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Kaga T, Inaba S, Shikano Y, Watanabe Y, Fujisawa T, Akazawa Y, Ohshita M, Kawakami H, Higashi H, Aono J, Nagai T, Islam MZ, Wannous M, Sakata M, Yamamoto K, Furukawa TA, Yamaguchi O. Utility of RAND/UCLA appropriateness method in validating multiple-choice questions on ECG. BMC Med Educ 2024; 24:448. [PMID: 38658906 PMCID: PMC11044544 DOI: 10.1186/s12909-024-05446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study aimed to investigate the utility of the RAND/UCLA appropriateness method (RAM) in validating expert consensus-based multiple-choice questions (MCQs) on electrocardiogram (ECG). METHODS According to the RAM user's manual, nine panelists comprising various experts who routinely handle ECGs were asked to reach a consensus in three phases: a preparatory phase (round 0), an online test phase (round 1), and a face-to-face expert panel meeting (round 2). In round 0, the objectives and future timeline of the study were elucidated to the nine expert panelists with a summary of relevant literature. In round 1, 100 ECG questions prepared by two skilled cardiologists were answered, and the success rate was calculated by dividing the number of correct answers by 9. Furthermore, the questions were stratified into "Appropriate," "Discussion," or "Inappropriate" according to the median score and interquartile range (IQR) of appropriateness rating by nine panelists. In round 2, the validity of the 100 ECG questions was discussed in an expert panel meeting according to the results of round 1 and finally reassessed as "Appropriate," "Candidate," "Revision," and "Defer." RESULTS In round 1 results, the average success rate of the nine experts was 0.89. Using the median score and IQR, 54 questions were classified as " Discussion." In the expert panel meeting in round 2, 23% of the original 100 questions was ultimately deemed inappropriate, although they had been prepared by two skilled cardiologists. Most of the 46 questions categorized as "Appropriate" using the median score and IQR in round 1 were considered "Appropriate" even after round 2 (44/46, 95.7%). CONCLUSIONS The use of the median score and IQR allowed for a more objective determination of question validity. The RAM may help select appropriate questions, contributing to the preparation of higher-quality tests.
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Affiliation(s)
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan.
| | - Yukari Shikano
- Ehime University Graduate School of Medicine, Toon, Japan
| | | | - Tomoki Fujisawa
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Yusuke Akazawa
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Jun Aono
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Mohammad Zahidul Islam
- Department of Information Communication Technology ICT Division, Government of Bangladesh, Dhaka, Bangladesh
| | - Muhammad Wannous
- Department of Computer Information Science, Higher Colleges of Technology, Abu Dhabi, UAE
| | - Masatsugu Sakata
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazumichi Yamamoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Institute for Airway Disease, Hyogo, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
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Matsumoto H, Annen S, Mukai N, Ohshita M, Murata S, Harima Y, Ogawa S, Okita M, Nakabayashi Y, Kikuchi S, Takeba J, Sato N. Circulating Syndecan-1 Levels Are Associated with Chronological Coagulofibrinolytic Responses and the Development of Disseminated Intravascular Coagulation (DIC) after Trauma: A Retrospective Observational Study. J Clin Med 2023; 12:4386. [PMID: 37445421 DOI: 10.3390/jcm12134386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the association between endotheliopathy represented by high levels of circulating syndecan-1 (SDC-1) and coagulofibrinolytic responses due to trauma, which can lead to disseminated intravascular coagulation (DIC). METHODS We retrospectively evaluated 48 eligible trauma patients immediately admitted to our hospital and assessed SDC-1 and coagulofibrinolytic parameters for 7 days after admission. We compared the longitudinal changes of coagulofibrinolytic parameters and SDC-1 levels between two groups (high and low SDC-1) according to median SDC-1 value on admission. RESULTS The median circulating SDC-1 level was 99.6 (61.1-214.3) ng/mL on admission, and levels remained high until 7 days after admission. Coagulofibrinolytic responses assessed by biomarkers immediately after trauma were correlated with SDC-1 elevation (thrombin-antithrombin complex, TAT: r = 0.352, p = 0.001; antithrombin, AT: r = -0.301, p < 0.001; plasmin-α2-plasmin inhibitor complex, PIC: r = 0.503, p = 0.035; tissue plasminogen activator, tPA: r = 0.630, p < 0.001). Sustained SDC-1 elevation was associated with intense and prolonged coagulation activation, impairment of anticoagulation, and fibrinolytic activation followed by inhibition of fibrinolysis, which are the primary responses associated with development of DIC in the acute phase of trauma. Elevation of circulating SDC-1 level was also associated with consumption coagulopathy and the need for transfusion, which revealed a significant association between high SDC-1 levels and the development of DIC after trauma (area under the curve, AUC = 0.845, cut-off value = 130.38 ng/mL, p = 0.001). CONCLUSIONS High circulating levels of syndecan-1 were associated with intense and prolonged coagulation activation, impairment of anticoagulation, fibrinolytic activation, and consumption coagulopathy after trauma. Endotheliopathy represented by SDC-1 elevation was associated with trauma induced coagulopathy, which can lead to the development of DIC.
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Affiliation(s)
- Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Naoki Mukai
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Yutaka Harima
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Shirou Ogawa
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Mitsuo Okita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Yuki Nakabayashi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Ehime University, Toon 791-0295, Ehime, Japan
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Matsumoto H, Kikuchi S, Murata S, Ohshita M, Harima Y, Annen S, Mukai N, Nakabayashi Y, Ogawa S, Okita M, Takeba J, Sato N. Dynamic coagulofibrinolytic responses under long-term VV-ECMO management without anticoagulation in a COVID-19-ARDS patient: A case report. Medicine (Baltimore) 2023; 102:e32817. [PMID: 36705388 PMCID: PMC9875986 DOI: 10.1097/md.0000000000032817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Venovenous extracorporeal membrane oxygenation (ECMO) is recommended for the treatment of critically ill patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19). However, ECMO management can cause both bleeding and thrombotic complications. There are insufficient coagulofibrinolytic data for appropriate ECMO management in patients with COVID-19. PATIENT CONCERNS A 48-year-old man with severe COVID-19-acute respiratory distress syndrome underwent long-term venovenous ECMO management for 48 days. Refractory oronasal bleeding developed on day 13, so the administration of unfractionated heparin was ceased for 29 days. DIAGNOSIS The patient showed dynamic coagulofibrinolytic responses associated with ECMO management, as shown by fibrin/fibrinogen degradation products, soluble fibrin, thrombin-antithrombin complex, and plasmin-α2-plasmin inhibitor complex elevations, suggesting the development of ECMO-induced coagulopathy. INTERVENTIONS We assessed coagulofibrinolytic markers to decide the appropriate timing for controlling excessive activation of coagulation by exchanging ECMO circuits. Moreover, viscoelastic hemostatic assays were used for adequate transfusion of blood products. OUTCOMES Safe long-term ECMO management was completed, which was withdrawn on day 48. The patient was weaned off mechanical ventilation on day 57 and was transferred to another hospital for rehabilitation. LESSONS Monitoring the coagulofibrinolytic status using markers and viscoelastic hemostatic assays may be effective for safe long-term ECMO management even without anticoagulant therapy.
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Affiliation(s)
- Hironori Matsumoto
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
- * Correspondence: Hironori Matsumoto, Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Shitsukawa 454, Toon City, Ehime 791-0295, Japan (e-mail: )
| | - Satoshi Kikuchi
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Satoru Murata
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Muneaki Ohshita
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Yutaka Harima
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Suguru Annen
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Naoki Mukai
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Yuki Nakabayashi
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Shirou Ogawa
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Mitsuo Okita
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Jun Takeba
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
| | - Norio Sato
- Ehime University, Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Toon City, Ehime, Japan
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Mukai N, Okada M, Konishi S, Okita M, Ogawa S, Nishikawa K, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Aibara S, Sei H, Aoishi K, Asayama R, Sato E, Takagi T, Tanaka-Nishikubo K, Teraoka M, Hato N, Takeba J, Sato N. Cricotracheostomy for patients with severe COVID-19: A case control study. Front Surg 2023; 10:1082699. [PMID: 36733889 PMCID: PMC9888534 DOI: 10.3389/fsurg.2023.1082699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Background Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients. Materials and methods Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation. Results Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04). Conclusions These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.
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Affiliation(s)
- Naoki Mukai
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan,Correspondence: Masahiro Okada
| | - Saki Konishi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mitsuo Okita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Siro Ogawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kosuke Nishikawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan,Department of Bone and Joint Surgery, Ehime University School of Medicine, Toon, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yutaka Harima
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shiori Aibara
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kaori Tanaka-Nishikubo
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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Aibara S, Okada M, Tanaka‐Nishikubo K, Asayama R, Sato E, Sei H, Aoishi K, Takagi T, Teraoka M, Mukai N, Konishi S, Okita M, Ogawa S, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Takeba J, Sato N, Hato N. Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019. Laryngoscope Investig Otolaryngol 2022; 7:1909-1914. [PMID: 36544958 PMCID: PMC9764797 DOI: 10.1002/lio2.874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/13/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Laryngeal complications have been reported after endotracheal intubation and prone positioning in patients with critical coronavirus disease 2019 (COVID-19), but their association is unclear. In this study, we investigated the rate of laryngeal complications in patients with COVID-19 compared to an alternative condition (control group). Methods We retrospectively analyzed the data of 40 patients who underwent endotracheal intubation for either COVID-19 or an alternative condition (control group). Data on age, sex, body mass index (BMI), cardiovascular disease (CVD) risk factors, use of prone therapy, duration of endotracheal intubation, and duration from extubation/tracheostomy to laryngeal evaluation were collected from medical records. Results There were no significant differences in BMI, frequency of CVD risk factors, duration of endotracheal intubation, or duration from extubation/tracheostomy to laryngeal evaluation between the two groups. In the COVID-19 group, all patients adopted the prone position. In comparison, only one patient in the control group adopted the prone position. Significant differences were observed between the two groups regarding the incidence of vocal fold immobility and laryngeal granuloma. Conclusion Laryngeal complications were more common in the COVID-19 group than in the control group. Prone positioning may be a risk factor for these complications. Level of Evidence 4.
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Affiliation(s)
- Shiori Aibara
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Kaori Tanaka‐Nishikubo
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
| | - Naoki Mukai
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Saki Konishi
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Mitsuo Okita
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Siro Ogawa
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Suguru Annen
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Satoru Murata
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Yutaka Harima
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Jun Takeba
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Norio Sato
- Department of Emergency and Critical Care MedicineEhime University Graduate School of MedicineToonJapan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck SurgeryEhime University Graduate School of MedicineToonJapan
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Matsumoto H, Takeba J, Umakoshi K, Kikuchi S, Ohshita M, Annen S, Moriyama N, Nakabayashi Y, Sato N, Aibiki M. ADAMTS13 activity decreases in the early phase of trauma associated with coagulopathy and systemic inflammation: a prospective observational study. Thromb J 2021; 19:17. [PMID: 33712048 PMCID: PMC7953673 DOI: 10.1186/s12959-021-00270-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 03/03/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We conducted a prospective observational study for investigating the changes in the 13th member of a disintegrin-like and metalloprotease with thrombospondin type 1 motif (ADAMTS13) and its association with the coagulofibrinolytic response in adult trauma patients. METHODS In 39 trauma patients hospitalized for longer than 7 days, time-course changes in biomarkers of coagulofibrinolysis and systemic inflammation along with ADAMTS13 activity were examined. The patients were stratified into three groups based on ADAMTS13 activities on admission (day 0): normal group (≥70%), mildly decreased group (≥50 and < 70%) and moderately decreased group (< 50%). RESULTS Among 39 patients with a median Injury Severity Score (ISS) of 20, 11 patients developed disseminated intravascular coagulation (DIC) and 16 patients required transfusion. Six of 39 patients (15.4%) showed moderate decreased ADAMTS13 activity to < 50%, and 20 patients (51.3%) showed mild drops (≥50 and < 70%). These changes in ADAMTS13 activity on day 0 were significantly correlated with changes in IL-6 and other coagulofibrinolytic markers such as platelet counts, prothrombin time and fibrin/fibrinogen degradation product (FDP). Antithrombin activity (AT) and serum albumin (Alb) level showed significantly positive linear correlations with ADAMTS13 activity (AT: r = 0.513, p < 0.001; Alb: r = 0.647, p < 0.001). Simple logistic regression analyses showed that ADAMTS13 activity, if less than 50%, was significantly correlated with the development of DIC (OR 7.499, 95%CI 1.121-49.242, p = 0.038) and the need for transfusion of fresh frozen plasma (OR 9.000, 95%CI 1.327-61.025, p = 0.028). CONCLUSIONS ADAMTS13 activity decreased even in the early phase of trauma, which was complicated by coagulopathy and systemic inflammation. Furthermore, the decrease in ADAMTS13 activity was correlated with DIC and plasma transfusion.
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Affiliation(s)
- Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan.
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Kensuke Umakoshi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Naoki Moriyama
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Yuki Nakabayashi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
| | - Mayuki Aibiki
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime, 791-0295, Japan
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7
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Matsumoto H, Takeba J, Umakoshi K, Nakabayashi Y, Moriyama N, Annen S, Ohshita M, Kikuchi S, Sato N, Aibiki M. Successful treatment for disseminated intravascular coagulation (DIC) corresponding to phenotype changes in a heat stroke patient. J Intensive Care 2019; 7:2. [PMID: 30675362 PMCID: PMC6332900 DOI: 10.1186/s40560-019-0359-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heat stroke induces coagulofibrinolytic activation, which leads to life-threatening disseminated intravascular coagulation (DIC). However, treatment strategies for DIC in heat stroke have not yet been established, and also, the time course changes in coagulofibrinolytic markers have not been thoroughly evaluated. We report a severe heat stroke case with DIC who was eventually saved by anti-DIC treatments in accordance with changes in coagulofibrinolytic markers. CASE PRESENTATION A 45-year-old man was found unconscious outside, and his body temperature was elevated to 41.9 °C. For heat stroke, we performed an immediate tracheal intubation under the general anesthesia along with cooling by iced gastric lavage, cold fluid administration, and an intravascular cooling using Thermogard™. About 4 h after admission, his core temperature fell to 37 °C. We assessed coagulofibrinolytic biomarkers and treated in accordance with changes in these parameters. This case exhibited a biphasic change varying from an enhanced to a suppressed fibrinolytic type of DIC depending on the relative balance between fibrinolytic activation and the level of plasminogen activator inhibitor-1 (PAI-1). In the early phase with consumption coagulopathy and enhanced fibrinolysis, we transfused a large amount of fresh frozen plasma (FFP) and platelets with tranexamic acid, an antifibrinolytic agent, possibly providing relief for the bleeding tendency. Anticoagulant therapy using recombinant human thrombomodulin-α (rh-TM-α) and antithrombin III (ATIII) concentrate was especially effective for DIC with a suppressed fibrinolytic phenotype in the later phase, after which organ failure that included severe hepatic failure was remarkably improved. CONCLUSION The present case may indicate the clinical significance of monitoring coagulifibrinolytic changes and the potential benefits of anticoagulants for heat stroke-induced DIC.
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Affiliation(s)
- Hironori Matsumoto
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Jun Takeba
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Kensuke Umakoshi
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Yuki Nakabayashi
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Naoki Moriyama
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Suguru Annen
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Muneaki Ohshita
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Satoshi Kikuchi
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Norio Sato
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
| | - Mayuki Aibiki
- Graduate School of Medicine, Department of Emergency and Critical Care Medicine, Ehime University, Shitsukawa 454, Toon, Ehime 791-0295 Japan
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Matsumoto H, Takeba J, Umakoshi K, Kikuchi S, Ohshita M, Annen S, Moriyama N, Nakabayashi Y, Sato N, Aibiki M. Decreased antithrombin activity in the early phase of trauma is strongly associated with extravascular leakage, but not with antithrombin consumption: a prospective observational study. Thromb J 2018; 16:17. [PMID: 30078997 PMCID: PMC6069797 DOI: 10.1186/s12959-018-0171-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/26/2018] [Indexed: 01/26/2023] Open
Abstract
Background We conducted a prospective observational study for investigating coagulofibrinolytic changes and mechanisms of antithrombin (AT) alternations in trauma. Methods Trauma patients hospitalized for more than seven days were analyzed for coagulofibrinolytic biomarkers. The patients were stratified into two groups according to AT activity level on admission (day 0), comprising normal AT and low AT patients. Results Thirty-nine patients (median Injury Severity Score 20) exhibited initial coagulatory activation and triphasic fibrinolytic changes. AT activity did not show a negative linear correlation with levels of thrombin-antithrombin complex (TAT), a marker of coagulation activity and AT consumption, but was strongly correlated with levels of albumin (Alb), an index of vascular permeability, on day 0 (r = 0.702, p < 0.001). Furthermore, Alb was one of the independent predictors for AT on day 0. IL-6 on day 0 and thrombomodulin (TM) levels during the study period, reflecting systemic inflammation and endothelial cell injury, respectively, were significantly higher in the lower AT group (n = 10) than in the normal group (n = 29) (IL-6, p = 0.004; TM, p = 0.017). On days 2 and 4, TAT levels in the lower AT group were significantly higher than in the normal group. Conclusions Trauma caused clear triphasic coagulofibrinolytic changes. Decreased AT in the later phase might lead to a prolonged hypercoagulation. AT reduction in the initial phase of trauma is strongly associated with extravascular leakage as suggested by the association of Alb depletion with IL-6 and TM elevation, but not with AT consumption.
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Affiliation(s)
- Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Kensuke Umakoshi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Naoki Moriyama
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Yuki Nakabayashi
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
| | - Mayuki Aibiki
- Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, Shitsukawa 454, Toon City, Ehime 791-0295 Japan
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Matsumoto H, Annen S, Umakoshi K, Takeba J, Kikuchi S, Nakabayashi Y, Moriyama N, Ohshita M, Aibiki M. Sudden cerebral depression detected by bispectral index monitoring in cryptococcal meningitis with elevated near-fatal cerebrospinal fluid pressure. Acute Med Surg 2017; 4:338-340. [PMID: 29123886 PMCID: PMC5674465 DOI: 10.1002/ams2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/21/2017] [Indexed: 12/03/2022] Open
Abstract
Case An increase in cerebrospinal fluid pressure (CSFP) is usually prominent in cryptococcal meningitis, which has a high mortality rate, so aggressive management to control CSFP is crucial. In this case, a 40‐year‐old‐man survived cryptococcal meningitis treated with continuous spinal drainage under bispectral index (BIS) monitoring. He unexpectedly showed hypertension, went into a coma, and even loss his light reflexes due to CSFP elevation. His BIS values had abruptly dropped before developing these symptoms, but dramatically recovered after lumbar puncture drainage, suggesting that BIS monitoring could reflect cerebral function changes due to CSFP alternations. Outcome Inducing continuous spinal drainage to control CSFP provided stable control of blood pressure and brain activity, which was continuously monitored by BIS, enabling us to provide prompt treatment. Conclusion Cerebral depressions due to elevated CSFP may suddenly develop, so continuous spinal drainage is needed for preventing catastrophic events. Bispectral index could be useful for detecting early changes from CSFP elevation in meningitis cases with intracranial hypertension.
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Affiliation(s)
- Hironori Matsumoto
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Suguru Annen
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Kensuke Umakoshi
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Jun Takeba
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Satoshi Kikuchi
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Yuki Nakabayashi
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Naoki Moriyama
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Muneaki Ohshita
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
| | - Mayuki Aibiki
- Graduate School of Medicine Department of Emergency and Critical Care Medicine Ehime University Tohon City Ehime Japan
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Takeba J, Takahashi T, Watanabe S, Imai H, Kikuchi S, Umakoshi K, Matsumoto H, Ohshita M, Miura H, Aibiki M. Short-term clinical results of arthroscopic osteochondral fixation for elbow osteochondritis dissecans in teenaged baseball players. J Shoulder Elbow Surg 2015; 24:1749-56. [PMID: 26480880 DOI: 10.1016/j.jse.2015.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reports regarding arthroscopic fixation of the osteochondral fragments for elbow osteochondritis dissecans (OCD) are few. This study assessed the clinical outcomes of arthroscopic fixation of unstable osteochondral fragments by using absorbable pins over a postoperative period of at least 1 year. METHODS The patients were 13 adolescent baseball players with a mean age of 14 years (range, 12-16 years) who underwent OCD of primary lesions at International Cartilage Repair Society grades III and IV. The patients were evaluated by using validated outcome measures at a mean follow-up period of 24 months (range, 12-50 months). RESULTS The mean (standard deviation) score in the disability/symptom section of the Disabilities of the Arm, Shoulder, and Hand improved from 12.4 (6.0) before the surgery to 0.5 (1.2) after the surgery, and the sports section improved from 74.5 (25.4) to 1.4 (5.2). The mean (standard deviation) extension improved from -11° (10.8) to -2° (3.9; P < .001). The mean (SD) flexion improved from 129° (11.6) to 137° (5.6; P = .040). All patients were able to resume playing baseball, and 9 (69%) resumed playing at the same position as before their injuries. CONCLUSIONS The clinical results of arthroscopic osteochondral fragment fixation in the teenaged baseball players with elbow OCD, albeit obtained over only a short period, were favorable. This arthroscopic treatment enables repair of lesions and is considered appropriate for unstable OCD during the adolescent growth spurt.
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Affiliation(s)
- Jun Takeba
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | | | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Hiroshi Imai
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Satoshi Kikuchi
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | - Kensuke Umakoshi
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | | | - Muneaki Ohshita
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University, Toon, Ehime, Japan
| | - Mayuki Aibiki
- Department of Emergency Medicine, Ehime University, Toon, Ehime, Japan
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Aibiki M, Annen S, Moriyama N, Matsumoto H, Umakoshi K, Kikuchi S, Ohshita M, Takeba J. Can therapeutic hypothermia of 33°C itself not modulate inflammatory response after out-of-hospital cardiac arrest? Resuscitation 2015; 92:e1. [PMID: 25979159 DOI: 10.1016/j.resuscitation.2015.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mayuki Aibiki
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan.
| | - Suguru Annen
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Naoki Moriyama
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Hironori Matsumoto
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Kensuke Umakoshi
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Satoshi Kikuchi
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Muneaki Ohshita
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Jun Takeba
- The Department of Emergency and Critical Care Medicine, Ehime University, Graduate School of Medicine, 454 Shitsukawa, Tohon, Ehime 791-0295, Japan
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Aibiki M, Kikuchi S, Umakoshi K, Ohtsubo S, Ohshita M, Matsumoto H, Nishiyama T. Good neurological recovery of a post-cardiac arrest patient with very low bispectral index values and high suppression ratios after resumption of spontaneous circulation. Resuscitation 2012; 83:e87-8. [DOI: 10.1016/j.resuscitation.2011.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
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Fujimura A, Morimoto S, Uchida K, Takeda R, Ohshita M, Ebihara A. The influence of delivery mode on biological inactive renin level in umbilical cord blood. Am J Hypertens 1990; 3:23-6. [PMID: 2405882 DOI: 10.1093/ajh/3.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In order to investigate the influence of delivery mode on biological inactive renin levels in fetal circulation, plasma inactive renin (PIR), plasma renin activity (PRA) and plasma total renin (PTR) were measured in umbilical venous blood samples of 21 infants delivered vaginally after spontaneous labor and of 9 infants delivered by elective cesarean section after the onset of labor. Biological renin activities were measured by bioassay. The PIR levels in infants delivered vaginally were significantly lower than those in infants delivered by cesarean section, while the PRA levels were the opposite. However, the PTR levels were not significantly different between the two groups. These results suggest that the plasma levels of biological inactive renin in infants delivered vaginally may decrease, probably due to its conversion to active renin in the second stage of labor.
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Affiliation(s)
- A Fujimura
- Department of Medicine, Kanazawa University, Japan
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Kamiyama Y, Takeda H, Ohshita M, Nambu H, Yamaoka Y. Hepatic metabolic changes following energy deprivation by ammonia in patients and rabbits with jaundice. Surg Gynecol Obstet 1977; 145:33-40. [PMID: 877822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ozawa K, Sato M, Kamiyama Y, Ohshita M, Kimura K, Yamaoka Y. A blood-borne factor stimulating hepatic biosynthetic process in hepatectomized rabbits. Life Sci 1976; 19:919-26. [PMID: 966970 DOI: 10.1016/0024-3205(76)90320-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ohshita M, Takeda H, Kamiyama Y, Ozawa K, Honjo I. A direct method for the estimation of ornithine carbamoyltransferase activity in serum. Clin Chim Acta 1976; 67:145-52. [PMID: 1248151 DOI: 10.1016/0009-8981(76)90253-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ornithine carbamoyltransferase (EC 2.1.3.3) activity was estimated by determining the amount of citrulline produced. The citrulline was colorimetrically measured by using a diacetylmonoxime-thiosemicarbazide reaction without deproteinization. The color complex which had the maximum absorbance at 515 nm was stable at room temperature in daylight for at least several hours. The proposed method was superior to other methods already reported in sensitivity, stability and simplicity.
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