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Article: Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia: A Single-Center Retrospective Observational Study.

Araki, Taisuke / Yamazaki, Yoshitaka / Kimoto, Masanobu / Goto, Norihiko / Ikuyama, Yuichi / Takahashi, Yuko / Kosaka, Makoto

Journal of clinical medicine

2023 Volume 13, Issue 1

Abstract: ... ...

Abstract	Introduction
Language	English
Publishing date	2023-12-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13010230
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Article ; Online: Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia

Taisuke Araki / Yoshitaka Yamazaki / Masanobu Kimoto / Norihiko Goto / Yuichi Ikuyama / Yuko Takahashi / Makoto Kosaka

Journal of Clinical Medicine, Vol 13, Iss 1, p

A Single-Center Retrospective Observational Study

2023 Volume 230

Abstract: Introduction : Clinical pathways (CPWs) are patient management tools based on a standardized treatment plan aimed at improving quality of care. This study aimed to investigate whether CPW-guided treatment has a favorable impact on the outcomes of ... ...

Abstract	Introduction : Clinical pathways (CPWs) are patient management tools based on a standardized treatment plan aimed at improving quality of care. This study aimed to investigate whether CPW-guided treatment has a favorable impact on the outcomes of hospitalized older patients with aspiration pneumonia. Method : This retrospective study included patients with aspiration pneumonia, aged ≥ 65 years, and hospitalized at a community hospital in Japan. CPW implementation was arbitrarily determined by the attending physician upon admission. Outcomes were compared according to with or without the CPW (CPW-group and non-CPW groups). Propensity score (PS)-based analyses were used to control for confounding factors. Logistic regression analyses were conducted to evaluate the impact of CPW on the clinical course and outcomes. Results : Of 596 included patients, 167 (28%) received the CPW-guided treatment. The mortality rate was 16.4%. In multivariable model, CPW implementation did not increase the risk for total and 30-day mortality, and resulted in shorter antibiotic therapy duration (≤9 days) (PS matching (PSM): odds ratio (OR) 0.50, p = 0.001; inverse provability of treatment weighting (IPTW): OR 0.48, p < 0.001) and length of hospital stay (≤21 days) (PSM: OR 0.67, p = 0.05; IPTW: OR 0.66, p = 0.03). Conclusions : This study support CPW utility in this population.
Keywords	aspiration pneumonia ; clinical pathway ; propensity score ; propensity score matching ; inverse probability of treatment weighting ; older patients ; Medicine ; R
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Effect of multidrug therapy on the prognosis of Mycobacterium avium complex pulmonary disease.

Ushiki, Atsuhito / Tanaka, Shunnosuke / Yamanaka, Miwa / Akahane, Jumpei / Ikuyama, Yuichi / Komatsu, Masamichi / Sonehara, Kei / Ichiyama, Takashi / Wada, Yosuke / Tateishi, Kazunari / Kitaguchi, Yoshiaki / Hanaoka, Masayuki

Scientific reports

2024 Volume 14, Issue 1, Page(s) 4438

Abstract: Multidrug therapy for Mycobacterium avium complex pulmonary disease (MAC-PD) results in negative sputum cultures. However, the prognostic value of this treatment approach remains unclear. This study aimed to clarify whether multidrug therapy reduces the ... ...

Abstract	Multidrug therapy for Mycobacterium avium complex pulmonary disease (MAC-PD) results in negative sputum cultures. However, the prognostic value of this treatment approach remains unclear. This study aimed to clarify whether multidrug therapy reduces the incidence of events related to MAC-PD and improves the mortality rate. Patients who met the diagnostic criteria for MAC-PD at our hospital between 2003 and 2019 were retrospectively evaluated using medical records. Events related to MAC-PD were defined as hospitalisation for haemoptysis or respiratory infection and the development of chronic respiratory failure. There were 90 and 108 patients in the multidrug and observation groups, respectively. The median observation period was 86 months. Intergroup differences in body mass index, proportion of patients with cavities, and erythrocyte sedimentation rate were not significant. However, the observation group was older with a higher mean age (multidrug group: 62 years, observation group: 69 years; P < 0.001) and had a higher proportion of male patients (multidrug group: 13/90 [14.4%], observation group: 35/108 [32.4%]; P < 0.01). Furthermore, intergroup differences in the incidence of events related to MAC-PD (multidrug group: 26.69/1000 person-years, observation group: 25.49/1000 person-years), MAC-PD-associated mortality rate (multidrug group: 12.13/1000 person-years, observation group: 12.74/1000 person-years), and total mortality (multidrug group: 24.26/1000 person-years, observation group: 29.50/1000 person-years) were not significant. Many patients relapse even after multidrug therapy, and our findings suggest that multidrug therapy has no effect in preventing the onset of respiratory events or prolonging life expectancy.
MeSH term(s)	Humans ; Male ; Middle Aged ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/microbiology ; Retrospective Studies ; Drug Therapy, Combination ; Leprostatic Agents/pharmacology ; Lung Diseases/microbiology ; Prognosis
Chemical Substances	Leprostatic Agents
Language	English
Publishing date	2024-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-55135-0
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Article: A Case of Lung Adenocarcinoma with Long-Term Response after Late-Onset Pembrolizumab-Induced Acute Adrenal Insufficiency.

Sonehara, Kei / Tateishi, Kazunari / Hirabayashi, Taro / Araki, Taisuke / Ikuyama, Yuichi / Machida, Ryosuke / Hanaoka, Masayuki

Case reports in oncology

2021 Volume 14, Issue 1, Page(s) 1–7

Abstract: Pembrolizumab is an anti-programmed cell death protein-1 antibody that is mainly used for the treatment of non-small cell lung cancer (NSCLC). Immune-related adverse events can be caused by immune checkpoint inhibitors; however, few case reports evaluate ...

Abstract	Pembrolizumab is an anti-programmed cell death protein-1 antibody that is mainly used for the treatment of non-small cell lung cancer (NSCLC). Immune-related adverse events can be caused by immune checkpoint inhibitors; however, few case reports evaluate the prognosis of patients with NSCLC with late-onset immune-related adverse events. In this case, a 63-year-old man with stage IVA lung adenocarcinoma received pembrolizumab as first-line therapy and achieved a complete response. The patient developed hypothyroidism and skin toxicity owing to pembrolizumab over the course of treatment; however, the patient continued with pembrolizumab. The patient discontinued pembrolizumab after 20 cycles owing to appetite loss from 14 months after the initiation of pembrolizumab. Two months later, the symptoms worsened and the patient was taken to hospital by an ambulance owing to movement difficulty. The patient was diagnosed with acute adrenal insufficiency by endocrinological examinations. The condition of the patient improved after hydrocortisone treatment. Sixteen months have passed without the readministration of pembrolizumab and no recurrence of lung adenocarcinoma has been observed. Late-onset, severe, and diverse immune-related adverse events may be a favorable prognostic factor associated with survival.
Language	English
Publishing date	2021-01-11
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2458961-5
ISSN	1662-6575
ISSN	1662-6575
DOI	10.1159/000508068
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Article ; Online: Prognostic value of geriatric nutritional risk index for aspiration pneumonia: a retrospective observational cohort study.

Araki, Taisuke / Yamazaki, Yoshitaka / Goto, Norihiko / Takahashi, Yuko / Ikuyama, Yuichi / Kosaka, Makoto

Aging clinical and experimental research

2021 Volume 34, Issue 3, Page(s) 563–571

Abstract: Background: The clinical characteristics and prognostic factors of aspiration pneumonia remain poorly defined. Geriatric nutrition risk index (GNRI) has recently been reported to exhibit a prognostic value for several diseases in older adults.: Aims: ...

Abstract	Background: The clinical characteristics and prognostic factors of aspiration pneumonia remain poorly defined. Geriatric nutrition risk index (GNRI) has recently been reported to exhibit a prognostic value for several diseases in older adults. Aims: We investigated the clinical characteristics and prognostic significance of GNRI for aspiration pneumonia in older adult patients. Methods: In this retrospective observational cohort study, conducted in a single-institute acute-phase community hospital, patients with aspiration pneumonia diagnosed at our institute between April 2014 and March 2016 were enrolled. Data on patient characteristics, microbiological findings, and clinical course were collected. The outcome was in-hospital mortality. Receiver operating characteristic curve (ROC) analysis was conducted to compare the predictive value of each parameter. Logistic regression analysis was performed to identify independent prognostic factors. Results: Overall, 587 aspiration pneumonia patients aged ≥ 65 years were enrolled. Their mean age was 86 years. Among them, 97 (16.5%) died. In ROC analysis for in-hospital mortality, as compared to albumin, body mass index, and A-DROP score, GNRI had a greater area under the curve value, with a significant difference between GNRI and albumin (p = 0.0058). Male sex (p = 0.028), chronic heart failure (p = 0.023), history of malignancy (p = 0.0025), lower GNRI (p < 0.001), and initial antibiotic change (p < 0.001) were identified as independent adverse prognostic factors in multivariate analysis. Discussion and conclusions: Our findings indicate that GNRI is a potential prognostic marker for older adults with aspiration pneumonia and may act as a proxy for disease severity. Our results support the use of GNRI in the clinical management of aspiration pneumonia.
MeSH term(s)	Aged ; Aged, 80 and over ; Geriatric Assessment/methods ; Humans ; Male ; Malnutrition/diagnosis ; Nutrition Assessment ; Nutritional Status ; Pneumonia, Aspiration ; Prognosis ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-08-11
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	2104785-6
ISSN	1720-8319 ; 1594-0667
ISSN (online)	1720-8319
ISSN	1594-0667
DOI	10.1007/s40520-021-01948-2
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Article ; Online: Obstructive Pneumonia Associated with Endobronchial Aspergilloma: Successful Treatment with Interventional Bronchoscopy and Antifungals.

Komatsu, Masamichi / Yasuo, Masanori / Wada, Yosuke / Takata, Munetake / Azuhata, Hisanori / Ikuyama, Yuichi / Akahane, Jumpei / Sonehara, Kei / Ushiki, Atsuhito / Yamamoto, Hiroshi / Hanaoka, Masayuki

Internal medicine (Tokyo, Japan)

2022 Volume 61, Issue 17, Page(s) 2643–2647

Abstract: Endobronchial aspergilloma is a rare disease. A 64-year-old man with severe diabetes mellitus developed a cough and fever and was referred to our hospital. He was diagnosed with obstructive pneumonia associated with endobronchial aspergilloma, underwent ... ...

Abstract	Endobronchial aspergilloma is a rare disease. A 64-year-old man with severe diabetes mellitus developed a cough and fever and was referred to our hospital. He was diagnosed with obstructive pneumonia associated with endobronchial aspergilloma, underwent interventional bronchoscopy, and was treated with antifungals. While the optimal treatment has not been established, interventional bronchoscopy along with systemic antifungals may improve the outcome in such cases.
MeSH term(s)	Antifungal Agents/therapeutic use ; Bronchoscopy ; Humans ; Male ; Middle Aged ; Pneumonia ; Pulmonary Aspergillosis/complications ; Pulmonary Aspergillosis/diagnostic imaging ; Pulmonary Aspergillosis/drug therapy
Chemical Substances	Antifungal Agents
Language	English
Publishing date	2022-02-08
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	32371-8
ISSN	1349-7235 ; 0021-5120 ; 0918-2918
ISSN (online)	1349-7235
ISSN	0021-5120 ; 0918-2918
DOI	10.2169/internalmedicine.8202-21
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Article ; Online: Usual Interstitial Pneumonia Pattern Interstitial Lung Disease Developed in a Patient with IgG4-related Chronic Sclerosing Sialadenitis.

Yamamoto, Hiroshi / Komatsu, Masamichi / Sonehara, Kei / Ikuyama, Yuichi / Urushihata, Kazuhisa / Tateishi, Kazunari / Kitaguchi, Yoshiaki / Ushuiki, Atsuhito / Asaka, Shiho / Uehara, Takeshi / Kawakami, Satoshi / Mori, Kentaro / Hamanaka, Kazutoshi / Nishie, Kenichi / Hebisawa, Akira / Hanaoka, Masayuki

Internal medicine (Tokyo, Japan)

2022 Volume 61, Issue 17, Page(s) 2637–2642

Abstract: A 69-year-old man was diagnosed with immunoglobulin (Ig) G4-related disease (IgG4-RD) at 62 years old. At that time, he had high serum IgG4 levels and bilateral submandibular gland swelling on CT; thus, a gland biopsy was performed. Because a reticular ... ...

Abstract	A 69-year-old man was diagnosed with immunoglobulin (Ig) G4-related disease (IgG4-RD) at 62 years old. At that time, he had high serum IgG4 levels and bilateral submandibular gland swelling on CT; thus, a gland biopsy was performed. Because a reticular shadow was found on chest CT, a lung surgical biopsy was also performed. The specimens revealed usual interstitial pneumonia (UIP) pattern interstitial pneumonia with some IgG4-positive cells. The patient was subsequently followed up without treatment. His forced vital capacity and radiological findings progressively deteriorated, consistent with UIP pattern interstitial lung disease but different from a lung lesion of IgG4-RD.
MeSH term(s)	Aged ; Autoimmune Diseases/pathology ; Chronic Disease ; Humans ; Idiopathic Pulmonary Fibrosis ; Immunoglobulin G ; Immunoglobulin G4-Related Disease ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/diagnostic imaging ; Male ; Middle Aged ; Sialadenitis/complications ; Sialadenitis/diagnosis
Chemical Substances	Immunoglobulin G
Language	English
Publishing date	2022-02-08
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	32371-8
ISSN	1349-7235 ; 0021-5120 ; 0918-2918
ISSN (online)	1349-7235
ISSN	0021-5120 ; 0918-2918
DOI	10.2169/internalmedicine.8937-21
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Article ; Online: Blood urea nitrogen-to-serum albumin ratio and A-DROP are useful in assessing the severity of Pneumocystis pneumonia in patients without human immunodeficiency virus infection.

Akahane, Jumpei / Ushiki, Atsuhito / Kosaka, Makoto / Ikuyama, Yuichi / Matsuo, Akemi / Hachiya, Tsutomu / Yoshiike, Fumiaki / Koyama, Shigeru / Hanaoka, Masayuki

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

2020 Volume 27, Issue 5, Page(s) 707–714

Abstract: Introduction: There 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. ... ...

Abstract	Introduction: There 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. Methods: This 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. Results: Overall, 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. Conclusions: In 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.
MeSH term(s)	Blood Urea Nitrogen ; HIV Infections/complications ; Humans ; Pneumonia, Pneumocystis/diagnosis ; Pneumonia, Pneumocystis/epidemiology ; Retrospective Studies ; Serum Albumin
Chemical Substances	Serum Albumin
Language	English
Publishing date	2020-12-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1355399-9
ISSN	1437-7780 ; 1341-321X
ISSN (online)	1437-7780
ISSN	1341-321X
DOI	10.1016/j.jiac.2020.12.017
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Article ; Online: Prognosis of patients with acute exacerbation of combined pulmonary fibrosis and emphysema: a retrospective single-centre study.

Ikuyama, Yuichi / Ushiki, Atsuhito / Kosaka, Makoto / Akahane, Jumpei / Mukai, Yuichi / Araki, Taisuke / Kitaguchi, Yoshiaki / Tateishi, Kazunari / Urushihata, Kazuhisa / Yasuo, Masanori / Yamamoto, Hiroshi / Hanaoka, Masayuki

BMC pulmonary medicine

2020 Volume 20, Issue 1, Page(s) 144

Abstract: Background: Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute ... ...

Abstract	Background: Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute exacerbations (AE) of CPFE. Methods: We retrospectively reviewed the medical records of patients who had been treated at the Shinshu University Hospital (Matsumoto, Japan) between 2003 and 2017. We identified 21 patients with AE of CPFE and 41 patients with AE of idiopathic pulmonary fibrosis (IPF) and estimated their prognoses using the Kaplan-Meier method. Results: Treatment content and respiratory management were not significantly different between the two groups before and after exacerbation. At the time of AE, the median serum Krebs von den Lungen-6 level was significantly lower in the CPFE group (Krebs von den Lungen-6: 966 U/μL; white blood cell count: 8810 /μL) than that in the IPF group (Krebs von den Lungen-6: 2130 U/μL, p < 0.001; white blood cells: 10809/μL, p = 0.0096). The baseline Gender-Age-Physiology scores were not significantly different between the two groups (CPFE, 4.5 points; IPF, 4.7 points; p = 0.58). Kaplan-Meier curves revealed that the survival time after AE for patients with CPFE was longer than that for patients with IPF (p < 0.001, log-rank test). Conclusions: Survival prognoses after AE were significantly better for patients with CPFE than that for those with IPF. Our findings may improve the medical treatment and respiratory management of patients with AE-CPFE.
MeSH term(s)	Aged ; Disease Progression ; Female ; Humans ; Idiopathic Pulmonary Fibrosis/diagnostic imaging ; Idiopathic Pulmonary Fibrosis/epidemiology ; Japan ; Male ; Prognosis ; Pulmonary Emphysema/diagnostic imaging ; Pulmonary Emphysema/epidemiology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Analysis ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-05-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-020-01185-9
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Article ; Online: A Four-Center Retrospective Study of the Efficacy and Toxicity of Low-Dose Trimethoprim-Sulfamethoxazole for the Treatment of Pneumocystis Pneumonia in Patients without HIV Infection.

Kosaka, Makoto / Ushiki, Atsuhito / Ikuyama, Yuichi / Hirai, Kazuya / Matsuo, Akemi / Hachiya, Tsutomu / Hanaoka, Masayuki

Antimicrobial agents and chemotherapy

2017 Volume 61, Issue 12

Abstract: The dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment ... ...

Abstract	The dose of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of
MeSH term(s)	Aged ; Female ; Humans ; Male ; Pneumocystis carinii/drug effects ; Pneumonia, Pneumocystis/drug therapy ; Pneumonia, Pneumocystis/mortality ; Pneumonia, Pneumocystis/parasitology ; Retrospective Studies ; Survival Rate ; Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
Chemical Substances	Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2017-11-22
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/AAC.01173-17
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