記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Superior/middle cluneal nerve entrapment (CN-E) is an elicitor of low back pain (LBP). The painDETECT questionnaire is used to characterize CN-E symptoms. METHODS: Nineteen consecutive patients with LBP caused by CN-E (superior CN-E = 7; middle CN-E = 12) participated in a Japanese language painDETECT questionnaire survey before surgery. A score of 12 or lower was recorded as 'neuropathic component unlikely', a score of 19 or higher as 'neuropathic pain likely', and scores between 13 and 18 as 'neuropathic pain possible'. LBP severity was recorded on a numerical rating scale, the Roland-Morris Disability Questionnaire, and the EuroQol-5 dimension-5 level. RESULTS: The mean painDETECT score was 11.8 and did not significantly differ between the superior CN-E and middle CN-E groups. We classified low back pain as unlikely to have a neuropathic component in 13 patients, as likely to have a neuropathic component in 2 patients, and as possibly neuropathic in 4 patients. There was no significant difference in the pain level of patients with scores of ≤12 and ≥13 on painDETECT. All patients reported trigger pain; the positive rate was high for electric shock pain, radiating pain, and pain attacks and low for a burning or tingling sensation, pain elicited by a light touch, and pain caused by cold or hot stimulation. CONCLUSION: The painDETECT questionnaire may not reliably identify LBP caused by superior/middle CN-E as neuropathic pain. A diagnosis of LBP due to CN-E must be made carefully because symptoms resemble nociceptive pain.

DOI： 10.1272/jnms.JNMS.2024_91-312

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy of the posterior tibial nerve. Surgery can be performed less invasively under local anesthesia. We adopted zig-zag skin incision to prevent postoperative wound complications. METHODS: Between July 2022 and June 2023, we operated on 19 legs of 14 consecutive TTS patients (5 males, 11 females; average age 73.3 years). We made a 2- to 3-cm zig-zag skin incision on the tarsal tunnel. After posterior tibial nerve decompression by posterior tibial artery (PTA) transposition, the subcutaneous layer was tightly sutured with 4-0 PDS and the skin was closed with Dermabond Advanced. We investigated adverse events that developed during the first 30 postoperative days and recorded surgical outcomes at the final visit. RESULTS: In all patients the nerves were successfully decompressed with PTA transposition. There were no intraoperative complications. During the 30 postoperative days there were no adverse events, including wound complications, and patients' symptoms improved significantly. CONCLUSION: Zig-zag skin incision was easy and convenient for surgical TTS treatment and may be useful for preventing postoperative wound complications.

DOI： 10.1272/jnms.JNMS.2024_91-404

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Persistent primitive olfactory arteries (PPOAs) are a rare variant of the anterior cerebral artery (ACA). Cerebral aneurysms may arise in the PPOA; most are saccular and on the unilateral PPOA. We report a 66-year-old male with bilateral PPOAs and a fusiform aneurysm on the left side detected at a health check-up. A brain magnetic resonance imaging (MRI) scan revealed a fusiform dilation in the proximal portion of the left ACA on a brain MRI. Good surgical results were obtained by combining trapping-and bonnet bypass surgery. Brain MRI and cerebral angiograms showed bilateral PPOAs and a fusiform aneurysm with the pearl-and-string sign in the proximal portion of the left PPOA. The aneurysm was trapped and a bonnet bypass using a radial artery (RA) graft was placed between the left superficial temporal artery and the distal portion of the left PPOA. The postoperative course was uneventful and 30 months after surgery he had no neurological symptoms; MRA showed no recurrence. In this patient, aneurysmal trapping and an A3-A3 bypass were an option, however, it would have placed an additional load on the right PPOA. Our decision to trap the aneurysm and perform bonnet bypass surgery using an RA graft led to success.

DOI： 10.2176/jns-nmc.2024-0156

PubMed

researchmap

掲載種別：研究論文（学術雑誌）  

with dabigatran and underwent reversal therapy with idarucizumab. The items examined included patient background, neurological and imaging findings at arrival, course after admission, complications, and outcomes. A total of 23 patients were enrolled in the study. The patients had a mean age of 78.9 years. Cause of TBI was fall in 60.9% of the subjects. Mean Glasgow Coma Scale score at arrival was 8.7; anisocoria was present in 31.8% of cases. Exacerbation of consciousness was found in 30.4%, but only in 13.3% of subjects treated with idarucizumab before consciousness and imaging findings worsened. Dabigatran was discontinued in 81.8% of cases after hematoma development, with a mean withdrawal period of 12.1 days. The favorable outcome rate was 21.7%, and mortality was 39.1%. In multi-variate analysis, timing of idarucizumab administration was associated with a favorable outcome. There were ischemic complications in 3 cases (13.1%), and all three events occurred ‡7 days after administration of idarucizumab. These findings suggest that in cases that develop hematoma during treatment with dabigatran, it is important to administer idarucizumab early and restart dabigatran after conditions stabilize.

DOI： 10.1089/neur.2023.0065

Scopus

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

症例は48歳女性で、前日からの頭痛を主訴とした。頭部CTでくも膜下出血を脳底槽からシルビウス裂に認め、やや左優位であった。脳血管撮影では右内頸動脈・左内頸動脈・左中大脳動脈・左前大脳動脈に多発脳動脈瘤を認めた。造影MRIによるvessel wall imagingで破裂瘤は右内頸動脈前壁動脈瘤の可能性が高いと判断し、同日開頭クリッピング術を行ったが、術中破裂所見は認めず動脈瘤を切除した。翌日に左側開頭クリッピング術を行い、左前大脳動脈瘤を破裂瘤と判断し、中内脳動脈瘤と左内頸動脈瘤もクリッピングした。初回手術7日後に脳血管撮影にて各動脈瘤の消失を確認し、遺残した高次脳機能障害のリハビリテーション目的に第76病日に転院した。切除した右内頸動脈瘤の病理所見では脳動脈瘤壁に炎症細胞の浸潤および毛細血管の増生を認め、造影された原因と考えられた。

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10143-023-02139-5

researchmap

その他リンク： https://link.springer.com/article/10.1007/s10143-023-02139-5/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Internal carotid artery (ICA) ligation for placing a high-flow extracranial-intracranial (EC-IC) bypass is used in patients with aneurysms on the cavernous portion of the ICA. Recanalization and rupture after proximal ICA ligation can occur. We present four patients who underwent endovascular distal ICA occlusion and report our surgical technique and treatment results. We ligated the ICA to place an EC-IC bypass using a radial artery (RA) graft. Failure to obtain spontaneous occlusion in the distal region required endovascular treatment an average of 219 days later. A guide catheter was placed in the common carotid artery, a guide or distal access catheter was introduced in the RA graft from the external carotid artery, and a microcatheter was navigated into the cavernous aneurysm through the RA graft. Using detachable coils, endovascular ICA occlusion was from just distal to the aneurysmal neck to a site proximal to the origin of the ophthalmic artery. Aneurysmal occlusion was completed by endovascular occlusion of the distal ICA. Complications were RA graft stenosis and transient consciousness disturbance due to local subarachnoid hemorrhage. Outpatient follow-up for a mean of 109.5 months revealed no recurrences. Distal occlusion of the ICA through the implanted RA graft is simple and presents a low risk for cerebral infarction due to thrombus formation during the procedure. To treat cavernous carotid aneurysms that do not disappear after placing the EC-IC bypass after ICA ligation at the aneurysmal neck, we offer our procedure as a treatment option.

DOI： 10.2176/jns-nmc.2022-0303

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Posterior inferior cerebellar artery (PICA) infarction can lead to ischemic stroke at the lateral part of the medullary oblongata. PICA dissection can also elicit an ischemic event in this region but its detection on radiological images is difficult due to the small diameter of the vessel. We report a 48-year-old male with Wallenberg syndrome due to PICA dissection, which was difficult to diagnose on first admission. He reported sudden-onset sensory disturbance on the right side of his face, ataxic gait, and headache. Brain magnetic resonance imaging (MRI) revealed a fresh cerebral infarct in the right lateral medulla oblongata. Serial MRI and magnetic resonance angiography (MRA) performed at the time of his admission failed to demonstrate cerebral vessel abnormalities. MRI study performed 18 months after the attack revealed a fusiform aneurysm on the lateral medullary segment of the PICA; its site was extremely close to the cerebral infarct. We concluded that the infarct was due to PICA dissection because it was sudden onset of the symptom at the event and the lesion enlarged dissecting aneurysm located to be coincident with symptoms of Wallenberg syndrome. The aneurysm was trapped, and an occipital artery-PICA bypass was placed. At the latest follow-up, one year after the operation, he manifested no neurological symptoms.Imaging findings at the time of his first admission indicated that the PICA was intact in this patient with Wallenberg syndrome attributable to PICA dissection, which obscured on imaging studies performed at symptom onset and was diagnosed later. However,18 months later, MRI revealed enlargement of an aneurysm at the site of the dissection. A cerebral infarct in the PICA territory in patients with headache may be indicative of PICA dissection.

DOI： 10.1272/jnms.JNMS.2024_91-101

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Placing an extracranial-intracranial (EC-IC) high-flow bypass using a radial artery (RA) graft plus internal carotid artery (ICA) trapping or ligation is an option for treating patients expected to be at high risk for complications by direct surgical treatment of the ICA. We focused on the anastomosis between the external carotid artery (ECA) and the RA graft in the cervical region and present adverse events and salvage procedures. METHODS: EC-IC high-flow bypass procedures using an RA graft were performed to treat 87 consecutive patients. The ECA diameter at the midpoint of the planned ECA-RA anastomosis and the non-branched length of the ECA were measured on preoperative angiograms. To study adverse events related to ECA-RA anastomoses, we reviewed the patients' surgical records and intraoperative videos. RESULTS: In 11 patients (12.6%) we encountered adverse events during anastomosis between the ECA and RA. The rate of ECA dissection was significantly higher in male patients (4 of 17; 23.5%) than female patients (3 of 70; 4.3%) (P = 0.012). Logistic regression analysis revealed that male sex, individuals with diabetes mellitus, and patients whose non-branching length of the ECA was short (16.1 ± 6.7 mm) were at high risk of ECA problems. We set the cutoff point at 17.5 mm (the area under the receiver operator characteristic curve was 0.72). CONCLUSIONS: Our findings indicate that patients, especially male patients, treated by EC-IC high-flow bypass using an RA graft are at increased risk for adverse events when the ECA length at the site of the planned anastomosis is shorter than 17.5 mm.

DOI： 10.1016/j.wneu.2022.04.061

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The ring finger protein 213 (RNF213) susceptibility gene has been detected in more than 80% of Japanese and Korean patients with moyamoya disease (MMD), a bilateral internal carotid artery (ICA) occlusion. Furthermore, RNF213 has been detected in more than 20% of East Asians with atherosclerotic ICA stenosis. In this study, we evaluated the frequency of RNF213 mutations in congenital occlusive lesions of the ICA system. This case series was conducted jointly at four university hospitals. Patients with a family history of MMD, quasi-MMD, or related diseases were excluded. Ten patients were diagnosed with abnormal ICA or middle cerebral artery (MCA) angiogenesis. Patients with neurofibromatosis were excluded. Finally, nine patients with congenital vascular abnormalities were selected; of these, five had ICA deficiency and four had twig-like MCA. The RNF213 c.14576G > A mutation was absent in all patients. Therefore, the RNF213 c.14576G > A mutation may not be associated with ICA and MCA congenital dysplasia-rare vascular anomalies making it difficult to study a large number of cases. However, an accumulation of cases is required for accurate determination. The results of this study may help differentiate congenital vascular diseases from MMD.

DOI： 10.1038/s41598-021-01623-6

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A mutation in RNF213 (c.14576G>A), a gene associated with moyamoya disease (>80%), plays a role in terminal internal carotid artery (ICA) stenosis (>15%) (ICS). Studies on RNF213 and cerebral aneurysms (AN), which did not focus on the site of origin or morphology, could not elucidate the relationship between the two. However, a report suggested a relationship between RNF213 and AN in French-Canadians. Here, we investigated the relationship between ICA saccular aneurysm (ICA-AN) and RNF213. We analyzed RNF213 expression in subjects with ICA-AN and atherosclerotic ICS. Cases with a family history of moyamoya disease were excluded. AN smaller than 4 mm were confirmed as AN only by surgical or angiographic findings. RNF213 was detected in 12.2% of patients with ICA-AN and 13.6% of patients with ICS; patients with ICA-AN and ICS had a similar risk of RNF213 mutation expression (odds ratio, 0.884; 95% confidence interval, 0.199-3.91; p = 0.871). The relationship between ICA-AN and RNF213 (c.14576G>A) was not correlated with the location of the ICA and bifurcation, presence of rupture, or multiplicity. When the etiology and location of AN were more restricted, the incidence of RNF213 mutations in ICA-AN was higher than that reported in previous studies. Our results suggest that strict maternal vessel selection and pathological selection of AN morphology may reveal an association between genetic mutations and ICA-AN development. The results of this study may form a basis for further research on systemic vascular diseases, in which the RNF213 (c.14576G>A) mutation has been implicated.

DOI： 10.3390/genes12101468

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To examine the relationship between trap location and cerebral infarction in the anterior choroidal artery (AChA) region and associated risks in ruptured internal carotid artery blood blister-like aneurysm (BLA) treatment with high-flow bypass and lesion trapping. METHODS: We included 26 patients diagnosed with BLAs and treated with high-flow bypass and trapping. We examined clinical characteristics including age, aneurysm trap location, final prognosis, cerebral infarction on postoperative magnetic resonance imaging, and modified Rankin Scale score at discharge. We also searched the literature for similar studies. RESULTS: The modified Rankin Scale score at discharge was 0-2 in 20 patients, 3-5 in 2 patients, and 6 in 2 patients. In 19/26 patients (73.1%), the trapped segment was between the posterior communicating (PcomA) and the ophthalmic arteries. In 2 patients (7.7%), the trapped segment included the PcomA and the AChA; in 4 patients (15.4%), the trapped segment was within the PcomA. In these patients, the PcomA was occluded, and blood from the high-flow bypass flowed out to the AChA alone. No patient showed cerebral infarction. Our systematic review identified 70 patients. Of all 96 patients, 12 had AChA cerebral infarction; however, the infarction affected the prognosis of only 2 patients. CONCLUSIONS: When treating BLAs with high-flow bypass and lesion trapping, the frequency of AChA cerebral infarction is low even when the PcomA is occluded, leaving the AChA as the only outflow vessel during high-flow bypass. However, PcomA occlusion may be associated with risks when treating patients with advanced arteriosclerosis near C1-2.

DOI： 10.1016/j.wneu.2021.06.084

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Scholar  

<sec id="st1">
<title>Background: </title>
Extracranial carotid artery aneurysms are rare. Surgery may be difficult when vessels are tortuous and on a high cervical level. We report two patients whose tortuous extracranial internal carotid artery (ICA) aneurysm located on a high cervical level was successfully treated by ICA ligation and a high-flow bypass using a radial artery (RA) graft between the external carotid- and the middle cerebral artery.


</sec>
<sec id="st2">
<title>Case Description: </title>
(Case 1) A 47-year-old man suffered a recurrent cerebral infarct despite medical treatment. His right extracranial ICA aneurysm measured 33 mm; it was tortuous and located at a high cervical level. We ligated the ICA after placing a high-flow bypass using an RA graft. The aneurysm was not repaired. (Case 2) A 59-year-old woman noticed pulsatile swelling on her left neck. It was due to an extracranial ICA aneurysm that was large (36 mm), tortuous, and located at a high cervical level. We performed ICA ligation after placing a high-flow bypass using an RA graft without direct aneurysmal repair. Six months after the operation she noted a pulsatile bulge on the left oropharynx. We confirmed recurrence of an aneurysm from retrograde blood flow and performed internal trapping by occluding the distal portion of the ICA aneurysm using an intravascular procedure.


</sec>
<sec id="st3">
<title>Conclusion: </title>
ICA ligation after placing a high-flow bypass with an RA-graft is a technically demanding, but safe procedure to address extracranial ICA aneurysms that are tortuous and located at a high cervical level.


</sec>

DOI： 10.25259/sni_408_2021

PubMed

researchmap

その他リンク： http://surgicalneurologyint.com/surgicalint-articles/high-flow-bypass-surgery-using-a-radial-artery-graft-for-an-extracranial-internal-carotid-artery-aneurysm-case-reports-and-literature-review/

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: There have been reports on postoperative ischemic complications with vascular reconstructive surgery. However, various factors, such as lesions, operative technique, and perioperative treatment, prevent analyzing the causes of ischemic complications in vascular reconstruction surgeries. In the present study, we analyzed the cause of ischemic complications for vascular reconstruction surgeries with the same operator, surgical procedure, and perioperative treatment and without focusing on the lesions. PATIENTS AND METHODS: We retrospectively reviewed 66 patients, including 24 aneurysm cases and 42 ischemic disease cases, between 2008 and 2018. The patient group comprised 35 males and 31 females, and the patient mean age was 63.3 (23-87) years. We investigated the postoperative presence of symptomatic and asymptomatic cerebral ischemia on MRIDWI performed within 4 postoperative days. We conducted a statistical analysis of the ischemic complications and clinical and treatment factors. RESULTS: Symptomatic cerebral ischemia was detected in 3 cases, whereas asymptomatic ischemic findings were identified in 8 cases. All cases of symptomatic cerebral ischemia involved cerebral aneurysms. Results of a univariate analysis revealed an association between symptomatic cerebral ischemia and preoperative antithrombotic therapy (OR, 0.07; p =  0.049 (95 %CI; 0.007-0.8794)), clipping (OR, 4.8; p =  0.0501 (95 %CI; 1.641-342.9)), and aneurysm (OR, 14.16; p =  0.0423 (95 %CI; 0.6991-286.9)). Significant associations were found between asymptomatic cerebral ischemia and preoperative antithrombotic therapy [OR, 0.2941; p =  0.0514 (95 %CI; 0.08335-1.038)], aneurysms [OR, 7.8; p =  0.0146 (95 %CI; 1.414-43.04)] and radial artery grafts (RAGs) [OR, 6.8; p =  0.0192 (95 %CI; 1.410-32.98)]. Multivariate analysis identified clipping [OR, 5.462; p =  0.045 (95 %CI; 1.01-78.25] and preoperative antithrombotic therapy [OR, 0.187; p =  0.037 (95 %CI; 0.004-0.813)] as the risk factors for symptomatic cerebral ischemia. Further, a correlation was found between asymptomatic cerebral ischemia and RAGs [OR, 9.244; p =  0.00013 (95 %CI; 2.34-29.44)]. CONCLUSION: Ischemic complications associated with combined vascular reconstruction surgeries for cerebral aneurysms are possibly associated with procedures related to aneurysmal occlusions. Thus, vascular reconstruction surgeries can be performed relatively safely. Further, preoperative antithrombotic treatment should be considered, and caution is required for asymptomatic cerebral ischemia in RAG cases.

DOI： 10.1016/j.clineuro.2020.105768

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Cerebral vasospasm is associated with poor prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH), and biomarkers for predicting poor prognosis have not yet been established. We attempted to clarify the relationship between serum glucose/potassium ratio and cerebral vasospasm in patients with aneurysmal SAH. METHODS: We studied 333 of 535 aneurysmal SAH patients treated between 2006 and 2016 (123 males, 210 females; mean age 59.7 years; range 24-93). We retrospectively analyzed the relationship between cerebral vasospasm grade and clinical risk factors, including serum glucose/potassium ratio. RESULTS: Postoperative angiography revealed cerebral vasospasm in 112 patients (33.6%). Significant correlations existed between the ischemic complication due to cerebral vasospasm and glucose/potassium ratio (P < .0001), glucose (P = .016), and potassium (P = .0017). Serum glucose/potassium ratio was elevated in the cerebral vasospasm grade dependent manner (Spearman's r = 0.1207, P = .0279). According to the Glasgow Outcome Scale (GOS) score at discharge, 185 patients (55.5%) had a poor outcome (GOS scores 1-3). Serum glucose/potassium ratio was significantly correlated between poor outcome (GOS scores 1-3) and age (P < .0001), serum glucose/potassium ratio (P < .0001), glucose (P < .0001), potassium (P = .0004), white blood cell count (P = .0012), and cerebral infarction due to cerebral vasospasm (P < .0001). Multivariate logistic regression analyzes showed significant correlations between cerebral infarction due to cerebral vasospasm and serum glucose/potassium ratio (P = .018), glucose (P = .027), and potassium (P = .052). CONCLUSIONS: Serum glucose/potassium ratio in cases of aneurysmal SAH was significantly associated with cerebral infarction due to cerebral vasospasm and GOS at discharge. Therefore, this factor was useful to predict prognosis in patients with cerebral vasospasm and aneurysmal SAH.

DOI： 10.1016/j.jstrokecerebrovasdis.2019.03.041

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳卒中の外科学会  

橈骨動脈(RA)グラフトの基本手技と連続10症例の結果を報告した。基本手技は浅側頭動脈中大脳動脈(STA-MCA)吻合術を併用したexternal carotid artery(ECA)-RA-M2 bypassで、STA-MCA吻合術はassistとしてよりも灌流圧のモニタリングとして重視している。グラフトの皮下通しでは皮下トンネル作成用のchest tubeに通した糸とクリップに結んだ糸を結紮し引き込むことでグラフトのねじれを防止した。頸部での血管吻合の際にはECA-RA吻合前にRAのねじれをとり、切断は外頸動脈のarteriotomy終了後とし、未破裂例の予定手術では術前から抗血小板剤を用いた。10症例の術後MRIでは症候性虚血性合併症はみられず、術前症候が認められた9例中7例は1ヵ月以内に症状が改善した。

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02079&link_issn=&doc_id=20190524130002&doc_link_id=%2Fcp4strok%2F2019%2F004701%2F002%2F0006-0011%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp4strok%2F2019%2F004701%2F002%2F0006-0011%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (SAH) can result in poor outcomes, and biomarkers for predicting poor prognosis have not yet been established. The aim of this study was to clarify the significance of the serum glucose/potassium ratio for predicting the prognosis of aneurysmal SAH. METHODS: The authors retrospectively reviewed the records of 565 patients with aneurysmal SAH between 2006 and 2016. The patient group comprised 208 men and 357 women (mean age 61.5 years, range 10-95 years). A statistical analysis was conducted of the clinical and laboratory risk factors of poor outcome, including the serum glucose/potassium ratio. RESULTS: On estimation of the initial assessment using Hunt and Kosnik (H-K) grading, 233 patients (41.2%) were classified as the severe SAH group (H-K Grade IV or V). There were significant correlations between the severe SAH group and serum glucose/potassium ratio (p < 0.0001). Serum glucose/potassium ratio was elevated in an H-K grade-dependent manner (Spearman's r = 0.5374, p < 0.0001). With the estimation of the Glasgow Outcome Scale (GOS) score at discharge, 355 patients (62.8%) were classified as poor outcome (GOS score 1-3). The serum glucose/potassium ratio was elevated in a GOS score at discharge-dependent manner (Spearman's r = 0.4006, p < 0.0001), and was significantly elevated in the poor outcome group compared with the good outcome group (GOS score 4 or 5; p = 0.0245). There were significant correlations between poor outcome and serum glucose/potassium ratio (p < 0.0001), age (p < 0.0001), brain natriuretic peptide levels (p = 0.011), cerebral infarction due to vasospasm (p < 0.0001), and H-K grade (p < 0.0001). Multivariate logistic regression analyses showed significant correlations between poor outcome and serum glucose/potassium ratio (p = 0.009). CONCLUSIONS: In this study, the serum glucose/potassium ratio of patients with aneurysmal SAH at admission was significantly correlated with H-K grade and GOS score at discharge. Therefore, this ratio was useful for predicting prognosis of aneurysmal SAH, especially in severe cases.

DOI： 10.3171/2017.5.JNS162799

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

脳血行再建術には様々な術式がある。我々は、1995年より上山博康先生に脳血行再建術と脳神経外科手術の基本をご指導いただき、その実際と我々の応用を報告してきた。この20年間にJET Study、JAM trialも行われ、STA-MCA吻合術における虚血性合併症防止の重要性が指摘されている。実際、COSSでは虚血性合併症の多さが指摘された。STA-MCA吻合術を中心に、我々が励行している血管吻合術における様々な虚血性合併症を予防するため手技を提示する。当院で行われた動脈硬化性虚血性病変に対するSTA-MCA吻合術における虚血性合併症を予防するための手術手技の要点を提示し、実際の虚血性合併症を検討する。その要点として、*血管、脳溝の剥離操作におけるlayerの可視化の重要性、*Donorの捻じれとSpasmの防止を目的としたliquid angioplastyによる、temporary clipとヘパリン加生食での血管拡張維持、*血管内血栓形成予防のための血流を残した血管遮断法、*吻合血管のpatency確認法の実際などについてのべる。また、ICGとFLOW 800を用いてdonorの早期描出とrecipientの両方向への血流を繰り返し確認することの重要性と実際の方法を提示する。当院で行われたSTA-MCA吻合術では症候性虚血性合併症は見られなかった。最新式の上山式とは異なるかもしれないが、基本概念に大きな変化はないと考えている。上山先生から学んだ、"神の手"でなく、"人の手"で安全な手術を行うための手技を提示する。(著者抄録)

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03385&link_issn=&doc_id=20180122270001&doc_link_id=%2Fce6nokyu%2F2017%2F002202%2F001%2F0085-0092%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fce6nokyu%2F2017%2F002202%2F001%2F0085-0092%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Large or giant internal carotid artery (ICA) aneurysms often cause visual deficits and cranial nerve palsy. The aim of this study was to investigate the efficacy of ligation of the ICA with high-flow bypass. METHODS: We retrospectively analyzed the findings from patients with visual deficit and ophthalmologic symptoms due to ICA aneurysms. In addition, we analyzed the recovery factors associated with the visual deficit and ophthalmologic symptoms postoperatively, focusing on the type of cranial nerve palsy, aneurysm size, location, and the time to treatment from first symptoms. RESULTS: We identified 38 patients (35 women, 3 men) with a mean age at surgery of 63.6 years (range, 24-81 years) with visual and ophthalmologic symptoms due to large or giant internal carotid aneurysm. Aneurysms ranged in size from 15-50 mm (mean, 25.2 mm). Visual disturbance (7 cases, 18%) and ophthalmoplegia (31 cases, 82%) were the only preoperative cranial nerve palsies. Aneurysms were completely thrombosed in 94.7% of cases (36/38). Visual disturbance improved in 28.5% of cases (2/7), and ophthalmoplegia improved in 87.1% of cases (27/31). Time to therapy from developing a visual disturbance was longer than time to therapy from developing ophthalmoplegia (P = 0.001). Time to therapy was significantly associated with recovery from cranial nerve palsy (P < 0.0001). The recovery of visual disturbance was worse than that of ophthalmoplegia (P = 0.001). CONCLUSION: Early treatment is recommended when the visual and ophthalmologic symptoms are present because treatment delay is a risk factor for nonimprovement of symptoms.

DOI： 10.1016/j.wneu.2016.10.082

PubMed

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

In neurosurgical procedures, avoiding damage of surrounding tissues such as muscle and periosteum during a craniotomy is important for esthetic and other reasons. We devised a protection tool by using an amputated syringe barrel to cover the perforating drill and protect temporal muscle damage. This device made it possible to prevent damage to surrounding tissues, such as the muscle and periosteum, during cranial perforation. This method could be useful as it is cost-effective, simple, and versatile.

DOI： 10.1016/j.wneu.2016.01.001

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Confirming the patency of the proximal parent and distal artery is necessary in cerebral aneurysm surgery. To understand the relationship between the parent and distal arteries of the aneurysm, the blood vessels running through the subarachnoid space should be extensively dissected, which is time consuming. To examine the efficacy of a temporary clip with indocyanine green (ICG) technique, in which the parent artery is temporarily occluded using a temporary clip, an ICG videoangiography (ICGVAG) is performed to clarify the relationship between the distal artery and the proximal parent artery. Three patients with a distal aneurysm. This technique was used to confirm the connection of the parent and the distal artery in distal aneurysms. With regard to middle cerebral artery (MCA), the procedure is conducted as follows. First, the M2 within the Sylvian fissure is investigated to ensure the absence of atherosclerosis and perforators and that this vessel could undergo occlusion by temporary clipping. The subarachnoid space surrounding the distal artery of the lesion site suspected of an existent aneurysm is dissected. The image range of the ICGVAG is set sufficiently wide to accommodate the possibility that the distal artery is not the artery that was anticipated. Subsequently, after the temporary clip occlusion is completed, the ICGVAG is recorded. In the three distal aneurysms, the relationship between the aneurysm, the distal artery, and the parent artery was confirmed. This method was useful, suggesting that unnecessary dissection in the subarachnoid space might be reduced.

DOI： 10.2176/nmc.tn.2013-0249

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：Hindawi Publishing Corporation  

Gremlin is an antagonist of bone morphogenetic protein (BMP) and a major driving force in skeletal modeling in the fetal stage. Several recent reports have shown that Gremlin is also involved in angiogenesis of lung cancer and diabetic retinopathy. The purpose of this study was to investigate the role of Gremlin in tumor angiogenesis in pituitary adenoma. Double fluorescence immunohistochemistry of Gremlin and CD34 was performed in pituitary adenoma tissues obtained during transsphenoidal surgery in 45 cases (7 PRLoma, 17 GHoma, 2 ACTHoma, and 2 TSHoma). Gremlin and microvascular density (MVD) were detected by double-immunofluorescence microscopy in CD34-positive vessels from tissue microarray analysis of 60 cases of pituitary adenomas (6 PRLoma, 23 GHoma, 22 NFoma, 5 ACTHoma, and 4 TSHoma). In tissue microarray analysis, MVD was significantly correlated with an increased Gremlin level (linear regression:<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.005,</mml:mn></mml:math>  <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>r</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup><mml:mo>=</mml:mo><mml:mn>0.4958</mml:mn></mml:math>). In contrast, Gremlin expression showed no correlation with tumor subtype or Knosp score. The high level of expression of Gremlin in pituitary adenoma tissue with many CD34-positive vessels and the strong coherence of these regions indicate that Gremlin is associated with angiogenesis in pituitary adenoma cells.

DOI： 10.1155/2015/834137

researchmap

その他リンク： http://downloads.hindawi.com/journals/ije/2015/834137.xml

DOI： 10.2176/nmccrj.2013-0318

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECT: To understand the relationship between the parent artery and its distal arteries, blood vessels running through the subarachnoid space need to be extensively dissected, which is time-consuming. We examined the efficacy of temporary clipping with the indocyanine green (ICG) technique (target-controlled infusion (TCI) technique), in which the parent artery is occluded using a temporary clip, and ICGV (videoangiography) is performed to clarify the relationship between the distal M4 and proximal M2. METHODS: Thirteen radial artery grafts (RAGs) for internal carotid aneurysm underwent TCI to confirm the relationship between M2 and cortical M4. To monitor the perfusion pressure of the cortical middle cerebral artery, superficial temporal artery (STA) to M4 anastomosis was performed before RA-M2 anastomosis. We performed anastomosis of the recipient of STA- M4 that was distal and downstream of the M2 segment that is the recipient of RA-M2 anastomosis. To select the proper recipient M4 of the STA-M4 anastomosis, the ICGV image range was set sufficiently wide to accommodate the possibility that the distal artery was not the one anticipated. ICGV followed complete occlusion by temporary clipping of the recipient M2. RESULTS: In 2 of the 13 cases, the relationship between the M2 and M4 could not be clarified. CONCLUSIONS: In cases with developed collateral circulation or small perfusion area of the occluded M2, it was difficult to ascertain the relationship by TCI. Nevertheless, TCI was useful in 11 of the 13 cases, suggesting that unnecessary dissection in the subarachnoid space may be reduced using this technique.

DOI： 10.1016/j.clineuro.2014.01.015

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.clineuro.2013.05.022

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECT: Only a few studies have reported the risk of ischemic complications occurring when superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is performed during surgery for complex MCA aneurysms. SUBJECTS AND METHODS: This is a retrospective study of 10 patients (age 52-73) with MCA aneurysms treated with revascularization surgery. The aneurysms were 10-50mm in size (mean: 21mm). We studied the causes and frequency of ischemic complications by analyzing postoperative magnetic resonance imaging. RESULTS: Postoperative diffusion-imaging confirmed ischemic complications in six of the 10 patients (in two of the five ruptured aneurysms and in four of the five unruptured). The ischemic complications that observed were infarction of the lenticulostriate artery territory in three cases, cortical infarction in two cases, and cerebral infarction that was likely to be due to cerebral vasospasm in one case. In one case, both cortical infarction and infarction of the lenticulostriate artery territory were observed. The Glasgow Outcome Scale (GOS) scores at the time of discharge indicated good recovery (GR) and moderate disability (MD) in seven cases, severe disability (SD) in two cases, and death (D) in one case. CONCLUSIONS: The present study suggests the possibility that STA-MCA anastamosis in surgeries for MCA aneurysms can be performed with comparatively better safety. However, the temporary occlusion time with this surgery is longer than that with a temporary clipping for aneurysmal surgery; thus, we believe that adequate countermeasures are required to prevent ischemic complications.

DOI： 10.1016/j.clineuro.2012.08.007

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We aim to present and discuss clinical outcomes of preoperative liquid embolization of hemangioblastomas (HB) using N-butyl cyanoacrylate (NBCA). METHODS: From 1999 through 2010, 19 patients presenting with symptoms of vertigo and/or headaches were diagnosed with HB based on preoperative magnetic resonance imaging and cerebral angiographic findings at our institution. Preoperative embolization with NBCA was performed on tumors in 10 of 21 operations for 19 patients. For each of these patients, the lesion was pathologically confirmed as HB. RESULTS: Embolization had a favorable outcome in all patients. No permanent neurological complications were observed after preoperative embolization using NBCA. However, thalamic infarction and minor hemorrhage were observed in two patients with cerebellar HB. CONCLUSION: The authors recommend NBCA as an embolization material for large cerebellar HB.

DOI： 10.1007/s00234-011-0985-5

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of the present study was to assess a new technique of surgical microscope-based indocyanine green (ICG) videoangiography (VAG) to confirm the patency of the anterior communicating artery (AcomA) after clipping AcomA aneurysms. METHODS: Aneurysmal clipping of five cases of unruptured, broad-neck AcomA aneurysm was performed using the Carl Zeiss Surgical Microscope OPMI Pentero INFRARED 800. RESULTS: In all five patients, after clipping AcomA aneurysms, the patency of AcomA was confirmed using ICGVAG findings and temporary unilateral occlusion of the A1 segment of the anterior cerebral artery using temporary clips. Images were excellent and enabled a real-time surgical assessment because the structures of interest, including vessels, perforating arteries, or residual aneurysm neck, were visible to the surgeon's eye under the microscope in all five patients. CONCLUSIONS: ICGVAG and temporary unilateral occlusion with clips provides a simple, reliable, real-time, and rapid intraoperative assessment of the patency of AcomA. This technique may help to improve the quality of neurosurgical procedures.

DOI： 10.1016/j.wneu.2011.03.044

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The intraoperative findings of an indocyanine green videoangiography (ICG-VAG) study of a cavernous angioma located in the optic chiasm are reported. A 23-year-old Japanese man suddenly developed visual field loss, and magnetic resonance imaging suggested the presence of a suprasellar tumor in contact with the optic chiasm. Preoperative angiography did not clearly show any tumor shadow. Right fronto-temporal craniotomy was performed, and an aggregation of blood vessels was seen on the right surface of the optic chiasm. Cavernous angioma was suspected. ICG-VAG was begun 22 seconds after the beginning of contrast agent infusion via a peripheral blood vessel. The lesion remained unstained, although the brain surface, an artery superior to the optic nerve, and veins were visualized. The cavernous angioma was resected following surface coagulation. ICG-VAG is currently being evaluated for future application in the differential diagnosis based on imaging findings, and the present case provides an important example of intraoperative ICG-VAG imaging of an unoperated cavernous angioma.

PubMed

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Congress of Neurological Surgeons  

OBJECT: The aim of the present study is to assess whether a new technique of surgical microscope-based indocyanine green (ICG) videoangiography (VAG) to assess cortical blood flow is suitable for intraoperative confirmation of successful aneurysm clipping. CASE REPORT: We used a Carl Zeiss Surgical Microscope OPMI® Pentero INFRARED 800 and FLOW 800 system (Carl Zeiss Co., Tokyo, Japan), in the case of a 61-year-old woman with an unruptured left middle cerebral artery aneurysm. FLOW 800 is a new tool to analyze video data subsequent its acquisition with ICGVAG. Images were excellent and enabled a real-time surgical assessment if the structures of interest were visible to the surgeon's eye under the microscope, including vessels, perforating arteries, or residual aneurysm neck. Blood flow intensity data were revealed relative to alterations in fluorescence intensity. CONCLUSIONS: ICGVAG and the FLOW 800 system provide simple, reliable, real-time and rapid intraoperative assessment of relative cortical perfusion. This technique may help to improve the quality of neurosurgical procedures.

DOI： 10.7887/jcns.18.839

Scopus

researchmap

記述言語：日本語   出版者・発行元：(一社)日本医療安全学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

掲載種別：速報，短報，研究ノート等（学術雑誌）  

DOI： 10.3171/2018.3.JNS18510

Scopus

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

36歳。妊娠40週時に心窩部痛を主訴として近医産婦人科を受診し、HELLP症候群と診断され、ターミネーションのため帝王切開を施行された。分娩後1～2時間経過した時点で意識レベルがJCS III-300に低下し、軽度の痙攣があった。痙攣頓挫後も意識障害が遷延したため、精査加療目的で当院へ搬送された。頭部CTで左尾状核頭に出血を認め、脳室ドレナージを施行した。第2病日の頭部CTで脳室内血腫の大半が残存していたため、第3病日にウロキナーゼ60000単位で脳室洗浄を行ったところ、その後のCTで血腫はほぼ消失しているのが確認された。意識障害が遷延したため第10病日に気管切開を行い、最終的にGCS(E4VTM5)10、mRS4の状態で第15病日に回復期リハ病院へ転院となった。救命できた要因として、開頭術を要さずに侵襲度の低い脳室ドレナージのみで脳圧コントロールが可能であったことと、発症後早期に診断できたことが考えられた。

researchmap

記述言語：日本語   出版者・発行元：(一社)日本臨床救急医学会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：日本救急医学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本脳神経外科救急学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳卒中学会  

【目的】Merci Retriever適応基準を満たすwake-up ischemic stroke(WUIS)例について、急性期血栓回収術応用の可能性について検討した。【方法】2009年1月より2010年12月に入院した心原性脳塞栓症158例を対象としてWUISの発症比率、頭蓋内主要血管閉塞症例のDWI-ASPECTSを評価した。【結果】28症例(17.7%)がWUISであった。DWI-ASPECTSは発症2時間以内搬送群、2-8時間搬送群、WUIS群の3群間で有意差はなかった。WUIS群には血行再建術の適応となり得るDWI-ASPECTS高スコアで、当施設の使用適応基準を満たす例が5例存在した。実際にMerci Retrieverを使用したWUIS2例の予後は良好であった。【結論】WUIS患者においても適切な患者選択をすれば脳血管内治療の有効性が期待できることが示唆された。(著者抄録)

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J01786&link_issn=&doc_id=20120731030003&doc_link_id=%2Fdh3strok%2F2012%2F003404%2F003%2F0228-0234%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdh3strok%2F2012%2F003404%2F003%2F0228-0234%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

researchmap

記述言語：日本語   出版者・発行元：日本医科大学医学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(NPO)日本レーザー医学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

61歳女。尿崩症をきたし、原因検索のために行ったMRIでラトケ嚢胞と左中大脳動脈瘤を指摘された。まず経鼻内視鏡的にラトケ嚢胞の手術を行い、その後、左中大脳動脈瘤のクリッピングを行うこととなった。左pterional approachで通常の前頭側頭開頭を行い、Carl Zeiss社手術用顕微鏡OPMI Penteroの下でシルビウス裂を開放し、中大脳動脈のM1からM3の全貌を露出しクリッピングに備えた。動脈瘤の残存血流、末梢血管、末梢血管領域の脳表の輝度を観察した。脳表、動脈瘤の単位時間当たりの輝度変化を相対的かつ経時的に評価することにより、正常な脳表血流と動脈瘤の不完全閉塞による血流残存が明瞭に評価でいた。OPMI Penteroは、簡便な相対的経時的輝度変化評価法としてきわめて有用と思われた。

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J02632&link_issn=&doc_id=20091112350007&doc_link_id=10.7887%2Fjcns.18.839&url=https%3A%2F%2Fdoi.org%2F10.7887%2Fjcns.18.839&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01160&link_issn=&doc_id=20091030430016&doc_link_id=10.1507%2Fendocrine.85.Supplement-2_39&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.85.Supplement-2_39&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

researchmap

記述言語：英語   会議種別：口頭発表（一般）  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：英語   会議種別：ポスター発表  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap

記述言語：日本語   会議種別：口頭発表（一般）  

researchmap