Rinsho byori. The Japanese journal of clinical pathology
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Transesophageal echocardiography (TEE) has become a routine monitor in the operating room for cardiac surgery because it provides instantaneous and continuous assessment of cardiac function and anatomy. TEE aids intraoperative management and improves outcome in patients undergoing cardiac valve repairs, complex congenital heart corrections, and high-risk patients undergoing coronary artery bypass graft surgery. Especially in mitral valve repair surgery, it is mandatory to evaluate the results of the surgical procedure after cardiopulmonary bypass during surgery. ⋯ A task force of the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists developed guidelines for the appropriate use of TEE, which were evidence-based and focused on the effectiveness of perioperative TEE in improving clinical outcomes. Compliance with the guidelines for basic intraoperative TEE resulted in a marked improvement in intraoperative TEE practice. Technical progress of echocardiographic equipment and the TEE probe will increase the application of intraoperative and perioperative TEE in the future.
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An intraoperative monitoring is essential for performing surgery, especially in the neurosurgical field. Intraoperative neurological monitoring methods may involve an application of evoked potential examinations in clinical physiology. Accordingly, it is necessary to perform intraoperative neurological monitoring to basically understand the principles and techniques of evoked potential examinations. ⋯ Consequently elimination of noise from these various sources from the monitoring records would promote the success of intoraoperative neurological monitoring. In this study, differential amplifiers, class I medical electronic equipments, and shield mats were tested to eliminate the alternating current noise that frequently contaminates the intraoperative neurological monitoring record. In addition, neurological monitoring system, recording electrodes, and extension cables are introduced as necessary equipment and materials for the intraoperative neurological monitoring.
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Transthyretin (TTR) is a beta-sheet rich protein whose plasma half life is 1.9 days. It behaves as a tetramer and binds to retinol binding protein (RBP) and thyroxin in plasma. Since TTR is a tryptophan-rich-protein, the protein is used as a useful marker protein for nutrition supporting team (NST). ⋯ We synthesized ATTR Y78P, a spontaneously misfolded TTR, and injected it to amyloid laden transgenic mice having human ATTR V30M to induce the antibody for amyloid fibrils. As we expected, amyloid deposition was significantly reduced by the injection of ATTR Y78P to the mice. These therapies may become novel strategies for essential FAP therapy instead of liver transplantation.
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Sphingosine 1-phosphate (S1P) is concentrated in lipoprotein, especially high density lipoprotein (HDL), in plasma. We characterized the role of HDL-associated S1P in HDL-induced anti-atherogenic effects. ⋯ On the other hand, HDL-induced nitric oxide production and inhibition of adhesion molecule expression were mediated by two pathways, i.e, HDL-associated apoprotein A-I, A-II/SR-BI and S1P/S1P receptors in endothelial cells. Thus, in endothelial cells, HDL-associated S1P is a key player of HDL-induced anti-atherogenic effects.
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Phlebotomy-related nerve injury is relatively rare but could be a serious complication of venipuncture; however, widely recognized and effective methods to prevent nerve injury at venipuncture have not been established. By considering the anatomical features of peripheral nerves and veins of the arm, several techniques may be feasible. To prevent median nerve injury, which is the most serious among the nerve injuries in the arm, the following order of vein selection is recommended: (1) radial vein (2) median cubital vein (3) basilic vein (4) forearm veins (5) veins of the back of the hands. ⋯ In addition to these technical efforts, it is critical to ask each patient before venipuncture whether he or she has experienced nerve injury during previous phlebotomy in order to avoid unnecessary repetitive nerve injuries in the same patient. In order to avoid such situations, we have established a computer-based system to alert phlebotomists to the complications which patients have experienced during venipuncture. These and other methods should be tested in many institutes and data should be systematically collected to investigate whether phlebotomy-related nerve injury can be effectively prevented.