反復的な督励が口頭指導下の心肺蘇生法に与える効果に関する無作為化シミュレーション研究

Background: Current guidelines emphasize the assistance of the emergency dispatcher in bystander cardiopulmonary resusitation (CPR). Its quality, however, has varied across cases. Objective: To determine the effect of repetitive coaching by dispatchers using verbal encouragement on the quality of lay-rescuer CPR. Methods: We conducted a dispatch-assisted CPR (DACPR) simulation study. Participants with no CPR training within the previous year were assigned randomly to 1 of 2 DACPR simulations. One was the No Coaching Group: callers were told to perform CPR and the dispatcher periodically confirmed that the caller was performing CPR. The second group was the Coaching Group: the dispatcher repetitively coached, encouraged, and counted aloud using a metronome. Participants performed CPR for 2 min under instruction from the study dispatcher. Parameters including chest compression depth, rate, and chest compression fraction were recorded by video camera and CPR manikin. Results: Forty-nine participants 20 to 50 years of age were recruited, and 48 completed the simulation (Coaching Group, n = 27; No Coaching Group, n = 21). The chest compression fraction was higher in the Coaching Group (99.4% vs. 93.0%, p = 0.005) and no participants interrupted chest compression more than 10 s in this group. When comparing the average depth of each 30-s period in each group, the depth increased over time in the Coaching Group (40.9 mm, 43.9 mm, 44.1 mm, and 42.8 mm), while it slightly decreased in the No Coaching Group (40.6 mm, 40.1 mm, 39.4 mm, and 39.8 mm). Conclusions: Repetitive verbal encouragements augmented chest compression depth with less-hands off time. Continuous coaching by dispatchers can optimize lay-rescuer CPR.博士（医学）・甲第852号・令和4年9月28日© 2022 Elsevier Inc.© 2022 The Author(s). Published by Elsevier Inc.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Refined Solutions of Optimal Stopping Games for Symmetric Markov Processes

We find refined solutions without exceptional starting points of the three problems of the optimal stopping, the zero-sum stopping game (Dynkin\u27s game) and the nonzero sum stopping game for a general symmetric Markov process under the absolute continuity condition on the transition function

Characteristic Upregulation of Glucose-Regulated Protein 78 in an Early Lesion Negative for Hitherto Established Cytochemical Markers in Rat Hepatocarcinogenesis

Previously, we reported α2-macroglobulin (α2M) to be a novel marker characteristic of rat hepatocellular preneoplastic and neoplastic lesions negative for hitherto well-established markers. In the present study, we further examined other candidate markers with specificity for the same type of lesions. Glutathione S-transferase-placental form (GST-P)-negative hepatocellular altered foci (HAF) were generated using a two-stage (initiation and promotion) carcinogenesis protocol with N,N-diethylnitrosamine (DEN) and either Wy-14,643 or clofibrate, two peroxisome proliferators. Microarray analysis using total RNAs isolated from laser-microdissected GST-P-negative HAF (amphophilic cell foci) and adjacent normal tissues was conducted along with immunohistochemistry and real-time RT-PCR. Staining for glucose-regulated protein 78 (GRP78) was detected in GST-P-negative HAF and hepatocellular adenomas, and slightly increased GRP78 mRNA expression was observed in the lesions by real-time RT-PCR analysis. Thus, an early increase of GRP78 expression in hepatocarcinogenesis is likely a feature of the amphophilic subset of HAF

Elevated Levels of VE-Cadherin-Positive Endothelial Microparticles in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease

ObjectivesThe purpose of this study was to examine whether CD144-EMP (endothelium-derived microparticles) is useful as a specific marker of endothelial cell (EC) dysfunction and to determine whether plasma levels of circulating CD144-EMP predicted coronary artery disease (CAD) in patients with type 2 diabetes mellitus (DM).BackgroundEndothelial cell dysfunction is involved in atherogenesis; however, the quantitative assessment of EC dysfunction has yet to be established clinically. Endothelium-derived microparticles are small, membrane-shed vesicles that are generated from the EC surface in response to cellular dysfunction and/or injury. Diabetes mellitus is known to be associated with EC dysfunction and accelerated atherosclerosis.MethodsWe characterized EMP using anti-CD144 (VE-Cadherin) antibody in various atherosclerosis-related cells and investigated the association between the levels of CD144-positive microparticles and hydrogen-peroxide-induced EC injury and acetylcholine-induced coronary vasomotion. Furthermore, we evaluated plasma CD144-EMP levels in patients with and without DM.ResultsWe demonstrated that CD144-positive microparticles were derived selectively from human EC. The levels of CD144-EMP reflected the degree of in vitro hydrogen-peroxide-induced EC injury and impairment of in vivo endothelium-dependent coronary vasodilation (p < 0.01). Plasma CD144-EMP levels were increased significantly in DM patients compared with patients without DM (p < 0.001). In DM patients, the elevated levels of CD144-EMP were the most significant risk factor for CAD relative to all other traditional risk factors (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8 to 6.9, p < 0.001). Notably, plasma CD144-EMP identified a subpopulation of established CAD patients in DM subjects without typical anginal symptoms (OR 10.6, 95% CI 3.9 to 29.5, p < 0.001).ConclusionsThe CD144-positive EMP exist in human plasma, and plasma CD144-EMP levels can be a clinically specific and quantitative marker of EC dysfunction and/or injury. Measurement of CD144-EMP, by providing a quantitative assessment of EC dysfunction, may be useful for identifying DM patients with increased risk of CAD

Clarifying Demographic Impacts on Embodied and Materially Retained Carbon toward Climate Change Mitigation

Modern lifestyles demand a number of products derived from petroleum-based sources that eventually cause carbon emissions. The quantification of lifestyle and household consumption impacts upon carbon emissions from both the embodied CO2 (EC) and materially retained carbon (MRC) viewpoints is critical to deriving amelioration policies and meeting emission reduction goals.This study, for the first time, details a methodology to estimate both EC and MRC for Japan, focusing on petrochemicals and woody products utilizing the time series input-output table, physical value tables and the national survey of family income and expenditure, leveraging time series input-output-based material flow analysis (IO-MFA), and structural decomposition analysis (SDA).Findings elucidated hot spots of deleterious consumption by age of householder and the critical factors which underpin them including intensity effects, pattern effects, and demographic shifts over time. Although demographic shifts associated with an aging,shrinking population in Japan decreased EC and MRC, the negative effect reduced in size over time during 1990?2005. Policy implications identify the potential to mitigate approximately 21% of required household emission reductions by 2030 through strategies including recycling initiatives and the recovery of carbon from products covered within current recycling laws and hot spot sectors which are not currently considered such as apparel

Ethanol Does Not Promote MeIQx-initiated Rat Colon Carcinogenesis Based on Evidence from Analysis of a Colon Cancer Surrogate Marker

Epidemiological studies suggest that alcohol consumption increases the risk of developing colorectal cancer. However, the data are confounded by numerous cosegregating variables. To cast further light on the relationships between alcohol intake and colon cancer development, 21-day-old male F344/DuCrj rats were fed 200 ppm 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) in their diet for 8 weeks and doses of 0, 0.1, 0.3, 1, 3, 10 and 20% of ethanol in their drinking water ad libitum for 16 weeks thereafter. The rats were sacrificed after 24 weeks of experiment, and aberrant crypt foci (ACF), surrogate lesions for colon cancer, were examined under a light microscope at low magnification. Ethanol was found not to affect the ACF formation at any dose compared with the initiated-controls. Furthermore, ethanol did not alter colon epithelial cell proliferation. These data, obtained by analysis of a colon cancer surrogate marker lesion, indicate that ethanol lacks promotion activity for MeIQx-initiated rat colon carcinogenesis

PAHs concentration and toxicity in organic solvent extracts of atmospheric particulate matters and sea sediments

The concentration of polycyclic aromatic hydrocarbons (PAHs) and the toxicity to marine bacteria (Vibrio fischeri) were measured for the organic solvent extracts of sea sediments collected from an urban watershed area (Hiroshima Bay) of Japan and compared with the concentrations and toxicity of atmospheric particulate matters. Among atmospheric particulate matters, the PAHs concentration was highest in FPM collected during cold seasons. The concentrations of sea sediments were 0.01-0.001 times those of atmospheric particulate matters. 1/EC50 was 1-10 L g-1 PM for atmospheric particulate matters and 0.1-1 L g-1 dry solids for sea sediments. These results imply that toxic substances from atmospheric PM are diluted several tens or hundreds times in sea sediments. The ratio of the 1/EC50 to PAHs concentration ((1/EC50)/16PAHs) was stable for all sea sediments (0.1-1 L μg-1 16PAHs) and was the same in the order of the magnitude as that of FPM and CPM. The ratio of sediments collected from the west was more similar to that of CPM while that of the east was to FPM, possibly because of hydraulic differences among water bodies. The PAHs concentration pattern analyses (principal component analysis and isomer ratio analysis) were conducted and from the results. PAHs pattern of sea sediments was fairly different from that of FPM and CPM. Comparison to previously conducted PAHs analyses suggested that biomass burning residues comprised a major portion of these other sources.This work was supported by Kurita Water and Environmental Foundation and Grant-in-Aid for Scientific Research (C