A New Minimally Invasive Technique of Combined Chest Wall Resection for Lung Cancer : Advanced Data of Implication of Advanced Bipolar Device in Video-Assisted Chest Wall Resection for Lung Cancer.

We describe a novel method for resecting lung cancer that has invaded the chest wall using an advanced bipolar device during video-assisted thoracoscopic surgery. The method is convenient for both tumor and chest wall resection because it is easy to handle and less invasive than the currently used technique

Current status of delirium assessment tools in the intensive care unit: a prospective multicenter observational survey

Delirium is a critical challenge in the intensive care unit (ICU) or high care unit (HCU) setting and is associated with poor outcomes. There is not much literature on how many patients in this setting are assessed for delirium and what tools are used. This study investigated the status of delirium assessment tools of patients in the ICU/HCU. We conducted a multicenter prospective observational study among 20 institutions. Data for patients who were admitted to and discharged from the ICU/HCU during a 1-month study period were collected from each institution using a survey sheet. The primary outcome was the usage rate of delirium assessment tools on an institution- and patient-basis. Secondary outcomes were the delirium prevalence assessed by each institution's assessment tool, comparison of delirium prevalence between delirium assessment tools, delirium prevalence at the end of ICH/HCU stay, and the relationship between potential factors related to delirium and the development of delirium. Result showed that 95% of institutions used the Intensive Care Delirium Screening Checklist (ICDSC) or the Confusion Assessment Method for the ICU (CAM-ICU) to assess delirium in their ICU/HCU, and the remaining one used another assessment scale. The usage rate (at least once during the ICU/HCU stay) of the ICDSC and the CAM-ICU among individual patients were 64.5% and 25.1%, and only 8.2% of enrolled patients were not assessed by any delirium assessment tool. The prevalence of delirium during ICU/HCU stay was 17.9%, and the prevalence of delirium at the end of the ICU/HCU stay was 5.9%. In conclusion, all institutions used delirium assessment tools in the ICU/HCU, and most patients received delirium assessment. The prevalence of delirium was 17.9%, and two-thirds of patients had recovered at discharge from ICU/HCU

Analysis of Expressed Sequence Tags from the Fungus Aspergillus oryzae Cultured Under Different Conditions

We performed random sequencing of cDNAs from nine biologically or industrially important cultures of the industrially valuable fungus Aspergillus oryzae to obtain expressed sequence tags (ESTs). Consequently, 21 446 raw ESTs were accumulated and subsequently assembled to 7589 non-redundant consensus sequences (contigs). Among all contigs, 5491 (72.4%) were derived from only a particular culture. These included 4735 (62.4%) singletons, i.e. lone ESTs overlapping with no others. These data showed that consideration of culture grown under various conditions as cDNA sources enabled efficient collection of ESTs. BLAST searches against the public databases showed that 2953 (38.9%) of the EST contigs showed significant similarities to deposited sequences with known functions, 793 (10.5%) were similar to hypothetical proteins, and the remaining 3843 (50.6%) showed no significant similarity to sequences in the databases. Culture-specific contigs were extracted on the basis of the EST frequency normalized by the total number for each culture condition. In addition, contig sequences were compared with sequence sets in eukaryotic orthologous groups (KOGs), and classified into the KOG functional categories

肺水腫成犬におけるInversed Ratio Ventilation (IRV)が頭蓋内圧に及ぼす影響

雑種成犬にて肺水腫モデルを作成しコンプライアンスの低下した肺で,inversed ratio ventilation (IRV)がintracranial pressure (ICP)に及ぼす影響を検討した.人工呼吸器の呼気/呼気比(I : E比) 1 : 2での測定値を対照値として,ICP,体血圧,肺動脈圧,中心静脈圧,心拍出量,肺コンプライアンス,血液ガス分析,最高気道内圧(peak inspiratory pressure, PIP),平均気道内圧(mean airway pressure, mAWP)を測定した.その後に,オレイン酸(0.05ml/kgを30分間で持続静注)で,肺水腫を作成し,動脈血酸素分圧(PaO_2)の低下を確認した後にI : E比を1 : 2, 1.7 : 1, 2.3 : 1, 4 : 1と順次呼気時間を延長させ,再度,対照値のI : E比1 : 2に戻した.対照値の時と同じ測定項目をそれぞれのI : E比で測定した.ICP (mean±SD, cmH_2O)はオレイン酸投与前I : E=1 : 2で10.0±3.2,投与後は12.5±4.2と有意に上昇したが,吸気時間を延長させてもICPは10.0±2.9, 11.1±2.2, 11.3±2.7, 12.3±2.9と有意の変化を認めなかった.オレイン酸投与によりPaO_2,心拍出量は有意に低下し,肺動脈圧は有意に上昇したが,その他の測定項目は各I : E比間での有意の変化を認めなかった.以上のことから肺水腫の発生に伴い肺コンプライアンスは低下し,PIPの上昇とともにICPは上昇したが,その後吸気時間を延長させたIRVで換気してもPIPは変化せず,ICPには影響を及ぼさなかった.この結果は,肺コンプライアンスの低下した頭蓋内圧亢進患者へのIRVの適応の可能性を示唆した.Although correlation between variations in the inspiratory to expiratory ratio (I : E ratio) and intracranial pressure (ICP) has not been clarified, the study of Mihira showed that IRV (at I : E ratios of 1.7 : 1, 2, 3 : 1, and 4 : 1) does not influence ICP in dogs with normal or elevated ICP. In order to estimate the influence of lowered lung compliance on ICP during IRV, an additional study was designed to observe the I : E ratio = 1 : 2 to 4 : 1 on ICP in 10 dogs with pulmonary edema induced by Oleic acid. Following baseline measuerment of control ventilation (I : E ratio = 1 : 2), lung edema was induced by venous injection of Oleic acid (0.05 mL/kg). After verifying the reduction of lung compliance, four different I : E ratios were applied in the order of I : E = 1 : 2, 1.7 : 1, 2.3 : 1, and 4 : 1. Throughout the period of these measurements, PaCO_2 constantly maintained normocapnia and arterial blood pressure was kept within normal range. Intracranial hemodynamics (ICP, cerebral perfusion pressure), lung mechanics (mean airway pressure (mAWP), peak inspiratory pressure (PIP), lung compliance), systemic hemodynamics (mean arterial pressure, mean pulmonary artery pressure, central venous pressure, cardiac output), and blood gases were measured at 30 min under every I : E ratio ventilatory moe. In these dogs with pulmonary edema, mAWP significantly increased during IRV in comparison with that during control ventilation (p<0.05), but there was no significant difference in PIP between control ventilation and IRV. ICP remained unchanged during IRV (12.5±4.2, 10.0±2.9, 11.1±2.2, 11.3±2.7 at I : E = 1 : 2, 1.7 : 1, 2, 3 : 1 and 4 : 1, respectively). This study suggested that IRV (at I : E ratios of 1.7 : 1, 2.3 : 1, and 4 : 1), which can minimize ventilator-induced lung unjury, has no influence on ICP. Therefore, IRV may be one beneficial options as ventilation strategy for acute respiratory distress syndrome with intracranial hypertension