HItoshi Sugawara
Jichi Medical University, Comprehensive Medicine 1, Faculty Member
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Oct 2016 – Present Division Head, Professor, Division of General Medicine, Department of Comprehensive Medicine 1, Sa... moreOct 2016 – Present Division Head, Professor, Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University
Apr 2008 – Sep 2016 Division Head, Associate Professor, Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University
Apr 2004 - Mar 2008 Assistant Professor, Division of General Medicine, Department of Comprehensive Medicine 1, Omiya Medical Center, Jichi Medical University
Jan 2003 - Mar 2004 Research Associate, Division of General Medicine, Department of Comprehensive Medicine 1, Omiya Medical Center, Jichi Medical University
Sep 2001 - Dec 2002 Division Head, Division of Internal Medicine, Omiya Medical Association Hospital
Jun 1998 - Aug 2001 Research Associate, Division of General Medicine, Department of Comprehensive Medicine 1, Omiya Medical Center, Jichi Medical University
Jun 1997 - May 1998 Division Head, Division of Cardiology, Hakodate Kyoaikai Hospital
Jun 1996 - May 1997 Research Associate, Division of General Medicine, Department of Comprehensive Medicine 1, Omiya Medical Center, Jichi Medical University
Jun 1994 - Mar 1996 Postdoctoral fellow, Section of Immunology, Boyer Center for Molecular Medicine, School of Medicine, Yale University
Jun 1992 - May 1994 Hospital Director, General Medicine, RISHIRI Island National Health Insurance Center Hospital
Jun 1985 - Mar 1994 Research scholar, 1st Department of Internal Medicine, Asahikawa Medical University
Jun 1990 - May 1992 Medical Staff Physician, 1st Department of Internal Medicine, Asahikawa Medical University
Jun 1988 - May 1990 Superintendent, Hokkaido Prefectural Utoro Clinic
Jun 1987 – May 1988 Medical Staff Physician, Internal Medicine, Wakkanai Municipal Hospital
Apr 1987 - Sep 1987 Resident, Medicine, Asahikawa Municipal Hospital
Oct 1987 - May 1987 Resident, Surgery, Internal Medicine, Asahikawa Medical University Hospital
Jun 1985 - Mar 1987 Resident, Internal Medicine, Anesthesiology, Pediatrics, Asahikawa Medical University Hospital
Mar 1985 Graduated Jichi Medical University, Jichi Medical University edit
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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Background The coronavirus disease 2019 (COVID-19) pandemic has put a strain on the healthcare system, and sudden changes in disease status during home treatment have become a serious issue. Therefore, prediction of disease severity and... more
Background The coronavirus disease 2019 (COVID-19) pandemic has put a strain on the healthcare system, and sudden changes in disease status during home treatment have become a serious issue. Therefore, prediction of disease severity and allocation of sufficient medical resources, including high-flow nasal cannula (HFNC), to patients in need are important. We aimed to determine risk factors for the need of HFNC use in COVID-19. Methods This was a single-center retrospective observational cohort study including all eligible hospitalized adult patients aged �18 years diagnosed with COVID-19 between April 14, 2020 and August 5, 2021 who were treated in the study hospital. The primary outcome is the need for HFNC. Nineteen potential predictive variables, including patient characteristics at hospital admission, were screened using least absolute shrinkage and selection operator and logistic regression to construct a predictive risk score. Accuracy of the risk score was determined using area under the receiver operating characteristic curve.
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Background: During the early stages of the COVID-19 pandemic in Japan, access to reverse transcription polymerase chain reaction (RT-PCR) testing was limited. All patients with COVID-19 required hospitalization, and isolation of suspected... more
Background: During the early stages of the COVID-19 pandemic in Japan, access to reverse transcription polymerase chain reaction (RT-PCR) testing was limited. All patients with COVID-19 required hospitalization, and isolation of suspected COVID-19 patients had not yet been implemented. With the recently acquired evidence on COVID-19, it is important to develop a risk stratification system for isolation rooms in the context of limited resources for better resource management. Objective: This study aimed to develop and validate a COVID-19 risk-scoring strategy, the Fukuchi-Manabe score, to safely stratify and manage isolation rooms, personal protective equipment (PPE), and RT-PCR testing in the context of limited RT-PCR testing and a short supply of PPE. Methods: This single-center prospective study consecutively enrolled suspected COVID-19 adult inpatients between March 1 and August 31, 2020. The primary and secondary outcomes were a positive RT-PCR test and the occurrence of nosocomial infections during the study period, respectively. Factors related to patient history, symptoms, chest computed tomography findings, and laboratory data suggestive of COVID-19 were scored, totaled, and divided into four categories ("probable," "possible," "less likely," and "non-suspicious") based on the likelihood of COVID-19. Sensitivity, specificity, and positive and negative predictive values were evaluated for each probability category. Findings: Twenty of 224 inpatients were positive on the RT-PCR test, including 18 "probable" patients (90.0%), one "possible" patient, and one "less likely" patient. The area under the curve (AUC) (95% confidence interval: 0.841-0.977), sensitivity, and specificity were 0.909, 90.0%, and 80.4%, respectively. The positive and negative predictive values and accuracy for the "probable" category were 0.90, 0.80, and 0.82, respectively. The mean and standard deviation of AUCs, validated by bootstrap analysis, were 0.910±0.034. No nosocomial infections were observed. Conclusion: The Fukuchi-Manabe score will be helpful when other novel pathogens emerge in the future before the availability of genetic testing methods.
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A 77-year-old obese man presented with a 4-day history of scrotal enlargement following 2 weeks of frequent urination and dysuria. He had no fever. Physical examination revealed left scrotal swelling without tenderness. Computed... more
A 77-year-old obese man presented with a 4-day history of scrotal enlargement following 2 weeks of frequent urination and dysuria. He had no fever. Physical examination revealed left scrotal swelling without tenderness. Computed tomography (CT) revealed a prolapsed urinary bladder into the scrotum (Fig. 1) and bilateral hydronephrosis (Fig. 2). He was diagnosed with inguinal bladder hernia (IBH). His symptoms improved after bladder catheterization.
IBH occurs in 1–3% of inguinal hernias.1 Although most patients with IBH are asymptomatic; they can develop lower urinary tract symptoms including incontinence and dysuria. Reduction in hernia size after urination is a characteristic sign of IBH.1 Reduced bladder wall tension, obesity, and pelvic floor muscle weakness contribute to IBH pathogenesis.2,3 The patient’s obesity and profession (a baseball umpire) may have contributed to IBH development.
Delayed diagnosis of IBH can lead to necrosis at the hernia site, a complication which may require bladder resection.2,4 IBH can be diagnosed by CT, ultrasound, retrograde cystography, or magnetic resonance imaging. When IBH is suspected, imaging should be performed to guide surgical intervention and avoid complications.
IBH occurs in 1–3% of inguinal hernias.1 Although most patients with IBH are asymptomatic; they can develop lower urinary tract symptoms including incontinence and dysuria. Reduction in hernia size after urination is a characteristic sign of IBH.1 Reduced bladder wall tension, obesity, and pelvic floor muscle weakness contribute to IBH pathogenesis.2,3 The patient’s obesity and profession (a baseball umpire) may have contributed to IBH development.
Delayed diagnosis of IBH can lead to necrosis at the hernia site, a complication which may require bladder resection.2,4 IBH can be diagnosed by CT, ultrasound, retrograde cystography, or magnetic resonance imaging. When IBH is suspected, imaging should be performed to guide surgical intervention and avoid complications.
Background: In recent years, reports of disseminated nontuberculous mycobacterial (NTM) infections in adults with anti-interferon-gamma (IFN-γ) autoantibodies have increased, particularly in Southeast Asia. The absence of previous... more
Background: In recent years, reports of disseminated nontuberculous mycobacterial (NTM) infections in adults with anti-interferon-gamma (IFN-γ) autoantibodies have increased, particularly in Southeast Asia. The absence of previous immunodeficiency and nonspecific initial symptoms in patients are likely to cause a diagnostic delay. Clinical symptoms, imaging findings, and culture of organ specimens are included in the diagnostic criteria; however, the cultures are not always positive. Granuloma formation is a characteristic pathology of NTM infections, assisting in the diagnosis, which is not observed in the presence of immunodeficiency. Case Report: A 69-year-old Japanese woman with no history of immunodeficiency presented with a pulmonary nodule, neutrophilic dermatosis, and pyogenic lymphadenitis. Bronchoscopy, transbronchial aspiration cytology, endobronchial ultrasound-guided transbronchial needle aspiration, computed tomography-guided lung biopsy, thoracoscopic lymph node biopsy, right subclavian lymph node biopsy, skin biopsy, and blood cultures were performed. Results: While the cultures were negative, a pathological examination revealed inflammatory cell infiltrates, mainly composed of macrophages. Mycobacterium abscessus subsp. massiliense was recovered in an open biopsy of the left inguinal lymph node. Further, QuantiFERON®TB Gold Plus, a commercialized IFN-γ release assay, was inconclusive, whereas anti-IFN-γ autoantibodies were positive. Notably, eight months after symptom onset, the patient was diagnosed with disseminated M. abscessus subsp. massiliense infection associated with adult-onset immunodeficiency due to the presence of anti-IFN-γ autoantibodies. Conclusion: Obtaining this definitive diagnosis was challenging owing to the delayed identification of anti-IFN-γ autoantibodies, a lack of positive cultures, and an absence of granuloma formation. Thus, for early diagnosis, screening for anti-IFN-γ autoantibodies using QuantiFERON®TB Gold Plus, repeated culture examinations, and pathological studies are recommended.
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Background: Masks are well accepted in Japan, where they were already part of daily life even before the COVID-19 pandemic. Unlike many other countries where mask mandates were lifted as soon as the pandemic was under control, Japan was... more
Background: Masks are well accepted in Japan, where they were already part of daily life even before the COVID-19 pandemic. Unlike many other countries where mask mandates were lifted as soon as the pandemic was under control, Japan was one of the last countries to ease mask-wearing guidelines. Even after the formal announcement to allow masks-off in mid-March 2023, many Japanese still voluntarily wear masks. In this work, possible reasons for this extreme "mask-affinity" of Japanese people were studied by exploring various information sources including tweets (now known as X posts) and subsequent text-analysis, online news, and medical literature. Methods: An observational study was conducted based on tweets prospectively collected during 5 months from June 26 th , 2022 to November 26 th , 2022. Tweets with the hashtag "mask (in Japanese)" were collected weekly via the Twitter application programming interface by using R version 4.0.3 to gauge public opinions. The word clouds to allow intuitive understanding of the key words were drawn from the tokenized text. Results: The data collection period included the 7 th flareups of the newly infected cases i.e. "the 7 th surge". In total, 161,592 tweets were collected. Word clouds for 1) before the 7 th surge based on 18,000 tweets on June 26 th and 2) during/after the 7 th surge based on 143,592 tweets between July-November were created with the R package "wordcloud2". The results indicated that the people wanted to take off masks due to the heat in summer, then shifted again toward mask-wearing along with the 7 th surge but with a certainly growing "no-mask" sentiment. Conclusions: Subsequent review of domestic information sources suggested that various factors, not only wellknown peer pressure, may have contributed the public's mask affinity in Japan. This work revealed an aspect of Japanese struggle toward adaptation to life in an unexpected pandemic by focusing on masks as our closest daily adjunct over the past 3 years of isolation. Trial registration: not applicable.
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Skeletal muscle biology, Eosinophil, Medicine, Biopsy, Humans, and 13 moreInternal Medicine, Chronic Disease, Female, Headache, Follow-up studies, Clinical Sciences, Middle Aged, Public health systems and services research, Churg Strauss Syndrome, Acetaminophen, Antipyretic, Arteries, and Drug hypersensitivity
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Dialysis, Japan, Linear models, Humans, Internal Medicine, and 15 moreKidney, Female, Incidence, Body Mass Index, Clinical Sciences, Aged, Longitudinal Studies, Adult, Asian Continental Ancestry Group, Body Weight, Chi Square Distribution, Asymptomatic, Cross sectional Study, Cross Sectional Studies, and Logistic Models
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Endocrinology, Cardiovascular, Japan, Insulin Resistance, Humans, and 15 moreInternal Medicine, Insulin, Female, Male, Body Mass Index, Adult, Asian Continental Ancestry Group, Biological markers, Chi Square Distribution, Glucose Tolerance Test, Asymptomatic, Cross Sectional Studies, Logistic Models, Cardiovascular medicine and haematology, and amylases
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Adult‐onset Still's disease may cause intestinal pseudo‐obstruction via a cytokine storm. Early diagnosis and treatment are the key for patient survival before the development of serious complications such as macrophage activation... more
Adult‐onset Still's disease may cause intestinal pseudo‐obstruction via a cytokine storm. Early diagnosis and treatment are the key for patient survival before the development of serious complications such as macrophage activation syndrome.
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Supplemental Digital Content is available in the text Abstract The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear. To explore the risk factors... more
Supplemental Digital Content is available in the text Abstract The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear. To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions. Retrospective, single-center, case-controlled cross-sectional study. University teaching hospital. Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013. Extremely high RPG (≥500 mg/dl). Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity. A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (−5.142 + 0.901log (CK) −1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%. The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.
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The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients... more
The risk factors associated with mortality in patients with extremely high serum C-reactive protein (CRP) levels are controversial. In this retrospective single-center cross-sectional study, the clinical and laboratory data of patients with CRP levels ≥40 mg/dL treated in Saitama Medical Center, Japan from 2004 to 2017 were retrieved from medical records. The primary outcome was defined as 72-hour mortality after the final CRP test. Forty-four mortal cases were identified from the 275 enrolled cases. Multivariate logistic regression analysis (MLRA) was performed to explore the parameters relevant for predicting mortality. As an alternative method of prediction, we devised a novel risk predictor, “weighted average of risk scores” (WARS). WARS features the following: (1) selection of candidate risk variables for 72-hour mortality by univariate analyses, (2) determination of C-statistics and cutoff value for each variable in predicting mortality, (3) 0–1 scoring of each risk variable a...
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In pancreatic β-cells, glucose-induced closure of the ATP-sensitive K(+) (KATP) channel is an initial process triggering glucose-stimulated insulin secretion (GSIS). This KATP-channel dependent pathway has been believed to be a central... more
In pancreatic β-cells, glucose-induced closure of the ATP-sensitive K(+) (KATP) channel is an initial process triggering glucose-stimulated insulin secretion (GSIS). This KATP-channel dependent pathway has been believed to be a central mechanism for GSIS. However, since the resting membrane potential of cells is determined by the balance of the net result of current amplitudes in outward and inward directions, it must be taken into consideration that not only KATP channel inhibition but also inward current via the basal opening of non-selective cation channels (NSCCs) plays a crucial role in membrane potential regulation. The basal activity of NSCCs is essential to effectively evoke depolarization in concert with KATP channel closure that is dependent on glucose metabolism. The present study summarizes recent findings regarding the roles of NSCCs in GSIS and GTP-binding protein coupled receptor-(GPCR) operated potentiation of GSIS.
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Two cases of miliary tuberculosis with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) were reported. Case 1. A 70-year-old woman suffering from general fatigue and appetite loss developed neck stiffness and stupor... more
Two cases of miliary tuberculosis with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) were reported. Case 1. A 70-year-old woman suffering from general fatigue and appetite loss developed neck stiffness and stupor three days after admission. The chest X-ray film showed a miliary pattern in both lungs. The lumber puncture showed high pressure and increased leucocytes in the cerebrospinal fluid. Serum natrium concentration was 113 mEq/L. Tubercle bacilli were seen in the broncho-alveolar lavage fluid by the Ziehl-Nielsen staining. An improvement in electrolytes balance was produced by 2.5% NaCl and antituberculous treatment, then her mental function recovered. Case 2. A 71-year-old man was admitted with gastric ulcer. When he developed dry cough thirty days after admission, the chest X-ray film showed a miliary pattern in both lungs. Acute respiratory failure advanced concomitantly. Tubercle bacilli were seen in the sputum (Gaffky 5) by the Ziehl-Nielsen staining....
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Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data... more
Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data from medical records of adult patients treated at Saitama Medical Center, Japan, from 2005 to 2019. We conducted a multivariate logistic after adjusting for age, sex, height, weight, body mass index, Brinkman Index, vital signs, biochemical values, updated Charlson Comorbidity Index (CCI) score, CCI components, and underlying causes. A logistic regression model with selected validity risks and higher C-statistic for predicting 72-h mortality was established. During the 15-year period, 428 patients (133 non-survivors and 295 survivors [cases and controls by survival
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Common adverse effects of serotonin-norepinephrine reuptake inhibitors are nausea, dry mouth, dizziness and headache. We describe the case of a patient with dysosmia and subsequent dysgeusia associated with duloxetine. A 68-year-old... more
Common adverse effects of serotonin-norepinephrine reuptake inhibitors are nausea, dry mouth, dizziness and headache. We describe the case of a patient with dysosmia and subsequent dysgeusia associated with duloxetine. A 68-year-old Japanese woman with a history of type 1 diabetes mellitus, hypertension, insomnia and reflux esophagitis presented to a local hospital with bilateral leg pain; she was treated with duloxetine. However, after 4 weeks, she sensed rotten egg smell, experienced nausea and vomiting and was admitted to our hospital. We diagnosed dysosmia using the T&T olfactometer threshold test and dysgeusia using filter paper disk method. Taste was assessed using electrogustometry. We suspected that dysosmia and dysgeusia were adverse effects of duloxetine. After stopping duloxetine, her symptoms gradually subsided and the above test results improved, despite continuing the other ongoing medication. To the best of our knowledge, this is the first case report of dysosmia and ...
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A 54-year-old Japanese man noticed painful swelling and redness of his left leg. He was admitted for treatment of cellulitis, which was accompanied with increased anti-streptolysin O and anti-streptokinase titers in his clinical course.... more
A 54-year-old Japanese man noticed painful swelling and redness of his left leg. He was admitted for treatment of cellulitis, which was accompanied with increased anti-streptolysin O and anti-streptokinase titers in his clinical course. After Piperacillin/Tazobactam administration, the skin lesion resolved. However, the patient then developed arthritis, palpable purpura, and intermittent abdominal pain, later found to be secondary to a severe duodenal ulcer. He was diagnosed with cellulitis-associated anaphylactoid purpura and was given prednisolone, which dramatically improved his symptoms. The anaphylactoid purpura was likely caused by Streptococcus-induced cellulitis, which was successfully treated with prednisolone. Association between these diseases is rare.
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We report the case of a 71-year-old Japanese woman with adult-onset Still's disease (AOSD) in whom macrophage activation syndrome (MAS) developed despite therapy with oral high-dose prednisolone and intravenous methylprednisolone... more
We report the case of a 71-year-old Japanese woman with adult-onset Still's disease (AOSD) in whom macrophage activation syndrome (MAS) developed despite therapy with oral high-dose prednisolone and intravenous methylprednisolone pulse therapy twice. She was successfully treated with tocilizumab (TCZ). Soon afterward, her fever ceased and high levels of both ferritin and C-reactive protein levels decreased. Her course was complicated by disseminated intravascular coagulation, cytomegalovirus infection, and Pneumocystis jirovecii pneumonia. After these were resolved, AOSD-associated MAS was well controlled. She was discharged on hospital day 87. Although biologics such as TCZ are becoming established for the treatment of AOSD, there is no recommended therapy for AOSD-associated MAS. Several biologics have been tried for this complication, but their efficacy and safety remain controversial. We reviewed reported cases of AOSD-associated MAS successfully treated with various biologi...