Accelerated organ region segmentation by the revised radial basis function network using a graphics processing unit.

This study aimed to accelerate the segmentation of organs in medical imaging with the revised radial basis function (RBF) network, using a graphics processing unit (GPU). We segmented the lung and liver regions from 250 chest x-ray computed tomography (CT) images and 160 abdominal CT images, respectively, using the revised RBF network. We compared the time taken to segment images and their accuracy between serial processing by a single-core central processing unit (CPU), parallel processing using four CPU cores, and GPU processing. Segmentation times for lung and liver organ regions shortened to 57.80 and 35.35 seconds for CPU parallel processing and 20.16 and 11.02 seconds for GPU processing, compared to 211.03 and 124.21 seconds for CPU serial processing, respectively. The concordance rate of the segmented region to the normal region in slices excluding the upper and lower ends (173 lung and 111 liver slices) was 98% for lung and 96% for liver. The use of CPU parallel processing and GPU shortened the organ segmentation time in the revised RBF network without compromising segmentation accuracy. In particular, segmentation time was shortened to less than 10%with GPU. This processing method will contribute to workload reduction in imaging analysis. J. Med. Invest. 66 : 86-92, February, 2019.

The Journal of Medical Investigation : JMI


Systemic inflammation and family history in relation to the prevalence of type 2 diabetes based on an alternating decision tree

To investigate unknown patterns associated with type 2 diabetes in the Japanese population, we first used an alternating decision tree (ADTree) algorithm, a powerful classification algorithm from data mining, for the data from 1,102 subjects aged 35-69 years. On the basis of the investigated patterns, we then evaluated the associations of serum high-sensitivity C-reactive protein (hs-CRP) as a biomarker of systemic inflammation and family history of diabetes (negative, positive or unknown) with the prevalence of type 2 diabetes because their detailed associations have been scarcely reported. Elevated serum hs-CRP levels were proportionally associated with the increased prevalence of type 2 diabetes after adjusting for probable covariates, including body mass index and family history of diabetes (P for trend = 0.016). Stratified analyses revealed that elevated serum hs-CRP levels were proportionally associated with increased prevalence of diabetes in subjects without a family history of diabetes (P for trend = 0.020) but not in those with a family history or with an unknown family history of diabetes. Our study demonstrates that systemic inflammation was proportionally associated with increased prevalence of type 2 diabetes even after adjusting for body mass index, especially in subjects without a family history of diabetes.


Predictability of Pressure Ulcers Based on Operation Duration, Transfer Activity, and Body Mass Index Through the Use of an Alternating Decision Tree

To develop a prediction model for pressure ulcer cases that continue to occur at an acute care hospital with a low occurrence rate of pressure ulcers. Analyzing data were collected from patients hospitalized at Tokushima University Hospital during 2012 using an alternating decision tree (ADT) data mining method. The ADT-based analysis revealed transfer activity, operation time, and low body mass index (BMI) as important factors for predicting pressure ulcer development. Among the factors identified, only "transfer activity" can be modified by nursing intervention. While shear force and friction are known to lead to pressure ulcers, transfer activity has not been identified as such. Our results suggest that transfer activities creating shear force and friction correlate with pressure ulcer development. The ADT algorithm was effective in determining prediction factors, especially for highly imbalanced data. Our three stumps ADT yielded accuracy, sensitivity, and specificity values of 72.1%±3.7%, 79.3%±18.1%, and 72.1%±3.8%, respectively. Transfer activity, identified as an interventional factor, can be modified through nursing interventions to prevent pressure ulcer formation. The ADT method was effective in identifying factors within largely imbalanced data. J. Med. Invest. 63: 248-255, August, 2016.


Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis.

OBJECT The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors. METHODS Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period. RESULTS The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior. CONCLUSIONS Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.


On-Admission Pressure Ulcer Prediction Using the Nursing Needs Score

Pressure ulcers (PUs) are considered a serious problem in nursing care and require preventive measures. Many risk assessment methods are currently being used, but most require the collection of data not available on admission. Although nurses assess the Nursing Needs Score (NNS) on a daily basis in Japanese acute care hospitals, these data are primarily used to standardize the cost of nursing care in the public insurance system for appropriate nurse staffing, and have never been used for PU risk assessment. The objective of this study was to predict the risk of PU development using only data available on admission, including the on-admission NNS score. Logistic regression was used to generate a prediction model for the risk of developing PUs after admission. A random undersampling procedure was used to overcome the problem of imbalanced data. A combination of gender, age, surgical duration, and on-admission total NNS score (NNS group B; NNS-B) was the best predictor with an average sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 69.2% (6920/100), 82.8% (8280/100), and 84.0% (8400/100), respectively. The model with the median AUC achieved 80% (4/5) sensitivity, 81.3% (669/823) specificity, and 84.3% AUC. We developed a model for predicting PU development using gender, age, surgical duration, and on-admission total NNS-B score. These results can be used to improve the efficiency of nurses and reduce the number of PU cases by identifying patients who require further examination.


The Behavior Modification to the Lifestyle by Healthy Condition Visualization which Utilized NFC Communication Pedometer

NFC通信歩数計を活用した健康データの可視化による生活習慣の行動変容

To record individual body weight and physical activity has been shown to be beneficial for maintaining personal health. We, therefore, established a system which connects a personal computer and health appliances to record body weight, daily step, and blood pressure. We applied this system to 226 employees in 3 companies during the period of October, 2011-March, 2013 and evaluated whether this system could improve individual behavioral modification. One hundred sixty seven persons (73.9%) had continuously recorded the measurement of the pedometer for at least one year. We compared the average of the first three months with the average of the next three months. As a result, the number of steps tended to increase to 7,515±4,629 steps from 7,299±3,731steps (p=0.075). As for blood pressure, the systolic phase significantly decreased from 129.2±13.2 mmHg to 127.1±13.5 mmHg (p=0.028), and diastolic phase decreased from 78.6±9.8 mmHg to 76.0±9.9 mmHg (p=0.00016). BMI also significantly decreased from 23.3±2.9 kg/m2 to 23.2±2.8 kg/m2(p=0.029). In conclusion, to record daily step, body weight and blood pressure by using newly established system improved individual behavior towards a healthy condition.

健康データの登録の自動化と可視化ができるシステムを利用することで，計測者が健康改善に向けての意識変化や行動変容が起こるかどうか，健康管理を継続することにより健康データに変化が起こるかどうかについて検証することを目的としている．日常の健康管理を行う際に体重や運動の記録が自動で登録・グラフ化できるように，PCとNFC通信歩数計・体組成計・血圧計などの健康機器を連携したシステムを構築した．このシステムを利用し，健康データを日々計測することによってデータの可視化を図り，計測者が健康改善に向けての行動変容が起きるかについて検証を行った．利用期間が1年を経過している企業3社226名の利用者について，2011年10月から2013年3月までに得られたデータで分析を行った．歩数計の計測を2013年3月まで継続し続けたのは167名(73.9%)となった．歩数は「1カ月∼3カ月」の平均と「4カ月∼6カ月」の平均を比べると，7,299±3,731歩から7,515±4,629歩(p＝0.075)へと増加傾向があった．血圧は収縮期が129.2±13.2 mmHgから127.1±13.5 mmHg(p＝0.028)へ有意に減少し，拡張期も78.6±9.8 mmHgから76.0±9.9 mmHg(p＝0.00016)へと有意に減少しており，BMIについても，23.3±2.9 kg/m2から23.2±2.8 kg/m2(p＝0.029)へと有意に減少していた．これらの結果より，システムを利用することで開始当初に健康データが改善し，その後も血圧に関しては継続効果が認められ，健康改善に向けての行動変容が生じたと考えられた．


Supporting self-control of individual training for motor-skill development with a social web environment

This study proposes a system to support self-controlled motor-skill development in a web-community environment. We discuss the difficulties involved in sustaining self-controlled training without systematic supports. The system proposed provides a function to suggest an appropriate range of target goals based on data from previous training sessions. A prototype system has been designed and developed. This study reports a case study based on a trial use of the system. The results suggest that our approach contributes to each user's ability to achieve target goals.

International Journal of Knowledge and Web Intelligence


Endoscopic management of Dieulafoy's lesion using Isoamyl-2-cyanoacrylate.

Dieulafoy's lesion (DL) is a rare but important cause of obscure gastrointestinal bleeding that may be overlooked during diagnostic endoscopy. Mortality rates are similar to those of other causes for gastrointestinal bleeding. Diagnosis by upper endoscopy is the modality of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL, when diagnosed, endoscopist experience is the major determinant of the treatment strategy. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured gastrointestinal lesion is suspected. Cyanoacryltes compounds have been used successfully in management of Gastric varices and DLs. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE(®); Concord Drugs Ltd., Hyderabad, India) as an effective therapy for gastric DL without serious complications. In our case study, Isoamyl-2-cyanoacrylate (AMCRYLATE(®)) was effective and safe for treating DL. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.

World Journal of Gastrointestinal Endoscopy


The effectiveness of an interactive 3-dimensional computer graphics model for medical education.

Interactive 3DCG materials have positive effects on medical education when properly integrated into conventional education. In particular, our results suggest that interactive 3DCG is more efficient than textbooks alone in medical education and can motivate students to understand complex anatomical structures.


Experience of the Virtual Nursing Consultation Room, 4 years after its establishment

バーチャル看護相談室開設から4年間の利用状況分析

The Journal of Japan Society for Health Care Management

日本医療マネジメント学会雑誌


徳島大学病院における個人情報保護対策 プライバシーマーク認証取得のための組織的アプローチ

日本医療マネジメント学会雑誌


【徳島大学の医学教育を考える】 医学教育におけるe-Learningの活用 マルチメディア教材の分析


The development and evaluation of virtual nursing consultation room

バーチャル看護相談室の開発と有用性の検討

医療マネジメント学会雑誌


統合失調症用のクリニカルパス及びアウトカム管理の確認項目の作成と重要性の検討

統合失調症用のクリニカルパス及びアウトカム管理の確認項目の作成と重要性の検討

近年，クリニカルパスはケアを改善するために用いられるようになった．この研究の目的は統合失調症用のためのCPを開発することである．その主要な焦点は，①ノーマライゼーションの理念に基づいたチームケアを実践すること，②CPと連動した患者アウトカム管理用の重要な品質管理項目を明確にすることである．アウトカム管理を病院で行うことによって，患者·家族のQuality of Lifeの向上，良好な費用対効果，医療者の満足度の向上，入院期間の短縮等の効果が得られる．筆者らは，(Interdisciplinary Collaborative Team Care Model: ICTCM)を2000年に導入し，1999年の平均在院日数205．7日(1994年の平均在院日数675．5日)を2004年には155．2日に短縮した病院において，学際的なケア提供者と事務責任者を調査対象として，聞き取り調査を行い，統合失調症用のCPとアウトカム管理項目を作成した．


FTF and CMC Hybrid Lecture for the Medical/Dental Department Using the Syllabus-Based e-Learning System

シラバスに基づくe-Learningシステムを用いた医学·歯学系教育におけるFTF·CMCハイブリッド型授業実践

我々はシラバスに基づき種々の機能提供を行うe-LearningシステムMLSの開発と，その医学·歯学系教育への適用を行った．MLSは，従来の対面式授業に加え，オンライン·オフラインのハイブリッド型授業に対して用いることができる．さらに，レポート管理や授業補講などが行え，従来の直接的対面式授業と，遠隔非同期による学習の双方の特長を相補活用したシステムとして実現した．本論文では，このようなシステムの設計·開発について詳述し，さらにMLSを医学·歯学系教育に実践適用した結果を述べる．


Relation between Treatment Delay and Development of Complications in Type 2 Diabetes Mellitus

2型糖尿病における治療の遅れと合併症の発症について

To evaluate the effectiveness of the early treatment, we investigated the development of complications of patient who received late treatment. Two hundred and ninety-eight early-treated patients (early group) and 98 late-treated patients (late group) with type 2 diabetes participated in this study. Period from the onset of disease, treatment period, and diabetic complications were investigated retrospectively based on medical records. Each group was stratified by the duration from the onset of disease for removing the selection bias (under 10 years, 10-20 years, under 20 years, and over 20 years). The result of the comparison, odds ratio [OR] was 1.88 (95% confidence interval [CI], 1.05-3.36) for development of retinopathy in under 20 years. The onset-adjusted ORs were 1.73 (95% CI, 1.06-2.82) for development of retinopathy and 1.72 (95% CI, 1.06-2.80) for development of nephropathy. Macrovascular complications were irrelevant to delay of the treatment. Based on these findings, the early treatment is effective for the prevention of diabetic retinopathy and diabetic nephropathy.

早期治療の有効性を評価するために，治療開始に遅れがあった者の合併症の発症割合を調査して比較検討した．調査対象は，1998年10月∼12月に徳島県下の医療機関を受診(外来，入院)した2型糖尿病患者で，徳島県糖尿病コメディカル研究会を通じて得られた396例である．糖尿病の治療歴は，診療録に基づく後ろ向き調査により把握し，バイアスを取り除くために，罹病期間により調整(層化)を行った．「早期治療群」と「治療遅れ群」を比較した結果，罹病期間「0∼19年」では，網膜症に有意差がみられた(P=0.046)．治療が遅れた場合，網膜症の発症リスクは1.88倍(1.05∼3.36倍)になった．罹病期間で調整した場合，網膜症，腎症に有意差がみられた(それぞれP=0.037，P=0.040)．治療が遅れた場合，網膜症の発症リスクは1.73倍(1.06∼2.82倍)，腎症は1.72倍(1.06∼2.80倍)になった．大血管系疾患では，治療の遅れと関連がなかった．以上より，網膜症と腎症の発症防止のために，早期治療を行うことは効果的であると思われる．今後，より正確な前向き調査を実施することが望ましいと思われる．

Journal of Shikoku Public Health Society


Establishment of electronic medical record and system

電子カルテとシステムの確立

In the medical treatment with a strong subjective, experienced element, the flow of informationization is rapid in the maturation process of the society. Accuracy and the efficiency improvement of the medical treatment are strongly requested by the change in a social background, and a more systematic medical treatment system is needed though the medical treatment is complicated more and has upgraded. Environment, which improves the quality of the medical treatment and offers medical treatment efficiently is requested for the achievement. In the environment the technology of the information infrastructure, security, and the information exchange, information literacy, and the legislation etc. are maintained. EMR(Electronic Medical Record) with the function which becomes the center begins to spread, and the introduction in the clinic and the hospital is accelerating. The current state of an electronic medical record, the problem, and the constructive process of the system are outlined.


Role of CD13/Aminopeptidase N in Rat Lymphocytic Alveolitis Caused by Thoracic Irradiation

CD13/aminopeptidase N is a cell surface glycoprotein that is widely distributed in a variety of mammalian cells. It was recently shown to have chemotactic activity for T lymphocytes. This study examined the role of CD13/aminopeptidase N in lymphocytic alveolitis in radiation-induced lung injury caused by a single-dose thoracic irradiation (15 Gy) in rats. Significantly increased aminopeptidase activity was detected in bronchoalveolar lavage fluid obtained from irradiated rats at 4 weeks after irradiation compared to the activity in unirradiated rats. Significantly higher aminopeptidase activity was detected on alveolar macrophages from irradiated rats at 2 and 4 weeks than on those from unirradiated rats. Western blot analysis showed an increased expression of CD13/aminopeptidase N protein in alveolar macrophages from irradiated rats at 4 weeks. Chemotactic activity for normal rat lymphocytes was detected in bronchoalveolar lavage fluid from irradiated rats at 4 weeks, and approximately 60% of the activity was inhibited by pretreatment of bronchoalveolar lavage fluid with bestatin, a specific aminopeptidase inhibitor. This study suggests that CD13/aminopeptidase N may play an important role as a lymphocyte chemoattractant in lymphocyte-mediated alveolitis in experimental radiation-induced lung injury.


Medicine and IT(Information Technology) of 21st century-from the university to the region

The medicine has been complicated, and the judgment whether it is correct or not has become more difficult. And the obtained consequences have come to conceive contradiction mutually. Moreover, correct, efficient, and effective medical treatments are being requested by a lot of people including the patient. Therefore, the system of medicine to connect variety of service fields is planned by using IT (Information Technology). The information system, which attempted the cooperation of the health, medical care, welfare in Kochi Prefecture was shown as the piece. In addition, fair, accurate ``systematized medicine" by which information is shared should be important and the clinical management also be taken into consideration. And the development of an intelligent medical system which centers on an electronic clinical record to share information and allot the role in the region will be important in the near future. The occupational category of coordinator of medical system who has the expertise and the management ability of informationization and the engineering technique will be needed for that. It seems that the era when treatment and care are done based on shared information which makes use of the ability and speciality of the individual and facilities in the region to its maximum will come soon.


Autoantibodies to IL-1 alpha in sera from rapidly progressive idiopathic pulmonary fibrosis

To clarify the clinical significance of autoantibodies to interleukin-1 alpha (IL-1 alpha autoantibodies) in rapidly progressive idiopathic pulmonary fibrosis (IPF), we measured the level of IL-1 alpha autoantibodies in serum of 11 patients on the first hospital day, when patients were admitted due to severe symptoms, and on the 21st hospital day. IL-1 alpha autoantibodies in serum were measured using radioimmunoassay, and the limitation of this assay for IL-1 alpha autoantibodies was 5 ng/ml. These antibodies were detected in 5 of 11 patients on the first hospital day. On the 21st hospital day, these antibodies were detected in all patients, and its level was increased compared with that on the first hospital day. IL-1 alpha autoantibodies that appeared in patients corresponded to that of IgG. The half life of exogenous autoantibodies was investigated following administration of autoantibody rich plasma obtained from healthy blood donors to 6 control patients (CP) and 6 progressive IPF patients. These autoantibody levels in their serum were less than 5 ng/ml before administration. Serum was obtained at the indicated time after administration of IL-1 alpha autoantibodies and the level of these autoantibodies in serum was measured, then the half life was calculated. Half life of exogenous IL-1 alpha autoantibodies in progressive IPF patients was significantly shorter than that in CP (71.3 +/- 31.8 hr vs 352.0 +/- 98.3 hr, p < 0.01). These findings suggested that IL-1 alpha autoantibodies were generated in response to the inflammatory process of rapidly progressive IPF and may act as a regulatory factor for IL-1 alpha.

The Journal of Medical Investigation : JMI


The development of a pollen information system for the improvement of QOL

The Kochi Prefecture Japanese Cedar and Cypress Pollen Information System (P-Net Kochi) was established in 1991 on the initiative of the Pharmaceuticals and Sanitation Division to improve the quality of life of people in Kochi Prefecture, particularly patients with pollinosis. Kochi Prefecture has the highest forests percentage (84%) in Japan. In addition, 40% of the population of the prefecture is concentrated in Kochi City. The average pollen count at 10 observation points an one year was about 20,000/ (2) during the observation period, but it exceeded 110,000/ (2) in 1995, when it was also high nationwide. Kochi Prefecture organized a system to promote people's understanding of pollinosis in connection with environmental problems, and to enlighten people on appropriate preventive measures. The system has been improved in the rapid and efficient transmission of information over the years with technological advances. The introduction of an automatic monitoring system not dependent on human labor and the support of the users proved to be indispensable for the maintenance of the system.


Prediction of pressure ulcer by on-admission Nursing Needs Score transfer activity

Nursing Journal of Osaka Aoyama University

大阪青山大学看護学ジャーナル


急性期治療病棟で用いる統合失調症用のクリニカルパスをベースとしたアウトカム管理者の職務内容の検討

近年，ケアの質改善を目指してクリニカルパスは用いられるようになった．しかし日本では，統合失調症患者のためのクリニカルパスとアウトカム管理のための項目は十分に検討されていない．この研究の目的は，急性期治療病棟で用いる統合失調症用のクリニカルパスをベースとしたアウトカム管理の確認項目の検討を通してアウトカム管理を担うものの職務内容を明確化することである．筆者らは，(Interdisciplinary Collaborative Team Care Model: ICTCM)を2000年に導入し，1999年の平均在院日数205．7日(1994年の平均在院日数675．5日)を2004年には155．2日に短縮した精神科専門の病院(ベッド数243床，病床回転率235．9%，病床利用率86．8%)において，学際的なケア提供者と事務責任者を調査対象として，聞き取り調査を行った．その結果から，急性期治療病棟で用いる統合失調症用のクリニカルパスをベースとしたアウトカム管理を行うための職務内容の詳細を明確にした．

季刊 こころの臨床 a·la·care

季刊 こころの臨床 a·la·care


医療のエスノメソドロジー研究の現状と課題

医療のエスノメソドロジー研究の現状と課題

Social Science Research University of Tokushima


顕微蛍光測光装置によるラット肺胞マクロファ-ジのリソゾ-ム内pH測定の検討

顕微蛍光測光装置によるラット肺胞マクロファ-ジのリソゾ-ム内pH測定の検討


顕微蛍光測光装置による単一細胞ライソゾ-ム内pH測定の検討

顕微蛍光測光装置による単一細胞ライソゾ-ム内pH測定の検討