研究者詳細 - 吉野　鉄大

論文 - 吉野　鉄大

分割表示 124 件中 41 - 60 件目／全件表示 >>

虚実中間証を含む虚実証の予測モデル

前田絢子, 吉野鉄大, 片山琴絵, 堀場裕子, 引網宏彰, 嶋田豊, 並木隆雄, 田原英一, 南澤潔, 村松慎一, 山口類, 井元清哉, 宮野悟, 美馬秀樹, 三村將, 中村智徳, 渡辺賢治

日本東洋医学雑誌（(一社)日本東洋医学会） 71 （ 4 ） 315 - 325 2020年10月

ISSN 0287-4857

[目的]自動問診システムを用いて得た患者問診結果から医師の虚実診断を予測するモデルを構築したが、既報のモデルは中間証を予測できなかった。本研究では、中間証を含む虚実予測モデルを構築し施設間でカットオフ値を比較した。[方法]2012年1月-2015年2月に6施設を初めて受診し研究に同意した患者を対象とした。データ欠損、20歳未満、問診項目回答数が20項目未満、対象でない証の患者を除外した。ランダムフォレストを用いて、6施設統合データより抽出した学習データから虚実予測モデルを構築した。[結果]施設毎に学習データを除いたデータから虚実予測値を算出した。医師の診断結果をもとに受信者動作特性曲線からカットオフ値を求めたところ、全施設の虚実予測値のカットオフ値は虚証と中間証が0.5以下、実証と中間証が0.5以上であった。[考察]虚実予測モデルより計算した全施設のカットオフ値は狭い範囲に収まっていた。(著者抄録)

中村智徳, 吉野鉄大, 堀場裕子, 渡辺賢治, 三村將, 小川恵子, 南澤潔, 並木隆雄 and 牧野利明

医薬品相互作用研究 44 （ 2 ） 75 - 86 2020年09月

ISSN 0385-5015

Discrimination of prediction models between cold-heat and deficiency-excess patterns

Maeda-Minami A., Yoshino T., Katayama K., Horiba Y., Hikiami H., Shimada Y., Namiki T., Tahara E., Minamizawa K., Muramatsu S., Yamaguchi R., Imoto S., Miyano S., Mima H., Mimura M., Nakamura T., Watanabe K.

Complementary Therapies in Medicine （Complementary Therapies in Medicine） 49 102353 - 102353 2020年03月

査読有り, ISSN 09652299

Objective: The purpose of this study was to extract important patient questionnaire items by creating random forest models for predicting pattern diagnosis considering an interaction between deficiency-excess and cold-heat patterns. Design: A multi-centre prospective observational study. Setting: Participants visiting six Kampo speciality clinics in Japan from 2012 to 2015. Main outcome measure: Deficiency–excess pattern diagnosis made by board-certified Kampo experts. Methods: We used 153 items as independent variables including, age, sex, body mass index, systolic and diastolic blood pressures, and 148 subjective symptoms recorded through a questionnaire. We sampled training data with an equal number of the different patterns from a 2 × 2 factorial combination of deficiency–excess and cold–heat patterns. We constructed the prediction models of deficiency–excess and cold–heat patterns using the random forest algorithm, extracted the top 10 essential items, and calculated the discriminant ratio using this prediction model. Results: BMI and blood pressure, and subjective symptoms of cold or heat sensations were the most important items in the prediction models of deficiency–excess pattern and of cold–heat patterns, respectively. The discriminant ratio was not inferior compared with the result ignoring the interaction between the diagnoses. Conclusions: We revised deficiency–excess and cold–heat pattern prediction models, based on balanced training sample data obtained from six Kampo speciality clinics in Japan. The revised important items for diagnosing a deficiency–excess pattern and cold–heat pattern were compatible with the definition in the 11th version of international classification of diseases.

Access to Document (DOI)

Prediction of Deficiency, Medium, and Excess Patterns in Japanese Kampo Medicine: A Multicenter Prospective Observational Study

Ayako Maeda-Minami, Tetsuhiro Yoshino, Yuko Horiba, Hiroaki Hikiami, Yutaka Shimada, Takao Namiki, Eiichi Tahara, Kiyoshi Minamizawa, Shinichi Muramatsu, Masaru Mimura, Tomonori Nakamura, Kenji Watanabe

2020年

Access to Document (DOI)

こんな人が来ている漢方外来

鉄大, 吉野

2020年

Japanese government research grants for Kampo medicine: aAn overview of 10 years (1997-2017).

Hyun MK, Yoon HY, Yoshino T, Park MJ

Integrative medicine research 8 （ 4 ） 279 - 283 2019年12月

査読有り, ISSN 2213-4220

Access to Document (DOI)

Identification of glycyrrhizin metabolites in humans and of a potential biomarker of liquorice-induced pseudoaldosteronism: a multi-centre cross-sectional study

Takahashi K., Yoshino T., Maki Y., Ishiuchi K., Namiki T., Ogawa-Ochiai K., Minamizawa K., Makino T., Nakamura T., Mimura M., Watanabe K.

Archives of Toxicology （Archives of Toxicology） 93 （ 11 ） 3111 - 3119 2019年11月

査読有り, ISSN 03405761

Liquorice [main ingredient, glycyrrhizin (GL)] is widely used as a food sweetener and herbal medicine. Occasionally, liquorice consumption causes pseudoaldosteronism as a side effect which causes oedema, hypokalaemia, and hypertension due to hyperactivity of mineral corticoid receptor. We aimed to detect GL metabolites in human blood and urine samples and to determine the pathological relationship between GL metabolites and pseudoaldosteronism. For this multi-centre, retrospective, cross-sectional study, we recruited patients who had visited Center for Kampo Medicine in Keio University Hospital, Department of Japanese Oriental (Kampo) Medicine in Chiba University Hospital, Clinic of Japanese Oriental (Kampo) Medicine in Kanazawa University Hospital, and Department of Oriental Medicine in Kameda Medical Center from November 2011 to July 2018. We collected laboratory data including concentration of serum potassium, plasma activity of renin and aldosterone, and residual blood and/or urine samples of participants who had experienced symptoms/signs of pseudoaldosteronism in the form of increase in blood pressure and occurrence or aggregation of oedema while taking liquorice-containing herbal preparations, and measured GL metabolites using a highly selective liquid chromatography tandem mass spectrometer system. We registered 97 participants (mean age 60 ± 15 years; male:female 14:83). 18β-glycyrrhetinic acid (GA) was detected in 67 serum samples (median 122 nM, range 5 nM–1.8 µM) and 18β-glycyrrhetyl-3-O-sulfate (compound 3) in 68 samples (median 239 nM, range 2 nM–4.2 µM). 3-Monoglucuronyl 18β-glycyrrhetinic acid, 22α-hydroxy-18β-glycyrrhetyl-3-O-sulfate-30-glucuronide, 22α-hydroxy-18β-glycyrrhetyl-3-O-sulfate, and GL itself were not or rarely detected. We could not find any correlation between blood pressure or peripheral oedema and serum concentration of GL metabolites. Sulfotransferase 2A1 catalysed the metabolic reaction of GA to compound 3, a major GL metabolite in human blood. High serum concentration of compound 3 was related to lower renin, aldosterone, and potassium levels, suggesting a pathological relationship between compound 3 and liquorice-induced pseudoaldosteronism. This is the first study to identify the association between a novel metabolite, compound 3, and the incidence of pseudoaldosteronism, highlighting it as a promising biomarker.

Access to Document (DOI)

Differences in demographics and complementary and alternative medicine use between patients attending integrative kampo versus biomedical clinics in Japan

Melby M., Yoshino T., Tonob D., Horiba Y., Watanabe K.

Complementary Therapies in Medicine （Complementary Therapies in Medicine） 46 202 - 209 2019年10月

査読有り, ISSN 09652299

© 2019 Elsevier Ltd Objectives: Growing interest in integrative medicine motivates examination of who seeks integrative care, and why. By examining differences in demographics and complementary and alternative medicine (CAM) use between patients recruited from Japanese Kampo (traditional herbal medicine) versus biomedical clinics, this study aimed to identify whether integrative medicine options might attract different patients. Design and setting: In this cross-sectional, observational study we administered the International Complementary and Alternative Medicine-Questionnaire (I-CAM-Q) to 209 patients recruited from four hospital clinics. Demographics, use of different types of CAM (self-help CAM, CAM practitioners, CAM products), and motivations were compared between Kampo and Non-Kampo patients and by gender. Factors influencing attendance at the Kampo clinic and CAM use were identified using logistic regression. Results: While some demographic characteristics, CAM provider and total CAM use differed between Kampo and non-Kampo patients, self-help CAM use did not. Motivations (for acute, long-term, health maintenance, or other reasons) differed between Kampo and non-Kampo clinic patients for going to non-Kampo physicians (P = 0.02) and Kampo physicians (P = 0.1). Logistic regression results for ‘any CAM’ use showed odds ratio of 0.32 (95%CI 0.15-0.67) for self-rated health, and 1.60 (95%CI 1.10–2.32) for Macarthur subjective social status scale. Attendance at the Kampo clinic showed odds ratios of 1.50 (95%CI 1.11–2.02) for education and 0.56 (95%CI 0.39-0.80) for employment status. Conclusions: Better understanding of factors such as motivation, self-rated health, and socioeconomic conditions that influence patients’ CAM use and integrative clinic attendance may enable more effective targeting of populations and integration of CAM into biomedical settings.

Access to Document (DOI)

Classification of patients with cold sensation by a review of systems database: A single-centre observational study

Yoshino T., Katayama K., Yamaguchi R., Imoto S., Miyano S., Mima H., Watanabe K.

Complementary Therapies in Medicine （Complementary Therapies in Medicine） 45 7 - 13 2019年08月

査読有り, ISSN 09652299

© 2019 Elsevier Ltd Objectives: In Kampo medicine, a traditional medicine pattern(TM1) refers to the complete clinical presentation of the patient at a given moment in time. Candidate herbal formulas are chosen for a chief complaint, and an appropriate formula is determined on the basis of the pattern(TM1) diagnosis. In this study, we demonstrated the importance of accompanying symptoms in diagnosing traditional medicine patterns(TM1). Design: Single centre observational study. Setting: We analysed data from 524 new patients with a hypersensitivity to cold sensation as their primary diagnosis (mean age 51.6 ± 17.8 years; female ratio 82.1%) who visited the Keio University Hospital Kampo Clinic between 2008 and 2013. Main outcome measures: Accompanying symptoms were recorded on the browser-based e-questionnaire system, which contained 128 items. The Japan Society for Oriental Medicine's board certified Kampo specialists diagnosed the traditional medicine patterns(TM1). Results: When participants were classified according to the origin of their cold sensation, there were no differences in their traditional medicine patterns. In contrast, when patients were classified based on the number of accompanying symptoms, a significant difference in the patterns was identified. An increasing number of accompanying symptoms was associated with more frequent qi stagnation and blood stasis pattern(TM1). Patients with a qi stagnation pattern had higher rates of depression and insomnia. In contrast, patients with a blood stasis pattern(TM1), had higher rates of acne, body stiffness, and menstrual abnormality. Conclusions: Qi stagnation and blood stasis patterns(TM1) are related to a number of different accompanying symptoms in the patients with hypersensitivity to cold sensation.

Access to Document (DOI)

Prediction of deficiency-excess pattern in Japanese Kampo medicine: Multi-centre data collection

Complementary Therapies in Medicine （Complementary Therapies in Medicine） 45 228 - 233 2019年08月

査読有り, ISSN 09652299

© 2019 Elsevier Ltd Objective: The purpose of the present study was to compare important patient questionnaire items by creating a random forest model for predicting deficiency-excess pattern diagnosis in six Kampo specialty clinics. Design: A multi-centre prospective observational study. Setting: Participants who visited six Kampo specialty clinics in Japan from 2012 to 2015. Main outcome measure: Deficiency-excess pattern diagnosis made by board-certified Kampo experts. Methods: To predict the deficiency-excess pattern diagnosis by Kampo experts, we used 153 items as independent variables, namely, age, sex, body mass index, systolic and diastolic blood pressures, and 148 subjective symptoms recorded through a questionnaire. We extracted the 30 most important items in each clinic's random forest model and selected items that were common among the clinics. We integrated participating clinics’ data to construct a prediction model in the same manner. We calculated the discriminant ratio using this prediction model for the total six clinics’ data and each clinic's independent data. Results: Fifteen items were commonly listed in top 30 items in each random forest model. The discriminant ratio of the total six clinics’ data was 82.3%; moreover, with the exception of one clinic, the independent discriminant ratio of each clinic was approximately 80% each. Conclusions: We identified common important items in diagnosing a deficiency-excess pattern among six Japanese Kampo clinics. We constructed the integrated prediction model of deficiency-excess pattern.

Access to Document (DOI)

易怒性を伴う高齢者の便秘症状に大承気湯が奏効し、治療後にアルツハイマー型認知症の合併が明らかになった2例

小池宙, 吉野鉄大, 中澤敦, 堀場裕子, 足立智英, 渡辺賢治

日本東洋医学雑誌（(一社)日本東洋医学会） 70 （ 3 ） 219 - 226 2019年07月

ISSN 0287-4857

[緒言]大承気湯により便秘と精神状態が改善した後、アルツハイマー型認知症が明らかとなった便秘型過敏性腸症候群の2例を報告する。[症例1]82歳男性。過敏性腸症候群に対して整腸剤や下剤で治療を受けるも改善せず精神状態も不安定だった。大承気湯を開始後、消化器症状は精神状態とともに安定した。その後の検査でアルツハイマー型認知症が明らかになった。[症例2]74歳男性。強い便秘症状があり浣腸と摘便を時に怒りを表出しながら強く希望し受診していた。大承気湯開始後、便秘は改善し精神状態も安定した。その後アルツハイマー型認知症が明らかとなった。[考察]易怒性を伴う便秘に大承気湯が有効だった2例を経験した。自覚なく未診断だったアルツハイマー型認知症が背景に存在し、そのストレスが便秘型過敏性腸症候群の増悪因子だったと考えられた。易怒性を伴う便秘患者には認知症が隠れている可能性があり注意する必要がある。(著者抄録)

Risk factors associated with pseudoaldosteronism in patients with chronic hepatitis: A retrospective cohort study

Komatsu A., Yoshino T., Suzuki T., Nakamura T., Kanai T., Watanabe K.

Basic and Clinical Pharmacology and Toxicology （Basic and Clinical Pharmacology and Toxicology） 124 （ 5 ） 607 - 614 2019年05月

査読有り, ISSN 17427835

© 2018 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society) Glycyrrhizin is used to treat chronic hepatitis, but it also plays an important role in pseudoaldosteronism. Multidrug resistance-associated protein 2 is important for glycyrrhizin excretion. Dysfunction of this transporter increases the serum levels of direct bilirubin, glycyrrhizin and its metabolites. Hence, elevated direct-bilirubin levels could predict the risk of pseudoaldosteronism. This study aimed to evaluate the relationship between elevated direct-bilirubin levels and hypokalaemia, which is the most sensitive marker of pseudoaldosteronism. This retrospective cohort study was conducted in a Japanese university hospital. The occurrence of hypokalaemia is defined as a serum potassium level of ≤3.5 mEq/L after the administration of a glycyrrhizin-containing medication, and a further decline of ≥0.5 mEq/L or an increase of ≥0.5 mEq/L after discontinuing the glycyrrhizin-containing medication was examined in patients with chronic hepatitis between January 2009 and December 2015. This analysis involved 1392 patients, including 596 women. Hepatitis C virus infections were the most common cause of chronic hepatitis in this study. Seventy-nine patients received glycyrrhizin (exposed group; mean age: 60.5 ± 14.2) and 1313 did not receive glycyrrhizin (control group; mean age: 58.3 ± 15.8 years). Synergistic effects of glycyrrhizin-containing medications and elevated direct-bilirubin levels were associated with hypokalaemia. Elevated direct-bilirubin levels and hypoalbuminaemia were associated with hypokalaemia in the exposed group. Older age, female sex, high daily glycyrrhizin dosage, longer duration of glycyrrhizin intake, and potassium-lowering medications were not associated with hypokalaemia after the model adjustment. Elevated direct-bilirubin levels and hypoalbuminaemia may predict pseudoaldosteronism caused by glycyrrhizin.

Access to Document (DOI)

Clinical Roundup: Selected Treatment Options for Respiratory Infections

吉野鉄大

Alternative and Complementary Therapies 25 （ 2 ） 116 - 119 2019年04月

査読有り

Access to Document (DOI)

The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: A systematic review and meta-analysis

Yoshino T., Arita R., Horiba Y., Watanabe K.

BMC Complementary and Alternative Medicine （BMC Complementary and Alternative Medicine） 19 （ 1 ） 68 - 68 2019年03月

査読有り

© 2019 The Author(s). Background: Influenza is a common viral infection worldwide. Maoto (ma-huang-tang) was developed in ancient China and is used to alleviate flu symptoms. Currently, no meta-analyses have evaluated the efficacy and safety of maoto for alleviating flu symptoms. Methods: In the present study, we searched MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, a Japanese database (Ichushi), two Chinese databases (China National Knowledge Infrastructure and VIP), and two Korean databases (Korean Medical database and Korean Association of Medical Journal Editors) for studies published in or before October 2017. Clinical studies that compared maoto plus neuraminidase inhibitors (NAIs) vs. NAIs alone, or maoto alone vs. NAIs alone, were included in the present analysis. The primary outcome measure (efficacy) was the length of time from the start of medication to resolution of influenza symptoms (fever, headache, malaise, myalgia, and chills) and virus isolation. The secondary outcome measures (safety) were as follows: (1) side effects and adverse reactions, such as nausea, abnormal behaviour, or discontinuation of symptomatic treatment; (2) morbidity (complications caused by influenza infection) or mortality; and (3) hospitalisation for any reason. Results: Twelve relevant studies were identified, including two randomised controlled trials (RCTs, N = 60) and ten non-randomised studies (NRSs, N = 1110). We found that maoto plus NAIs was superior to NAIs alone in terms of the duration of fever in one RCT (P < 0.05, median difference = - 6 h) and four NRSs (P = 0.003, weighted mean difference = - 5.34 h). The duration of symptoms or virus isolation did not differ between maoto and NAIs. No severe side effects or adverse reactions were reported related to maoto or NAIs. Conclusions: Although we could not reach a definitive conclusion because of the small sample sizes and high risk of bias in the analysed studies, maoto may lower the duration of fever when it is used alone or in combination with NAIs and may be a well-tolerated treatment. More RCTs are needed to determine the efficacy and safety of maoto.

Access to Document (DOI)

証を見極め風邪の漢方を使い分ける

鉄大, 吉野

2019年

Pseudoaldosteronism as an adverse effect of Glycyrrhiza intake: pathophysiology and detection of the causative metabolite

Yoshino, Tetsuhiro

2019年

Use of maoto (Ephedra Decoction) to Alleviate Flu Symptoms

Tetsuhiro Yoshino, Ryutaro Arita, Yuko Horiba, Watanabe, Kenji

2019年

Relationship Between the Frequency of Accompanying Symptoms and Traditional Medicine Pattern Diagnosis

Yoshino, Tetsuhiro

2019年

臨床研究論文の読み方

吉野鉄大

2019年

不定愁訴に使える漢方

鉄大, 吉野

2019年

　前のページ - 次のページ　

吉野 鉄大

論文 - 吉野 鉄大

吉野　鉄大

論文 - 吉野　鉄大