草島 邦夫

PURPOSE: To develop and validate a prediction model for sleep apnea syndrome (SAS) treated with continuous positive airway pressure (CPAP) in the general population. METHODS: Using claims and health checkup data held by JMDC Inc. linked to personal health records (Pep Up), we developed and internally validated a prediction model for SAS treated with CPAP, defined as a SAS diagnosis and reimbursement records of CPAP. Every 3 months from January 1, 2022 to July 1, 2024 (11 timepoints), we identified eligible individuals with available data both 1 year before and after that timepoint to define the presence/absence of SAS treated with CPAP, along with 279 predictor variables. We developed a LightGBM model for the training and tuning datasets and evaluated its performance on the validation dataset. RESULTS: Overall, 18,692,873 observations (mean age: 44.8 ± 11.3 years; female, 37.5%) were obtained from 1,858,566 individuals; of these observations, 300,868 observations (1.6%) were found to have SAS treated with CPAP. The area under the receiver operating characteristic curve was 0.898 (95% confidence interval 0.895-0.901). The positive predictive values among observations in the top 1% and 10% of predicted risk were 28.3% and 10.3%, respectively. According to the SHapley Additive exPlanations plots, male sex was the most important predictor, followed by age, body mass index, and waist circumference. Moreover, personal health records significantly improved the predictive performance. CONCLUSION: We developed a prediction model to identify individuals at high risk of SAS treated with CPAP and encourage them to undergo polysomnography or related tests.

A 76-year-old woman with cervical cancer was treated with nedaplatin, a platinum-based drug. After the initiation of the treatment, she became aware of numbness, dizziness, and loss of appetite. Exploration of the causes revealed no clues, but blood tests revealed hypocalcemia and hypomagnesemia. She was treated with intravenous calcium and magnesium, which resolved calcium, magnesium levels, and her symptoms. She was diagnosed with hypomagnesemia because of nedaplatin. Regular follow-up is necessary for patients during or after nedaplatin. Awareness of electrolyte disturbances may elucidate the accurate diagnosis even in patients with obscure symptoms, particular in undergoing or following anticancer therapies.

医学部低学年に在籍する筆頭著者が，医療機関で多職種業務を実践し，成員となっていく過程を「正統的周辺参加理論」に基づき考察した．学習者と実践共同体の間に互恵的関係が構築される過程で，学習者の学びが促進され，実践共同体の成員として認められた．さらに，実践共同体にも建設的な変化が観察された．本活動は医学生にとって有意義な学習機会であり，転用性の高い活動となりうる．