Publications by authors named "Keita Iyama"

15 Publications

  • Page 1 of 1

Current situation survey for establishing personally acceptable radiation dose limits for nuclear disaster responders.

J Radiat Res 2022 Jul;63(4):615-619

Department of Radiation Disaster Medicine, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.

When responding to disasters, emergency preparedness is essential to ensure that disaster activities are performed smoothly, safely and efficiently. Investigations on the Fukushima accident revealed that lack of preparedness, poor communication and unsuitable emergency measures contributed to an inadequate emergency response to the nuclear disaster. In this study, we conducted a questionnaire survey on the establishment of a personal radiation exposure dose among Disaster Medical Assistance Team (DMAT) members in Japan who might be involved in the initial response to a nuclear disaster. Establishing personal exposure doses for personnel can encourage emergency preparedness and inform decisions on appropriate role assignments during nuclear response activities. Valid responses were obtained from 178 participants, and the response distribution was as follows: 'Already have own acceptable dose standard,' 16 (9%); 'Follow own institution's standard (and know its value),' 30 (17%); 'Follow own institution's standard (but do not know its value),' 59 (33%); 'Haven't decided,' 63 (35%) and 'Don't understand question meaning,' 10 (6%). We also assessed intention to engage in nuclear disaster activities among respondents via engagement intent scores (EIS) and found that participants who had established personal exposure standards had significantly higher EIS scores than those who had not decided or who did not understand the question. Thus, educating potential nuclear disaster responders on personal exposure doses may contribute to a higher intention to engage in emergency responses and improve preparedness and response efficiency.
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http://dx.doi.org/10.1093/jrr/rrac026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9303598PMC
July 2022

Increasing Disaster Medical Assistance Teams' Intent to Engage with Specific Hazards.

Int J Environ Res Public Health 2021 11 5;18(21). Epub 2021 Nov 5.

Department of Radiation Disaster Medicine, Fukushima Medical University, Fukushima 960-1295, Japan.

To ensure human resource availability for a smooth response during various types of disasters, there is a need to improve the intent of those involved in responding to each hazard type. However, Disaster Medical Assistance Team personnel's intent to engage with specific hazards has yet to be clarified. This study therefore aimed to clarify the factors affecting Disaster Medical Assistance Team members' ( = 178) intent to engage with each type of hazard through an anonymous web questionnaire survey containing 20 questions. Our results show that the intent to engage in disaster response activities was significantly lower for chemical (50), biological (47), radiological/nuclear (58), and explosive (52) incidents compared with natural (82) and man-made hazards (82) ( < 0.01). Multiple regression analysis showed that incentives were the most common factor affecting responders' intent to engage with all hazard types, followed by self-confidence. Thus, creating a system that provides generous incentives could effectively improve disaster responders' intent to engage with specific hazards. Another approach could be education and training to increase disaster responders' confidence. We believe that the successful implementation of these measures would improve the intent of responders to engage with hazards and promote the recruitment of sufficient human resources.
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http://dx.doi.org/10.3390/ijerph182111630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583079PMC
November 2021

Survey about Intention to Engage in Specific Disaster Activities among Disaster Medical Assistance Team Members.

Prehosp Disaster Med 2021 Dec 18;36(6):684-690. Epub 2021 Oct 18.

Department of Radiation Disaster Medicine, Fukushima Medical University, Fukushima, Japan.

Introduction: Different disaster activities should be performed smoothly. In relation to this, human resources for disaster activities must be secured. To achieve a stable supply of human resources, it is essential to improve the intentions of individuals responding to each type of disaster. However, the current intention of Disaster Medical Assistance Team (DMAT) members has not yet been assessed.

Study Objective: To facilitate a smooth disaster response, this survey aimed to assess the intention to engage in each type of disaster activity among DMAT members.

Methods: An anonymous web questionnaire survey was conducted. Japanese DMAT members in the nuclear disaster-affected area (Group A; n = 79) and the non-affected area (Group N; n = 99) were included in the analysis. The outcome was the answer to the following question: "Will you actively engage in activities during natural, human-made, and chemical (C), biological (B), radiological/nuclear (R/N), and explosive (E) (CBRNE) disasters?" Then, questionnaire responses were compared according to disaster type.

Results: The intention to engage in C (50), B (47), R/N (58), and E (52) disasters was significantly lower than that in natural (82) and human-made (82) disasters (P <.001). The intention to engage in CBRNE disasters among younger participants (age ≤39 years) was significantly higher in Group A than in Group N. By contrast, the intention to engage in R/N disasters alone among older participants (age ≥40 years) was higher in Group A than in Group N. However, there was no difference between the two groups in terms of intention to engage in C, B, and E disasters. Moreover, the intention to engage in all disasters between younger and older participants in Group A did not differ. In Group N, older participants had a significantly higher intention to engage in B and R/N disasters.

Conclusion: Experience with a specific type of calamity at a young age may improve intention to engage in not only disasters encountered, but also other types. In addition, the intention to engage in CBRNE disasters improved with age in the non-experienced population. To respond smoothly to specific disasters in the future, measures must be taken to improve the intention to engage in CBRNE disasters among DMAT members.
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http://dx.doi.org/10.1017/S1049023X21001035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607140PMC
December 2021

Acute Coronary Syndrome Developed in a 17-year-old Boy with Sitosterolemia Comorbid with Takayasu Arteritis: A Rare Case Report and Review of the Literature.

Intern Med 2022 Apr 5;61(8):1169-1177. Epub 2021 Oct 5.

Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan.

A 17-year-old boy with acute coronary syndrome was admitted to our hospital. He had xanthomas over his elbow and Achilles tendon and a high level of low-density lipoprotein cholesterol; therefore, his initial diagnosis was familial hypercholesterolemia. However, a genetic analysis revealed a compound heterozygous mutation in the ABCG5 gene with a high serum level of sitosterol, leading to the diagnosis of sitosterolemia. After lipid-lowering treatment, percutaneous coronary intervention was performed. Furthermore, a persistently high C-reactive protein level and images of large arteries led to a diagnosis of Takayasu arteritis. To our knowledge, this is the first case of sitosterolemia complicated by Takayasu arteritis.
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http://dx.doi.org/10.2169/internalmedicine.8288-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9107993PMC
April 2022

Development of computer simulator 'Kawauchi Legends' as disaster response medical training software: overcoming the COVID-19 pandemic.

Ann ICRP 2021 Jul 4;50(1_suppl):181-186. Epub 2021 Jun 4.

Department of Radiation Disaster Medicine, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, Japan; e-mail:

Medical disaster response training is provided for international students in Kawauchi Village to share the lessons learnt from the accident at Fukushima Daiichi nuclear power plant. At present, this is difficult due to the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this article is to report the development of hands-on medical training software on a topic that does not require in-person attendance. The 'Kawauchi Legends' disaster simulator was developed as a useful tool to teach the medical response to various disasters, and this was applied in a 3-day webinar in October 2020. Fourteen students participated in the webinar and successfully learnt medical management, manipulating their avatars in the virtual environment. This software can be an effective substitute for in-person disaster training without physical involvement. Such innovative teaching methods mean that lessons from the Fukushima accident can continue to be shared, even in the COVID-19 pandemic situation.
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http://dx.doi.org/10.1177/01466453211006804DOI Listing
July 2021

How to Safely Prevent Venous Thromboembolism in Severe Trauma Patients.

Int Heart J 2020 Sep 12;61(5):993-998. Epub 2020 Sep 12.

Acute and Critical Care Center, Nagasaki University Hospital.

Venous thromboembolism (VTE) is a life-threatening complication after trauma. Several studies have reported VTE prophylaxis using low-molecular-weight heparin; however, there is no consensus for prophylaxis after trauma. This study aimed to assess the efficacy and safety of our new anticoagulation therapy protocol using unfractionated heparin (UFH) plus intermittent pneumatic compression (IPC) to prevent post-traumatic VTE in high-risk trauma patients.This study enrolled 70 trauma patients who were admitted to the emergency medical center of Nagasaki University Hospital and had Risk Assessment Profile (RAP) scores ≥ 5. After stopping bleeding at the trauma site, all patients received intravenous UFH (10,000 U/day) plus IPC, which was continued for 14 days or until the patients could walk. On days 7 and 14, all patients underwent lower extremity sonography for deep-vein thrombosis screening. VTE incidences between patients with the above intervention and historical controls with IPC alone were compared.No significant differences in age, sex, and the RAP score were observed between the 105 controls and intervention patients. VTE occurrence was fewer in patients with the intervention (14.3%) than in the controls (28.6%; P = 0.029). No hemorrhagic complications occurred after UFH administration. Multivariable logistic analysis revealed a significant association between the intervention and low incidence of VTE (odds ratio: 0.390; 95% confidence interval: 0.163-0.913; P = 0.030).Routine UFH administration with IPC may prevent post-traumatic VTE without adverse events.
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http://dx.doi.org/10.1536/ihj.20-153DOI Listing
September 2020

Sudden onset of thyrotoxicosis induced by amiodarone mimicking low cardiac output syndrome in a patient with dilated cardiomyopathy.

J Cardiol Cases 2020 Aug 6;22(2):81-84. Epub 2020 Jun 6.

Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Amiodarone-induced thyrotoxicosis (AIT) is a complication of amiodarone therapy that can be difficult to diagnose and manage, especially in patients with dilated cardiomyopathy (DCM). We describe a 47-year-old female patient with DCM who experienced the sudden onset of type II AIT with symptoms mimicking low cardiac output syndrome, namely, general malaise and nausea. Early type II AIT was diagnosed, and effectively treated with prednisolone. < Amiodarone-induced thyrotoxicosis (AIT) is a complication of amiodarone therapy that can be difficult to diagnose and manage, especially in patients with dilated cardiomyopathy because of symptoms mimicking low cardiac output syndrome. We have to consider sudden onset of AIT in patients treated with amiodarone not to be late for appropriate management for it.>.
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http://dx.doi.org/10.1016/j.jccase.2020.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403601PMC
August 2020

Factors associated with the intention to participate in activities during a nuclear disaster situation among firefighters.

J Radiat Res 2020 Nov;61(6):871-875

Department of Radiation Disaster Medicine, Fukushima Medical University, Fukushima, Japan.

Willingness to participate in activities during a nuclear disaster situation among firefighters is low. Thus, we aimed to identify the factors affecting the intention to participate in nuclear disaster activities. A questionnaire survey was conducted among firefighter training students (n = 186) and firefighters (n = 410), and a multivariate logistic regression analysis was performed to identify factors affecting the intention to participate in nuclear disaster activities. The percentage of students and firefighters who were willing to participate in nuclear disaster activities was 70.4% (n = 131) and 56.3% (n = 231) (P < 0.01), respectively. The factors affecting the students' intention to participant were "wish to learn more information about radiation" and "firefighters should actively work in a nuclear disaster." Meanwhile, the factors affecting the firefighters' intention to work were "have self-confidence during nuclear disaster activities," "participate if there is an incentive," "unable to get a family member to understand the need to participate in a nuclear disaster activity," and marital status. A student's decision might be strongly connected to social norms about participating in nuclear disaster activities. The willingness to participate in nuclear disaster activities among firefighters might be improved by facilitating activities that can build their self-confidence, providing sufficient incentives, and helping their families understand their work. Therefore, not only direct education for responders but also educational activities for the general public and their families are essential.
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http://dx.doi.org/10.1093/jrr/rraa061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674679PMC
November 2020

A case of chronic myocarditis.

Pathol Int 2020 Oct 27;70(10):793-797. Epub 2020 Jul 27.

Department of Cardiovascular Medicine, Nagasaki University Hospital, Nagasaki, Japan.

Chronic myocarditis is sometimes difficult to diagnose using several clinical diagnostic modalities. A 43-year-old Japanese man was admitted to our hospital with heart failure due to a diffusely hypokinetic left ventricle. No abnormal accumulation was seen on F-fluorodeoxyglucose positron emission tomography/computed tomography. Coronary angiography showed no abnormalities. Endomyocardial biopsy was performed on suspicion of dilated cardiomyopathy, revealing diffuse cell infiltration (more T lymphocytes associated with macrophages than B cells on immunohistochemical staining), myocyte damage, and replacement fibrosis. The pathological diagnosis of biopsy specimen was difficult to differentiate between chronic myocarditis and inflammatory dilated cardiomyopathy without immunohistochemistry. Endomyocardial biopsy offers one of the most useful methods for diagnosing chronic myocarditis.
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http://dx.doi.org/10.1111/pin.12989DOI Listing
October 2020

Novel screening criteria for post-traumatic venous thromboembolism by using D-dimer.

Acute Med Surg 2019 Jan 17;6(1):40-48. Epub 2018 Oct 17.

Acute and Critical Care Center Nagasaki University Hospital Nagasaki Japan.

Aim: Because severe trauma patients frequently manifest coagulopathy, it is extremely important to detect venous thromboembolism (VTE) in the acute phase. However, no reference value for D-dimer in post-traumatic VTE has been reported given the substantial increase in its levels after injury. Therefore, this study evaluates the ability of our screening criteria using D-dimer to detect VTE in severe trauma patients.

Methods: Trauma patients ( = 455) who were admitted to our emergency medical center during October 2011-June 2015 were included in this study. To prevent VTE, intermittent pneumatic compression was carried out in most patients. Our screening criteria included the following: (i) ≥5 days of hospital stay, (ii) increasing D-dimer levels across 3 measuring days, (iii) D-dimer levels ≥15 μg/mL. Patients who met these screening criteria underwent contrast-enhanced computed tomography (CE-CT) to detect VTE.

Results: During the study period, 108 cases satisfied the screening criteria; 73 of these underwent CE-CT, 34 of whom were diagnosed with VTE (positive predictive value, 46.6%). The median hospital stay on satisfying the screening criteria and before undergoing CE-CT was 7 and 10 days, respectively. No patient had VTE symptoms at the time of diagnosis. Also, none of the remaining 347 patients who did not satisfy the screening criteria had VTE symptoms.

Conclusion: The screening criteria using D-dimer presented herein can be used as reference for efficiently detecting VTE in severe trauma patients.
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http://dx.doi.org/10.1002/ams2.375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328915PMC
January 2019

Intention to return to the town of Tomioka in residents 7 years after the accident at Fukushima Daiichi Nuclear Power Station: a cross-sectional study.

J Radiat Res 2019 Jan;60(1):51-58

Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, Japan.

The aim of our study was to identify the factors associated with intention to return (ITR) in residents of Tomioka town, Fukushima Prefecture. We contacted approximated 8000 residents aged 20 years or older who lived in Tomioka. We invited them to take part in a written survey on ITR. In all, 1749 residents' replies were included in the analysis. We asked about ITR in former residents of Tomioka town. We also asked about relevant factors and about risk perception in relation to the health effects of radiation exposure. Of those contacted, 469 (26.8%) had an ITR. Logistic regression analysis revealed that being male (OR = 1.6, 95% Cl: 1.24-1.96, P < 0.001), the anticipation of improving shopping in the town (OR = 1.5, 95% Cl: 1.26-1.67, P < 0.001) and requests for individual consultation with experts on the health effects of radiation (OR = 2.7, 95% Cl: 2.10-3.48, P <0.001) were associated with the ITR (+), and living with children under 18 years of age (OR = 0.7, 95% Cl: 0.51-0.95, P = 0.023), reluctance to drink tap water (OR = 0.5, 95% Cl: 0.36-0.69, P < 0.001) and anxiety regarding genetic effects of radiation in the next generation (OR = 0.6, 95% Cl: 0.45-079, P <0.001) were associated with the ITR (-) to Tomioka town, independent of other covariates. To allay the anxieties of residents who have an ITR to their hometown, careful risk communication, including information on the potential effects of radiation on health, is important.
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http://dx.doi.org/10.1093/jrr/rry094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373670PMC
January 2019

Identification of Three Novel Fusion Oncogenes, SQSTM1/NTRK3, AFAP1L2/RET, and PPFIBP2/RET, in Thyroid Cancers of Young Patients in Fukushima.

Thyroid 2017 06 25;27(6):811-818. Epub 2017 Apr 25.

1 Department of Radiation Medical Sciences, Atomic Bomb Disease Institute , Nagasaki University, Nagasaki, Japan .

Background: The BRAF mutation is the most frequent genetic abnormality in adult papillary thyroid carcinomas (PTCs). On the other hand, various chromosomal rearrangements are more prevalent in childhood and adolescent PTCs. The aim of the present study was to identify novel rearrangements in PTCs from young patients.

Methods: Among 63 postoperative specimens of childhood and adolescent PTCs, which had been discovered by the thyroid ultrasound screening program in Fukushima, nine samples without prevalent known oncogenes, BRAF, RAS, RET/PTC1, RET/PTC3, and ETV6/NTRK3, were analyzed in the current study by quantitative real-time reverse transcription polymerase chain reaction to screen for novel fusion genes by comparing transcript expression between extracellular and kinase domains of ALK, NTRK1, NTRK3, and RET.

Results: Of the above nine samples, five samples were suspected to harbor a fusion, and using subsequent 5' rapid amplification of cDNA end (RACE), two already reported fusion oncogenes, STRN/ALK and TPR/NTRK1, and three novel fusions, SQSTM1/NTRK3, AFAP1L2/RET, and PPFIBP2/RET, were identified. Functional analyses of these three chimeric genes were performed, and their transforming abilities were confirmed through the activation of mitogen-activated protein kinase (MAPK).

Conclusions: Three novel fusion oncogenes have been identified in young PTC patients in Fukushima, suggesting that rare fusions may be present among the cases negative for known oncogenes in this age group and that such rearrangements can play a significant role in thyroid carcinogenesis.
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http://dx.doi.org/10.1089/thy.2016.0673DOI Listing
June 2017

Successful Treatment of Cardiac Tamponade After a Closed-Chest Cardiac Massage.

Ann Thorac Surg 2017 Feb;103(2):e191

Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.

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http://dx.doi.org/10.1016/j.athoracsur.2016.08.026DOI Listing
February 2017

An adult case of laryngopharyngeal burn by drinking hot water.

Acute Med Surg 2017 04 13;4(2):198-201. Epub 2016 Sep 13.

Nagasaki University Hospital Emergency Medical Center Nagasaki Japan.

Case: A 61-year-old man who was hospitalized with schizophrenia in a psychiatric hospital drank hot water estimated to be 90°C. Eight hours after injury, laryngopharynx edema gradually progressed, and his breathing deteriorated. Upon arrival at our emergency room, we secured his respiratory tract by nasal intubation under a bronchoscope.

Outcome: The edema gradually improved after peaking at hospital day 2, and he was extubated on hospital day 18. There were no apparent respiratory or esophageal problems, and he was discharged back to the psychiatric hospital on day 28.

Conclusion: These types of laryngopharynx burns caused by ingesting hot foods or drinks have been rarely reported for adults. In cases of adults, when the patient is in a special situation such as having a psychiatric disorder, it is necessary to assume that the laryngopharynx burns might be aggravated.
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http://dx.doi.org/10.1002/ams2.237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667262PMC
April 2017

Implication of Nitrate in Drinking Water in Kawauchi Village, Fukushima.

Thyroid 2015 Sep 2;25(9):1064-5. Epub 2015 Jul 2.

1 Department of Global Health, Medicine, and Welfare, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki, Japan .

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http://dx.doi.org/10.1089/thy.2015.0161DOI Listing
September 2015
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