107 results on '"Yasufumi Nakajima"'
Search Results
2. Unexpected abnormal positive pressure due to misconnection of excess gas tube
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Atsuhiro Kitaura, Hiroatsu Sakamoto, Kensuke Toho, Shota Tsukimoto, Haruyuki Yuasa, and Yasufumi Nakajima
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Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2023
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3. A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement
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Atsuhiro Kitaura, Shota Tsukimoto, Hiroatsu Sakamoto, Shinichi Hamasaki, Shinichi Nakao, and Yasufumi Nakajima
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Medicine ,Science - Abstract
Abstract Remimazolam, an ultrashort-acting benzodiazepine, allows for rapid and reliable arousal. Rapid awakening using remimazolam may be beneficial in transcatheter aortic valve replacement (TAVR), as it allows rapid detection of neurologic deficits. The purpose of this study was to compare arousal time and outcomes between monitored anesthesia care (MAC) with remimazolam and remifentanil and conventional MAC with dexmedetomidine, propofol, and remifentanil. This study was a single center retrospective study. All TAVR cases performed under MAC (MAC-TAVR) at our institution between 2019 and 2021 were included. Patients were classified by anesthesia method into remimazolam and dexmedetomidine groups. Among 258 MAC-TAVR patients, 253 were enrolled. After propensity score matching, 76 patients were assigned to each group. The time from end of drug-administration to arousal [20.0 (16.0, 24.0) min vs. 38.5 (30.0, 56.3) min, p
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- 2023
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4. Difficult ventilation due to an undetected mask crack
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Atsuhiro Kitaura, Issei Fukuda, Haruyuki Yuasa, Shota Tsukimoto, and Yasufumi Nakajima
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Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2023
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5. Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: a systematic review and meta-analysis
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Jun Takeshita, Kazuya Tachibana, Yasufumi Nakajima, and Nobuaki Shime
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Central venous catheterization ,Ultrasonography ,Bloodstream infections ,Incidence ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Ultrasonographic guidance is widely used for central venous catheterization. Several studies have revealed that ultrasound-guided central venous catheterization increases the rate of success during the first attempt and reduces the procedural duration when compared to the anatomical landmark-guided insertion technique, which could result in protection from infectious complications. However, the effect of ultrasound-guided central venous catheterization on catheter-related bloodstream infections remains unclear. We aimed to conduct a systematic review and meta-analysis to evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections and catheter colonization associated with central venous catheterization. Methods The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE (via PubMed) were searched up to May 9, 2022 for randomized controlled trials (RCTs) comparing ultrasound-guided and anatomical landmark-guided insertion techniques for central venous catheterization. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs. A meta-analysis was performed for catheter-related bloodstream infections and catheter colonization, as primary and secondary outcomes, respectively. Results Four RCTs involving 1268 patients met the inclusion criteria and were analyzed. Ultrasound-guided central venous catheterization was associated with a slightly lower incidence of catheter-related bloodstream infections (risk ratio, 0.46; 95% confidence interval [CI], 0.16–1.32) and was not associated with a lower incidence of catheter colonization (risk ratio, 1.36; 95% CI, 0.57–3.26). Conclusion Ultrasound-guided central venous catheterization might reduce the incidence of catheter-related bloodstream infections. Additional RCTs are necessary to further evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections with central venous catheterization.
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- 2022
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6. Blood flow kinetic energy is a novel marker for right ventricular global systolic function in patients with left ventricular assist device therapy
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Koichi Akiyama, Paolo C. Colombo, Eric J. Stöhr, Ruiping Ji, Isaac Y. Wu, Keiichi Itatani, Shohei Miyazaki, Teruyasu Nishino, Naotoshi Nakamura, Yasufumi Nakajima, Barry J McDonnell, Koji Takeda, Melana Yuzefpolskaya, and Hiroo Takayama
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right ventricular failure ,left ventricular assist device ,vector flow mapping ,kinetic energy ,echocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ObjectivesRight ventricular (RV) failure remains a major concern in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We aimed to measure the kinetic energy of blood in the RV outflow tract (KE-RVOT) – a new marker of RV global systolic function. We also aimed to assess the relationship of KE-RVOT to other echocardiographic parameters in all subjects and assess the relationship of KE-RVOT to hemodynamic parameters of RV performance in HF patients.MethodsFifty-one subjects were prospectively enrolled into 4 groups (healthy controls, NYHA Class II, NYHA Class IV, LVAD patients) as follows: 11 healthy controls, 32 HF patients (8 NYHA Class II and 24 Class IV), and 8 patients with preexisting LVADs. The 24 Class IV HF patients included 21 pre-LVAD and 3 pre-transplant patients. Echocardiographic parameters of RV function (TAPSE, St', Et', IVA, MPI) and RV outflow color-Doppler images were recorded in all patients. Invasive hemodynamic parameters of RV function were collected in all Class IV HF patients. KE-RVOT was derived from color-Doppler imaging using a vector flow mapping proprietary software. Kruskal-Wallis test was performed for comparison of KE-RVOT in each group. Correlation between KE-RVOT and echocardiographic/hemodynamic parameters was assessed by linear regression analysis. Receiver operating characteristic curves for the ability of KE-RVOT to predict early phase RV failure were generated.ResultsKE-RVOT (median ± IQR) was higher in healthy controls (55.10 [39.70 to 76.43] mW/m) than in the Class II HF group (22.23 [15.41 to 35.58] mW/m, p
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- 2023
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7. Remimazolam-Based Anesthesia in Patients with Heart Failure Due to Mitral Regurgitation and Low Left Ventricular Function: A Case Series
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Atsuhiro Kitaura, Hiroatsu Sakamoto, Shinichi Hamasaki, Shota Tsukimoto, and Yasufumi Nakajima
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remimazolam ,MitraClip ,mitral regurgitation ,heart failure ,anesthesia ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: Remimazolam is a new ultrashort-acting benzodiazepine anesthetic. Remimazolam appears to be useful in patients with severe valvular disease because of its minimal cardiovascular impact. In this retrospective case series study, we assessed the efficacy and safety of remimazolam for maintaining hemodynamic stability during anesthetic induction and maintenance. Cases: MitraClip was performed on 18 cases with severe mitral regurgitation with low left ventricular function who presented with heart failure, and remimazolam was administered for general anesthesia with induction (12 mg/kg/h) and maintenance (1 mg/kg/h). The impact of remimazolam on the hemodynamics at anesthetic induction and during anesthetic maintenance was investigated retrospectively using electronic medical records. Blood pressure decreased significantly during anesthetic induction with remimazolam (78.5 [72, 81.25] and 66.1 [62.2, 74.2], median [IQR], p = 0.0001), but only mildly, by about 10 mmHg. There was no significant change in the cardiac index (2.0 [1.8, 2.4] vs. 1.9 [1.8, 2.3], p = 0.57642) or pulse rate (73.5 ± 8.85 vs. 74.7 ± 11.7, mean ± SD, p = 0.0876) during anesthetic induction with remimazolam. All patients underwent MitraClip without major hemodynamic concerns, with no or small increases in inotropes. Conclusions: Remimazolam may be used safely in patients with severe mitral regurgitation and low left ventricular function presenting with heart failure.
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- 2023
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8. Preoperative Left Ventricular Energy Loss in the Operating Theater Reflects Subjective Symptoms in Chronic Aortic Regurgitation
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Atsushi Kainuma, Keiichi Itatani, Koichi Akiyama, Yoshifumi Naito, Maki Ishii, Masaru Shimizu, Junya Ohara, Naotoshi Nakamura, Yasufumi Nakajima, Satoshi Numata, Hitoshi Yaku, and Teiji Sawa
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energy loss (EL) ,aortic regurgitation (AR) ,vector flow mapping (VFM) ,transesophageal echocardiography ,subjective symptoms ,Surgery ,RD1-811 - Abstract
BackgroundThere is currently no subjective, definitive evaluation method for therapeutic indication other than symptoms in aortic regurgitation. Energy loss, a novel parameter of cardiac workload, can be visualized and quantified using echocardiography vector flow mapping. The purpose of the present study was to evaluate whether energy loss in patients with chronic aortic regurgitation can quantify their subjective symptoms more clearly than other conventional metrics.MethodsWe studied 15 patients undergoing elective aortic valve surgery for aortic regurgitation. We divided the patients into symptomatic and asymptomatic groups using their admission records. We analyzed the mean energy loss in one cardiac cycle using transesophageal echocardiography during the preoperative period. The relationships between symptoms, energy loss, and other conventional metrics were statistically analyzed.ResultsThere were seven and eight patients in the symptomatic and asymptomatic groups, respectively. The mean energy loss of one cardiac cycle was higher in the symptomatic group (121 mW/m [96–184]) than in the asymptomatic group (87 mW/m [80–103]) (p = 0.040), whereas the diastolic diameter was higher in the asymptomatic group (65 mm [59–78]) than in the symptomatic group (57 mm [51–57]) (p = 0.040). There was no significant difference between the symptomatic and asymptomatic groups in terms of other conventional metrics.ConclusionsAn energy loss can quantify patients' subjective symptoms more clearly than other conventional metrics. The small sample size is the primary limitation of our study, further studies assessing larger cohort of patients are warranted to validate our findings.
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- 2022
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9. Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review
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Yoshinobu Nakayama, Jun Takeshita, Yasufumi Nakajima, and Nobuaki Shime
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Ultrasound ,Pediatrics ,Peripheral catheterization ,Blood vessels ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.
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- 2020
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10. Combined short-axis out-of-plane and long-axis in-plane approach versus long-axis in-plane approach for ultrasound-guided central venous catheterization in infants and small children: A randomized controlled trial.
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Jun Takeshita, Yasufumi Nakajima, Kazuya Tachibana, Hirofumi Hamaba, Tomonori Yamashita, and Nobuaki Shime
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Medicine ,Science - Abstract
The ultrasound-guided long-axis in-plane approach for central venous catheterization in infants and small children can prevent posterior wall penetration. The combined short-axis out-of-plane and long-axis in-plane approach reportedly prevents such penetration in adults. To test the hypothesis of non-inferiority of the combined approach to the long-axis in-plane approach, we compared the two approaches in infants and small children. Patients were randomized based on whether they underwent ultrasound-guided internal jugular vein catheterization using the combined or long-axis in-plane approach. Posterior wall penetration rates, first-attempt success rates, overall success rates within 20 min; scanning, puncture, and procedure durations; and number of attempts were compared between the groups. In the combined and long-axis in-plane groups (n = 55 per group), the posterior wall penetration rates were 5.5% (3/55) and 3.6% (2/55) (P = 0.65), the first-attempt success rates were 94.5% (52/55) and 92.7% (51/55) (P = 0.70), and the overall success rates within 20 min were 100% (55/55) and 98.2% (54/55) (P = 0.32), respectively. In the combined and long-axis in-plane groups, the median (interquartile range) scanning durations were 21 (16.5-34.8) s and 47 (29.3-65) s (P
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- 2022
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11. Cold storage conditions modify microRNA expressions for platelet transfusion.
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Nobuhiro Mukai, Yoshinobu Nakayama, Sachiyo Ishi, Takayuki Murakami, Satoru Ogawa, Kyoko Kageyama, Satoshi Murakami, Yuji Sasada, Jun Yoshioka, and Yasufumi Nakajima
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Medicine ,Science - Abstract
MicroRNAs (miRNAs) are small RNA molecules that modulate gene and protein expression in hematopoiesis. Platelets are known to contain a fully functional miRNA machinery. While platelets used for transfusion are normally stored at room temperature, recent evidence suggests more favorable effects under a cold-storage condition, including higher adhesion and aggregation properties. Thus, we sought to determine whether functional differences in platelets are associated with the differential profiling of platelet miRNA expressions. To obtain the miRNA expression profile, next-generation sequencing was performed on human platelets obtained from 10 healthy subjects. The miRNAs were quantified after being stored in three different conditions: 1) baseline (before storage), 2) stored at 22°C with agitation for 72 h, and 3) stored at 4°C for 72 h. Following the identification of miRNAs by sequencing, the results were validated at the level of mature miRNAs from 18 healthy subjects, by using quantitative polymerase chain reaction (qPCR). Differential expression was observed for 125 miRNAs that were stored at 4°C and 9 miRNAs stored at 22°C as compared to the baseline. The validation study by qPCR confirmed that storage at 4°C increased the expression levels (fold change 95% CI) of mir-20a-5p (1.87, p
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- 2019
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12. Residual shunt in an infant following patent ductus arteriosus ligation detected via transesophageal echocardiography monitoring during pulmonary artery banding: a case report
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Takayuki Yoshida, Natsuki Anada, and Yasufumi Nakajima
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Anesthesiology ,RD78.3-87.3 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Published
- 2019
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13. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis
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Rie Soeda, Fumika Taniguchi, Maiko Sawada, Saeko Hamaoka, Masayuki Shibasaki, Yasufumi Nakajima, Satoru Hashimoto, Teiji Sawa, and Yoshinobu Nakayama
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Anesthesiology ,RD78.3-87.3 - Abstract
A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.
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- 2016
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14. Erratum to: Vector flow mapping analysis of left ventricular energetic performance in healthy adult volunteers
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Koichi Akiyama, Sachiko Maeda, Tasuku Matsuyama, Atsushi Kainuma, Maki Ishii, Yoshifumi Naito, Mao Kinoshita, Saeko Hamaoka, Hideya Kato, Yasufumi Nakajima, Naotoshi Nakamura, Keiichi Itatani, and Teiji Sawa
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2017
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15. Ultrasound-Guided Short-Axis Out-of-Plane Approach With or Without Dynamic Needle-Tip Positioning for Peripheral Venous Catheterization in Pediatric Patients: A Systematic Review With Network Meta-Analysis
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Jun Takeshita, Yoshinobu Nakayama, Kazuya Tachibana, Yasufumi Nakajima, and Nobuaki Shime
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Anesthesiology and Pain Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
16. ST segment elevation immediately after cardiopulmonary bypass during modified Blalock-Taussig shunt and pulmonary artery banding
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Koichi Akiyama, Isaac Y. Wu, Kei Hori, Hiroatsu Sakamoto, Reiko Kosumi, Hirokazu Koto, Satoshi Asada, and Yasufumi Nakajima
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Anesthesiology and Pain Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
17. Impact of Permissive Hypoxia and Hyperoxia Avoidance on Clinical Outcomes in Septic Patients Receiving Mechanical Ventilation: A Retrospective Single-Center Study
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Takehiro Soeda, Munenori Kusunoki, Kota Nishimoto, Takahiko Kamibayashi, Takeshi Umegaki, Yasufumi Nakajima, Tomohiro Shoji, Sayaka Ohira, Natsuki Anada, and Takeo Uba
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Male ,Article Subject ,Organ Dysfunction Scores ,medicine.medical_treatment ,Single Center ,behavioral disciplines and activities ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,law ,Sepsis ,Humans ,Medicine ,Permissive ,Hypoxia ,APACHE ,Aged ,Retrospective Studies ,Hyperoxia ,Mechanical ventilation ,General Immunology and Microbiology ,business.industry ,General Medicine ,Oxygenation ,Hypoxia (medical) ,University hospital ,Respiration, Artificial ,Intensive care unit ,Oxygen ,Intensive Care Units ,Anesthesia ,Female ,sense organs ,medicine.symptom ,business ,Research Article - Abstract
Background. Septic patients often require mechanical ventilation due to respiratory dysfunction, and effective ventilatory strategies can improve survival. The effects of the combination of permissive hypoxia and hyperoxia avoidance for managing mechanically ventilated patients are unknown. This study examines these effects on outcomes in mechanically ventilated septic patients. Methods. In a retrospective before-and-after study, we examined adult septic patients (aged ≥18 years) requiring mechanical ventilation at a university hospital. On April 1, 2017, our mechanical ventilation policy changed from a conventional oxygenation target (SpO2: ≥96%) to more conservative targets with permissive hypoxia (SpO2: 88-92% or PaO2: 60 mmHg) and hyperoxia avoidance (reduced oxygenation for Pa O 2 > 110 mmHg ). Patients were divided into a prechange group (April 2015 to March 2017; n = 83 ) and a postchange group (April 2017 to March 2019; n = 130 ). Data were extracted from clinical records and insurance claims. Using a multiple logistic regression model, we examined the association of the postchange group (permissive hypoxia and hyperoxia avoidance) with intensive care unit (ICU) mortality after adjusting for variables such as Sequential Organ Failure Assessment (SOFA) score and PaO2/FiO2 ratios. Results. The postchange group did not have significantly lower adjusted ICU mortality (0.67, 0.33-1.43; P = 0.31 ) relative to the prechange group. However, there were significant intergroup differences in mechanical ventilation duration (prechange: 11.0 days, postchange: 7.0 days; P = 0.01 ) and ICU stay (prechange: 11.0 days, postchange: 9.0 days; P = 0.02 ). Conclusions. Permissive hypoxia and hyperoxia avoidance had no significant association with reduced ICU mortality in mechanically ventilated septic patients. However, this approach was significantly associated with shorter mechanical ventilation duration and ICU stay, which can improve patient turnover and ventilator access.
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- 2021
18. Ultrasound-guided short-axis out-of-plane approach with or without dynamic needle tip positioning for arterial line insertion in children: A systematic review with network meta-analysis
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Jun Takeshita, Yoshinobu Nakayama, Kazuya Tachibana, Yasufumi Nakajima, and Nobuaki Shime
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Anesthesiology and Pain Medicine ,General Medicine ,Critical Care and Intensive Care Medicine - Published
- 2023
19. Intraoperative Diagnosis of a Stuck Bioprosthetic Valve Leaflet Due to a Loop of Suture After Mitral Valve Replacement
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Yasufumi Nakajima, Jun Takeshita, Koichi Akiyama, and Natsuki Anada
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medicine.medical_specialty ,Cardiovascular Complication ,business.industry ,medicine.medical_treatment ,Diastole ,Mitral valve replacement ,030204 cardiovascular system & hematology ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Suture (anatomy) ,030202 anesthesiology ,law ,Mitral valve ,Cardiopulmonary bypass ,Medicine ,Systole ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
A stuck mechanical valve leaflet is a well-known cardiovascular complication; however, a stuck bioprosthetic valve is a rare but potentially fatal complication. Herein a case of stuck bioprosthetic mitral valve caused by a loop of suture, which was detected on intraoperative 3-dimensional (3D) transesophageal echocardiography immediately after cardiopulmonary bypass, is presented. Restricted motion of the 2 leaflets during diastole and incomplete coaptation during systole were observed clearly on 3D imaging. Thus, intraoperative 3D transesophageal echocardiography imaging is useful for detecting such complications immediately after cardiopulmonary bypass.
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- 2021
20. Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A Randomized Controlled Trial*
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Ai Fujiwara, Nobuaki Shime, Hideki Matsuura, Hirofumi Hamaba, Kazuya Tachibana, Gaku Nagai, Tomonori Yamashita, Jun Takeshita, and Yasufumi Nakajima
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Catheterization, Central Venous ,medicine.medical_specialty ,Short axis ,Venous catheterization ,Critical Care and Intensive Care Medicine ,law.invention ,Out of plane ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,030225 pediatrics ,medicine ,Humans ,Prospective Studies ,Child ,Internal jugular vein ,Ultrasonography, Interventional ,Ultrasonography ,business.industry ,030208 emergency & critical care medicine ,Ultrasound guided ,Surgery ,In plane ,Child, Preschool ,Relative risk ,Pediatrics, Perinatology and Child Health ,Female ,Jugular Veins ,business - Abstract
Objectives The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia. Design Prospective randomized controlled trial. Setting Operating room of Osaka Women's and Children's Hospital. Patients Pediatric patients less than 5 years old who underwent cardiovascular surgery. Interventions Ultrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach. Measurements and main results The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98). Conclusions The long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.
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- 2020
21. Ultrasound-guided dynamic needle tip positioning versus conventional palpation approach for catheterisation of posterior tibial or dorsalis pedis artery in infants and small children
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Kazuya Tachibana, Tomonori Yamashita, Yasufumi Nakajima, Nobuaki Shime, Yoshinobu Nakayama, Hirofumi Hamaba, and Jun Takeshita
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Small children ,Palpation ,Ultrasound guided ,Posterior tibial artery ,Ultrasound guidance ,Anesthesiology and Pain Medicine ,medicine.artery ,Dorsalis pedis artery ,medicine ,Blood pressure monitoring ,Radiology ,business - Published
- 2021
22. Bent peripheral venous catheter inserted using ultrasound-guided dynamic needle tip positioning
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Kazuya Tachibana, Yasufumi Nakajima, Jun Takeshita, and Nobuaki Shime
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Cephalic vein ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Interventional ultrasonography ,030204 cardiovascular system & hematology ,Ultrasound guided ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,medicine.anatomical_structure ,Forearm ,Nephrology ,Medicine ,Peripheral venous catheter ,Surgery ,Radiology ,Ultrasonography ,business ,Vein - Abstract
Herein, we report the case of a 2-year-old boy in whom a bent peripheral venous catheter was inserted using ultrasound-guided dynamic needle tip positioning via a short-axis out-of-plane approach. The peripheral venous catheter appeared to be successfully inserted into the cephalic vein in the forearm using dynamic needle tip positioning via a short-axis out-of-plane approach. However, after removing the inner needle, no blood return was confirmed. The removed catheter was noted to be bent at approximately one-third of the catheter length from the tip. A large change in the puncture angle during dynamic needle tip positioning for a deeply located vein might have caused this bend. Deeply located veins are not targeted when a blind puncture technique is used, as they are not visible and palpable. They can be visualized by ultrasonography and can be targeted using DNTP; however, the catheter may bend. Clinicians should be aware of this issue and, therefore, they are suggested to ensure that the puncture angle is not too steep and use a long length catheter; in addition, very deep veins should not be targeted.
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- 2020
23. Paraplegia After Open Surgical Repair Versus Thoracic Endovascular Aortic Repair for Thoracic Aortic Disease: A Retrospective Analysis of Japanese Administrative Data
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Susumu Kunisawa, Takahiko Kamibayashi, Takeshi Umegaki, Yasufumi Nakajima, Kota Nishimoto, and Yuichi Imanaka
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medicine.medical_specialty ,Aortic Diseases ,Aorta, Thoracic ,Logistic regression ,Blood Vessel Prosthesis Implantation ,Japan ,Risk Factors ,medicine ,Humans ,Thoracic aortic disease ,Retrospective Studies ,Surgical repair ,Paraplegia ,Aortic Aneurysm, Thoracic ,business.industry ,Incidence (epidemiology) ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives To comparatively examine the risk of postoperative paraplegia between open surgical descending aortic repair and thoracic endovascular aortic repair (TEVAR) among patients with thoracic aortic disease. Design Retrospective cohort study. Setting Acute-care hospitals in Japan. Participants A total of 6,202 patients diagnosed with thoracic aortic disease. Interventions None. Measurements and Main Results The main outcome of this study was the incidence of postoperative paraplegia. Multiple logistic regression models, using inverse probability of treatment weighting and an instrumental variable (ratio of TEVAR use to open surgical repair and TEVAR uses), showed that the odds ratios of paraplegia for TEVAR (relative to open surgical descending aortic repair) were 0.81 (95% confidence interval: 0.42-1.59; p = 0.55) in the inverse probability of treatment-weighted model and 0.88 (0.42-1.86; p = 0.75) in the instrumental-variable model. Conclusions There were no statistical differences in the risk of paraplegia between open surgical repair and TEVAR in patients with thoracic aortic disease. Improved perioperative management for open surgical repair may have contributed to the similarly low incidence of paraplegia in these two surgery types.
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- 2021
24. Difference in Intraventricular Vortex Between the Single Right Ventricle and Single Left Ventricle
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Isaac Y. Wu, Hiroo Takayama, Yasufumi Nakajima, Teiji Sawa, Yurie Obata, Masaaki Yamagishi, Yosuke Tachibana, Koichi Akiyama, and Keiichi Itatani
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Single left ventricle ,business.industry ,Heart Ventricles ,Single right ventricle ,Anatomy ,Vortex ,Anesthesiology and Pain Medicine ,Text mining ,Diastole ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Published
- 2021
25. Preoperative left ventricular energy loss in the operating theater reflects subjective symptoms in chronic aortic regurgitation
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Atsushi Kainuma, Keiichi Itatani, Koichi Akiyama, Yoshifumi Naito, Maki Ishii, Masaru Shimizu, Junya Ohara, Naotoshi Nakamura, Yasufumi Nakajima, Satoshi Numata, Hitoshi Yaku, and Teiji Sawa
- Subjects
RD1-811 ,transesophageal echocardiography ,subjective symptoms ,Surgery ,vector flow mapping (VFM) ,energy loss (EL) ,aortic regurgitation (AR) - Abstract
BackgroundThere is currently no subjective, definitive evaluation method for therapeutic indication other than symptoms in aortic regurgitation. Energy loss, a novel parameter of cardiac workload, can be visualized and quantified using echocardiography vector flow mapping. The purpose of the present study was to evaluate whether energy loss in patients with chronic aortic regurgitation can quantify their subjective symptoms more clearly than other conventional metrics.MethodsWe studied 15 patients undergoing elective aortic valve surgery for aortic regurgitation. We divided the patients into symptomatic and asymptomatic groups using their admission records. We analyzed the mean energy loss in one cardiac cycle using transesophageal echocardiography during the preoperative period. The relationships between symptoms, energy loss, and other conventional metrics were statistically analyzed.ResultsThere were seven and eight patients in the symptomatic and asymptomatic groups, respectively. The mean energy loss of one cardiac cycle was higher in the symptomatic group (121 mW/m [96–184]) than in the asymptomatic group (87 mW/m [80–103]) (p = 0.040), whereas the diastolic diameter was higher in the asymptomatic group (65 mm [59–78]) than in the symptomatic group (57 mm [51–57]) (p = 0.040). There was no significant difference between the symptomatic and asymptomatic groups in terms of other conventional metrics.ConclusionsAn energy loss can quantify patients' subjective symptoms more clearly than other conventional metrics. The small sample size is the primary limitation of our study, further studies assessing larger cohort of patients are warranted to validate our findings.
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- 2020
26. Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review
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Nobuaki Shime, Yoshinobu Nakayama, Yasufumi Nakajima, and Jun Takeshita
- Subjects
medicine.medical_specialty ,Less invasive ,Review ,Critical Care and Intensive Care Medicine ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,Blood vessels ,030202 anesthesiology ,Peripheral catheterization ,Intensive care ,Ultrasound ,Catheterization, Peripheral ,Medicine ,Humans ,Medical physics ,Child ,Ultrasonography, Interventional ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Perioperative ,lcsh:RC86-88.9 ,Ultrasound guided ,Ultrasound guidance ,Vascular catheterization ,Narrative review ,business - Abstract
Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.
- Published
- 2020
27. Vector Flow Mapping and Impaired Left Ventricular Flow After the Alfieri Stitch
- Author
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Satoshi Numata, Masaru Shimizu, Koichi Akiyama, Hiroaki Yasumoto, Mao Kinoshita, Saeko Hamaoka, Yoshifumi Naito, Yasufumi Nakajima, Teiji Sawa, Keiichi Itatani, Hideya Kato, and Hitoshi Yaku
- Subjects
Aortic valve ,medicine.medical_specialty ,Blood viscosity ,Vectorcardiography ,Diastole ,Cardiomyopathy ,030204 cardiovascular system & hematology ,01 natural sciences ,law.invention ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,law ,Monitoring, Intraoperative ,Internal medicine ,Mitral valve ,0103 physical sciences ,Cardiopulmonary bypass ,medicine ,Humans ,Intraoperative Complications ,Aged, 80 and over ,010302 applied physics ,Vector flow ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Published
- 2017
28. Ultrasonographic Detection of Micro-Bubbles in the Right Atrium to Confirm Peripheral Venous Catheter Position in Children
- Author
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Muneyuki Takeuchi, Masashi Taniguchi, Yoshiyuki Shimizu, Nobuaki Shime, Atsushi Kawamura, Yasufumi Nakajima, and Jun Takeshita
- Subjects
Male ,medicine.medical_treatment ,Contrast Media ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Catheters, Indwelling ,Randomized controlled trial ,law ,Catheterization, Peripheral ,medicine ,Humans ,Heart Atria ,Prospective Studies ,Prospective cohort study ,Ultrasonography ,Microbubbles ,business.industry ,Infant ,030208 emergency & critical care medicine ,Extravasation ,Peripheral ,medicine.anatomical_structure ,030228 respiratory system ,Child, Preschool ,Peripheral venous catheter ,Right atrium ,Female ,business ,Nuclear medicine ,Central venous catheter ,Micro bubble - Abstract
OBJECTIVES In pediatric patients, indwelling peripheral venous catheters are sometimes displaced to extravascular positions, causing infiltration or extravasation. No reliable techniques are available to confirm accurate IV catheterization. However, ultrasonographic detection of micro-bubble turbulence in the right atrium after saline injection has been reported to be useful in confirming central venous catheter positions in both adults and children. This study evaluated whether this micro-bubble detection test can offer better confirmation of peripheral venous catheter positions compared with the smooth saline injection technique in pediatric patients. DESIGN Randomized controlled study. SETTING Single tertiary PICU. PATIENTS Pediatric patients (weighing < 15 kg) who already had or required a peripheral venous catheter. INTERVENTIONS Patients were randomly allocated to either of the two groups (150 patients per group): undergoing either the micro-bubble detection test (M group) or the smooth saline injection test (S group). MEASUREMENTS AND MAIN RESULTS The peripheral venous catheters were confirmed to be IV located in the final position in 137 and 139 patients in the M and S groups, respectively. In properly located catheters, the tests were positive in 100% (n = 137/137; sensitivity, 100%; 95% CI, 97.8-100), and in 89% (n = 124/139; 95% CI, 82.8-93.8) of the M and S groups, respectively (p = 0.0001). Among the catheters located in extravascular positions, the tests were negative in 100% (n = 13/13; specificity, 100%; 95% CI, 79.4-100), and in 64% (n = 7/11; 95% CI, 30.8-89.1) of the M and S groups, respectively (p = 0.017). CONCLUSIONS The micro-bubble detection test is a useful technique for detecting extravasation and confirming proper positioning of peripheral IV catheters in pediatric patients.
- Published
- 2019
29. Superiority of Dynamic Needle Tip Positioning for Ultrasound-Guided Peripheral Venous Catheterization in Patients Younger Than 2 Years Old: A Randomized Controlled Trial
- Author
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Yasufumi Nakajima, Takayuki Yoshida, Yukie Ito, Nobuaki Shime, Muneyuki Takeuchi, Jun Takeshita, Kei Nishiyama, Yoshiyuki Shimizu, and Yoshinobu Nakayama
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,law.invention ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Randomized controlled trial ,Interquartile range ,law ,Catheterization, Peripheral ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Vein ,Fisher's exact test ,Ultrasonography, Interventional ,business.industry ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Surgery ,medicine.anatomical_structure ,Needles ,Relative risk ,Pediatrics, Perinatology and Child Health ,symbols ,Mann–Whitney U test ,Female ,Peripheral Venous Catheterization ,business - Abstract
Objectives This study evaluated whether the dynamic needle tip positioning technique increased the success rate of ultrasound-guided peripheral venous catheterization in pediatric patients with a small-diameter vein compared with the static ultrasound-guided technique. Design Randomized controlled study. Setting Single institution, Osaka Women's and Children's Hospital. Patients The study population included 60 pediatric patients less than 2 years old who required peripheral venous catheterization in the PICU. Interventions Patients were randomly divided into the dynamic needle tip positioning (n = 30) or static group (n = 30). Each group received ultrasound-guided peripheral venous catheterization with or without dynamic needle tip positioning, respectively. The Fisher exact test, Kaplan-Meier curve plots, log-rank tests, and Mann-Whitney U test were used in the statistical analysis. Measurements and main results The first-attempt success rate was higher in the dynamic needle tip positioning group than in the static group (86.7% vs 60%; p = 0.039; relative risk = 1.44; 95% CI, 1.05-2.0). The overall success rate within 10 minutes was higher in the dynamic needle tip positioning group than in the static group (90% vs 63.3%; p = 0.03; relative risk = 1.42; 95% CI, 1.06-1.91). Significantly fewer attempts were made in the dynamic needle tip positioning group than in the static group (median [interquartile range, range] = 1 [1-1, 1-2] vs 1 [1-2, 1-3]; p = 0.013]). The median (interquartile range) catheterization times were 51.5 seconds (43-63 s) and 71.5 seconds (45-600 s) in the dynamic needle tip positioning and static groups, respectively (p = 0.01). Conclusions Dynamic needle tip positioning increased the first-attempt and overall success rates of ultrasound-guided peripheral venous catheterization in pediatric patients less than 2 years old.
- Published
- 2019
30. Residual shunt in an infant following patent ductus arteriosus ligation detected via transesophageal echocardiography monitoring during pulmonary artery banding: a case report
- Author
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Natsuki Anada, Yasufumi Nakajima, and Takayuki Yoshida
- Subjects
medicine.medical_specialty ,business.industry ,Pain medicine ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:RC86-88.9 ,Shunt (medical) ,Surgery ,Pulmonary artery banding ,lcsh:RD78.3-87.3 ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,lcsh:Anesthesiology ,Ductus arteriosus ,Anesthesiology ,medicine ,business ,Ligation ,Letter to the Editor - Published
- 2019
31. A Practical Training Program for Peripheral Radial Artery Catheterization in Adult Patients
- Author
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Toshiki Mizobe, Teiji Sawa, Yuko Inagaki, Yasufumi Nakajima, Nobuhiro Mukai, Satoru Ogawa, Yoshinobu Nakayama, and Daniel I. Sessler
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Ultrasound ,030208 emergency & critical care medicine ,Palpation ,Pulse pressure ,Surgery ,law.invention ,Peripheral ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,030202 anesthesiology ,law ,medicine.artery ,medicine ,Observational study ,Radial artery ,business ,Prospective cohort study - Abstract
Background The main cause of unsuccessful peripheral radial artery catheterization using traditional palpation is imprecisely locating the arterial center. The authors evaluated factors causing disparities between the arterial centers determined by palpation versus ultrasound. The authors applied them to create and test a novel catheterization training program. Methods The arterial central axis was determined by ultrasound and palpation in 350 adults. Potential independent predictors of disparity included sex, body mass index, pulse pressure, transverse arterial diameter, subcutaneous arterial depth, chronic hypertension, and experience as an anesthesiologist (less than 3 vs. greater than or equal to 3 yr). Using the results, the authors developed a radial artery catheterization training program. It was tested by enrolling 20 first-year interns, randomized to a training or control group. The time to successful insertion was the primary outcome measure. The success rate and time required for catheterization by palpation were evaluated in 100 adult patients per group. Results Independent predictors of central axis disparity were pulse pressure, subcutaneous radial artery depth, years of experience, and chronic hypertension. Training improved the catheterization time (training group 56 ± 2 s vs. control group 109 ± 2 s; difference –53 ± 3 s; 95% CI, –70 to –36 s; P < 0.0001) and total success rate (training group 83 of 100 attempts, 83%; 95% CI, 75 to 90 vs. control group 57 of 100, 57%; 95% CI, 47 to 66; odds ratio, 3.7; 95% CI, 2.7 to 5.1). Conclusions Misjudging the central axis position of the radial artery is common with a weak pulse and/or deep artery. The authors’ program, which focused on both these issues, shortened the time for palpation-guided catheterization and improved success.
- Published
- 2016
32. Controversies in the temperature management of critically ill patients
- Author
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Yasufumi Nakajima
- Subjects
medicine.medical_specialty ,Resuscitation ,Fever ,Critical Illness ,Vital signs ,030204 cardiovascular system & hematology ,Body Temperature ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Hypothermia, Induced ,law ,Intensive care ,medicine ,Animals ,Humans ,Intensive care medicine ,Psychiatry ,business.industry ,Disease Management ,030208 emergency & critical care medicine ,Perioperative ,Hypothermia ,Clinical trial ,Anesthesiology and Pain Medicine ,Blood pressure ,Anesthesia ,medicine.symptom ,business ,Body Temperature Regulation - Abstract
Although body temperature is a classic primary vital sign, its value has received little attention compared with the others (blood pressure, heart rate, and respiratory rate). This may result from the fact that unlike the other primary vital signs, aging and diseases rarely affect the thermoregulatory system. Despite this, when humans are exposed to various anesthetics and analgesics and acute etiologies of non-infectious and infectious diseases in perioperative and intensive care settings, abnormalities may occur that shift body temperature up and down. A recent upsurge in clinical evidence in the perioperative and critical care field resulted in many clinical trials in temperature management. The results of these clinical trials suggest that aggressive body temperature modifications in comatose survivors after resuscitation from shockable rhythm, and permissive fever in critically ill patients, are carried out in critical care settings to improve patient outcomes; however, its efficacy remains to be elucidated. A recent, large multicenter randomized controlled trial demonstrated contradictory results, which may disrupt the trends in clinical practice. Thus, updated information concerning thermoregulatory interventions is essential for anesthesiologists and intensivists. Here, recent controversies in therapeutic hypothermia and fever management are summarized, and their relevance to the physiology of human thermoregulation is discussed.
- Published
- 2016
33. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis
- Author
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Satoru Hashimoto, Yoshinobu Nakayama, Masayuki Shibasaki, Saeko Hamaoka, Fumika Taniguchi, Maiko Sawada, Rie Soeda, Yasufumi Nakajima, and Teiji Sawa
- Subjects
medicine.medical_specialty ,business.industry ,Subglottic stenosis ,Case Report ,medicine.disease ,Extracorporeal ,Surgery ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,lcsh:Anesthesiology ,030202 anesthesiology ,030220 oncology & carcinogenesis ,Anesthesia ,medicine ,Inner diameter ,business ,Difficult airway ,Endotracheal tube - Abstract
A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.
- Published
- 2016
34. Dynamic Needle Tip Positioning for Ultrasound-Guided Arterial Catheterization in Infants and Small Children With Deep Arteries: A Randomized Controlled Trial
- Author
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Yoshinobu Nakayama, Yoshiyuki Shimizu, Yukie Ito, Takayuki Yoshida, Yasufumi Nakajima, Nobuaki Shime, Muneyuki Takeuchi, Kei Nishiyama, and Jun Takeshita
- Subjects
Male ,medicine.medical_specialty ,law.invention ,Arterial catheterization ,03 medical and health sciences ,0302 clinical medicine ,Posterior wall ,Randomized controlled trial ,030202 anesthesiology ,law ,medicine.artery ,Catheterization, Peripheral ,medicine ,Humans ,In patient ,Prospective Studies ,Radial artery ,Single institution ,Ultrasonography, Interventional ,business.industry ,Small children ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Ultrasound guided ,Surgery ,Anesthesiology and Pain Medicine ,Radial Artery ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Arterial catheterization for infants and small children is technically challenging. This study evaluated whether the dynamic needle tip positioning (DNTP) technique improved the success rate of ultrasound-guided radial artery catheterization in patients with a radial artery depth ≥4 mm compared with the conventional ultrasound-guided technique. Design Randomized controlled study. Setting Single institution, Osaka Women's and Children's Hospital. Participants Patients (n = 40; age Interventions Patients were divided randomly into 2 groups. The DNTP group received ultrasound-guided radial artery catheterization with DNTP; the conventional group received catheterization without DNTP. Measurements and Main Results First-attempt success rates were 85% and 50% in the DNTP and conventional groups, respectively (p = 0.018; relative risk = 1.7; 95% CI: 1.06-2.73). Overall success rates within 10 minutes were 95% and 60% in the DNTP and conventional groups, respectively (p = 0.008; relative risk = 1.58; 95% CI: 1.09-2.3). Posterior wall puncture rates were 5% and 50% in the DNTP and conventional groups, respectively (p = 0.0014; relative risk = 0.1; 95% CI: 0.014-0.71). Significantly fewer attempts were made in the DNTP group (median = 1 v 1.5; p = 0.01). The median catheterization times were 38 seconds (34-55.5) and 149 seconds (49.5-600) in the DNTP and conventional groups, respectively (p = 0.0003). Conclusion Dynamic needle tip positioning improved first-attempt and overall success rates of ultrasound-guided radial artery catheterization in pediatric patients with a radial artery depth ≥4 mm.
- Published
- 2018
35. [Case Report : Monitored Anesthesia Care (MAC) with Dexmedetomidine.]
- Author
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Eriko, Nakamura, Kyoko, Kageyama, Masanao, Okabayashi, Shinya, Kasai, Yasufumi, Nakajima, Teiij, Sawa, and Kyoko, Nakamura
- Subjects
Aged, 80 and over ,Male ,Humans ,Hypnotics and Sedatives ,Female ,Dexmedetomidine ,Aged ,Monitoring, Physiologic - Abstract
Dexmedetomidine (DEX) is a sedative used for monitored anesthesia care (MAC). DEX has been used frequently for MAC because of its less respiratory depressant effect We used DEX in four patients with severe complications who needed surgery under MAC. We started MAC with continuous infusion of 0.5-0.9 μtg - kg(-1) . hr(-1) of DEX, without initial loading dose, combined with regional anesthesia, and gradually either increased or decreased continuous infusion according to Ramsay sedation scale (RSS). The simulated plasma concentrations of DEX were calculated by AnestAs- sistTM PK . PD(-1). All patients were well sedated and operations were completed safely, although simulated plasma concentrations of DEX were low. Remarkable cardiovascular responses and respiratory depression were not observed. Our study indicated that the usage of DEX without initial loading dose combined with regional anesthesia could be an option for patients with severe complications undergoing MAC.
- Published
- 2018
36. Prohemostatic Activity of Factor X in Combination With Activated Factor VII in Dilutional Coagulopathy
- Author
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Shusuke Takeshita, Nobuhiro Mukai, Yoshinobu Nakayama, Kenichi A. Tanaka, Teiji Sawa, Satoru Ogawa, Yasufumi Nakajima, and Toshiki Mizobe
- Subjects
Male ,Time Factors ,Prothrombin level ,Factor VIIa ,Pharmacology ,chemistry.chemical_compound ,In vivo ,medicine ,Humans ,Cardiac Surgical Procedures ,Blood Coagulation ,Prothrombin time ,Hemodilution ,medicine.diagnostic_test ,business.industry ,Coagulants ,Factor X ,Thrombin ,Blood Coagulation Disorders ,Prothrombin complex concentrate ,Blood Coagulation Factors ,Recombinant Proteins ,Thromboelastometry ,Anesthesiology and Pain Medicine ,Coagulation ,chemistry ,Clotting time ,Case-Control Studies ,Drug Therapy, Combination ,Female ,Blood Coagulation Tests ,business ,medicine.drug - Abstract
BACKGROUND Recombinant activated factor VII (rFVIIa) concentrate reduces allogeneic blood transfusions, but it may increase thromboembolic complications in complex cardiac surgery. The mixture of activated factor VII (FVIIa) and factor X (FX) (FVIIa/FX) (FVIIa:FX = 1:10) is a novel bypassing agent for hemophilia patients. We hypothesized that the combination of FX and FVIIa could improve thrombin generation (TG) in acquired multifactorial coagulation defects such as seen in cardiac surgery and conducted in vitro evaluation of FVIIa/FX in parallel with other coagulation factor concentrates using in vitro and in vivo diluted plasma samples. METHODS Plasma samples were collected from 9 healthy volunteers and 12 cardiac surgical patients. We measured TG (Thrombinoscope) using in vitro 50% dilution plasma and in vivo dilution plasma after cardiopulmonary bypass, in parallel with thromboelastometry (ROTEM) and standard coagulation assays. In vitro additions of FVIIa/FX (0.35, 0.7, and 1.4 μg/mL, based on the FVIIa level), rFVIIa (1.4, 2.8, and 6.4 μg/mL), prothrombin complex concentrate (0.3 international unit), and 20% plasma replacement were evaluated. RESULTS In diluted plasma, the addition of either FVIIa/FX or rFVIIa shortened the lag time and increased the peak TG, but the effect in lag time of FVIIa/FX at 0.35 μg/mL was more extensive than rFVIIa at 6.4 μg/mL. Prothrombin complex concentrate increased peak TG by increasing the prothrombin level but failed to shorten the lag time. No improvement in any of the TG variables was observed after 20% volume replacement with plasma. The addition of factor concentrates normalized prothrombin time/international normalized ratio but not with plasma replacement. In cardiac patients, similar patterns were observed on TG in post-cardiopulmonary bypass samples. FVIIa/FX shortened clotting time (CT) in a concentration-dependent manner on CT on thromboelastometry. Plasma replacement did not improve CT, but a combination of plasma and FVIIa/FX (0.35 μg/mL) more effectively shortened CT than FVIIa/FX alone. CONCLUSIONS The combination of FVIIa and FX improved TG more efficiently than rFVIIa alone or plasma in dilutional coagulopathy models. The required FVIIa dose in FVIIa/FX was considerably lower than those reported during bypassing therapy in hemophilia patients (1.4-2.8 μg/mL). The combination of plasma could restore coagulation more efficiently compared to FVIIa/FX alone. Lesser FVIIa requirement to exert procoagulant activity may be favorable in terms of reducing systemic thromboembolic complications.
- Published
- 2018
37. Changes in MicroRNA Expression Level of Circulating Platelets Contribute to Platelet Defect After Cardiopulmonary Bypass
- Author
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Satoru Ogawa, Sachiko Maeda, Teiji Sawa, Satoshi Murakami, Sachiyo Ishi, Toshiki Mizobe, Yasufumi Nakajima, Natuki Anada, Nobuhiro Mukai, and Yoshinobu Nakayama
- Subjects
0301 basic medicine ,Blood Platelets ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Real-Time Polymerase Chain Reaction ,law.invention ,R-SNARE Proteins ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,microRNA ,medicine ,Cardiopulmonary bypass ,Humans ,Platelet ,Prospective Studies ,RNA, Messenger ,Aged ,Glycoproteins ,Aged, 80 and over ,Messenger RNA ,Cardiopulmonary Bypass ,business.industry ,RNA ,Blot ,MicroRNAs ,030104 developmental biology ,Endocrinology ,Real-time polymerase chain reaction ,Membrane protein ,Female ,business - Abstract
Objectives Platelet defect mechanisms after cardiopulmonary bypass remain unclear. Our hypothesis microRNA expressions in circulating platelets significantly change between pre and post cardiopulmonary bypass, and consequent messenger RNA and protein expression level alterations cause postcardiopulmonary bypass platelet defect. Design Single-center prospective observational study. Setting Operating room of Kyoto Prefectural University of Medicine. Patients Twenty-five adult patients scheduled for elective cardiac surgeries under cardiopulmonary bypass. Interventions None. Measurements and main results In the initial phase, changes in microRNA expression between pre and post cardiopulmonary bypass underwent next generation sequencing analysis (10 patients). Based on the results, we focused on changes in mir-10b and mir-96, which regulate glycoprotein 1b and vesicle-associated membrane protein 8, respectively, and followed them until messenger RNA and protein syntheses (15 patients) using quantitative polymerase chain reaction and Western blotting. Seven microRNAs including mir-10b and mir-96 exhibited significant differences in the initial phase. In the subsequent phase, mir-10b-5p and mir-96-5p overexpressions were confirmed, and glycoprotein 1b and vesicle-associated membrane protein 8 messenger RNA levels were significantly decreased after cardiopulmonary bypass: fold differences (95% CI): mir-10b-5p: 1.35 (1.05-2.85), p value equals to 0.01; mir-96-5p: 1.59 (1.06-2.13), p value equals to 0.03; glycoprotein 1b messenger RNA: 0.46 (0.32-0.60), p value of less than 0.001; and vesicle-associated membrane protein messenger RNA: 0.70 (0.56-0.84), p value of less than 0.001. Glycoprotein 1b and vesicle-associated membrane protein 8 were also significantly decreased after cardiopulmonary bypass: glycoprotein 1b: 82.6% (71.3-93.8%), p value equals to 0.005; vesicle-associated membrane protein 8: 79.0% (70.7-82.3%), p value of less than 0.001. Conclusions Expressions of several microRNAs in circulating platelets significantly changed between pre and post cardiopulmonary bypass. Overexpressions of mir-10b and mir-96 decreased glycoprotein 1b and vesicle-associated membrane protein 8 messenger RNA as well as protein, possibly causing platelet defect after cardiopulmonary bypass.
- Published
- 2018
38. A Comparative Study of Point-of-Care Prothrombin Time in Cardiopulmonary Bypass Surgery
- Author
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Kenichi A. Tanaka, Toshiki Mizobe, Teiji Sawa, Takashi Nishiyama, Shihoko Okabayashi, Satoru Ogawa, Yoshinobu Nakayama, Yasufumi Nakajima, and Shusuke Takeshita
- Subjects
Adult ,Male ,Point-of-care testing ,Point-of-Care Systems ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030202 anesthesiology ,law ,Monitoring, Intraoperative ,Cardiopulmonary bypass ,Medicine ,Humans ,International Normalized Ratio ,Prospective Studies ,Point of care ,Prothrombin time ,Cardiopulmonary Bypass ,medicine.diagnostic_test ,business.industry ,Warfarin ,Anticoagulants ,Heparin ,Middle Aged ,Prothrombin complex concentrate ,Anesthesiology and Pain Medicine ,Coagulation ,Anesthesia ,Prothrombin Time ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Point-of-care (POC) devices allow for prothrombin time/international normalized ratio (PT/INR) testing in whole blood (WB) and timely administration of plasma or prothrombin complex concentrate during cardiopulmonary bypass surgery. This study evaluated the sensitivities of a new POC PT test, a dry-hematology method with heparin neutralization technology (DRIHEMATO PT-S [DRI PT-S]; AT Corporation, Kanagawa, Japan), and compared it with other POC tests currently available.Prospective, observational study.University hospital, single center.Healthy volunteers and warfarin-treated and cardiac surgical patients.In WB samples obtained from 6 healthy volunteers, PT-INR results of DRI PT-S were not affected by an in vitro addition of heparin6.0 U/mL. In warfarin-treated samples (n = 88, PT/INR 0.98-3.87), PT-INR with DRI PT-S showed acceptable correlation with the laboratory method (rThis study demonstrated that PT/INR can be accurately assessed using the dry-hematology method in WB under therapeutic heparin levels. Currently available other POC PT/INR tests are affected by heparin, and thus they are not recommended for coagulation monitoring during cardiopulmonary bypass.
- Published
- 2017
39. Changes in platelet Bax levels contribute to impaired platelet response to thrombin after cardiopulmonary bypass: prospective observational clinical and laboratory investigations
- Author
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Yasufumi Nakajima, Nobuhiro Mukai, Daniel I. Sessler, Yoshinobu Nakayama, M. Murase, and Satoru Ogawa
- Subjects
0301 basic medicine ,Blood Platelets ,Male ,Necrosis ,Platelet Aggregation ,Blotting, Western ,Apoptosis ,030204 cardiovascular system & hematology ,Pharmacology ,Platelet membrane glycoprotein ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Thrombin ,Postoperative Complications ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Platelet ,Prospective Studies ,Blood Platelet Disorders ,Aged ,bcl-2-Associated X Protein ,Aged, 80 and over ,Cardiopulmonary Bypass ,biology ,business.industry ,Middle Aged ,Flow Cytometry ,Platelet Activation ,030104 developmental biology ,Anesthesiology and Pain Medicine ,Glycoprotein Ib ,biology.protein ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Background Anucleate platelets can undergo apoptosis in response to various stimuli, as do nucleated cells. Cardiopulmonary bypass (CPB) causes platelet dysfunction and can also activate platelet apoptotic pathways. We therefore evaluated time-dependent changes in blood platelet Bax (a pro-apoptotic molecule) levels and platelet dysfunction after cardiac surgery. Methods We assessed blood samples obtained from subjects having on-pump or off-pump coronary artery bypass graft surgery (n=20 each). We also evaluated the in vitro effects of platelet Bax increase in eight healthy volunteers. Results Thrombin-induced platelet calcium mobilisation and platelet-surface glycoprotein Ib (GPIb) expression were lowest at weaning from CPB and did not recover on postoperative day one. On-pump surgery increased platelet expression of Bax, especially the oligomerised form, along with translocation of Bax from the cytosol to mitochondria and platelet-surface tumour necrosis factor-alpha (TNF-α)–converting enzyme (TACE) expression. In contrast, mitochondrial cytochrome c expression was reduced. While similar in direction, the magnitude of the observed changes was smaller in patients having off-pump surgery. In vitro, a cell-permeable Bax peptide increased platelet Bax expression to the same extent seen during bypass and produced similar platelet changes. These apoptotic-like changes were largely reversed by Bcl-xL pre-administration, and were completely reversed by combined application of inhibitors that stabilise outer mitochondrial membrane permeability and TACE. Conclusions CPB increases platelet Bax expression, which contributes to reduced platelet-surface GPIb expression and thrombin-induced platelet calcium changes. These changes in platelet apoptotic signalling might contribute to platelet dysfunction after CPB. Clinical trial registration UMIN Clinical Trials Registry (number UMIN000006033).
- Published
- 2017
40. Erratum to: Vector flow mapping analysis of left ventricular energetic performance in healthy adult volunteers
- Author
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Sachiko Maeda, Tasuku Matsuyama, Mao Kinoshita, Maki Ishii, Teiji Sawa, Saeko Hamaoka, Naotoshi Nakamura, Atsushi Kainuma, Yasufumi Nakajima, Hideya Kato, Koichi Akiyama, Yoshifumi Naito, and Keiichi Itatani
- Subjects
Adult ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Heart Ventricles ,MEDLINE ,Energetic performance index ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Reference Values ,Coronary Circulation ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Angiology ,Observer Variation ,Vector flow ,business.industry ,Published Erratum ,Myocardial Perfusion Imaging ,Vector flow mapping ,Reproducibility of Results ,Myocardial Contraction ,Healthy Volunteers ,Biomechanical Phenomena ,Echocardiography, Doppler, Color ,Cardiac surgery ,Energy loss ,Energy Transfer ,lcsh:RC666-701 ,Female ,Erratum ,Cardiology and Cardiovascular Medicine ,business ,Kinetic energy ,Vortex ,Research Article - Abstract
Background Vector flow mapping, a novel flow visualization echocardiographic technology, is increasing in popularity. Energy loss reference values for children have been established using vector flow mapping, but those for adults have not yet been provided. We aimed to establish reference values in healthy adults for energy loss, kinetic energy in the left ventricular outflow tract, and the energetic performance index (defined as the ratio of kinetic energy to energy loss over one cardiac cycle). Methods Transthoracic echocardiography was performed in fifty healthy volunteers, and the stored images were analyzed to calculate energy loss, kinetic energy, and energetic performance index and obtain ranges of reference values for these. Results Mean energy loss over one cardiac cycle ranged from 10.1 to 59.1 mW/m (mean ± SD, 27.53 ± 13.46 mW/m), with a reference range of 10.32 ~ 58.63 mW/m. Mean systolic energy loss ranged from 8.5 to 80.1 (23.52 ± 14.53) mW/m, with a reference range of 8.86 ~ 77.30 mW/m. Mean diastolic energy loss ranged from 7.9 to 86 (30.41 ± 16.93) mW/m, with a reference range of 8.31 ~ 80.36 mW/m. Mean kinetic energy in the left ventricular outflow tract over one cardiac cycle ranged from 200 to 851.6 (449.74 ± 177.51) mW/m with a reference range of 203.16 ~ 833.15 mW/m. The energetic performance index ranged from 5.3 to 37.6 (18.48 ± 7.74), with a reference range of 5.80 ~ 36.67. Conclusions Energy loss, kinetic energy, and energetic performance index reference values were defined using vector flow mapping. These reference values enable the assessment of various cardiac conditions in any clinical situation.
- Published
- 2017
41. Potential contribution of erythrocyte microRNA to secondary erythrocytosis and thrombocytopenia in congenital heart disease
- Author
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Toshihito Tanahashi, Natsuko Tokuhira, Yasufumi Nakajima, Sachiyo Ishii, Satoshi Murakami, Satoru Ogawa, Toshiki Mizobe, Teiji Sawa, Nobuhiro Mukai, Daniel I. Sessler, and Yoshinobu Nakayama
- Subjects
0301 basic medicine ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Erythrocytes ,Heart disease ,Heart Diseases ,Cellular differentiation ,Megakaryocyte differentiation ,Disease ,Polycythemia ,Gastroenterology ,03 medical and health sciences ,Megakaryocyte ,Internal medicine ,microRNA ,medicine ,Humans ,Hypoxia ,business.industry ,Infant, Newborn ,Infant ,medicine.disease ,Thrombocytopenia ,Haematopoiesis ,MicroRNAs ,030104 developmental biology ,Real-time polymerase chain reaction ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
BackgroundChildren with cyanotic heart disease develop secondary erythrocytosis and thrombocytopenia via unknown mechanisms. Mature erythrocyte microRNAs may reflect clinical pathologies and cell differentiation processes pre-enucleation. This study evaluated erythrocyte microRNAs in children with cyanotic heart disease.MethodsErythrocyte microRNAs from children with cyanotic and acyanotic heart disease and without cardiac disease were quantified with Ion PGM System (n=10 per group). Differential expression was confirmed by quantitative PCR (qPCR; n=20 per group).ResultsMir-486-3p, mir-486-5p, and mir-155-5p increased in patients with cyanotic heart disease compared with those without heart disease: fold differences (95% confidence interval): mir-486-3p: 1.92 (1.14-3.23), P=0.011; mir-486-5p: 2.27 (1.41-3.65), P
- Published
- 2017
42. Hyperglycaemia augments lipopolysaccharide-induced reduction in rat and human macrophage phagocytosis via the endoplasmic stress-C/EBP homologous protein pathway
- Author
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Sachiyo Ishii, Sachiko Maeda, J. Iida, Yasufumi Nakajima, Masayuki Shibasaki, Yoshinobu Nakayama, D. I. Sessler, N. Anada, K. Kageyama, H. Teramae, and Teiji Sawa
- Subjects
Adult ,Lipopolysaccharides ,Male ,Lipopolysaccharide ,Phagocytosis ,Inflammation ,CHOP ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,030202 anesthesiology ,Medicine ,Macrophage ,Animals ,Humans ,Rats, Wistar ,Cells, Cultured ,business.industry ,Endoplasmic reticulum ,Macrophages ,Transfection ,Endoplasmic Reticulum Stress ,Cell biology ,Rats ,Disease Models, Animal ,Anesthesiology and Pain Medicine ,chemistry ,Hyperglycemia ,medicine.symptom ,business ,Intracellular ,Transcription Factor CHOP ,Signal Transduction - Abstract
Background Macrophage phagocytosis constitutes an essential part of the host defence against microbes and the resolution of inflammation. Hyperglycaemia during sepsis is reported to reduce macrophage function, and thus, potentiate inflammatory deterioration. We investigated whether high-glucose concentrations augment lipopolysaccharide-induced reduction in macrophage phagocytosis via the endoplasmic stress-C/EBP homologous protein (CHOP) pathway using animal and laboratory investigations. Methods Peritoneal macrophages of artificially ventilated male Wistar rats, divided into four groups based on target blood glucose concentrations achieved by glucose administration with or without lipopolysaccharide, were obtained after 24 h. Human macrophages were also cultured in normal or high glucose with or without lipopolysaccharide exposure for 72 h. Changes in the phagocytic activity, intranuclear CHOP expression, and intracellular Akt phosphorylation status of macrophages were evaluated. These changes were also evaluated in human macrophages after genetic knock-down of CHOP by specific siRNA transfection or resolvin D2 treatment. Results Lipopolysaccharide impaired phagocytosis, increased intranuclear expression of CHOP, and inhibited Akt phosphorylation in both rat peritoneal and human macrophages. Hyperglycaemic glucose concentrations augmented these changes. Genetic knock-down of CHOP restored phagocytic ability and Akt phosphorylation in human macrophages. Furthermore, resolvin D2 co-incubation restored the inhibited phagocytosis and Akt phosphorylation along with the inhibition of intranuclear CHOP expression in human macrophages. Conclusions These findings imply that controlling endoplasmic reticulum stress might provide new strategies for restoring reduced macrophage phagocytosis in sepsis-induced hyperglycaemia.
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- 2017
43. Comparison of In-hospital Outcomes Between Transcatheter and Surgical Aortic Valve Replacement in Patients with Aortic Valve Stenosis: A Retrospective Cohort Study Using Administrative Data
- Author
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Yasufumi Nakajima, Yuichi Imanaka, Takahiko Kamibayashi, Susumu Kunisawa, Kiyohide Fushimi, and Takeshi Umegaki
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Aortic valve ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Acute care ,medicine ,Humans ,030212 general & internal medicine ,Hospital Mortality ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,valvular heart disease ,Retrospective cohort study ,Odds ratio ,Aortic Valve Stenosis ,medicine.disease ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Logistic Models ,Aortic valve stenosis ,Aortic Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The number of surgeries for valvular heart disease performed in Japan has greatly increased over the past decade, and surgical aortic valve replacements (SAVR) constitute the vast majority of aortic valve replacement procedures. Although transcatheter aortic valve implantation (TAVI) was recently introduced, studies have yet to compare the clinical outcomes between TAVI and SAVR in the Japanese healthcare setting. This study aimed to compare in-hospital outcomes between TAVI and SAVR using a multicenter administrative database.Retrospective cohort study.Acute care hospitals in Japan.A total of 16,775 patients diagnosed with aortic valve stenosis.None.The main study outcome measure was in-hospital mortality. Based on multiple logistic regression analysis using inverse probability of treatment weighting, the odds ratio of in-hospital mortality for TAVI (relative to SAVR) was calculated to be 0.36 (95% confidence intervals: 0.13-0.98; p = 0.04). In patients aged 80 years or older, the odds ratio was even lower at 0.34 (95% confidence intervals: 0.15-0.73; p0.01). In addition, the incidences of reoperations, hemorrhagic complications, cardiac tamponade, and postoperative infections were significantly higher in the SAVR patients.This large-scale multicenter comparative analysis of TAVI and SAVR in Japan indicated that TAVI produced better clinical outcomes in patients with aortic valve stenosis. The improved outcomes were particularly notable in patients aged 80 years or older.
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- 2017
44. Vector flow mapping analysis of left ventricular energetic performance in healthy adult volunteers
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Mao Kinoshita, Maki Ishii, Yasufumi Nakajima, Keiichi Itatani, Atsushi Kainuma, Teiji Sawa, Yoshifumi Naito, Koichi Akiyama, Sachiko Maeda, Saeko Hamaoka, Hideya Kato, Tasuku Matsuyama, and Naotoshi Nakamura
- Subjects
Flow visualization ,medicine.medical_specialty ,Cardiac cycle ,Vector flow ,business.industry ,Diastole ,Reference range ,030204 cardiovascular system & hematology ,Kinetic energy ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,Coronary circulation ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,Ventricular outflow tract ,Cardiology and Cardiovascular Medicine ,business - Abstract
Vector flow mapping, a novel flow visualization echocardiographic technology, is increasing in popularity. Energy loss reference values for children have been established using vector flow mapping, but those for adults have not yet been provided. We aimed to establish reference values in healthy adults for energy loss, kinetic energy in the left ventricular outflow tract, and the energetic performance index (defined as the ratio of kinetic energy to energy loss over one cardiac cycle). Transthoracic echocardiography was performed in fifty healthy volunteers, and the stored images were analyzed to calculate energy loss, kinetic energy, and energetic performance index and obtain ranges of reference values for these. Mean energy loss over one cardiac cycle ranged from 10.1 to 59.1 mW/m (mean ± SD, 27.53 ± 13.46 mW/m), with a reference range of 10.32 ~ 58.63 mW/m. Mean systolic energy loss ranged from 8.5 to 80.1 (23.52 ± 14.53) mW/m, with a reference range of 8.86 ~ 77.30 mW/m. Mean diastolic energy loss ranged from 7.9 to 86 (30.41 ± 16.93) mW/m, with a reference range of 8.31 ~ 80.36 mW/m. Mean kinetic energy in the left ventricular outflow tract over one cardiac cycle ranged from 200 to 851.6 (449.74 ± 177.51) mW/m with a reference range of 203.16 ~ 833.15 mW/m. The energetic performance index ranged from 5.3 to 37.6 (18.48 ± 7.74), with a reference range of 5.80 ~ 36.67. Energy loss, kinetic energy, and energetic performance index reference values were defined using vector flow mapping. These reference values enable the assessment of various cardiac conditions in any clinical situation.
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- 2017
45. Flow Energy Loss Evaluation in a Systolic Anterior Motion Case After the Ross Procedure
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Keiichi Itatani, Takako Miyazaki, Teiji Sawa, Koichi Akiyama, Mao Kinoshita, Masaaki Yamagishi, Hitoshi Yaku, Maki Ishii, Yasufumi Nakajima, and Yoshifumi Naito
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Male ,medicine.medical_specialty ,Energy loss ,medicine.medical_treatment ,Motion (geometry) ,030204 cardiovascular system & hematology ,01 natural sciences ,Transplantation, Autologous ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,0103 physical sciences ,medicine ,Humans ,010302 applied physics ,Heart Valve Prosthesis Implantation ,business.industry ,Ross procedure ,Aortic Valve Stenosis ,medicine.disease ,Anesthesiology and Pain Medicine ,Flow (mathematics) ,Aortic valve stenosis ,Child, Preschool ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity ,Echocardiography, Transesophageal - Published
- 2016
46. Temperature Management in Perioperative and Critically Ill Patients and Associated Patient Outcomes
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Yasufumi Nakajima
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medicine.medical_specialty ,Critically ill ,business.industry ,medicine ,Perioperative ,Intensive care medicine ,business - Published
- 2013
47. Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping
- Author
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Teiji Sawa, Yoshifumi Naito, Satoshi Numata, Koichi Akiyama, Masaru Shimizu, Naotoshi Nakamura, Mao Kinoshita, Hitoshi Yaku, Yasufumi Nakajima, Keiichi Itatani, Hideya Kato, Saeko Hamaoka, Toshiki Mizobe, and Hiroaki Yasumoto
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,030204 cardiovascular system & hematology ,Preoperative care ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Mitral valve annuloplasty ,Internal medicine ,Mitral valve ,Monitoring, Intraoperative ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Prospective Studies ,Cardiac Surgical Procedures ,Prospective cohort study ,Aged ,Mitral valve repair ,Vector flow ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,Surgery ,Vortex ,Echocardiography, Doppler, Color ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Blood Flow Velocity - Abstract
Objectives We assessed vortex patterns and energy loss in left ventricular flow in patients who underwent mitral valve repair or replacement with bioprosthetic valves. Methods Vector flow mapping was performed before and after the procedure in 15 and 17 patients who underwent repair and replacement, respectively. The preprocedure mitral-septal angle was measured in all patients. Relationships between vortex patterns or energy loss change (ELC) and annuloplasty ring or bioprosthetic valve sizes or the effect of mitral leaflet resection in the repair group were statistically analysed. Results Normal vortex patterns were observed in 13 and 1 patients who underwent repair and replacement, respectively. Abnormal vortex patterns were observed in 2 and 16 patients who underwent repair and replacement, respectively. ELC was significantly higher in the replacement group (196.6 ± 180.8) than in the repair group (71.9 ± 43.9). In the repair group, preoperative mitral-septal angles in patients with normal vortex patterns (79.2° ± 3.4°) were significantly larger than those in patients with abnormal vortex patterns (67.5° ± 3.5°). No significant differences were observed in the effects of annuloplasty ring and bioprosthetic valve sizes on vortex patterns and ELC, and in the effect of mitral valve resection (80.4 ± 56.3) and respect (without leaflet resection) (53.8 ± 28.4) on ELC in the repair group. Conclusions Mitral valve replacement alters the intraventricular vortex pattern and increases flow energy loss. A small mitral-septal angle is a risk factor for abnormal vortex patterns after mitral valve repair surgery.
- Published
- 2016
48. A Practical Training Program for Peripheral Radial Artery Catheterization in Adult Patients: A Prospective, Randomized Controlled Trial
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Yoshinobu, Nakayama, Yuko, Inagaki, Yasufumi, Nakajima, Daniel I, Sessler, Nobuhiro, Mukai, Satoru, Ogawa, Toshiki, Mizobe, and Teiji, Sawa
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Male ,Palpation ,Catheterization, Peripheral ,Radial Artery ,Humans ,Internship and Residency ,Female ,Clinical Competence ,Prospective Studies ,Middle Aged ,Ultrasonography, Interventional ,Anesthesiologists - Abstract
The main cause of unsuccessful peripheral radial artery catheterization using traditional palpation is imprecisely locating the arterial center. The authors evaluated factors causing disparities between the arterial centers determined by palpation versus ultrasound. The authors applied them to create and test a novel catheterization training program.The arterial central axis was determined by ultrasound and palpation in 350 adults. Potential independent predictors of disparity included sex, body mass index, pulse pressure, transverse arterial diameter, subcutaneous arterial depth, chronic hypertension, and experience as an anesthesiologist (less than 3 vs. greater than or equal to 3 yr). Using the results, the authors developed a radial artery catheterization training program. It was tested by enrolling 20 first-year interns, randomized to a training or control group. The time to successful insertion was the primary outcome measure. The success rate and time required for catheterization by palpation were evaluated in 100 adult patients per group.Independent predictors of central axis disparity were pulse pressure, subcutaneous radial artery depth, years of experience, and chronic hypertension. Training improved the catheterization time (training group 56 ± 2 s vs. control group 109 ± 2 s; difference -53 ± 3 s; 95% CI, -70 to -36 s; P0.0001) and total success rate (training group 83 of 100 attempts, 83%; 95% CI, 75 to 90 vs. control group 57 of 100, 57%; 95% CI, 47 to 66; odds ratio, 3.7; 95% CI, 2.7 to 5.1).Misjudging the central axis position of the radial artery is common with a weak pulse and/or deep artery. The authors' program, which focused on both these issues, shortened the time for palpation-guided catheterization and improved success.
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- 2016
49. Comparison of Methods for Estimating Optimal Pediatric Endotracheal Tube Depth
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Nobuaki Shime, Sachiyo Ishii, Toshiki Mizobe, Masayuki Shibasaki, Yasufumi Nakajima, and Teiji Sawa
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business.industry ,Anesthesia ,Medicine ,business ,Endotracheal tube - Published
- 2012
50. Anesthetic Management of a Patient with Thoracic Spine Tumor by One-Lung Ventilation in the Prone Position
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Kazuhiro Awai, Kyoko Kageyama, Yosuke Yamaguchi, Satoru Hashimoto, and Yasufumi Nakajima
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medicine.medical_specialty ,Prone position ,business.industry ,Thoracic spine ,Anesthesia ,medicine ,Anesthetic management ,business ,One lung ventilation ,Surgery - Abstract
腹臥位下に分離肺換気を行った胸椎腫瘍摘出術の麻酔を経験した.分離肺換気時の低換気,低酸素血症の対策として,4点支持フレームの除圧枕を使用し肺胸郭コンプライアンスを維持,頭部は三点支持固定とし分離肺換気操作が行いやすいようワーキングスペースを確保した.片肺換気時,非換気側肺のシャント血流残存効果による動脈血酸素飽和度(SpO2)の低下を認めたが,非換気側肺に持続陽圧呼吸(continuous positive airway pressure:CPAP)を行うことにより酸素化を維持した.腹臥位分離肺換気の呼吸生理を理解し,低酸素性肺血管収縮反応についての対策を考えた麻酔管理を行うことが必要である.
- Published
- 2011
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