傾向スコアマッチング解析を用いた、全身麻酔術後の気管抜管後に発生する呼吸数変化を伴わない動脈血酸素飽和度低下の影響

BACKGROUND: It has been suggested that oxygen desaturation may be paradoxically related to the absence of an abnormal respiratory rate (RR) during acoustic respiratory rate (RRa) monitoring in a postoperative setting. We retrospectively compared the incidence of desaruration in patients without an abnormal RR with that in patients with an abnormal RR using propensity scorer matching. We also explored the factors contributing to oxygen desaturation without an RR monitoring alert. METHODS: We used ≤ 8 h postoperative data of the first 935 patients. Outcomes of patients with and without critical RR changes (RR > 30 or 2 min) (critical RR change vs. noncritical RR change) were first compared according to oxygen desaturation levels (SpO₂ 10 s). Multivariate analysis was used to determine oxygen desaturation-associated explanatory factors. RESULTS: Propensity score matching yielded 259 patients without critical RR changes and 259 patients with critical RR changes, respectively. Oxygen desaturation rates were higher in patients without critical RR changes [noncritical RR change vs. critical RR change: 39/220 (15.1%) vs. 16/243 (6.2%)]. An odds ratio and 95% CI for the noncritical RR change was 2.56 (1.38-4.55, P = 0.002). A critical change in the RRa was not observed in 576 patients; of these, oxygen desaturation was observed in 76 (13.2%) patients. Surgery duration (OR, 1.018 per 10 min increase; 95% CI, 1.002 to 1.035) was independently associated with oxygen desaturation without critical RR change. CONCLUSION: Postoperative oxygen desaturation paradoxically occurred more frequently in patients without critical RR changes, whose RR was monitored by the RRa under oxygen therapy. The duration of surgery may explain the possibility of postoperative oxygen desaturation without an RRa device alert.博士（医学）・甲第679号・平成30年3月15日Copyright © 2017 by authors and Via Medica This work is licensed under the Creative Commons Attribution International License (CC BY-NC-ND 4.0). https://creativecommons.org/licenses/by-nc-nd/4.0/The definitive version is available at " http://dx.doi.org/10.5603/AIT.a2017.0038

Debt, Ownership Structure, and R&D Investment: Evidence from Japan

Financial factors and ownership structure are both part of the determinants of corporate R&D investment. Considering listed firms in the R&D intensive industries during the 2000s, this paper examines whether financial factors and ownership structure explain R&D investment in Japan. Following the methodology of Brown et al. (2009), which extends the dynamic investment model of Bond and Maghir (1994) to R&D investment, we find that only small, young firms mainly listed on new emerging markets face financial constraints. We also find that large firms finance R&D investment partly from debt. For firms with relatively limited assets, however, higher leverage leads to lower R&D investment. Finally, we find no evidence that large shareholdings by foreign investors enforce myopic behavior on firms in R&D intensive industries.

Neutral solution low in glucose degradation products is associated with less peritoneal fibrosis and vascular sclerosis in patients receiving peritoneal dialysis.

BACKGROUND: The effects of novel biocompatible peritoneal dialysis (PD) solutions on human peritoneal membrane pathology have yet to be determined. Quantitative evaluation of human peritoneal biopsy specimens may reveal the effects of the new solutions on peritoneal membrane pathology. METHODS: Peritoneal specimens from 24 PD patients being treated with either acidic solution containing high-glucose degradation products [GDPs (n = 12)]or neutral solution with low GDPs (n = 12) were investigated at the end of PD. As controls, pre-PD peritoneal specimens, obtained from 13 patients at PD catheter insertion, were also investigated. The extent of peritoneal fibrosis, vascular sclerosis, and advanced glycation end-product (AGE) accumulation were evaluated by quantitative or semi-quantitative methods. The average densities of CD31-positive vessels and podoplanin-positive lymphatic vessels were also determined. RESULTS: Peritoneal membrane fibrosis, vascular sclerosis, and AGE accumulation were significantly suppressed in the neutral group compared with the acidic group. The neutral group also showed lower peritoneal equilibration test scores and preserved ultrafiltration volume. The density of blood capillaries, but not of lymphatic capillaries, was significantly increased in the neutral group compared with the acidic and pre-PD groups. CONCLUSIONS: Neutral solutions with low GDPs are associated with less peritoneal membrane fibrosis and vascular sclerosis through suppression of AGE accumulation. However, contrary to expectation, blood capillary density was increased in the neutral group. The altered contents of the new PD solutions modified peritoneal membrane morphology and function in patients undergoing PD

Soft Coral Sarcophyton (Cnidaria: Anthozoa: Octocorallia) Species Diversity and Chemotypes

Research on the soft coral genus Sarcophyton extends over a wide range of fields, including marine natural products and the isolation of a number of cembranoid diterpenes. However, it is still unknown how soft corals produce this diverse array of metabolites, and the relationship between soft coral diversity and cembranoid diterpene production is not clear. In order to understand this relationship, we examined Sarcophyton specimens from Okinawa, Japan, by utilizing three methods: morphological examination of sclerites, chemotype identification, and phylogenetic examination of both Sarcophyton (utilizing mitochondrial protein-coding genes MutS homolog: msh1) and their endosymbiotic Symbiodinium spp. (utilizing nuclear internal transcribed spacer of ribosomal DNA: ITS- rDNA). Chemotypes, molecular phylogenetic clades, and sclerites of Sarcophyton trocheliophorum specimens formed a clear and distinct group, but the relationships between chemotypes, molecular phylogenetic clade types and sclerites of the most common species, Sarcophyton glaucum, was not clear. S. glaucum was divided into four clades. A characteristic chemotype was observed within one phylogenetic clade of S. glaucum. Identities of symbiotic algae Symbiodinium spp. had no apparent relation to chemotypes of Sarcophyton spp. This study demonstrates that the complex results observed for S. glaucum are due to the incomplete and complex taxonomy of this species group. Our novel method of identification should help contribute to classification and taxonomic reassessment of this diverse soft coral genus

Impact of absence of critical respiratory rate change on oxygen desaturation following tracheal extubation after general anaesthesia: a propensity score-matched analysis

  BACKGROUND: It has been suggested that oxygen desaturation may be paradoxically related to the absence of an abnormal respiratory rate (RR) during acoustic respiratory rate (RRa) monitoring in a postoperative setting. We retrospectively compared the incidence of desaruration in patients without an abnormal RR with that in patients with an abnormal RR using propensity scorer matching. We also explored the factors contributing to oxygen desaturation without an RR monitoring alert. METHODS: We used ≤ 8 h postoperative data of the first 935 patients. Outcomes of patients with and without critical RR changes (RR > 30 or < 8 beats per min for > 2 min) (critical RR change vs. noncritical RR change) were first compared according to oxygen desaturation levels (SpO2< 90% for > 10 s). Multivariate analysis was used to determine oxygen desaturation-associated explanatory factors. RESULTS: Propensity score matching yielded 259 patients without critical RR changes and 259 patients with critical RR changes, respectively. Oxygen desaturation rates were higher in patients without critical RR changes [noncritical RR change vs. critical RR change: 39/220 (15.1%) vs. 16/243 (6.2%)]. An odds ratio and 95% CI for the noncritical RR change was 2.56 (1.38–4.55, P = 0.002). A critical change in the RRa was not observed in 576 patients; of these, oxygen desaturation was observed in 76 (13.2%) patients. Surgery duration (OR, 1.018 per 10 min increase; 95% CI, 1.002 to 1.035) was independently associated with oxygen desaturation without critical RR change. CONCLUSION: Postoperative oxygen desaturation paradoxically occurred more frequently in patients without critical RR changes, whose RR was monitored by the RRa under oxygen therapy. The duration of surgery may explain the possibility of postoperative oxygen desaturation without an RRa device alert.  BACKGROUND: It has been suggested that oxygen desaturation may be paradoxically related to the absence of an abnormal respiratory rate (RR) during acoustic respiratory rate (RRa) monitoring in a postoperative setting. We retrospectively compared the incidence of desaruration in patients without an abnormal RR with that in patients with an abnormal RR using propensity scorer matching. We also explored the factors contributing to oxygen desaturation without an RR monitoring alert. METHODS: We used ≤ 8 h postoperative data of the first 935 patients. Outcomes of patients with and without critical RR changes (RR > 30 or < 8 beats per min for > 2 min) (critical RR change vs. noncritical RR change) were first compared according to oxygen desaturation levels (SpO2< 90% for > 10 s). Multivariate analysis was used to determine oxygen desaturation-associated explanatory factors. RESULTS: Propensity score matching yielded 259 patients without critical RR changes and 259 patients with critical RR changes, respectively. Oxygen desaturation rates were higher in patients without critical RR changes [noncritical RR change vs. critical RR change: 39/220 (15.1%) vs. 16/243 (6.2%)]. An odds ratio and 95% CI for the noncritical RR change was 2.56 (1.38–4.55, P = 0.002). A critical change in the RRa was not observed in 576 patients; of these, oxygen desaturation was observed in 76 (13.2%) patients. Surgery duration (OR, 1.018 per 10 min increase; 95% CI, 1.002 to 1.035) was independently associated with oxygen desaturation without critical RR change. CONCLUSION: Postoperative oxygen desaturation paradoxically occurred more frequently in patients without critical RR changes, whose RR was monitored by the RRa under oxygen therapy. The duration of surgery may explain the possibility of postoperative oxygen desaturation without an RRa device alert

A Retrospective Analysis of Oxygen Desaturation during Acoustic Respiratory Rate Monitoring in Non-ICU Patients following Tracheal Extubation after General Anesthesia

Purpose. Acoustic respiratory rate (RRa) monitoring provides an accurate estimation of the respiratory rate (RR). We investigated the incidence of oxygen desaturation under RRa monitoring in a postoperative setting and identified its related factors. Methods. This study was a retrospective chart review of postoperative patients outside an intensive care unit setting. Using the data collected during the first 8 h postoperatively, patients were divided into oxygen desaturated (SpO2 < 90% for >10 s) and nondesaturated groups under oxygen administration. Multivariate analysis was used to determine oxygen desaturation-associated explanatory factors. Results. Oxygen desaturation was detected in 102 of 935 patients (10.9%). % vital capacity [odds ratio (OR), 0.885 per 10% increase; 95% confidence interval (CI), 0.790 to 0.992], coexisting chronic obstructive pulmonary disease (OR, 2.195; 95% CI, 1.088 to 4.428), and absence of a critical RRa change (RR > 30 or <8 beats/min for >2 min) (OR, 1.972; 95% CI, 1.226 to 3.172) were independently associated with oxygen desaturation. Conclusion. Postoperative oxygen desaturation was observed in more than 10% of the patients whose RR was monitored by RRa under oxygen therapy. It is more likely to occur in patients with impaired pulmonary function or morbid pulmonary status and can also occur in the absence of abnormal RR

COVID-19パンデミックが慢性疼痛患者の痛みの強さ、心理状態、運動習慣に与えた短期間での影響

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people worldwide. The first declaration of a state of emergency in Japan, based on the Act on Special Measures for the Prevention and Control of the Novel Coronavirus, was issued from 16 April 2020 to 14 May 2020 to reduce person-to-person contact. Restrictions on going out, participating in community activities, and visiting hospitals were in place. This study investigates the short-term effects of the COVID-19 pandemic on patients with chronic pain. Methods: This study included outpatients with chronic pain undergoing treatment at the Pain Center of Nara Medical University Hospital. The patients had completed questionnaires for a disability during the study period, from 1 July to 30 September 2019 (baseline), 1 October to 31 December 2019 (pre-pandemic), and 1 July to 30 September 2020 (during the pandemic). The questionnaire covered changes in disability, pain intensity, health-related quality of life (QOL), anxiety, depression, catastrophic thinking, and the presence/absence of exercise habits at baseline, pre-pandemic, and during the pandemic. Results: Of the 245 eligible patients, there was no significant disability difference between baseline, pre-pandemic, and during the pandemic (p = 0.14). Similarly, pain intensity, health-related QOL, anxiety, depression, and the presence/absence of exercise habits did not significantly differ between baseline, pre-pandemic, and during the pandemic either. The current study observed significant differences in terms of catastrophic thinking (p = 0.02). Conclusion: The effects of the COVID-19 pandemic on patients with chronic pain were not apparent in the short-term. Clinical trail registration: UMIN000043174.博士（医学）・甲第839号・令和4年3月15日© Japanese Society of Anesthesiologists 2021.This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00540-021-02992-y.発行元が定める登録猶予期間終了の後、本文を登録予定（2022.12

A Study on Threat Analysis and Risk Assessment Based on the &#x201C;Asset Container&#x201D; Method and CWSS

In recent years, legislation and standardization of cyber security management for cyber-physical systems such as automotive systems have been progressing steadily. ISO/SAE 21434, published in 2021, addresses the management and analysis of electrical systems within road vehicles from a cybersecurity perspective. It also recommends some methods for the threat analysis and risk assessment (TARA) process. However, there are two problems in the evaluation methods derived from conventional security analysis approaches. One problem is related to the insufficient evaluation of attack feasibilities for cyber-physical systems by the CVSS-based approach. Another problem is the unclear relationship between damage factors in analyzing the impact of damage to each asset. In this paper, we focus on the TARA process, and apply an &#x201C;asset container&#x201D; method for threat classification, proposed by the authors at DECSoS 2017, and a CWSS-based risk quantification method. Moreover, we can also add some perspective to improve risk evaluation suitable for automotive systems. Following our past studies on methodologies to evaluate the risk of such special cyber-physical systems, we can quantify risks limited to some cyber-physical systems, such as direct access attacks to in-vehicle networks

Neutral solution low in glucose degradation products is associated with less peritoneal fibrosis and vascular sclerosis in patients receiving peritoneal dialysis.

♦ Background: The effects of novel biocompatible peritoneal dialysis (PD) solutions on human peritoneal membrane pathology have yet to be determined. Quantitative evaluation of human peritoneal biopsy specimens may reveal the effects of the new solutions on peritoneal membrane pathology. ♦ Methods: Peritoneal specimens from 24 PD patients being treated with either acidic solution containing high-glucose degradation products [GDPs (n = 12)] or neutral solution with low GDPs (n = 12) were investigated at the end of PD. As controls, pre-PD peritoneal specimens, obtained from 13 patients at PD catheter insertion, were also investigated. The extent of peritoneal fibrosis, vascular sclerosis, and advanced glycation end-product (AGE) accumulation were evaluated by quantitative or semi-quantitative methods. The average densities of CD31-positive vessels and podoplanin-positive lymphatic vessels were also determined. ♦ Results: Peritoneal membrane fibrosis, vascular sclerosis, and AGE accumulation were significantly suppressed in the neutral group compared with the acidic group. The neutral group also showed lower peritoneal equilibration test scores and preserved ultrafiltration volume. The density of blood capillaries, but not of lymphatic capillaries, was significantly increased in the neutral group compared with the acidic and pre-PD groups. ♦ Conclusions: Neutral solutions with low GDPs are associated with less peritoneal membrane fibrosis and vascular sclerosis through suppression of AGE accumulation. However, contrary to expectation, blood capillary density was increased in the neutral group. The altered contents of the new PD solutions modified peritoneal membrane morphology and function in patients undergoing PD