Functional mapping of regional liver asialoglycoprotein receptor amount from single blood sample and SPECT

金沢大学大学院医学系研究科The objective of this study was to validate a method for estimating regional liver asialoglycoprotein (ASGP) receptor amount from single blood samples using static SPECT with 99mTc-diethylenetriaminepentaacetic acid galactosyl human serum albumin (99mTc-GSA). Methods: Based on a 2-compartment nonlinear model, regional ASGP receptor amount could be calculated from total liver ASGP receptor amount (Ro) and regional GSA uptake at a specific time. Because Ro could be estimated from single blood samples using an empiric formula, regional GSA uptake obtained as a SPECT voxel count could be converted to regional ASGP receptor amount by solving a non-linear model equation. To validate this method, data from 62 patients with chronic liver disease underwent dynamic SPECT (30 rotations per 30 min) and simultaneous multiblood sampling and were analyzed by this method. Ro was calculated as the sum of voxel values of parametric receptor images generated from plasma concentration of GSA at 20 min and of static SPECT images generated by merging dynamic SPECT data (12-20 min). Ro was also estimated by fitting time-activity curves (4-30 min) of plasma and whole liver to the nonlinear model using the nonlinear regression method. Ro obtained from the receptor image was compared with that from curve fitting in relation to the results of hepatic function tests (indocyanine green test, hepaplastin test, and branched-chain amino acids/tyrosine plasma concentration ratio) and Child\u27s classification. Results: Ros from the 2 methods showed a significant linear correlation (r2 = 0.938; P < 0.0001; slope = 0.90; y-intercept = 1.5). Both Ros had significant correlations with the results of hepatic function tests (P < 0.001) and differed significantly among the 3 groups of Child\u27s classification (P < 0.0001). Conclusion: The present method could provide a quantitative ASGP receptor image without dynamic data acquisition. This approach could be useful for quantitative evaluation of regional liver function and estimation of residual liver function in hepatectomy

献血血液の安全度と献血者確保について 輸血部における安全な輸血管理と適正使用

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外科領域におけるリスクマネージメント 血液製剤とそのリスク

雑誌掲載版血液製剤のリスクは感染性リスクと非感染性リスクに大別される。リスク回避法として、製剤の安全性向上と製剤の適切な使用があげられる。死亡率の高い輸血副作用として、ABO不適合輸血と輸血関連急性肺障害(TRALI)が重要である。血液製剤の感染リスクは格段に低くなったが、いまだゼロになっていない。病原体不活化が検討されているが、実現までに克服すべき課題は多い。輸血は頻繁に行われる移植医療であるため、受血者に何らかの免疫反応が引き起こされる。術後の癌再発や創感染、心筋梗塞発生などに対する影響が検討されているが、一定の結論は出ていない。出血性ショックや術中大量出血に的確に対応するためには院内システムの構築が必要で、危機的出血発生時には、危機的出血への対応ガイドラインに則った対応が求められる。血液製剤使用時には、リスクとベネフィットを比較考慮し、エビデンスに基づいた血液製剤使用を目指すことが必要である

【臨床検査Yearbook 2010 臨床に役立つ検査のポイント 免疫血清・輸血・移植医療の検査】 輸血検査 輸血副作用の監視体制 ―輸血遡及調査―

著者最終原稿版輸血副作用には、輸血開始直後に発生するものから輸血後長期間経て初めてその発生が確認できるものまで含まれる。輸血開始から輸血後数日以内に発生する副作用は注意深い患者観察により容易に発見でき、原因製剤の確保も可能であるため輸血との因果関係を調査判断しやすい。しかし、輸血後数ヵ月以上経てから発生する副作用と輸血の関連性を明らかにすることは難しい。そのためには輸血を受けた患者を未来に向けて前向きに追跡し、何らかの副作用が発生した時に過去に遡って輸血との関係を調査できる体制を作る必要がある

Purification of aluminum and gold by levitation melting in ultra-high vacuum

The aim of this work is to improve the purity of metals. Samples of aluminum and gold have been melted in ultra-high vacuum less than 1 × 10–5 Pa using a cold-crucible induction furnace. Levitation melting has been performed at a temperature just above the melting point of these metals. The purity of both samples was improved by one order of magnitude. The impurity elements well removed by this method have a distribution coefficient less than 1. The evaporation of the melted sample is low in spite of ultra-high vacuum. The mass decrease during levitation melting is close to the theoretical estimation using the Maxwell velocity distribution. From the present results, it is suggested that the evaporation of metals strongly depends on their purity