名古屋大学国際交流会館RA（レジデント・アシスタント）研修及びハンドブックの発行

2016-10-01departmental bulletin pape

Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer : A case report and literature review

Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κβ ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86-year-old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab-related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab-related ONJ had a similar clinical presentation to BP-related ONJ. There was also a tendency for denosumab-related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab-related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab-related ONJ, non-improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab-related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.thesi

Predicate Detection in Large-Scale Locality-Driven Networks

Global predicate detection is an important problem in many distributed systems. It aims at detecting whether a certain distributed property has been satisfied during the system execution. The traditional detection algorithms are based on logical clocks. They explore the causal relationship between events occurring during the system execution. However, this makes these algorithms not suitable to detect global properties in physical time. Furthermore, in arising new types of distributed systems, such as wireless sensor networks and modular robotics, where events are locality driven and the scale of the system is large with individual process having limited computation resources, the traditional algorithms simply cannot handle the complexities. To address these issues, we first propose the concept of locality-aware predicate (LAP) which aims at detecting predicates within a local region. Although a LAP is defined only within a local region, observing the local area consistently requires considering the entire system in a consistent manner. This raises the challenge of making the complexities of the corresponding detection algorithms scale-free. We design algorithms for detecting both stable and unstable LAPs and show that they are scale-free. We also propose the methodology of hierarchical repeated detection. This approach of detecting predicates relies only on neighborhood communication to collaboratively detect global predicates. Compared with the traditional detection algorithms, hierarchical detection incurs a much smaller cost which is distributed across the entire system, and is capable of continuing the detection even when individual node crashes during the detection. The performance evaluation of our proposed algorithm shows its great potential for detecting predicates in networks where individual process only has limited resources and is prone to crash failure. Furthermore, we propose the Instantaneously detection algorithm which is built on top of the hierarchical detection methodology. We combine several approximation techniques with the hierarchical detection method to make the algorithm capable of detecting predicates in physical time even when synchronized physical clock is not available in the system. Since the detection is achieved via neighborhood communication only, this algorithm can detect predicates in physical time with a high accuracy while still relies solely on logical clocks

Incidence of MMR in children with CI who wore HAs for different duration.

Incidence of MMR in children with CI who wore HAs for different duration.</p

Partial correlation analysis of the age at HA use initiation and MMR latency, amplitude.

Partial correlation analysis of the age at HA use initiation and MMR latency, amplitude.</p

A preliminary study of auditory mismatch response on the day of cochlear implant activation in children with hearing aids prior implantation - Fig 1

a) Mismatch negativity of Mandarin lexical tone discrimination in a child with CI; b) Positive-mismatch response of Mandarin lexical tone discrimination in a child with CI. (Deviant: deviant stimulus; Standard: standard stimulus; Difference: difference wave; p: positive wave; N: negative wave).</p

Basic information of four patients without MMR.

Basic information of four patients without MMR.</p

Personalized Monitoring Model for Electrocardiogram Signals: Diagnostic Accuracy Study

Background: Due to the COVID-19 pandemic, the demand for remote electrocardiogram (ECG) monitoring has increased drastically in an attempt to prevent the spread of the virus and keep vulnerable individuals with less severe cases out of hospitals. Enabling clinicians to set up remote patient ECG monitoring easily and determining how to classify the ECG signals accurately so relevant alerts are sent in a timely fashion is an urgent problem to be addressed for remote patient monitoring (RPM) to be adopted widely. Hence, a new technique is required to enable routine and widespread use of RPM, as is needed due to COVID-19. Objective: The primary aim of this research is to create a robust and easy-to-use solution for personalized ECG monitoring in real-world settings that is precise, easily configurable, and understandable by clinicians. Methods: In this paper, we propose a Personalized Monitoring Model (PMM) for ECG data based on motif discovery. Motif discovery finds meaningful or frequently recurring patterns in patient ECG readings. The main strategy is to use motif discovery to extract a small sample of personalized motifs for each individual patient and then use these motifs to predict abnormalities in real-time readings of that patient using an artificial logical network configured by a physician. Results: Our approach was tested on 30 minutes of ECG readings from 32 patients. The average diagnostic accuracy of the PMM was always above 90% and reached 100% for some parameters, compared to 80% accuracy for the Generalized Monitoring Models (GMM). Regardless of parameter settings, PMM training models were generated within 3-4 minutes, compared to 1 hour (or longer, with increasing amounts of training data) for the GMM. Conclusions: Our proposed PMM almost eliminates many of the training and small sample issues associated with GMMs. It also addresses accuracy and computational cost issues of the GMM, caused by the uniqueness of heartbeats and training issues. In addition, it addresses the fact that doctors and nurses typically do not have data science training and the skills needed to configure, understand, and even trust existing black box machine learning models

MMR characteristics in cochlear implanted children with different duration of HA use.

MMR characteristics in cochlear implanted children with different duration of HA use.</p

Auditory MMR characteristics in children of different ages at cochlear implantation.

Auditory MMR characteristics in children of different ages at cochlear implantation.</p