徳重 明央 (トクシゲ アキヒロ)

Tokushige Akihiro

写真a

職名

准教授

科研費研究者番号

70780287

現在の所属組織 【 表示 / 非表示

  • 専任   琉球大学   医学研究科   准教授  

取得学位 【 表示 / 非表示

  • 鹿児島大学 -  博士(医学)  医学

職歴 【 表示 / 非表示

  • 2012年01月
    -
    2015年12月

      鹿児島大学医学部  

  • 2016年01月
    -
    2016年03月

      鹿児島大学病院  

  • 2016年04月
    -
    2019年03月

      琉球大学大学院医学研究科  

  • 2016年04月
    -
    2019年03月

      琉球大学 医学研究科 助教  

  • 2019年04月
    -
    2021年08月

      鹿児島大学大学院医歯学総合研究科  

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研究分野 【 表示 / 非表示

  • ライフサイエンス / 循環器内科学

  • 臨床薬理学

  • ライフサイエンス / 医療管理学、医療系社会学

論文 【 表示 / 非表示

  • Secondary rotational atherectomy is associated with reduced occurrence of prolonged ST-segment elevation following ablation.

    Daisuke Kanda, Takuro Takumi, Ryo Arikawa, Kazuhiro Anzaki, Takeshi Sonoda, Kenta Ohmure, Daichi Fukumoto, Akihiro Tokushige, Mitsuru Ohishi

    Internal and emergency medicine   18 ( 7 ) 1995 - 2002   2023年10月 [ 査読有り ]

    掲載種別: 研究論文(学術雑誌)

     概要を見る

    Elevation of the ST segment after percutaneous coronary intervention (PCI) using rotational atherectomy (RA) for severely calcified lesions often persists after disappearance of the slow-flow phenomenon on angiography. We investigated clinical factors relevant to prolonged ST-segment elevation following RA among 152 patients with stable angina undergoing elective PCI. PCI procedures were divided into two strategies, RA without (primary RA strategy) or with (secondary RA strategy) balloon dilatation before RA. Incidence of prolonged ST-segment elevation after disappearance of slow-flow phenomenon was higher in the 56 patients with primary RA strategy (13%) than in the 96 patients with secondary RA strategy (3%, p = 0.039). Univariate logistic regression analysis showed levels of low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.93-0.99; p = 0.013), levels of triglycerides (OR 0.97, 95%CI 0.94-0.99; p = 0.040), and secondary RA strategy (OR 0.23, 95% CI 0.05-0.85; p = 0.028) were inversely associated with occurrence of prolonged ST-segment elevation following ablation. However, hemodialysis, diabetes mellitus, left-ventricular ejection fraction, lesion length ≥ 20 mm, and burr size did not show significant associations. Multivariate logistic regression analysis modeling revealed that secondary RA strategy was significantly associated with the occurrence of prolonged ST-segment elevation (Model 1: OR 0.24, 95% CI 0.05-0.95, p = 0.042; Model 2: OR 0.17, 95% CI 0.03-0.68, p = 0.018; Model 3: OR 0.21, 95% CI 0.03-0.87, p = 0.041) even after adjusting for levels of LDL-C and triglycerides. Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following RA.

  • Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention.

    Shimono H, Tokushige A, Kanda D, Ohno A, Hayashi M, Fukuyado M, Akao M, Kawasoe M, Arikawa R, Otsuji H, Chaen H, Okui H, Oketani N, Ohishi M

    Heart and vessels ( Heart and Vessels )  38 ( 10 ) 1205 - 1217   2023年10月 [ 査読有り ]

    掲載種別: 研究論文(学術雑誌)

     概要を見る

    There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.

  • Agile 3+and Agile 4, noninvasive tests for liver fibrosis, are excellent formulae to predict liver-related events in nonalcoholic fatty liver disease

    Miura, K; Hayashi, H; Kamada, Y; Fujii, H; Takahashi, H; Oeda, S; Iwaki, M; Kawaguchi, T; Tomita, E; Yoneda, M; Tokushige, A; Ueda, S; Aishima, S; Sumida, Y; Nakajima, A; Okanoue, T

    HEPATOLOGY RESEARCH ( Hepatology Research )  53 ( 10 ) 978 - 988   2023年10月 [ 査読有り ]

    掲載種別: 研究論文(学術雑誌)

     概要を見る

    AIM: The noninvasive tests (NITs) Agile 3+ and Agile 4 effectively identify patients with nonalcoholic fatty liver disease (NAFLD) complicated with advanced fibrosis (F3-4) and cirrhosis (F4), respectively. Little information is available on associations between Agile scores and intra-/extrahepatic events. The aim of this study was to determine the predictive performance of Agile scores for intra-/extrahepatic events in Asian patients with biopsy-proven NAFLD. METHODS: We undertook a retrospective multicenter cohort study to investigate associations between intra-/extrahepatic events and two Agile scores, Agile 3+ and Agile 4. The scores were obtained by combining clinical parameters and liver stiffness measurement using transient elastography. RESULTS: Among 403 enrolled patients, 11 had liver-related events (LREs), including seven with hepatocellular carcinoma (HCC). The incidence of LREs and HCC showed a stepwise increase in the advanced fibrosis group (F3-4), Agile 3+ rule-in (F3-4, highly suspected), and Agile 4 rule-in (F4, highly suspected) groups, compared to their counterparts. Hazard ratios for LREs in the advanced fibrosis group, Agile 3+ rule-in, and Agile 4 rule-in groups were 4.05 (p = 0.03), 23.5 (p = 0.003), and 45.5 (p < 0.001), respectively. The predictive performance results for Agile 3+ and Agile 4 were 0.780 and 0.866, respectively, which were higher than for fibrosis (0.595). Unlike for LREs, Agile scores failed to identify patients with extrahepatic events, including cardiovascular events and extrahepatic cancer. CONCLUSIONS: Agile 3+ and Agile 4 scores are excellent NITs for predicting LREs in patients with NAFLD, possibly without histological assessment.

  • Living alone predicts poor prognosis among patients with acute myocardial infarction.

    Daichi Fukumoto, Daisuke Kanda, Takuro Takumi, Yoshiyuki Ikeda, Akihiro Tokushige, Kenta Ohmure, Takeshi Sonoda, Ryo Arikawa, Kazuhiro Anzaki, Mitsuru Ohishi

    Coronary artery disease     2023年09月 [ 査読有り ]

    掲載種別: 研究論文(学術雑誌)

     概要を見る

    BACKGROUND: Living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in acute myocardial infarction (AMI) patients. METHODS: Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause and cardiac deaths after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. RESULTS: Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, P = 0.019 and 14% vs. 4%, P = 0.004). Multivariate Cox proportional hazards regression analysis models showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20-5.62; P = 0.016 and HR, 4.17; 95% CI, 1.60-10.84; P = 0.003] and GRACE risk score (HR, 1.02; 95% CI, 1.01-1.03; P = 0.003 and HR, 1.03; 95% CI, 1.01-1.04; P < 0.001) correlated significantly with all-cause and cardiac deaths. Cox proportional hazards modeling revealed that patients living alone with GRACE risk score ≥162 derived from the receiver-operating characteristic curve showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score <162 (HR 16.57; 95% CI 6.67-41.21; P < 0.001). CONCLUSION: Among AMI patients, living alone represents an independent risk factor for all-cause and cardiac deaths after PCI, separate from GRACE risk score. Furthermore, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.

  • Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients

    Kanno, K; Fujiwara, N; Moromizato, T; Fujii, S; Ami, Y; Tokushige, A; Ueda, S

    PEDIATRIC CRITICAL CARE MEDICINE ( Pediatric Critical Care Medicine )  24 ( 9 ) 767 - 774   2023年09月 [ 査読有り ]

    掲載種別: 研究論文(学術雑誌)

     概要を見る

    OBJECTIVES: We performed our standard air leak, leak percentage, and cuff leak percentage tests in pediatric patients intubated with microcuff pediatric tracheal tubes (MPTTs) just before extubation. We examined the association between test findings and the subsequent occurrence of post-extubation laryngeal edema (PLE). DESIGN: Prospective, single-center, observational study. SETTING: PICU (June 1, 2020 to May 31, 2021). PATIENTS: Pediatric patients intubated and scheduled for extubation during the day shift in the PICU. INTERVENTIONS: Multiple pre-extubation leak tests were performed on each patient immediately before extubation. In our center, the standard leak test is positive if a leak is audible at 30 cm H 2 O applied pressure with the MPTT cuff deflated. Two other tests were calculated in the pressure control-assist control ventilator mode using the following formulas: leak percentage with deflated cuff = (inspiratory tidal volume [V t ]-expiratory V t ) × 100/inspiratory V t ; cuff leak percentage = (expiratory V t with inflated cuff-expiratory V t with deflated cuff) × 100/expiratory V t with inflated cuff. MEASUREMENTS AND MAIN RESULTS: The diagnostic criteria for PLE was made by at least two healthcare professionals and included upper airway stricture with stridor-requiring nebulized epinephrine. Eighty-five pediatric patients (< 15 yr) who had been intubated for at least 12 hours using the MPTT were included. Positive rates for the standard leak, leak percentage (cutoff 10%), and cuff leak percentage (cutoff 10%) tests were 0.27, 0.20, and 0.64, respectively. The standard leak, leak percentage, and cuff leak tests showed sensitivities of 0.36, 0.27, and 0.55, respectively; and specificities of 0.74, 0.81, and 0.35, respectively. PLE occurred in 11 of 85 patients (13%), and there were no instances of needing reintubation. CONCLUSIONS: The pre-extubation leak tests in current practice for intubated pediatric patients in the PICU all lack diagnostic accuracy for PLE.

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MISC(その他業績・査読無し論文等) 【 表示 / 非表示

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学術関係受賞 【 表示 / 非表示

  • ・2015年日本心血管インターベンション治療学会(CVIT)ベストサイテーション賞

    2015年   日本心血管インターベンション治療学会  

    受賞者: 徳重 明央

科研費獲得情報 【 表示 / 非表示

  • がん患者におけるミトコンドリア関連miRNAを介した心血管機能への影響の解明

    若手研究

    課題番号: 20K16528

    研究期間: 2020年04月  -  2023年03月 

    代表者: 徳重 明央 

    直接経費: 2,700,000(円)  間接経費: 3,510,000(円)  金額合計: 810,000(円)

  • がん患者におけるミトコンドリア関連miRNAを介した心血管機能への影響の解明

    若手研究

    課題番号: 20K16528

    研究期間: 2020年04月  -  2023年03月 

    代表者: 徳重 明央 

    直接経費: 2,700,000(円)  間接経費: 3,510,000(円)  金額合計: 810,000(円)

  • コルヒチン医師主導治験

    ■■■

    課題番号: 00000000

    研究期間: 2018年  -  2018年 

    代表者: 徳重 明央 

    直接経費: 0(円)  間接経費: 0(円)  金額合計: 0(円)

  • 鹿児島大学地域活性化研究支援事業(若手研究者向け) 令和4年度

    ■■■

    課題番号: 00000000

    研究期間: 1900年01月  -  1900年01月 

その他研究費獲得情報 【 表示 / 非表示

  • コルヒチン医師主導治験

    研究費種類: 財団・社団法人等の民間助成金  参画方法: 研究代表者

    研究種別: 研究助成  事業名: ■■■

    研究期間: 2018年  -  2018年 

    代表者: 徳重 明央  資金配分機関: 公益財団法人 臨床薬理研究振興財団

    直接経費: 0(円)  間接経費: 0(円)  金額合計: 0(円)

  • 鹿児島大学地域活性化研究支援事業(若手研究者向け) 令和4年度

    研究費種類: 学内助成(後援会・財団含む)  参画方法: 研究代表者

    研究種別: 研究助成  事業名: ■■■

    研究期間: 1900年01月  -  1900年01月 

    資金配分機関: ■■■