Open MRI Operating Room with Automatic Electronic Recording of Medical Equipment Provided by Wireless LAN - Anesthesia Care Experience of ２５ Cases in Hiroshima University Hospital

オープンMRI設置手術室で25例の麻酔を経験した。MRI設置手術室では術中にMRI画像を判断材料として手術をすすめるため，MRI画像へのノイズ混入対策が必要である。また，MRI磁場の影響で術中にモニター機器や麻酔器が誤動作を起こす可能性があるため，MRI非対応機器からの画像ノイズの遮断対策として，電子機器から発生するノイズの軽減には特殊シールドボックスやイキソルメッシュを使用し，手術室外からのノイズには手術室全体にシールド工事を行った。MRIが発生させる磁場による電子機器の誤動作・故障対策は，オープンMRIの磁場が5ガウス以下となる範囲に電子機器や手術器具を置くことで対応した。問題の克服に加えて，医療機器からのデータの無線通信により，ケーブル類をなくすことでMRI撮影時の患者移動の簡素化をはかり，安全性を高めることができた。We provided anesthesia care for 25 patients in an open MRI operating room and summarized here our experience. When surgeons use MRI during surgery, the presence of noise in the images caused by other electronic equipment in the area often hinders accurate diagnosis.　In addition, malfunction of monitoring and anesthesia equipment during surgery due to the MRI magnetic field created during an MR examination can occur. In order to prevent imaging interference affecting equipment not compatible with MRI, we utilized 2 specially prepared shield boxes and wrapped the personal computer used for coordinating the data with a mesh-like cloth made by Ixol-mesh.　In addition, we prepared a shielded operating room in order to block noise from the outside. To prevent malfunction of the surgical and electronic instruments, we kept them outside the magnetic field of 5 Gauss or lower to minimize the magnetic effect generated with MRI.　Furthermore, patient safety during MRI imaging was improved by establishing a wireless communication system to feed data from medical devices, which allowed elimination of cabling

The role of eating together among university students

論文 (Article

Differentiation of murine B cells induced by chondroitin sulfate B

A two-step culture system was used to investigate the role of chondroitin sulfate (CS) B, which is mitogenic to B cells, in differentiation of B cells. Mouse spleen B cells were incubated for 3 days with CSB in the presence of interleukin (IL)-4 and IL-5. After washing, the cells were replated at 10(5) viable cells/well and recultured without CSB in the presence of IL-4 and IL-5. CSB dose-dependently increased IgM production, the greatest enhancement being 450%. Dextran sulfate had a similar effect, whereas other glycosaminoglycans, CSA, CSC, heparin and hyaluronic acid, were marginally effective. Treatment of B cells with CSB resulted in increases in the number of IgM-secreting cells and numbers of CD138-positive cells and CD45R/B220-negative cells. CSB-induced IgM production was inhibited by the protein kinase C (PKC) inhibitor GF109203X but not by the phosphatidylinositol 3-kinase (P13K) inhibitor wortmannin. These results demonstrated that CSB promoted differentiation of B cells in the presence of IL-4 and IL-5 and suggested that PKC but not P13K is crucial for CSB-induced IgM production.</p

Immunohistochemistry of connexin43 and zonula occludens-1 in the myocardium as markers of early ischemia in autopsy material

Immunohistochemistry of the terminal complement complex (C5b-9) and fibronectin (FN) is useful to detect myocardial ischemia preceding necrosis in the postmortem diagnosis of sudden cardiac death. The present immunohistochemical study examined connexin43 (Cx43) and zonula occludens-1 (ZO-1) as markers of early myocardial ischemia in addition to the above-mentioned markers, using forensic autopsy cases of acute deaths due to myocardial infarction (MI, n=15) and acute ischemic heart disease (AIHD) without apparent myocardial necrosis (n=8), compared with those of acute mechanical asphyxiation (As, n=24) and drowning (D, n=10) as controls. Immunopositivities of each marker in the myocardium were semi-quantitatively graded by scoring. ZO-1, C5b-9 and FN were detected in the myocardial cytoplasm, whereas Cx43 and nonphosphorylated (np) Cx43 showed varied localizations at the intercalated disc, in the cytoplasm and along the lateral cell border. ZO-1 and FN showed a tendency to be detected more intensely in MI and IHD than in As and D. C5b-9 showed specific staining at the site of ischemia in MI (n=10/15) and AIHD (n=6/8), while the distribution of npCx43 was different in most cases of MI (n=14/15) and AIHD (n=5/8), compared with As and D; npCx43 positivity score was higher in the cytoplasm than at the intercalated disc, indicating redistribution due to myocardial ischemia. Such findings were detected in a few cases of As (n=3/24). These findings suggest that the combination of npCx43 and C5b-9 immunohistochemistry is useful for detecting early lesions of myocardial ischemia in sudden cardiac death

Toward Revision of the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’

Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the “Best Practice for Diabetic Patients on Hemodialysis 2012”. While glycated hemoglobin (HbA1c) is used mainly as a glycemic control index for dialysis patients overseas, Japan is the first country in the world to use glycated albumin (GA) for assessment. According to a survey conducted by the JSDT in 2018, the number of facilities measuring only HbA1c has decreased compared with 2013, while the number of facilities measuring GA or both has significantly increased. Ten years have passed since the publication of the first edition of the guidelines, and several clinical studies regarding the GA value and mortality of dialysis patients have been reported. In addition, novel antidiabetic agents have appeared, and continuous glucose monitoring of dialysis patients has been adopted. On the other hand, Japanese dialysis patients are rapidly aging, and the proportion of patients with malnutrition is increasing. Therefore, there is great variation among diabetes patients on dialysis with respect to their backgrounds and characteristics. This review covers the indices and targets of glycemic control, the treatment of hyperglycemia, and diet recommendations for dialysis patients with diabetes

Toward Revision of the &lsquo;Best Practice for Diabetic Patients on Hemodialysis 2012&rsquo;

Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the &ldquo;Best Practice for Diabetic Patients on Hemodialysis 2012&rdquo;. While glycated hemoglobin (HbA1c) is used mainly as a glycemic control index for dialysis patients overseas, Japan is the first country in the world to use glycated albumin (GA) for assessment. According to a survey conducted by the JSDT in 2018, the number of facilities measuring only HbA1c has decreased compared with 2013, while the number of facilities measuring GA or both has significantly increased. Ten years have passed since the publication of the first edition of the guidelines, and several clinical studies regarding the GA value and mortality of dialysis patients have been reported. In addition, novel antidiabetic agents have appeared, and continuous glucose monitoring of dialysis patients has been adopted. On the other hand, Japanese dialysis patients are rapidly aging, and the proportion of patients with malnutrition is increasing. Therefore, there is great variation among diabetes patients on dialysis with respect to their backgrounds and characteristics. This review covers the indices and targets of glycemic control, the treatment of hyperglycemia, and diet recommendations for dialysis patients with diabetes

Development of an Automatic Ultrasound Image Classification System for Pressure Injury Based on Deep Learning

The classification of ultrasound (US) findings of pressure injury is important to select the appropriate treatment and care based on the state of the deep tissue, but it depends on the operator’s skill in image interpretation. Therefore, US for pressure injury is a procedure that can only be performed by a limited number of highly trained medical professionals. This study aimed to develop an automatic US image classification system for pressure injury based on deep learning that can be used by non-specialists who do not have a high skill in image interpretation. A total 787 training data were collected at two hospitals in Japan. The US images of pressure injuries were assessed using the deep learning-based classification tool according to the following visual evidence: unclear layer structure, cobblestone-like pattern, cloud-like pattern, and anechoic pattern. Thereafter, accuracy was assessed using two parameters: detection performance, and the value of the intersection over union (IoU) and DICE score. A total of 73 images were analyzed as test data. Of all 73 images with an unclear layer structure, 7 showed a cobblestone-like pattern, 14 showed a cloud-like pattern, and 15 showed an anechoic area. All four US findings showed a detection performance of 71.4–100%, with a mean value of 0.38–0.80 for IoU and 0.51–0.89 for the DICE score. The results show that US findings and deep learning-based classification can be used to detect deep tissue pressure injuries

Factors influencing subclinical atherosclerosis in patients with biopsy-proven nonalcoholic fatty liver disease.

Although the presence of nonalcoholic fatty liver disease (NAFLD) is known to be related to subclinical atherosclerosis, the relationship between the severity of NAFLD and subclinical atherosclerosis is not clear. This study aimed to clarify the factors related to subclinical arteriosclerosis, including the histopathological severity of the disease and PNPLA3 gene polymorphisms, in NAFLD patients. We measured brachial-ankle pulse wave velocity (baPWV) as an index of arterial stiffness in 153 biopsy-proven NAFLD patients. The baPWV values were significantly higher in the advanced fibrosis group than in the less advanced group (median, 1679 cm/s vs 1489 cm/s; p = 5.49×10-4). Multiple logistic regression analysis revealed that older age (≥55 years) (p = 8.57×10-3; OR = 3.03), hypertension (p = 1.05×10-3; OR = 3.46), and advanced fibrosis (p = 9.22×10-3; OR = 2.94) were independently linked to baPWV ≥1600 cm/s. NAFLD patients were categorized into low-risk group (number of risk factors = 0), intermediate-risk group (= 1), and high-risk group (≥2) based on their risk factors, including older age, hypertension, and biopsy-confirmed advanced fibrosis. The prevalence of baPWV ≥1600 cm/s was 7.1% (3/42) in the low-risk group, 30.8% (12/39) in the intermediate-risk group, and 63.9% (46/72) in the high-risk group. Non-invasive liver fibrosis markers and scores, including the FIB-4 index, NAFLD fibrosis score, hyaluronic acid, Wisteria floribunda agglutinin positive Mac-2-binding protein, and type IV collagen 7s, were feasible substitutes for invasive liver biopsy. Older age, hypertension, and advanced fibrosis are independently related to arterial stiffness, and a combination of these three factors may predict risk of arteriosclerosis in NAFLD patients