Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Oxygenator exchange during extracorporeal membrane oxygenation (ECMO) is a life-threatening procedure. D-dimer has been used to predict oxygenator failure, but it is a parameter used a few days before oxygenator exchange. This study investigated parameters before and immediately after ECMO initiation that predict oxygenator exchange. METHODS: This was a single-center, retrospective study of 28 patients who received veno-venous ECMO with heparin/silicone-coated polypropylene oxygenator (NSH-R HPO-23WH-C; Senko Medical Inc., Tokyo, Japan), due to acute respiratory failure, from April 2015 to March 2020. Clinical data before ECMO initiation and during the first 3 days on ECMO were compared between the patients with oxygenator exchange (exchange group) and those without oxygenator exchange (non-exchange group). RESULTS: Nine (32%) patients required oxygenator exchange. The exchange group had significantly higher white blood cell count (WBC) (16,944 ± 2423/µL vs 10,342 ± 1442/µL, p < 0.05) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (31 ± 5 vs 25 ± 8, p < 0.05) before ECMO initiation than the non-exchange group. The partial pressure of oxygen at the outlet of the oxygenator (PO2 outlet) and activated partial thromboplastin time (aPTT) during the first 3 days on ECMO were significantly lower in the exchange group than in the non-exchange group. CONCLUSIONS: High WBC and APACHE II score before ECMO initiation, low PO2 outlet, and aPTT during the first 3 days on ECMO were associated with oxygenator exchange during veno-venous ECMO. These parameters could be used to avoid unexpected oxygenator exchange.

DOI： 10.1177/03913988221118382

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Language：Japanese   Publisher：日本結核・非結核性抗酸菌症学会関東支部学会・日本呼吸器学会関東地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

The successful use of prolonged (ie, >28 days) veno-venous extracorporeal membrane oxygenation (V-V ECMO) is being increasingly reported. However, limited data are available on its outcomes. This study investigated the outcomes of acute respiratory distress syndrome (ARDS) patients on prolonged ECMO support. We retrospectively evaluated 57 patients requiring V-V ECMO for ARDS between 2015 and 2020. The patients were divided into two groups according to ECMO duration: (a) ≤28 days group (n = 43, 75%) or (b) >28 days (n = 14, 25%) group. Clinical characteristics, complications, and outcomes between these two groups were statistically compared. There were no significant differences in demographics, comorbidity, ARDS etiology, and severity scores between the two groups. However, the mechanical ventilation period before ECMO initiation was significantly longer in the >28 days group than in the ≤28 days group (10.5 days vs. 1 day; P < .05). The incidence of positive bacterial blood culture results during ECMO was significantly higher in the >28 days group than in the ≤28 days group (43% vs. 9%; P < .05). Additionally, the hospital survival rate was significantly lower in the >28 days group than in the ≤28 days ECMO group (21% vs. 60%; P < .05). Prolonged ECMO was associated with worse hospital survival outcomes. Early initiation of ECMO along with meticulous care and appropriate treatment against infection during ECMO could improve the hospital survival of ARDS patients on prolonged ECMO support.

DOI： 10.1111/aor.14051

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Language：English  

DOI： 10.1093/omcr/omab103

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Language：English   Publishing type：Research paper (scientific journal)  

Intravascular lymphoma is a rare disease that progresses to multiple organ dysfunction caused primarily by tumor cell proliferation in small blood vessels. Few studies have investigated critical care management of intravascular lymphoma. We describe a rare case of multiple organ failure due to intravascular lymphoma with severe lactic acidosis in a patient who survived. A 64-year-old man with impaired consciousness was diagnosed as having intravascular large B-cell lymphoma by means of a random skin biopsy. The patient arrived at our hospital's intensive care unit (ICU) with impaired consciousness, respiratory failure that required mechanical ventilation, and lactic acidosis that required renal replacement therapy. Mechanical ventilation and renal replacement therapy were continued in the ICU, and his respiratory status and circulatory dynamics eventually stabilized. However, his impaired consciousness and hyperlactatemia did not improve until after the start of chemotherapy with doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab. Although he developed tumor lysis syndrome immediately after chemotherapy, his systemic condition was gradually stabilized by continued critical care management primarily comprising renal replacement therapy. He was weaned from ventilator support after a tracheotomy and moved to the general ward. Hematopoietic malignancy with hyperlactatemia has a very poor prognosis; however, hyperlactatemia and impaired consciousness were dramatically improved in this patient by critical care management and chemotherapy.

DOI： 10.1272/jnms.JNMS.2019_86-606

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Intraoperative neuromonitoring (IONM) might reduce the incidence of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy. Although dislocation of endotracheal tube surface electrodes can lead to false-positive IONM results (loss of signal), the risk factors for dislocation and the effects of muscle relaxants are unclear. Therefore, to identify factors that affect IONM results, we examined the frequency and risk factors for tube dislocation after cervical extension before surgery, the effect of sugammadex administration, and the correlation between IONM results and postoperative RLN palsy. METHODS: Thirty-nine patients scheduled for thyroidectomy from October 2016 to April 2017 were enrolled. All patients underwent standard IONM and pre- and postoperative laryngoscopy. Differences in patient characteristics in the tube dislocation group and non-dislocation group, and differences in amplitude during vagal stimulation before and after sugammadex administration, were assessed by the Mann-Whitney test or Fisher's exact test. RESULTS: Tube dislocation occurred in 27 patients (69%). Sterno-cricoid distance was significantly shorter in the dislocation group (n=27) than in the non-dislocation group (n=12) (43.88 [32.2-55.91] mm vs 49.46 [40.66-55.91] mm, respectively; p=0.048). Without sugammadex, amplitude during vagal stimulation was sufficient for monitoring. Nine patients had new-onset RLN palsy, which was transient in all patients. The sensitivity of IONM was 100%, the positive predictive value was 60%, and the negative predictive value was 100%. CONCLUSIONS: The present findings suggest that anesthesiologists should use video laryngoscopy to correct tube dislocation and that a rocuronium dose of 0.6 mg/kg, without sugammadex, is adequate for IONM.

DOI： 10.1272/jnms.JNMS.2019_86-408

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We elaborated the rat hippocampi in order to assess for central nervous system changes following a peripheral neuropathic injury. DESIGN, SETTING, SUBJECTS: We examined the gene changes in the hippocampi of chronic constriction injury (CCI) rats with TaqMan® low-density array analysis (TLDA) and quantitative real-time polymerase chain reaction (qRT-PCR) of miR-125b, -132, and messenger RNAs (mRNAs) of neuropeptide Y, brain-derived neural factor, N-methyl-D-aspartate glutamate 2A receptor, gamma-aminobutyric acid A a1 receptor, gamma-aminobutyric acid A b1 receptor, gamma-aminobutyric acid B b2 receptor, serotonin 1A receptor, serotonin 2A receptor, serotonin 2C receptor, and serotonin 3A receptor on days 0, 7, and 15 after surgery. INTERVENTIONS: None. OUTCOME MEASURES: Two behavioral tests (thermal and mechanical stimulation tests) were performed three times at 5-minute intervals to assess pain thresholds. MicroRNA (miRNA) changes were examined by TLDA. mRNA changes were examined by qRT-PCR. Statistical significance was determined by Tukey-Kramer's method and paired t-test. RESULTS: All rats showed mechanical and thermal hypersensitivity on the ipsilateral side. Out of 373 miRNAs analyzed, 237 were expressed, and 51 changed their expressions after CCI. By TLDA, cluster analysis found obvious miRNA changes on day 7 that tended to recover by day 15. For miR-125b, the relative expression decreased to 0.70 ± 0.30 at day 7 and recovered to 1.65 ± 0.19 at day 15. The miR-132 relative expressions were 0.69 ± 0.30 and 0.70 ± 0.15, respectively. The mRNA changes followed the miRNA changes. CONCLUSIONS: Our results showed that the peripheral nerve injury altered rat hippocampal miRNA.

DOI： 10.1111/pme.12066

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Language：English   Publishing type：Research paper (scientific journal)  

Elucidation of the mechanisms underlying neuropathic pain is expected to aid in the discovery and selection of effective therapeutic methods. Currently, microRNA (miRNA) is thought to play an important role in the development and maintenance of the nervous system. We, therefore, hypothesized that miRNAs are involved in neuropathic pain, and investigated this possibility by analyzing miRNA expression in the dorsal horn of the spinal cord in a chronic constriction injury (CCI) rat model using the TaqMan® Low Density Array (TLDA). Neuropathic pain model rats were produced by CCI induced by ligation of the sciatic nerve. The miRNA expression in the dorsal horn of the spinal cord was analyzed in Day 0 rats, with no sciatic nerve ligation or sham operation, Day 7 rats, examined 7 days after sciatic nerve ligation or sham operation, and Day 14 rats, examined 14 days after sciatic nerve ligation or sham operation using TLDA. In this study, 111 miRNAs were significantly regulated in CCI rats in both the Day 7 and Day 14 groups compared with sham rats in both groups. Of these 111, there were 75 miRNAs (67.6%) that had been analyzed in previous reports and 36 miRNAs (32.4%) related to the development of tumors of the nervous system and neurodegenerative diseases. Certain miRNAs were reported to be related to neuropathic pain; miR-500, -221 and -21. The expression levels of a large number of miRNAs in the dorsal horn of the spinal cord in CCI rats changed. These results provide a step toward elucidation of the mechanisms underlying neuropathic pain.

DOI： 10.3892/ijmm.2012.1163

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In previous studies, the authors showed that anesthetics affect the expression ratios of many genes in rat liver. microRNAs (miRNA) negatively regulate more than 30% of genes in cells, and control cell proliferation, inflammation, and metabolism. The authors hypothesized that anesthetics influence miRNA expression in the liver, and performed miRNA screening tests using TaqMan low-density arrays. METHODS: Rats were randomly assigned to the 2.4% sevoflurane group, the 600 µg·kg⁻¹·min⁻¹ propofol group, and the control group without anesthetics. Rats were allowed to breathe spontaneously under anesthesia for 6 h. The miRNA expression profile of the liver was analyzed, and 15 representative miRNAs were validated by quantitative real-time reverse transcriptase polymerase chain reaction. RESULTS: TaqMan low-density arrays analysis showed 46 miRNAs that were differentially expressed by anesthetics. After sevoflurane treatment, 16 miRNAs were significantly increased and 11 were significantly decreased compared with controls, whereas after propofol treatment, 31 miRNAs were increased and 8 were decreased. Twenty expressed miRNAs were common to both anesthetics, whereas three miRNAs were differentially expressed. Bland-Altman analysis was performed across the validations to compare the fold changes measured by both methods, and they were equivalent (mean difference=0.01, 95% CI=-0.26 to 0.27). This showed that the TaqMan low-density arrays results are accurate and can be confirmed using an independent experimental approach. CONCLUSION: The results showed that anesthetics cause many miRNA expression changes, and the miRNA expression pattern was particular for each anesthetic. Further studies are needed to determine the functional consequence of miRNA modulation by anesthetics.

DOI： 10.1097/ALN.0b013e3182746676

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Language：English   Publishing type：Research paper (scientific journal)  

Reportedly, a large number of microRNAs (miRNAs) play an important role in inflammatory lung diseases such as asthma, idiopathic pulmonary fibrosis (IPF), acute respiratory distress syndrome (ARDS), and pulmonary arterial hypertension (PAH). Sevoflurane is routinely used to various patients, and its safety has been confirmed by clinical outcomes; however, its effects to lungs at the miRNA level have not been elucidated. In our previous genomic studies, we showed that sevoflurane anesthesia affected the expression of many genes and mRNAs in rat lungs. In this study, we comprehensively investigated changes in miRNA expression caused by sevoflurane anesthesia (2.0% and 4.0%). Sevoflurane anesthesia resulted in apparent changes in miRNA expression in rat lungs, and the pattern of 2.0% sevoflurane-induced changes in miRNA expression was similar to that of 4.0% sevoflurane. Some of the differentially expressed miRNAs are known to be involved in asthma, IPF, and PAH. Especially, miR-146a, the most up-regulated miRNA, is known to attenuate the toxic effects associated with LPS stimulation. We showed, for the first time, dynamic changes in miRNA expression caused by sevoflurane anesthesia, and moreover, our results were important to understand the influence of sevoflurane anesthesia on any patients suffered from various lung diseases.

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Language：Japanese   Publisher：(一社)日本呼吸療法医学会  

重症呼吸不全に対する呼吸ECMO(extracorporeal membrane oxygenation)患者へのリハビリテーションと多職種介入のエビデンスは限られる。症例1:20代男性。肺炎、急性呼吸促迫症候群(acute respiratory distress syndrome:ARDS)に対するECMO導入後にカタレプシー症状を認め、早期の多職種によるメンタルケアを行った。ICU退室時には四肢筋力低下や易疲労もあったが、リハビリテーションを継続し退院時には日常生活動作(activities of daily living:ADL)自立まで改善した。症例2:7歳男児。インフルエンザを契機とした喘息発作のためエアリーク症候群となりECMO導入。その後呼吸状態は改善しECMO離脱したが、母親の不安が強く児の活動も乏しかった。リハビリテーションと臨床心理士の介入により母親の不安は改善、児の活動も拡大し学校生活に復帰できた。結論:ECMO管理中より社会復帰に至るまでシームレスなリハビリテーションと多職種介入が重要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本呼吸療法医学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

J-GLOBAL

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本小児感染症学会  

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Language：Japanese   Publisher：日本小児感染症学会  

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

＜文献概要＞出血性ショックは,循環血液量減少性ショックの一形態であり,重度の失血により,細胞レベルにおける酸素供給が不十分になる。出血への対応が遅れると,早々に生命の危機に瀕することになる。

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Language：Japanese   Publisher：(株)メディカル・サイエンス・インターナショナル  

＜文献概要＞出血性ショックは,循環血液量減少性ショックの一形態であり,重度の失血により,細胞レベルにおける酸素供給が不十分になる。出血への対応が遅れると,早々に生命の危機に瀕することになる。

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本急性血液浄化学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：(一社)日本ペインクリニック学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：日本循環制御医学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：日本臨床麻酔学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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