左室心筋と右室心筋のストレス応答性の違い

学位の種別: 課程博士審査委員会委員 : (主査)東京大学教授 長瀬 隆英, 東京大学特任教授 絹川 弘一郎, 東京大学講師 大門 雅夫, 東京大学講師 犬塚 亮, 東京大学講師 平田 康隆University of Tokyo(東京大学

TEE image quality improvement with our devised probe cover

OBJECTIVE(S): Our hypothesis was that our devised transesophageal echocardiography probe cover with the capacity for pinpoint suction would improve image quality. DESIGN: Prospective cohort study. SETTING: Single tertiary medical center. PARTICIPANTS: Patients undergoing surgery requiring intraoperative transesophageal echocardiography. INTERVENTIONS: Suctioning with inserted orogastric tube. MEASUREMENTS AND MAIN RESULTS: Changes in image quality with suctioning were assessed by 2 methods. In method #1, investigators categorized the quality of all acquired images on a numeric scale based on each investigator\u27s impression (1: very poor, 2: poor, 3: acceptable, 4: good, and 5: very good). In method #2, the reproducibility of the left ventricular fraction area change (LV FAC) was assessed, assuming that improved transgastric midpapillary short-axis view image quality would yield better LV FAC reproducibility. With method #1, for midesophageal views, 26.5%, 70.5%, and 3.0% of images showed improved, the same, and worsened image quality, respectively. For transgastric views, 55.3%, 43.3%, and 1.4% showed improved, the same, and worsened image quality, respectively. For deep transgastric views, 60.0%, 38.0%, and 2.0% showed improved, the same, and worsened image quality, respectively. With method #2, the presuction group had an ICC of 0.942 (95% CI: 0.91, 0.965). The postsuction group had an ICC of 0.988 (95% CI: 0.981, 0.993). CONCLUSIONS: Our investigation validates the potential image quality improvement withour devised TEE probe cover. However, its clinical validity needs to be confirmed by further studies

Sildenafil ameliorates right ventricular early molecular derangement during left ventricular pressure overload.

Right ventricular (RV) dysfunction following left ventricular (LV) failure is associated with poor prognosis. RV remodeling is thought initiated by the increase in the afterload of RV due to secondary pulmonary hypertension (PH) to impaired LV function; however, RV molecular changes might occur in earlier stages of the disease. cGMP (cyclic guanosine monophosphate)-phosphodiesterase 5 (PDE5) inhibitors, widely used to treat PH through their pulmonary vasorelaxation properties, have shown direct cardiac benefits, but their impacts on the RV in LV diseases are not fully determined. Here we show that RV molecular alterations occur early in the absence of RV hemodynamic changes during LV pressure-overload and are ameliorated by PDE5 inhibition. Two-day moderate LV pressure-overload (transverse aortic constriction) neither altered RV pressure/ function nor RV weight in mice, while it induced only mild LV hypertrophy. Importantly, pathological molecular features were already induced in the RV free wall myocardium, including up-regulation of gene markers for hypertrophy and inflammation, and activation of extracellular signal-regulated kinase (ERK) and calcineurin. Concomitant PDE5 inhibition (sildenafil) prevented induction of such pathological genes and activation of ERK and calcineurin in the RV as well as in the LV. Importantly, dexamethasone also prevented these RV molecular changes, similarly to sildenafil treatment. These results suggest the contributory role of inflammation to the early pathological interventricular interaction between RV and LV. The current study provides the first evidence for the novel early molecular cross-talk between RV and LV, preceding RV hemodynamic changes in LV disease, and supports the therapeutic strategy of enhancing cGMP signaling pathway to treat heart diseases

Hepatic Vein Flow Index During Orthotopic Liver Transplantation as a Predictive Factor for Postoperative Early Allograft Dysfunction

OBJECTIVES: The authors devised a hepatic vein flow index (HVFi), using intraoperative transesophageal echocardiography and graft weight, and investigated its predictive value for postoperative graft function in orthotopic liver transplant. DESIGN: Prospective clinical trial. SETTING,: Single-center tertiary academic hospital. PARTICIPANTS: Ninety-seven patients who had orthotopic liver transplant with the piggy-back technique between February 2018 and December 2019. MEASUREMENTS AND MAIN RESULTS: HVFi was defined with HV flow/graft weight. Patients who developed early graft dysfunction (EAD) had low HVFi in systole (HVFi sys, 1.23 v 2.19 L/min/kg, p \u3c 0.01), low HVFi in diastole (HVFi dia, 0.87 v 1.54 L/min/kg, p \u3c 0.01), low hepatic vein flow (HVF) in systole (HVF sys, 2.04 v 3.95 L/min, p \u3c 0.01), and low HVF in diastole (HVF dia, 1.44 v 2.63 L/min, p \u3c 0.01). More cardiac death, more vasopressors at the time of measurement, more acute rejection, longer time to normalize total bilirubin (TIME t-bil), longer surgery time, longer neohepatic time, and more packed red blood cell transfusion were observed in the EAD patients. All HVF parameters were negatively correlated with TIME t-bil (HVFi sys R = -0.406, p \u3c 0.01; HFVi dia R = -0.442, p \u3c 0.01; HVF sys R = -0.44, p \u3c 0.01; HVF dia R = -0.467, p \u3c 0.01). The receiver operating characteristic curve analysis determined the best cut-off levels of HVFi to predict occurrence of EAD (HVFi sys \u3c1.608, HVFi dia \u3c0.784 L/min/kg), acute rejection (HVFi sys \u3c1.388, HVFi dia \u3c1.077 L/min/kg), and prolonged high total bilirubin (HVFi sys \u3c1.471, HVFi dia \u3c1.087 L/min/kg). CONCLUSIONS: The authors\u27 devised HVFi has the potential to predict the postoperative graft function

Challenged by the 3.11 Disaster: Reflections on the Human Experience (3.11 ni Towarete: hitobito no keiken o meguru kōsatsu)

The simultaneous occurrence of the earthquake disaster, large tsunami and nuclear accident, the subsequent crisis and confusion put out contradictions revealed by this society at once. From there, serious problem groups covering all sectors such as science and technology, economy, interregional relations, politics and consumer life have been exposed. What have people experienced in this catastrophic event? And what do we ask from this event "3 · 11"? This book is an attempt to explore this question deeply and to explore clues to future thoughts and actions, rooted in historical viewpoints such as modern times and after the war and problem consciousness through domestic and overseas