重度大動脈弁狭窄症患者の大動脈弁置換術後における血小板機能および高分子量 von Willebrand 因子多量体の急速な回復

AIM: Patients with severe aortic stenosis (AS) may have bleeding episodes due to the loss of high-molecular-weight (HMW) von Willebrand factor multimers (VWFMs). The absence of HMW-VWFMs and bleeding tendency are usually corrected after aortic valve replacement (AVR). To investigate the process of VWFM recovery and symptoms in patients with severe AS, we analyzed changes in VWF antigen (VWF:Ag), ADAMTS13 activity (ADAMTS13:AC), and platelet thrombus formation under high shear stress conditions. METHODS: Nine patients with severe AS undergoing AVR were analyzed. RESULTS: Evident deficiency of HMW-VWFMs was observed in six patients before surgery, which was rapidly restored within 8 days after AVR. Median levels of VWF:Ag before surgery, on postoperative days (PODs) 1, 8, 15, and 22, and one year after AVR were 78.1%, 130%, 224%, 155%, 134%, and 142%, respectively. In contrast, ADAMTS13:AC was 50.5%, 35.5%, 25.5%, 25.1%, 30.3%, and 84.6%, respectively. Preoperative thrombus formation but not surface coverage was significantly lower than that on POD 22, which was considered as normal level in each patient. Compared with preoperative levels, thrombus volume was significantly lower on POD 1, but rapidly increased by POD 8. CONCLUSION: Bleeding tendency and loss of HMW-VWFMs observed in patients with severe AS before surgery was rapidly corrected after AVR. Instead, patients were in a VWF-predominant state between POD 8 and 22.博士（医学）・乙第1395号・平成29年3月15日Copyright © 2016 Japan Atherosclerosis Society本論文の著作権は日本動脈硬化学会が保持しています。This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License

心臓血管外科領域におけるゼラチンシートの止血効果、癒着防止効果の検討

BACKGROUND:The bi1ayer gelatin sealing sheet was developed as a safe, effective, easy-to-handle and low-cost hemostatic agent. OBJECTIVE:To examine the feasibility of gelatin sealing sheets using a canine aterial hemorrhage mode1. METHODS:In vivo degradation of gelatin sealing sheets was examined by implanting subcutaneously in rats. For the hemostatic and anti-adhesion efficacy investigations, femoral arteries of dogs were pricked with syringe needle to make as mall hole, and a gelatin(i.e. experimental group) or fibrin glue sealing sheet (i.e. control group) was applied on the hole to stop bleeding (n=8). After discontinuation of the bleeding, the skin incisions were closed and re-examined 4 weeks postoperatively. RESULTS:From the degradation study, 4h thermally treated gelatin sheet which degraded within 3 weeks in vivo was chosen for the further hemostatic study. In all cases of gelatin and fibrin glue sealing sheets, bleeding from the needle hole on canine femoral arteries was effectively stopped. Postoperative adhesions and inflammation at the site in the experimental group were significantly less than those in the control group (P<0.01 for adhesion scores). CONCLUSIONS:The gelatin sealing sheet was found to be as effective as the fibrin glue sealing sheet as a surgical hemostatic agent, and more effective in preventing postoperative adhesions.博士（医学）・甲第632号・平成27年3月16日Copyright ©2015 IOS Pres

Generation of a monoclonal antibody reactive to prefusion myocytes.

We established a novel monoclonal antibody, Yaksa that is specific to a subpopulation of myogenic cells. The Yaksa antigen is not expressed on the surface of growing myoblasts but only on a subpopulation of myogenin-positive myocytes. When Yaksa antigen-positive mononucleated cells were freshly prepared from a murine myogenic cell by a cell sorter, they fused with each other and formed multinucleated myotubes shortly after replating while Yaksa antigen-negative cells scarcely generated myotubes. These results suggest that Yaksa could segregate fusion-competent, mononucleated cells from fusion-incompetent cells during muscle differentiation. The Yaksa antigen was also expressed in developing muscle and regenerating muscle in vivo and it was localized at sites of cell-cell contact between mono-nucleated muscle cells and between mono-nucleated muscle cells and myotubes. Thus, Yaksa that marks prefusion myocytes before myotube formation can be a useful tool to elucidate the cellular and molecular mechanisms of myogenic cell fusion

腎動脈遮断を要する腹部大動脈手術に対する冷却リンゲル液による腎潅流の治療効果

Background/aim: Treating abdominal aortic aneurysms (AAA) of the juxtarenal artery with renal artery clamps burdens the kidneys. We investigated the outcomes of intra-operative renal artery perfusion using the cold Ringer's solution method for renal protection. Patients and methods: We enrolled 290 AAA patients who underwent open aortic repair. Surgical outcomes were investigated based on renal protection. Results: We evaluated 231 patients requiring infrarenal artery clamp (Group I), and 59 patients requiring perfusion in addition to the clamp (Group J). Patient demographics, acute kidney injury (AKI) incidence (Group I: 11.7% and Group J: 20.3%), hospital mortality (Group I: 1.3% and Group J: 1.7%), and 30-day mortality (Group I: 0.4% and Group J: 0%) were not different between the groups. The AKI incidence was low (13%) in cases requiring a renal artery clamp for ≥45 min (n=40). Conclusion: Perfusion with cold Ringer's solution offers renal protection and may improve surgical outcomes.博士（医学）・乙第1470号・令和2年9月30日Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.Articles from In Vivo are provided here courtesy of International Institute of Anticancer Research.The publication is available at International Institute of Anticancer Research via http://dx.doi.org/10.21873/invivo.1183