Publications by authors named "Takayuki Kawaura"

7 Publications

  • Page 1 of 1

Early voice therapy for unilateral vocal fold paralysis improves subglottal pressure and glottal closure.

Am J Otolaryngol 2020 Nov - Dec;41(6):102727. Epub 2020 Sep 13.

Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka 573-1010, Japan.

Purpose: In cases of unilateral vocal fold paralysis (UVFP), voice disorders caused by glottic insufficiency can lead to a considerable reduction in the patient's quality of life. Voice therapy (VT) is an effective treatment that must be started early after the onset of vocal fold paralysis. This study examined the effect of early VT for patients with UVFP occurring after esophagectomy.

Materials And Methods: Patients who had residual UVFP at 1 month postoperatively after esophagectomy for esophageal cancer between November 2014 and March 2017 were evaluated. Seventeen patients were divided into the VT group (n = 6) and non-VT group (n = 11). We compared these two groups and retrospectively examined the effect of early VT. The study endpoints included aerodynamic tests, laryngeal endoscopy, laryngeal stroboscopy, and glottal closure. All of these evaluations were performed at preoperatively and at 1 and 3 months postoperatively.

Results: Subglottal pressure reduced notably in the VT group, and both the mean flow rate and maximum phonation time tended to improve after VT. Conversely, there were no significant differences in MFR and MPT in the non-VT group. Furthermore, although UVFP remained after VT, we achieved glottal closure for all three patients. Conversely, only two of the six patients with glottic insufficiency in the non-VT group achieved glottal closure.

Conclusion: VT may be effective for improving impaired vocal function in patients with UVFP. It is reasonable to expect that VT can be initiated 1 month after the onset of vocal fold paralysis.
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December 2020

Development and external validation of a preoperative nomogram for predicting pathological locally advanced disease of clinically localized upper urinary tract carcinoma.

Cancer Med 2020 06 6;9(11):3733-3741. Epub 2020 Apr 6.

Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.

Objective: To develop and validate a preoperative nomogram to predict pathological locally advanced disease (pLAD) of clinically localized upper urinary tract urothelial carcinoma (UTUC) treated with extirpative surgery.

Methods: In total, 1101 patients with cN0M0 UTUC (development cohort, n = 604; validation cohort, n = 497) from 2 independent academic databases were retrospectively analyzed. pLAD was defined as pT3/4 and/or pN+. Multivariate logistic regression was used to develop a nomogram. The accuracy of the nomogram was evaluated with a receiver operating characteristic curve, calibration plot, and decision curve analysis.

Results: The development and validation cohorts comprised 204 (33.8%) and 178 (35.8%) patients with pLAD, respectively. The multivariate analyses showed that the neutrophil-to-lymphocyte ratio (hazard ratio [HR], 2.27; P < .001), chronic kidney disease (HR, 1.56; P = .032), tumor location (HR, 1.60; P = .029), hydronephrosis (HR, 2.71; P < .001), and local invasion on imaging (HR, 8.59; P < .001) were independent predictive factors. After bootstrapping, a well-calibrated nomogram achieved discriminative accuracy of 0.77 in the development cohort. The decision curve analysis demonstrated improved risk prediction against threshold probabilities (≥8%) of pLAD. These results were consistent in the validation cohort.

Conclusion: Our novel nomogram allows for more highly accurate prediction of pLAD of UTUC. This nomogram integrates standard imaging and laboratory factors that help to identify patients who will benefit from preoperative chemotherapy, extended lymph node dissection, or both.
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June 2020

Ligating the pulmonary vein at the pericardial reflection is useful for preventing thrombus formation in the pulmonary vein stump after left upper lobectomy.

Gen Thorac Cardiovasc Surg 2019 May 11;67(5):450-456. Epub 2018 Nov 11.

Department of Thoracic Surgery, Kansai Medical University, Hirakatashi, Japan.

Objectives: Thrombus formation in the pulmonary vein stump after left upper lobectomy is supposedly a risk factor for systemic thrombosis, resulting in a critical course for the patient. The purpose of this study was to assess the efficacy of the proximal ligation method preventing thrombus formation and thrombosis comparing the two groups of patients (those who did and those who did not undergo pulmonary vein ligation).

Methods: We performed a surgical procedure to shorten the pulmonary vein stump in the left upper lobectomy. In this procedure, we first dissected the pericardium from the left upper pulmonary vein, and then we ligated the pulmonary vein at the pericardial reflection before stapling transection.

Results: In the group that was not treated with the proximal ligation method, thrombus formation in the pulmonary vein stump was detected in all four cases. In contrast, thrombus formation in the pulmonary vein stump was detected in one only case of the eight cases treated with the proximal ligation method, which was significantly fewer than among those not treated with the ligation method (p = 0.010). The logistic regression analysis revealed in both the univariate (p = 0.0014) and multivariate analyses (p = 0.0071) that the proximal ligation method was significantly associated with reduced thrombus formation in the pulmonary vein stump.

Conclusions: Thrombus formation in the pulmonary vein stump was significantly reduced by ligating the pulmonary vein at the pericardial reflection.
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May 2019

Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews.

BMJ Open 2018 03 16;8(3):e016666. Epub 2018 Mar 16.

Department of Mathematics, Kansai Medical University, Hirakata, Japan.

Introduction: Many researchers have addressed overdosage and inappropriate use of antibiotics. Many meta-analyses have investigated antibiotic prophylaxis for low-risk laparoscopic cholecystectomy with the aim of reducing unnecessary antibiotic use. Most of these meta-analyses have concluded that prophylactic antibiotics are not required for low-risk laparoscopic cholecystectomies. This study aimed to assess the validity of this conclusion by systematically reviewing these meta-analyses.

Methods: A systematic review was undertaken. Searches were limited to meta-analyses and systematic reviews. PubMed and Cochrane Library electronic databases were searched from inception until March 2016 using the following keyword combinations: 'antibiotic prophylaxis', 'laparoscopic cholecystectomy' and 'systematic review or meta-analysis'. Two independent reviewers selected meta-analyses or systematic reviews evaluating prophylactic antibiotics for laparoscopic cholecystectomy. All of the randomised controlled trials (RCTs) analysed in these meta-analyses were also reviewed.

Results: Seven meta-analyses regarding prophylactic antibiotics for low-risk laparoscopic cholecystectomy that had examined a total of 28 RCTs were included. Review of these meta-analyses revealed 48 miscounts of the number of outcomes. Six RCTs were inappropriate for the meta-analyses; one targeted patients with acute cholecystitis, another measured inappropriate outcomes, the original source of a third was not found and the study protocols of the remaining three were not appropriate for the meta-analyses. After correcting the above miscounts and excluding the six inappropriate RCTs, pooled risk ratios (RRs) were recalculated. These showed that, contrary to what had previously been concluded, antibiotics significantly reduced the risk of postoperative infections. The rates of surgical site, distant and overall infections were all significantly reduced by antibiotic administration (RR (95% CI); 0.71 (0.51 to 0.99), 0.37 (0.19 to 0.73), 0.50 (0.34 to 0.75), respectively).

Conclusions: Prophylactic antibiotics reduce the incidence of postoperative infections after elective laparoscopic cholecystectomy.
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March 2018

Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma.

J Hepatobiliary Pancreat Sci 2017 Nov 19;24(11):616-626. Epub 2017 Oct 19.

Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Background: The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC).

Methods: To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor.

Results: Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS.

Conclusions: Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.
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November 2017

Analysis of the relation between health statistics and eating habits in Japanese prefectures using fuzzy robust regression model.

Comput Biol Med 2016 May 22;72:256-62. Epub 2016 Jan 22.

Waseda University, 2-7 Hibikino, Wakamatsuku, Kitakyushu, Fukuoka 808-013, Japan. Electronic address:

In recent years, the Japanese Ministry of Health, Labour, and Welfare is working to improve citizen׳s lifestyle and social environment to improve their health. This is because of the following reasons. Diseases related to lifestyle such as malignant neoplasms, heart disease, and cerebrovascular disease account for about 60% of the deaths in 2013. In addition, 32% of all medical expenditures are made on lifestyle-related disease. Lifestyle-related diseases can be prevented by daily exercise, a well-balanced diet, and not smoking. This ministry is promoting measures such as dietary education, physical activity, and exercise. Improvement of diet is the easiest way to reduce the occurrence of lifestyle-related diseases. Thus, in this paper, we analyze the relation between health and diet using our fuzzy robust regression model.
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May 2016

Analysis of Medical Care Expenditure by Japanese Prefecture using Fuzzy Robust Regression Model.

Stud Health Technol Inform 2014 ;207:400-9

Waseda University.

In 2012, 15.13% of the total fiscal medical care expenditure was for lifestyle-related health care costs, which was approximately 179 billion yen. Lifestyle-related diseases are not only the biggest factor in reducing healthy life expectancy but also have the most significant impact on the national medical care expenditure. In addition, lifestyle-related diseases can be prevented by moderate daily exercise, a well-balanced diet, and not smoking. Our fuzzy robust regression model is a controllable model describing a target system. Therefore, our model is used to analyze the relation between medical care expenditure and selected lifestyle factors.
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January 2018