Evaluation of hypercoagulability status after off-pump coronary artery bypass grafting using rotation thromboelastometry

Background: Recently, off-pump coronary artery bypass (OPCAB) surgery, which dose not require cardiopulmonary bypass (CPB), has been commonly performed. It has been revealed that OPCAB decreases the incidence of perioperative infarctions triggered by thrombolism from aorta. However, OPCAB has also been associated with postoperative stroke. Thromboelastography (TEG) is a bedside blood test that can be used to defi ne the viscoelastic properties of blood. ROTEM® analyzer (Pentapharm GmbH, Munich,Germany) is a modifi ed form of TEG. The aim of this study is to evaluate the hypercoagulability status of the blood after OPCA Bsurgery by using ROTEM®.Methods: This is a prospective study of 10 OPCAB patients each who underwent OPCAB, on-pump surgery, AAA repair, and VATS for a period of 7 days with ROTEM® assays. From ROTEM data, Coagulation Index (CI) was calculated for each patient.Results: The CI values of OPCAB patients from the extrinsic assay during the perioperative period were consistent with hypercoagulability. In comparison between the OPCAB and CPB patients from the extrinsic assay, a signifi cant difference was observed during the postoperative state. Comparison between the OPCAB and AAA patients revealed significantly higher CI values in the OPCAB patients immediately after surgery. Similarly, comparison between the OPCAB and VATS patients revealed significantly higher CI values in the OPCAB patients through the entire course of measurements.Conclusions: A state of hypercoagulability of the blood, as measured by ROTEM, existed in the OPCAB patients beyond acute postoperative stage. The extrinsic coagulation, in particular, was hypercoagulable in the OPCAB patients.departmental bulletin pape

Novel measurement method for mitral valve anterior leafl et free margin length using 3DTEE

Background: The aim of our study is to establish an accurate measurement method for anterior mitral leafl et (AML) free margin length, which is a key aspect for prediction of the extent of resection in anterior mitral valve (MV) leafl et repair.Method: Among the patients who underwent anterior MV leafl et repair between July 2010 and August 2012, we studied 17 patients with data on 3D echocardiography obtained pre- and intra-operatively and intraoperative direct measurements of AML free margin.The AML free margin lengths measured at different frames (early-opening frame of MV and end-opening frame of MV) by using realtime 3D transesophageal echocardiography (RT-3DTEE) were compared with the values directly measured during mitral valvuloplasty (MVP). For acquisition of 3D data during surgery, RT-3DTEE images of MV were obtained by using the Philips iE33 echocardiography system with X7-2 probe before MVP.Result: The free margin length values measured with Q-LAB MVQ. Regarding the correlation between the measured values with the RT-3DTEE and values directly measured intraoperatively, the measured values at the early-opening frame of MV had no correlation between the actual measured values and r-value = 0.338 (P=0.184). Conversely, the measured values at the end-opening frame of MV had an extremely high signifi cant correlation between the measured values and r-value = 0.980 (P<0.0001).Conclusion: In conclusion, the novel measurement method enables measurement of anterior mitral leafl et free margin length by using RT-3DTEE. At the end-opening frame of MV, the novel measurement method that refl ects more accurate actual measured value was established.departmental bulletin pape

Characterization of an Acute Muscle Contraction Model Using Cultured C2C12 Myotubes

A cultured C2C12 myotube contraction system was examined for application as a model for acute contraction-induced phenotypes of skeletal muscle. C2C12 myotubes seeded into 4-well rectangular plates were placed in a contraction system equipped with a carbon electrode at each end. The myotubes were stimulated with electric pulses of 50 V at 1 Hz for 3 ms at 997-ms intervals. Approximately 80% of the myotubes were observed to contract microscopically, and the contractions lasted for at least 3 h with electrical stimulation. Calcium ion $(Ca^{2+})$ transient evoked by the electric pulses was detected fluorescently with Fluo-8. Phosphorylation of protein kinase B/Akt (Akt), 5′ AMP-activated protein kinase (AMPK), p38 mitogen-activated protein kinase (p38), and c-Jun NH2-terminal kinase (JNK)1/2, which are intracellular signaling proteins typically activated in exercised/contracted skeletal muscle, was observed in the electrically stimulated C2C12 myotubes. The contractions induced by the electric pulses increased glucose uptake and depleted glycogen in the C2C12 myotubes. C2C12 myotubes that differentiated after exogenous gene transfection by a lipofection or an electroporation method retained their normal contractile ability by electrical stimulation. These findings show that our C2C12 cell contraction system reproduces the muscle phenotypes that arise in vivo (exercise), in situ (hindlimb muscles in an anesthetized animal), and in vitro (dissected muscle tissues in incubation buffer) by acute muscle contraction, demonstrating that the system is applicable for the analysis of intracellular events evoked by acute muscle contraction

臨地実習における看護学教員と実習指導者に関する研究動向と課題

本研究の目的は，臨地実習における看護学教員と実習指導者に関する論文を分析し，研究動向と課題を明らかに することである．医学中央雑誌Web. 版を用いて「臨地実習」「看護学教員」「実習指導者」をキーワードとした原 著論文の検索を行った．文献レビューシート一覧を作成し，研究の種類・デザイン，研究方法，研究内容等の分 析を行った．その結果，対象文献は54件であり，研究の種類は量的研究が50.0％と半数を占め，研究デザインは因 子探索研究が最も多く47.5％であった．研究対象者は，実習指導者が最も多く41.9％，研究者の所属は看護大学が 35.2％であった．対象文献を内容分析の手法を用いて分類した結果，【看護学教員と実習指導者の連携・協働に関 する研究】【臨地実習指導におけるやりがいや困難感に関する研究】【効果的な臨地実習指導の検討に関する研究】 【臨地実習の評価に関する研究】【実習指導者の資質向上に関する研究】の5つのカテゴリーで構成された．今後の 研究課題として，1．看護学教員と実習指導者のそれぞれが認識している役割についての研究，2．看護学教員と実 習指導者の異なる役割や専門性・視点の明確化，3．看護学教員と実習指導者の連携・協働のあり方，4．指導力や 教授活動への自己効力感を高めるための要因，5．学生からの臨地実習評価の蓄積と分析，6．実習指導者講習会の 効果の分析，の6つを得た．The aims of this research were to analyze published papers relating to nursing teachers and clinical instructors responsible for clinical practicums, and from the results clarify research trends and issues in this area. Original papers containing the keywords 'clinical practicum' (rinchijisshu), 'nursing teacher' (kangogakukyoin), and 'clinical instructor' (jisshushidosha) were identified in a literature search of Ichushi Web. A summary of the literature review was created and examined for aspects including research type, design, methods, and contents. In total 54 papers were reviewed. Among them, in terms of research type, 50% were based on quantitative research and, in terms of research design, 47.5% used factor analysis. The highest percentage of research, 41.9%, investigated clinical instructors, and 35.2% of the researchers belonged to colleges of nursing. Based on the content analysis results, the studies were classified into five categories:【 studies on cooperation between nursing teachers and clinical instructors】;【studies on the sense of reward and difficulties in clinical practicum guidance】;【 studies on effective guidance in clinical practicums】;【 studies on evaluation of clinical practicums】;【 and studies on improving the quality of clinical instructors】. Future topics for research were summarized in the following six areas: 1) research on the roles perceived by nursing teachers and by clinical instructors; 2) clarification of different roles, expertise, and perspectives for nursing teachers and clinical instructors; 3) desirable ways for nursing teachers and clinical instructors to cooperate; 4) factors for improving self-efficacy in leadership and teaching activities; 5) accumulation and analysis of students' evaluation of clinical practicum sessions; and 6) analysis of the effectiveness of clinical instructors' seminars

Magnifying Endoscopy with Blue Laser Imaging Improves the Microstructure Visualization in Early Gastric Cancer: Comparison of Magnifying Endoscopy with Narrow-Band Imaging

Backgrounds. Magnifying endoscopy with blue laser imaging (ME-BLI) for diagnosis of early gastric cancer (EGC) is as effective as magnifying endoscopy with narrow-band imaging (ME-NBI). However, there are different EGCs in microstructure visualization between ME-BLI and ME-NBI. This study aimed to clarify the pathological features of the EGCs, in which microstructure visualization was different between ME-NBI and ME-BLI. Methods. EGCs were classified into groups A (irregular microsurface pattern (MSP) in ME-BLI and absent MSP in ME-NBI), B (irregular MSP in two modalities), or C (absent MSP in two modalities), according to the vessel plus surface classification. We compared the pathological features of EGCs between the three groups. Results. 17, four, and five lesions could be evaluated in detail in groups A, B and C, respectively. Well-differentiated adenocarcinomas with shallow crypts were more frequent in group A than in group B (58.8 and 0%, resp.). The mean crypt depth of group A was significantly shallower than that of group B (56 ± 20, 265 ± 64 μm, resp., P=0.0002). Conclusions. ME-BLI could better visualize the microstructures of the EGCs with shallow crypts compared with ME-NBI. Therefore, ME-BLI could enable a more accurate diagnosis of EGC with shallow crypts

サリチル酸中毒に関する研究(第I報) : サリチル酸長期投与ラットの臨床的観察

In this thesis we treat with the clinical effects of chronic toxicity in Wistar rats by 98-week oral administration experiments with salicylic acid. The results were as follows : (1) Inhibition of increase of body weight was observed in administered groups, especially in 0.1% level of salicylic acid. (2) A high incidence of tumors in lung, skin and lymphatic vessel was found in administered groups. (3) Effects of salicylic acid on the count of erythrocyte and leucocyte, and concentration of hemoglobin were not observed