持続的腎代替療法におけるメシル酸ナファモスタットの血中動態

Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.博士（医学）・乙第1531号・令和5年3月15

Rapid Efficacy of Low Carbohydrate Diet for Diabetic Patient by Use of FreeStyle Libre

In recent years, continuous glucose monitoring (CGM) has been introduced and used in clinical diabetic research. Authors have investigated research about Low Carbohydrate Diet (LCD) and Calorie Restriction (CR) and developed medical and social LCD movement through Japan LCD Promotion Association (JLCDPA). In this study, a case with remarkable improving effect for change from CR to LCD is presented using CGM. The case is 41 years-old female with type 2 diabetes mellitus (T2DM). She was newly diagnosed as T2DM with HbA1c 11.0%, glucose >400 mg/dL, BMI 26.0, AST 30 IU/mL, Hb 16.3 g/dL. She was given CR meal with 60% carbohydrate on day 1 to 4, and LCD meal with 12% carbohydrate on day 5 to 7. Daily profile of blood glucose showed 200-400 mg/dL in day 1-4, 160-240 mg/dL on day 5 and 110-150 mg/dL on day 7. FreeStyle Libre (Abbott, USA) has been valid and useful medical apparatus for monitoring the the detailed fluctuation of blood glucose. Blood glucose value was immediately decreased just after starting LCD, and the short-term effect of the LCD was found. These results would become basal and reference data and contribute to the development of future research

Quantification of Hepatic Iron Concentration in Chronic Viral Hepatitis: Usefulness of T2-weighted Single-Shot Spin-Echo Echo-Planar MR Imaging

Objective: To investigate the usefulness of single-shot spin-echo echo-planar imaging (SSEPI) sequence for quantifying mild degree of hepatic iron stores in patients with viral hepatitis. Methods: This retrospective study included 34 patients with chronic viral hepatitis/cirrhosis who had undergone histological investigation and magnetic resonance imaging with T2-weighted gradient-recalled echo sequence (T2-GRE) and diffusion-weighted SSEPI sequence with b-factors of 0 s/mm 2 (T2-EPI), 500 s/mm 2 (DW-EPI-500), and 1000 s/mm 2 (DW-EPI-1000). The correlation between the liver-to-muscle signal intensity ratio, which was generated by regions of interest placed in the liver and paraspinous muscles of each sequence image, and the hepatic iron concentration (mmol/g dry liver), which was assessed by spectrophotometry, was analyzed by linear regression using a spline model. Akaike information criterion (AIC) was used to select the optimal model. Results: Mean 6 standard deviation of the hepatic iron concentration quantified by spectrophotometry was 24.6616.

Bit-Error and Soft-Error Resilient 7T/14T SRAM with 150-nm FD-SOI Process

Background: The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS). Methods: We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9-0.5 years after percutaneous coronary interventions in which stents were deployed. Coronary angiography was performed within 3 months of the stress test. ISS was defined as ≥50% stenosis in a coronary segment with previous stenting. Significant coronary artery disease (CAD) was defined as ≥50% stenosis within or outside the stented coronary segment. Results: The stent was deployed in 1 coronary artery in 52 patients, and in 2 coronary arteries in 20 patients (a total of 92 detected in 42 (58%) patients (51 stents). Reversible perfusion abnormalities were present in 34 of patients

Disordered Cubic Spinel Structure in the Delithiated Li2MnO3 Revealed by Difference Pair Distribution Function Analysis

An archetypical Li-rich layered oxide, Li2MnO3, shows a large initial charge capacity of ~350 mAh g-1 with little oxidation of the constituent Mn ions, yet, the crystal structure of delithiated Li2MnO3 is still unclarified because the structural disorder induced by the considerable Li extraction makes the analysis challenging. X-ray pair distribution function (PDF) analysis is a powerful tool to experimentally elucidate the structure of the disordered phase. Here, we conducted a comprehensive analysis with a focus on PDF analysis in combination with the X-ray powder diffraction (XRPD), transmission electron microscopy (TEM), and X-ray absorption spectroscopy (XAS) to reveal the disordered crystalline structure of the electrochemically delithiated Li2MnO3. The XRPD and TEM analyses clarified the formation of a low-crystallinity phase in the light of the average structure. The XAS and PDF analyses further revealed that the MnO6–based framework was rearranged with maintaining the MnO6 octahedral coordination after the initial charge. The difference pair distribution function (d-PDF) technique was therefore employed to extract the structural information of the low-crystallinity disordered phase. The delithiated phase was found to have a structure similar to the cubic spinel, LiMn2O4, rather than that of delithiated LiMn2O4 (λ-MnO2). In addition, the middle-range order of the delithiated phase deteriorated after the charge, indicating a decrease of coherent domain size to a single nm order. The composite structure formed after the first charge, therefore, consists of the disordered cubic spinel structure and unreacted Li2MnO3. The formation of the composite structure “activates” the electrode material structurally and eventually induces characteristic large capacity of this material

Clinical effect for diabetic pregnant female by Low Carbohydrate Diet (LCD) and Continuous Glucose Monitoring (CGM)

In the diabetic medical practice, continuous glucose monitoring (CGM) has been recently used with beneficial efficacy. Authors have continued women’s medical care and research on Calorie Restriction (CR) and Low Carbohydrate Diet (LCD), and developed medical and social LCD movement by Japan LCD Promotion Association (JLCDPA). In this study, a diabetic female case with remarkable improving effect is shown using CGM and LCD. The case is 27 years-old female with type 2 diabetes mellitus (T2DM). She has been pregnant and on multiple daily insulin injection (MDI) with insulin 48 units/day in the university hospital. She was on this treatment until 28th weeks with no preeclampsia symptoms, and hoped to change the treatment of LCD. She came to our women’s clinic with the current data of weight 101kg, BMI 37.1 and HbA1c 7.0%. By application of FreeStyle Libre (Abbott, USA), her glucose variability showed around 160mg/dL with some episodes of hyperglycemia. The meal was changed from CR to LCD after 29th week, then insulin administration could be discontinued in 10 days. This glucose variability showed remarkable efficacy for combination of LCD and CGM. These results would become basal and reference data and contribute to the development of future research

Developing a Systematic Subject Instruction Curriculum in Student Teaching Practice: Through the Development and Application of Rubrics

In the practical training at Hiroshima University, we provided practical training guidance using rubrics. Based on the appraisal of the apprentices based on the rubrics and analysis based on the descriptions in the questionnaire and the lesson plan, we found that the rubrics are an effective tool for clarifying the goals to be achieved in the initial stage of apprenticeship and the policies that apprentices should take