Search

Purpose The availability of difficult airway management (DAM) resources and the extent of capnometry use in Japanese intensive care units (ICUs) remained unclear. The purpose of this study was to clarify whether: (1) DAM resources were adequate, and (2) capnometry was routinely applied in Japanese ICUs. Methods This nationwide cross-sectional study was conducted from September 2015 to February 2016. All ICUs received a mailed questionnaire about their DAM resources and use of capnometry. Outcome measures were availability of: (1) 24-h in-house backup coverage; (2) a supraglottic airway device (SGA); (3) a dedicated DAM cart; and (4) surgical airway devices, and (5) routine use of capnometry to verify tube placement and for continuous monitoring of ventilator-dependent patients. The association between these outcomes and ICU type (academic, high-volume, closed, surgical) was also analyzed. Results Of the 289 ICUs, 196 (67.8 %) returned completed questionnaires. In-house backup coverage and surgical airway devices were highly available (89.3 and 95.9 %), but SGAs and dedicated DAM carts were not (60.2 and 60.7 %). The routine use of capnometry to confirm tube placement was reported by 55.6 % of the ICUs and was highest in closed ICUs (67.2 %, p = 0.03). The rate of continuous capnography monitoring was also 55.6 % and was highest in academic ICUs (64.5 %, p = 0.04). Conclusion In Japanese ICUs, SGAs and dedicated DAM carts were less available, and capnometry was not universally applied either to confirm tube placement, or for continuous monitoring of ventilated patients. Our study revealed areas in need of improvement., Author(s): Yuko Ono[sup.1] [sup.4] , Koichi Tanigawa[sup.2] [sup.3] , Kazuaki Shinohara[sup.4] , Tetsuhiro Yano[sup.1] , Kotaro Sorimachi[sup.1] , Lubna Sato[sup.1] , Ryota Inokuchi[sup.5] , Jiro Shimada[sup.1] , Choichiro Tase[sup.1] Author [...]

Purpose Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. Methods This nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting. Results Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps. Conclusion In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure., Author(s): Yuko Ono[sup.1] [sup.2] , Kazuaki Shinohara[sup.2] , Aya Goto[sup.3] , Tetsuhiro Yano[sup.1] , Lubna Sato[sup.1] , Hiroyuki Miyazaki[sup.1] , Jiro Shimada[sup.1] , Choichiro Tase[sup.1] Author Affiliations: (1) Emergency and [...]

Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation. Keywords Takotsubo cardiomyopathy * Peripartum cardiomyopathy * Cesarean section * Anesthesia, Introduction Takotsubo cardiomyopathy is an acute stress-induced cardiomyopathy presenting as left ventricular apical ballooning. Postmenopausal women are particularly susceptible to this myopathy, which is generally associated with a good prognosis [...]

Research was conducted to examine structural and functional characteristics of whole and truncated forms of alpha-amylase in Bacillus subtilis. Results from genomic and protein analyses indicated both forms orginated from the same gene and the truncated form exhibited structural domains of enzyme activity.

Amylomaltase from Thermus aquaticus catalyzes intramolecular transglycosylation of alpha-1,4 glucans to produce cyclic alpha-1,4 glucans (cycloamyloses) with degrees of polymerization of 22 and higher. Although the amylomaltase mainly catalyzes the transglycosylation reaction, it also has weak hydrolytic activity, which results in a reduction in the yield of the cycloamyloses.

The expansion factors for the mean-square end-to-end distance and radius of gyration are studied for the helical worm-like (HW) chain with the excluded-volume effects incorporated in the Yamakawa–Stockmayer scheme. In this scheme, approximate closed expressions for them are expressed in terms of the excluded-volume parameter z and the first-order perturbation coefficient K(L) as a function of the total contour length L of the chain. The ring-closure probabilities necessary for the evaluation of K(L) are evaluated by a slight modification of the method previously developed for the Kratky–Porod (KP) worm-like chain. The actual evaluation is carried out for the values of the HW model parameters in their limited ranges, and also for the KP chain. It is then numerically shown that K(L) for the HW chain is approximately equal to that for the KP chain. From a simple analysis, this conclusion may be expected to be generally correct, so that the expansion factors for the HW chain may be expressed in terms of the simple K(L) for the KP chain. The derived closed expressions for them may be regarded as valid for any ordinary flexible chains of arbitrary length. [ABSTRACT FROM AUTHOR]

In order to examine the correlation between stiffness and excluded-volume effects in polymer chains, polymethylene-like rotational isomeric state chains with excluded volume are simulated and their mean-square radii of gyration are evaluated by Monte Carlo methods. The present results and also experimental data for ordinary flexible chains may well be explained by the Kratky–Porod worm-like chain, or more generally the helical worm-like chain, with the excluded-volume effects incorporated in the Yamakawa–Stockmayer scheme. For typical stiff chains with excluded volume, however, there is clear disagreement between their theory and experiment, and the problem remains unsolved. [ABSTRACT FROM AUTHOR]

Introduction: On March 11, 2011, the Great East Japan Earthquake with a 9.0 magnitude struck the northeastern coast of Japan. The death toll reached 15,892 and 2,576 people were reported missing. Tohoku University and Fukushima Medical University, both of which are located in the affected prefectures, responded massively to the disaster. Method: To deal with the next disaster, both universities established the "Conductor type Human Resources Development" (CHRD) program for Disaster Medicine and Health Care in 2019, not only for doctors, but also other medical professionals (such as dentists, nurses, pharmacists, etc.) supported by the Japanese government. The main course of CHRD program, "Disaster Management course," which is also a certification program at Tohoku University, comprises 14 practical educational contents (seven practical trainings and seven lectures) based on the work experience of both universities in collaboration with various organizations. Results: To date, 59 students have enrolled in the Disaster Management course, two students are enrolled in the board-certified physician in public health and social medicine acquisition course, three students are enrolled in the master's course, a Tohoku University Graduate School of Medicine course, and two students are enrolled in the doctoral course. Until October 2022, a total of 17 people were certified to have completed the "Disaster Management course," and one person completed the board-certified physician in public health and social medicine acquisition course. A total of 68 practical trainings and lectures were held until 2021, the total number of times this program was attended by students until 2021 was 916. Average comprehension rate and satisfaction rate with practical trainings and lectures by students are 97.2% and 98.3%, respectively. Conclusion: All the students who complete the CHRD program are believed to acquire comprehensive skills related to disaster health and medical care and will be able to respond effectively in all phases. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic also raged in Fukushima Prefecture, Japan. Moreover, it forced a response to the medical crisis just as much as the disaster. After the Great East Japan Earthquake, disaster response system development progressed in Fukushima Prefecture. The relationship between the DMAT and the Prefectural Medical Health and Welfare Department was becoming more assertive. Method: However, as the disaster response members became fixed, there was an urgent need to develop new young human resources. Results: Meanwhile, flood damage caused by Typhoon No. 24 occurred in September 2018. It was the first time since the Great East Japan Earthquake that a disaster countermeasures headquarters was set up within the prefectural office. In that response, we discovered young talents. Furthermore, they nurtured in response to the medical crisis caused by the COVID-19 pandemic. Conclusion: In recent years, the main elements of disaster response required support for continuing medical care and securing public health. Unfortunately, however, these things are insufficient both as medical education and as postgraduate education. Therefore, few human resources are interested in disaster medicine and taking action. In addition, it is also a fact that, like surgical operations, if disasters are not responded to, they will not come to fruition. The response to this pandemic is genuinely an opportunity for human resource development. Taking advantage of this crisis to develop new human resources can be a blessing. [ABSTRACT FROM AUTHOR]