New Vascular-Access Intervention Assistance Plate Provides Good Operability and Safety by Preventing Accidental Falls: First Experience of 1,872 Cases

Vascular-access interventions are necessary for the continuation of hemodialysis, and they are performed under X-ray guidance. During interventions, patients’ accidental falls from the bed are a serious problem, and spe-cialized fixation systems for hemodialysis patients to prevent their falls from the bed have been lacking. We developed a new fixation plate made of polypropylene homopolymer and tested its ability to prevent such falls retrospectively. This plate, which we named the ‘vascular-access intervention assistance plate,’ offers functional features such as the concurrent fixation of the body and either arm and an arm space with serrations for fixing a forearm strap. We performed computer simulations to examine the strength of the plate, and we evaluated the efficacy of fall prevention by reviewing patients’ medical records. The results demonstrated that the functional design of the plate provides good operability via accurate concurrent fixations of the body and arm. The com-puter simulation analysis results indicated the plate’s sufficient strength. The medical records analysis revealed three accidental falls before the plate’s introduction (401 patients, 1,437 interventions), and none after plate introduction (683 patients, 1,872 interventions). Accidental falls were significantly prevented by use of the plate (p < 0.05). The dementia rate and type of procedure were not significantly different between the patients who fell and those who did not. This vascular-access intervention assisted plate provides good operability and safety by preventing accidental falls among hemodialysis patients

Linear chain aldehydes evoke calcium responses in B16 melanoma cells

Oxidative stress is involved in various physiological impairing stages, such as aging, diabetes, atherosclerosis, cirrhosis, and neurological disorders. Recent research indicates that aldehyde compounds derived from oxidized lipids increase in cancer patients compared to healthy individuals. Among of them, hexanal, a six-carbon liner chain aldehyde, is commonly found in cancer patients. Lipid oxidation products including aldehydes are in general chemically unstable and react with biological molecules such as proteins. The purpose of this study is to investigate effects of lipid-derived aldehydes and the related compounds on intracellular Ca2+ responses in B16 melanoma cells. Hexanal-induced [Ca2+]i elevation is observed in B16 cells in a dose dependent manner, but [Ca2+]i changes were observed neither in 3T3-L1 cells nor Caco-2 cells. Propanal, a chain length analogue of hexanal, elicited no change in [Ca2+]i, but nonanal initiated [Ca2+]i increases. Analogue compounds of hexanal failed to induce [Ca2+]i elevation. Furthermore, unsaturated aldehydes known as TRPA1 channel agonists also failed to alter [Ca2+]i levels in B16 melanoma cells. Pharmacological spectra using inhibitors against intracellular Ca2+ signaling suggest that hexanal-induced [Ca2+]i responses in B16 cells might be involved in TRP channels other than TRPA1. Our results suggest that saturated aliphatic chain aldehydes would be novel compounds for initiating [Ca2+]i increases through very strict recognitions of chain saturation, aldehydic base structures, and chain lengths in B16 melanoma cells. B16 cells would have sensing mechanisms for oxidative status and/or metabolic activities in their growth environment

血液透析用カテーテル留置位置の事前設定器具の開発

　血液透析分野では人口の高齢化に伴いカテーテルを用いた透析のニーズが高まっています。安全で効率よく透析を行うための正確なカテーテル留置には、医師の専門的な知識・技術が必要です。正確な位置に留置できなければ、正しく血液透析を行う事ができないだけはなく、医療事故を引き起こしたり、再留置時の透視装置の使用による患者さんへの被爆を増大させたり、高価な透析用カテーテル廃棄による医療費の無駄が生じます。 この問題を解決するために、私達はカテーテルの留置位置事前設定器具を考案し特許申請し、メディカルテクノおかやまの協力を得て、ケイ・テクノ社でプロトタイプを完成させました。この度、重井医学研究所附属病院で臨床研究を行い、安全性に問題なく、良好な留置成績を得る事ができました。今後は成果を学会、論文で発表すると共に、透析以外のカテーテルへの応用や海外展開も視野に事業化を進めていく予定です

高周波聴力の左右差 : 一側性の蝸牛障害の評価への応用

High-frequency audiometry has the potential to detect hearing impairment at its early stage. However, several problems prevent the clinical application of high-frequency audiometry. In this study, the dispersion and left-right difference in the high-frequency sensitivity were investigated in normal hearing volunteers. In our results, the difference between the left and right ears varied only slightly among individuals or age groups, while dispersion of hearing threshold values became marked with an increase in frequency. The results suggest that the measurement of left-right difference in high-frequency sensitivity may be useful for the evaluation of unilateral impairment. To investigate this usefulness, the left-right differences were measured in the patients complaining of unilateral cochlear symptom with normal hearing. Considering the results of normal hearing, we determined that abnormal left-right difference in high-frequency sensitivity was over 20 dB. In 12 patients with unilateral tinnitus, 7 showed left-right differences, and 6 had tinnitus in the ear with increased thresholds. Our results suggested a relationship between tinnitus with normal hearing and hearing impairment in the high-frequency range.博士（医学）・乙1335号・平成26年3月17

A Promising New Anti-Cancer Strategy: Iron Chelators Targeting CSCs

Iron is a trace but vital element in the human body and is necessary for a multitude of crucial processes in life. However, iron overload is known to induce carcinogenesis via oxidative stress. Cancer cells require large amounts of iron for their rapid division and cell growth. Iron was recently found to play a role in cancer stem cells (CSCs); it maintains stemness during development. Iron also plays an important role in stemness by moderating reactive oxygen species. Thus, iron metabolism in CSCs is a promising therapeutic target. In this review, we summarize the roles of iron in cancer cells and CSCs. We also summarize anti-cancer therapeutic studies with iron chelators and describe our expectation of a new therapeutic strategy for CSCs on the basis of our findings

Assistant-Based Standardization of Prone Position Thoracoscopic Esophagectomy

Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n＝37) and a post-standardization group (n＝28). The thoracoscopic operative time was significantly shorter (p＝0.0037) in the post-standardization group (n＝28; 267±31min) than in the pre-standardization group (n＝37;301±53min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy

Thioredoxin interacting protein protects mice from fasting induced liver steatosis by activating ER stress and its downstream signaling pathways

Under normal conditions, fasting results in decreased protein disulfide isomerase (PDI) activity and accumulation of unfolded proteins, leading to the subsequent activation of the unfolded protein response (UPR)/autophagy signaling pathway to eliminate damaged mitochondria. Fasting also induces upregulation of thioredoxin-interacting protein (TXNIP) expression and mice deficient of this protein (TXNIP-KO mice) was shown to develop severe hypoglycemia, hyperlipidemia and liver steatosis (LS). In the present study, we aimed to determine the role of TXNIP in fasting-induced LS by using male TXNIP-KO mice that developed LS without severe hypoglycemia. In TXNIP-KO mice, fasting induced severe microvesicular LS. Examinations by transmission electron microscopy revealed mitochondria with smaller size and deformities and the presence of few autophagosomes. The expression of beta-oxidation-associated genes remained at the same level and the level of LC3-II was low. PDI activity level stayed at the original level and the levels of p-IRE1 and X-box binding protein 1 spliced form (sXBP1) were lower. Interestingly, treatment of TXNIP-KO mice with bacitracin, a PDI inhibitor, restored the level of LC3-II after fasting. These results suggest that TXNIP regulates PDI activity and subsequent activation of the UPR/autophagy pathway and plays a protective role in fasting-induced LS