術を実施された。搬入時から発熱,頻脈を認めていたが,術後も持続し不穏状態も遷延した。入院9日目,FT4 5.82ng/dL,TSH<0.01μIU/mLが判明し,当科へコンサルトされた。未受診のBasedow病を背景としたTSの診断に至り,治療を開始し速やかに症状の改善を得た。交通外傷後の発熱や頻脈,意識障害の鑑別は多岐にわたるが,TSは予後も考慮し早期に鑑別にあげる必要がある。(著者抄録)

高クレアチンキナーゼ血症から偶発的に診断されたベッカー型7例を含む筋ジストロフィー9例の臨床的検討

伊藤拓郎, 福村忍, 土田晃輔, 山本晃代, 津川毅, 安藤悠開, 下村遼太郎, 飯塚裕典, 星野恵美子, 櫻井のどか, 平川賢史, 布施茂登, 森俊彦

臨床小児医学 ( (財)小児愛育協会 ) 70 ( 1-6 ) 15 - 19 2023年03月 [査読有り]

筋ジストロフィー(muscular dystrophy;MD)は,偶発的に高クレアチンキナーゼ(creatine kinase;CK)血症でみつかることがある。今回,明らかな運動発達遅滞がなく偶発的に高CK血症でMDと診断された9例について後方視的に検討した。性別は全例男性であり,診断名は8例がジストロフィン異常症(ベッカー型7例,中間型1例),1例がカルパイン異常症であった。また,9例中5例の患者で家族から運動の苦手さを指摘されていなかった。発見時CKは,中央値15,489.5U/L(499～30,480U/L)だった。うちベッカー型MDの1例はCKの中央値が1,589U/L(56～3,122U/L)で,非感染時の採血でCK値が正常化していた。4例がDMD遺伝子MLPA(multiplex ligation-dependent probe amplification)法で変異がみつからず,筋生検で診断された。本人への告知は4例に行い,2例が12歳,2例が15歳時だった。全例告知後の受け入れは良好だった。本人への告知の時期は中学生頃を目処に,児の理解力と家族の支援体制を総合的に考慮して行う必要がある。(著者抄録)

Bacillus Calmette-Guérin-induced lupus vulgaris in a patient with Mendelian susceptibility to mycobacterial disease caused by a novel STAT1 variation.

Aika Shionoya, Yuko Yoto, Tokimasa Hida, Aki Ishikawa, Tadashi Hasegawa, Takeshi Tsugawa, Hisashi Uhara

The British journal of dermatology 188 ( 1 ) 142 - 143 2023年01月 [査読有り] [国際誌]

DOI PubMed

Parental Decision-Making in Cancer Therapy: A Long-Term Observational Study.

Ryoko Michinobu, Masaki Yamamoto, Yoshiyuki Sakai, Takahiro Mikami, Keita Igarashi, Kotoe Iesato, Akira Takebayashi, Tsukasa Hori, Hiroyuki Tsutsumi, Takeshi Tsugawa

Clinical pediatrics 62 ( 9 ) 99228221150606 - 99228221150606 2023年01月 [査読有り] [国際誌]

担当区分：最終著者

Parental participation in shared decision-making in children's cancer therapy is essential because parents advocate for and support their children's wishes. However, little research has focused on this issue. We conducted a longitudinal observational study of 7 parents whose child had received their first cancer treatment. We recorded parents' behaviors, interactions, and narratives in 1 pediatric ward and 2 outpatient clinics. The recordings were systematically conducted and thematically analyzed using variable-oriented and process-oriented modes to assess the causal relationships among phenomena. We found 4 themes describing the processes by which parents developed and participated in shared decision-making. The first 2 themes reflected the development of reciprocal parental relationships and parent-other child relationships. These 2 types of relationship generated mutual trust and a sense of solidarity among parents (the third theme). This, in turn, became the foundation for parents to share decision-making with health care professionals (the fourth theme).

DOI PubMed

Sequence analysis of a feline- and porcine-origin G3P[9] rotavirus A strain in a child with acute gastroenteritis in Japan.

Yuya Fukuda, Kaoru Araki, Megumi Hara, Yuji Yamashita, Shuhei Adachi, Saho Honjo, Atsuo Togashi, Satoshi Hirakawa, Shinobu Fukumura, Masaki Yamamoto, Takeshi Tsugawa

Archives of virology 168 ( 2 ) 45 - 45 2023年01月 [査読有り] [国際誌]

担当区分：最終著者 , 責任著者

We isolated the rare G3P[9] rotavirus strain RVA/Human-wt/JPN/R11-035/2015/G3P[9] from a 2-year-old girl presenting with vomiting and diarrhea who had daily contact with cats in Japan, 2015. Full-genome analysis revealed that the R11-035 strain had an AU-1-like genetic constellation, except for the NSP3 (T) gene: G3-P[9]-I3-R3-C3-M3-A3-N3-T1-E3-H6. Phylogenetic analysis showed that strain R11-035 is closely related to human/feline-like human strains, and only the NSP3 (T1) gene was clustered together with Taiwanese porcine strains. We postulate that the R11-035 strain was directly transmitted from a cat to the patient and acquired its NSP3 gene through intergenotype reassortment with porcine strains before being transmitted to humans.

DOI PubMed

データベースを用いた国内小児新型コロナウイルス感染症の臨床症状に関する評価

勝田友博, 清水直樹, 神谷元, 天羽清子, 大城誠, 菅秀, 津川毅, 西村直子, 菱木はるか, 藤岡雅司, 細矢光亮, 水野由美, 吉川哲史, 和田泰三, 石和田稔彦, 是松聖悟, 中野貴司, 宮入烈, 尾内一信, 齋藤昭彦, 森内浩幸, 多屋馨子, 日本小児科学会予防接種・感染症対策委員会

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 127 ( 1 ) 79 - 83 2023年01月

2020年2月～2022年4月に専用データベースに報告された小児コロナウイルス感染症2019患者のうち、0～15歳の5411例(男児2889例、女児2522例)の急性期における臨床的特徴を解析した。オミクロン株流行により感染経路は家庭内感染から学校・幼稚園・保育所へ変化した。オミクロン株流行期に初発症状でけいれん発作を起こした割合は1～4歳で13.4%、5～11歳で7.4%、オミクロン株流行期に初発症状で悪心・嘔吐を認めた割合は1～4歳で12.2%、5～11歳で22.6%、12～15歳で14.6%であり、いずれもデルタ株流行前またはデルタ株流行期と比較して大幅に増加した。最終的に全体の約2%にけいれんを伴う合併症が報告された。肺炎の合併率は変異株の違いによる変化をほとんど認めなかった。発症後28日を超えた症例報告書が提出された1697例(男児899例、女児798例、年齢中央値6.3歳)のうち、55例(3.2%)に発症後28日を超えても何らかの症状が残存した。

コロナウイルス感染症2019流行下における国内小児医療の現状に関する調査

中村幸嗣, 勝田友博, 清水直樹, 神谷元, 天羽清子, 大城誠, 菅秀, 津川毅, 西村直子, 菱木はるか, 藤岡雅司, 細矢光亮, 水野由美, 吉川哲史, 和田泰三, 石和田稔彦, 是松聖悟, 中野貴司, 宮入烈, 尾内一信, 相澤悠太, 庄司健介, 齋藤昭彦, 森内浩幸, 多屋馨子, 日本小児科学会予防接種・感染症対策委員会

日本小児科学会雑誌 ( (公社)日本小児科学会 ) 127 ( 1 ) 84 - 89 2023年01月

国内の地域偏在を調整後に無作為に抽出した小児科1次医療施設100施設、2次医療施設100施設と全ての3次医療施設119施設を候補として、2020年4月(I期)、2020年10月(II期)、2021年4月(III期)の各時点における診療体制についてインターネットを介してアンケート調査した。回答があったのは1次医療施設27施設(回答率27%)、2次医療施設19施設(回答率19%)、3次医療施設72施設(回答率61%)であった。発熱患者の診療応需についてはコロナウイルス感染症2019(COVID-19)接触歴を有する場合、1次医療施設で応需困難となったのはI期で29.6%であったが、II期22.2%、III期14.8%と経時的に減少した。COVID-19患者の診療体制はIII期においても3次医療施設の約半数で軽症・無症状患者の診療が応需されていた。面会制限は大多数の施設で導入され、面会禁止とした施設がIII期においても2次医療施設の63.2%、3次医療施設の38.9%で存在した。

Acute and Postacute Clinical Characteristics of Coronavirus Disease 2019 in Children in Japan.

Tomohiro Katsuta, Yuta Aizawa, Kensuke Shoji, Naoki Shimizu, Kenji Okada, Takashi Nakano, Hajime Kamiya, Kiyoko Amo, Naruhiko Ishiwada, Satoshi Iwata, Makoto Oshiro, Nobuhiko Okabe, Seigo Korematsu, Shigeru Suga, Takeshi Tsugawa, Naoko Nishimura, Haruka Hishiki, Masashi Fujioka, Mitsuaki Hosoya, Yumi Mizuno, Isao Miyairi, Chiaki Miyazaki, Tsuneo Morishima, Tetsushi Yoshikawa, Taizo Wada, Kazunobu Ouchi, Hiroyuki Moriuchi, Keiko Tanaka-Taya, Akihiko Saitoh

The Pediatric infectious disease journal 42 ( 3 ) 240 - 246 2022年11月 [査読有り] [国際誌]

BACKGROUND: The clinical features of coronavirus disease 2019 (COVID-19) in children have been changing because of the emergence and rapid spread of variants of concern (VOC). The increase in cases infected with VOC has brought concern with persistent symptoms after COVID-19 in children. This survey aimed to analyze the clinical manifestations and persistent symptoms of pediatric COVID-19 cases in Japan. METHODS: We analyzed the clinical manifestations of pediatric COVID-19 cases reported between February 2020 and April 2022 in Japan, using a dedicated database updated voluntarily by the members of the Japan Pediatric Society. Using the same database, we also analyzed persistent symptoms after COVID-19 in children who were diagnosed between February 2020 and November 2021. RESULTS: A total of 5411 and 1697 pediatric COVID-19 cases were included for analyzing clinical manifestations and persistent symptoms, respectively. During the Omicron variant predominant period, the percentage of patients with seizures increased to 13.4% and 7.4% in patient groups aged 1-4 and 5-11 years, respectively, compared with the pre-Delta (1.3%, 0.4%) or Delta period (3.1%, 0.0%). Persistent and present symptoms after 28 days of COVID-19 onset were reported in 55 (3.2%). CONCLUSIONS: Our survey showed that the rate of symptomatic pediatric COVID-19 cases increased gradually, especially during the Omicron variant predominant period, and a certain percentage of pediatric cases had persistent symptoms. Certain percentages of pediatric COVID-19 patients had severe complications or prolonged symptoms. Further studies are needed to follow such patients.

DOI PubMed

Rhinovirus Infection and Virus-Induced Asthma

Yuriko Hayashi, Mitsuru Sada, Tatsuya Shirai, Kaori Okayama, Ryusuke Kimura, Mayumi Kondo, Mitsuaki Okodo, Takeshi Tsugawa, Akihide Ryo, Hirokazu Kimura

Viruses ( MDPI AG ) 14 ( 12 ) 2616 - 2616 2022年11月 [査読有り] [国際誌]

While the aetiology of asthma is unclear, the onset and/or exacerbation of asthma may be associated with respiratory infections. Virus-induced asthma is also known as virus-associated/triggered asthma, and the reported main causative agent is rhinovirus (RV). Understanding the relationship between viral infections and asthma may overcome the gaps in deferential immunity between viral infections and allergies. Moreover, understanding the complicated cytokine networks involved in RV infection may be necessary. Therefore, the complexity of RV-induced asthma is not only owing to the response of airway and immune cells against viral infection, but also to allergic immune responses caused by the wide variety of cytokines produced by these cells. To better understand RV-induced asthma, it is necessary to elucidate the nature RV infections and the corresponding host defence mechanisms. In this review, we attempt to organise the complexity of RV-induced asthma to make it easily understandable for readers.

DOI PubMed

Detailed Molecular Interactions between Respiratory Syncytial Virus Fusion Protein and the TLR4/MD-2 Complex In Silico.

Mao Akagawa, Tatsuya Shirai, Mitsuru Sada, Norika Nagasawa, Mayumi Kondo, Makoto Takeda, Koo Nagasawa, Ryusuke Kimura, Kaori Okayama, Yuriko Hayashi, Toshiyuki Sugai, Takeshi Tsugawa, Haruyuki Ishii, Hisashi Kawashima, Kazuhiko Katayama, Akihide Ryo, Hirokazu Kimura

Viruses 14 ( 11 ) 2022年10月 [査読有り] [国際誌]

Molecular interactions between respiratory syncytial virus (RSV) fusion protein (F protein) and the cellular receptor Toll-like receptor 4 (TLR4) and myeloid differentiation factor-2 (MD-2) protein complex are unknown. Thus, to reveal the detailed molecular interactions between them, in silico analyses were performed using various bioinformatics techniques. The present simulation data showed that the neutralizing antibody (NT-Ab) binding sites in both prefusion and postfusion proteins at sites II and IV were involved in the interactions between them and the TLR4 molecule. Moreover, the binding affinity between postfusion proteins and the TLR4/MD-2 complex was higher than that between prefusion proteins and the TLR4/MD-2 complex. This increased binding affinity due to conformational changes in the F protein may be able to form syncytium in RSV-infected cells. These results may contribute to better understand the infectivity and pathogenicity (syncytium formation) of RSV.

DOI PubMed

Liver Enzyme Elevation Related to Human Parainfluenza Virus Type 3 Infection.

Yoshimasa Kudo, Tomohiro Wakabayashi, Shuichi Miyamoto, Yuta Sasaoka, Yoshiyuki Sakai, Takeshi Tsugawa

The Pediatric infectious disease journal 41 ( 10 ) e437-e438 2022年10月 [査読有り] [国際誌]

担当区分：最終著者

DOI PubMed

A novel ZC4H2 variant in a female with severe respiratory complications.

Tomohiro Wakabayashi, Miyako Mizukami, Kojiro Terada, Aki Ishikawa, Shiro Hinotsu, Masaki Kobayashi, Koji Kato, Tomoo Ogi, Takeshi Tsugawa, Akihiro Sakurai

Brain & development 44 ( 8 ) 571 - 577 2022年09月 [査読有り] [国際誌]

INTRODUCTION: An X-linked ZC4H2 variant is associated with a variety of phenotypes that have abnormalities related to external malformation and neurodevelopment. There have been no reports on severe respiratory dysfunction resulting in surgical treatments not being possible due to the deformity resulting from in this disease. Here we report a female with arthrogryposis multiplex congenita with a severe respiratory complication. CASE: A two-year-old girl had arthrogryposis multiplex congenita at delivery and subsequently had hypotonia and feeding difficulty. A novel ZC4H2 frameshift variant was identified by whole-exome sequencing in her genome. At eight months, she had recurrent aspiration pneumonia. A tracheostomy and gastrostomy were required; however, surgical intervention was not possible because of her short neck and complicated airway. CONCLUSION: We compared this case with previous reports. The truncation group had more described phenotypes than the non-truncation group. The patient had the most severe respiratory dysfunction in truncating variant.

DOI PubMed

Molecular Evolution of the Pseudomonas aeruginosa DNA Gyrase gyrA Gene.

Mitsuru Sada, Hirokazu Kimura, Norika Nagasawa, Mao Akagawa, Kaori Okayama, Tatsuya Shirai, Soyoka Sunagawa, Ryusuke Kimura, Takeshi Saraya, Haruyuki Ishii, Daisuke Kurai, Takeshi Tsugawa, Atsuyoshi Nishina, Haruyoshi Tomita, Mitsuaki Okodo, Shinichiro Hirai, Akihide Ryo, Taisei Ishioka, Koichi Murakami

Microorganisms 10 ( 8 ) 2022年08月 [査読有り] [国際誌]

DNA gyrase plays important roles in genome replication in various bacteria, including Pseudomonasaeruginosa. The gyrA gene encodes the gyrase subunit A protein (GyrA). Mutations in GyrA are associated with resistance to quinolone-based antibiotics. We performed a detailed molecular evolutionary analyses of the gyrA gene and associated resistance to the quinolone drug, ciprofloxacin, using bioinformatics techniques. We produced an evolutionary phylogenetic tree using the Bayesian Markov Chain Monte Carlo (MCMC) method. This tree indicated that a common ancestor of the gene was present over 760 years ago, and the offspring formed multiple clusters. Quinolone drug-resistance-associated amino-acid substitutions in GyrA, including T83I and D87N, emerged after the drug was used clinically. These substitutions appeared to be positive selection sites. The molecular affinity between ciprofloxacin and the GyrA protein containing T83I and/or D87N decreased significantly compared to that between the drug and GyrA protein, with no substitutions. The rate of evolution of the gene before quinolone drugs were first used in the clinic, in 1962, was significantly lower than that after the drug was used. These results suggest that the gyrA gene evolved to permit the bacterium to overcome quinolone treatment.

DOI PubMed

Genotypes and transmission routes of noroviruses causing sporadic acute gastroenteritis among adults and children, Japan, 2015-2019.

Saho Honjo, Koji Kuronuma, Yoshihiro Fujiya, Mami Nakae, Susumu Ukae, Hiroshi Nihira, Masaki Yamamoto, Yusuke Akane, Kenji Kondo, Satoshi Takahashi, Hirokazu Kimura, Hiroyuki Tsutsumi, Yukihiko Kawasaki, Takeshi Tsugawa

Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases 104 105348 - 105348 2022年08月 [査読有り] [国際誌]

担当区分：最終著者 , 責任著者

Noroviruses (NoVs) are major causes of acute viral gastroenteritis at all ages worldwide. The molecular epidemiology of sporadic cases remains poorly understood, especially in adults. Additionally, no studies have analyzed the transmission route in sporadic acute gastroenteritis. In this study, we investigated cases of very mild sporadic NoV acute gastroenteritis in adults (medical staff) who do not visit the outpatient clinic and child outpatients. We also evaluated genotype differences between adults and children and possible transmission routes in adults during 5 years. The number of NoV positives were 58 in adults and 124 in children. In adults, the NoV positivity rate in this study was higher (64.4%) than that in previous reports of outpatients (10%) and inpatients (5%) in the United State. This finding suggested that the NoV positivity rate might be high in adults with very mild acute gastroenteritis. In adults, human-to-human transmission rates from children and food-borne transmission (raw oysters) were 21.6% (11/51) and 19.6% (10/51), respectively. Among adults, GII.2, GII.4, and GII.17 were the predominant genotypes, with rates of 32.7%, 30.9%, and 21.8%, respectively. Among children, GII.4 and GII.2 were the predominant genotypes, with rates of 45.5% and 40.6%, respectively. GII.17 was only detected in 0.8% (1/123) of children. Trends in NoV genotypes are expected to differ depending on the patient's age. Investigating sporadic cases including the patient's background (age and transmission route) may be helpful to monitor the trend of NoV strains, forecast prevalent NoV GII genotypes, and develop NoV vaccines.

DOI PubMed

Delayed dexamethasone treatment at initiation of oxygen supplementation for coronavirus disease 2019 is associated with the exacerbation of clinical condition.

Yuta Ibe, Tomoyuki Ishigo, Satoshi Fujii, Yoshihiro Fujiya, Koji Kuronuma, Takeshi Tsugawa, Satoshi Takahashi, Masahide Fukudo

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 28 ( 7 ) 875 - 883 2022年07月 [査読有り] [国際誌]

INTRODUCTION: Coronavirus disease 2019 (COVID-19) frequently causes inflammatory lung injury as its symptoms progress. While dexamethasone reportedly reduces inflammation and prevents progression to respiratory failure, the appropriate time to administer dexamethasone in patients with COVID-19 remains unclear. METHODS: This was a single-center, retrospective cohort study, where we consecutively enrolled patients hospitalized with COVID-19 who received oxygen and oral dexamethasone (n = 85). We assessed the association between the number of days to the initiation of dexamethasone and the cumulative rate of exacerbation defined as death or initiation of mechanical ventilation within 28 days of symptom onset. RESULTS: The optimal cut-off value from the initiation of oxygen supplementation to that of dexamethasone administration was two days (sensitivity, 85%; specificity, 59%), whereas that from oxygen saturation (SpO2) < 95% to the initiation of dexamethasone administration was five days (sensitivity, 78%; specificity, 59%). adjusting for age, sex, body mass index, Charlson comorbidity index score, time of oxygen supplementation (two or more days), and SpO2 < 95% (five or more days), Cox regression analysis results showed that delayed dexamethasone administration since the initiation of oxygen supplementation was significantly associated with a higher risk of death or greater need for mechanical ventilation (hazard ratio: 5.51, 95% confidence interval, 1.79-16.91). CONCLUSIONS: In patients with COVID-19 and hypoxemia, early administration of dexamethasone, preferably less than two days from initiation of oxygen supplementation, may be required to improve clinical outcomes.

DOI PubMed

House Dust Mite Subcutaneous Immunotherapy and Lung Function Trajectory in Children and Adolescents with Asthma.

Kazutaka Nogami, Mizuho Nagao, Takafumi Takase, Yasuaki Yasuda, Shingo Yamada, Mayumi Matsunaga, Miyuki Hoshi, Kana Hamada, Yu Kuwabara, Takeshi Tsugawa, Takao Fujisawa

Children (Basel, Switzerland) 9 ( 4 ) 2022年04月 [査読有り] [国際誌]

Background: Allergen-specific immunotherapy is currently the only disease-modifying treatment for allergic asthma, and it has been shown to improve control of asthma while reducing both drug use and asthma exacerbations. However, its effects on lung function—especially its long-term effects—remain controversial. We aimed to identify factors associated with a possible beneficial effect of allergen-specific immunotherapy on lung function in asthma by retrospectively evaluating the long-term changes in lung function in children with asthma who received house dust mite subcutaneous immunotherapy (HDM-SCIT). Methods: We enrolled children with asthma who had undergone HDM-SCIT for more than 1 year. Clinical information and lung function measurements were retrieved from the electronic chart system. To characterize the trajectory of lung function change, we performed linear regression analysis to evaluate the maximal expiratory flow at 50% of the forced vital capacity during two periods: before and during HDM-SCIT. Slopes from a least-squares regression line for the two periods, i.e., S1 before HDM-SCIT and S2 during HDM-SCIT, were compared. The subjects were then classified into two groups: an improving group (Group I) defined as S2 − S1 > 0, and a declining group (Group D) defined as S2 − S1 < 0. The clinical factors at the start of HDM-SCIT were compared between the two groups. Results: A total of 16 patients were analyzed. Eight patients were classified into each of Group I and Group D. The mean ages were 10.5 and 11.8 years, and the mean treatment periods were 4.1 and 3.9 years. Group I had a significantly lower blood eosinophil count and a significantly higher HDM-specific IgE level than Group D. Logistic regression showed a strong relationship between those two markers and the lung function trajectory. Conclusion: Control of the blood eosinophil count in highly HDM-sensitized patients may increase the beneficial effect of HDM-SCIT on lung function.

DOI PubMed

繰り返す腰椎穿刺により脳脊髄液漏出をきたした脊髄性筋萎縮症I型の1例

加藤辰輔, 土田晃輔, 福村忍, 津川毅

臨床小児医学 ( (財)小児愛育協会 ) 69 ( 1-6 ) 55 - 59 2022年03月 [査読有り]

担当区分：最終著者

はじめに:ヌシネルセンは、脊髄性筋萎縮症に対するアンチセンス・オリゴヌクレオチド製剤で、髄腔内に投与される。今回、繰り返す腰椎穿刺により、脳脊髄液漏出をきたした脊髄性筋萎縮症I型を経験した。症例:脊髄性筋萎縮症I型の5歳女児。2歳よりL3-4間に23ゲージ針穿刺によるヌシネルセン髄腔内投与を4ヵ月ごとに繰り返した。12回目の投与後、穿刺部より髄液の漏れおよび腰部皮下浮腫を生じた。頭痛などの症状は認めず、圧迫、安静により、数日で浮腫、髄液漏は消失した。以後は穿髄間を変更し、再発は認めていない。14回目を最後に、経口のアンチセンス・オリゴヌクレオチド製剤に切り替えた。考察:繰り返す腰椎穿刺の際は、髄液漏の出現に注意が必要である。リスク回避には、穿刺髄間を同一にしないこと、細く非侵襲的な脊髄針の選択、経口製剤へ移行が考慮される。(著者抄録)

Transient personality changes with bilateral thalamic infarction in a 12-year-old girl.

Shuhei Adachi, Shinobu Fukumura, Shinsuke Kato, Takeshi Mikami, Takeshi Tsugawa

Pediatrics international : official journal of the Japan Pediatric Society 64 ( 1 ) e15352 2022年01月 [査読有り] [国際誌]

担当区分：最終著者

DOI PubMed

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