京都大学 / 新制・課程博士 / 博士(医学) / 甲第23465号 / 医博第4772号 / 新制||医||1053(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 山本 洋介, 教授 松村 由美 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This master’s thesis determines qualities of the application used as a supporting tool in decision-making processes and which is useful for automatization of time series analysis. The thesis describes solution created by following the formulated criteria. It shows examples of use of the created application in praxis and interprets the outputs.

The diploma thesis focuses on assessment of given financial indicators of chosen company. It is predicted the future development of chosen financial indicators using appropriate statistical methods. It contains assessment of financial situation of analysed company and solutions of its present situation.

Canine parvoviral enteritis is an economically important disease in South Africa and globally. Although treatment of dogs with parvoviral enteritis is often successful, many dogs die of complications related to septicaemia or are euthanized because of anticipated high costs. More effective prediction of the outcome of this disease will have an economic impact if a prognosis can be determined early in the course of the disease. Although leukocyte responses seldom are pathognomonic for a specific disease, they can provide clinical information to establish a fairly reliable prognosis. A prospective study was performed on 62 puppies presented to the OVAH with typical clinical signs of canine parvoviral enteritis that subsequently was confirmed on electron microscopy. Full haematology was performed at admission as well as every consecutive day until death or discharge. Of the 11 puppies that died (18%), nine died due to complications of the disease and two were euthanized due to financial restrictions and a poor prognosis. The puppies that died due to the disease died within the first three days of hospitalization. All the puppies that died were sent for a full post mortem examination and histopathological evaluation. Statistical analysis of the data showed that there was a definite difference between the puppies that died and those that survived in several of the leukocyte parameters. These parameters included the total leukocyte, lymphocyte, monocyte and eosinophil counts. In none of the puppies that died from the disease did the total leukocyte count rise above 2.0 × 10 9 /l (normal reference range: 6.0-15.0 × 10 9 /l). In the puppies that survived, the total leukocyte count started rising within 24 – 48 hours after admission and often resulted in a rebound leukocytosis. The puppies that died did not develop lymphocytosis to indicate an immune response, whereas the surviving puppies developed lymphocytosis within 24 – 48 hours after admission. The puppies that died also did not develop monocytosis and remained severely eosinopaenic during the course University of Pretoria etd – Goddard, A (2006) xii of the disease. Evidence of impaired leukocyte production was found on histopathology. Most of the puppies that died from the disease showed marked to severe thymic and lymphoid atrophy and marked to severe bone marrow hypocellularity. These results show that a reliable prognosis can be obtained at 24 and 48 hours after admission by evaluation of the leukocytes, specifically the total leukocyte, lymphocyte, monocyte and eosinophil counts. / Dissertation (Master in Veterinary Medicine(Clinical Laboratory Diagnostics))--University of Pretoria, 2006. / Companion Animal Clinical Studies / unrestricted

JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley and Sons Australia, Ltd. Background and Aim: The United Kingdom-primary biliary cholangitis (UK-PBC) and global primary biliary cholangitis group (GLOBE) prognostic models have been recently developed to predict long-term outcomes in primary biliary cholangitis (PBC). However, these predictive scores have not yet been well evaluated in the U.S. population. Methods: We retrospectively reviewed newly diagnosed PBC patients at the Cleveland Clinic between November 1998 and February 2017. Adverse events were defined as liver transplantation, liver-related mortality, and all-cause mortality. Transplant-free survival (TFS) was estimated using the Kaplan–Meier method. Predictive performances of all prognostic models were evaluated using the C-statistic. Results: We identified 352 patients who used ursodeoxycholic acid therapy. Of them, 311 (88.4%) only had PBC, while 41 (11.6%) were diagnosed with PBC-autoimmune hepatitis overlap. A total of 22 (6%), 47 (13%), and 55 (16%) patients had adverse events within 5, 10, and 15 years after diagnosis, respectively. In patients with PBC only, the C-statistic in predicting 15-year adverse events was 0.75 per GLOBE compared to 0.74 per UK-PBC (P = 0.94), 0.73 per Rotterdam (P = 0.44), 0.66 per Barcelona (P = 0.004), 0.65 per Paris 1 (P = 0.005), 0.62 per Paris 2 (P < 0.0001), 0.60 per Toronto (P < 0.0001), and 0.60 per Mayo (P < 0.0001) scores. Median follow-up was 9.2 years. Ten-year TFS for patients who had optimal versus suboptimal treatment response was 92 versus 74% per Paris 1 (P < 0.0001), 95 versus 79% per Paris 2 (P = 0.0002), 93 versus 65% per Barcelona (P < 0.0001), and 96 versus 68% per Rotterdam (P < 0.0001) risk scores, respectively. Conclusion: In our cohort of PBC patients, the UK-PBC and GLOBE scores were both accurate and reasonably valid prognostic models in the U.S. population.

Prostate cancer is the most common newly diagnosed non-skin cancer and the second leading cause of cancer death in men. It is a unique neoplasm because of the large discrepancy between its clinical incidence and the much higher incidence of latent cancer. Predicting the prognosis of prostate cancer, especially the cancers detected incidentally or by screening, remains a clinically important problem. Immunoreactivity for Onco-antigen 519 (OA- 519), a recently described fatty acid synthase (FAS), has been associated with poor prognosis in breast cancers. The authors have previously shown that its detection in prostate cancer correlated with high-grade, large volume, and advanced stage tumors. This study examines the association between OA- 519 immunoreactivity in primary prostate cancer and disease progression. The authors used immunohistochemistry with an affinity-purified anti-OA-519 antibody and examined primary prostate cancers (stages A1 to D1) from 99 men with a mean follow-up of 4 years (range= 2 to 9.3). Survival analysis was used to evaluate differences in progression-free survival. OA-519 immunoreactivity was seen in 56 (57%) of the 99 primary prostate cancers examined. OA-519-positive cancers were more likely to progress than the OA- 519-negative cancers (P < .04). Univariate survival analysis showed that OA- 519 (FAS), histological grade (Gleason score), and clinical stage were significant predictors of disease progression. Multivariate analyses of all cases showed that only histological grade was significant. However, multivariate analysis of the 85 cancers with Gleason scores 2-7 (ie, low to intermediate grade) showed OA-519 (FAS) immunoreactivity to be the only statistically significant predictor of cancer progression (P<.02). Expression of the fatty acid synthase OA-519 by prostate cancers is potentially a clinically useful predictor of disease progression. It appears to be independent of histological grade (Gleason score), at least in cancers with low to intermediate grades. Further studies are needed to evaluate the role of fatty acid synthase in malignancy and the potential therapeutic implications of enzyme blockers.

Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.

Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.

Posterior reversible encephalopathy syndrome (PRES) is associated with seizures, visual disturbances, headache, and altered mental status. Given its presentation, the diagnosis can be mistaken for other severe conditions. Palliative medicine consultants should be aware of PRES and be prepared to counsel families on the treatment and prognosis of this syndrome.

Carta al editor / Revisión por pares